NEUROANATOMICAL CORRELATES OF RELIGIOUS OR SPIRITUL BELIEFS ASSOCIATED WITH LESS RISK FOR MAJOR DEPRESSION

A recent article by L. Miller, PhD et al in JAMA Psyhiatry [2014;71(2):128135] reported on their previous 10 year prospective study of adult children who had a parent with major depression, showing that they had a 90% reduced risk for depression if they stated that religion or spirituality was important to them.  The reduced risk was most prominent in the higher risk group and represented a reduced risk of recurrence of depression vs reduced risk of the onset [first episode].  This same group of investigators had previously [J Amer Acad Adolesc Psychiatry 1997; 36:1416-1425] reported that women with a depressed parent were more than 90% less likely to experience a depression if they reported that religion or spirituality was important to them.  In addition, they reported on results of a metanalysis of 147 studies showing an inverse relationship between religious beliefs and depression.  This was also found with the elderly and it was clear how their religious beliefs helped them cope with stress and they utilized mental health treatment more consistently. It was pointed out that in any given year, almost one fourth of those seeking mental health services were referred by clergy!

Also, L. Miller, PhD had previously reported imaging results showing large areas of cortical thinning on the lateral surface of the right hemisphere for adults with depression.  This study investigated whether those peopole who reported strong religious or spiritual beliefs besides a 90% reduced risk of depression also had reduced or no cortical thinning.  They found that religious and spiritual beliefs were coorelated with thicker cortices and the researchers wondered if this was what protected these people from experiencing a major depression.

So, it seems clear that having self-reported strong religious or spiritual beliefs will protect you from having depression and your brain will not show cortical thinning.  Is it really possible that religious or spiritual beliefs can cause our brains to have thicker cortices or protect us from the thinning that can occur related to experiencing a major depression?  What do you think?

HOW BIG A PROBLEM IS DRINKING [ALCOHOL] FOR UNIVERSITY AND COLLEGE STUDENTS?

A recent JAMA[2014;311(12):1218-1224] study by Kypros Kypri, Ph.D. et al that used an internet based screening for alcohol abuse followed by random assignment to a brief intervention or no intervention. Those who screened positive for alcohol abuse [Alcohol Use Disorders Identifying Test AUDIT-C score > 4] either got only the screening or also 10 minutes of assessment and feedback [including medical guidelines and peer norms] on alcohol expenditure, peak blood alcohol concentrations, alcohol dependence and access to help and information. The results showed no change for those who received the intervention but did indicate that of the 5135 students screened, 3422 scored positive for alcohol abuse.  Thus, in this study they found that two thirds of the university students were at risk for alcohol abuse and other alcohol related problems.  Another study by Knight, JR et al in the Journal of Studies of Alcohol 2002;(63)3:263-270, sen questionnaires to 14,000 college students from 114 four year colleges and found that 61% for alcohol abuse and 6% for alcohol dependence.  Episodic heavy drinkers were more likely to be dependent on alcohol.  

In addition, studies have identified that heavy drinking is associated with increased risk of accidents, partner violence, unwanted sexual encounters, tobacco use and lower academic performance.  Also, alcohol dependence is difficult to treat and very frequently the best outcome is abstinance supported by daily meetings at Alcoholics Anonymous meetings.

So, the risks associated with even episodic heavy drinking in university or college students are very high and yet it is still difficult to treat alcohol abusing students.  It seems very clear that screening to identify at risk university and college students and intervening before they have problems may be the only way to stem the tide of this serious medical problem.

Please ask your children who are attending a university or college [and suggest your friends to do the same] about their drinking habits and encourage them to go to student counseling to get help in determining if they may be at risk for developing an alcohol problem.

IS PASSIVE SUICIDAL IDEATION REALLY PASSIVE?

An article by Robert I Simon, M.D. in Current Psychiatry, Vol 13, No 3, March 2014, talks about passive suicidal ideation and feels that active suicidal ideation [a plan] is also present.  Dr. Simon believes that there is always a continuum of severity of thoughts and feelings and indicates changes in the patient's psychiatric disorder.  He recommends a careful clinical assessment of suicide risk for anyone with even "fleeting, passive" suicidal ideation.  He comments on a study by Hall et al in Psyhosomatics, 1999, 40(1):18-27 found that 69 out of 100 patients who made severe suicide attempts had only "fleeting" or no suicidal ideation before their attempt.

I have previously blogged about assessing the risk of suicidal behavior if someone has suicidal ideation. I reported that 60% of adolescents who had a suicidal plan attempted suicide within one year of the onset of suicidal ideation.  This would seem to support the importance of a clinical assessment of suicide risk by a trained professional.  I also reported on factors that increased the risk of a suicide attempt. These were: being a female; diagnoses with depression,dysthymia, eating disorders, ADHD and conduct disorder; and symptoms of anxiety, agitation and poor behavioral control.  Less risk of suicide attempts was associated with living with both parents and having siblings.  

It is clearly very important to have a trained professional carefully evaluate anyone with any type of suicidal ideation.   

SUICIDE...IS IT IMMORAL?

A recent article by Ronald Pies, M.D. published in the February 2014, Vol XXXI, No2 issue of the Psychiatric Times was entitled: "Is Suicide Immoral?"  Dr. Pies reflects on his own and his families experience with the suicide of his uncle.  Dr. Pies describes the longstanding impact that the suicide had on his family and himself.  He describes the still ongoing questions about why and what they could have done to prevent it.  Dr. Pies, being a psychiatrist, is aware that the question of moral or immoral does not seem appropriate for his area of concern.  Instead, it is considered appropriate for psychiatrists to focus on detecting suicidal thoughts and assessing the risk that someone will act on these thoughts and then treating these at risk people in order to reduce the risk and help them to feel like life is worth living.  However, others have pointed out that a physician's work of healing and taking care of others is intrinsically about values and virtues.  So, it seems that a physician's committment to preserve and protect life puts in a position of taking a moral stance about suicide. 

So, what about the moral question regarding suicide.  One understanding is that suicide is about personal autonomy and every human beings right to decide their own fate regardgin living or dying.  However, Dr. Pies reports comments from Jennifer Hecht in her book, Stay: A History of Suicide and the Philosophies Against It, comments on the need to see suicide from it's impact on community and community values.  Ms. Hecht feels that suicide has a dramatic and damaging impact on the community. This would seem to indicate moral implications for the act of suicide.  Dr. Pies clarifies that he is not promoting castigating people who are suicidal or make suicide attempts as they are already most likely suffering from negative feelings about themselves.  However, he mentions the possibility of discussing the impact on the community with his patients who are suicidal. 

I believe that the recognition of the impact of suicide on communities [and families, of course] can help the understanding of why some people become suicidal.  I wonder if this isn't related to feelings of isolation from others, from their community.  Maybe a focus on helping people feel more connected to others would significantly reduce the incidence of suicides.  

It seems that we [human beings as well as other species] are meant to be in a community and connected with each other.  If this connection is broken, it is a problem for the person and for the community.  So, suicide is not only damaging to the community but also may represent a failure of the community to reach out to the individual.

COME ALIVE

Howard Thurman is quoted as saying: "Don't ask yourself what the world needs.  Ask yourself what makes you come alive and go do that, because what the world needs is people who have come alive." Howard Thurman was a theologian, author, philosopher, educator and civil rights leader who influenced many people with his faith and wisdom.  He is frequently quoted and I will include one more here.  "There is something in everyone of you that waits and listens for the sound of the genuine in yourself.  It is the only true guide you will ever have.  And if you cannot hear it, you will all of your life spend your days on the ends of strings that somebody else pulls."  

I have found that it is hard for us to listen to ourselves, especially when we are feeling stressed with worries about the past or the future.  It is like we only hear other voices and not our own.  I wonder if this listening for the sound of the genuine in ourselves is like listening with our hearts [intuition?]in order to be able to hear what makes us come alive.  I also believe that all of us are capable of listening and acting on what is genuine [essential?] for us.  

I hope that we all make a committment to listen to the genuine in ourselves and support others to do the same.