Overweight Children Face Stigma

The July issue of Psych Bulletin has an article which indicates that overweight children are teased by their peers as early as age 3. They face bias from their parents and teachers, giving them a quality of life comparable to people with cancer, a new analysis concludes. Children who report teasing, rejection, bullying and other types of abuse because of their weight are two to three times more likely to report suicidal thoughts as well as to suffer from other health issues such as high blood pressure and eating disorders, researchers said.

Even with a growing percentage of overweight people, the stigma shows no signs of subsiding, due to the fact that television and other media continue to reinforce negative stereotypes.

Children as young as 3 are more likely to consider overweight peers to be mean, stupid, ugly and sloppy. A growing body of research shows that parents and educators are also biased against heavy children. In a 1999 study of 115 middle and high school teachers, 20 percent said they believed obese people are untidy, less likely to succeed and more emotional.

Suicides in New Orleans

This is a reprinting of a posting to a blog that I used to manage.

I worked for about 10 years in Nassau county, which is a suburb of New York. The last three years I coordinated a program for high functioning middle school students diagnosed with autism (I'm long since gone).

One of the things that focused on teaching was Theory of Mind, a complex skill that requires individuals to put themselves in other people's shoes, to think their thoughts - in essence, to feel their emotions, to be happy when they are happy and to cry when they are sad. I was rarely successful. Jack was not a success story for me. Sure he had develops some friendships while I was there, but he had not fully mastered the idea of Theory of Mind. But I enjoyed him immensely, despite his resistance to schoolwork and his chronic narcolepsy.

When I went back to visit him in 2005 and the others, he asked me to play chess, his favorite game. We sat there, enjoying each other's silence as the cool September breeze blew over us through the corner window.

"So, did you watch CNN at all?", he broke the silence.

"Yep"

"That's really a shame about those people in New Orleans."

My interest was piqued. "Yes it is-"

"I mean, when the waters are drained those people are gonna go back to destroyed houses, and wow - they might get depression or something bad- or even worse they might kill themselves"

"Why would they kill themselves?"

"WHY?! WHY?! - you're the psychologist - you tell me - they're gonna go home and nothing is there - if that happened to me - I have no idea how I would cope with it. Just no idea. Those poor people."
______________________________________________________

So if a child with autism could predict massive depression and suicides, why can't the Federal government, FEMA, the President, the governor of Louisiana or the mayor of New Orleanse predict it? Why couldn't they preliminarily deal with it?

The New York Times reported about a month ago that the suicide rate in New Orleans has risen to at least two times more than the average national rate. Many people who live though natural or wartime disasters tend to develop a disorder named Post Traumatic Stress Disorder or PTSD.

Common characteristics of the disorder include reliving the traumatic event through frightening memories, or nightmares that provoke the same feelings of horror, helplessness, and fear that you felt at the time of the event. These memories can be triggered by exposure to reminders of the event. Of course, the people who returned to their devastated, destroyed, demolished homes were forced to confront and relive the disaster over and over again.

PTSD is a type of anxiety disorder. Researchers from the University of Winnipeg in Manitoba, Canada found that the presence of an anxiety disorder as well as intense levels of hopelessness and despair increased the probability that an individual would commit suicide. It doesn't take a Ph.D. in psychology to know that hopelessness and continued exposure to a stressful event could lead to suicide. It also doesn't take an advanced to degree or a heightened level of civic-mindedness that something can be done to deal with this situation.

The science of prevention is a burgeoning field in psychology, which is guided by a principle borrowed from medicine. Prevention science has led to mandatory inoculations of children to fluoride in water. People who exercise more are less likely to get sick; some managed health care companies now fully or partially subsidize gym memberships. The same goes for psychology as well. Instead of attempting to heal once the damage has been done, we can either:

• prevent the problem altogether
• innoculate the individual so that the problem is not that bad.

Of course, if you have seen the examples I listed above, many of the prevention programs need to come from governmental agencies or need to be instituted by various corporate organizations. It would do no good if two or three socially conscious doctors began to dump fluoride into our reservoirs - we need the federal government to enact this into legislation.

While the entire population of New Orleans required some form of "inoculation" before re-entering the city (as well as ongoing interventions after entering the city), there are certain people who are more at risk for developing PTSD and then evidencing suicidality. Women are more likely to develop PTSD than men; minorities who come from a lower socioeconomic level are also more likely to develop PTSD. Then again, males tend to complete suicides more frequently than females, due to access to more lethal and more severe methods (e.g., guns).

While many people were ready to blame FEMA for the debacle in initial assistance to the residents of New Orleans, they were really not to blame. FEMA is an agency that deals with more long term, protracted issues. FEMA is responsible for initiating and maintaining rescue operations as well as clean-up and rebuilding. FEMA should also be responsible for initiating a suicide and PTSD prevention program for the city; this is FEMA's and the Federal government's most flagrant abuse in this whole matter so far.

School Psychologists and Suicide

One of my students contacted me this morning and was quite upset about a problem she was facing.

She had dealt with a child who was evidencing suicidal ideation, and she told her principal and AP about it (her supervisor was out sick). Her administration told her to ignore it. She didn't. She spoke to her supervisor and they agreed that they needed to report this.

She called the parents of the child and arranged for a hospital visit. Her administration was not amused. They apparently threatened to "get them in trouble".

I told her that this was a common reaction of administrators when school psychologists do things that are not in their control. According to the NASP Ethics Code: "School psychologists are committed to the application of their professional expertise for the purpose of promoting improvement in the quality of life for children, their families, and the school community." This child obviously did not have a good quality of life, and, her actions were an attempt to make that better.

Good job, I say. For further information, check out the NASP reprint of an article in the communique discussing what can be done for children who are suicidal.

http://www.nasponline.org/publications/cq/cq354suicide.aspx

Kids' Suicides Rise, CDC Report Finds

Something isn't going well - and I'm not sure why


Kids' Suicides Rise, CDC Report Finds

Associated Press - February 05, 2007


CHICAGO - New government figures show a surprising increase in youth suicides after a decade of decline, and some mental health experts think a drop in use of antidepressant drugs may be to blame.

Suicides climbed 18 percent from 2003 to 2004 for Americans under age 20, from 1,737 to 1,985 deaths. Most suicides occurred in older teens, according to the data - the most current to date from the federal Centers for Disease Control and Prevention.

By contrast, the suicide rate among 15- to 19-year-olds fell in previous years, from about 11 per 100,000 in 1990 to 7.3 per 100,000 in 2003.

Suicides were the only cause of death that increased for children through age 19 from 2003-04, according to a CDC report released Monday.

"This is very disturbing news," said Dr. David Fassler, a University of Vermont psychiatry professor.

He noted that the increase coincided with regulatory action by the U.S. Food and Drug Administration that led to a black box warning on prescription packages cautioning that antidepressants could cause suicidal behavior in children.

Fassler testified at FDA hearings on antidepressants during 2003 and 2004 and urged caution about implementing black box warnings. The agency ordered the warnings in October 2004 and they began to appear on drug labels about six months later.

Psychologist David Shern, president of Mental Health America, called the new data "a disturbing reversal of progress."

Other research has linked certain antidepressants with decreasing suicide rates, Shern said, adding, "We must therefore wonder if the FDA's actions and the subsequent decrease in access to these antidepressants in fact have caused an increase in youth suicide."

The advocacy group receives funding from makers of antidepressants, government agencies and private donations.

The suicide data are in a report on vital statistics published in February's Pediatrics.
Antidepressant use among children decreased during the same time period. Data from Verispan show 3 million antidepressant prescriptions were written for kids through age 12 in 2004, down 6.8 percent from 2003. Among 13- to 19-year-olds, the number dropped less than 1 percent to 8.11 million in 2004. Steeper declines in both age groups occurred in 2005, according to the prescription tracking firm.

The suicide data are preliminary and don't show whether suicides might have been concentrated in one region or among one gender or ethnic group, said the CDC's Dr. Alexander Crosby.
"It's something that we want to look a little bit closer into," Crosby said. "It's probably too early to say" if declining use of antidepressants had anything to do with it, he said,

The CDC is expected to issue a more thorough report on the data in a month or two.
The data are concerning, but it's too soon to know if they're anything more than a statistical blip, said Dr. John March, a Duke University psychiatry professor. He led landmark National Institute of Mental Health research linking antidepressant use with an increased risk for suicidal behavior, but also showing that getting psychotherapy at the same time canceled out that risk.

Some mental health experts believe suicide prevention programs and effective use of treatment including drugs and therapy contributed to the decline in suicides that occurred in the 1990s.
Funding cuts for school-based suicide prevention programs might have contributed to the apparent rise noted in the new CDC report, said Emory University psychologist Nadine Kaslow. But the rise might not indicate a nationwide trend and needs to be investigated, she said.
"It's definitely concerning" but will need to be followed to see whether increases occurred in subsequent years, Kaslow said.

The New Orleans problem is still at hand

This article describes how 10 months after the Katrina disaster, New Orleans and the surrounding area is still dealing with issues of depression and suicide. Click here to read the article. Although the article does not necessarily point any fingers as to who is at fault, my take is that the federal gov't., specifically, FEMA has really dropped the ball in providing mental health assistance.

Back in February, I wrote something on this issue on my other blog.




Technorati tags: Katrina FEMA New Orleans disaster prevention suicide depression PTSD school trauma psychology anxiety

Report on Hispanic Mental Health in the Schools

An interesting report which was conducted by the Center for Disease Control reports that Hispanic teenagers are at risk for many mental health issues. The CDC survey of nearly 14,000 U.S. high school students has been conducted every other year, since 1991. Results reported Thursday were from last year's survey. Some of the more interesting findings were:

• More than 11 percent of all Latino students - and 15 percent of Latino girls - said they had attempted suicide. The white and black rates were about 7.5 percent.
• Latinos also reported much higher rates of using cocaine, heroin, ecstasy and methamphetamines.
• Hispanics report that their use of condoms was at lower rates than the other population groups.
• About 36 percent of Hispanics reported prolonged feelings of sadness or hopelessness, slightly higher than previous years. In contrast, about 28.5 percent of black students reported such feelings in the 2005 survey, about the same as two previous surveys. And about 26 percent of white students reported such feelings, down slightly from 2003 and 2001.
• 1 in 8 Latino students said they had done cocaine, 1 in 10 had done ecstasy, 1 in 11 methamphetamines and 1 in 28 heroin.

Hispanic, Latino, mental health, children, suicide, drug use, school psychology, depression,

Adolescent suicide and antidepressants

Although this article does nor get to the bottom of the issue, it is an interesting intro into the nature of adolescent anti-depressant usage and suicide. In general, what I have seen is that the nature of most medications is not well-researched in children (except with Ritalin), and more studies are needed in this area. So the area is ripe for armchair discussion. I would be curious to hear what any or all of you have to say on the issue....



What happens outside a tightly-controlled study is harder to know. Indeed, any chance that a teen may take his or her life is reason for concern. Suicides accounted for nearly 32,000 American deaths in 2002, with most of them occurring in teens between 18 and 19 years of age. Dr. David Shaffer, the director of child and adolescent psychology at Columbia University and a leading expert on suicidal behavior, discusses these risks and puts the recent controversy over antidepressants into perspective.

How common is it for adolescents to have suicidal thoughts? They are very, very common. Suicidal thoughts occur in around 20 percent of all high school-aged kids. One in five high school kids have thought about suicide within the last year.

Have the thoughts or attempts of suicide gone down in recent years? The rate of attempts doesn't appear to have gone down. The rate of ideation [suicidal thoughts] that's being tracked has gone down from about 25 percent two years ago to about 19 percent today

These lower rates have happened while more and more teens are taking antidepressants. Is it possible that the antidepressants are decreasing the risk of suicide? I think it's highly likely. There have only been two previous periods in the last 105 years when suicide rates have gone down and both were during World War I and World War II. They were probably related to alcohol, because alcohol tends to drive the suicide rate. If you look at the 1990-2004 alcohol use rates, there has been no decline in alcohol use at all. So there are other possible explanations and I think we've all looked at them, and nothing strikes one as very convincing.

What about the possibility that antidepressants may increase the risk of suicide? The really big argument that antidepressants are not causing a lot of suicides comes from autopsy studies. There are two places, one in New York and one in Salt Lake City, where they've been doing toxicology on youth suicides, and they're just not finding any trace of SSRIs [antidepressants, like Prozac] there. So my best guess is that non-treatment is more likely to lead to suicide than the reverse. However, that's not to say that antidepressants don't influence your behavior in a way that might make you talk much more about suicide, and it may also make you more aggressive and hostile.

Why has there been such a concern about antidepressants? Most suicidal thoughts are kept inside, with even more attempts never revealed to anyone. When you're on an SSRI, you become less inhibited, and kids who have been totally silent and really uncommunicative within a few doses may be over-talkative and disclosing a lot. You are more likely to disclose your thoughts after taking an antidepressant. That doesn't necessarily mean to say the antidepressant is working; it's just one of the nonspecific effects.

Is there no risk of suicide from taking these drugs? There are some kids who become quite hostile and aggressive when they take antidepressants. If you become aggressive and hostile, it's possible that you will get into trouble.

Do the benefits outweigh the risk? I think the risk of not treating depression is much, much greater than the possible effects of treatment. But I think because you can get side effects, you can't just hand out a starter pack and say, "Try these and come back in a month."
How do you prevent this kind of reaction in teens who take antidepressants? You tell the parents about the risk, and you start the patients on a very low dose. If you're not going to see the patient for a week or for two weeks, then you make sure that there are telephone contacts. And so you telephone the parent to ask what changes they've noticed, if any. And you give them a list of some of the things to look out for, like losing your temper, having difficulty sleeping or talking about suicide.