APA 2011

HONOLULU – About 8% of U.S. veterans are problem gamblers who report between one and four gambling-related problems, and an additional 2% are pathological gamblers with five or more such problems, a study of 2,185 veterans in Department of Veterans Affairs care reveals.

Age, education level, and ethnicity were not big predictors of pathological gambling risk. "The one that does show a lot of difference is unemployment [odds ratio, 1.85], which is not necessarily what you expect. People need money to gamble, and they need a lot of money," Dr. Joseph J. Westermeyer IV said at the annual meeting of the American Psychiatric Association. The unemployed in the study, however, included part-time and seasonal workers who had some access to money, he said, and others were "homebodies" (typically unemployed men who were married to women with jobs).

(c) Tom Lozano/Creative Commons License

Marital status emerged as an important variable in a binary analysis, with unemployment remaining significant (OR, 1.41). "The folks who were divorced, separated, widowed, or single were underrepresented [OR, 0.69], so folks who were married were more likely to be in the problem and pathological gambling group. Again, this is not necessarily what you would expect," said Dr. Westermeyer, who is director of the mental health service at the Minneapolis VA Medical Center and professor of psychiatry at the University of Minnesota.

"Interestingly, male veterans and female veterans had almost identical rates of both problem gambling and pathological gambling, which is not – so far – what you see in the general population." Men usually outnumber women by a factor of two to three or more, Dr. Westermeyer said. It might be that the military exposes more women to gambling. "Some of the women we talked to say, ‘We hang around with the guys when we have time off. We don’t go to different places. We go to the same bars, and if they go gambling, we go gambling with them.’ "

The study included only veterans who were treated at least once in the previous 2 years at a VA facility. This design was intentional, so that any demographic or other risk factor that was identified would be relevant when incorporated into a future screening instrument.

Another aim was to identify comorbid symptoms "so primary care, as well as psychiatry, can begin to be alert to what might be associated with pathological gambling," Dr. Westermeyer said.

The veterans completed the SCL-90 (the 90-item Symptom Checklist instrument) and the PCL (PTSD [Posttraumatic Stress Disorder] Checklist). Their responses were directly and highly correlated with DSM-IV criteria and the South Oaks Gambling Screen. "In other words, people who have more posttraumatic symptoms, anxiety, and depression tend to have more gambling problems," Dr. Westermeyer said.

Participants also completed the AUDIT (Alcohol Use Disorders Identification Test) and the MAST (Michigan Alcohol Screening Test). The AUDIT addresses recent alcohol use and the MAST is a lifetime alcohol use measure, which was adapted to include drug use. Again, correlations were high. But in this study, people with more alcohol and drug problems tended to have fewer gambling problems, according to Dr. Westermeyer, which is contrary to other research that shows more substance problems associated with more gambling problems.

"All these findings tend to be a tad atypical," Dr. Westermeyer said.

The data were assessed in two different ways to reflect the current prevalence and to predict the future prevalence of problem and pathological gambling. For example, data were weighted to reflect the typical older male population that is seen at most VA centers today. Raw data included an oversampling of women (to bring the 7% in weighted data up to 35%) as well as younger veterans from the Iraq and Afghanistan conflicts (to reflect the way the VA population is likely to appear in a decade or two).

The weighted data show that veterans have about twice the rate of problem gambling as does the general population. The raw data suggest a greater disparity in the future, with a rate 2.7 times that of the general population.

The other worrisome thing about the future is the ratio of problem gamblers to pathological gamblers, Dr. Westermeyer said. General population surveys show a 1:1 ratio of problem gambling to pathological gambling among people who are exposed to gambling for a decade or more, and up to 2:1 with more recent exposure. "It’s worrisome with the veterans. The ratio is ... like four or five problem gamblers to one pathological gambler. The problem gamblers are the people at risk to become pathological gamblers ... which does not bode well for the future."

"Veterans in VA care have a high rate" of pathological gambling, he added.

All 10 DSM-IV gambling symptoms were assessed in the study. The sixth criteria (characterized in the DSM-IV as "chasing one’s losses") was the most common symptom, endorsed by 6.3% of participants with problem or pathological gambling. Tolerance was next at 5.1%, followed by escape gambling at 5.1%. The eighth criteria, which refers to committing illegal acts such as writing bad checks and committing property crimes, was the least commonly reported symptom, at just over 1%.

Another unexpected finding was a propensity for younger veterans to have higher scores on the South Oaks Gambling Screen for pathological gambling. "Most surveys that include people in their 20s rarely find a high prevalence [of pathological gambling], so ours was not a typical finding," said Dr. Westermeyer. Those who show up on the survey data tend to be people aged 35 years and older, he noted.

Participants were paid $20 to complete 2 hours of computer-based data collection; a research assistant was on hand to answer any questions. Participants were recruited at two VA medical centers and 14 rural community-based outpatient clinics.

This was a clinical epidemiologic study and not community-based research, a potential limitation.

Unanswered questions remain, Dr. Westermeyer said. Do these high rates among veterans in VA care reflect rates among all veterans? Also, would it be possible to identify earlier cases through screening?

The study was funded by VA Health Services Research & Development. Dr. Westermeyer said he had no relevant disclosures.

HONOLULU – About 8% of U.S. veterans are problem gamblers who report between one and four gambling-related problems, and an additional 2% are pathological gamblers with five or more such problems, a study of 2,185 veterans in Department of Veterans Affairs care reveals.

Age, education level, and ethnicity were not big predictors of pathological gambling risk. "The one that does show a lot of difference is unemployment [odds ratio, 1.85], which is not necessarily what you expect. People need money to gamble, and they need a lot of money," Dr. Joseph J. Westermeyer IV said at the annual meeting of the American Psychiatric Association. The unemployed in the study, however, included part-time and seasonal workers who had some access to money, he said, and others were "homebodies" (typically unemployed men who were married to women with jobs).

(c) Tom Lozano/Creative Commons License

Marital status emerged as an important variable in a binary analysis, with unemployment remaining significant (OR, 1.41). "The folks who were divorced, separated, widowed, or single were underrepresented [OR, 0.69], so folks who were married were more likely to be in the problem and pathological gambling group. Again, this is not necessarily what you would expect," said Dr. Westermeyer, who is director of the mental health service at the Minneapolis VA Medical Center and professor of psychiatry at the University of Minnesota.

"Interestingly, male veterans and female veterans had almost identical rates of both problem gambling and pathological gambling, which is not – so far – what you see in the general population." Men usually outnumber women by a factor of two to three or more, Dr. Westermeyer said. It might be that the military exposes more women to gambling. "Some of the women we talked to say, ‘We hang around with the guys when we have time off. We don’t go to different places. We go to the same bars, and if they go gambling, we go gambling with them.’ "

The study included only veterans who were treated at least once in the previous 2 years at a VA facility. This design was intentional, so that any demographic or other risk factor that was identified would be relevant when incorporated into a future screening instrument.

Another aim was to identify comorbid symptoms "so primary care, as well as psychiatry, can begin to be alert to what might be associated with pathological gambling," Dr. Westermeyer said.

The veterans completed the SCL-90 (the 90-item Symptom Checklist instrument) and the PCL (PTSD [Posttraumatic Stress Disorder] Checklist). Their responses were directly and highly correlated with DSM-IV criteria and the South Oaks Gambling Screen. "In other words, people who have more posttraumatic symptoms, anxiety, and depression tend to have more gambling problems," Dr. Westermeyer said.

Participants also completed the AUDIT (Alcohol Use Disorders Identification Test) and the MAST (Michigan Alcohol Screening Test). The AUDIT addresses recent alcohol use and the MAST is a lifetime alcohol use measure, which was adapted to include drug use. Again, correlations were high. But in this study, people with more alcohol and drug problems tended to have fewer gambling problems, according to Dr. Westermeyer, which is contrary to other research that shows more substance problems associated with more gambling problems.

"All these findings tend to be a tad atypical," Dr. Westermeyer said.

The data were assessed in two different ways to reflect the current prevalence and to predict the future prevalence of problem and pathological gambling. For example, data were weighted to reflect the typical older male population that is seen at most VA centers today. Raw data included an oversampling of women (to bring the 7% in weighted data up to 35%) as well as younger veterans from the Iraq and Afghanistan conflicts (to reflect the way the VA population is likely to appear in a decade or two).

The weighted data show that veterans have about twice the rate of problem gambling as does the general population. The raw data suggest a greater disparity in the future, with a rate 2.7 times that of the general population.

The other worrisome thing about the future is the ratio of problem gamblers to pathological gamblers, Dr. Westermeyer said. General population surveys show a 1:1 ratio of problem gambling to pathological gambling among people who are exposed to gambling for a decade or more, and up to 2:1 with more recent exposure. "It’s worrisome with the veterans. The ratio is ... like four or five problem gamblers to one pathological gambler. The problem gamblers are the people at risk to become pathological gamblers ... which does not bode well for the future."

"Veterans in VA care have a high rate" of pathological gambling, he added.

All 10 DSM-IV gambling symptoms were assessed in the study. The sixth criteria (characterized in the DSM-IV as "chasing one’s losses") was the most common symptom, endorsed by 6.3% of participants with problem or pathological gambling. Tolerance was next at 5.1%, followed by escape gambling at 5.1%. The eighth criteria, which refers to committing illegal acts such as writing bad checks and committing property crimes, was the least commonly reported symptom, at just over 1%.

Another unexpected finding was a propensity for younger veterans to have higher scores on the South Oaks Gambling Screen for pathological gambling. "Most surveys that include people in their 20s rarely find a high prevalence [of pathological gambling], so ours was not a typical finding," said Dr. Westermeyer. Those who show up on the survey data tend to be people aged 35 years and older, he noted.

Participants were paid $20 to complete 2 hours of computer-based data collection; a research assistant was on hand to answer any questions. Participants were recruited at two VA medical centers and 14 rural community-based outpatient clinics.

This was a clinical epidemiologic study and not community-based research, a potential limitation.

Unanswered questions remain, Dr. Westermeyer said. Do these high rates among veterans in VA care reflect rates among all veterans? Also, would it be possible to identify earlier cases through screening?

The study was funded by VA Health Services Research & Development. Dr. Westermeyer said he had no relevant disclosures.

HONOLULU – About 8% of U.S. veterans are problem gamblers who report between one and four gambling-related problems, and an additional 2% are pathological gamblers with five or more such problems, a study of 2,185 veterans in Department of Veterans Affairs care reveals.

Age, education level, and ethnicity were not big predictors of pathological gambling risk. "The one that does show a lot of difference is unemployment [odds ratio, 1.85], which is not necessarily what you expect. People need money to gamble, and they need a lot of money," Dr. Joseph J. Westermeyer IV said at the annual meeting of the American Psychiatric Association. The unemployed in the study, however, included part-time and seasonal workers who had some access to money, he said, and others were "homebodies" (typically unemployed men who were married to women with jobs).

(c) Tom Lozano/Creative Commons License

Marital status emerged as an important variable in a binary analysis, with unemployment remaining significant (OR, 1.41). "The folks who were divorced, separated, widowed, or single were underrepresented [OR, 0.69], so folks who were married were more likely to be in the problem and pathological gambling group. Again, this is not necessarily what you would expect," said Dr. Westermeyer, who is director of the mental health service at the Minneapolis VA Medical Center and professor of psychiatry at the University of Minnesota.

"Interestingly, male veterans and female veterans had almost identical rates of both problem gambling and pathological gambling, which is not – so far – what you see in the general population." Men usually outnumber women by a factor of two to three or more, Dr. Westermeyer said. It might be that the military exposes more women to gambling. "Some of the women we talked to say, ‘We hang around with the guys when we have time off. We don’t go to different places. We go to the same bars, and if they go gambling, we go gambling with them.’ "

The study included only veterans who were treated at least once in the previous 2 years at a VA facility. This design was intentional, so that any demographic or other risk factor that was identified would be relevant when incorporated into a future screening instrument.

Another aim was to identify comorbid symptoms "so primary care, as well as psychiatry, can begin to be alert to what might be associated with pathological gambling," Dr. Westermeyer said.

The veterans completed the SCL-90 (the 90-item Symptom Checklist instrument) and the PCL (PTSD [Posttraumatic Stress Disorder] Checklist). Their responses were directly and highly correlated with DSM-IV criteria and the South Oaks Gambling Screen. "In other words, people who have more posttraumatic symptoms, anxiety, and depression tend to have more gambling problems," Dr. Westermeyer said.

Participants also completed the AUDIT (Alcohol Use Disorders Identification Test) and the MAST (Michigan Alcohol Screening Test). The AUDIT addresses recent alcohol use and the MAST is a lifetime alcohol use measure, which was adapted to include drug use. Again, correlations were high. But in this study, people with more alcohol and drug problems tended to have fewer gambling problems, according to Dr. Westermeyer, which is contrary to other research that shows more substance problems associated with more gambling problems.

"All these findings tend to be a tad atypical," Dr. Westermeyer said.

The data were assessed in two different ways to reflect the current prevalence and to predict the future prevalence of problem and pathological gambling. For example, data were weighted to reflect the typical older male population that is seen at most VA centers today. Raw data included an oversampling of women (to bring the 7% in weighted data up to 35%) as well as younger veterans from the Iraq and Afghanistan conflicts (to reflect the way the VA population is likely to appear in a decade or two).

The weighted data show that veterans have about twice the rate of problem gambling as does the general population. The raw data suggest a greater disparity in the future, with a rate 2.7 times that of the general population.

The other worrisome thing about the future is the ratio of problem gamblers to pathological gamblers, Dr. Westermeyer said. General population surveys show a 1:1 ratio of problem gambling to pathological gambling among people who are exposed to gambling for a decade or more, and up to 2:1 with more recent exposure. "It’s worrisome with the veterans. The ratio is ... like four or five problem gamblers to one pathological gambler. The problem gamblers are the people at risk to become pathological gamblers ... which does not bode well for the future."

"Veterans in VA care have a high rate" of pathological gambling, he added.

All 10 DSM-IV gambling symptoms were assessed in the study. The sixth criteria (characterized in the DSM-IV as "chasing one’s losses") was the most common symptom, endorsed by 6.3% of participants with problem or pathological gambling. Tolerance was next at 5.1%, followed by escape gambling at 5.1%. The eighth criteria, which refers to committing illegal acts such as writing bad checks and committing property crimes, was the least commonly reported symptom, at just over 1%.

Another unexpected finding was a propensity for younger veterans to have higher scores on the South Oaks Gambling Screen for pathological gambling. "Most surveys that include people in their 20s rarely find a high prevalence [of pathological gambling], so ours was not a typical finding," said Dr. Westermeyer. Those who show up on the survey data tend to be people aged 35 years and older, he noted.

Participants were paid $20 to complete 2 hours of computer-based data collection; a research assistant was on hand to answer any questions. Participants were recruited at two VA medical centers and 14 rural community-based outpatient clinics.

This was a clinical epidemiologic study and not community-based research, a potential limitation.

Unanswered questions remain, Dr. Westermeyer said. Do these high rates among veterans in VA care reflect rates among all veterans? Also, would it be possible to identify earlier cases through screening?

The study was funded by VA Health Services Research & Development. Dr. Westermeyer said he had no relevant disclosures.

HONOLULU – About 8% of U.S. veterans are problem gamblers who report between one and four gambling-related problems, and an additional 2% are pathological gamblers with five or more such problems, a study of 2,185 veterans in Department of Veterans Affairs care reveals.

Age, education level, and ethnicity were not big predictors of pathological gambling risk. "The one that does show a lot of difference is unemployment [odds ratio, 1.85], which is not necessarily what you expect. People need money to gamble, and they need a lot of money," Dr. Joseph J. Westermeyer IV said at the annual meeting of the American Psychiatric Association. The unemployed in the study, however, included part-time and seasonal workers who had some access to money, he said, and others were "homebodies" (typically unemployed men who were married to women with jobs).

(c) Tom Lozano/Creative Commons License

Marital status emerged as an important variable in a binary analysis, with unemployment remaining significant (OR, 1.41). "The folks who were divorced, separated, widowed, or single were underrepresented [OR, 0.69], so folks who were married were more likely to be in the problem and pathological gambling group. Again, this is not necessarily what you would expect," said Dr. Westermeyer, who is director of the mental health service at the Minneapolis VA Medical Center and professor of psychiatry at the University of Minnesota.

"Interestingly, male veterans and female veterans had almost identical rates of both problem gambling and pathological gambling, which is not – so far – what you see in the general population." Men usually outnumber women by a factor of two to three or more, Dr. Westermeyer said. It might be that the military exposes more women to gambling. "Some of the women we talked to say, ‘We hang around with the guys when we have time off. We don’t go to different places. We go to the same bars, and if they go gambling, we go gambling with them.’ "

The study included only veterans who were treated at least once in the previous 2 years at a VA facility. This design was intentional, so that any demographic or other risk factor that was identified would be relevant when incorporated into a future screening instrument.

Another aim was to identify comorbid symptoms "so primary care, as well as psychiatry, can begin to be alert to what might be associated with pathological gambling," Dr. Westermeyer said.

The veterans completed the SCL-90 (the 90-item Symptom Checklist instrument) and the PCL (PTSD [Posttraumatic Stress Disorder] Checklist). Their responses were directly and highly correlated with DSM-IV criteria and the South Oaks Gambling Screen. "In other words, people who have more posttraumatic symptoms, anxiety, and depression tend to have more gambling problems," Dr. Westermeyer said.

Participants also completed the AUDIT (Alcohol Use Disorders Identification Test) and the MAST (Michigan Alcohol Screening Test). The AUDIT addresses recent alcohol use and the MAST is a lifetime alcohol use measure, which was adapted to include drug use. Again, correlations were high. But in this study, people with more alcohol and drug problems tended to have fewer gambling problems, according to Dr. Westermeyer, which is contrary to other research that shows more substance problems associated with more gambling problems.

"All these findings tend to be a tad atypical," Dr. Westermeyer said.

The data were assessed in two different ways to reflect the current prevalence and to predict the future prevalence of problem and pathological gambling. For example, data were weighted to reflect the typical older male population that is seen at most VA centers today. Raw data included an oversampling of women (to bring the 7% in weighted data up to 35%) as well as younger veterans from the Iraq and Afghanistan conflicts (to reflect the way the VA population is likely to appear in a decade or two).

The weighted data show that veterans have about twice the rate of problem gambling as does the general population. The raw data suggest a greater disparity in the future, with a rate 2.7 times that of the general population.

The other worrisome thing about the future is the ratio of problem gamblers to pathological gamblers, Dr. Westermeyer said. General population surveys show a 1:1 ratio of problem gambling to pathological gambling among people who are exposed to gambling for a decade or more, and up to 2:1 with more recent exposure. "It’s worrisome with the veterans. The ratio is ... like four or five problem gamblers to one pathological gambler. The problem gamblers are the people at risk to become pathological gamblers ... which does not bode well for the future."

"Veterans in VA care have a high rate" of pathological gambling, he added.

All 10 DSM-IV gambling symptoms were assessed in the study. The sixth criteria (characterized in the DSM-IV as "chasing one’s losses") was the most common symptom, endorsed by 6.3% of participants with problem or pathological gambling. Tolerance was next at 5.1%, followed by escape gambling at 5.1%. The eighth criteria, which refers to committing illegal acts such as writing bad checks and committing property crimes, was the least commonly reported symptom, at just over 1%.

Another unexpected finding was a propensity for younger veterans to have higher scores on the South Oaks Gambling Screen for pathological gambling. "Most surveys that include people in their 20s rarely find a high prevalence [of pathological gambling], so ours was not a typical finding," said Dr. Westermeyer. Those who show up on the survey data tend to be people aged 35 years and older, he noted.

Participants were paid $20 to complete 2 hours of computer-based data collection; a research assistant was on hand to answer any questions. Participants were recruited at two VA medical centers and 14 rural community-based outpatient clinics.

This was a clinical epidemiologic study and not community-based research, a potential limitation.

Unanswered questions remain, Dr. Westermeyer said. Do these high rates among veterans in VA care reflect rates among all veterans? Also, would it be possible to identify earlier cases through screening?

The study was funded by VA Health Services Research & Development. Dr. Westermeyer said he had no relevant disclosures.

To listen to an HHS Healthbeat broadcast about gambling, press play here.

HONOLULU – About 8% of U.S. veterans are problem gamblers who report between one and four gambling-related problems, and an additional 2% are pathological gamblers with five or more such problems, a study of 2,185 veterans in Department of Veterans Affairs care reveals.

Age, education level, and ethnicity were not big predictors of pathological gambling risk. "The one that does show a lot of difference is unemployment [odds ratio, 1.85], which is not necessarily what you expect. People need money to gamble, and they need a lot of money," Dr. Joseph J. Westermeyer IV said at the annual meeting of the American Psychiatric Association. The unemployed in the study, however, included part-time and seasonal workers who had some access to money, he said, and others were "homebodies" (typically unemployed men who were married to women with jobs).

(c) Tom Lozano/Creative Commons License

Marital status emerged as an important variable in a binary analysis, with unemployment remaining significant (OR, 1.41). "The folks who were divorced, separated, widowed, or single were underrepresented [OR, 0.69], so folks who were married were more likely to be in the problem and pathological gambling group. Again, this is not necessarily what you would expect," said Dr. Westermeyer, who is director of the mental health service at the Minneapolis VA Medical Center and professor of psychiatry at the University of Minnesota.

"Interestingly, male veterans and female veterans had almost identical rates of both problem gambling and pathological gambling, which is not – so far – what you see in the general population." Men usually outnumber women by a factor of two to three or more, Dr. Westermeyer said. It might be that the military exposes more women to gambling. "Some of the women we talked to say, ‘We hang around with the guys when we have time off. We don’t go to different places. We go to the same bars, and if they go gambling, we go gambling with them.’ "

The study included only veterans who were treated at least once in the previous 2 years at a VA facility. This design was intentional, so that any demographic or other risk factor that was identified would be relevant when incorporated into a future screening instrument.

Another aim was to identify comorbid symptoms "so primary care, as well as psychiatry, can begin to be alert to what might be associated with pathological gambling," Dr. Westermeyer said.

The veterans completed the SCL-90 (the 90-item Symptom Checklist instrument) and the PCL (PTSD [Posttraumatic Stress Disorder] Checklist). Their responses were directly and highly correlated with DSM-IV criteria and the South Oaks Gambling Screen. "In other words, people who have more posttraumatic symptoms, anxiety, and depression tend to have more gambling problems," Dr. Westermeyer said.

Participants also completed the AUDIT (Alcohol Use Disorders Identification Test) and the MAST (Michigan Alcohol Screening Test). The AUDIT addresses recent alcohol use and the MAST is a lifetime alcohol use measure, which was adapted to include drug use. Again, correlations were high. But in this study, people with more alcohol and drug problems tended to have fewer gambling problems, according to Dr. Westermeyer, which is contrary to other research that shows more substance problems associated with more gambling problems.

"All these findings tend to be a tad atypical," Dr. Westermeyer said.

The data were assessed in two different ways to reflect the current prevalence and to predict the future prevalence of problem and pathological gambling. For example, data were weighted to reflect the typical older male population that is seen at most VA centers today. Raw data included an oversampling of women (to bring the 7% in weighted data up to 35%) as well as younger veterans from the Iraq and Afghanistan conflicts (to reflect the way the VA population is likely to appear in a decade or two).

The weighted data show that veterans have about twice the rate of problem gambling as does the general population. The raw data suggest a greater disparity in the future, with a rate 2.7 times that of the general population.

The other worrisome thing about the future is the ratio of problem gamblers to pathological gamblers, Dr. Westermeyer said. General population surveys show a 1:1 ratio of problem gambling to pathological gambling among people who are exposed to gambling for a decade or more, and up to 2:1 with more recent exposure. "It’s worrisome with the veterans. The ratio is ... like four or five problem gamblers to one pathological gambler. The problem gamblers are the people at risk to become pathological gamblers ... which does not bode well for the future."

"Veterans in VA care have a high rate" of pathological gambling, he added.

All 10 DSM-IV gambling symptoms were assessed in the study. The sixth criteria (characterized in the DSM-IV as "chasing one’s losses") was the most common symptom, endorsed by 6.3% of participants with problem or pathological gambling. Tolerance was next at 5.1%, followed by escape gambling at 5.1%. The eighth criteria, which refers to committing illegal acts such as writing bad checks and committing property crimes, was the least commonly reported symptom, at just over 1%.

Another unexpected finding was a propensity for younger veterans to have higher scores on the South Oaks Gambling Screen for pathological gambling. "Most surveys that include people in their 20s rarely find a high prevalence [of pathological gambling], so ours was not a typical finding," said Dr. Westermeyer. Those who show up on the survey data tend to be people aged 35 years and older, he noted.

Participants were paid $20 to complete 2 hours of computer-based data collection; a research assistant was on hand to answer any questions. Participants were recruited at two VA medical centers and 14 rural community-based outpatient clinics.

This was a clinical epidemiologic study and not community-based research, a potential limitation.

Unanswered questions remain, Dr. Westermeyer said. Do these high rates among veterans in VA care reflect rates among all veterans? Also, would it be possible to identify earlier cases through screening?

The study was funded by VA Health Services Research & Development. Dr. Westermeyer said he had no relevant disclosures.

To listen to an HHS Healthbeat broadcast about gambling, press play here.

HONOLULU – About 8% of U.S. veterans are problem gamblers who report between one and four gambling-related problems, and an additional 2% are pathological gamblers with five or more such problems, a study of 2,185 veterans in Department of Veterans Affairs care reveals.

Age, education level, and ethnicity were not big predictors of pathological gambling risk. "The one that does show a lot of difference is unemployment [odds ratio, 1.85], which is not necessarily what you expect. People need money to gamble, and they need a lot of money," Dr. Joseph J. Westermeyer IV said at the annual meeting of the American Psychiatric Association. The unemployed in the study, however, included part-time and seasonal workers who had some access to money, he said, and others were "homebodies" (typically unemployed men who were married to women with jobs).

(c) Tom Lozano/Creative Commons License

Marital status emerged as an important variable in a binary analysis, with unemployment remaining significant (OR, 1.41). "The folks who were divorced, separated, widowed, or single were underrepresented [OR, 0.69], so folks who were married were more likely to be in the problem and pathological gambling group. Again, this is not necessarily what you would expect," said Dr. Westermeyer, who is director of the mental health service at the Minneapolis VA Medical Center and professor of psychiatry at the University of Minnesota.

"Interestingly, male veterans and female veterans had almost identical rates of both problem gambling and pathological gambling, which is not – so far – what you see in the general population." Men usually outnumber women by a factor of two to three or more, Dr. Westermeyer said. It might be that the military exposes more women to gambling. "Some of the women we talked to say, ‘We hang around with the guys when we have time off. We don’t go to different places. We go to the same bars, and if they go gambling, we go gambling with them.’ "

The study included only veterans who were treated at least once in the previous 2 years at a VA facility. This design was intentional, so that any demographic or other risk factor that was identified would be relevant when incorporated into a future screening instrument.

Another aim was to identify comorbid symptoms "so primary care, as well as psychiatry, can begin to be alert to what might be associated with pathological gambling," Dr. Westermeyer said.

The veterans completed the SCL-90 (the 90-item Symptom Checklist instrument) and the PCL (PTSD [Posttraumatic Stress Disorder] Checklist). Their responses were directly and highly correlated with DSM-IV criteria and the South Oaks Gambling Screen. "In other words, people who have more posttraumatic symptoms, anxiety, and depression tend to have more gambling problems," Dr. Westermeyer said.

Participants also completed the AUDIT (Alcohol Use Disorders Identification Test) and the MAST (Michigan Alcohol Screening Test). The AUDIT addresses recent alcohol use and the MAST is a lifetime alcohol use measure, which was adapted to include drug use. Again, correlations were high. But in this study, people with more alcohol and drug problems tended to have fewer gambling problems, according to Dr. Westermeyer, which is contrary to other research that shows more substance problems associated with more gambling problems.

"All these findings tend to be a tad atypical," Dr. Westermeyer said.

The data were assessed in two different ways to reflect the current prevalence and to predict the future prevalence of problem and pathological gambling. For example, data were weighted to reflect the typical older male population that is seen at most VA centers today. Raw data included an oversampling of women (to bring the 7% in weighted data up to 35%) as well as younger veterans from the Iraq and Afghanistan conflicts (to reflect the way the VA population is likely to appear in a decade or two).

The weighted data show that veterans have about twice the rate of problem gambling as does the general population. The raw data suggest a greater disparity in the future, with a rate 2.7 times that of the general population.

The other worrisome thing about the future is the ratio of problem gamblers to pathological gamblers, Dr. Westermeyer said. General population surveys show a 1:1 ratio of problem gambling to pathological gambling among people who are exposed to gambling for a decade or more, and up to 2:1 with more recent exposure. "It’s worrisome with the veterans. The ratio is ... like four or five problem gamblers to one pathological gambler. The problem gamblers are the people at risk to become pathological gamblers ... which does not bode well for the future."

"Veterans in VA care have a high rate" of pathological gambling, he added.

All 10 DSM-IV gambling symptoms were assessed in the study. The sixth criteria (characterized in the DSM-IV as "chasing one’s losses") was the most common symptom, endorsed by 6.3% of participants with problem or pathological gambling. Tolerance was next at 5.1%, followed by escape gambling at 5.1%. The eighth criteria, which refers to committing illegal acts such as writing bad checks and committing property crimes, was the least commonly reported symptom, at just over 1%.

Another unexpected finding was a propensity for younger veterans to have higher scores on the South Oaks Gambling Screen for pathological gambling. "Most surveys that include people in their 20s rarely find a high prevalence [of pathological gambling], so ours was not a typical finding," said Dr. Westermeyer. Those who show up on the survey data tend to be people aged 35 years and older, he noted.

Participants were paid $20 to complete 2 hours of computer-based data collection; a research assistant was on hand to answer any questions. Participants were recruited at two VA medical centers and 14 rural community-based outpatient clinics.

This was a clinical epidemiologic study and not community-based research, a potential limitation.

Unanswered questions remain, Dr. Westermeyer said. Do these high rates among veterans in VA care reflect rates among all veterans? Also, would it be possible to identify earlier cases through screening?

The study was funded by VA Health Services Research & Development. Dr. Westermeyer said he had no relevant disclosures.

To listen to an HHS Healthbeat broadcast about gambling, press play here.

HONOLULU  – Diabetes can be a challenge to control, depression can be difficult to treat and keep in remission, and growing evidence suggests the combination can be especially problematic for patients. And as if this adverse synergy were not bad enough, having these two conditions more than doubles the likelihood that a patient will develop dementia, Dr. Wayne J. Katon said.

Screening all patients with type 2 diabetes for depression, therefore, could have a big impact, he said at the annual meeting of the American Psychiatric Association. The American Diabetes Association has endorsed such screening since 2005.

Given the bidirectional relationship between these conditions, physicians treating patients with depression also should assess, counsel, and monitor them for the development of diabetes. "Some of our psychiatric education will be pushing residents to keep up their medical skills to do monitoring. If we only train psychiatrists to do blood pressure monitoring alone, it would make a big difference," said Dr. Katon, professor of psychiatry and behavioral sciences at the University of Washington in Seattle.

This dual comorbidity puts patients at increased risk for earlier mortality.

Major depression predicts an increased likelihood of cigarette smoking during adolescence (and more difficulty quitting), a sedentary lifestyle, and obesity. Patients with major depression also can feature decreased insulin sensitivity, increased inflammatory markers, and high cortisol levels, which all become risk factors for diabetes and heart disease.

"You can see why you would be at higher risk of earlier mortality," Dr. Katon said.

Diabetes and depression are independent risk factors for dementia, based on the findings in a prospective study of 3,837 primary care patients (J. Gen. Intern. Med. 2010;25:423-9). "It looks like these are particularly bad conditions to have together in terms of risk of dementia," he said.

Dr. Katon and his colleagues found that 7.9% of patients with diabetes and major depression developed dementia over a 5-year period (based on ICD-9 codes) compared with 4.8% of those with diabetes alone (fully adjusted hazard ratio, 2.69). "This was not explained by depression being a prodrome for dementia," he said.

A more than twofold increased risk for dementia is "especially frightening," Dr. Katon added. "It speaks to the importance of more aggressively screening diabetics for depression and more effectively treating them."

Beyond having an increased risk of mortality and dementia, people with diabetes and depression also have lower levels of self-care, do not exercise as much, and are not as adherent to medications, compared with nondepressed diabetics (Diabetes Care 2004;27:2154-60). In this study, those with diabetes and major depression had significantly more nonadherent medication days over time, compared with nondepressed diabetics. "This does not portend well for increased risk of morbidity and mortality," Dr. Katon said.

Session moderator Dr. Herbert Pardes commented, "This is a big deal. The comorbidity of depression with a major medical condition ... people have got to pay attention to the medical health as part of the comorbidities." Dr. Pardes is president and CEO of the New York Presbyterian Hospital in New York City.

The baseline severity of diabetes (higher number of symptoms) was a strong predictor of a patient having major depression in a 5-year follow-up study (Psychosomatics 2009;50:570-9). Dr. Katon and his coauthors also found having one or more coronary procedures during the 5 years predicted major depression in this prospective study of 2,759 primary care patients with diabetes.

The study also revealed a higher likelihood for all-cause mortality associated with depression (hazard ratio, 1.53, vs. 1.23 for those without depression). "Diabetics with major depression were about 50% more likely to die than nondepressed diabetics over 5 years," Dr. Katon said.

After confounders, including cigarette smoking and a sedentary lifestyle were controlled for, major depression was associated with more microvascular complications (HR, 1.33 vs. 1.05); more macrovascular complications (1.38 vs. 1.32), and a higher prevalence of foot ulcers (1.99 vs. 1.22).

Diabetes, depression, and coronary artery disease appear to be one of the "natural clusters of illnesses that doctors see," Dr. Katon said. These illnesses each have a high prevalence, high comorbidity, and bidirectional adverse interactions. Depression, chronic pain, and substance abuse comprise another natural cluster, he added "but that is a whole other lecture for another day."

Dr. Katon said he has received honoraria from Forest Laboratories, Lilly, Pfizer, and Wyeth.

HONOLULU  – Diabetes can be a challenge to control, depression can be difficult to treat and keep in remission, and growing evidence suggests the combination can be especially problematic for patients. And as if this adverse synergy were not bad enough, having these two conditions more than doubles the likelihood that a patient will develop dementia, Dr. Wayne J. Katon said.

Screening all patients with type 2 diabetes for depression, therefore, could have a big impact, he said at the annual meeting of the American Psychiatric Association. The American Diabetes Association has endorsed such screening since 2005.

Given the bidirectional relationship between these conditions, physicians treating patients with depression also should assess, counsel, and monitor them for the development of diabetes. "Some of our psychiatric education will be pushing residents to keep up their medical skills to do monitoring. If we only train psychiatrists to do blood pressure monitoring alone, it would make a big difference," said Dr. Katon, professor of psychiatry and behavioral sciences at the University of Washington in Seattle.

This dual comorbidity puts patients at increased risk for earlier mortality.

Major depression predicts an increased likelihood of cigarette smoking during adolescence (and more difficulty quitting), a sedentary lifestyle, and obesity. Patients with major depression also can feature decreased insulin sensitivity, increased inflammatory markers, and high cortisol levels, which all become risk factors for diabetes and heart disease.

"You can see why you would be at higher risk of earlier mortality," Dr. Katon said.

Diabetes and depression are independent risk factors for dementia, based on the findings in a prospective study of 3,837 primary care patients (J. Gen. Intern. Med. 2010;25:423-9). "It looks like these are particularly bad conditions to have together in terms of risk of dementia," he said.

Dr. Katon and his colleagues found that 7.9% of patients with diabetes and major depression developed dementia over a 5-year period (based on ICD-9 codes) compared with 4.8% of those with diabetes alone (fully adjusted hazard ratio, 2.69). "This was not explained by depression being a prodrome for dementia," he said.

A more than twofold increased risk for dementia is "especially frightening," Dr. Katon added. "It speaks to the importance of more aggressively screening diabetics for depression and more effectively treating them."

Beyond having an increased risk of mortality and dementia, people with diabetes and depression also have lower levels of self-care, do not exercise as much, and are not as adherent to medications, compared with nondepressed diabetics (Diabetes Care 2004;27:2154-60). In this study, those with diabetes and major depression had significantly more nonadherent medication days over time, compared with nondepressed diabetics. "This does not portend well for increased risk of morbidity and mortality," Dr. Katon said.

Session moderator Dr. Herbert Pardes commented, "This is a big deal. The comorbidity of depression with a major medical condition ... people have got to pay attention to the medical health as part of the comorbidities." Dr. Pardes is president and CEO of the New York Presbyterian Hospital in New York City.

The baseline severity of diabetes (higher number of symptoms) was a strong predictor of a patient having major depression in a 5-year follow-up study (Psychosomatics 2009;50:570-9). Dr. Katon and his coauthors also found having one or more coronary procedures during the 5 years predicted major depression in this prospective study of 2,759 primary care patients with diabetes.

The study also revealed a higher likelihood for all-cause mortality associated with depression (hazard ratio, 1.53, vs. 1.23 for those without depression). "Diabetics with major depression were about 50% more likely to die than nondepressed diabetics over 5 years," Dr. Katon said.

After confounders, including cigarette smoking and a sedentary lifestyle were controlled for, major depression was associated with more microvascular complications (HR, 1.33 vs. 1.05); more macrovascular complications (1.38 vs. 1.32), and a higher prevalence of foot ulcers (1.99 vs. 1.22).

Diabetes, depression, and coronary artery disease appear to be one of the "natural clusters of illnesses that doctors see," Dr. Katon said. These illnesses each have a high prevalence, high comorbidity, and bidirectional adverse interactions. Depression, chronic pain, and substance abuse comprise another natural cluster, he added "but that is a whole other lecture for another day."

Dr. Katon said he has received honoraria from Forest Laboratories, Lilly, Pfizer, and Wyeth.

HONOLULU  – Diabetes can be a challenge to control, depression can be difficult to treat and keep in remission, and growing evidence suggests the combination can be especially problematic for patients. And as if this adverse synergy were not bad enough, having these two conditions more than doubles the likelihood that a patient will develop dementia, Dr. Wayne J. Katon said.

Screening all patients with type 2 diabetes for depression, therefore, could have a big impact, he said at the annual meeting of the American Psychiatric Association. The American Diabetes Association has endorsed such screening since 2005.

Given the bidirectional relationship between these conditions, physicians treating patients with depression also should assess, counsel, and monitor them for the development of diabetes. "Some of our psychiatric education will be pushing residents to keep up their medical skills to do monitoring. If we only train psychiatrists to do blood pressure monitoring alone, it would make a big difference," said Dr. Katon, professor of psychiatry and behavioral sciences at the University of Washington in Seattle.

This dual comorbidity puts patients at increased risk for earlier mortality.

Major depression predicts an increased likelihood of cigarette smoking during adolescence (and more difficulty quitting), a sedentary lifestyle, and obesity. Patients with major depression also can feature decreased insulin sensitivity, increased inflammatory markers, and high cortisol levels, which all become risk factors for diabetes and heart disease.

"You can see why you would be at higher risk of earlier mortality," Dr. Katon said.

Diabetes and depression are independent risk factors for dementia, based on the findings in a prospective study of 3,837 primary care patients (J. Gen. Intern. Med. 2010;25:423-9). "It looks like these are particularly bad conditions to have together in terms of risk of dementia," he said.

Dr. Katon and his colleagues found that 7.9% of patients with diabetes and major depression developed dementia over a 5-year period (based on ICD-9 codes) compared with 4.8% of those with diabetes alone (fully adjusted hazard ratio, 2.69). "This was not explained by depression being a prodrome for dementia," he said.

A more than twofold increased risk for dementia is "especially frightening," Dr. Katon added. "It speaks to the importance of more aggressively screening diabetics for depression and more effectively treating them."

Beyond having an increased risk of mortality and dementia, people with diabetes and depression also have lower levels of self-care, do not exercise as much, and are not as adherent to medications, compared with nondepressed diabetics (Diabetes Care 2004;27:2154-60). In this study, those with diabetes and major depression had significantly more nonadherent medication days over time, compared with nondepressed diabetics. "This does not portend well for increased risk of morbidity and mortality," Dr. Katon said.

Session moderator Dr. Herbert Pardes commented, "This is a big deal. The comorbidity of depression with a major medical condition ... people have got to pay attention to the medical health as part of the comorbidities." Dr. Pardes is president and CEO of the New York Presbyterian Hospital in New York City.

The baseline severity of diabetes (higher number of symptoms) was a strong predictor of a patient having major depression in a 5-year follow-up study (Psychosomatics 2009;50:570-9). Dr. Katon and his coauthors also found having one or more coronary procedures during the 5 years predicted major depression in this prospective study of 2,759 primary care patients with diabetes.

The study also revealed a higher likelihood for all-cause mortality associated with depression (hazard ratio, 1.53, vs. 1.23 for those without depression). "Diabetics with major depression were about 50% more likely to die than nondepressed diabetics over 5 years," Dr. Katon said.

After confounders, including cigarette smoking and a sedentary lifestyle were controlled for, major depression was associated with more microvascular complications (HR, 1.33 vs. 1.05); more macrovascular complications (1.38 vs. 1.32), and a higher prevalence of foot ulcers (1.99 vs. 1.22).

Diabetes, depression, and coronary artery disease appear to be one of the "natural clusters of illnesses that doctors see," Dr. Katon said. These illnesses each have a high prevalence, high comorbidity, and bidirectional adverse interactions. Depression, chronic pain, and substance abuse comprise another natural cluster, he added "but that is a whole other lecture for another day."

Dr. Katon said he has received honoraria from Forest Laboratories, Lilly, Pfizer, and Wyeth.

HONOLULU  – Diabetes can be a challenge to control, depression can be difficult to treat and keep in remission, and growing evidence suggests the combination can be especially problematic for patients. And as if this adverse synergy were not bad enough, having these two conditions more than doubles the likelihood that a patient will develop dementia, Dr. Wayne J. Katon said.

Screening all patients with type 2 diabetes for depression, therefore, could have a big impact, he said at the annual meeting of the American Psychiatric Association. The American Diabetes Association has endorsed such screening since 2005.

Given the bidirectional relationship between these conditions, physicians treating patients with depression also should assess, counsel, and monitor them for the development of diabetes. "Some of our psychiatric education will be pushing residents to keep up their medical skills to do monitoring. If we only train psychiatrists to do blood pressure monitoring alone, it would make a big difference," said Dr. Katon, professor of psychiatry and behavioral sciences at the University of Washington in Seattle.

This dual comorbidity puts patients at increased risk for earlier mortality.

Major depression predicts an increased likelihood of cigarette smoking during adolescence (and more difficulty quitting), a sedentary lifestyle, and obesity. Patients with major depression also can feature decreased insulin sensitivity, increased inflammatory markers, and high cortisol levels, which all become risk factors for diabetes and heart disease.

"You can see why you would be at higher risk of earlier mortality," Dr. Katon said.

Diabetes and depression are independent risk factors for dementia, based on the findings in a prospective study of 3,837 primary care patients (J. Gen. Intern. Med. 2010;25:423-9). "It looks like these are particularly bad conditions to have together in terms of risk of dementia," he said.

Dr. Katon and his colleagues found that 7.9% of patients with diabetes and major depression developed dementia over a 5-year period (based on ICD-9 codes) compared with 4.8% of those with diabetes alone (fully adjusted hazard ratio, 2.69). "This was not explained by depression being a prodrome for dementia," he said.

A more than twofold increased risk for dementia is "especially frightening," Dr. Katon added. "It speaks to the importance of more aggressively screening diabetics for depression and more effectively treating them."

Beyond having an increased risk of mortality and dementia, people with diabetes and depression also have lower levels of self-care, do not exercise as much, and are not as adherent to medications, compared with nondepressed diabetics (Diabetes Care 2004;27:2154-60). In this study, those with diabetes and major depression had significantly more nonadherent medication days over time, compared with nondepressed diabetics. "This does not portend well for increased risk of morbidity and mortality," Dr. Katon said.

Session moderator Dr. Herbert Pardes commented, "This is a big deal. The comorbidity of depression with a major medical condition ... people have got to pay attention to the medical health as part of the comorbidities." Dr. Pardes is president and CEO of the New York Presbyterian Hospital in New York City.

The baseline severity of diabetes (higher number of symptoms) was a strong predictor of a patient having major depression in a 5-year follow-up study (Psychosomatics 2009;50:570-9). Dr. Katon and his coauthors also found having one or more coronary procedures during the 5 years predicted major depression in this prospective study of 2,759 primary care patients with diabetes.

The study also revealed a higher likelihood for all-cause mortality associated with depression (hazard ratio, 1.53, vs. 1.23 for those without depression). "Diabetics with major depression were about 50% more likely to die than nondepressed diabetics over 5 years," Dr. Katon said.

After confounders, including cigarette smoking and a sedentary lifestyle were controlled for, major depression was associated with more microvascular complications (HR, 1.33 vs. 1.05); more macrovascular complications (1.38 vs. 1.32), and a higher prevalence of foot ulcers (1.99 vs. 1.22).

Diabetes, depression, and coronary artery disease appear to be one of the "natural clusters of illnesses that doctors see," Dr. Katon said. These illnesses each have a high prevalence, high comorbidity, and bidirectional adverse interactions. Depression, chronic pain, and substance abuse comprise another natural cluster, he added "but that is a whole other lecture for another day."

Dr. Katon said he has received honoraria from Forest Laboratories, Lilly, Pfizer, and Wyeth.

HONOLULU  – Diabetes can be a challenge to control, depression can be difficult to treat and keep in remission, and growing evidence suggests the combination can be especially problematic for patients. And as if this adverse synergy were not bad enough, having these two conditions more than doubles the likelihood that a patient will develop dementia, Dr. Wayne J. Katon said.

Screening all patients with type 2 diabetes for depression, therefore, could have a big impact, he said at the annual meeting of the American Psychiatric Association. The American Diabetes Association has endorsed such screening since 2005.

Given the bidirectional relationship between these conditions, physicians treating patients with depression also should assess, counsel, and monitor them for the development of diabetes. "Some of our psychiatric education will be pushing residents to keep up their medical skills to do monitoring. If we only train psychiatrists to do blood pressure monitoring alone, it would make a big difference," said Dr. Katon, professor of psychiatry and behavioral sciences at the University of Washington in Seattle.

This dual comorbidity puts patients at increased risk for earlier mortality.

Major depression predicts an increased likelihood of cigarette smoking during adolescence (and more difficulty quitting), a sedentary lifestyle, and obesity. Patients with major depression also can feature decreased insulin sensitivity, increased inflammatory markers, and high cortisol levels, which all become risk factors for diabetes and heart disease.

"You can see why you would be at higher risk of earlier mortality," Dr. Katon said.

Diabetes and depression are independent risk factors for dementia, based on the findings in a prospective study of 3,837 primary care patients (J. Gen. Intern. Med. 2010;25:423-9). "It looks like these are particularly bad conditions to have together in terms of risk of dementia," he said.

Dr. Katon and his colleagues found that 7.9% of patients with diabetes and major depression developed dementia over a 5-year period (based on ICD-9 codes) compared with 4.8% of those with diabetes alone (fully adjusted hazard ratio, 2.69). "This was not explained by depression being a prodrome for dementia," he said.

A more than twofold increased risk for dementia is "especially frightening," Dr. Katon added. "It speaks to the importance of more aggressively screening diabetics for depression and more effectively treating them."

Beyond having an increased risk of mortality and dementia, people with diabetes and depression also have lower levels of self-care, do not exercise as much, and are not as adherent to medications, compared with nondepressed diabetics (Diabetes Care 2004;27:2154-60). In this study, those with diabetes and major depression had significantly more nonadherent medication days over time, compared with nondepressed diabetics. "This does not portend well for increased risk of morbidity and mortality," Dr. Katon said.

Session moderator Dr. Herbert Pardes commented, "This is a big deal. The comorbidity of depression with a major medical condition ... people have got to pay attention to the medical health as part of the comorbidities." Dr. Pardes is president and CEO of the New York Presbyterian Hospital in New York City.

The baseline severity of diabetes (higher number of symptoms) was a strong predictor of a patient having major depression in a 5-year follow-up study (Psychosomatics 2009;50:570-9). Dr. Katon and his coauthors also found having one or more coronary procedures during the 5 years predicted major depression in this prospective study of 2,759 primary care patients with diabetes.

The study also revealed a higher likelihood for all-cause mortality associated with depression (hazard ratio, 1.53, vs. 1.23 for those without depression). "Diabetics with major depression were about 50% more likely to die than nondepressed diabetics over 5 years," Dr. Katon said.

After confounders, including cigarette smoking and a sedentary lifestyle were controlled for, major depression was associated with more microvascular complications (HR, 1.33 vs. 1.05); more macrovascular complications (1.38 vs. 1.32), and a higher prevalence of foot ulcers (1.99 vs. 1.22).

Diabetes, depression, and coronary artery disease appear to be one of the "natural clusters of illnesses that doctors see," Dr. Katon said. These illnesses each have a high prevalence, high comorbidity, and bidirectional adverse interactions. Depression, chronic pain, and substance abuse comprise another natural cluster, he added "but that is a whole other lecture for another day."

Dr. Katon said he has received honoraria from Forest Laboratories, Lilly, Pfizer, and Wyeth.

HONOLULU  – Diabetes can be a challenge to control, depression can be difficult to treat and keep in remission, and growing evidence suggests the combination can be especially problematic for patients. And as if this adverse synergy were not bad enough, having these two conditions more than doubles the likelihood that a patient will develop dementia, Dr. Wayne J. Katon said.

Screening all patients with type 2 diabetes for depression, therefore, could have a big impact, he said at the annual meeting of the American Psychiatric Association. The American Diabetes Association has endorsed such screening since 2005.

Given the bidirectional relationship between these conditions, physicians treating patients with depression also should assess, counsel, and monitor them for the development of diabetes. "Some of our psychiatric education will be pushing residents to keep up their medical skills to do monitoring. If we only train psychiatrists to do blood pressure monitoring alone, it would make a big difference," said Dr. Katon, professor of psychiatry and behavioral sciences at the University of Washington in Seattle.

This dual comorbidity puts patients at increased risk for earlier mortality.

Major depression predicts an increased likelihood of cigarette smoking during adolescence (and more difficulty quitting), a sedentary lifestyle, and obesity. Patients with major depression also can feature decreased insulin sensitivity, increased inflammatory markers, and high cortisol levels, which all become risk factors for diabetes and heart disease.

"You can see why you would be at higher risk of earlier mortality," Dr. Katon said.

Diabetes and depression are independent risk factors for dementia, based on the findings in a prospective study of 3,837 primary care patients (J. Gen. Intern. Med. 2010;25:423-9). "It looks like these are particularly bad conditions to have together in terms of risk of dementia," he said.

Dr. Katon and his colleagues found that 7.9% of patients with diabetes and major depression developed dementia over a 5-year period (based on ICD-9 codes) compared with 4.8% of those with diabetes alone (fully adjusted hazard ratio, 2.69). "This was not explained by depression being a prodrome for dementia," he said.

A more than twofold increased risk for dementia is "especially frightening," Dr. Katon added. "It speaks to the importance of more aggressively screening diabetics for depression and more effectively treating them."

Beyond having an increased risk of mortality and dementia, people with diabetes and depression also have lower levels of self-care, do not exercise as much, and are not as adherent to medications, compared with nondepressed diabetics (Diabetes Care 2004;27:2154-60). In this study, those with diabetes and major depression had significantly more nonadherent medication days over time, compared with nondepressed diabetics. "This does not portend well for increased risk of morbidity and mortality," Dr. Katon said.

Session moderator Dr. Herbert Pardes commented, "This is a big deal. The comorbidity of depression with a major medical condition ... people have got to pay attention to the medical health as part of the comorbidities." Dr. Pardes is president and CEO of the New York Presbyterian Hospital in New York City.

The baseline severity of diabetes (higher number of symptoms) was a strong predictor of a patient having major depression in a 5-year follow-up study (Psychosomatics 2009;50:570-9). Dr. Katon and his coauthors also found having one or more coronary procedures during the 5 years predicted major depression in this prospective study of 2,759 primary care patients with diabetes.

The study also revealed a higher likelihood for all-cause mortality associated with depression (hazard ratio, 1.53, vs. 1.23 for those without depression). "Diabetics with major depression were about 50% more likely to die than nondepressed diabetics over 5 years," Dr. Katon said.

After confounders, including cigarette smoking and a sedentary lifestyle were controlled for, major depression was associated with more microvascular complications (HR, 1.33 vs. 1.05); more macrovascular complications (1.38 vs. 1.32), and a higher prevalence of foot ulcers (1.99 vs. 1.22).

Diabetes, depression, and coronary artery disease appear to be one of the "natural clusters of illnesses that doctors see," Dr. Katon said. These illnesses each have a high prevalence, high comorbidity, and bidirectional adverse interactions. Depression, chronic pain, and substance abuse comprise another natural cluster, he added "but that is a whole other lecture for another day."

Dr. Katon said he has received honoraria from Forest Laboratories, Lilly, Pfizer, and Wyeth.

HONOLULU  – Diabetes can be a challenge to control, depression can be difficult to treat and keep in remission, and growing evidence suggests the combination can be especially problematic for patients. And as if this adverse synergy were not bad enough, having these two conditions more than doubles the likelihood that a patient will develop dementia, Dr. Wayne J. Katon said.

Screening all patients with type 2 diabetes for depression, therefore, could have a big impact, he said at the annual meeting of the American Psychiatric Association. The American Diabetes Association has endorsed such screening since 2005.

Given the bidirectional relationship between these conditions, physicians treating patients with depression also should assess, counsel, and monitor them for the development of diabetes. "Some of our psychiatric education will be pushing residents to keep up their medical skills to do monitoring. If we only train psychiatrists to do blood pressure monitoring alone, it would make a big difference," said Dr. Katon, professor of psychiatry and behavioral sciences at the University of Washington in Seattle.

Major depression predicts an increased likelihood of cigarette smoking during adolescence (and more difficulty quitting), a sedentary lifestyle, and obesity. Patients with major depression also can feature decreased insulin sensitivity, increased inflammatory markers, and high cortisol levels, which all become risk factors for diabetes and heart disease.

"You can see why you would be at higher risk of earlier mortality," Dr. Katon said.

Diabetes and depression are independent risk factors for dementia, based on the findings in a prospective study of 3,837 primary care patients (J. Gen. Intern. Med. 2010;25:423-9). "It looks like these are particularly bad conditions to have together in terms of risk of dementia," he said.

Dr. Katon and his colleagues found that 7.9% of patients with diabetes and major depression developed dementia over a 5-year period (based on ICD-9 codes) compared with 4.8% of those with diabetes alone (fully adjusted hazard ratio, 2.69). "This was not explained by depression being a prodrome for dementia," he said.

A more than twofold increased risk for dementia is "especially frightening," Dr. Katon added. "It speaks to the importance of more aggressively screening diabetics for depression and more effectively treating them."

Beyond having an increased risk of mortality and dementia, people with diabetes and depression also have lower levels of self-care, do not exercise as much, and are not as adherent to medications, compared with nondepressed diabetics (Diabetes Care 2004;27:2154-60). In this study, those with diabetes and major depression had significantly more nonadherent medication days over time, compared with nondepressed diabetics. "This does not portend well for increased risk of morbidity and mortality," Dr. Katon said.

Session moderator Dr. Herbert Pardes commented, "This is a big deal. The comorbidity of depression with a major medical condition ... people have got to pay attention to the medical health as part of the comorbidities." Dr. Pardes is president and CEO of the New York Presbyterian Hospital in New York City.

The baseline severity of diabetes (higher number of symptoms) was a strong predictor of a patient having major depression in a 5-year follow-up study (Psychosomatics 2009;50:570-9). Dr. Katon and his coauthors also found having one or more coronary procedures during the 5 years predicted major depression in this prospective study of 2,759 primary care patients with diabetes.

The study also revealed a higher likelihood for all-cause mortality associated with depression (hazard ratio, 1.53, vs. 1.23 for those without depression). "Diabetics with major depression were about 50% more likely to die than nondepressed diabetics over 5 years," Dr. Katon said.

After confounders, including cigarette smoking and a sedentary lifestyle were controlled for, major depression was associated with more microvascular complications (HR, 1.33 vs. 1.05); more macrovascular complications (1.38 vs. 1.32), and a higher prevalence of foot ulcers (1.99 vs. 1.22).

Diabetes, depression, and coronary artery disease appear to be one of the "natural clusters of illnesses that doctors see," Dr. Katon said. These illnesses each have a high prevalence, high comorbidity, and bidirectional adverse interactions. Depression, chronic pain, and substance abuse comprise another natural cluster, he added "but that is a whole other lecture for another day."

Dr. Katon said he has received honoraria from Forest Laboratories, Lilly, Pfizer, and Wyeth.

HONOLULU  – Diabetes can be a challenge to control, depression can be difficult to treat and keep in remission, and growing evidence suggests the combination can be especially problematic for patients. And as if this adverse synergy were not bad enough, having these two conditions more than doubles the likelihood that a patient will develop dementia, Dr. Wayne J. Katon said.

Screening all patients with type 2 diabetes for depression, therefore, could have a big impact, he said at the annual meeting of the American Psychiatric Association. The American Diabetes Association has endorsed such screening since 2005.

Given the bidirectional relationship between these conditions, physicians treating patients with depression also should assess, counsel, and monitor them for the development of diabetes. "Some of our psychiatric education will be pushing residents to keep up their medical skills to do monitoring. If we only train psychiatrists to do blood pressure monitoring alone, it would make a big difference," said Dr. Katon, professor of psychiatry and behavioral sciences at the University of Washington in Seattle.

Major depression predicts an increased likelihood of cigarette smoking during adolescence (and more difficulty quitting), a sedentary lifestyle, and obesity. Patients with major depression also can feature decreased insulin sensitivity, increased inflammatory markers, and high cortisol levels, which all become risk factors for diabetes and heart disease.

"You can see why you would be at higher risk of earlier mortality," Dr. Katon said.

Diabetes and depression are independent risk factors for dementia, based on the findings in a prospective study of 3,837 primary care patients (J. Gen. Intern. Med. 2010;25:423-9). "It looks like these are particularly bad conditions to have together in terms of risk of dementia," he said.

Dr. Katon and his colleagues found that 7.9% of patients with diabetes and major depression developed dementia over a 5-year period (based on ICD-9 codes) compared with 4.8% of those with diabetes alone (fully adjusted hazard ratio, 2.69). "This was not explained by depression being a prodrome for dementia," he said.

A more than twofold increased risk for dementia is "especially frightening," Dr. Katon added. "It speaks to the importance of more aggressively screening diabetics for depression and more effectively treating them."

Beyond having an increased risk of mortality and dementia, people with diabetes and depression also have lower levels of self-care, do not exercise as much, and are not as adherent to medications, compared with nondepressed diabetics (Diabetes Care 2004;27:2154-60). In this study, those with diabetes and major depression had significantly more nonadherent medication days over time, compared with nondepressed diabetics. "This does not portend well for increased risk of morbidity and mortality," Dr. Katon said.

Session moderator Dr. Herbert Pardes commented, "This is a big deal. The comorbidity of depression with a major medical condition ... people have got to pay attention to the medical health as part of the comorbidities." Dr. Pardes is president and CEO of the New York Presbyterian Hospital in New York City.

The baseline severity of diabetes (higher number of symptoms) was a strong predictor of a patient having major depression in a 5-year follow-up study (Psychosomatics 2009;50:570-9). Dr. Katon and his coauthors also found having one or more coronary procedures during the 5 years predicted major depression in this prospective study of 2,759 primary care patients with diabetes.

The study also revealed a higher likelihood for all-cause mortality associated with depression (hazard ratio, 1.53, vs. 1.23 for those without depression). "Diabetics with major depression were about 50% more likely to die than nondepressed diabetics over 5 years," Dr. Katon said.

After confounders, including cigarette smoking and a sedentary lifestyle were controlled for, major depression was associated with more microvascular complications (HR, 1.33 vs. 1.05); more macrovascular complications (1.38 vs. 1.32), and a higher prevalence of foot ulcers (1.99 vs. 1.22).

Diabetes, depression, and coronary artery disease appear to be one of the "natural clusters of illnesses that doctors see," Dr. Katon said. These illnesses each have a high prevalence, high comorbidity, and bidirectional adverse interactions. Depression, chronic pain, and substance abuse comprise another natural cluster, he added "but that is a whole other lecture for another day."

Dr. Katon said he has received honoraria from Forest Laboratories, Lilly, Pfizer, and Wyeth.

HONOLULU  – Diabetes can be a challenge to control, depression can be difficult to treat and keep in remission, and growing evidence suggests the combination can be especially problematic for patients. And as if this adverse synergy were not bad enough, having these two conditions more than doubles the likelihood that a patient will develop dementia, Dr. Wayne J. Katon said.

Screening all patients with type 2 diabetes for depression, therefore, could have a big impact, he said at the annual meeting of the American Psychiatric Association. The American Diabetes Association has endorsed such screening since 2005.

Given the bidirectional relationship between these conditions, physicians treating patients with depression also should assess, counsel, and monitor them for the development of diabetes. "Some of our psychiatric education will be pushing residents to keep up their medical skills to do monitoring. If we only train psychiatrists to do blood pressure monitoring alone, it would make a big difference," said Dr. Katon, professor of psychiatry and behavioral sciences at the University of Washington in Seattle.

Major depression predicts an increased likelihood of cigarette smoking during adolescence (and more difficulty quitting), a sedentary lifestyle, and obesity. Patients with major depression also can feature decreased insulin sensitivity, increased inflammatory markers, and high cortisol levels, which all become risk factors for diabetes and heart disease.

"You can see why you would be at higher risk of earlier mortality," Dr. Katon said.

Diabetes and depression are independent risk factors for dementia, based on the findings in a prospective study of 3,837 primary care patients (J. Gen. Intern. Med. 2010;25:423-9). "It looks like these are particularly bad conditions to have together in terms of risk of dementia," he said.

Dr. Katon and his colleagues found that 7.9% of patients with diabetes and major depression developed dementia over a 5-year period (based on ICD-9 codes) compared with 4.8% of those with diabetes alone (fully adjusted hazard ratio, 2.69). "This was not explained by depression being a prodrome for dementia," he said.

A more than twofold increased risk for dementia is "especially frightening," Dr. Katon added. "It speaks to the importance of more aggressively screening diabetics for depression and more effectively treating them."

Beyond having an increased risk of mortality and dementia, people with diabetes and depression also have lower levels of self-care, do not exercise as much, and are not as adherent to medications, compared with nondepressed diabetics (Diabetes Care 2004;27:2154-60). In this study, those with diabetes and major depression had significantly more nonadherent medication days over time, compared with nondepressed diabetics. "This does not portend well for increased risk of morbidity and mortality," Dr. Katon said.

Session moderator Dr. Herbert Pardes commented, "This is a big deal. The comorbidity of depression with a major medical condition ... people have got to pay attention to the medical health as part of the comorbidities." Dr. Pardes is president and CEO of the New York Presbyterian Hospital in New York City.

The baseline severity of diabetes (higher number of symptoms) was a strong predictor of a patient having major depression in a 5-year follow-up study (Psychosomatics 2009;50:570-9). Dr. Katon and his coauthors also found having one or more coronary procedures during the 5 years predicted major depression in this prospective study of 2,759 primary care patients with diabetes.

The study also revealed a higher likelihood for all-cause mortality associated with depression (hazard ratio, 1.53, vs. 1.23 for those without depression). "Diabetics with major depression were about 50% more likely to die than nondepressed diabetics over 5 years," Dr. Katon said.

After confounders, including cigarette smoking and a sedentary lifestyle were controlled for, major depression was associated with more microvascular complications (HR, 1.33 vs. 1.05); more macrovascular complications (1.38 vs. 1.32), and a higher prevalence of foot ulcers (1.99 vs. 1.22).

Diabetes, depression, and coronary artery disease appear to be one of the "natural clusters of illnesses that doctors see," Dr. Katon said. These illnesses each have a high prevalence, high comorbidity, and bidirectional adverse interactions. Depression, chronic pain, and substance abuse comprise another natural cluster, he added "but that is a whole other lecture for another day."

Dr. Katon said he has received honoraria from Forest Laboratories, Lilly, Pfizer, and Wyeth.

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – The antipsychotic ziprasidone does not appear to work as well in patients with bipolar disorder who are either obese or hyperglycemic, according to a study funded by the drug’s maker, Pfizer.

Among 267 acutely manic patients on ziprasidone (Geodon) monotherapy for 2-3 weeks, those with body mass indexes below 28.8 kg/m² were about twice as likely to respond to ziprasidone or go into remission during treatment than were those with BMIs above 28.8 kg/m², which roughly defines the border between being overweight and obese.

Among other findings, 52% of patients below that cut-off responded to treatment; for those above it, the response rate was 37%.

Meanwhile, patients with randomly tested blood glucose levels below 140 mg/dL were more than three times more likely to go into remission and more than five times more likely to respond to treatment than were those with blood glucose levels at or above 140 mg/dL, a level rarely reached in people with normal glucose metabolism.

More than half of patients with randomly tested glucose levels below 140 mg/dL – but only 16% of patients who tested at or above that level – responded to treatment.

Obese and hyperglycemic patients also showed less improvement on Global Assessment of Functioning scores. The findings all were statistically significant.

"Patients with bipolar disorder who have elevated blood glucose and/or elevated BMI do not respond as well to ziprasidone treatment of acute mania" and "may have a lower probability of responding" to antipsychotics in general, said lead author Dr. Roger S. McIntyre, associate professor of psychiatry and pharmacology at the University of Toronto.

Obese patients might need higher-than-typical doses to overcome greater body mass, but that’s "not clear at this point. You can increase the drug dose all you want; it may not make any difference," said Dr. McIntyre, who also is head of the mood disorders psychopharmacology unit at University Health Network in Toronto.

In any case, he said the findings offer another good reason to encourage patients to lose weight, and also argue for using antipsychotics such as ziprasidone that are less likely than others to cause weight gain, since excess weight now appears to diminish the effects of antipsychotics.

The problem with hyperglycemia might be related to insulin dysregulation; there’s emerging consensus "that insulin dysregulation manifesting as hyperglycemia might be neurotoxic," Dr. McIntyre noted.

He and his colleagues pooled data from previous Pfizer studies to gauge the effects of BMI on response. "It’s intuitive if you have an [elevated] BMI, that the psychopharmacotherapies you are taking would have different distributions and different concentrations, [but] it’s almost never been studied," Dr. McIntyre said.

Based on the results, the research community needs to rethink the effect of BMI on response, he said. "It’s an important way to stratify data."

The patients in the study were at least moderately manic, with baseline Mania Rating Scale scores of 14 or greater. Remission was defined by a score dropped below 10 by the study’s end; response was defined by a greater than 50% score reduction.

HONOLULU – Economic crisis in the United States could lead to an increase in suicides if U.S. trends follow the pattern in Japan during that country’s economic downturn a decade ago, according to Dr. William R. Yates and his colleagues.

If the U.S. experience does mirror that of Japan, Dr. Yates and his colleagues project an increase of more than 14,500 suicides per year in the United States. The Japanese experience suggests that almost 90% of the increase would occur among men, Dr. Yates reported in a poster presentation at the annual meeting of the American Psychiatric Association.

Right now, the U.S. economic outlook parallels Japan’s in the late 1990s, with increased unemployment, a burst housing bubble, and a troubled stock market, said Dr. Yates, lead author of the analysis. As unemployment increased 50% in Japan between 1998 and 1999, suicide rates increased 23.1% among women and 47.3% among men. Men over 50 were especially hard hit. Unemployment and divorce were the first and second leading psychosocial factors, one of Dr. Yates’s Japanese colleagues found. Better suicide reporting did not seem to account for the increase in deaths.

Clinicians should be aware that a similar scenario could occur in the United States – or could already be happening if a recent increase in baby-boomer suicides is any indication, said Dr. Yates, who is affiliated with the University of Oklahoma department of psychiatry in Tulsa and is a former department chairman. Indeed, a recent study shows a connection between U.S. suicide rates and business cycles (Am. J. Public Health 2011;101:1139-46).

"We are not necessarily saying this will occur, but if it should, these would be the patterns that might be seen," he said. "We know psychiatric illness is the primary determinant of suicide, but psychosocial factors can influence overall rates."

To arrive at their figures, Dr. Yates and his colleagues compared economic trends in the United States and Japan, and applied Japanese suicide rates during the downturn to U.S. population figures based on the 2010 Census. "The baseline number of suicides in the U.S. average around 33,000 per year," Dr. Yates wrote in a blog about his poster. "If suicide rates were to increase to the magnitude found in Japan, the number of increased suicides in the U.S." probably surpass 14,000 each year.

Also, based on that model, for instance, they project a possible increase of about 3,000 suicides per year over the next few years in men aged 55-74.

The experience in Japan might not be generalizable to the United States. There are significant cultural differences between the two countries, among other possible confounders that Dr. Yates plans to examine.

Dr. Yates said he is paying more attention to the employment status of his patients and "whether they are at risk of losing their job, and even talking about what they would do if they lose their jobs." The main issue for jobless patients is access to care. He lets patients know they can get help even without insurance from community mental health services, which often have sliding-scale payment schemes, though there might be a lengthy wait.

In addition, Dr. Yates tells his patients that "the worst thing they can do if they are currently being treated and lose insurance would be to stop medical care and medication. That’s the time they need to be followed closely, rather than being out there on their own," he said. He’d also like to see companies mention community mental health services as an option for laid-off employees.

He got the idea for the study from his work with a small, informal group of psychiatrists and researchers that meets in a retreat setting in Itasca State Park in Minnesota and focuses on cross-cultural psychiatric issues. He and his colleagues, who call themselves the Itasca Brain and Behavior Association, started looking into the issue after Japanese members mentioned the jump in Japanese suicides around 1998.

Dr. Yates said he has no relevant disclosures.

HONOLULU – Economic crisis in the United States could lead to an increase in suicides if U.S. trends follow the pattern in Japan during that country’s economic downturn a decade ago, according to Dr. William R. Yates and his colleagues.

If the U.S. experience does mirror that of Japan, Dr. Yates and his colleagues project an increase of more than 14,500 suicides per year in the United States. The Japanese experience suggests that almost 90% of the increase would occur among men, Dr. Yates reported in a poster presentation at the annual meeting of the American Psychiatric Association.

Right now, the U.S. economic outlook parallels Japan’s in the late 1990s, with increased unemployment, a burst housing bubble, and a troubled stock market, said Dr. Yates, lead author of the analysis. As unemployment increased 50% in Japan between 1998 and 1999, suicide rates increased 23.1% among women and 47.3% among men. Men over 50 were especially hard hit. Unemployment and divorce were the first and second leading psychosocial factors, one of Dr. Yates’s Japanese colleagues found. Better suicide reporting did not seem to account for the increase in deaths.

Clinicians should be aware that a similar scenario could occur in the United States – or could already be happening if a recent increase in baby-boomer suicides is any indication, said Dr. Yates, who is affiliated with the University of Oklahoma department of psychiatry in Tulsa and is a former department chairman. Indeed, a recent study shows a connection between U.S. suicide rates and business cycles (Am. J. Public Health 2011;101:1139-46).

"We are not necessarily saying this will occur, but if it should, these would be the patterns that might be seen," he said. "We know psychiatric illness is the primary determinant of suicide, but psychosocial factors can influence overall rates."

To arrive at their figures, Dr. Yates and his colleagues compared economic trends in the United States and Japan, and applied Japanese suicide rates during the downturn to U.S. population figures based on the 2010 Census. "The baseline number of suicides in the U.S. average around 33,000 per year," Dr. Yates wrote in a blog about his poster. "If suicide rates were to increase to the magnitude found in Japan, the number of increased suicides in the U.S." probably surpass 14,000 each year.

Also, based on that model, for instance, they project a possible increase of about 3,000 suicides per year over the next few years in men aged 55-74.

The experience in Japan might not be generalizable to the United States. There are significant cultural differences between the two countries, among other possible confounders that Dr. Yates plans to examine.

Dr. Yates said he is paying more attention to the employment status of his patients and "whether they are at risk of losing their job, and even talking about what they would do if they lose their jobs." The main issue for jobless patients is access to care. He lets patients know they can get help even without insurance from community mental health services, which often have sliding-scale payment schemes, though there might be a lengthy wait.

In addition, Dr. Yates tells his patients that "the worst thing they can do if they are currently being treated and lose insurance would be to stop medical care and medication. That’s the time they need to be followed closely, rather than being out there on their own," he said. He’d also like to see companies mention community mental health services as an option for laid-off employees.

He got the idea for the study from his work with a small, informal group of psychiatrists and researchers that meets in a retreat setting in Itasca State Park in Minnesota and focuses on cross-cultural psychiatric issues. He and his colleagues, who call themselves the Itasca Brain and Behavior Association, started looking into the issue after Japanese members mentioned the jump in Japanese suicides around 1998.

Dr. Yates said he has no relevant disclosures.

HONOLULU – Economic crisis in the United States could lead to an increase in suicides if U.S. trends follow the pattern in Japan during that country’s economic downturn a decade ago, according to Dr. William R. Yates and his colleagues.

If the U.S. experience does mirror that of Japan, Dr. Yates and his colleagues project an increase of more than 14,500 suicides per year in the United States. The Japanese experience suggests that almost 90% of the increase would occur among men, Dr. Yates reported in a poster presentation at the annual meeting of the American Psychiatric Association.

Right now, the U.S. economic outlook parallels Japan’s in the late 1990s, with increased unemployment, a burst housing bubble, and a troubled stock market, said Dr. Yates, lead author of the analysis. As unemployment increased 50% in Japan between 1998 and 1999, suicide rates increased 23.1% among women and 47.3% among men. Men over 50 were especially hard hit. Unemployment and divorce were the first and second leading psychosocial factors, one of Dr. Yates’s Japanese colleagues found. Better suicide reporting did not seem to account for the increase in deaths.

Clinicians should be aware that a similar scenario could occur in the United States – or could already be happening if a recent increase in baby-boomer suicides is any indication, said Dr. Yates, who is affiliated with the University of Oklahoma department of psychiatry in Tulsa and is a former department chairman. Indeed, a recent study shows a connection between U.S. suicide rates and business cycles (Am. J. Public Health 2011;101:1139-46).

"We are not necessarily saying this will occur, but if it should, these would be the patterns that might be seen," he said. "We know psychiatric illness is the primary determinant of suicide, but psychosocial factors can influence overall rates."

To arrive at their figures, Dr. Yates and his colleagues compared economic trends in the United States and Japan, and applied Japanese suicide rates during the downturn to U.S. population figures based on the 2010 Census. "The baseline number of suicides in the U.S. average around 33,000 per year," Dr. Yates wrote in a blog about his poster. "If suicide rates were to increase to the magnitude found in Japan, the number of increased suicides in the U.S." probably surpass 14,000 each year.

Also, based on that model, for instance, they project a possible increase of about 3,000 suicides per year over the next few years in men aged 55-74.

The experience in Japan might not be generalizable to the United States. There are significant cultural differences between the two countries, among other possible confounders that Dr. Yates plans to examine.

Dr. Yates said he is paying more attention to the employment status of his patients and "whether they are at risk of losing their job, and even talking about what they would do if they lose their jobs." The main issue for jobless patients is access to care. He lets patients know they can get help even without insurance from community mental health services, which often have sliding-scale payment schemes, though there might be a lengthy wait.

In addition, Dr. Yates tells his patients that "the worst thing they can do if they are currently being treated and lose insurance would be to stop medical care and medication. That’s the time they need to be followed closely, rather than being out there on their own," he said. He’d also like to see companies mention community mental health services as an option for laid-off employees.

He got the idea for the study from his work with a small, informal group of psychiatrists and researchers that meets in a retreat setting in Itasca State Park in Minnesota and focuses on cross-cultural psychiatric issues. He and his colleagues, who call themselves the Itasca Brain and Behavior Association, started looking into the issue after Japanese members mentioned the jump in Japanese suicides around 1998.

Dr. Yates said he has no relevant disclosures.

HONOLULU – Economic crisis in the United States could lead to an increase in suicides if U.S. trends follow the pattern in Japan during that country’s economic downturn a decade ago, according to Dr. William R. Yates and his colleagues.

If the U.S. experience does mirror that of Japan, Dr. Yates and his colleagues project an increase of more than 14,500 suicides per year in the United States. The Japanese experience suggests that almost 90% of the increase would occur among men, Dr. Yates reported in a poster presentation at the annual meeting of the American Psychiatric Association.

Right now, the U.S. economic outlook parallels Japan’s in the late 1990s, with increased unemployment, a burst housing bubble, and a troubled stock market, said Dr. Yates, lead author of the analysis. As unemployment increased 50% in Japan between 1998 and 1999, suicide rates increased 23.1% among women and 47.3% among men. Men over 50 were especially hard hit. Unemployment and divorce were the first and second leading psychosocial factors, one of Dr. Yates’s Japanese colleagues found. Better suicide reporting did not seem to account for the increase in deaths.

Clinicians should be aware that a similar scenario could occur in the United States – or could already be happening if a recent increase in baby-boomer suicides is any indication, said Dr. Yates, who is affiliated with the University of Oklahoma department of psychiatry in Tulsa and is a former department chairman. Indeed, a recent study shows a connection between U.S. suicide rates and business cycles (Am. J. Public Health 2011;101:1139-46).

"We are not necessarily saying this will occur, but if it should, these would be the patterns that might be seen," he said. "We know psychiatric illness is the primary determinant of suicide, but psychosocial factors can influence overall rates."

To arrive at their figures, Dr. Yates and his colleagues compared economic trends in the United States and Japan, and applied Japanese suicide rates during the downturn to U.S. population figures based on the 2010 Census. "The baseline number of suicides in the U.S. average around 33,000 per year," Dr. Yates wrote in a blog about his poster. "If suicide rates were to increase to the magnitude found in Japan, the number of increased suicides in the U.S." probably surpass 14,000 each year.

Also, based on that model, for instance, they project a possible increase of about 3,000 suicides per year over the next few years in men aged 55-74.

The experience in Japan might not be generalizable to the United States. There are significant cultural differences between the two countries, among other possible confounders that Dr. Yates plans to examine.

Dr. Yates said he is paying more attention to the employment status of his patients and "whether they are at risk of losing their job, and even talking about what they would do if they lose their jobs." The main issue for jobless patients is access to care. He lets patients know they can get help even without insurance from community mental health services, which often have sliding-scale payment schemes, though there might be a lengthy wait.

In addition, Dr. Yates tells his patients that "the worst thing they can do if they are currently being treated and lose insurance would be to stop medical care and medication. That’s the time they need to be followed closely, rather than being out there on their own," he said. He’d also like to see companies mention community mental health services as an option for laid-off employees.

He got the idea for the study from his work with a small, informal group of psychiatrists and researchers that meets in a retreat setting in Itasca State Park in Minnesota and focuses on cross-cultural psychiatric issues. He and his colleagues, who call themselves the Itasca Brain and Behavior Association, started looking into the issue after Japanese members mentioned the jump in Japanese suicides around 1998.

Dr. Yates said he has no relevant disclosures.

HONOLULU – Economic crisis in the United States could lead to an increase in suicides if U.S. trends follow the pattern in Japan during that country’s economic downturn a decade ago, according to Dr. William R. Yates and his colleagues.

If the U.S. experience does mirror that of Japan, Dr. Yates and his colleagues project an increase of more than 14,500 suicides per year in the United States. The Japanese experience suggests that almost 90% of the increase would occur among men, Dr. Yates reported in a poster presentation at the annual meeting of the American Psychiatric Association.

Right now, the U.S. economic outlook parallels Japan’s in the late 1990s, with increased unemployment, a burst housing bubble, and a troubled stock market, said Dr. Yates, lead author of the analysis. As unemployment increased 50% in Japan between 1998 and 1999, suicide rates increased 23.1% among women and 47.3% among men. Men over 50 were especially hard hit. Unemployment and divorce were the first and second leading psychosocial factors, one of Dr. Yates’s Japanese colleagues found. Better suicide reporting did not seem to account for the increase in deaths.

Clinicians should be aware that a similar scenario could occur in the United States – or could already be happening if a recent increase in baby-boomer suicides is any indication, said Dr. Yates, who is affiliated with the University of Oklahoma department of psychiatry in Tulsa and is a former department chairman. Indeed, a recent study shows a connection between U.S. suicide rates and business cycles (Am. J. Public Health 2011;101:1139-46).

"We are not necessarily saying this will occur, but if it should, these would be the patterns that might be seen," he said. "We know psychiatric illness is the primary determinant of suicide, but psychosocial factors can influence overall rates."

To arrive at their figures, Dr. Yates and his colleagues compared economic trends in the United States and Japan, and applied Japanese suicide rates during the downturn to U.S. population figures based on the 2010 Census. "The baseline number of suicides in the U.S. average around 33,000 per year," Dr. Yates wrote in a blog about his poster. "If suicide rates were to increase to the magnitude found in Japan, the number of increased suicides in the U.S." probably surpass 14,000 each year.

Also, based on that model, for instance, they project a possible increase of about 3,000 suicides per year over the next few years in men aged 55-74.

The experience in Japan might not be generalizable to the United States. There are significant cultural differences between the two countries, among other possible confounders that Dr. Yates plans to examine.

Dr. Yates said he is paying more attention to the employment status of his patients and "whether they are at risk of losing their job, and even talking about what they would do if they lose their jobs." The main issue for jobless patients is access to care. He lets patients know they can get help even without insurance from community mental health services, which often have sliding-scale payment schemes, though there might be a lengthy wait.

In addition, Dr. Yates tells his patients that "the worst thing they can do if they are currently being treated and lose insurance would be to stop medical care and medication. That’s the time they need to be followed closely, rather than being out there on their own," he said. He’d also like to see companies mention community mental health services as an option for laid-off employees.

He got the idea for the study from his work with a small, informal group of psychiatrists and researchers that meets in a retreat setting in Itasca State Park in Minnesota and focuses on cross-cultural psychiatric issues. He and his colleagues, who call themselves the Itasca Brain and Behavior Association, started looking into the issue after Japanese members mentioned the jump in Japanese suicides around 1998.

Dr. Yates said he has no relevant disclosures.

HONOLULU – Economic crisis in the United States could lead to an increase in suicides if U.S. trends follow the pattern in Japan during that country’s economic downturn a decade ago, according to Dr. William R. Yates and his colleagues.

If the U.S. experience does mirror that of Japan, Dr. Yates and his colleagues project an increase of more than 14,500 suicides per year in the United States. The Japanese experience suggests that almost 90% of the increase would occur among men, Dr. Yates reported in a poster presentation at the annual meeting of the American Psychiatric Association.

Right now, the U.S. economic outlook parallels Japan’s in the late 1990s, with increased unemployment, a burst housing bubble, and a troubled stock market, said Dr. Yates, lead author of the analysis. As unemployment increased 50% in Japan between 1998 and 1999, suicide rates increased 23.1% among women and 47.3% among men. Men over 50 were especially hard hit. Unemployment and divorce were the first and second leading psychosocial factors, one of Dr. Yates’s Japanese colleagues found. Better suicide reporting did not seem to account for the increase in deaths.

Clinicians should be aware that a similar scenario could occur in the United States – or could already be happening if a recent increase in baby-boomer suicides is any indication, said Dr. Yates, who is affiliated with the University of Oklahoma department of psychiatry in Tulsa and is a former department chairman. Indeed, a recent study shows a connection between U.S. suicide rates and business cycles (Am. J. Public Health 2011;101:1139-46).

"We are not necessarily saying this will occur, but if it should, these would be the patterns that might be seen," he said. "We know psychiatric illness is the primary determinant of suicide, but psychosocial factors can influence overall rates."

To arrive at their figures, Dr. Yates and his colleagues compared economic trends in the United States and Japan, and applied Japanese suicide rates during the downturn to U.S. population figures based on the 2010 Census. "The baseline number of suicides in the U.S. average around 33,000 per year," Dr. Yates wrote in a blog about his poster. "If suicide rates were to increase to the magnitude found in Japan, the number of increased suicides in the U.S." probably surpass 14,000 each year.

Also, based on that model, for instance, they project a possible increase of about 3,000 suicides per year over the next few years in men aged 55-74.

The experience in Japan might not be generalizable to the United States. There are significant cultural differences between the two countries, among other possible confounders that Dr. Yates plans to examine.

Dr. Yates said he is paying more attention to the employment status of his patients and "whether they are at risk of losing their job, and even talking about what they would do if they lose their jobs." The main issue for jobless patients is access to care. He lets patients know they can get help even without insurance from community mental health services, which often have sliding-scale payment schemes, though there might be a lengthy wait.

In addition, Dr. Yates tells his patients that "the worst thing they can do if they are currently being treated and lose insurance would be to stop medical care and medication. That’s the time they need to be followed closely, rather than being out there on their own," he said. He’d also like to see companies mention community mental health services as an option for laid-off employees.

He got the idea for the study from his work with a small, informal group of psychiatrists and researchers that meets in a retreat setting in Itasca State Park in Minnesota and focuses on cross-cultural psychiatric issues. He and his colleagues, who call themselves the Itasca Brain and Behavior Association, started looking into the issue after Japanese members mentioned the jump in Japanese suicides around 1998.

Dr. Yates said he has no relevant disclosures.