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Internet Use Good for Mental Well-Being?
Contrary to previous research that suggests internet use can have a deleterious effect on mental health, a new study of more than 2 million individuals suggested it can actually enhance well-being.
Between 2006 and 2021, investigators studied more than 2 million people between the ages of 15 and 99 years in 168 countries, focusing on their psychological well-being and their use of the internet. Many of the included countries have rarely or never been studied in this connection.
“We were surprised to find a positive correlation between well-being and internet use across the majority of the thousands of models we used for our analysis,” lead author Matti Vuorre, PhD, of Tilburg University, Tilburg, the Netherlands, and a research associate at Oxford Internet Institute in England, said in a news release.
The study was published online on May 13 in Technology, Mind, and Behavior.
A Global Phenomenon
Coauthor Andrew K. Przybylski, PhD, professor of human behavior and technology at Oxford Internet Institute, explained the motive for conducting the study.
“Whilst internet technologies and their platforms and their potential psychological consequences remain debated, research to date has been inconclusive and of limited geographic and demographic scope,” he said.
He noted that the “overwhelming majority” of studies have focused on the Global North and on younger people and “ignoring the fact that the penetration of the internet has been, and continues to be, a global phenomenon.”
The researchers set out to address this gap by analyzing “how internet access, mobility internet access, and active internet use might predict psychological well-being on a global level across the life stages,” Dr. Przybylski continued. “To our knowledge, no other research has directly grappled with these issues and addressed the worldwide scope of the debate.”
To study internet use, the investigators analyzed data from the 2022 Gallup World Poll, a nationally representative survey of each country’s civilian, non-institutionalized adult population (ie, aged ≥ 15 years), conducted between 2002 and 2022. The poll assessed well-being using face-to-face, as well as phone interviews, conducted by local interviewers in the respondents’ native languages.
The total sample size included 2,414,295 adults drawn from 186 countries (53.1% women), drawn from countries that included those located in Latin America, Asia, and Africa.
The researchers examined eight indicators of well-being: life satisfaction, daily negative and positive experiences, two indices of social well-being, physical well-being, community well-being, and experiences of purpose.
Covariates included respondents’ income, education, work, relationship status, the ability to meet basic needs (food and shelter), and whether they reported having health problems.
Greater Life Satisfaction
The researchers conducted a “multiverse” of 33,792 types of analyses, researching the average differences in well-being between individuals who had access to mobile internet or had used the internet in the past 7 days.
They found that for the average country, those who had access to the internet reported approximately 0.08 units greater life satisfaction, positive experiences, and social life satisfaction and 0.06 units lower negative experience than those without access.
They also reported approximately 0.08 units greater experiences of purpose and 0.1 unit greater physical, 0.02 units greater community, and 0.08 units greater social well-being than individuals without access.
Being an active internet user was associated with a 0.03- to 0.08-unit increase in life satisfaction, positive experiences, social well-being, and physical well-being and a 0.04-unit decrease in negative experiences. Access to a smartphone predicted increases of 0.06 and 0.07 units.
Although the standard deviations (SDs) of well-being outcomes were small (eg, the median life satisfaction difference was 0.36 SDs between individuals who did and did not have access to the internet), they were “not negligible.”
In fact, when the researchers examined the associations’ robustness across all analyses, they found that 84.9% resulted in positive and statistically significant associations between internet connectivity and well-being.
Of the 4.9% of associations between internet use and community well-being that were negative, most were observed among young women between the ages of 15 and 24 years.
While the researchers did not identify this as a causal relationship, they noted that this finding is consistent with previous reports of increased cyberbullying and negative associations between social media use and depressive symptoms in young women.
“Overall, we found that average associations were consistent across internet adoption predictors and well-being outcomes, with those who had access to or actively used the internet reporting meaningfully greater well-being than those who did not,” Dr. Przybylski said.
The study’s limitations included comparing individuals with each other, given that there “are likely myriad other feature of the human condition that are associated with both uptake of internet technologies and well-being in such a manner that they might case spurious associations or mask true associations,” the authors noted.
Moreover, longitudinal studies tracking participants over time can provide more information about the “contexts of how and why an individual might be affected by internet technologies and platforms.” In addition, the self-reported measures of technology might be “lacking.”
Dr. Przybylski hopes that the findings will “bring some greater context to the screen time debate; however, further work is still needed in this important area.”
He urged platform providers “to share their detailed data on user behavior with social scientists working in this field for transparent and independent scientific enquiry, to enable a more comprehensive understanding of internet technologies in our daily lives.”
A Starting Point
In a separate news release, Kevin McConway, PhD, MBA, emeritus professor of applied statistics, The Open University, Milton Keynes, England, noted that there has been “endless debate and considerable speculation on the possible effects of internet use on well-being, in general across all ages, but more specifically in relation to children and young people.”
The current study “certainly extends the available information beyond simple speculation and beyond previous studies that used participants mostly in relatively rich Northern countries,” noted Dr. McConway, who was not involved in the study.
However, he cautioned, the study is only “a starting point, and if nothing else, it casts very serious doubt on the view, held by some people, that the internet is bad for us all.”
In particular, the observational nature of the study meant that the positive associations between internet use and measure of well-being could have been caused by other factors and are not causative.
“It’s important to understand that none of the well-being measures used in this research has been properly validated by experts in psychological measurement,” said Dr. McConway.
No source of study funding was listed. Dr. Przybylski’s research is supported by the Huo Family Foundation and the Economic and Social Research Council. In the preceding 5 years, Dr. Przybylski has worked on research grants provided by the John Fell Fund, The Diana Award, and the children’s charity Barnardo’s. These research grants were paid to Dr. Przybylski’s employer, the Oxford Internet Institute. During this period, Dr. Przybylski has engaged unpaid consultations with several organizations including UNICEF, the Organization for Economic Co-operation and Development, Meta Inc., UKIE, UK Research and Innovation, The UK’s DCMS, The Office of the UK’s Chief Medical Officer, the Office of the US Surgeon General, The UK’s Academy of Medical Sciences, and the UK Parliament. There were no financial products or benefits resulting from these consultations. Dr. Vuorre reported no relevant financial relationships. Neither author reported any conflicts of interest. Dr. McConway is a trustee of the Science Media Center. However, his remarks are in the capacity of an independent professional statistician.
A version of this article appeared on Medscape.com.
Contrary to previous research that suggests internet use can have a deleterious effect on mental health, a new study of more than 2 million individuals suggested it can actually enhance well-being.
Between 2006 and 2021, investigators studied more than 2 million people between the ages of 15 and 99 years in 168 countries, focusing on their psychological well-being and their use of the internet. Many of the included countries have rarely or never been studied in this connection.
“We were surprised to find a positive correlation between well-being and internet use across the majority of the thousands of models we used for our analysis,” lead author Matti Vuorre, PhD, of Tilburg University, Tilburg, the Netherlands, and a research associate at Oxford Internet Institute in England, said in a news release.
The study was published online on May 13 in Technology, Mind, and Behavior.
A Global Phenomenon
Coauthor Andrew K. Przybylski, PhD, professor of human behavior and technology at Oxford Internet Institute, explained the motive for conducting the study.
“Whilst internet technologies and their platforms and their potential psychological consequences remain debated, research to date has been inconclusive and of limited geographic and demographic scope,” he said.
He noted that the “overwhelming majority” of studies have focused on the Global North and on younger people and “ignoring the fact that the penetration of the internet has been, and continues to be, a global phenomenon.”
The researchers set out to address this gap by analyzing “how internet access, mobility internet access, and active internet use might predict psychological well-being on a global level across the life stages,” Dr. Przybylski continued. “To our knowledge, no other research has directly grappled with these issues and addressed the worldwide scope of the debate.”
To study internet use, the investigators analyzed data from the 2022 Gallup World Poll, a nationally representative survey of each country’s civilian, non-institutionalized adult population (ie, aged ≥ 15 years), conducted between 2002 and 2022. The poll assessed well-being using face-to-face, as well as phone interviews, conducted by local interviewers in the respondents’ native languages.
The total sample size included 2,414,295 adults drawn from 186 countries (53.1% women), drawn from countries that included those located in Latin America, Asia, and Africa.
The researchers examined eight indicators of well-being: life satisfaction, daily negative and positive experiences, two indices of social well-being, physical well-being, community well-being, and experiences of purpose.
Covariates included respondents’ income, education, work, relationship status, the ability to meet basic needs (food and shelter), and whether they reported having health problems.
Greater Life Satisfaction
The researchers conducted a “multiverse” of 33,792 types of analyses, researching the average differences in well-being between individuals who had access to mobile internet or had used the internet in the past 7 days.
They found that for the average country, those who had access to the internet reported approximately 0.08 units greater life satisfaction, positive experiences, and social life satisfaction and 0.06 units lower negative experience than those without access.
They also reported approximately 0.08 units greater experiences of purpose and 0.1 unit greater physical, 0.02 units greater community, and 0.08 units greater social well-being than individuals without access.
Being an active internet user was associated with a 0.03- to 0.08-unit increase in life satisfaction, positive experiences, social well-being, and physical well-being and a 0.04-unit decrease in negative experiences. Access to a smartphone predicted increases of 0.06 and 0.07 units.
Although the standard deviations (SDs) of well-being outcomes were small (eg, the median life satisfaction difference was 0.36 SDs between individuals who did and did not have access to the internet), they were “not negligible.”
In fact, when the researchers examined the associations’ robustness across all analyses, they found that 84.9% resulted in positive and statistically significant associations between internet connectivity and well-being.
Of the 4.9% of associations between internet use and community well-being that were negative, most were observed among young women between the ages of 15 and 24 years.
While the researchers did not identify this as a causal relationship, they noted that this finding is consistent with previous reports of increased cyberbullying and negative associations between social media use and depressive symptoms in young women.
“Overall, we found that average associations were consistent across internet adoption predictors and well-being outcomes, with those who had access to or actively used the internet reporting meaningfully greater well-being than those who did not,” Dr. Przybylski said.
The study’s limitations included comparing individuals with each other, given that there “are likely myriad other feature of the human condition that are associated with both uptake of internet technologies and well-being in such a manner that they might case spurious associations or mask true associations,” the authors noted.
Moreover, longitudinal studies tracking participants over time can provide more information about the “contexts of how and why an individual might be affected by internet technologies and platforms.” In addition, the self-reported measures of technology might be “lacking.”
Dr. Przybylski hopes that the findings will “bring some greater context to the screen time debate; however, further work is still needed in this important area.”
He urged platform providers “to share their detailed data on user behavior with social scientists working in this field for transparent and independent scientific enquiry, to enable a more comprehensive understanding of internet technologies in our daily lives.”
A Starting Point
In a separate news release, Kevin McConway, PhD, MBA, emeritus professor of applied statistics, The Open University, Milton Keynes, England, noted that there has been “endless debate and considerable speculation on the possible effects of internet use on well-being, in general across all ages, but more specifically in relation to children and young people.”
The current study “certainly extends the available information beyond simple speculation and beyond previous studies that used participants mostly in relatively rich Northern countries,” noted Dr. McConway, who was not involved in the study.
However, he cautioned, the study is only “a starting point, and if nothing else, it casts very serious doubt on the view, held by some people, that the internet is bad for us all.”
In particular, the observational nature of the study meant that the positive associations between internet use and measure of well-being could have been caused by other factors and are not causative.
“It’s important to understand that none of the well-being measures used in this research has been properly validated by experts in psychological measurement,” said Dr. McConway.
No source of study funding was listed. Dr. Przybylski’s research is supported by the Huo Family Foundation and the Economic and Social Research Council. In the preceding 5 years, Dr. Przybylski has worked on research grants provided by the John Fell Fund, The Diana Award, and the children’s charity Barnardo’s. These research grants were paid to Dr. Przybylski’s employer, the Oxford Internet Institute. During this period, Dr. Przybylski has engaged unpaid consultations with several organizations including UNICEF, the Organization for Economic Co-operation and Development, Meta Inc., UKIE, UK Research and Innovation, The UK’s DCMS, The Office of the UK’s Chief Medical Officer, the Office of the US Surgeon General, The UK’s Academy of Medical Sciences, and the UK Parliament. There were no financial products or benefits resulting from these consultations. Dr. Vuorre reported no relevant financial relationships. Neither author reported any conflicts of interest. Dr. McConway is a trustee of the Science Media Center. However, his remarks are in the capacity of an independent professional statistician.
A version of this article appeared on Medscape.com.
Contrary to previous research that suggests internet use can have a deleterious effect on mental health, a new study of more than 2 million individuals suggested it can actually enhance well-being.
Between 2006 and 2021, investigators studied more than 2 million people between the ages of 15 and 99 years in 168 countries, focusing on their psychological well-being and their use of the internet. Many of the included countries have rarely or never been studied in this connection.
“We were surprised to find a positive correlation between well-being and internet use across the majority of the thousands of models we used for our analysis,” lead author Matti Vuorre, PhD, of Tilburg University, Tilburg, the Netherlands, and a research associate at Oxford Internet Institute in England, said in a news release.
The study was published online on May 13 in Technology, Mind, and Behavior.
A Global Phenomenon
Coauthor Andrew K. Przybylski, PhD, professor of human behavior and technology at Oxford Internet Institute, explained the motive for conducting the study.
“Whilst internet technologies and their platforms and their potential psychological consequences remain debated, research to date has been inconclusive and of limited geographic and demographic scope,” he said.
He noted that the “overwhelming majority” of studies have focused on the Global North and on younger people and “ignoring the fact that the penetration of the internet has been, and continues to be, a global phenomenon.”
The researchers set out to address this gap by analyzing “how internet access, mobility internet access, and active internet use might predict psychological well-being on a global level across the life stages,” Dr. Przybylski continued. “To our knowledge, no other research has directly grappled with these issues and addressed the worldwide scope of the debate.”
To study internet use, the investigators analyzed data from the 2022 Gallup World Poll, a nationally representative survey of each country’s civilian, non-institutionalized adult population (ie, aged ≥ 15 years), conducted between 2002 and 2022. The poll assessed well-being using face-to-face, as well as phone interviews, conducted by local interviewers in the respondents’ native languages.
The total sample size included 2,414,295 adults drawn from 186 countries (53.1% women), drawn from countries that included those located in Latin America, Asia, and Africa.
The researchers examined eight indicators of well-being: life satisfaction, daily negative and positive experiences, two indices of social well-being, physical well-being, community well-being, and experiences of purpose.
Covariates included respondents’ income, education, work, relationship status, the ability to meet basic needs (food and shelter), and whether they reported having health problems.
Greater Life Satisfaction
The researchers conducted a “multiverse” of 33,792 types of analyses, researching the average differences in well-being between individuals who had access to mobile internet or had used the internet in the past 7 days.
They found that for the average country, those who had access to the internet reported approximately 0.08 units greater life satisfaction, positive experiences, and social life satisfaction and 0.06 units lower negative experience than those without access.
They also reported approximately 0.08 units greater experiences of purpose and 0.1 unit greater physical, 0.02 units greater community, and 0.08 units greater social well-being than individuals without access.
Being an active internet user was associated with a 0.03- to 0.08-unit increase in life satisfaction, positive experiences, social well-being, and physical well-being and a 0.04-unit decrease in negative experiences. Access to a smartphone predicted increases of 0.06 and 0.07 units.
Although the standard deviations (SDs) of well-being outcomes were small (eg, the median life satisfaction difference was 0.36 SDs between individuals who did and did not have access to the internet), they were “not negligible.”
In fact, when the researchers examined the associations’ robustness across all analyses, they found that 84.9% resulted in positive and statistically significant associations between internet connectivity and well-being.
Of the 4.9% of associations between internet use and community well-being that were negative, most were observed among young women between the ages of 15 and 24 years.
While the researchers did not identify this as a causal relationship, they noted that this finding is consistent with previous reports of increased cyberbullying and negative associations between social media use and depressive symptoms in young women.
“Overall, we found that average associations were consistent across internet adoption predictors and well-being outcomes, with those who had access to or actively used the internet reporting meaningfully greater well-being than those who did not,” Dr. Przybylski said.
The study’s limitations included comparing individuals with each other, given that there “are likely myriad other feature of the human condition that are associated with both uptake of internet technologies and well-being in such a manner that they might case spurious associations or mask true associations,” the authors noted.
Moreover, longitudinal studies tracking participants over time can provide more information about the “contexts of how and why an individual might be affected by internet technologies and platforms.” In addition, the self-reported measures of technology might be “lacking.”
Dr. Przybylski hopes that the findings will “bring some greater context to the screen time debate; however, further work is still needed in this important area.”
He urged platform providers “to share their detailed data on user behavior with social scientists working in this field for transparent and independent scientific enquiry, to enable a more comprehensive understanding of internet technologies in our daily lives.”
A Starting Point
In a separate news release, Kevin McConway, PhD, MBA, emeritus professor of applied statistics, The Open University, Milton Keynes, England, noted that there has been “endless debate and considerable speculation on the possible effects of internet use on well-being, in general across all ages, but more specifically in relation to children and young people.”
The current study “certainly extends the available information beyond simple speculation and beyond previous studies that used participants mostly in relatively rich Northern countries,” noted Dr. McConway, who was not involved in the study.
However, he cautioned, the study is only “a starting point, and if nothing else, it casts very serious doubt on the view, held by some people, that the internet is bad for us all.”
In particular, the observational nature of the study meant that the positive associations between internet use and measure of well-being could have been caused by other factors and are not causative.
“It’s important to understand that none of the well-being measures used in this research has been properly validated by experts in psychological measurement,” said Dr. McConway.
No source of study funding was listed. Dr. Przybylski’s research is supported by the Huo Family Foundation and the Economic and Social Research Council. In the preceding 5 years, Dr. Przybylski has worked on research grants provided by the John Fell Fund, The Diana Award, and the children’s charity Barnardo’s. These research grants were paid to Dr. Przybylski’s employer, the Oxford Internet Institute. During this period, Dr. Przybylski has engaged unpaid consultations with several organizations including UNICEF, the Organization for Economic Co-operation and Development, Meta Inc., UKIE, UK Research and Innovation, The UK’s DCMS, The Office of the UK’s Chief Medical Officer, the Office of the US Surgeon General, The UK’s Academy of Medical Sciences, and the UK Parliament. There were no financial products or benefits resulting from these consultations. Dr. Vuorre reported no relevant financial relationships. Neither author reported any conflicts of interest. Dr. McConway is a trustee of the Science Media Center. However, his remarks are in the capacity of an independent professional statistician.
A version of this article appeared on Medscape.com.
Mental Health Worsens in Trans, Gender-Nonconforming Adults
TOPLINE:
Mental health distress increased disproportionately among transgender and gender-nonconforming US adults between 2014 and 2021 compared with their cisgender counterparts, a new study suggested. Investigators said the findings among an historically marginalized segment of society point to a need to address a growing inequality in mental health.
METHODOLOGY:
- Investigators drew on 2014-2021 US Behavioral Risk Factor Surveillance System (BRFSS) survey data, using logistic and ordinary least squares regression to document temporal trends in the transgender-cisgender disparity in self-reports of the number of poor mental health days in the past month and frequent mental distress.
- They included 43 states that implemented the optional sexual orientation and gender identity module in the BRFSS.
- Outcomes included the number of poor mental health days in the past month, as well as frequent mental distress (≥ 14 poor mental health days in the past month).
TAKEAWAY:
- Even in 2014, there was a discrepancy between cisgender and transgender and gender-nonconforming individuals in the reported mean of poor mental health days (3.68 vs 5.42).
- The size of this disparity, adjusted by differences in observable characteristics, increased by 2.75 days (95% CI, 0.58-4.91) over the study period.
- The inequality in mental health status between cisgender and transgender and nonconforming adults grew from 11.4% vs 18.9% in 2014, respectively, to 14.6% vs 32.9% in 2021, respectively.
IN PRACTICE:
“Our findings demonstrate sizable and worsening inequities in mental health across gender identity,” the authors wrote. “Mental health and primary care providers must be prepared to address the unique psychosocial needs of gender minority adults. Furthermore, our findings highlight the need for action to reduce these disparities.”
SOURCE:
Samuel Mann, PhD, of the RAND Corporation, was the corresponding author of the study. It was published online on April 10 in the American Journal of Public Health.
LIMITATIONS:
Measures of mental health were derived from self-reports. In addition, data from seven states were missing because these states did not include sexual orientation and gender identity in the BRFSS. And the BRFSS does not survey people who are unhoused, incarcerated, or in group living quarters.
DISCLOSURES:
No source of study funding was listed. The authors disclosed no relevant financial relationships.
A version of this article appeared on Medscape.com.
TOPLINE:
Mental health distress increased disproportionately among transgender and gender-nonconforming US adults between 2014 and 2021 compared with their cisgender counterparts, a new study suggested. Investigators said the findings among an historically marginalized segment of society point to a need to address a growing inequality in mental health.
METHODOLOGY:
- Investigators drew on 2014-2021 US Behavioral Risk Factor Surveillance System (BRFSS) survey data, using logistic and ordinary least squares regression to document temporal trends in the transgender-cisgender disparity in self-reports of the number of poor mental health days in the past month and frequent mental distress.
- They included 43 states that implemented the optional sexual orientation and gender identity module in the BRFSS.
- Outcomes included the number of poor mental health days in the past month, as well as frequent mental distress (≥ 14 poor mental health days in the past month).
TAKEAWAY:
- Even in 2014, there was a discrepancy between cisgender and transgender and gender-nonconforming individuals in the reported mean of poor mental health days (3.68 vs 5.42).
- The size of this disparity, adjusted by differences in observable characteristics, increased by 2.75 days (95% CI, 0.58-4.91) over the study period.
- The inequality in mental health status between cisgender and transgender and nonconforming adults grew from 11.4% vs 18.9% in 2014, respectively, to 14.6% vs 32.9% in 2021, respectively.
IN PRACTICE:
“Our findings demonstrate sizable and worsening inequities in mental health across gender identity,” the authors wrote. “Mental health and primary care providers must be prepared to address the unique psychosocial needs of gender minority adults. Furthermore, our findings highlight the need for action to reduce these disparities.”
SOURCE:
Samuel Mann, PhD, of the RAND Corporation, was the corresponding author of the study. It was published online on April 10 in the American Journal of Public Health.
LIMITATIONS:
Measures of mental health were derived from self-reports. In addition, data from seven states were missing because these states did not include sexual orientation and gender identity in the BRFSS. And the BRFSS does not survey people who are unhoused, incarcerated, or in group living quarters.
DISCLOSURES:
No source of study funding was listed. The authors disclosed no relevant financial relationships.
A version of this article appeared on Medscape.com.
TOPLINE:
Mental health distress increased disproportionately among transgender and gender-nonconforming US adults between 2014 and 2021 compared with their cisgender counterparts, a new study suggested. Investigators said the findings among an historically marginalized segment of society point to a need to address a growing inequality in mental health.
METHODOLOGY:
- Investigators drew on 2014-2021 US Behavioral Risk Factor Surveillance System (BRFSS) survey data, using logistic and ordinary least squares regression to document temporal trends in the transgender-cisgender disparity in self-reports of the number of poor mental health days in the past month and frequent mental distress.
- They included 43 states that implemented the optional sexual orientation and gender identity module in the BRFSS.
- Outcomes included the number of poor mental health days in the past month, as well as frequent mental distress (≥ 14 poor mental health days in the past month).
TAKEAWAY:
- Even in 2014, there was a discrepancy between cisgender and transgender and gender-nonconforming individuals in the reported mean of poor mental health days (3.68 vs 5.42).
- The size of this disparity, adjusted by differences in observable characteristics, increased by 2.75 days (95% CI, 0.58-4.91) over the study period.
- The inequality in mental health status between cisgender and transgender and nonconforming adults grew from 11.4% vs 18.9% in 2014, respectively, to 14.6% vs 32.9% in 2021, respectively.
IN PRACTICE:
“Our findings demonstrate sizable and worsening inequities in mental health across gender identity,” the authors wrote. “Mental health and primary care providers must be prepared to address the unique psychosocial needs of gender minority adults. Furthermore, our findings highlight the need for action to reduce these disparities.”
SOURCE:
Samuel Mann, PhD, of the RAND Corporation, was the corresponding author of the study. It was published online on April 10 in the American Journal of Public Health.
LIMITATIONS:
Measures of mental health were derived from self-reports. In addition, data from seven states were missing because these states did not include sexual orientation and gender identity in the BRFSS. And the BRFSS does not survey people who are unhoused, incarcerated, or in group living quarters.
DISCLOSURES:
No source of study funding was listed. The authors disclosed no relevant financial relationships.
A version of this article appeared on Medscape.com.
The DEA Plans to Reschedule Marijuana: What Happens Next?
The US Drug Enforcement Agency (DEA) is moving forward with plans to move marijuana from a Schedule I to a Schedule III controlled substance under the Controlled Substance Act (CSA), the US Department of Justice officials announced this week.
First reported by the Associated Press and since confirmed by this news organization through a US Department of Justice spokesperson, the news made international headlines. Despite the media splash, the final rule is still months away.
How did we get here? What happens next? What impact might rescheduling have on clinicians, patients, researchers, and the medical cannabis industry?
Why Reschedule? Why Now?
The DEA’s decision is based on a 2023 determination from the US Food and Drug Administration (FDA) that marijuana has a legitimate medical use and should be moved to Schedule III.
This class includes ketamine, acetaminophen with codeine, and buprenorphine.
Even though the manufacturing, distribution, sale, and use of marijuana has long violated federal law, 38 states and Washington, DC, have legalized medical cannabis, and 24 states and DC have legalized its recreational use.
Congress has allowed states leeway for the distribution and use of medical marijuana, and current and previous presidential administrations have chosen not to aggressively pursue prosecution of state-allowed marijuana use, the Congressional Research Service (CRS) reports.
Pressure to address the conflict between federal and state laws and an increasing interest in drug development of cannabis and cannabis-derived products probably contributed to the DEA’s decision, said Stephen Strakowski, MD, professor, and vice chair of psychiatry at Indiana University in Indianapolis, and professor and associate vice president at University of Texas in Austin.
“The trend toward legalization is everywhere and even though nationally the feds in this instance are lagging the states, the pressure to legalize has been intense for 50 years and it’s not surprising that the DEA is finally following that lead,” Dr. Strakowski told this news organization.
How Does Rescheduling Work? What’s the Timeline?
The DEA will submit a formal rule proposing that marijuana be moved from Schedule I to Schedule III to the White House Office of Management and Budget. The timing of the submission is unclear.
Once the proposed rule is posted to the Federal Register, there will be a public comment period, which usually lasts 30-60 days.
“This will likely generate a lot of public comment,” Robert Mikos, JD, LaRoche Family Chair in Law at Vanderbilt University Law School in Nashville, Tennessee, told this news organization. “Then the agency has to go back and wade through those comments and decide if they want to proceed with the rule as proposed or modify it.”
A final rule will probably be posted before the end of the current presidential term in January, Mr. Mikos said. While a lawsuit blocking its implementation is possible, there is a “low chance that a court would block this,” he added.
How Will Rescheduling Affect Medical Marijuana?
For medical marijuana, changing the drug to a Schedule III means that it can legally be prescribed but only in states that have legalized medical cannabis, Mr. Mikos said.
“If you’re a patient in a state with a medical marijuana law and your physician gives you a prescription for medical marijuana and you possess it, you will no longer be guilty of a federal crime,” he said.
Rescheduling could also benefit patients who receive care through the Veterans Administration (VA), Mr. Mikos said. For several years, the VA has had a policy that blocked clinicians from prescribing medical marijuana because as a Schedule I drug, it was determined to have no accepted medical use.
“It’s possible the VA may drop that policy once the drug gets rescheduled. If you’re in a medical marijuana state, if you’re a VA patient, and you don’t want to spend the extra money to go outside that system, this will have meaningful impact on their lives,” Mr. Mikos said.
But what about patients living in states that have not legalized medical cannabis?
“You still wouldn’t be committing a federal crime, but you could be violating state law,” Mr. Mikos said. “That’s a much more salient consideration because if you look at who goes after individuals who possess small amounts of drugs, the state handles 99% of those cases.”
The manufacture, distribution, and possession of recreational marijuana would remain illegal under federal law.
What Does It Mean for Medical Marijuana Dispensaries?
Though rescheduling makes it legal for clinicians to prescribe medical marijuana and for patients to use it, the actual sale of the drug will remain illegal under federal law because rescheduling only changes prescribing under the CSA, Mr. Mikos said.
“If you’re a dispensary and you sell it, even if it’s to somebody who’s got a prescription, you’re still probably violating the Food, Drug and Cosmetics Act. Rescheduling doesn’t change that,” he said.
“Even assuming the DEA follows through with this and it doesn’t come undone at some future date, the industry is still going struggle to comply with the Controlled Substances Act post rescheduling because that statute is going to continue to impose a number of regulations on the industry,” Mr. Mikos added.
However, rescheduling would change the tax status of the estimated 12,000-15,000 state-licensed cannabis dispensaries in the United States, allowing access to certain tax deductions that are unavailable to sales involving Schedule I controlled substances, James Daily, JD, MS, with Center for Empirical Research in the Law at Washington University School of Law in St. Louis, told this news organization.
“Many cannabis businesses do in fact pay federal taxes, but the inability to take any federal tax credits or deductions means that their effective tax rate is much higher than it would otherwise be,” Mr. Daily said.
Although new federal tax deductions would likely available to cannabis businesses if marijuana were rescheduled to Schedule III, “their business would still be in violation of federal law,” he said.
“This creates a further tension between state and federal law, which could be resolved by further legalization or it could be resolved by extending the prohibition on tax deductions to include cannabis and not just Schedule I and II drugs,” he added.
Will Rescheduling Make It Easier to Conduct Cannabis-Related Research?
Research on medical cannabis has been stymied by FDA and DEA regulations regarding the study of Schedule I controlled substances. Although rescheduling could lift that barrier, other challenges would remain.
“Schedule III drugs can be more easily researched, but it’s unclear if, for example, a clinical trial could lawfully obtain the cannabis from a dispensary or if they would still have to go through the one legal federal supplier of cannabis,” Daily said.
The FDA reports having received more than 800 investigational new drug applications for and pre-investigational new drug applications related to cannabis and cannabis-derived products since the 1970s, the agency reports. To date, the FDA has not approved any marketing drug applications for cannabis for the treatment of any disease or condition.
In January 2023, the agency published updated guidelines for researchers and sponsors interested in developing drugs containing cannabis or cannabis-derived compounds.
It’s unclear whether those guidelines would be updated if the rescheduling moves forward.
Does Rescheduling Marijuana Pose Any Risk?
In its report to the DEA that marijuana be rescheduled, the FDA was careful to note that the agency’s recommendation is “not meant to imply that safety and effectiveness have been established for marijuana that would support FDA approval of a marijuana drug product for a particular indication.”
That’s a notation that clinicians and patients should take to heart, Dr. Strakowski said.
“It’s important to remind people that Schedule III drugs, by definition, have addiction and other side effect risks,” he said. “The celebrity marketing that sits behind a lot of this is incompletely informed. It’s portrayed as fun and harmless in almost every movie and conversation you see, and we know that’s not true.”
Previous studies have linked cannabis to increased risk for mania, anxiety disorders, and schizophrenia.
“It is increasingly clear that marijuana use is linked to poor outcomes in people who struggle with mental illness,” Dr. Strakowski said. “We have no evidence that it can help you but there is evidence that it can harm you.”
Dr. Strakowski likens cannabis use to alcohol, which is a known depressant that is associated with worse outcomes in people with mental illness.
“I think with cannabis, we don’t know enough about it yet, but we do know that it does have some anxiety risks,” he said. “The risks in people with mental illness are simply different than in people who don’t have mental illness.”
Dr. Strakowski, Mr. Mikos, and Mr. Daily report no relevant disclosures.
A version of this article appeared on Medscape.com.
The US Drug Enforcement Agency (DEA) is moving forward with plans to move marijuana from a Schedule I to a Schedule III controlled substance under the Controlled Substance Act (CSA), the US Department of Justice officials announced this week.
First reported by the Associated Press and since confirmed by this news organization through a US Department of Justice spokesperson, the news made international headlines. Despite the media splash, the final rule is still months away.
How did we get here? What happens next? What impact might rescheduling have on clinicians, patients, researchers, and the medical cannabis industry?
Why Reschedule? Why Now?
The DEA’s decision is based on a 2023 determination from the US Food and Drug Administration (FDA) that marijuana has a legitimate medical use and should be moved to Schedule III.
This class includes ketamine, acetaminophen with codeine, and buprenorphine.
Even though the manufacturing, distribution, sale, and use of marijuana has long violated federal law, 38 states and Washington, DC, have legalized medical cannabis, and 24 states and DC have legalized its recreational use.
Congress has allowed states leeway for the distribution and use of medical marijuana, and current and previous presidential administrations have chosen not to aggressively pursue prosecution of state-allowed marijuana use, the Congressional Research Service (CRS) reports.
Pressure to address the conflict between federal and state laws and an increasing interest in drug development of cannabis and cannabis-derived products probably contributed to the DEA’s decision, said Stephen Strakowski, MD, professor, and vice chair of psychiatry at Indiana University in Indianapolis, and professor and associate vice president at University of Texas in Austin.
“The trend toward legalization is everywhere and even though nationally the feds in this instance are lagging the states, the pressure to legalize has been intense for 50 years and it’s not surprising that the DEA is finally following that lead,” Dr. Strakowski told this news organization.
How Does Rescheduling Work? What’s the Timeline?
The DEA will submit a formal rule proposing that marijuana be moved from Schedule I to Schedule III to the White House Office of Management and Budget. The timing of the submission is unclear.
Once the proposed rule is posted to the Federal Register, there will be a public comment period, which usually lasts 30-60 days.
“This will likely generate a lot of public comment,” Robert Mikos, JD, LaRoche Family Chair in Law at Vanderbilt University Law School in Nashville, Tennessee, told this news organization. “Then the agency has to go back and wade through those comments and decide if they want to proceed with the rule as proposed or modify it.”
A final rule will probably be posted before the end of the current presidential term in January, Mr. Mikos said. While a lawsuit blocking its implementation is possible, there is a “low chance that a court would block this,” he added.
How Will Rescheduling Affect Medical Marijuana?
For medical marijuana, changing the drug to a Schedule III means that it can legally be prescribed but only in states that have legalized medical cannabis, Mr. Mikos said.
“If you’re a patient in a state with a medical marijuana law and your physician gives you a prescription for medical marijuana and you possess it, you will no longer be guilty of a federal crime,” he said.
Rescheduling could also benefit patients who receive care through the Veterans Administration (VA), Mr. Mikos said. For several years, the VA has had a policy that blocked clinicians from prescribing medical marijuana because as a Schedule I drug, it was determined to have no accepted medical use.
“It’s possible the VA may drop that policy once the drug gets rescheduled. If you’re in a medical marijuana state, if you’re a VA patient, and you don’t want to spend the extra money to go outside that system, this will have meaningful impact on their lives,” Mr. Mikos said.
But what about patients living in states that have not legalized medical cannabis?
“You still wouldn’t be committing a federal crime, but you could be violating state law,” Mr. Mikos said. “That’s a much more salient consideration because if you look at who goes after individuals who possess small amounts of drugs, the state handles 99% of those cases.”
The manufacture, distribution, and possession of recreational marijuana would remain illegal under federal law.
What Does It Mean for Medical Marijuana Dispensaries?
Though rescheduling makes it legal for clinicians to prescribe medical marijuana and for patients to use it, the actual sale of the drug will remain illegal under federal law because rescheduling only changes prescribing under the CSA, Mr. Mikos said.
“If you’re a dispensary and you sell it, even if it’s to somebody who’s got a prescription, you’re still probably violating the Food, Drug and Cosmetics Act. Rescheduling doesn’t change that,” he said.
“Even assuming the DEA follows through with this and it doesn’t come undone at some future date, the industry is still going struggle to comply with the Controlled Substances Act post rescheduling because that statute is going to continue to impose a number of regulations on the industry,” Mr. Mikos added.
However, rescheduling would change the tax status of the estimated 12,000-15,000 state-licensed cannabis dispensaries in the United States, allowing access to certain tax deductions that are unavailable to sales involving Schedule I controlled substances, James Daily, JD, MS, with Center for Empirical Research in the Law at Washington University School of Law in St. Louis, told this news organization.
“Many cannabis businesses do in fact pay federal taxes, but the inability to take any federal tax credits or deductions means that their effective tax rate is much higher than it would otherwise be,” Mr. Daily said.
Although new federal tax deductions would likely available to cannabis businesses if marijuana were rescheduled to Schedule III, “their business would still be in violation of federal law,” he said.
“This creates a further tension between state and federal law, which could be resolved by further legalization or it could be resolved by extending the prohibition on tax deductions to include cannabis and not just Schedule I and II drugs,” he added.
Will Rescheduling Make It Easier to Conduct Cannabis-Related Research?
Research on medical cannabis has been stymied by FDA and DEA regulations regarding the study of Schedule I controlled substances. Although rescheduling could lift that barrier, other challenges would remain.
“Schedule III drugs can be more easily researched, but it’s unclear if, for example, a clinical trial could lawfully obtain the cannabis from a dispensary or if they would still have to go through the one legal federal supplier of cannabis,” Daily said.
The FDA reports having received more than 800 investigational new drug applications for and pre-investigational new drug applications related to cannabis and cannabis-derived products since the 1970s, the agency reports. To date, the FDA has not approved any marketing drug applications for cannabis for the treatment of any disease or condition.
In January 2023, the agency published updated guidelines for researchers and sponsors interested in developing drugs containing cannabis or cannabis-derived compounds.
It’s unclear whether those guidelines would be updated if the rescheduling moves forward.
Does Rescheduling Marijuana Pose Any Risk?
In its report to the DEA that marijuana be rescheduled, the FDA was careful to note that the agency’s recommendation is “not meant to imply that safety and effectiveness have been established for marijuana that would support FDA approval of a marijuana drug product for a particular indication.”
That’s a notation that clinicians and patients should take to heart, Dr. Strakowski said.
“It’s important to remind people that Schedule III drugs, by definition, have addiction and other side effect risks,” he said. “The celebrity marketing that sits behind a lot of this is incompletely informed. It’s portrayed as fun and harmless in almost every movie and conversation you see, and we know that’s not true.”
Previous studies have linked cannabis to increased risk for mania, anxiety disorders, and schizophrenia.
“It is increasingly clear that marijuana use is linked to poor outcomes in people who struggle with mental illness,” Dr. Strakowski said. “We have no evidence that it can help you but there is evidence that it can harm you.”
Dr. Strakowski likens cannabis use to alcohol, which is a known depressant that is associated with worse outcomes in people with mental illness.
“I think with cannabis, we don’t know enough about it yet, but we do know that it does have some anxiety risks,” he said. “The risks in people with mental illness are simply different than in people who don’t have mental illness.”
Dr. Strakowski, Mr. Mikos, and Mr. Daily report no relevant disclosures.
A version of this article appeared on Medscape.com.
The US Drug Enforcement Agency (DEA) is moving forward with plans to move marijuana from a Schedule I to a Schedule III controlled substance under the Controlled Substance Act (CSA), the US Department of Justice officials announced this week.
First reported by the Associated Press and since confirmed by this news organization through a US Department of Justice spokesperson, the news made international headlines. Despite the media splash, the final rule is still months away.
How did we get here? What happens next? What impact might rescheduling have on clinicians, patients, researchers, and the medical cannabis industry?
Why Reschedule? Why Now?
The DEA’s decision is based on a 2023 determination from the US Food and Drug Administration (FDA) that marijuana has a legitimate medical use and should be moved to Schedule III.
This class includes ketamine, acetaminophen with codeine, and buprenorphine.
Even though the manufacturing, distribution, sale, and use of marijuana has long violated federal law, 38 states and Washington, DC, have legalized medical cannabis, and 24 states and DC have legalized its recreational use.
Congress has allowed states leeway for the distribution and use of medical marijuana, and current and previous presidential administrations have chosen not to aggressively pursue prosecution of state-allowed marijuana use, the Congressional Research Service (CRS) reports.
Pressure to address the conflict between federal and state laws and an increasing interest in drug development of cannabis and cannabis-derived products probably contributed to the DEA’s decision, said Stephen Strakowski, MD, professor, and vice chair of psychiatry at Indiana University in Indianapolis, and professor and associate vice president at University of Texas in Austin.
“The trend toward legalization is everywhere and even though nationally the feds in this instance are lagging the states, the pressure to legalize has been intense for 50 years and it’s not surprising that the DEA is finally following that lead,” Dr. Strakowski told this news organization.
How Does Rescheduling Work? What’s the Timeline?
The DEA will submit a formal rule proposing that marijuana be moved from Schedule I to Schedule III to the White House Office of Management and Budget. The timing of the submission is unclear.
Once the proposed rule is posted to the Federal Register, there will be a public comment period, which usually lasts 30-60 days.
“This will likely generate a lot of public comment,” Robert Mikos, JD, LaRoche Family Chair in Law at Vanderbilt University Law School in Nashville, Tennessee, told this news organization. “Then the agency has to go back and wade through those comments and decide if they want to proceed with the rule as proposed or modify it.”
A final rule will probably be posted before the end of the current presidential term in January, Mr. Mikos said. While a lawsuit blocking its implementation is possible, there is a “low chance that a court would block this,” he added.
How Will Rescheduling Affect Medical Marijuana?
For medical marijuana, changing the drug to a Schedule III means that it can legally be prescribed but only in states that have legalized medical cannabis, Mr. Mikos said.
“If you’re a patient in a state with a medical marijuana law and your physician gives you a prescription for medical marijuana and you possess it, you will no longer be guilty of a federal crime,” he said.
Rescheduling could also benefit patients who receive care through the Veterans Administration (VA), Mr. Mikos said. For several years, the VA has had a policy that blocked clinicians from prescribing medical marijuana because as a Schedule I drug, it was determined to have no accepted medical use.
“It’s possible the VA may drop that policy once the drug gets rescheduled. If you’re in a medical marijuana state, if you’re a VA patient, and you don’t want to spend the extra money to go outside that system, this will have meaningful impact on their lives,” Mr. Mikos said.
But what about patients living in states that have not legalized medical cannabis?
“You still wouldn’t be committing a federal crime, but you could be violating state law,” Mr. Mikos said. “That’s a much more salient consideration because if you look at who goes after individuals who possess small amounts of drugs, the state handles 99% of those cases.”
The manufacture, distribution, and possession of recreational marijuana would remain illegal under federal law.
What Does It Mean for Medical Marijuana Dispensaries?
Though rescheduling makes it legal for clinicians to prescribe medical marijuana and for patients to use it, the actual sale of the drug will remain illegal under federal law because rescheduling only changes prescribing under the CSA, Mr. Mikos said.
“If you’re a dispensary and you sell it, even if it’s to somebody who’s got a prescription, you’re still probably violating the Food, Drug and Cosmetics Act. Rescheduling doesn’t change that,” he said.
“Even assuming the DEA follows through with this and it doesn’t come undone at some future date, the industry is still going struggle to comply with the Controlled Substances Act post rescheduling because that statute is going to continue to impose a number of regulations on the industry,” Mr. Mikos added.
However, rescheduling would change the tax status of the estimated 12,000-15,000 state-licensed cannabis dispensaries in the United States, allowing access to certain tax deductions that are unavailable to sales involving Schedule I controlled substances, James Daily, JD, MS, with Center for Empirical Research in the Law at Washington University School of Law in St. Louis, told this news organization.
“Many cannabis businesses do in fact pay federal taxes, but the inability to take any federal tax credits or deductions means that their effective tax rate is much higher than it would otherwise be,” Mr. Daily said.
Although new federal tax deductions would likely available to cannabis businesses if marijuana were rescheduled to Schedule III, “their business would still be in violation of federal law,” he said.
“This creates a further tension between state and federal law, which could be resolved by further legalization or it could be resolved by extending the prohibition on tax deductions to include cannabis and not just Schedule I and II drugs,” he added.
Will Rescheduling Make It Easier to Conduct Cannabis-Related Research?
Research on medical cannabis has been stymied by FDA and DEA regulations regarding the study of Schedule I controlled substances. Although rescheduling could lift that barrier, other challenges would remain.
“Schedule III drugs can be more easily researched, but it’s unclear if, for example, a clinical trial could lawfully obtain the cannabis from a dispensary or if they would still have to go through the one legal federal supplier of cannabis,” Daily said.
The FDA reports having received more than 800 investigational new drug applications for and pre-investigational new drug applications related to cannabis and cannabis-derived products since the 1970s, the agency reports. To date, the FDA has not approved any marketing drug applications for cannabis for the treatment of any disease or condition.
In January 2023, the agency published updated guidelines for researchers and sponsors interested in developing drugs containing cannabis or cannabis-derived compounds.
It’s unclear whether those guidelines would be updated if the rescheduling moves forward.
Does Rescheduling Marijuana Pose Any Risk?
In its report to the DEA that marijuana be rescheduled, the FDA was careful to note that the agency’s recommendation is “not meant to imply that safety and effectiveness have been established for marijuana that would support FDA approval of a marijuana drug product for a particular indication.”
That’s a notation that clinicians and patients should take to heart, Dr. Strakowski said.
“It’s important to remind people that Schedule III drugs, by definition, have addiction and other side effect risks,” he said. “The celebrity marketing that sits behind a lot of this is incompletely informed. It’s portrayed as fun and harmless in almost every movie and conversation you see, and we know that’s not true.”
Previous studies have linked cannabis to increased risk for mania, anxiety disorders, and schizophrenia.
“It is increasingly clear that marijuana use is linked to poor outcomes in people who struggle with mental illness,” Dr. Strakowski said. “We have no evidence that it can help you but there is evidence that it can harm you.”
Dr. Strakowski likens cannabis use to alcohol, which is a known depressant that is associated with worse outcomes in people with mental illness.
“I think with cannabis, we don’t know enough about it yet, but we do know that it does have some anxiety risks,” he said. “The risks in people with mental illness are simply different than in people who don’t have mental illness.”
Dr. Strakowski, Mr. Mikos, and Mr. Daily report no relevant disclosures.
A version of this article appeared on Medscape.com.
Survey Finds Mental Health Issues Increased After Cosmetic Procedure Complications
BALTIMORE — of patients with dermatology-related complications.
The study used an anonymous 40-question survey circulated to a Facebook cosmetic complication support group. Seventy-one of 100 individuals completed the questionnaire, reporting significantly higher rates of mental health issues after their complications than before. Results were presented at the annual conference of the American Society for Laser Medicine and Surgery (ASLMS). Almost all the survey respondents (99%) were female, with 61% aged 25-44 years and 34% aged 45-64 years.
“Cosmetic procedures have increased over the past decade, with procedures being increasingly performed by an evolving variety of providers,” the study’s lead author, Taryn Murray, MD, a dermatologist at Cleveland Clinic, Cleveland, Ohio, told this news organization. “Appropriate patient assessment and counseling and proper procedure technique are important for obtaining safe and effective results. Complications may not only impact patients physically but can also be harmful to their mental health.”
Rise in Mental Health Issues
The study found that before respondents had the treatment that led to their complications, 16% reported a history of generalized anxiety disorder, 15% a history of depression, and 1% a history of either BDD or PTSD. Following the complication, 50% reported a positive depression screening, 63% a positive BDD Questionnaire – Dermatology Version, and 63% a positive Primary Care PTSD screen, Dr. Murray said. “Almost half of respondents (46%) reported thinking about their complication for more than 3 hours a day,” she said in presenting the results.
Dr. Murray said the idea for the study grew out of her experience as a fellow working with Paul Friedman, MD, at the Dermatology and Laser Surgery Center at University of Texas Health in Houston.
“We were seeing a lot of complications,” Dr. Murray said in an interview. “Some of these were local. Some of these patients were flying in from out-of-state looking for help with the complication, and we could see what a mental and emotional burden this put on these patients. They were routinely in the office in tears saying it was interfering with their daily life, it was interfering with their job, saying they were going to lose their job, all because they were so distressed over what was happening to them.”
Yet, the research into psychological distress in patients with dermatologic complications is minimal, Dr. Murray added. “We think that body dysmorphic disorder is prevalent for patients seeking dermatology or plastic surgery services, but I don’t think either of the specialties do a great job in screening people for that when they come for treatment, so I think a lot of it goes undiagnosed. There’s been a trend looking at more at complications lately, but there’s been a gap in the literature.”
The treatments the patients in the survey had were microneedling with radiofrequency (29%), laser (24%), ultrasound for skin tightening (11%), radiofrequency for skin tightening (11%), microneedling (4%), chemical peel (3%), body contouring/sculpting (1%), and “other” (17%).
The study found that the largest share of procedures, 47%, were done by an esthetician/laser technician, followed by a nondermatologist physician (17%), a board-certified dermatologist (14%), an advanced practice provider (12%), and “other” (10%).
Self-reported complications included scarring (38%), hyperpigmentation (26%), erythema (24%), burn (23%), blisters (11%), and hypopigmentation (3%); 71% characterized their complications as “other,” and one respondent reported multiple complications.
“Respondents said they were satisfied with the previous cosmetic care they received,” Dr. Murray said during her presentation at the meeting. “And there was a consensus among the respondents that they did not feel adequately counseled on the risks of the procedure and that it did not meet their expectations and anticipated outcome.”
Take-Home Lesson
The lesson here is that practitioners who perform cosmetic procedures should be well-versed in the task and potential complications, Dr. Murray said in the interview. “If you’re going to be doing a procedure, make sure you know the proper techniques, the proper endpoints, and how to treat if you’re to have a complication,” she said. “If you don’t know how to treat a complication from the device, then you should think twice about using it.”
She also suggested screening patients for potentially undiagnosed mental health disorders. “It can play a role in the initial consultation and potentially any after-care they might need if there is a complication,” she said. “We may not have the adequate tools at this time to know how to best handle these patients and these scenarios, but hopefully my abstract will shed a little more light on it.”
She said she hopes her findings lead to more research in the future.
Asked to comment on the study, Jennifer Lin, MD, assistant professor of dermatology at Brigham and Women’s Hospital and Dana Farber Cancer Institute in Boston, Massachusetts, said one finding of the study stood out to her. “ I was very surprised from her dataset that patients think about it more than 3 hours a day,” she told this news organization. “That’s really significant. We talk about the side effects, but we don’t necessarily talk about the burden of how long the recovery will be or the psychological burden of potentially dealing with it.”
She noted that “there’s a bit of movement” toward developing guidelines for laser treatments, which would address the risk of complications. “That’s the goal: To have better guidelines to avoid these complications in the first place,” Dr. Lin said.
The study findings also point to a need for “premonitoring” individuals before procedures, she added. “We talked about patient selection and make sure someone doesn’t have body dysmorphic disorder, but we don’t formally screen for it,” she said. “We don’t our train our residents to screen for it. And I think doing more pre- and post-testing of how people are affected by laser treatment is going to become more important.”
Dr. Murray disclosed relationships with R2 Technologies. Dr. Lin had no relationships to disclose.
A version of this article appeared on Medscape.com.
BALTIMORE — of patients with dermatology-related complications.
The study used an anonymous 40-question survey circulated to a Facebook cosmetic complication support group. Seventy-one of 100 individuals completed the questionnaire, reporting significantly higher rates of mental health issues after their complications than before. Results were presented at the annual conference of the American Society for Laser Medicine and Surgery (ASLMS). Almost all the survey respondents (99%) were female, with 61% aged 25-44 years and 34% aged 45-64 years.
“Cosmetic procedures have increased over the past decade, with procedures being increasingly performed by an evolving variety of providers,” the study’s lead author, Taryn Murray, MD, a dermatologist at Cleveland Clinic, Cleveland, Ohio, told this news organization. “Appropriate patient assessment and counseling and proper procedure technique are important for obtaining safe and effective results. Complications may not only impact patients physically but can also be harmful to their mental health.”
Rise in Mental Health Issues
The study found that before respondents had the treatment that led to their complications, 16% reported a history of generalized anxiety disorder, 15% a history of depression, and 1% a history of either BDD or PTSD. Following the complication, 50% reported a positive depression screening, 63% a positive BDD Questionnaire – Dermatology Version, and 63% a positive Primary Care PTSD screen, Dr. Murray said. “Almost half of respondents (46%) reported thinking about their complication for more than 3 hours a day,” she said in presenting the results.
Dr. Murray said the idea for the study grew out of her experience as a fellow working with Paul Friedman, MD, at the Dermatology and Laser Surgery Center at University of Texas Health in Houston.
“We were seeing a lot of complications,” Dr. Murray said in an interview. “Some of these were local. Some of these patients were flying in from out-of-state looking for help with the complication, and we could see what a mental and emotional burden this put on these patients. They were routinely in the office in tears saying it was interfering with their daily life, it was interfering with their job, saying they were going to lose their job, all because they were so distressed over what was happening to them.”
Yet, the research into psychological distress in patients with dermatologic complications is minimal, Dr. Murray added. “We think that body dysmorphic disorder is prevalent for patients seeking dermatology or plastic surgery services, but I don’t think either of the specialties do a great job in screening people for that when they come for treatment, so I think a lot of it goes undiagnosed. There’s been a trend looking at more at complications lately, but there’s been a gap in the literature.”
The treatments the patients in the survey had were microneedling with radiofrequency (29%), laser (24%), ultrasound for skin tightening (11%), radiofrequency for skin tightening (11%), microneedling (4%), chemical peel (3%), body contouring/sculpting (1%), and “other” (17%).
The study found that the largest share of procedures, 47%, were done by an esthetician/laser technician, followed by a nondermatologist physician (17%), a board-certified dermatologist (14%), an advanced practice provider (12%), and “other” (10%).
Self-reported complications included scarring (38%), hyperpigmentation (26%), erythema (24%), burn (23%), blisters (11%), and hypopigmentation (3%); 71% characterized their complications as “other,” and one respondent reported multiple complications.
“Respondents said they were satisfied with the previous cosmetic care they received,” Dr. Murray said during her presentation at the meeting. “And there was a consensus among the respondents that they did not feel adequately counseled on the risks of the procedure and that it did not meet their expectations and anticipated outcome.”
Take-Home Lesson
The lesson here is that practitioners who perform cosmetic procedures should be well-versed in the task and potential complications, Dr. Murray said in the interview. “If you’re going to be doing a procedure, make sure you know the proper techniques, the proper endpoints, and how to treat if you’re to have a complication,” she said. “If you don’t know how to treat a complication from the device, then you should think twice about using it.”
She also suggested screening patients for potentially undiagnosed mental health disorders. “It can play a role in the initial consultation and potentially any after-care they might need if there is a complication,” she said. “We may not have the adequate tools at this time to know how to best handle these patients and these scenarios, but hopefully my abstract will shed a little more light on it.”
She said she hopes her findings lead to more research in the future.
Asked to comment on the study, Jennifer Lin, MD, assistant professor of dermatology at Brigham and Women’s Hospital and Dana Farber Cancer Institute in Boston, Massachusetts, said one finding of the study stood out to her. “ I was very surprised from her dataset that patients think about it more than 3 hours a day,” she told this news organization. “That’s really significant. We talk about the side effects, but we don’t necessarily talk about the burden of how long the recovery will be or the psychological burden of potentially dealing with it.”
She noted that “there’s a bit of movement” toward developing guidelines for laser treatments, which would address the risk of complications. “That’s the goal: To have better guidelines to avoid these complications in the first place,” Dr. Lin said.
The study findings also point to a need for “premonitoring” individuals before procedures, she added. “We talked about patient selection and make sure someone doesn’t have body dysmorphic disorder, but we don’t formally screen for it,” she said. “We don’t our train our residents to screen for it. And I think doing more pre- and post-testing of how people are affected by laser treatment is going to become more important.”
Dr. Murray disclosed relationships with R2 Technologies. Dr. Lin had no relationships to disclose.
A version of this article appeared on Medscape.com.
BALTIMORE — of patients with dermatology-related complications.
The study used an anonymous 40-question survey circulated to a Facebook cosmetic complication support group. Seventy-one of 100 individuals completed the questionnaire, reporting significantly higher rates of mental health issues after their complications than before. Results were presented at the annual conference of the American Society for Laser Medicine and Surgery (ASLMS). Almost all the survey respondents (99%) were female, with 61% aged 25-44 years and 34% aged 45-64 years.
“Cosmetic procedures have increased over the past decade, with procedures being increasingly performed by an evolving variety of providers,” the study’s lead author, Taryn Murray, MD, a dermatologist at Cleveland Clinic, Cleveland, Ohio, told this news organization. “Appropriate patient assessment and counseling and proper procedure technique are important for obtaining safe and effective results. Complications may not only impact patients physically but can also be harmful to their mental health.”
Rise in Mental Health Issues
The study found that before respondents had the treatment that led to their complications, 16% reported a history of generalized anxiety disorder, 15% a history of depression, and 1% a history of either BDD or PTSD. Following the complication, 50% reported a positive depression screening, 63% a positive BDD Questionnaire – Dermatology Version, and 63% a positive Primary Care PTSD screen, Dr. Murray said. “Almost half of respondents (46%) reported thinking about their complication for more than 3 hours a day,” she said in presenting the results.
Dr. Murray said the idea for the study grew out of her experience as a fellow working with Paul Friedman, MD, at the Dermatology and Laser Surgery Center at University of Texas Health in Houston.
“We were seeing a lot of complications,” Dr. Murray said in an interview. “Some of these were local. Some of these patients were flying in from out-of-state looking for help with the complication, and we could see what a mental and emotional burden this put on these patients. They were routinely in the office in tears saying it was interfering with their daily life, it was interfering with their job, saying they were going to lose their job, all because they were so distressed over what was happening to them.”
Yet, the research into psychological distress in patients with dermatologic complications is minimal, Dr. Murray added. “We think that body dysmorphic disorder is prevalent for patients seeking dermatology or plastic surgery services, but I don’t think either of the specialties do a great job in screening people for that when they come for treatment, so I think a lot of it goes undiagnosed. There’s been a trend looking at more at complications lately, but there’s been a gap in the literature.”
The treatments the patients in the survey had were microneedling with radiofrequency (29%), laser (24%), ultrasound for skin tightening (11%), radiofrequency for skin tightening (11%), microneedling (4%), chemical peel (3%), body contouring/sculpting (1%), and “other” (17%).
The study found that the largest share of procedures, 47%, were done by an esthetician/laser technician, followed by a nondermatologist physician (17%), a board-certified dermatologist (14%), an advanced practice provider (12%), and “other” (10%).
Self-reported complications included scarring (38%), hyperpigmentation (26%), erythema (24%), burn (23%), blisters (11%), and hypopigmentation (3%); 71% characterized their complications as “other,” and one respondent reported multiple complications.
“Respondents said they were satisfied with the previous cosmetic care they received,” Dr. Murray said during her presentation at the meeting. “And there was a consensus among the respondents that they did not feel adequately counseled on the risks of the procedure and that it did not meet their expectations and anticipated outcome.”
Take-Home Lesson
The lesson here is that practitioners who perform cosmetic procedures should be well-versed in the task and potential complications, Dr. Murray said in the interview. “If you’re going to be doing a procedure, make sure you know the proper techniques, the proper endpoints, and how to treat if you’re to have a complication,” she said. “If you don’t know how to treat a complication from the device, then you should think twice about using it.”
She also suggested screening patients for potentially undiagnosed mental health disorders. “It can play a role in the initial consultation and potentially any after-care they might need if there is a complication,” she said. “We may not have the adequate tools at this time to know how to best handle these patients and these scenarios, but hopefully my abstract will shed a little more light on it.”
She said she hopes her findings lead to more research in the future.
Asked to comment on the study, Jennifer Lin, MD, assistant professor of dermatology at Brigham and Women’s Hospital and Dana Farber Cancer Institute in Boston, Massachusetts, said one finding of the study stood out to her. “ I was very surprised from her dataset that patients think about it more than 3 hours a day,” she told this news organization. “That’s really significant. We talk about the side effects, but we don’t necessarily talk about the burden of how long the recovery will be or the psychological burden of potentially dealing with it.”
She noted that “there’s a bit of movement” toward developing guidelines for laser treatments, which would address the risk of complications. “That’s the goal: To have better guidelines to avoid these complications in the first place,” Dr. Lin said.
The study findings also point to a need for “premonitoring” individuals before procedures, she added. “We talked about patient selection and make sure someone doesn’t have body dysmorphic disorder, but we don’t formally screen for it,” she said. “We don’t our train our residents to screen for it. And I think doing more pre- and post-testing of how people are affected by laser treatment is going to become more important.”
Dr. Murray disclosed relationships with R2 Technologies. Dr. Lin had no relationships to disclose.
A version of this article appeared on Medscape.com.
FROM ASLMS 2024
Cannabis Constituent May Be Key to Easing THC-Induced Anxiety
, new data from a small study suggested.
Participants who inhaled vaporized D-limonene and THC reported significantly greater decreases in anxiogenic effects than did people who received either component alone or a placebo. Reductions were greater as the dose of the D-limonene was increased.
Investigators noted that the findings could have implications for the use of medicinal or recreational cannabis, which has increased in recent years due to state legalization efforts.
“People use cannabis to help reduce anxiety, depression, and posttraumatic stress disorder, but since THC levels vary widely, if a person overshoots their tolerance of THC, cannabis can induce anxiety rather than relieve it,” senior investigator Ryan Vandrey, PhD, professor of psychiatry and behavioral sciences, Johns Hopkins School of Medicine, Baltimore, said in a news release.
“Our study demonstrates that D-limonene can modulate the effects of THC in a meaningful way and make THC more tolerable to people using it for both therapeutic and non-therapeutic purposes,” he added.
The study was published online in Drug and Alcohol Dependence.
Entourage Theory
Cannabis legalization has opened the door to an increased range of medicinal and nonmedicinal uses, but its benefits can be limited by the anxiety and panic some people experience with its use, investigators noted.
Many cannabis plants have been bred to contain higher concentrations of THC, with some dispensaries selling cannabis with more than 20%-30% THC. The plants often include cannabidiol, “minor” cannabinoids, and terpenes, such as D-limonene.
Prior studies pointed to THC as the cause of acute behavioral and psychoactive effects some cannabis users experience. However, a new, untested theory, the “cannabis entourage effect theory,” suggested other components in cannabis, including D-limonene, may contribute to the anxiogenic symptoms.
“We were motivated by scientific publications that hypothesized D-limonene can attenuate the acute anxiogenic effects of cannabis, but for which empirical data did not exist,” Dr. Vandrey said.
Investigators designed a small double-blind, within-subjects crossover study of 20 healthy adults (median age, 26 years; 50% men). About half of participants were Caucasian/non-Hispanic, 30% African American/non-Hispanic, 10% Caucasian/Hispanic, and 10% Asian/non-Hispanic.
All participants completed nine outpatient drug administration sessions, during which they inhaled vaporized D-limonene alone (1 or 5 mg), THC alone (15 or 30 mg), the same doses of THC and D-limonene together, or placebo.
Primary outcomes included subjective drug effects, measured with the Drug Effect Questionnaire (DEQ) and the 20-item state subscale of the State-Trait Anxiety Inventory (STAI-S). Investigators also measured cognitive/psychomotor performance with the Digit Symbol Substitution Task (DSST) and the Paced Serial Addition Task.
Vital signs such as heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and plasma D-limonene and THC concentrations were also tracked.
Participants’ responses were measured at baseline and then an additional nine times after initial exposure over the course of each 6-hour test session. Blood and urine samples were collected from participants before, during, and after each session.
First Evidence
There were no significant differences in outcomes between the D-limonene alone and placebo groups.
Receipt of 15- and 30-mg doses of THC alone was associated with subjective reports of acute cannabis exposure, including cognitive and physiological effects.
A treatment effect was observed for “anxious/nervous” (P < .01), “paranoid” (P < .01), and “heart racing” (P < .0001).
In planned comparisons, ratings of anxiety-like subjective effects qualitatively decreased as D-limonene dose increased, and concurrent administration of 30-mg THC plus 15-mg D-limonene significantly reduced ratings of “anxious/nervous” and “paranoid” on the DEQ compared to 30 mg of THC alone (P < .05).
Findings were similar on the composite score of the STAI-S, and although planned comparisons did not reach the threshold for statistical significance, reductions in anxiety approached significance in the THC plus D-limonene group compared with the THC alone condition (P = .08). The combination group also reported significantly lower subjective ratings of unpleasant drug effects than the THC alone group (P = .03).
In particular, a main effect of treatment was found for the anxious/nervous category on the DEQ (P < .01), as well as the “paranoid” (P < .01) and heart racing (P < .0001) categories.
On the other hand, ratings of anxious/nervous and paranoid categories were significantly lower in the 30-mg THC plus 15-mg D-limonene vs the 30-mg THC alone condition (P < .05, for all).
As for cognition, following drug administration, a significant main effect of treatment was observed for the DSST (P < .05), but no significant differences between THC and THC plus D-limonene combination conditions or between D-limonene alone and placebo were detected.
There were no differences within each THC dose and between D-limonene alone versus placebo conditions. Moreover, there were no main effects of treatment found for SBP or DBP.
The combination condition produced significantly greater concentrations of THC than the THC alone condition (P < .05).
“This study provides the first evidence that there are chemical constituents found naturally in the cannabis plant that can reduce some of the adverse effects of using delta-9-THC,” Dr. Vandrey said.
Although the exact mechanism by which vaporized D-limonene counters the anxiogenic effects of THC is unclear, “our best guess is that D-limonene is producing an anxiolytic effect on its own that is not mediated by cannabinoid receptors,” Dr. Vandrey said.
Significant Impact
Commenting on the research, Joshua Lile, PhD, professor, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, noted that the study seems to be the first of its kind to study the influence of terpene on THC response.
The research “makes a significant impact on our field,” and is “among the few controlled clinical studies that have demonstrated interactions between THC and other cannabis constituents, supporting the validity of the ‘entourage’ effect,” said Dr. Lile, who was not involved with the current research.
“This work is particularly important, given the unfounded claims sometimes made by the cannabis industry regarding the effects of different cannabis products,” he added.
Also commenting on the study, Ziva Cooper, PhD, professor and director of the UCLA Center for Cannabis and Cannabinoids, University of California Los Angeles, said the findings “have direct implications for improving the safety of cannabis, whether it’s being used for medical or nonmedical purposes, especially in people and patients who do not have experience with cannabis, a group that is at high risk for experiencing anxiety after using cannabis.”
In addition, “an important aspect to this study is that the effects of limonene in reducing anxiety attributed to delta-9-THC were observed at higher concentrations (or doses) than those usually present in the plant,” Dr. Copper said. “This calls for further investigation into new cannabis formulations specifically designed to leverage the potential protective effects of the terpene.”
This research was supported by the National Institute on Drug Abuse. Dr. Vandrey served as a consultant or received honoraria from Mira1a Therapeutics, Inc.; Jazz Pharmaceuticals; Charlotte’s Web; Syqe Medical Ltd.; and WebMD. The other authors’ disclosures are listed on the original paper. Dr. Lile declared no relevant financial relationships. Dr. Cooper reported receiving study drug from Canopy Growth Corp and True Terpenes, study-related materials from Storz & Bickel, and research support from the National Institute on Drug Abuse, National Center for Complementary and Integrative Health, California Department of Cannabis Control, Center for Medicinal Cannabis Research, and California Highway Patrol.
A version of this article appeared on Medscape.com.
, new data from a small study suggested.
Participants who inhaled vaporized D-limonene and THC reported significantly greater decreases in anxiogenic effects than did people who received either component alone or a placebo. Reductions were greater as the dose of the D-limonene was increased.
Investigators noted that the findings could have implications for the use of medicinal or recreational cannabis, which has increased in recent years due to state legalization efforts.
“People use cannabis to help reduce anxiety, depression, and posttraumatic stress disorder, but since THC levels vary widely, if a person overshoots their tolerance of THC, cannabis can induce anxiety rather than relieve it,” senior investigator Ryan Vandrey, PhD, professor of psychiatry and behavioral sciences, Johns Hopkins School of Medicine, Baltimore, said in a news release.
“Our study demonstrates that D-limonene can modulate the effects of THC in a meaningful way and make THC more tolerable to people using it for both therapeutic and non-therapeutic purposes,” he added.
The study was published online in Drug and Alcohol Dependence.
Entourage Theory
Cannabis legalization has opened the door to an increased range of medicinal and nonmedicinal uses, but its benefits can be limited by the anxiety and panic some people experience with its use, investigators noted.
Many cannabis plants have been bred to contain higher concentrations of THC, with some dispensaries selling cannabis with more than 20%-30% THC. The plants often include cannabidiol, “minor” cannabinoids, and terpenes, such as D-limonene.
Prior studies pointed to THC as the cause of acute behavioral and psychoactive effects some cannabis users experience. However, a new, untested theory, the “cannabis entourage effect theory,” suggested other components in cannabis, including D-limonene, may contribute to the anxiogenic symptoms.
“We were motivated by scientific publications that hypothesized D-limonene can attenuate the acute anxiogenic effects of cannabis, but for which empirical data did not exist,” Dr. Vandrey said.
Investigators designed a small double-blind, within-subjects crossover study of 20 healthy adults (median age, 26 years; 50% men). About half of participants were Caucasian/non-Hispanic, 30% African American/non-Hispanic, 10% Caucasian/Hispanic, and 10% Asian/non-Hispanic.
All participants completed nine outpatient drug administration sessions, during which they inhaled vaporized D-limonene alone (1 or 5 mg), THC alone (15 or 30 mg), the same doses of THC and D-limonene together, or placebo.
Primary outcomes included subjective drug effects, measured with the Drug Effect Questionnaire (DEQ) and the 20-item state subscale of the State-Trait Anxiety Inventory (STAI-S). Investigators also measured cognitive/psychomotor performance with the Digit Symbol Substitution Task (DSST) and the Paced Serial Addition Task.
Vital signs such as heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and plasma D-limonene and THC concentrations were also tracked.
Participants’ responses were measured at baseline and then an additional nine times after initial exposure over the course of each 6-hour test session. Blood and urine samples were collected from participants before, during, and after each session.
First Evidence
There were no significant differences in outcomes between the D-limonene alone and placebo groups.
Receipt of 15- and 30-mg doses of THC alone was associated with subjective reports of acute cannabis exposure, including cognitive and physiological effects.
A treatment effect was observed for “anxious/nervous” (P < .01), “paranoid” (P < .01), and “heart racing” (P < .0001).
In planned comparisons, ratings of anxiety-like subjective effects qualitatively decreased as D-limonene dose increased, and concurrent administration of 30-mg THC plus 15-mg D-limonene significantly reduced ratings of “anxious/nervous” and “paranoid” on the DEQ compared to 30 mg of THC alone (P < .05).
Findings were similar on the composite score of the STAI-S, and although planned comparisons did not reach the threshold for statistical significance, reductions in anxiety approached significance in the THC plus D-limonene group compared with the THC alone condition (P = .08). The combination group also reported significantly lower subjective ratings of unpleasant drug effects than the THC alone group (P = .03).
In particular, a main effect of treatment was found for the anxious/nervous category on the DEQ (P < .01), as well as the “paranoid” (P < .01) and heart racing (P < .0001) categories.
On the other hand, ratings of anxious/nervous and paranoid categories were significantly lower in the 30-mg THC plus 15-mg D-limonene vs the 30-mg THC alone condition (P < .05, for all).
As for cognition, following drug administration, a significant main effect of treatment was observed for the DSST (P < .05), but no significant differences between THC and THC plus D-limonene combination conditions or between D-limonene alone and placebo were detected.
There were no differences within each THC dose and between D-limonene alone versus placebo conditions. Moreover, there were no main effects of treatment found for SBP or DBP.
The combination condition produced significantly greater concentrations of THC than the THC alone condition (P < .05).
“This study provides the first evidence that there are chemical constituents found naturally in the cannabis plant that can reduce some of the adverse effects of using delta-9-THC,” Dr. Vandrey said.
Although the exact mechanism by which vaporized D-limonene counters the anxiogenic effects of THC is unclear, “our best guess is that D-limonene is producing an anxiolytic effect on its own that is not mediated by cannabinoid receptors,” Dr. Vandrey said.
Significant Impact
Commenting on the research, Joshua Lile, PhD, professor, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, noted that the study seems to be the first of its kind to study the influence of terpene on THC response.
The research “makes a significant impact on our field,” and is “among the few controlled clinical studies that have demonstrated interactions between THC and other cannabis constituents, supporting the validity of the ‘entourage’ effect,” said Dr. Lile, who was not involved with the current research.
“This work is particularly important, given the unfounded claims sometimes made by the cannabis industry regarding the effects of different cannabis products,” he added.
Also commenting on the study, Ziva Cooper, PhD, professor and director of the UCLA Center for Cannabis and Cannabinoids, University of California Los Angeles, said the findings “have direct implications for improving the safety of cannabis, whether it’s being used for medical or nonmedical purposes, especially in people and patients who do not have experience with cannabis, a group that is at high risk for experiencing anxiety after using cannabis.”
In addition, “an important aspect to this study is that the effects of limonene in reducing anxiety attributed to delta-9-THC were observed at higher concentrations (or doses) than those usually present in the plant,” Dr. Copper said. “This calls for further investigation into new cannabis formulations specifically designed to leverage the potential protective effects of the terpene.”
This research was supported by the National Institute on Drug Abuse. Dr. Vandrey served as a consultant or received honoraria from Mira1a Therapeutics, Inc.; Jazz Pharmaceuticals; Charlotte’s Web; Syqe Medical Ltd.; and WebMD. The other authors’ disclosures are listed on the original paper. Dr. Lile declared no relevant financial relationships. Dr. Cooper reported receiving study drug from Canopy Growth Corp and True Terpenes, study-related materials from Storz & Bickel, and research support from the National Institute on Drug Abuse, National Center for Complementary and Integrative Health, California Department of Cannabis Control, Center for Medicinal Cannabis Research, and California Highway Patrol.
A version of this article appeared on Medscape.com.
, new data from a small study suggested.
Participants who inhaled vaporized D-limonene and THC reported significantly greater decreases in anxiogenic effects than did people who received either component alone or a placebo. Reductions were greater as the dose of the D-limonene was increased.
Investigators noted that the findings could have implications for the use of medicinal or recreational cannabis, which has increased in recent years due to state legalization efforts.
“People use cannabis to help reduce anxiety, depression, and posttraumatic stress disorder, but since THC levels vary widely, if a person overshoots their tolerance of THC, cannabis can induce anxiety rather than relieve it,” senior investigator Ryan Vandrey, PhD, professor of psychiatry and behavioral sciences, Johns Hopkins School of Medicine, Baltimore, said in a news release.
“Our study demonstrates that D-limonene can modulate the effects of THC in a meaningful way and make THC more tolerable to people using it for both therapeutic and non-therapeutic purposes,” he added.
The study was published online in Drug and Alcohol Dependence.
Entourage Theory
Cannabis legalization has opened the door to an increased range of medicinal and nonmedicinal uses, but its benefits can be limited by the anxiety and panic some people experience with its use, investigators noted.
Many cannabis plants have been bred to contain higher concentrations of THC, with some dispensaries selling cannabis with more than 20%-30% THC. The plants often include cannabidiol, “minor” cannabinoids, and terpenes, such as D-limonene.
Prior studies pointed to THC as the cause of acute behavioral and psychoactive effects some cannabis users experience. However, a new, untested theory, the “cannabis entourage effect theory,” suggested other components in cannabis, including D-limonene, may contribute to the anxiogenic symptoms.
“We were motivated by scientific publications that hypothesized D-limonene can attenuate the acute anxiogenic effects of cannabis, but for which empirical data did not exist,” Dr. Vandrey said.
Investigators designed a small double-blind, within-subjects crossover study of 20 healthy adults (median age, 26 years; 50% men). About half of participants were Caucasian/non-Hispanic, 30% African American/non-Hispanic, 10% Caucasian/Hispanic, and 10% Asian/non-Hispanic.
All participants completed nine outpatient drug administration sessions, during which they inhaled vaporized D-limonene alone (1 or 5 mg), THC alone (15 or 30 mg), the same doses of THC and D-limonene together, or placebo.
Primary outcomes included subjective drug effects, measured with the Drug Effect Questionnaire (DEQ) and the 20-item state subscale of the State-Trait Anxiety Inventory (STAI-S). Investigators also measured cognitive/psychomotor performance with the Digit Symbol Substitution Task (DSST) and the Paced Serial Addition Task.
Vital signs such as heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and plasma D-limonene and THC concentrations were also tracked.
Participants’ responses were measured at baseline and then an additional nine times after initial exposure over the course of each 6-hour test session. Blood and urine samples were collected from participants before, during, and after each session.
First Evidence
There were no significant differences in outcomes between the D-limonene alone and placebo groups.
Receipt of 15- and 30-mg doses of THC alone was associated with subjective reports of acute cannabis exposure, including cognitive and physiological effects.
A treatment effect was observed for “anxious/nervous” (P < .01), “paranoid” (P < .01), and “heart racing” (P < .0001).
In planned comparisons, ratings of anxiety-like subjective effects qualitatively decreased as D-limonene dose increased, and concurrent administration of 30-mg THC plus 15-mg D-limonene significantly reduced ratings of “anxious/nervous” and “paranoid” on the DEQ compared to 30 mg of THC alone (P < .05).
Findings were similar on the composite score of the STAI-S, and although planned comparisons did not reach the threshold for statistical significance, reductions in anxiety approached significance in the THC plus D-limonene group compared with the THC alone condition (P = .08). The combination group also reported significantly lower subjective ratings of unpleasant drug effects than the THC alone group (P = .03).
In particular, a main effect of treatment was found for the anxious/nervous category on the DEQ (P < .01), as well as the “paranoid” (P < .01) and heart racing (P < .0001) categories.
On the other hand, ratings of anxious/nervous and paranoid categories were significantly lower in the 30-mg THC plus 15-mg D-limonene vs the 30-mg THC alone condition (P < .05, for all).
As for cognition, following drug administration, a significant main effect of treatment was observed for the DSST (P < .05), but no significant differences between THC and THC plus D-limonene combination conditions or between D-limonene alone and placebo were detected.
There were no differences within each THC dose and between D-limonene alone versus placebo conditions. Moreover, there were no main effects of treatment found for SBP or DBP.
The combination condition produced significantly greater concentrations of THC than the THC alone condition (P < .05).
“This study provides the first evidence that there are chemical constituents found naturally in the cannabis plant that can reduce some of the adverse effects of using delta-9-THC,” Dr. Vandrey said.
Although the exact mechanism by which vaporized D-limonene counters the anxiogenic effects of THC is unclear, “our best guess is that D-limonene is producing an anxiolytic effect on its own that is not mediated by cannabinoid receptors,” Dr. Vandrey said.
Significant Impact
Commenting on the research, Joshua Lile, PhD, professor, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, noted that the study seems to be the first of its kind to study the influence of terpene on THC response.
The research “makes a significant impact on our field,” and is “among the few controlled clinical studies that have demonstrated interactions between THC and other cannabis constituents, supporting the validity of the ‘entourage’ effect,” said Dr. Lile, who was not involved with the current research.
“This work is particularly important, given the unfounded claims sometimes made by the cannabis industry regarding the effects of different cannabis products,” he added.
Also commenting on the study, Ziva Cooper, PhD, professor and director of the UCLA Center for Cannabis and Cannabinoids, University of California Los Angeles, said the findings “have direct implications for improving the safety of cannabis, whether it’s being used for medical or nonmedical purposes, especially in people and patients who do not have experience with cannabis, a group that is at high risk for experiencing anxiety after using cannabis.”
In addition, “an important aspect to this study is that the effects of limonene in reducing anxiety attributed to delta-9-THC were observed at higher concentrations (or doses) than those usually present in the plant,” Dr. Copper said. “This calls for further investigation into new cannabis formulations specifically designed to leverage the potential protective effects of the terpene.”
This research was supported by the National Institute on Drug Abuse. Dr. Vandrey served as a consultant or received honoraria from Mira1a Therapeutics, Inc.; Jazz Pharmaceuticals; Charlotte’s Web; Syqe Medical Ltd.; and WebMD. The other authors’ disclosures are listed on the original paper. Dr. Lile declared no relevant financial relationships. Dr. Cooper reported receiving study drug from Canopy Growth Corp and True Terpenes, study-related materials from Storz & Bickel, and research support from the National Institute on Drug Abuse, National Center for Complementary and Integrative Health, California Department of Cannabis Control, Center for Medicinal Cannabis Research, and California Highway Patrol.
A version of this article appeared on Medscape.com.
From Drug and Alcohol Dependence
Vocal Biomarkers a Tell for Mental Health Status?
A smartphone-based tool that tracks mental health status by detecting changes in voice may complement traditional psychiatric assessments and improve an individual’s ability to self-monitor depressive and other mental health symptoms, new research suggested.
Investigators used the Mental Fitness Vocal Biomarker (MFVB) scoring algorithm, which is incorporated into a smartphone voice journaling application, to detect increased or decreased risk for elevated mental health symptom severity by analyzing 30-second free speech voice recordings for specific vocal patterns previously linked to mental health.
“While the MFVB tool is not intended to diagnose or treat mental health conditions, these findings provide a robust initial foundation upon which to further explore its potential in personalized wellness tracking, which has so far not yet been able to extend measurement of physical health to mental wellbeing,” reported the researchers, led by Erik Larsen, PhD, with Boston-based Sonde Health, which developed the tool.
The study was published online in Frontiers in Psychiatry.
Eight Vocal Features
The potential value of vocal biomarkers for mental health assessment has gained increasing attention.
“Somebody that is depressed often sounds more monotone; they may have less inflection in their voice and speak slower with less energy, which can be recognized in voice recordings,” Dr. Larsen told this news organization.
“This is an area which has received quite a bit of research in the last few decades to find out what specific aspects of acoustics and rhythm of speech could point to conditions like depression,” Dr. Larsen said.
In the current study, the researchers set out to validate the ability of the MFVB platform to detect mental health symptoms.
With the tool, users record their thoughts and feelings as a 30-second voice journal. The tool analyzes the recordings for eight vocal features previously shown to be relevant to mental health. These include jitter, shimmer, pitch variability, energy variability, vowel space, phonation duration, speech rate, and pause duration.
The tool calculates a real-time MFVB score ranging from 0 to 100. A score of 80-100 is defined as “excellent” and 70-79 as “good,” while a score of 0-69 is categorized as “pay attention.” It was trained on more than 1 million voice samples to optimize performance across a diverse range of cultures, languages, and socioeconomic groups.
The current study included 104 outpatient psychiatric patients (73% women) with anxiety-related diagnoses, trauma, and stress-related disorders or depressive disorders. The cohort was mostly made up of White, non-Hispanic young adults. Patients with a history of substance abuse or who were taking psychiatric medications that may affect voice and speech were excluded.
During the 4-week study period, participants conducted 1336 app sessions with voice recordings, resulting in an average of 12.8 sessions per participant, or 3.2 per week.
MFVB scores were cross-referenced against the results of participants’ M3 Checklist, a clinically validated mental health assessment tool.
Over a period of 2 weeks, participants were twice as likely to report elevated mental health symptoms if their MFVB scores remained in the “pay attention” range vs in the “excellent” range, the researchers found.
The effect was more pronounced in those who used the app more frequently, with frequent users 8.5 times more likely to show elevated symptoms.
The correlation between MFVB scores and established mental health assessments was “not only statistically significant but also meaningful for participants,” researchers wrote. Subgroup analyses suggest the app works best for depression and stress- and trauma-related disorders.
The tool provides psychiatric outpatients with “immediate quantitative feedback on their mental health symptom severity,” the researchers noted.
In their paper, the investigators caution that the results highlight the “general ability” of MFVB score categories to differentiate mental health symptom severity levels but do not distinguish what type of symptoms these may be, such as depression, anxiety, or posttraumatic stress disorder.
In a statement, study investigator Lindsey Venesky, PhD, psychologist and clinical director at the Cognitive Behavior Institute in Pittsburgh, noted that the ability to collect mental health data from patients between clinic visits “could transform how we monitor symptoms and optimize treatment plans.”
“Voice-based health tracking technology can provide accurate insights into a client’s mental health status over time and can do so seamlessly and unobtrusively, with little added effort for clients,” Dr. Venesky said.
Need for Replication, Validation
Commenting on the findings, John Torous, MD, director of the division of digital psychiatry at Beth Israel Deaconess Medical Center, Boston, noted that “over the last 20 years, there has been a lot of interest in voice biomarkers, yet somehow that research has never been translated into mainstream clinical care.”
Voice biomarkers are “relevant and have potential” in mental health, he noted. The findings in this study are “interesting, but they need to be thoroughly externally replicated and validated to show that these biomarkers are valid and reliable,” Dr. Torous added.
Changes in voice are part of the mental status exam, Dr. Torous said, “but it’s only one piece of information that we collect in a clinical assessment of many pieces of information.”
Dr. Torous also cautioned that “as a practicing psychiatrist, it can be tricky to be given new data if you don’t know how to interpret it or what it means. An important step would be education, outreach, and resources for physicians to learn about potential voice biomarkers.”
The authors received internal financial support for the research, authorship, and/or publication of this article. The pilot phase of the study at St. Joseph’s Healthcare Hamilton was partially supported through Mitacs Accelerate International, Canada. Dr. Larsen and three coauthors are employed by Sonde Health. Dr. Torous had no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
A smartphone-based tool that tracks mental health status by detecting changes in voice may complement traditional psychiatric assessments and improve an individual’s ability to self-monitor depressive and other mental health symptoms, new research suggested.
Investigators used the Mental Fitness Vocal Biomarker (MFVB) scoring algorithm, which is incorporated into a smartphone voice journaling application, to detect increased or decreased risk for elevated mental health symptom severity by analyzing 30-second free speech voice recordings for specific vocal patterns previously linked to mental health.
“While the MFVB tool is not intended to diagnose or treat mental health conditions, these findings provide a robust initial foundation upon which to further explore its potential in personalized wellness tracking, which has so far not yet been able to extend measurement of physical health to mental wellbeing,” reported the researchers, led by Erik Larsen, PhD, with Boston-based Sonde Health, which developed the tool.
The study was published online in Frontiers in Psychiatry.
Eight Vocal Features
The potential value of vocal biomarkers for mental health assessment has gained increasing attention.
“Somebody that is depressed often sounds more monotone; they may have less inflection in their voice and speak slower with less energy, which can be recognized in voice recordings,” Dr. Larsen told this news organization.
“This is an area which has received quite a bit of research in the last few decades to find out what specific aspects of acoustics and rhythm of speech could point to conditions like depression,” Dr. Larsen said.
In the current study, the researchers set out to validate the ability of the MFVB platform to detect mental health symptoms.
With the tool, users record their thoughts and feelings as a 30-second voice journal. The tool analyzes the recordings for eight vocal features previously shown to be relevant to mental health. These include jitter, shimmer, pitch variability, energy variability, vowel space, phonation duration, speech rate, and pause duration.
The tool calculates a real-time MFVB score ranging from 0 to 100. A score of 80-100 is defined as “excellent” and 70-79 as “good,” while a score of 0-69 is categorized as “pay attention.” It was trained on more than 1 million voice samples to optimize performance across a diverse range of cultures, languages, and socioeconomic groups.
The current study included 104 outpatient psychiatric patients (73% women) with anxiety-related diagnoses, trauma, and stress-related disorders or depressive disorders. The cohort was mostly made up of White, non-Hispanic young adults. Patients with a history of substance abuse or who were taking psychiatric medications that may affect voice and speech were excluded.
During the 4-week study period, participants conducted 1336 app sessions with voice recordings, resulting in an average of 12.8 sessions per participant, or 3.2 per week.
MFVB scores were cross-referenced against the results of participants’ M3 Checklist, a clinically validated mental health assessment tool.
Over a period of 2 weeks, participants were twice as likely to report elevated mental health symptoms if their MFVB scores remained in the “pay attention” range vs in the “excellent” range, the researchers found.
The effect was more pronounced in those who used the app more frequently, with frequent users 8.5 times more likely to show elevated symptoms.
The correlation between MFVB scores and established mental health assessments was “not only statistically significant but also meaningful for participants,” researchers wrote. Subgroup analyses suggest the app works best for depression and stress- and trauma-related disorders.
The tool provides psychiatric outpatients with “immediate quantitative feedback on their mental health symptom severity,” the researchers noted.
In their paper, the investigators caution that the results highlight the “general ability” of MFVB score categories to differentiate mental health symptom severity levels but do not distinguish what type of symptoms these may be, such as depression, anxiety, or posttraumatic stress disorder.
In a statement, study investigator Lindsey Venesky, PhD, psychologist and clinical director at the Cognitive Behavior Institute in Pittsburgh, noted that the ability to collect mental health data from patients between clinic visits “could transform how we monitor symptoms and optimize treatment plans.”
“Voice-based health tracking technology can provide accurate insights into a client’s mental health status over time and can do so seamlessly and unobtrusively, with little added effort for clients,” Dr. Venesky said.
Need for Replication, Validation
Commenting on the findings, John Torous, MD, director of the division of digital psychiatry at Beth Israel Deaconess Medical Center, Boston, noted that “over the last 20 years, there has been a lot of interest in voice biomarkers, yet somehow that research has never been translated into mainstream clinical care.”
Voice biomarkers are “relevant and have potential” in mental health, he noted. The findings in this study are “interesting, but they need to be thoroughly externally replicated and validated to show that these biomarkers are valid and reliable,” Dr. Torous added.
Changes in voice are part of the mental status exam, Dr. Torous said, “but it’s only one piece of information that we collect in a clinical assessment of many pieces of information.”
Dr. Torous also cautioned that “as a practicing psychiatrist, it can be tricky to be given new data if you don’t know how to interpret it or what it means. An important step would be education, outreach, and resources for physicians to learn about potential voice biomarkers.”
The authors received internal financial support for the research, authorship, and/or publication of this article. The pilot phase of the study at St. Joseph’s Healthcare Hamilton was partially supported through Mitacs Accelerate International, Canada. Dr. Larsen and three coauthors are employed by Sonde Health. Dr. Torous had no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
A smartphone-based tool that tracks mental health status by detecting changes in voice may complement traditional psychiatric assessments and improve an individual’s ability to self-monitor depressive and other mental health symptoms, new research suggested.
Investigators used the Mental Fitness Vocal Biomarker (MFVB) scoring algorithm, which is incorporated into a smartphone voice journaling application, to detect increased or decreased risk for elevated mental health symptom severity by analyzing 30-second free speech voice recordings for specific vocal patterns previously linked to mental health.
“While the MFVB tool is not intended to diagnose or treat mental health conditions, these findings provide a robust initial foundation upon which to further explore its potential in personalized wellness tracking, which has so far not yet been able to extend measurement of physical health to mental wellbeing,” reported the researchers, led by Erik Larsen, PhD, with Boston-based Sonde Health, which developed the tool.
The study was published online in Frontiers in Psychiatry.
Eight Vocal Features
The potential value of vocal biomarkers for mental health assessment has gained increasing attention.
“Somebody that is depressed often sounds more monotone; they may have less inflection in their voice and speak slower with less energy, which can be recognized in voice recordings,” Dr. Larsen told this news organization.
“This is an area which has received quite a bit of research in the last few decades to find out what specific aspects of acoustics and rhythm of speech could point to conditions like depression,” Dr. Larsen said.
In the current study, the researchers set out to validate the ability of the MFVB platform to detect mental health symptoms.
With the tool, users record their thoughts and feelings as a 30-second voice journal. The tool analyzes the recordings for eight vocal features previously shown to be relevant to mental health. These include jitter, shimmer, pitch variability, energy variability, vowel space, phonation duration, speech rate, and pause duration.
The tool calculates a real-time MFVB score ranging from 0 to 100. A score of 80-100 is defined as “excellent” and 70-79 as “good,” while a score of 0-69 is categorized as “pay attention.” It was trained on more than 1 million voice samples to optimize performance across a diverse range of cultures, languages, and socioeconomic groups.
The current study included 104 outpatient psychiatric patients (73% women) with anxiety-related diagnoses, trauma, and stress-related disorders or depressive disorders. The cohort was mostly made up of White, non-Hispanic young adults. Patients with a history of substance abuse or who were taking psychiatric medications that may affect voice and speech were excluded.
During the 4-week study period, participants conducted 1336 app sessions with voice recordings, resulting in an average of 12.8 sessions per participant, or 3.2 per week.
MFVB scores were cross-referenced against the results of participants’ M3 Checklist, a clinically validated mental health assessment tool.
Over a period of 2 weeks, participants were twice as likely to report elevated mental health symptoms if their MFVB scores remained in the “pay attention” range vs in the “excellent” range, the researchers found.
The effect was more pronounced in those who used the app more frequently, with frequent users 8.5 times more likely to show elevated symptoms.
The correlation between MFVB scores and established mental health assessments was “not only statistically significant but also meaningful for participants,” researchers wrote. Subgroup analyses suggest the app works best for depression and stress- and trauma-related disorders.
The tool provides psychiatric outpatients with “immediate quantitative feedback on their mental health symptom severity,” the researchers noted.
In their paper, the investigators caution that the results highlight the “general ability” of MFVB score categories to differentiate mental health symptom severity levels but do not distinguish what type of symptoms these may be, such as depression, anxiety, or posttraumatic stress disorder.
In a statement, study investigator Lindsey Venesky, PhD, psychologist and clinical director at the Cognitive Behavior Institute in Pittsburgh, noted that the ability to collect mental health data from patients between clinic visits “could transform how we monitor symptoms and optimize treatment plans.”
“Voice-based health tracking technology can provide accurate insights into a client’s mental health status over time and can do so seamlessly and unobtrusively, with little added effort for clients,” Dr. Venesky said.
Need for Replication, Validation
Commenting on the findings, John Torous, MD, director of the division of digital psychiatry at Beth Israel Deaconess Medical Center, Boston, noted that “over the last 20 years, there has been a lot of interest in voice biomarkers, yet somehow that research has never been translated into mainstream clinical care.”
Voice biomarkers are “relevant and have potential” in mental health, he noted. The findings in this study are “interesting, but they need to be thoroughly externally replicated and validated to show that these biomarkers are valid and reliable,” Dr. Torous added.
Changes in voice are part of the mental status exam, Dr. Torous said, “but it’s only one piece of information that we collect in a clinical assessment of many pieces of information.”
Dr. Torous also cautioned that “as a practicing psychiatrist, it can be tricky to be given new data if you don’t know how to interpret it or what it means. An important step would be education, outreach, and resources for physicians to learn about potential voice biomarkers.”
The authors received internal financial support for the research, authorship, and/or publication of this article. The pilot phase of the study at St. Joseph’s Healthcare Hamilton was partially supported through Mitacs Accelerate International, Canada. Dr. Larsen and three coauthors are employed by Sonde Health. Dr. Torous had no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
Trauma, Racism Linked to Increased Suicide Risk in Black Men
One in three Black men in rural America experienced suicidal or death ideation (SDI) in the past week, new research showed.
A developmental model used in the study showed a direct association between experiences pertaining to threat, deprivation, and racial discrimination during childhood and suicide risk in adulthood, suggesting that a broad range of adverse experiences in early life may affect SDI risk among Black men.
“During the past 20-30 years, young Black men have evinced increasing levels of suicidal behavior and related cognitions,” lead author Steven Kogan, PhD, professor of family and consumer sciences at the University of Georgia, Athens, Georgia, and colleagues wrote.
“By controlling for depressive symptoms in assessing increases in SDI over time, our study’s design directly informed the extent to which social adversities affect SDI independent of other depressive problems,” they added.
The findings were published online in Cultural Diversity and Ethnic Minority Psychology.
Second Leading Cause of Death
Suicide is the second leading cause of death for Black Americans ages 15-24, according to the Centers for Disease Control and Prevention. The outlook is worse for Black men, whose death rate from suicide is about four times greater than for Black women.
Previous research suggests Black men are disproportionately exposed to social adversity, including poverty and discrimination, which may increase the risk for SDI. In addition, racial discrimination has been shown to increase the risks for depression, anxiety, and psychological distress among Black youth and adults.
But little research exists to better understand how these negative experiences affect vulnerability to SDI. The new study tested a model linking adversity during childhood and emerging exposure to racial discrimination to increases in suicidal thoughts.
Researchers analyzed data from 504 participants in the African American Men’s Project, which included a series of surveys completed by young men in rural Georgia at three different time points over a period of about 3 years.
Composite scores for childhood threat and deprivation were developed using the Adverse Childhood Experiences Scale and Childhood Trauma Questionnaire. Everyday discrimination was measured on the Schedule of Racist Events response scale.
To assess their experience with childhood threats, the men in the study, who were about 21 years old on average when they enrolled, were asked if they experienced a series of adverse childhood experiences and deprivation through age 16. Questions explored issues such as directly experiencing physical violence or witnessing abuse in the home and whether the men felt loved and “important or special” as children.
The investigators also asked the men about their experiences of racial discrimination, the quality of their relationships, their belief that aggression is a means of gaining respect, and their cynicism regarding romantic relationships.
Targeted Prevention
Overall, 33.6% of participants reported SDI in the previous week. A history of childhood threats and deprivation was associated with an increased likelihood of SDI (P < .001).
Researchers also found that a history of racial discrimination was significantly associated with the development of negative relational schemas, which are characterized by beliefs that other people are untrustworthy, uncaring, and/or hostile. Negative schemas were in turn associated with an increased risk for suicidal thoughts (P = .03).
“Clinical and preventive interventions for suicidality should target the influence of racism and adverse experiences and the negative relational schemas they induce,” the investigators noted.
“Policy efforts designed to dismantle systemic racism are critically needed. Interventions that address SDI, including programming designed to support Black men through their experiences with racial discrimination and processing of childhood experiences of adversity, may help young Black men resist the psychological impacts of racism, expand their positive support networks, and decrease their risk of SDI,” they added.
The study authors reported no funding sources or relevant financial relationships.
A version of this article appeared on Medscape.com.
One in three Black men in rural America experienced suicidal or death ideation (SDI) in the past week, new research showed.
A developmental model used in the study showed a direct association between experiences pertaining to threat, deprivation, and racial discrimination during childhood and suicide risk in adulthood, suggesting that a broad range of adverse experiences in early life may affect SDI risk among Black men.
“During the past 20-30 years, young Black men have evinced increasing levels of suicidal behavior and related cognitions,” lead author Steven Kogan, PhD, professor of family and consumer sciences at the University of Georgia, Athens, Georgia, and colleagues wrote.
“By controlling for depressive symptoms in assessing increases in SDI over time, our study’s design directly informed the extent to which social adversities affect SDI independent of other depressive problems,” they added.
The findings were published online in Cultural Diversity and Ethnic Minority Psychology.
Second Leading Cause of Death
Suicide is the second leading cause of death for Black Americans ages 15-24, according to the Centers for Disease Control and Prevention. The outlook is worse for Black men, whose death rate from suicide is about four times greater than for Black women.
Previous research suggests Black men are disproportionately exposed to social adversity, including poverty and discrimination, which may increase the risk for SDI. In addition, racial discrimination has been shown to increase the risks for depression, anxiety, and psychological distress among Black youth and adults.
But little research exists to better understand how these negative experiences affect vulnerability to SDI. The new study tested a model linking adversity during childhood and emerging exposure to racial discrimination to increases in suicidal thoughts.
Researchers analyzed data from 504 participants in the African American Men’s Project, which included a series of surveys completed by young men in rural Georgia at three different time points over a period of about 3 years.
Composite scores for childhood threat and deprivation were developed using the Adverse Childhood Experiences Scale and Childhood Trauma Questionnaire. Everyday discrimination was measured on the Schedule of Racist Events response scale.
To assess their experience with childhood threats, the men in the study, who were about 21 years old on average when they enrolled, were asked if they experienced a series of adverse childhood experiences and deprivation through age 16. Questions explored issues such as directly experiencing physical violence or witnessing abuse in the home and whether the men felt loved and “important or special” as children.
The investigators also asked the men about their experiences of racial discrimination, the quality of their relationships, their belief that aggression is a means of gaining respect, and their cynicism regarding romantic relationships.
Targeted Prevention
Overall, 33.6% of participants reported SDI in the previous week. A history of childhood threats and deprivation was associated with an increased likelihood of SDI (P < .001).
Researchers also found that a history of racial discrimination was significantly associated with the development of negative relational schemas, which are characterized by beliefs that other people are untrustworthy, uncaring, and/or hostile. Negative schemas were in turn associated with an increased risk for suicidal thoughts (P = .03).
“Clinical and preventive interventions for suicidality should target the influence of racism and adverse experiences and the negative relational schemas they induce,” the investigators noted.
“Policy efforts designed to dismantle systemic racism are critically needed. Interventions that address SDI, including programming designed to support Black men through their experiences with racial discrimination and processing of childhood experiences of adversity, may help young Black men resist the psychological impacts of racism, expand their positive support networks, and decrease their risk of SDI,” they added.
The study authors reported no funding sources or relevant financial relationships.
A version of this article appeared on Medscape.com.
One in three Black men in rural America experienced suicidal or death ideation (SDI) in the past week, new research showed.
A developmental model used in the study showed a direct association between experiences pertaining to threat, deprivation, and racial discrimination during childhood and suicide risk in adulthood, suggesting that a broad range of adverse experiences in early life may affect SDI risk among Black men.
“During the past 20-30 years, young Black men have evinced increasing levels of suicidal behavior and related cognitions,” lead author Steven Kogan, PhD, professor of family and consumer sciences at the University of Georgia, Athens, Georgia, and colleagues wrote.
“By controlling for depressive symptoms in assessing increases in SDI over time, our study’s design directly informed the extent to which social adversities affect SDI independent of other depressive problems,” they added.
The findings were published online in Cultural Diversity and Ethnic Minority Psychology.
Second Leading Cause of Death
Suicide is the second leading cause of death for Black Americans ages 15-24, according to the Centers for Disease Control and Prevention. The outlook is worse for Black men, whose death rate from suicide is about four times greater than for Black women.
Previous research suggests Black men are disproportionately exposed to social adversity, including poverty and discrimination, which may increase the risk for SDI. In addition, racial discrimination has been shown to increase the risks for depression, anxiety, and psychological distress among Black youth and adults.
But little research exists to better understand how these negative experiences affect vulnerability to SDI. The new study tested a model linking adversity during childhood and emerging exposure to racial discrimination to increases in suicidal thoughts.
Researchers analyzed data from 504 participants in the African American Men’s Project, which included a series of surveys completed by young men in rural Georgia at three different time points over a period of about 3 years.
Composite scores for childhood threat and deprivation were developed using the Adverse Childhood Experiences Scale and Childhood Trauma Questionnaire. Everyday discrimination was measured on the Schedule of Racist Events response scale.
To assess their experience with childhood threats, the men in the study, who were about 21 years old on average when they enrolled, were asked if they experienced a series of adverse childhood experiences and deprivation through age 16. Questions explored issues such as directly experiencing physical violence or witnessing abuse in the home and whether the men felt loved and “important or special” as children.
The investigators also asked the men about their experiences of racial discrimination, the quality of their relationships, their belief that aggression is a means of gaining respect, and their cynicism regarding romantic relationships.
Targeted Prevention
Overall, 33.6% of participants reported SDI in the previous week. A history of childhood threats and deprivation was associated with an increased likelihood of SDI (P < .001).
Researchers also found that a history of racial discrimination was significantly associated with the development of negative relational schemas, which are characterized by beliefs that other people are untrustworthy, uncaring, and/or hostile. Negative schemas were in turn associated with an increased risk for suicidal thoughts (P = .03).
“Clinical and preventive interventions for suicidality should target the influence of racism and adverse experiences and the negative relational schemas they induce,” the investigators noted.
“Policy efforts designed to dismantle systemic racism are critically needed. Interventions that address SDI, including programming designed to support Black men through their experiences with racial discrimination and processing of childhood experiences of adversity, may help young Black men resist the psychological impacts of racism, expand their positive support networks, and decrease their risk of SDI,” they added.
The study authors reported no funding sources or relevant financial relationships.
A version of this article appeared on Medscape.com.
FROM CULTURAL DIVERSITY AND ETHNIC MINORITY PSYCHOLOGY
Will Your Next Prescription Be 20 Minutes of Nature a Day?
What if a walk in a green environment could reshape brains, recalibrate sense of time, and stave off mental health conditions? If the research trends are true, you might soon find yourself writing prescriptions of 20 minutes of nature per day.
In the wake of the pandemic, the British government allocated more than £5 million to pandemic recovery efforts that specifically involved green spaces. Since then, it has committed even more funding toward an expansive social prescribing program that connects patients to “link workers” who determine personal care needs and facilitate community and volunteer-based interventions. These can include group walking and volunteering to help out in community gardens or conservation efforts. Similar green programs can be found in Japan, where shinrin-yoku (forest bathing) was recently adopted as a national health strategy, and in the United States and Canada.
“Disconnection from nature is a major part of the health problems that we have on this planet,” said William Bird, a UK-based general practitioner, green prescriber, and CEO of Intelligent Health, which is geared toward building healthy, active, and connected communities. Dr. Bird received the prestigious Member of the Order of the British Empire (MBE) in 2010 for services related to physical activity and health.
“Our brains are designed to connect to nature ... and we haven’t lost that instinct,” he explained. “Once we are with birdsong and water flowing and greenery, cortisol levels drop, our central vagus nerve improves, our fight and flight [response] disappears, and we start to be more receptive to other people.”
Shifting Time Perception and Health
Ricardo A. Correia, PhD, a biologist and researcher at the University of Helsinki in Finland, said he believed that the mechanism for at least some of these outcomes might be differences in how time is perceived. In a perspective that appeared in March in People and Nature, Dr. Correia explored how the “services” that nature provides shift time perceptions and, in turn, regulate overall well-being.
“I reached the realization that there was some evidence for the shift in some of the dimensions that we use to make sense of time in urban vs natural environments,” he told this news organization.
Dr. Correia explained that human time perception facilitates understanding cause and effect, so we can act in a way that allows us to survive.
“Time perception in humans is really complex and multifaceted,” he said. “The way that we make sense of time is not directly attached to any sensory organ, but rather goes through a range of cognitive, emotional, and bodily processes, all of which vary from person to person.”
Dr. Correia pointed to evidence showing that time perception is shorter in urban environments and longer in natural ones. This, in turn, influences attention and attention restoration. “When we live in cities, we are exposed to similar sorts of demanding environments, increased time pressures, less time for oneself and for recreational purposes,” he said. “Ever-mounting pressure on daily demands plus processes we use to make sense of time, especially attention, means that we pay a cognitive toll.”
Dr. Correia posits that it might be possible to recalibrate time perception, but only by breaking the cycle of exposure.
“If we are always exposed to fast-paced lifestyles, we become attuned to them and get caught up in an endless loop.” This cycle can be broken, Dr. Correia explained, by increasing exposure to natural environments. This leads to positive emotions, a sense of being in the present, and a heightened sense of mindfulness, all of which help mitigate the physical and mental health outcomes commonly associated with time scarcity.
Brain-Mental Health Benefits
To date, there is quite a bit of research exploring the impacts of exposure to nature on the brain. For example, data have shown that adolescents raised exclusively in rural environments have a larger hippocampus and better spatial processing than children exclusively raised in cities. Other research demonstrated that spending just an hour in the forest led to a decline in amygdala activity in adults, whereas it remained stable after walking in an urban setting, underscoring the salutogenic effects on brain regions related to stress. There is also evidence from a 10-year longitudinal study of more than 2 million Welsh adults that highlights the value of proximity to green or blue (eg, lakes and rivers) spaces and common mental health conditions, with every additional 360 meters to the nearest green or blue space associated with 10% greater odds of anxiety and depression.
Dr. Bird said there has been a massive sea change in attitudes among general practitioners, who have come around to embracing the concept of nature as medicine. This shift among peers, who teased him in the 1990s about his green walking and conservation prescriptions, portends a bandwagon of epic proportions that could benefit patients. He said that he was especially hopeful that green prescriptions will become mainstream in certain conditions, especially those like depression and anxiety that are resistant to medication.
But Dr. Bird cautions that primary care professionals need to be mindful. “Patients need to know that it’s real science, otherwise they’ll think that they’re being pawned off or dismissed,” he said. “I try to put real evidence behind it and explain that there’s no contraindication. The main thing is to start where patients are, what they’re feeling, and what they need. Some people just don’t like nature,” he said.
A version of this article appeared on Medscape.com.
What if a walk in a green environment could reshape brains, recalibrate sense of time, and stave off mental health conditions? If the research trends are true, you might soon find yourself writing prescriptions of 20 minutes of nature per day.
In the wake of the pandemic, the British government allocated more than £5 million to pandemic recovery efforts that specifically involved green spaces. Since then, it has committed even more funding toward an expansive social prescribing program that connects patients to “link workers” who determine personal care needs and facilitate community and volunteer-based interventions. These can include group walking and volunteering to help out in community gardens or conservation efforts. Similar green programs can be found in Japan, where shinrin-yoku (forest bathing) was recently adopted as a national health strategy, and in the United States and Canada.
“Disconnection from nature is a major part of the health problems that we have on this planet,” said William Bird, a UK-based general practitioner, green prescriber, and CEO of Intelligent Health, which is geared toward building healthy, active, and connected communities. Dr. Bird received the prestigious Member of the Order of the British Empire (MBE) in 2010 for services related to physical activity and health.
“Our brains are designed to connect to nature ... and we haven’t lost that instinct,” he explained. “Once we are with birdsong and water flowing and greenery, cortisol levels drop, our central vagus nerve improves, our fight and flight [response] disappears, and we start to be more receptive to other people.”
Shifting Time Perception and Health
Ricardo A. Correia, PhD, a biologist and researcher at the University of Helsinki in Finland, said he believed that the mechanism for at least some of these outcomes might be differences in how time is perceived. In a perspective that appeared in March in People and Nature, Dr. Correia explored how the “services” that nature provides shift time perceptions and, in turn, regulate overall well-being.
“I reached the realization that there was some evidence for the shift in some of the dimensions that we use to make sense of time in urban vs natural environments,” he told this news organization.
Dr. Correia explained that human time perception facilitates understanding cause and effect, so we can act in a way that allows us to survive.
“Time perception in humans is really complex and multifaceted,” he said. “The way that we make sense of time is not directly attached to any sensory organ, but rather goes through a range of cognitive, emotional, and bodily processes, all of which vary from person to person.”
Dr. Correia pointed to evidence showing that time perception is shorter in urban environments and longer in natural ones. This, in turn, influences attention and attention restoration. “When we live in cities, we are exposed to similar sorts of demanding environments, increased time pressures, less time for oneself and for recreational purposes,” he said. “Ever-mounting pressure on daily demands plus processes we use to make sense of time, especially attention, means that we pay a cognitive toll.”
Dr. Correia posits that it might be possible to recalibrate time perception, but only by breaking the cycle of exposure.
“If we are always exposed to fast-paced lifestyles, we become attuned to them and get caught up in an endless loop.” This cycle can be broken, Dr. Correia explained, by increasing exposure to natural environments. This leads to positive emotions, a sense of being in the present, and a heightened sense of mindfulness, all of which help mitigate the physical and mental health outcomes commonly associated with time scarcity.
Brain-Mental Health Benefits
To date, there is quite a bit of research exploring the impacts of exposure to nature on the brain. For example, data have shown that adolescents raised exclusively in rural environments have a larger hippocampus and better spatial processing than children exclusively raised in cities. Other research demonstrated that spending just an hour in the forest led to a decline in amygdala activity in adults, whereas it remained stable after walking in an urban setting, underscoring the salutogenic effects on brain regions related to stress. There is also evidence from a 10-year longitudinal study of more than 2 million Welsh adults that highlights the value of proximity to green or blue (eg, lakes and rivers) spaces and common mental health conditions, with every additional 360 meters to the nearest green or blue space associated with 10% greater odds of anxiety and depression.
Dr. Bird said there has been a massive sea change in attitudes among general practitioners, who have come around to embracing the concept of nature as medicine. This shift among peers, who teased him in the 1990s about his green walking and conservation prescriptions, portends a bandwagon of epic proportions that could benefit patients. He said that he was especially hopeful that green prescriptions will become mainstream in certain conditions, especially those like depression and anxiety that are resistant to medication.
But Dr. Bird cautions that primary care professionals need to be mindful. “Patients need to know that it’s real science, otherwise they’ll think that they’re being pawned off or dismissed,” he said. “I try to put real evidence behind it and explain that there’s no contraindication. The main thing is to start where patients are, what they’re feeling, and what they need. Some people just don’t like nature,” he said.
A version of this article appeared on Medscape.com.
What if a walk in a green environment could reshape brains, recalibrate sense of time, and stave off mental health conditions? If the research trends are true, you might soon find yourself writing prescriptions of 20 minutes of nature per day.
In the wake of the pandemic, the British government allocated more than £5 million to pandemic recovery efforts that specifically involved green spaces. Since then, it has committed even more funding toward an expansive social prescribing program that connects patients to “link workers” who determine personal care needs and facilitate community and volunteer-based interventions. These can include group walking and volunteering to help out in community gardens or conservation efforts. Similar green programs can be found in Japan, where shinrin-yoku (forest bathing) was recently adopted as a national health strategy, and in the United States and Canada.
“Disconnection from nature is a major part of the health problems that we have on this planet,” said William Bird, a UK-based general practitioner, green prescriber, and CEO of Intelligent Health, which is geared toward building healthy, active, and connected communities. Dr. Bird received the prestigious Member of the Order of the British Empire (MBE) in 2010 for services related to physical activity and health.
“Our brains are designed to connect to nature ... and we haven’t lost that instinct,” he explained. “Once we are with birdsong and water flowing and greenery, cortisol levels drop, our central vagus nerve improves, our fight and flight [response] disappears, and we start to be more receptive to other people.”
Shifting Time Perception and Health
Ricardo A. Correia, PhD, a biologist and researcher at the University of Helsinki in Finland, said he believed that the mechanism for at least some of these outcomes might be differences in how time is perceived. In a perspective that appeared in March in People and Nature, Dr. Correia explored how the “services” that nature provides shift time perceptions and, in turn, regulate overall well-being.
“I reached the realization that there was some evidence for the shift in some of the dimensions that we use to make sense of time in urban vs natural environments,” he told this news organization.
Dr. Correia explained that human time perception facilitates understanding cause and effect, so we can act in a way that allows us to survive.
“Time perception in humans is really complex and multifaceted,” he said. “The way that we make sense of time is not directly attached to any sensory organ, but rather goes through a range of cognitive, emotional, and bodily processes, all of which vary from person to person.”
Dr. Correia pointed to evidence showing that time perception is shorter in urban environments and longer in natural ones. This, in turn, influences attention and attention restoration. “When we live in cities, we are exposed to similar sorts of demanding environments, increased time pressures, less time for oneself and for recreational purposes,” he said. “Ever-mounting pressure on daily demands plus processes we use to make sense of time, especially attention, means that we pay a cognitive toll.”
Dr. Correia posits that it might be possible to recalibrate time perception, but only by breaking the cycle of exposure.
“If we are always exposed to fast-paced lifestyles, we become attuned to them and get caught up in an endless loop.” This cycle can be broken, Dr. Correia explained, by increasing exposure to natural environments. This leads to positive emotions, a sense of being in the present, and a heightened sense of mindfulness, all of which help mitigate the physical and mental health outcomes commonly associated with time scarcity.
Brain-Mental Health Benefits
To date, there is quite a bit of research exploring the impacts of exposure to nature on the brain. For example, data have shown that adolescents raised exclusively in rural environments have a larger hippocampus and better spatial processing than children exclusively raised in cities. Other research demonstrated that spending just an hour in the forest led to a decline in amygdala activity in adults, whereas it remained stable after walking in an urban setting, underscoring the salutogenic effects on brain regions related to stress. There is also evidence from a 10-year longitudinal study of more than 2 million Welsh adults that highlights the value of proximity to green or blue (eg, lakes and rivers) spaces and common mental health conditions, with every additional 360 meters to the nearest green or blue space associated with 10% greater odds of anxiety and depression.
Dr. Bird said there has been a massive sea change in attitudes among general practitioners, who have come around to embracing the concept of nature as medicine. This shift among peers, who teased him in the 1990s about his green walking and conservation prescriptions, portends a bandwagon of epic proportions that could benefit patients. He said that he was especially hopeful that green prescriptions will become mainstream in certain conditions, especially those like depression and anxiety that are resistant to medication.
But Dr. Bird cautions that primary care professionals need to be mindful. “Patients need to know that it’s real science, otherwise they’ll think that they’re being pawned off or dismissed,” he said. “I try to put real evidence behind it and explain that there’s no contraindication. The main thing is to start where patients are, what they’re feeling, and what they need. Some people just don’t like nature,” he said.
A version of this article appeared on Medscape.com.
Why We Need to Know About Our Patients’ History of Trauma
This case is a little out of the ordinary, but we would love to find out how readers would handle it.
Diana is a 51-year-old woman with a history of depression, obesity, hypertension, type 2 diabetes, and coronary artery disease. She has come in for a routine visit for her chronic illnesses. She seems very distant and has a flat affect during the initial interview. When you ask about any recent stressful events, she begins crying and explains that her daughter was just deported, leaving behind a child and boyfriend.
Their country of origin suffers from chronic instability and violence. Diana’s father was murdered there, and Diana was the victim of sexual assault. “I escaped when I was 18, and I tried to never look back. Until now.” Diana is very worried about her daughter’s return to that country. “I don’t want her to have to endure what I have endured.”
You spend some time discussing the patient’s mental health burden and identify a counselor and online resources that might help. You wonder if Diana’s adverse childhood experiences (ACEs) might have contributed to some of her physical illnesses.
ACEs and Adult Health
One of the most pronounced and straightforward links is that between ACEs and depression. In the Southern Community Cohort Study of more than 38,200 US adults, the highest odds ratio between ACEs and chronic disease was for depression. Persons who reported more than three ACEs had about a twofold increase in the risk for depression compared with persons without ACEs. There was a monotonic increase in the risk for depression and other chronic illnesses as the burden of ACEs increased.
In another study from the United Kingdom, each additional ACE was associated with a significant 11% increase in the risk for incident diabetes during adulthood. Researchers found that both depression symptoms and cardiometabolic dysfunction mediated the effects of ACEs in promoting higher rates of diabetes.
Depression and diabetes are significant risk factors for coronary artery disease, so it is not surprising that ACEs are also associated with a higher risk for coronary events. A review by Godoy and colleagues described how ACEs promote neuroendocrine, autonomic, and inflammatory dysfunction, which in turn leads to higher rates of traditional cardiovascular risk factors such as diabetes and obesity. Ultimately, the presence of four or more ACEs is associated with more than a twofold higher risk for cardiovascular disease compared with no ACEs.
Many of the pathologic processes that promote cardiovascular disease also increase the risk for dementia. Could the reach of ACEs span decades to promote a higher risk for dementia among older adults? A study by Yuan and colleagues of 7222 Chinese adults suggests that the answer is yes. This study divided the cohort into persons with a history of no ACEs, household dysfunction during childhood, or mistreatment during childhood. Child mistreatment was associated with higher rates of diabetes, depression, and cardiovascular disease, as well as an odds ratio of 1.37 (95% CI, 1.12 to 1.68) for cognitive impairment.
The magnitude of the effects ACEs can have on well-being is reinforced by epidemiologic data surrounding ACEs. According to the US Centers for Disease Control and Prevention (CDC), 64% of US adults report at least one ACE and 17% experienced at least four ACEs. Risk factors for ACEs include being female, American Indian or Alaska Native, or unemployed.
How do we reduce the impact of ACEs? Prevention is key. The CDC estimates that nearly 2 million cases of adult heart disease and more than 20 million cases of adult depression could be avoided if ACEs were eliminated.
But what is the best means to pragmatically reduce ACEs in our current practice models? How do we discover a history of ACEs in patients, and what are the best practices in managing persons with a positive history? We will cover these critical subjects in a future article, but for now, please provide your own comments and pearls regarding the prevention and management of ACEs.
Dr. Vega, health sciences clinical professor, family medicine, University of California, Irvine, disclosed ties with GlaxoSmithKline and Johnson and Johnson. Ms. Hurtado, MD candidate, University of California, Irvine School of Medicine, has disclosed no relevant financial relationships.
A version of this article appeared on Medscape.com.
This case is a little out of the ordinary, but we would love to find out how readers would handle it.
Diana is a 51-year-old woman with a history of depression, obesity, hypertension, type 2 diabetes, and coronary artery disease. She has come in for a routine visit for her chronic illnesses. She seems very distant and has a flat affect during the initial interview. When you ask about any recent stressful events, she begins crying and explains that her daughter was just deported, leaving behind a child and boyfriend.
Their country of origin suffers from chronic instability and violence. Diana’s father was murdered there, and Diana was the victim of sexual assault. “I escaped when I was 18, and I tried to never look back. Until now.” Diana is very worried about her daughter’s return to that country. “I don’t want her to have to endure what I have endured.”
You spend some time discussing the patient’s mental health burden and identify a counselor and online resources that might help. You wonder if Diana’s adverse childhood experiences (ACEs) might have contributed to some of her physical illnesses.
ACEs and Adult Health
One of the most pronounced and straightforward links is that between ACEs and depression. In the Southern Community Cohort Study of more than 38,200 US adults, the highest odds ratio between ACEs and chronic disease was for depression. Persons who reported more than three ACEs had about a twofold increase in the risk for depression compared with persons without ACEs. There was a monotonic increase in the risk for depression and other chronic illnesses as the burden of ACEs increased.
In another study from the United Kingdom, each additional ACE was associated with a significant 11% increase in the risk for incident diabetes during adulthood. Researchers found that both depression symptoms and cardiometabolic dysfunction mediated the effects of ACEs in promoting higher rates of diabetes.
Depression and diabetes are significant risk factors for coronary artery disease, so it is not surprising that ACEs are also associated with a higher risk for coronary events. A review by Godoy and colleagues described how ACEs promote neuroendocrine, autonomic, and inflammatory dysfunction, which in turn leads to higher rates of traditional cardiovascular risk factors such as diabetes and obesity. Ultimately, the presence of four or more ACEs is associated with more than a twofold higher risk for cardiovascular disease compared with no ACEs.
Many of the pathologic processes that promote cardiovascular disease also increase the risk for dementia. Could the reach of ACEs span decades to promote a higher risk for dementia among older adults? A study by Yuan and colleagues of 7222 Chinese adults suggests that the answer is yes. This study divided the cohort into persons with a history of no ACEs, household dysfunction during childhood, or mistreatment during childhood. Child mistreatment was associated with higher rates of diabetes, depression, and cardiovascular disease, as well as an odds ratio of 1.37 (95% CI, 1.12 to 1.68) for cognitive impairment.
The magnitude of the effects ACEs can have on well-being is reinforced by epidemiologic data surrounding ACEs. According to the US Centers for Disease Control and Prevention (CDC), 64% of US adults report at least one ACE and 17% experienced at least four ACEs. Risk factors for ACEs include being female, American Indian or Alaska Native, or unemployed.
How do we reduce the impact of ACEs? Prevention is key. The CDC estimates that nearly 2 million cases of adult heart disease and more than 20 million cases of adult depression could be avoided if ACEs were eliminated.
But what is the best means to pragmatically reduce ACEs in our current practice models? How do we discover a history of ACEs in patients, and what are the best practices in managing persons with a positive history? We will cover these critical subjects in a future article, but for now, please provide your own comments and pearls regarding the prevention and management of ACEs.
Dr. Vega, health sciences clinical professor, family medicine, University of California, Irvine, disclosed ties with GlaxoSmithKline and Johnson and Johnson. Ms. Hurtado, MD candidate, University of California, Irvine School of Medicine, has disclosed no relevant financial relationships.
A version of this article appeared on Medscape.com.
This case is a little out of the ordinary, but we would love to find out how readers would handle it.
Diana is a 51-year-old woman with a history of depression, obesity, hypertension, type 2 diabetes, and coronary artery disease. She has come in for a routine visit for her chronic illnesses. She seems very distant and has a flat affect during the initial interview. When you ask about any recent stressful events, she begins crying and explains that her daughter was just deported, leaving behind a child and boyfriend.
Their country of origin suffers from chronic instability and violence. Diana’s father was murdered there, and Diana was the victim of sexual assault. “I escaped when I was 18, and I tried to never look back. Until now.” Diana is very worried about her daughter’s return to that country. “I don’t want her to have to endure what I have endured.”
You spend some time discussing the patient’s mental health burden and identify a counselor and online resources that might help. You wonder if Diana’s adverse childhood experiences (ACEs) might have contributed to some of her physical illnesses.
ACEs and Adult Health
One of the most pronounced and straightforward links is that between ACEs and depression. In the Southern Community Cohort Study of more than 38,200 US adults, the highest odds ratio between ACEs and chronic disease was for depression. Persons who reported more than three ACEs had about a twofold increase in the risk for depression compared with persons without ACEs. There was a monotonic increase in the risk for depression and other chronic illnesses as the burden of ACEs increased.
In another study from the United Kingdom, each additional ACE was associated with a significant 11% increase in the risk for incident diabetes during adulthood. Researchers found that both depression symptoms and cardiometabolic dysfunction mediated the effects of ACEs in promoting higher rates of diabetes.
Depression and diabetes are significant risk factors for coronary artery disease, so it is not surprising that ACEs are also associated with a higher risk for coronary events. A review by Godoy and colleagues described how ACEs promote neuroendocrine, autonomic, and inflammatory dysfunction, which in turn leads to higher rates of traditional cardiovascular risk factors such as diabetes and obesity. Ultimately, the presence of four or more ACEs is associated with more than a twofold higher risk for cardiovascular disease compared with no ACEs.
Many of the pathologic processes that promote cardiovascular disease also increase the risk for dementia. Could the reach of ACEs span decades to promote a higher risk for dementia among older adults? A study by Yuan and colleagues of 7222 Chinese adults suggests that the answer is yes. This study divided the cohort into persons with a history of no ACEs, household dysfunction during childhood, or mistreatment during childhood. Child mistreatment was associated with higher rates of diabetes, depression, and cardiovascular disease, as well as an odds ratio of 1.37 (95% CI, 1.12 to 1.68) for cognitive impairment.
The magnitude of the effects ACEs can have on well-being is reinforced by epidemiologic data surrounding ACEs. According to the US Centers for Disease Control and Prevention (CDC), 64% of US adults report at least one ACE and 17% experienced at least four ACEs. Risk factors for ACEs include being female, American Indian or Alaska Native, or unemployed.
How do we reduce the impact of ACEs? Prevention is key. The CDC estimates that nearly 2 million cases of adult heart disease and more than 20 million cases of adult depression could be avoided if ACEs were eliminated.
But what is the best means to pragmatically reduce ACEs in our current practice models? How do we discover a history of ACEs in patients, and what are the best practices in managing persons with a positive history? We will cover these critical subjects in a future article, but for now, please provide your own comments and pearls regarding the prevention and management of ACEs.
Dr. Vega, health sciences clinical professor, family medicine, University of California, Irvine, disclosed ties with GlaxoSmithKline and Johnson and Johnson. Ms. Hurtado, MD candidate, University of California, Irvine School of Medicine, has disclosed no relevant financial relationships.
A version of this article appeared on Medscape.com.
Single Session Mindfulness Intervention Linked to Reduced Depression
TOPLINE:
One session of a telehealth intervention combining mindfulness and compassion significantly lowered self-perceived stress and symptoms of depression and anxiety compared with a waitlist control group, results of a new trial showed.
METHODOLOGY:
- The randomized clinical trial (RCT) included 91 participants aged 18-70 years recruited from the community and the University of Texas at Austin and followed from 2020 to 2021.
- To be included in the trial, participants had to be sheltering at home during the pandemic and endorse loneliness as one of the top issues affecting them.
- Participants were randomized to one of three groups that received single-session online interventions. These included mindfulness-only (MO), mindfulness and compassion (MC), and a waitlist control (WL) group.
- During the compassion component, participants were instructed to focus on a person, place, object, or spiritual figure that evoked feelings of warmth, love, and kindness in them. The primary outcome was self-reported loneliness and secondary outcomes were self-reported stress, depression, and anxiety.
TAKEAWAY:
- At 1-week follow-up, the MC group led to reductions in perceived stress (b = −3.75), anxiety (b = −3.79), and depression (b = −3.01) but not loneliness compared with control individuals.
- Compared with the MO group alone, the MC group had no meaningful differences in perceived depression (b = −1.08) or anxiety (b = −1.50), and the same was true at the 2-week follow-up.
- Researchers speculated that the lack of difference between outcomes in the two mindfulness groups probably meant that the MC group may have only been effective in reducing self-perceived symptoms of stress, anxiety, and depression compared with the control group.
IN PRACTICE:
“This brief single session mindfulness intervention offers an approach that can be easily adopted in a range of contexts. It is important for future research to evaluate this approach with larger samples and to examine whether changes in symptoms are maintained over longer periods of time,” the researchers wrote.
SOURCE:
Mikael Rubin, PhD, of Palo Alto University in Palo Alto, California, led the study, which was published online in PLOS ONE.
LIMITATIONS:
The study was limited by its small sample size and short follow-up period.
DISCLOSURES:
There was no funding listed for the study nor were there any reported disclosures.
A version of this article appeared on Medscape.com.
TOPLINE:
One session of a telehealth intervention combining mindfulness and compassion significantly lowered self-perceived stress and symptoms of depression and anxiety compared with a waitlist control group, results of a new trial showed.
METHODOLOGY:
- The randomized clinical trial (RCT) included 91 participants aged 18-70 years recruited from the community and the University of Texas at Austin and followed from 2020 to 2021.
- To be included in the trial, participants had to be sheltering at home during the pandemic and endorse loneliness as one of the top issues affecting them.
- Participants were randomized to one of three groups that received single-session online interventions. These included mindfulness-only (MO), mindfulness and compassion (MC), and a waitlist control (WL) group.
- During the compassion component, participants were instructed to focus on a person, place, object, or spiritual figure that evoked feelings of warmth, love, and kindness in them. The primary outcome was self-reported loneliness and secondary outcomes were self-reported stress, depression, and anxiety.
TAKEAWAY:
- At 1-week follow-up, the MC group led to reductions in perceived stress (b = −3.75), anxiety (b = −3.79), and depression (b = −3.01) but not loneliness compared with control individuals.
- Compared with the MO group alone, the MC group had no meaningful differences in perceived depression (b = −1.08) or anxiety (b = −1.50), and the same was true at the 2-week follow-up.
- Researchers speculated that the lack of difference between outcomes in the two mindfulness groups probably meant that the MC group may have only been effective in reducing self-perceived symptoms of stress, anxiety, and depression compared with the control group.
IN PRACTICE:
“This brief single session mindfulness intervention offers an approach that can be easily adopted in a range of contexts. It is important for future research to evaluate this approach with larger samples and to examine whether changes in symptoms are maintained over longer periods of time,” the researchers wrote.
SOURCE:
Mikael Rubin, PhD, of Palo Alto University in Palo Alto, California, led the study, which was published online in PLOS ONE.
LIMITATIONS:
The study was limited by its small sample size and short follow-up period.
DISCLOSURES:
There was no funding listed for the study nor were there any reported disclosures.
A version of this article appeared on Medscape.com.
TOPLINE:
One session of a telehealth intervention combining mindfulness and compassion significantly lowered self-perceived stress and symptoms of depression and anxiety compared with a waitlist control group, results of a new trial showed.
METHODOLOGY:
- The randomized clinical trial (RCT) included 91 participants aged 18-70 years recruited from the community and the University of Texas at Austin and followed from 2020 to 2021.
- To be included in the trial, participants had to be sheltering at home during the pandemic and endorse loneliness as one of the top issues affecting them.
- Participants were randomized to one of three groups that received single-session online interventions. These included mindfulness-only (MO), mindfulness and compassion (MC), and a waitlist control (WL) group.
- During the compassion component, participants were instructed to focus on a person, place, object, or spiritual figure that evoked feelings of warmth, love, and kindness in them. The primary outcome was self-reported loneliness and secondary outcomes were self-reported stress, depression, and anxiety.
TAKEAWAY:
- At 1-week follow-up, the MC group led to reductions in perceived stress (b = −3.75), anxiety (b = −3.79), and depression (b = −3.01) but not loneliness compared with control individuals.
- Compared with the MO group alone, the MC group had no meaningful differences in perceived depression (b = −1.08) or anxiety (b = −1.50), and the same was true at the 2-week follow-up.
- Researchers speculated that the lack of difference between outcomes in the two mindfulness groups probably meant that the MC group may have only been effective in reducing self-perceived symptoms of stress, anxiety, and depression compared with the control group.
IN PRACTICE:
“This brief single session mindfulness intervention offers an approach that can be easily adopted in a range of contexts. It is important for future research to evaluate this approach with larger samples and to examine whether changes in symptoms are maintained over longer periods of time,” the researchers wrote.
SOURCE:
Mikael Rubin, PhD, of Palo Alto University in Palo Alto, California, led the study, which was published online in PLOS ONE.
LIMITATIONS:
The study was limited by its small sample size and short follow-up period.
DISCLOSURES:
There was no funding listed for the study nor were there any reported disclosures.
A version of this article appeared on Medscape.com.