Holiday Suicide Myth Debunked

One of the goals of this blog is to provide evidence-based information about adolescent mental health. Scientific evidence helps us confirm truths and debunk myths. A recent BBC article looked at some Christmas myths debunked by the British Medical Journal. One of the myths the BMJ busted is the belief that suicides are more common during the holiday season and winter months.

"The combined stresses of family dysfunction, exacerbations in loneliness, and more depression over the cold dark winter months are commonly thought to increase the number of suicides," said Dr Vreeman. But, although the holidays may be difficult for some, there is no good evidence to suggest a peak in suicides. Also people are not more likely to commit suicide in the dark winter months - around the world suicides peak in warmer months, the researchers said.

Some of the other myths debunked in the article were: there's no cure for a hangover, eating late does not make you gain weight, and sugar doesn't make you hyperactive.

 ~ D. Venn

Child and Adolescent Mental Health Services Review: Why Understanding First Onset is Important

Medical News Today, in mid-November carried a short story on the recently released Child and Adolescent Mental Health Services (UK)review.

The report, which contains 20 recommendations for Government, sets out a clear vision for how we can all take responsibility for promoting children’s psychological well-being and mental health and how we can best achieve a step change in the quality and consistency of services at all levels.

While there is much in this review to discuss – some excellent and some less so, I want to focus on one of the recommendations that addresses, (in part at least), the needs of youth – ages 18 to 25. Congratulations – and it’s about time!

I remember sitting as a member of what was called the Transitional Age Task Force in Toronto in the mid 1980’s (so the UK report is only 20 years later – but at least they got to it which is more than I can say for much of Canada) and working with various stakeholders to consider how to address the mental health care needs of youth in this age group.

At that time the research was just coming in, and it was showing that the majority of what had traditionally been considered to be “adult” mental disorders actually onset during the late teens and early twenties. Furthermore, nascent brain development research was identifying substantial neurodevelopmental processes underway during those years – problems or perturbations in which (such as defective pruning of dopamine receptors) was being linked to major illnesses such as schizophrenia and bipolar disorder. Indeed, we re-designed our “adolescent psychiatry unit” at Sunnybrook Hospital to address this age group and did not know that we were in the vanguard of the “first onset” movement.

So if such a high proportion of major mental disorders (for example: depression; panic disorder, social anxiety disorder; bipolar disorder; schizophrenia) onset during these years, why have we not designed services to meet these needs. On the contrary, traditional mental health services have hacked a gap between child and adult systems just when the need for continuity and integrative care was most necessary. Why do child mental health systems across Canada cut off around 17 – 18 years of age? What reason is there to send a young person with unique developmental needs who is struggling from the impact of a recent onset major mental illness to an “adult” program that is not designed to meet her or his needs? It simply makes no sense!

And, just before we get too complacent about this and say something silly such as “the research is only just coming in” let's remind ourselves that the ancient Greeks had already noted this. So did the father of modern psychiatry Emil Kraepelin and the father of the study of adolescence – George Stanley Hall (the later two over 100 years ago – the Greeks of course were on to this centuries ago).

Whatever the reasons, and they would be speculations, it's time now to throw out a system that does not meet the mental health needs of young people and replace it with one that does. The CAMHS review is a good start at the policy level. There are good pilot programs in Canada and in Australia under the leadership of Dr. Patrick Mcgrory there is a national initiative well underway.

I propose that we have a national forum on this topic – and invite some international leaders and some of the young people that we had the privilege to serve in Toronto some 20 years ago and some of the young people that we are not serving well now. Perhaps now is the time.

~ Dr. Stan Kutcher

The Complexity of Youth Suicide and Prevention

There's a lot of misinformation out there about youth suicide. Suicide rates in young people nationally have decreased by about 20% from the mid 1990’s to 2004. Nova Scotia is a good case study. It is difficult to determine trends in youth suicide in Nova Scotia because of the small numbers involved, but total suicide rates as well as total suicide attempts in this province have decreased substantially between 1995 and 2004.

Why this has occurred is not clear. One explanation is that effective treatment of depression in young people may be an important factor. Studies have demonstrated a strong relationship between increased use of antidepressant medications and decreased suicide rates in youth. Evidence shows that both medications and psychological therapies decrease rates of suicide attempts in depressed youth. Recent research reports in both Canada and the USA indicate that when anti- depressant medication treatment in young people has decreased, suicide rates have increased. Treatment of depression in young people may effectively reduce suicide rates. 

Suicide behaviour is complex. Not all self-harm behaviours are suicide attempts. Self-harm behaviour in young people may not be related to suicide, but rather to deficient problem solving strategies, difficulties with emotional control or impulsivity. It is only recently that we have understood the need to differentiate the two in how we collect data. Treatment for young people who demonstrate self-harm behaviours may be different than treatments for youth who attempt suicide.

Self-harm behaviours reflect many mental disturbances and may be an important vehicle by which young people can access emergency care. Thus, increases in self-harm emergency visits may not reflect an increase in suicide as has been erroneously suggested, but may reflect other phenomenon such as: greater parental awareness of the importance of immediately addressing these behaviors; difficulty in access to specialty mental health services; inadequate delivery of child and adolescent mental health care in primary care; inadequacies in the capability to provide early identification and interventions for youth at risk for mental disorders; or others.

Suicide in young people is a complex problem that requires thoughtful, evidence-driven approaches to appropriately address. It is also an emotional issue raising substantial concern amongst parents, youth, care providers, policy makers and the public alike. There are some interventions that we know work to decrease suicide rates in young people.

One of the most important is improving the early identification and effective treatment of depression in youth. This includes enhancing the competencies of primary health care providers (doctors, nurses, social workers, psychologists, etc) in the diagnosis and treatment of adolescent depression. Training programs for school personnel including “gatekeeper” programs for teachers and linkages between schools and health providers to facilitate identification, rapid assessment and effective treatment may also decrease youth suicide. Restriction of access to lethal means (such as bridge barriers) is helpful as is reasonable and informed media reporting.

Youth suicide is an important public health problem. We must work together to better understand it and to apply what we know works. We need to avoid inciting public anxiety through media reports that are not based on a solid understanding of the issue and we need to support the further development of easily accessible and effective mental health care – not just in hospitals but in schools and community settings. We need to do the right thing – not just do something!

~ Dr. Stan Kutcher

Myths about Mental Illness

In the past decade we've come a long way in understanding mental illness, but we still have far to go. Dispelling myths about mental illness is one important step. Stigma about mental illness is still largely present in our social structures and institutions – including our health, social services, education and justice sectors. An October article in Canadian Living explored ten common myths about mental illness. 

One of the myths focused on children and adolescents:

Myth: Children don't get depression or other mental illnesses; their emotional problems are just part of growing up. Parents naturally want their children to do well, so some may brush off or explain away behavioural problems or other childhood difficulties as being mere growing pains. However, numerous psychiatric conditions, including depression, eating disorders, obsessive compulsive disorder and anxiety disorders, can and do occur in childhood, according to Kutcher. The U.S. Center for Mental Health Service reports that one in every 33 kids and one in every eight teens suffers from depression – and that's just one disorder.

Enhancing our knowledge and understanding about mental illness is one of the best ways to dispel these myths. ~ D. Venn

Evidence-Based Medicine and You

Evidence-based medicine (EBM) is a term that has become widely used in health care settings. But, what exactly is EBM and what does it mean for you?

EBM is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”. The “best evidence” comes from the more than 20,000 scientific research studies that are published every year, and “patient care” involves everything from diagnosis to treatment.

EBM is not just a recipe for treatment (e.g. every 15 year-old male with depression is not automatically prescribed the same medication). It is a methodical approach to patient care that is comprised of three components: the scientific evidence, the expertise of your health provider(s), and you.

EBM “integrates the best external evidence with individual clinical expertise and patients’ choice”  to ensure that patients receive the treatment that best meets their needs. Evidence-based medicine goes beyond treatments. It also applies to how patients are assessed, diagnosed, monitored, and followed over time.

When we are unwell, it is often difficult to tell what has caused the problem and what can best help. Imagine that you are ill for a few days with a sore throat and cough. When your condition improves, you might wonder what made you feel better. Was it the bedrest, the cold medication, the chicken soup, or was it simply giving your body enough time to fight off the illness? And what if your friend gave you a “secret remedy” made from milk, cognac and grass? Is that why you feel better?

Before you spend time and money on a treatment, you might have a lot of questions. You might want the best information about whether the treatment works, how well it works compared to other treatments and what possible problems can result from the treatment. You should be aware of possible problems (such as the types of side effects that might
happen, the cost of the treatment and the difficulties in taking the treatment) that may occur when you and your health care provider are deciding which treatment you should have.

The ultimate goal of EBM is to help patients receive the treatment that is most appropriate for them. This means finding a balance between the scientific evidence, the patient’s values and the experience of their health provider(s).

Remember, people can respond differently to any given treatment, so it is impossible to know exactly how you may respond. However, at least you can know what the chances are that you might be helped or harmed by a given treatment. This can help you, your doctor and other health providers come to a better decision about what treatment is right for you.

To help understand evidence-based medicine the Chair has developed a guide for patients. Feel free to download it from our website and use it to help you make the best decisions about your health care.

A teen version of this guide will be available sometime soon!

~ Dr. Stan Kutcher