A new study published in BioMedical Engineering has revealed that mental health is closely aligned to blood pressure and heart rate variations. The researchers found that mental illness could cause widely fluctuating blood pressure, which can lead to cardiovascular disease and organ damage.
University of South Australia researcher Dr Renly Lim and colleagues said there is clear evidence that mental illness interferes with the body’s autonomic functions, including blood pressure, heart rate, temperature and breathing.
“We reviewed 12 studies on people with anxiety, depression and panic disorders and found that, regardless of age, mental said is significantly associated with greater blood pressure variations during the day,” Dr Lim says.
“We also found that for people who are mentally ill, their heart rate does not adapt to external stressors as it should.
“Contrary to what many people think, a healthy heart is not one that beats like a metronome. Instead, it should adjust to withstand environmental and psychological challenges. A constantly changing heart rate is actually a sign of good health.”
Reduced heart rate variation (HRV) is common in people with mental illness and indicates that the body’s stress response is poor, exacerbating the negative effects of chronic stress.
Unlike normally consistent heart rates, HRV is more complex and is the time between two heartbeats, which should change according to external stressors.
“What we aim for is not a constantly changing heart rate but a high heart rate variation. This is achieved through a healthy diet, exercise, low stress and good mental health.”
Low HRV occurs during ‘fight-or-flight’ mode, or in those who are easily stressed and is common in people with chronic diseases, including cardiovascular and mental health problems.
While large blood pressure variations (BPV) during the day are not ideal, at night the systolic pressure should dip by between 10–20% to allow the heart to rest. People with mental health issues were found to have an insufficient BP drop at night, dropping less than 10%.
The reduced dipping can be caused by many factors, including autonomic dysfunction, poor quality of sleep and disrupted circadian rhythms that regulate the sleep-wake cycle.
“The takeout from this study is that we need to pay more attention to the physical impacts of mental illness,” Dr Lim said.
“It is a major global burden, affecting between 11–18 per cent (one billion) of people worldwide. Since mental illness can contribute to the deterioration of heart and blood pressure regulation, early therapeutic intervention is essential.”
According to research published in Nature Aging, seven hours is the ideal amount of sleep for people in their middle age and upwards, with too little or too much little sleep associated with poorer cognitive performance and mental health.
Sleep plays an important role in enabling cognitive function and maintaining good psychological health, and also removes waste products from the brain. Alterations in sleep patterns appear during ageing, including difficulty falling asleep and staying asleep, and decreased quantity and quality of sleep. It is thought that these sleep disturbances may contribute to cognitive decline and psychiatric disorders in the ageing population.
Scientists from the UK and China examined data from nearly 500 000 adults aged 38–73 years from the UK Biobank. Participants were asked about their sleeping patterns, mental health and wellbeing, and took part in a series of cognitive tests. Brain imaging and genetic data were available for almost 40 000 of the study participants.
The researchers found in their analysis that both insufficient and excessive sleep duration were associated with impaired cognitive performance, such as processing speed, visual attention, memory and problem-solving skills. The optimal amount of sleep was found to be seven hours per night for cognitive performance and good mental health. More symptoms of anxiety and depression and worse overall wellbeing were associated with sleeping for longer or shorter durations.
The researchers say one possible reason for the association between insufficient sleep and cognitive decline may be due to the disruption of slow-wave — ‘deep’ — sleep. Disruption to this type of sleep has been shown to have a close link with memory consolidation as well as the build-up of amyloid — a key protein which, when it misfolds, can cause ‘tangles’ in the brain characteristic of some forms of dementia. Additionally, lack of sleep may hamper the brain’s ability to rid itself of toxins.
The amount of sleep was also linked differences in the structure of brain regions involved in cognitive processing and memory, again with greater changes associated with greater than or less than seven hours of sleep.
Consistently getting seven hours’ sleep each night was also important to cognitive performance and good mental health and wellbeing. Interrupted sleep patterns have previously been shown to be associated with increased inflammation, indicating a susceptibility to age-related diseases in older people.
Professor Jianfeng Feng from Fudan University in China said: “While we can’t say conclusively that too little or too much sleep causes cognitive problems, our analysis looking at individuals over a longer period of time appears to support this idea. But the reasons why older people have poorer sleep appear to be complex, influenced by a combination of our genetic makeup and the structure of our brains.”
The researchers say the findings suggest that insufficient or excessive sleep duration may be a risk factor for cognitive decline in ageing. This is supported by previous studies that have reported a link between sleep duration and the risk of developing Alzheimer’s disease and dementia, in which cognitive decline is a hallmark symptom.
Professor Barbara Sahakian from the Department of Psychiatry at the University of Cambridge, one of the study’s authors, said: “Getting a good night’s sleep is important at all stages of life, but particularly as we age. Finding ways to improve sleep for older people could be crucial to helping them maintain good mental health and wellbeing and avoiding cognitive decline, particularly for patients with psychiatric disorders and dementias.”
Over time, antidepressant use is not associated with significantly better health-related quality of life, compared to people with depression who do not take the drugs, according to a new study reported in PLOS ONE.
Depression disorder is known to have a significant impact on the health-related quality of life (HRQoL) of patients. While studies have shown the efficacy of antidepressant medications for treatment of depression disorder, these medications’ effect on patients’ overall well-being and HRQoL remains controversial.
Researchers used data on adult patients with depression drawn from the 2005-2015 United States’ Medical Expenditures Panel Survey (MEPS), a large longitudinal study that tracks the health services that Americans use. There were 17.47 million adult patients diagnosed with depression each year over the study, with two years of follow-up, and 57.6% of these received treatment with antidepressant medications.
Use of antidepressants was associated with some improvement on the mental component of SF-12 – the survey tracking health-related quality of life. However, when this positive change was compared to the change in group of people who were diagnosed with depressive disorder but did not take antidepressants, there was no statistically significant association of antidepressants with either the physical (p=0.9595) or mental (p=0.6405) component of SF-12. In other words, the change in quality of life seen among those on antidepressants over two years was not significantly different from that seen among those not taking the drugs.
The study was not able to separately analyse any subtypes or varying severities of depression. Future studies should investigate the use of non-pharmacological depression interventions used in combination with antidepressants, said the researchers.
The authors noted that, “Although we still need our patients with depression to continue using their antidepressant medications, long-term studies evaluating the actual impact for pharmacological and non-pharmacological interventions on these patients’ quality of life is needed. With that being said, the role of cognitive and behavioural interventions on the long term-management of depression needs to be further evaluated in an effort to improve the ultimate goal of care for these patients; improving their overall quality of life.”
University students who put a lot of pressure on themselves to be the best at everything, known as the ‘superhero ideal’, have been hit especially hard by the pandemic. Recent research has shown that by developing authentic and healthy relationships, young people can fight the depressive symptoms associated with this superhero ideal.
The ‘superhero ideal’ was based off the ‘superwoman ideal‘, which is a construct has its origins in the 1960s feminist movement where women could ‘do it all and have it all’. In an article published in Acta Psychologica, Sally A. Theran, associate professor of psychology at Wellesley College and co-author Halina Dour, explain that internalising the superhero ideal is directly related to an increase in depressive symptoms.
“No matter how much we try to deemphasise achievement and success to college-age students and encourage them to work on their own intrinsic motivation and well-being, kids are internalising this message that they feel pressure to achieve,” said A/Prof Theran, who finds in her day-to-day interactions, in addition to her research, that many of her students feel they “have to be superheroes.”
One way for students to combat the effects of the superhero ideal is to cultivate authentic relationships with peers, parents, and educators, according to the study authors They define an authentic relationship as one in which a person feels able to be honest about who they are with someone else. That does not necessarily mean acting the same way around everyone they know – a student will act differently around a teacher than a friend – but rather that in each of those interactions the person feels they are being true to themselves.
To gauge the authenticity of a relationship, A/Prof Theran said, students can ask themselves, “Does this person make me feel good? Do I feel like I can be myself around this person?”
A/Prof Theran and her team found that students who had authentic relationships were able to partially mediate the relationship between the superhero ideal and depressive symptoms. Specifically, the link between superhero ideal and depressive symptoms is in part due to the lack of authenticity in these adolescents’ relationships. The more the superhero ideal was internalised, the less the authenticity there was with parents and peers. Lower levels of authenticity with parents and peers were associated with more depressive symptoms. Thus, authenticity in relationships is part of the mechanism for explaining the significant relation between the superhero ideal and depressive symptoms.
“In college you are more able to have a shift of self,” A/Prof Theran said. “‘Is this who I am? Is this what I want?’ And you may end up having an identity crisis, but that’s really healthy, in order to figure out who you are.” A/Prof Theran particularly sees this in students who have recently started at university. They are often trying to work out what they want to put effort into and care about, rather than going along with what parents and teachers wanted. The way out of such a crisis, according to A/Prof Theran, is for them to find people, like peers, teachers, parents, around whom they can be their true selves. Being honest about their achievements, failures, and even confusion is one way to go about building such authentic relationships.
A/Prof Theran uses this skill in her own classroom, telling her students when she has a paper rejected, for example, or doesn’t get a grant for which she had applied. “If you are not robotic with your students, then they will genuinely be themselves, too,” she said, “and then hopefully they are less likely to feel such superhero pressure in class and in other areas.” A/Prof Theran said that awareness of both the external and internal pressures on students to achieve is especially important now as adolescents consume social media even more in the pandemic, often unfavourably comparing their ‘worst’ selves with someone else’s filtered online self. Parents can help, A/Prof Theran said, by pointing out the use of filters and angles, and reminding them that someone is posting one curated minute of their day, not their whole self. “Encourage your teen to consider, how authentic are people being in their online presentation? And when people espouse authenticity online, it does not mean that they are actually being their true self,” she said. “The very nature of social media encourages internalisation of the superhero ideal while discouraging authenticity, but bolstering authenticity and critical thinking skills can help combat the negative repercussions of the superhero ideal.”
A/Prof Theran has studied authenticity in relationships for 20 years. She recently co-authored a paper on the ways authentic and empowered friendships among female university students can act as a buffer between childhood emotional and physical abuse and subsequent traumatic symptoms while in university. Another paper explored the roles of authentic relationships in adolescents’ prosocial experiences, which are positive aspects of being around peers. In adolescents with low levels of secure attachments, prosocial experiences increased as their level of authenticity with peers increased, A/Prof Theran found.
“The pandemic really made clear how much relationships mean to us,” said A/Prof Theran. “We feel empowered by our friendships. Reaching out and connecting with others can improve our well-being so much.”
Girls and boys might be more vulnerable to the negative effects of social media use at different times during their adolescence, according to a study in Nature Communications. Girls were found to experience a negative link between social media use and life satisfaction when they are 11–13 years old and boys when they are 14–15 years old. Increased social media use again predicts lower life satisfaction at age 19 years. At other times the link was not statistically significant.
Since its rapid emergence over a decade ago, social media has prompted concern over its possible impacts on wellbeing, especially in younger people.
A team of researchers analysed two UK datasets which included longitudinal data on 17 400 young people aged 10–21 years old. The team looked for a connection between estimated social media use and reported life satisfaction and found key periods of adolescence where social media use was associated with a decrease in life satisfaction 12 months later. Working backwards, the researchers also found that teens who have lower than average life satisfaction use more social media one year later.
In girls, social media use between ages 11 and 13 was associated with a drop in life satisfaction one year later, whereas in boys this occurred between 14 and 15. This suggests that sensitivity to social media use could be linked to developmental changes, possibly changes in the structure of the brain, or to puberty, which occurs later in boys than in girls.
In both females and males, social media use at the age of 19 years was again associated with a decrease in life satisfaction a year later. The researchers suggest that that social changes at this age, such as leaving home, may make people particularly vulnerable.
At other times, the link between social media use and life satisfaction one year later was not statistically significant. Decreases in life satisfaction also predicted increases in social media use one year later; however this does not change across age and or differ between the sexes.
Dr. Amy Orben, the study leader, said: “The link between social media use and mental wellbeing is clearly very complex. Changes within our bodies, such as brain development and puberty, and in our social circumstances appear to make us vulnerable at particular times of our lives.”
Professor Sarah-Jayne Blakemore, a co-author of the study, said: “It’s not possible to pinpoint the precise processes that underlie this vulnerability. Adolescence is a time of cognitive, biological and social change, all of which are intertwined, making it difficult to disentangle one factor from another. For example, it is not yet clear what might be due to developmental changes in hormones or the brain and what might be down to how an individual interacts with their peers.”
Dr. Orben added: “With our findings, rather than debating whether or not the link exists, we can now focus on the periods of our adolescence where we now know we might be most at risk and use this as a springboard to explore some of the really interesting questions.”
A further complication is that social media use can negatively impact wellbeing, but also the reverse is true, previously reported and confirmed by this study.
The researchers stress that these population-level findings do not predict which individuals are most vulnerable.
Professor Rogier Kievit said: “Our statistical modeling examines averages. This means not every young person is going to experience a negative impact on their wellbeing from social media use. For some, it will often have a positive impact. Some might use social media to connect with friends, or cope with a certain problem or because they don’t have anyone to talk to about a particular problem or how they feel—for these individuals, social media can provide valuable support.”
Professor Andrew Przybylski said: “To pinpoint which individuals might be influenced by social media, more research is needed that combines objective behavioural data with biological and cognitive measurements of development. We therefore call on social media companies and other online platforms to do more to share their data with independent scientists, and, if they are unwilling, for governments to show they are serious about tackling online harms by introducing legislation to compel these companies to be more open.”
Researchers have identified the fast-acting dissociative anaesthetic ketamine has significant potential as a treatment for mental health conditions. First manufactured more than 50 years ago, ketamine is often used in veterinary and emergency medicine. It also has a history of being an illicit party drug.
In a recent study published in the British Journal of Psychiatry, the research team found ketamine to have significant anti-depressant and anti-suicidal effects. They also found evidence that even more benefits.
Led by Psychology Professor Dr Zach Walsh and doctoral student Joey Rootman, the research team arrived at this conclusion after analysing more than 150 worldwide studies on the effects of sub-anaesthetic ketamine doses for the treatment of mental illness.
“We found strong evidence that indicates ketamine provides rapid and robust anti-depressant and anti-suicidal effects, but the effects were relatively short-lived,” explained Rootman. “However, repeated dosing appeared to have the potential to increase the duration of positive effects.”
The study also provides limited evidence to suggest a possible use for ketamine in the treatment of other disorders, such as eating disorders, problematic substance use, post-traumatic stress and anxiety.
“What our research provides is an up-to-date overview and synthesis of where the knowledge on ketamine is at right now,” said Rootman. “Our results signal that ketamine may indeed have a broader spectrum of potential applications in psychiatric treatment—and that tells us that more investigation is needed.”
This study serves as a foundation for fellow researchers looking to design ketamine-related projects and offers valuable data for clinicians considering using ketamine with their patients.
The results also help to satisfy the public’s appetite for information on innovative and emerging psychiatric treatments, said Dr Walsh, explaining that the review provides a relatively compact document with evidence regarding which ketamine treatments may be helpful for diverse diagnoses.
With many people experiencing mental health disorders, Dr Walsh said that “the reality is that existing treatments don’t work for everyone. As a result, many Canadians are curious about new approaches to help with these serious conditions.”
Overall, while Dr Walsh acknowledges research into other treatment areas is just beginning, he finds the preliminary evidence encouraging.
“We need a lot more information on how these interventions could work – for example, administering the drug is only a part of treatment. We need to figure out what amount and type of psychotherapy would best compliment the drug intervention to really maximise potential benefits,” he explained. “With that being said, it is a truly exciting time for ketamine research. If it can deliver the relief that early evidence suggests it can, this could be among the most significant developments in mental health treatment in decades.”
As the US state of Oregon becomes the first to permit psilocybin in clinical use, a new systematic evidence review reveals a lack of scientific research describing the interactions between widely used psychiatric medications and psychedelics like psilocybin and MDMA. The review was published in the journal Psychopharmacology.
The scarcity of data is problematic for people believed to benefit most from psychedelics: those with mental health conditions such as depression, anxiety and post-traumatic stress disorder.
“There’s a huge deficit in the scientific literature,” said lead author Aryan Sarparast, MD, assistant professor of psychiatry at the Oregon Health and Science University. “There’s a major incongruence between the public enthusiasm and exuberance with psychedelic substances for mental health issues – and what happens when they combine with the existing mental health treatments that we have now.”
The researchers decided to conduct the evidence review because they wanted to learn more about interactions between widely prescribed medications such as antidepressants and psychedelics, including MDMA and psilocybin.
They found a total of 40 studies dating back to 1958, including 26 from randomised controlled studies, 11 case reports and three epidemiologic studies.
Only one study was found that examined how psilocybin interacts with antidepressant medications. A/Prof Sarparast also noted that all of the clinical trials were conducted with healthy volunteers who were administered a psychiatric medication and a psychedelic at the same time – clearly showing a need for further research into combining pharmaceutical medications with psilocybin.
A/Prof Sarparast said he is concerned that the lack of evidence will lead many providers to direct patients to taper off existing medications before being offered clinical psilocybin therapy. In Oregon rules are being drawn up to permit the clinical use of psilocybin products and services from next year.
Patients with mental health conditions might well benefit from psilocybin therapy, but A/Prof Sarparast said he is concerned about the implications of stopping existing psychiatric treatment in order to receive psilocybin services. Vulnerable people may end up being forced into choosing between their existing medical treatment or psilocybin services.
“That’s a very, very tough place to be,” A/Prof Sarparast said.
A considerable amount of important data exists that is not captured in a literature review related to real-world use, noted co-author Christopher Stauffer, MD, assistant professor of psychiatry in the OHSU School of Medicine and a physician-scientist at the VA Portland Health Care System.
“Psilocybin has been around in Western society since the late 1950s, before many of our psychiatric medications have existed,” A/Prof Stauffer said. “Nonetheless, people attempting to navigate Oregon’s psilocybin services in the context of ongoing psychiatric treatment should work closely with knowledgeable professionals.”
In a study examining the perception of emotion in romantic relationships, researchers found that, regardless of how an individual is truly feeling, knowing their partner sees their emotions as a typical reaction to a given situation might lead to better relations between the couple, especially when conflict arises.
To find out how emotional meta-accuracy – the ability to correctly understand a romantic partner’s impressions of the self – impacted momentary relationship quality, the researchers surveyed 189 romantic couples. The couples were mostly heterosexual, average age 23 and were recruited from around the university campus. The researchers asked their subjects to engage in three different types of interactions: couples were asked to engage in a neutral unstructured conversation; then, they were asked to talk about something they disagreed on; finally, they engaged in a positive conversation. They were then surveyed on their own emotions and their partners’ perception of their emotions.
“We were interested in understanding how our beliefs about how we are seen by others affects the quality of our relationships,” said Hasagani Tissera, a PhD candidate and lead author on the paper.
“No matter why you are feeling a certain way, interactions within a couple are likely to be more positive when you know your romantic partner sees your emotions as similar to how a typical person would feel in a given situation,” Tissera said.
The researchers found that, overall, couples were better able to cope with conflict when they knew how their partner perceived their emotions.
Furthermore, the study suggests that “…to remain blissfully unaware of [your partner’s] unique impressions…” may lead to better momentary relationship quality. “Or, to put it differently, if you know your romantic partner sees you’re angry because of a reason that’s unique to your experience and not based on how the average person might feel, chances are it will hurt your relationship – at least in that moment,” Tissera said. The findings were published in the journal Personal and Social Psychology Bulletin.
Helping people feel better about how they are ageing could result in real improvements in health and well-being later on, according to research from the University of British Columbia which was published in JAMA Network Open.
Over a four-year period, researchers tracked changes in how participants felt about their own ageing, then looked for measurable changes in health and well-being after another four years had passed. Those participants whose attitudes had improved over the first four years were more likely to have measurable health improvements in the next four years.
“Prior research has looked at how psychological risk factors like depression and stress might adversely influence health and well-being outcomes, but we are interested in factors that might positively influence health and well-being outcomes,” said Julia Nakamura, a graduate student in UBC’s department of psychology and first author of the study. “With further research, our findings suggest that interventions to increase aging satisfaction might improve the health and well-being of our rapidly growing older adult population.”
Health and well-being are gaining favor as indicators of societal progress, over pure economic indicators. Governments and intergovernmental organisations have recognised that using gross domestic product as the primary measure of success can lead to policies that devalue environmental, psychological and social health. Increasingly, they are looking for more holistic ways to measure societal well-being.
In this study, more than 13 000 adults over age 50 contributed data through the Health and Retirement Study in the U.S. between 2008 and 2018. The research team analysed participants’ data at three separate intervals, four years apart.
At the first interval, the researchers recorded initial measures of health and well-being. They also captured aging satisfaction through participants’ responses to statements such as:
Things keep getting worse as I get older.
I am as happy now as I was when I was younger.
The older I get, the more useless I feel.
At the second interval, they assessed ageing satisfaction again.
At the third and final interval, they measured how health and well-being measures had changed four years after the second measurement of aging satisfaction.
Of the 35 outcomes they measured, 27 had improved in association with improved aging satisfaction four years earlier. Decreases in ageing satisfaction from the first to second interval were associated with worsening health and well-being outcomes by the third interval.
The order in which these measurements were taken is important. People in better health could be expected to have more positive attitudes about ageing than those with health problems, but this analysis in fact showed that increases in ageing satisfaction clearly preceded improvements in health and well-being.
“Interventions that make people feel better about aging could potentially produce concrete benefits,” said Nakamura. “Those interventions could come at both the individual level and the broader, societal level. At the societal level, combating ageism and reducing harmful stereotypes about aging are potential paths to improving individual aging satisfaction. If a person thinks ageing is destined to be a negative experience, that might become a self-fulfilling prophecy.”
Having a spinal cord injury increases risk of developing mental health conditions such as depression and anxiety by nearly 80% compared to those without the traumatic injury, a new study shows. However, chronic pain may have an equally large, negative effect on mental health.
The study, published in Spinal Cord, compared private insurance claims from more than 9000 adults with a traumatic spinal cord injury with those of more than 1 million without. Researchers accounted for a range of psychological conditions, from anxiety and mood disorders to insomnia and dementia.
People living with a spinal cord injury had a diagnosis of a mental health condition more often than those without – 59.1% versus 30.9%. While depression and adverse mental health effects are not inevitable consequences of every traumatic spinal injury, previous studies have consistently echoed higher levels of psychological morbidity among this group than the general population without spinal cord injuries.
However, this study found that chronic centralised and neuropathic pain among adults living with a spinal cord injury were robustly associated with post-traumatic stress disorder, substance use disorders and other mental health conditions. In most cases, chronic pain was an even greater influence on these conditions than exposure to living with the injury itself.
The study authors said the findings should prompt physicians to identify mental health conditions when seeing patients with spinal cord injuries and refer them for treatment.
“Improved clinical efforts are needed to facilitate screening of, and early treatment for, both chronic pain and psychological health in this higher-risk population,” said lead author Dr Mark Peterson, associate professor of physical medicine and rehabilitation at Michigan Medicine.
However, researchers note a lack of insurance coverage and limited available services will likely cause the issue to remain largely unaddressed.
“Stakeholders need to work together to lobby for more federal research funding and special policy amendments to ensure adequate and long-term insurance coverage for both physical and mental health to meet the needs of folks living with spinal cord injuries,” Dr Peterson said.