Family ties vary with different cultures, with some emphasizing obligation and strong bonds among parents, siblings and extended family members.
Can those ties have further consequences? That's what researchers from San Francisco State University set to find out in a recent study looking at the effect of family obligation on symptoms of depression in Chinese American teens.
Students from two high schools in San Francisco were recruited for the study, with 218 Chinese American adolescents completing surveys to determine their attitudes about family duties and responsibilities, and also their behavior regarding family obligation -- running errands, helping family members, etc. Researchers also gathered information on the students' birth order, gender, number of siblings, and whether or not they were a native of the U.S. or elsewhere. The teens were followed for two years, from age 14 to 16.
Those who engaged in more family obligation behaviors had fewer symptoms of depression, and over time, as behaviors increased, depression symptoms went down. Firstborn children and those with more siblings engaged in more family obligation activities than later-born siblings and those with fewer siblings. Teens not born in the U.S. had stronger attitudes about family obligation than those born here. Researchers also found that although family obligation behaviors decreased over the two years, attitudes about family duty stayed steady. Gender didn't seem to play a role in differences in behavior or attitude.
In the study, which appears in the June issue of the Journal of Family Psychology, the authors write, "There are a number of practical implications for these results. First, programs seeking to promote positive youth development should take cultural background into account. Programs geared toward immigrant youth from cultures where family obligation is central could emphasize youth's collective identity to strengthen ties to their family and culture and, in the process, remind youth of their family obligation."
-- Jeannine Stein
Photo credit: Michael Robinson Chavez / Los Angeles Times
Virtual online games involve chatting with people, performing quests together, forming groups and role-playing. One of the largest surveys of people who play virtual games, however, has found that time spent playing is linked to depression.
Researchers at Northwestern University surveyed 7,000 players of the virtual game EverQuest II. They found that depression levels in the groups ranged from almost 21% in people who didn't play the game that often to more than 30% in those who played a lot. "This could mean that highly active players get more depressed or that depressed people are more likely to be active role players," said the author of the study, Noshir Contractor, a professor of behavioral science.
The study was presented last week at a meeting of the American Assn. for the Advancement of Science. The study also found that many players underestimate the amount of time they spend playing and that women are the most dedicated and satisfied players. Studying people who play virtual games is important, Contractor said. "In many ways it's a microcosm of our existence in the general social world."
Postpartum depression can be a frightening and debilitating illness facing mothers after the birth of a child. Common symptoms include having low energy, problems with memory, withdrawing, changes in diet, and feeling overwhelmed. Some women are reluctant to go on medication, however, especially if they're breast-feeding.
But medication may not be the only remedy. A new study published online recently in the British Medical Journal found that peer counseling sessions may help mothers combat anxiety. Researchers recruited 701 at-risk Canadian women, about half of whom received telephone counseling from a community volunteer who had experienced postpartum depression and went through a four-hour training session. The other half served as a control group and were able to access standard postpartum care that included help from public health nurses, doctors, and community resources such as drop-in clinics (the counseling group also had access to these services).
A number of methods were used to assess women's levels of depression, anxiety and other emotional states, including the Edinburgh Postnatal Depression Scale (probable postnatal depression was defined as a score of more than 12 on the scale, a commonly used evaluation of postpartum depression). Nurses followed up with all study participants at 12 and 24 weeks, but they did not know to which group the women belonged.
At the beginning of the study, led by Cindy-Lee Dennis, a nursing professor at the Bloomberg Faculty of Nursing at the University of Toronto, both groups had similar EPDS scores: 12.5 for the counseling group, and 12.62 for the control. At 12 weeks, however, the counseling group showed an improvement: 14% had a score of more than 12, while in the control group 25% had a score of more than 12. No significant differences were found at 24 weeks, but since this was a prevention trial, those who had severe depression at 12 weeks were referred to a local health department for treatment.
Women in the counseling group were also asked to evaluate their experience; out of 221 who did, more than 80% said they would recommend it to a friend.
The 14 names are so familiar they raise few eyebrows when prescribed -- even when prescribed for uses not approved by the Food and Drug Administration. But perhaps they should.
Among prescription drugs, those medications' effectiveness and safety in off-label treatment are most in need of evaluation, a team of health experts has announced. The drugs are being prescribed, if not willy-nilly, at least without enough proof that they can help -- and not harm, the experts contend.
In a report published in the December issue of Pharmacotherapy, the researchers at the University of Illinois-Chicago, Stanford University and elsewhere explain their selection of the above drugs as the ones most deserving of further study. They considered how often the drugs were prescribed off-label without much evidence, the potential safety problems and the costs.
Of note is the fact that many drugs used off-label are antipsychotics or antidepressants (six on the list are being used to treat bipolar disorder). The researchers expound a bit on that in a press release, which includes a chart of the drugs' approved and nonapproved uses. (For more information about the drugs themselves, try the FDA site or the somewhat more accessible drugs.com.)
Doctors can prescribe whatever they think might help a patient, regardless of whether it's been proven to work. And they do -- especially when they lack good, approved options. But the practice isn't without risks and potential conflicts, hence an increasing effort to get a handle on the issue.
This list could be the beginning.
-- Tami Dennis
Photo: Effexor, approved to treat depression, is among the drugs increasingly used to treat conditions for which they're not approved (in this case, bipolar disorder).
Psychological studies have shown that old age can be one of the happiest and most satisfying times of life. But depression is an illness that can strike at any age -- even among the oldest of the old, according to new research.
A study from Temple University researchers presented today at the annual Gerontological Society Meeting of America looked for depression in a sample of 244 people who were age 100 or older. More than 25% of the people showed clinically relevant levels of depressive symptoms, but only 8% reported having been diagnosed with depression.
The findings are surprising because people who are prone to depression throughout life tend to have higher death rates. This group of people, however, had thrived physically but were suffering mentally, at least at this time in their lives. According to the lead author of the study, developmental psychologist Adam Davey, depression in centenarians could be linked to a number of factors, including poor nutritional status, urinary incontinence, limited physical activity and a past history of anxiety.
It's important for family members and caregivers to look for signs of depression even in very elderly people. The illness is easily treated, Davey said in a news release. Depression, he said, "is not just something that younger people suffer from."
Second-generation antidepressants, such as Prozac, Paxil, Zoloft and nine other medications, are equally effective, according to guidelines issued today by the American College of Physicians. Since the medications work equally well, doctors and patients should select an antidepressant based on its side effects -- which do vary among drugs -- cost and patient preference.
The newer antidepressants are often used in place of older antidepressants, such as tricyclic antidepressants, because they have fewer harsh side effects. The guidelines issued today reviewed more than 200 studies on the benefits and harms of 12 second-generation drugs: bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazadone and venlafaxine.
Side effects from these medications vary widely and can range from mild, such as constipation, to severe, such as suicidal thoughts. According to the paper, published in the Annals of Internal Medicine, patients should be assessed for adverse side effects within one to two weeks of starting therapy. The treatment should be changed if the patient does not have an adequate response by six to eight weeks of therapy. Treatment should continue for four to nine months after a satisfactory response in patients with a first episode of major depression.
For Latinos who speak only Spanish and who suffer from depression, the road back to mental health is longer and rockier than for those who speak English, a UCLA study has found. A team led by the Los Angeles Biomedical Research Center at UCLA's Harbor campus found that among Spanish-only speakers -- a group that makes up about one-third of American Latinos -- those seeking help for depressive symptoms were slower to respond to and less likely to get relief from antidepressant medications.
For physicians who see these patients, the lesson is clear, says Dr. Ira Lesser, the lead author of the article, published in the November issue of Psychiatric Services: These patients, who tend to be older, poorer, less educated and have more medical issues than English-speaking Latinos, may need more than just antidepressants for relief of their depression. The patients are also more likely to be women, and the physicians they seek out more likely to be primary-care providers, not psychiatrists.
The study, which looked at the records of 195 English- and Spanish-speaking Latinos who sought treatment for depression in Los Angeles and San Diego, was an offshoot of one of the mental health field's most comprehensive trials of treatments for depression. Among the best known of the findings emerging from that trial -- called the Sequenced Treatment Alternatives to Relieve Depression, or STAR-D, was that among patients who do not immediately respond to antidepressants, a switch in medicine and the addition of psychotherapy is highly successful in banishing depressive symptoms.
Researchers have found many obstacles to improved mental health for Latinos, including cultural resistance to admitting mental health problems, insurance rates, the availability of Spanish-speaking mental health professionals and compliance with medication.
It works. It doesn't. It works. It doesn't. That's health research news for you. One item that gives me whiplash, is the effectiveness -- or not -- of the herb St. John's wort for relief of depression.
Here, for example, is what the National Institutes of Health says: "There is some scientific evidence that St. John's wort is useful for treating mild to moderate depression. However, two large studies, one sponsored by NCCAM [the National Center for Complementary and Alternative Medicine], showed that the herb was no more effective than placebo in treating major depression of moderate severity."
The University of Maryland Medical Center says that, "In numerous studies, St. John's wort has been effective in reducing depressive symptoms in those with mild to moderate but not severe (called major) depression."
So one site says the herb's effective in treating moderately severemajordepression and the other says it's not effective for major depression but is effective for moderate and mild depression that would not be defined as major.
Argh! Argh! At this point one starts to wonder if the most confusing thing about these studies is the definition of depression. (According to Medline, "major depression" is diagnosed when five or more symptoms of depression persist for more than two weeks -- symptoms including feeling sad, hopeless, worthless or pessimistic.)
Perhaps it helps to not get overly hung up on such definitions. In any case, our friends from the Cochrane Collaboration have just weighed in with a Systematic Review that evaluated 29 trials on the topic and concluded the following: The herb does appear effective for major depression, at least mild and moderate versions thereof -- and, in fact, is as effective as antidepressants (and slightly better than placebos, suggesting that none of these items appear to be miracle-workers, antidepressants included).
But ... for some perplexing reason, trials conducted in German-speaking countries had better results than trials conducted in other countries. What the ?! Should melancholy, herb-chugging types all quickly move to Germany?
"This difference could be due to the inclusion of patients with slightly different types of depression," the review authors write. Use of the herb is quite accepted in such countries, which might influence what kind of patient enters a trial. "But it cannot be ruled out that some smaller studies from German-speaking countries were flawed and reported overoptimistic results."
The authors end their report with two reminders -- to tell your physician if you're taking the herb since it might interact with other meds, and bear in mind that supplements can vary a lot in quality.
-- Rosie Mestel
Photo: A worker harvests St. John's wort, with bright yellow flowers, at a farm in Canon City, Colo. Credit: Wally Skalij / Los Angeles Times
Two reports released today from the U.S. Centers for Disease Control and Prevention reveal the range of emotional, behavioral and mental health problems facing Americans of all ages.
In the first report, a nationally representative survey found that among children ages 4 to 17, 15% of their parents had discussed their children's emotional or behavioral difficulties with a healthcare provider or school staff. The study found that about 5% of children surveyed were prescribed medication for mental health or behavioral problem. The majority (89%) of those prescriptions were to treat attention deficit-hyperactivity disorder.
The report, which can be accessed on the CDC website, follows passage of model legislation in Massachusetts last month that may begin popping up in other states. In Massachusetts, a children's mental health law now requires that pediatricians screen children for mental health disorders with parental permission. It creates a system to help school personnel better recognize children with mental health needs, and it helps get children into appropriate community-based mental healthcare programs.
The second report from the CDC suggests that many teens and adults suffer from mental health problems without seeking treatment. That survey found that in any two-week period, 5.4% of Americans ages 12 and older experienced depression. Depression rates were higher in females, in people ages 40 to 59, in non-Hispanic black people and in poorer people. And these people aren't reporting simple bad moods. About 80% said they had some level of functional impairment because of their depression, and 27% reported serious difficulties at work and home.
Nevertheless, the survey found that only 29% of people who reported being depressed had contacted a mental health professional in the last year. Even among those described as being severely ill, only 39% reported contact.
These numbers can go down, experts say. The second report concludes: "Depression is a treatable condition. Successful depression treatment enables people to return to the level of functioning they had before becoming depressed."
In the largest analysis of gender differences in response to antidepressant treatment, researchers found that women are more likely to benefit from treatment with common antidepressants than are men.
The study, published online this week in the Journal of Psychiatric Research, found that women taking Celexa, a commonly prescribed antidepressant also available as a generic called citalopram, were more likely than men to get relief, according to a University of Michigan Health Center press release. In the study, 2,876 depressed patients, about half of them men and half women, were treated with the drug for 12 to 14 weeks.
When screened before the trial, the women had more severe depression symptoms, earlier onset of depression, were more likely to have a family history of depression or previous suicide attempts. Despite the greater severity of the disease, women were 33% more likely to experience a full remission from their depression at the end of the trial period.
"Other studies have suggested that there are differences between men and women in response to different antidepressants, but the evidence has been conflicting," Dr. Elizabeth Young said in the release. She is professor of psychiatry at the University of Michigan and lead author of the study. "This study is large enough, and we were able to control for enough complicating factors, that we feel confident there is a true difference."
All of the study participants, ages 18 to 75, had been depressed for years, with an average length of depression of 12 years.
Celexa, like Prozac, Zoloft, Luvox and Paxil, is a selective serotonin reuptake inhibitor, primarily affecting one neurotransmitter, serotonin. Earlier studies of an older generation of antidepressants called tricyclics showed gender differences. In those studies, women responded more slowly to tricyclics and were less likely than men to get relief from depression. This is the largest and most thorough study showing a gender difference with the new class of drugs.
The study itself didn't look at hormonal differences in men and women that might account for the difference. But animal studies have shown that estrogen, the primary female sex hormone, affects brain systems involved in the activity of serotonin.
Still, the drugs helped some men. About a quarter of men in the study achieved full remission of their depression. It's typical for depressed patients to try several medications before finding one that works well for them, often in combination with talk therapy.
Tami Dennis, who takes the word "skeptic" to previously uncharted territory, is the Times' Health and Science editor. She's adamant that pitches promoting awareness days, weeks or months are, by their nature, non-stories. And, because she's an adult, she refuses to use words like "veggies," "tummy" and "yummy."
Rosie Mestel, deputy Health and Science editor, studied genetics before abandoning flies, fungi and DNA for health/medical writing. Her hero is the biologist Ernst Haeckel, whose jellyfish paintings inspired snazzy chandeliers. Her favorite toast-spread is Marmite, a British delicacy made of yeast extract. Her least-favorite word is "millenniums."
Melissa Healy is a staff writer for the Health section reporting from Washington D.C. Healy's a veteran of The Times' National staff, having covered the Pentagon, Congress, poverty and social welfare, the environment, and the White House before shifting to Health in 2003. She writes frequently about mental health and human behavior, about federal health policy, prescription medication and ethics in medicine. More wonk than wellness freak, Healy chooses to believe in the health benefits of coffee and wine, and considers water a better work-out medium than beverage.
Karen Kaplan covers genetics, stem cells and cloning. She and colleague Thomas H. Maugh II comprise about 25% of the unofficial MIT-Alumni-in-Journalism Club, and she is proud to have taken more math (5) than English (0) courses in college. Her contributions to Booster Shots will, she hopes, appear more frequently than postings to her mommy blog.
Thomas H. Maugh II has been a science and medical writer at the Times for 23 years. Before that, he was on the staff of the journal Science for 13 years.
He has bachelor's degrees in English and chemistry from MIT and a doctorate in chemistry from UC Santa Barbara.
After a brief stint as a sports writer, Shari Roan turned to health journalism and has covered the topic for The Times for 18 years. She is the author of three books and the mother of two daughters, both teenagers who refer to her as a "health freak." She likes to jog, watch baseball and is very happy that dark chocolate contains some health benefit.
Jeannine Stein writes about fitness, sports medicine and obesity for the Health section. She’s a gym rat from way back and never met an elliptical trainer she didn’t like. Well, maybe one or two. She tempers exercise with a steady diet of reality television because she believes it’s all about balance.
But medication may not be the only remedy. A new study published online recently in the 
Psychological studies have shown that old age can be one of the happiest and most satisfying times of life. But depression is an illness that can strike at any age -- even among the oldest of the old, according to new research.
Second-generation antidepressants, such as Prozac, Paxil, Zoloft and nine other medications, are equally effective, according to guidelines issued today by the American College of Physicians. Since the medications work equally well, doctors and patients should select an antidepressant based on its side effects -- which do vary among drugs -- cost and patient preference.
