Mental health? Gays and lesbians appear more likely to try for it

When it comes to substance abuse and mental health disorders, gays, lesbians and bisexuals have been shown to have higher rates than the general population -- and the reasons for that are complicated. But, researchers say, this segment is also more likely -- twice as likely, in fact -- to seek mental health treatment than heterosexuals.

Researchers at UCLA parsed data on more than 2,000 people. They found that 48.5% of so-called sexual minorities had received therapy in the last year, but that only 22.5% of heterosexuals had.

(And this tidbit is no surprise, but let's point it out anyway: Lesbians and bisexual women were the most likely to seek treatment; straight men were the least likely.)

Among the researchers' conclusions: "The findings showed that minority sexual orientation predisposes individuals to seek out services, despite pervasive barriers that exist within the service delivery system that might even discourage their use by this population."

Here's the news release from UCLA.

Here's the full study, published Friday in the journal BMC Psychiatry.

-- Tami Dennis

Credit: Los Angeles Times

Percentage of veterans with mental health problems jumps dramatically

About 37% of veterans returning from Iraq and Afghanistan have mental health problems, a nearly 50% increase from the last time the prevalence was calculated, according to a new study published today analyzing national Department of Veterans Affairs data.

The study, which examined the records of about 289,000 veterans who sought care at the VA between 2002 and 2008, also found higher rates of post-traumatic stress disorder and depression.

 “What’s really striking is the dramatic acceleration in mental health diagnoses, particularly PTSD, after the beginning of the conflict in Iraq,” said the study’s lead author, Dr. Karen Seal, a staff physician at the San Francisco VA Medical Center and an assistant professor at UC San Francisco.

The researchers said they could not pinpoint the exact causes of the increase, but suggested: “Waning public support and lower morale among troops may predispose returning veterans to mental health problems, as occurred during the Vietnam era.”

They also suggested that more and longer deployments could have also contributed to the increase in diagnoses.

The previous study of national VA data, which examined Iraq and Afghanistan war veterans seeking care between 2001 and 2005, found that 25% of those veterans received mental health diagnoses. About 13% were diagnosed with the anxiety disorder PTSD and 5% with depression.

The new study by Seal and her colleagues, published in the American Journal of Public Health, found that 22% of the veterans in the study had PTSD and 17% had depression.

When the researchers compared veterans of Afghanistan from early in the war to veterans of Iraq four years later, they found the rates of PTSD diagnosis more than tripled.

The newest study correlates closely to a 2008 report by the Rand Corp., based on a much smaller sample of Iraq and Afghanistan veterans. In that study, about 14% met the criteria for PTSD and 14% for depression.

In related news:

The National Institute of Mental Health announced it has commissioned a $50-million study to identify risk and protective factors for suicide among soldiers, calling it “the largest study of suicide and mental health among military personnel ever undertaken.”

The institute said in a statement that the study was a direct response to the Army’s request to use the most promising scientific approaches to address the rising suicide rate. Though the suicide rate in the Army had been historically lower in the military than among civilians, that pattern reversed in 2008, when the suicide rate in the Army became about 20 suicides in every 100,000 soldiers.

The research teams will be based at the Uniformed Services University of the Health Sciences, University of Michigan, Harvard University and Columbia University.

-- Jia-Rui Chong

Photo: U.S. soldiers walk through the streets of Baquba, Iraq, in June. 

Credit: Ahmad Al-Rubaye / AFP / Getty Images  

Here's her story: Maureen McCormick on her mental illness

Personal and family secrets are contributing factors toward poor mental health, says Maureen McCormick, a star of the 1970s sitcom "The Brady Bunch." Appearing at the annual meeting of the American Psychiatric Assn. on Tuesday in San Francisco, McCormick described discovering her family’s history of mental illness as a child and her own reluctance to tell her daughter, now 20, about her own battles with drug addiction, bulimia and depression.

“Secrets are no good," said McCormick. "I was brought up in a family where we had so many secrets. It felt so good to let the world know I was human and suffered from depression and I wasn’t that perfect person everyone thought I was."

McCormick, 52, appeared on “The Brady Bunch” from 1969 to 1974 as the sweet and popular Marcia Brady. But after the show ended, McCormick battled severe drug addiction (cocaine, quaaludes), bulimia and depression. She re-entered the TV world in 2007 appearing as a contestant on “Celebrity Fit Club,” which follows celebrities as they try to lose weight. McCormick won the contest, and talked about the link between her weight gain and depression. After the show, she realized she wanted to publicly address her mental health and addiction problems. The result was a book, published late last year, titled “Here’s the Story: Surviving Marcia Brady and Finding My True Voice,” and a commitment to fighting the stigma and silence that can surround mental illness.

McCormick has a horrifying family history of mental illness, from suicidal grandparents to a mentally ill mother to brothers who are schizophrenic. In her appearance at the APA, she described feelings of emotional pain and sadness that began early in her life, even before she discovered her family’s turbulent mental health history.

“I felt alone and had this deep down sadness, that I didn’t know what it was," she said. "It was this pain that didn’t go away."

McCormick appeared at the event as part of the annual "Conversations" series at the APA conference that showcases unique perspectives on mental illness from well-known people. "Conversations" is in its eighth year and, by now, it should be apparent that being wealthy and famous and admired isn’t protection against mental illness. Past speakers have included Patty Duke, Brooke Shields, Mariel Hemingway, Greg Louganis, George Stephanopoulos, Tipper Gore and Carrie Fisher.

-- Shari Roan

Photo credit: Maureen McCormick / American Psychiatric Assn.

The destructive emotion du jour: bitterness

You know them. I know them. And, increasingly, psychiatrists know them. People who feel they have been wronged by someone and are so bitter they can barely function other than to ruminate about their circumstances.

This behavior is so common -- and so deeply destructive -- that some psychiatrists are urging it be identified as a mental illness under the name post-traumatic embitterment disorder. The behavior was discussed before an enthusiastic audience Monday at the annual meeting of the American Psychiatric Assn. meeting in San Francisco.

The disorder is modeled after post-traumatic stress disorder because it too is a response to a trauma that endures. People with PTSD are left fearful and anxious. Embittered people, however, are left seething for revenge.

"They feel the world has treated them unfairly. It's one step more complex than anger. They're angry plus helpless," says Dr. Michael Linden, a German psychiatrist who named the behavior.

Embittered people are typically good people who have worked hard at something important, such as a job or a relationship or activity, Linden says. When something unexpectedly awful happens -- they don't get the promotion, the wife files for divorce or they fail to make the Olympic team -- a profound sense of injustice overtakes them. Instead of dealing with the loss with the help of family and friends, they cannot let go of the feeling of being victimized. Almost immediately after the traumatic event, they become angry, pessimistic, aggressive, hopeless haters.

"Embitterment is a violation of basic beliefs," Linden says. "It causes a very severe emotional reaction.... We are always coping with negative life events. It's the reaction that varies."

There are only a handful of studies on the behavior, but psychiatrists meeting Monday were in agreement that much more research is needed on identifying and helping these people. One estimate is that 1% to 2% of the population are embittered, says Linden, who has published several studies on the behavior.

"These people usually don't come to treatment because 'the world has to change, not me,' " Linden says. "They are almost treatment resistant.... Revenge is not a treatment."

Nevertheless, Linden suggests that people once known as loving, normal individuals who suddenly snap and kill their family and themselves may have post-traumatic embitterment syndrome. That's reason enough for researchers to study how to treat the destructive emotion of bitterness.

-- Shari Roan 

Build those mental muscles before you shop

If you're looking to boost your brain power and shopping for a product that promises to help you do that, start by thinking twice. Many of the products don't have much of a track record.

The Stanford Center on Longevity is offering some guidance, backed up by more than two dozen brain scientists, on these so-called memory aids.

The statement begins: "There is no greater concern among aging people than the prospect of diminished capacity and the loss of independence."

It goes on to acknowledge the desperation people feel to keep their mental fitness, and explains just what is possible -- and what isn't. That is, supplements haven't been proven to work; software-based programs show little real-world effect; and there's no such thing as a cure or prevention for Alzheimer's (and don't let anyone tell you otherwise).  

But learning in general, community involvement and exercise ... those are all good.

Here's staff writer Melissa Healy's look at mental workouts:  Sort of like a StairMaster -- but for the brain  

-- Tami Dennis

Photo credit: UCLA School of Medicine

And now for some help analyzing healthcare in California ...

... at least as it pertains to ballot measures.

Today's story by Eric Bailey,  "Propositions 1D, 1E ask voters to think again," explains the goals of propositions 1D and 1E on the upcoming May 19 special election ballot -- and puts them in some historical context.

The measures would take money from programs intended to benefit young children and the mentally ill and use it to help balance the state's out-of-whack books. Voters had approved the programs' funding in recent years; now they're being asked to approve their un-funding.

The story quotes Larry Gerston, a San Jose State political science professor, as saying: "The voters have been as responsible for this budget mess as anyone else. ... Election after election, they have authorized money for this or that. And it ties the hands of the Legislature at budget time."
 
So if you're feeling guilty, curious or rebelliously analytical, head over to HealthVote.org before you make a decision.

Offered by the California Healthcare Foundation and the Center for Governmental Studies, the nonpartisan site provides not just non-inflammatory overviews (rare enough) and the official ballot summaries and arguments, but also an analysis and history of each measure as well as information on just who's giving money to the campaigns.

-- Tami Dennis

Photo: Voters cast ballots in the November election, likely to prove a higher-participation event than the upcoming one.

Credit: Ken Hively / Los Angeles Times

Brain drugs won't go away, so best give them some thought

If pills can make us better mentally -- and it seems clear they can -- it's time to answer the question of whether we should let them. 

For some people, the question is already moot. In the April 27 issue of the New Yorker, writer Margaret Talbot explores the issue of brain medications in "Brain Gain: The underground world of 'neuroenhancing' drugs."

She writes: "In recent years Adderall and Ritalin, another stimulant, have been adopted as cognitive enhancers: drugs that high-functioning, overcommitted people take to become higher-functioning and more overcommitted."

She tells her story in some part through a recent Harvard graduate named Alex. He makes a compelling case for what can be accomplished with a little help.

Some neuroscientists and ethicists have already answered the bigger question among themselves. Says a recent blog post from Times staff writer Melissa Healy: "Pop a smart pill? Why not, says a group of neuroethicists"

-- Tami Dennis

Photo: Ritalin -- the little helper for people with attention deficit hyperactivity disorder and overworked, over-stressed students -- is going mainstream.

Credit: Keith Beaty/Toronto Star/ZUMA Press

You don't really want that cookie; in fact, it's not even a cookie

Bad habits and willpower must be on a lot of minds these days. That's great -- I'm all for other people trying to break their bad habits and develop willpower.

In today's Health section, there's Habits can be broken, but not forgotten. Writer Karen Ravn warns us, somewhat harshly: "Chances are, you have a few habits you wish you didn't have, and quite possibly you've tried (and tried and tried) to break them. Scientists are learning why you may have failed (and failed and failed). In fact, they now know that once you have a habit, you can never really unlearn it."

She's a comfort. No, truly. Because then she advises us in Tips on breaking bad habits how to, if not unlearn bad habits, at least not to be controlled by them.  

My favorite is the "if-then" plan. Essentially, if you have a specific negative thought, then you perform a specific act to help overcome it. Food cravings and tennis game performances are used as examples. You should try it. Let me know if it works.

And today, NPR weighed in as well. (The media ... we really only want what's best for everyone.)

In Your Health: Willpower: A Game of Strategy, Alix Spiegel offers up a story involving a fascinating experiment with marshmallows or cookies and 4-year-olds possessing varying degrees -- none of them large -- of self-control.

In the study, the researcher told the kids, before leaving the room, that they could have a nearby treat right away or wait until he got back and have two treats. Many succumbed immediately. Others attempted to distract themselves, then succumbed. And we all know which type of 4-year-old we would have been.

Distraction is fine and can work, but the researcher also tried to get the children to think of the way they thought about the treat. The story says: "So, for example, to help the children resist the treat, before leaving the room Mischel told the kids to imagine the treat in front of them differently. 'I told them to think about those marshmallows as if they were just cotton puffs, or clouds. Those instructions to the 4-year-old had a dramatic effect on her ability to wait for the thing that she couldn't wait for before.'"

Apparently 4-year-olds have much to teach us all. 

-- Tami Dennis

Photo: They're not melt-in-your-mouth hazelnut chocolate Linzer cookies; they're just round, um, cardboard-y things. Really.

Credit: Robert Gauthier / Los Angeles Times

Waiting for biopsy results might not be healthy

When the biopsy results arrive, the waiting will stop. You'll either resume your previous life with its commitments and deadlines and blessed routine. Or you'll begin a new life, one punctuated by blood tests and treatments and only sometimes controllable fear.

But the results aren't in yet. And so you wait, seemingly forever. To say that this state of not-knowing is stressful would be an understatement. To say that it could harm might not be.

In a study published in the March issue of Radiology, researchers periodically measured cortisol (commonly known as the stress hormone, though there are actually several) in the saliva of 126 women who had undergone breast biopsies and were awaiting the results.

At the end of the testing, those women who didn't yet have a final diagnosis had similar cortisol profiles as the women who had received a diagnosis of cancer.

As the abstract says: "Uncertainty about the final diagnosis ... is associated with substantial biochemical distress, which may have adverse effects on immune defense and wound healing. Results indicate the need for more rapid communication of biopsy results."

In other words, not knowing can negatively affect physical health -- and that's the last thing a person preparing to battle cancer needs.

And although many doctors don't like to deliver bad news over the phone, if a phone call is what it takes to end the uncertainty, then a phone call might be what is needed.

Writer Deborah Lewis makes the case for the compassionate phone call in a thoughtful essay on the benefits of hearing bad news -- "you have breast cancer" -- as soon as possible. In When getting cancer results over the phone is a good thing, she writes:

"There is no way of understanding the receipt of such tough news without understanding the particular torture involved in waiting for medical test results. Time slows down and becomes caustic. The mind fixates on floating scenarios unmoored to actual facts, intruding constantly into weak attempts at daily living.

If I am going through that slow drip of waiting, I want to end my torment as soon as possible."

Others who have awaited biopsy results would likely agree with Lewis. There's much to be said for knowing as soon as possible -- with a plan to discuss the matter in more depth immediately after the initial mind-frying shock has worn off.

Your mental and physical health might depend on it.

-- Tami Dennis

How the brain generates delusions

People with certain types of brain disorders can suffer from delusions, which are erroneous beliefs in objects or situations that remain fixed in the mind despite evidence they are incorrect. Delusions make it hard for people to function with any normalcy in the real world and confound the doctors and therapists who are trying to help them.

Research published this week in the journal Neurology makes an important observation about the brains of people with neurological disorders, such as those with brain damage from strokes and Alzheimer's disease who suffer delusions, and suggests a novel theory for why delusions occur and persist. Researchers at New York University Langone Medical Center studied neurological patients with delusions and found a consistent pattern of injury to the front lobe and right hemisphere of the brain. It's possible that injury on the right side leads to overcompensation by the left hemisphere, thus producing delusions.

"Problems caused by these brain injuries include impairment in monitoring of self, awareness of errors and incorrectly identifying what is familiar and what is a work of fiction," said the lead author of the study, Dr. Orrin Devinsky, in a news release. "However, delusions result from the loss of these functions as well as the over activation of the left hemisphere and its language structures that 'create a story,' a story which cannot be edited and modified to account for reality. Delusions result from right hemisphere lesions, but it is the left hemisphere that is deluded."

The fact that people believe delusions despite evidence that they are wrong may be due to the dysfunction in the frontal lobe of the brain.

The research could be helpful by clarifying what psychological, cognitive and neurological mechanisms contribute to delusional thinking, the researchers said. That may lead to better strategies to treat the illness.

-- Shari Roan