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Global Health, Mental Health, Research, Stanford News

Study explores how cultural differences can shape the way we respond to suffering

Study explores how cultural differences can shape the way we respond to suffering

8909380232_a647e15c23_zOur emotions may be a deeply personal experience, but the way we perceive and express our feelings may not be as unique – or random – as we think. According to recent research, culture influences the way some Americans and Germans convey their mood. If this is universally true, it could mean that people of the same culture tend to express their feelings in similar ways.

As this Stanford Report story explains, researchers Jeanne Tsai, PhD, an associate professor of psychology, and Birgit Koopmann-Holm, PhD, a German citizen who earned her doctorate in Tsai’s lab, noticed that Americans of European decent and Germans seemed to differ in the way they express feelings of sympathy:

Americans tend to emphasize the positive when faced with tragedy or life-threatening situations. American culture arguably considers negativity, complaining and pessimism as somewhat “sinful,” [Tsai] added.

Unlike when Americans talk about illness, Germans primarily focus on the negative, Tsai and Koopmann-Holm wrote. For example, the “Sturm und Drang” (“Storm and Drive”) literary and musical movement in 18th-century Germany went beyond merely accepting negative emotions to actually glorifying them.

This seemingly simple observation could have important societal implications, the researchers explain: Studies show that empathy affects our willingness to help someone who is suffering. But, as noted in the article, “until now, Tsai said, no studies have specifically examined how culture shapes ‘different ways in which sympathy, compassion or other feelings of concern for another’s suffering might be expressed.'”

In their study (subscription required, pdf here), published in the Journal of Personality and Social Psychology, the researchers conducted four separate experiments on 525 undergraduate students in the U.S. and Germany to see if Americans accentuate the positive more than Germans do when expressing their condolences. The students were asked how they would feel in a variety of hypothetical situations (such as a scenario where a friend lost a loved one), what feelings they would want to avoid and how they would select and rate sympathy cards.
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Global Health, In the News, Mental Health, Public Health, Research

Study links air pollution with anxiety; calls it a “leading global health concern”

Study links air pollution with anxiety;  calls it a "leading global health concern"

3280739522_c1f8001000_zI often find that natural spaces and fresh air have a calming, balancing effect, and judging by the cultural association between relaxation and the outdoors, I’m not alone. Now some new research backs up the connection. Yesterday, the British Medical Journal published an article linking air pollution with anxiety, as well as an editorial on air pollution’s health effects and another study elaborating on a previously-noted connection between pollution and stroke.

The anxiety study, conducted by researchers at Harvard and Johns Hopkins University, showed a significant connection between exposure to fine particulate pollution and symptoms of anxiety for more than 70,000 older women (mean age of 70 years) in the contiguous United States. Bigger particles appeared to have no effects, interestingly, nor did living close to a major road. The connection was present over a variety of time periods from one month to fifteen years, but was stronger in the short term. This evidence shows a clear need for studies to be done in other demographic groups, and to elaborate on the biological plausibility of the connection.

The stroke article, meanwhile, is a meta-analysis of 103 studies conducted in 28 countries and including 6.2 million events. Researchers found that both gaseous and particulate air pollution had a “marked and close temporal association” with strokes resulting in hospital admissions or death.

As stated in the editorial, particulate air pollution has already been shown to be a contributing factor in a variety of serious health conditions, including a well-supported link to cardiopulmonary diseases, but also diabetes, low birth weight, and pre-term birth. In fact, the World Health Organization estimates that one of every eight deaths is caused by air pollution. The body of research on the topic suggests that pollution may initiate systemic inflammation, thereby affecting multiple organ systems.

With such a broad range of detrimental effects, and because it affects such a significant percentage of the population, air pollution is becoming a top public health concern. As the University of British Columbia’s Michael Brauer, ScD, wrote in the editorial:

The findings of these two studies support a sharper focus on air pollution as a leading global health concern… One of the unique features of air pollution as a risk factor for disease is that exposure to air pollution is almost universal. While this is a primary reason for the large disease burden attributable to outdoor air pollution, it also follows that even modest reductions in pollution could have widespread benefits throughout populations. The two linked papers in this issue confirm the urgent need to manage air pollution globally as a cause of ill health and offer the promise that reducing pollution could be a cost effective way to reduce the large burden of disease from both stroke and poor mental health.

Photo by Billy Wilson

Medical Education, Medicine and Literature, Medicine and Society, Mental Health, Patient Care

Using graphic art to understand the emotional aspects of disease

Using graphic art to understand the emotional aspects of disease

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When it comes to describing the feelings of hopelessness of depression, the fear and anxiety of having an operation or the unrelenting pain of a chronic condition, sometimes words are not enough. But, as some patients have discovered, art can be a powerful medium for portraying and translating these complex emotional experiences. Cartoons can also help future medical professionals empathize with patients and consider their experience from more than a clinical perspective.

An article published last week on the anthropology blog Teaching Culture explores the use of graphic art in medical anthropology courses. It takes its inspiration from Allie Brosh’s comic Hyperbole and a Half, in which she uses a crudely drawn figure to transport readers through the painful inertia and numbness of her depression. I stumbled upon this comic a few years ago when a dear friend was depressed. At the time, I didn’t understand how that could be or what that meant. Brosh’s bizarre, raw, and yes funny, comic resonated not only with what I saw my friend going through, but with my own experience, even though I was not depressed. It enabled me to empathize and to offer her support that was more relevant.

The article also describes a curriculum that incorporates “graphic pathographies” – graphic novels and comics about experiencing illness – into a course for pre-med students. The coursework “examines the multifaceted relations between biomedicine, culture, and the art of care, and places a special emphasis on how creative and humanistic approaches to illness and healing might enrich clinical practice.”

When I asked for his thoughts, Errol Ozdalga, MD, a professor of general medicine involved with the bedside medicine Stanford 25 initiative, commented:

Graphic art is an expression that is probably under-utilized. At Stanford, our guest services offers patients the chance to do guided imagery by expressing their feelings via drawing. Many physicians are unaware this service exists. It’s an opportunity to better understand our patients’ perspectives and promote the importance of connecting to patients among our students.

Previously: Engaging with art to improve clinical skills, Image of the week: a medical-focused manga comic and Stanford nurse’s whiteboard artistry brings cheer to patients, co-workers
Photo by Krystal T

Complementary Medicine, In the News, Mental Health, Neuroscience, Research

An oasis of peace in “the 500 channel universe”: Research on mindfulness and depression

An oasis of peace in "the 500 channel universe": Research on mindfulness and depression

1135112859_45dc222725_zEarlier this month, the American Psychological Association issued a feature on mindfulness and depression, highlighting research that suggests mindfulness is an effective way to ameliorate and treat mood disorders, particularly recurrent depression. Some of the featured research suggests a strong neurological basis for the association.

Zindel Segal, PhD, a psychologist at the University of Toronto who is quoted in the article and who was on the three-person team that created Mindfulness-Based Cognitive Therapy (MBCT), wonders if all the attention mindfulness is now receiving is part of a backlash against “the 500 channel universe” of distractions in modern society. It’s not a pill that can be taken and done with, though – it’s a restructuring of mental attitude that requires maintenance. Through MBCT, people learn to pay attention to sensations and feelings rather than evaluative thoughts.

The studies in the review suggest that MBCT works at least as well as medication to prevent recurrence, that it is effective for peri-natal depression, and that it may work especially well for people with histories of relapse or depression stemming from childhood. A brief prepared for the Department of Veterans Affairs found that mindfulness approaches were most effective against depression compared to other health conditions.

I found the neuroscience particularly interesting: Part of the reason for MBCT’s effectiveness may be that practicing mindfulness increases connectivity and tissue density in certain areas of the brain. This is a classic example of neuroplasticity – the idea that neurological pathways can adapt and change throughout one’s life.

Norman Farb, PhD, a neuroscientist at the University of Toronto, distinguishes two forms of self-reference that activate different areas of the brain: extended/narrative self-reference, which links experiences across time, and momentary/experiential self-reference, which is centered on the present. Mindfulness exercises emphasize the present, in contrast with destructive narrative patterns of thought common in those suffering from stress, anxiety, and depression. In Farb’s study, fMRI results show that regular mindfulness practice strengthens areas of the brain that focus on the moment. It suggests that although we habitually integrate these two forms of self-reference, they can be neurally dissociated through attentional training.

Neural differences may have effects even when someone is not actively engaging in mindfulness: A study led by Veronique Taylor at the University of Montreal showed that the experienced meditators has less activity in narrative self-referential areas than novice meditators even in a resting state. Another study led by Harvard University neuroscientist Sara Lazar, PhD, showed that over the course of an 8-week mindfulness stress reduction program, the gray matter in participants’ amygdala shrank in density, while density increased in areas related to sustained attention and emotion regulation. The amygdala is implicated in anxiety as well as depression, which correlates with the finding that the participants’ stress levels decreased.

According to the feature, Segal has been impressed with the dramatic rise in popularity of meditation over the past 20 years, which “resonates with people’s desires to find a way of slowing down and returning to an inner psychological reality that is not as easily perturbed,” he says. Perhaps most encouragingly, mindfulness practice has no adverse side-effects or contraindications, so I would expect to see more research into its efficacy, which could be good for all of us in our “500 channel universe.”

Previously: Mindfulness training may ease depression and improve sleep for both caregivers and patients, Using mindfulness-based programs to reduce stress and promote health, Using mindfulness therapies to treat veterans’ PTSD, How mindfulness-based therapies can improve attention and health and Study shows mindfulness may reduce cancer patients’ anxiety and depression.
Photo by ronsho

In the News, Men's Health, Mental Health, Parenting, Pregnancy, Research

Examining how fathers’ postpartum depression affects toddlers

Examining how fathers' postpartum depression affects toddlers

Zoe walking with GilPostpartum depression doesn’t only affect moms, and new research shows that fathers who suffer from it have just as great an effect on their kids as depressed mothers do. As described in a press release from Northwestern University late last week, toddlers who have a depressed parent of either sex can experience emotional turmoil that manifests both internally and externally, through behaviors such as hitting, sadness, anxiety, lying, and jitteriness.

Most previous studies on the consequences of postpartum depression have focused only on women; this study (subscription required), published in Couple and Family Psychology: Research and Practice, is one of the first to examine how toddlers are affected by depression in either parent. It was led by Sheehan Fisher, PhD, professor of psychiatry at Northwestern University’s Feinberg School of Medicine.

As quoted in the release, Fisher states:

Father’s emotions affect their children. New fathers should be screened and treated for postpartum depression, just as we do for mothers… Early intervention is the key. If we can catch parents with depression earlier and treat them, then there won’t be a continuation of symptoms, and, maybe even as importantly, their child won’t be affected by a parent with depression.

Data for the study was collected from nearly 200 couples; questionnaires were administered both in the first few months after their child’s birth, and when their child was three years old. The forms were completed by each partner independently. Parents who reported signs of postpartum depression soon after the birth of their child also showed these signs three years later – the symptoms didn’t self-resolve. The questionnaire also asked about fighting between parents, which, interestingly, did not contribute to children’s emotionally troubled behaviors as much as having a depressed mother or father did.

Fisher stated in the release that depressed parents may smile and make eye contact less than parents who are not depressed, and that such emotional disengagement may make it hard for the child to form close attachments and healthy emotions.

Previous studies have shown that fathers are at a greater risk of depression after the birth of a child than at any other time in a typical male’s life.

Previously: A telephone lifeline for moms with postpartum depression, 2020 Mom Project promotes awareness of perinatal mood disorders, In study, health professionals helped prevent postpartum depressionDads get postpartum depression too and A call for depression screening for pregnant women, moms
Photo by Michelle Brandt

Addiction, Media, Medicine and Society, Mental Health, Technology

Patient tells how social media helped her overcome the “shame” of her eating disorder

Patient tells how social media helped her overcome the "shame" of her eating disorder

3375657138_d025fc4092_bMany of us turn to our friends and families for encouragement when times are tough. So it’s no wonder that social media sites have also become important sources of emotional support for people with illnesses.

Recently, a story over on MindBodyGreen highlighted how one woman used Facebook as a tool to help her overcome the shame and deception that hampered her recovery from her eating disorder. As Lindsey Hall explains:

Two months into rehab, I was still struggling with letting go of the games of my eating disorder. Transitioning from in-patient to out, I’d been rapidly finding myself falling backwards instead of forwards.

Here I was, 24 years old, still living some days bagel by bagel, still opening the door to deception, and guilt and shame. I knew on some level that admitting to my eating disorder on social media would be a way for me to stop the show. I knew I needed to own this struggle in order to own all of myself, and to continue on my journey learning the art of self-acceptance.

As Hall describes in the story, her decision to make her eating disorder public on Facebook was a leap of faith with no guarantee that it was the right thing to do:

I’ll never really know what drove me to write that Facebook status, but I posted it anyway to the open arms of nearly 2,500 “friends” and family, to people that had met me once at a bar or sat next to on a plane. Having lived so long behind a smoke screen, I was ready to expose myself. I needed to feel bare, even while broken, in order to be able to clean my slate, and start from scratch in reconstructing my life.

The feedback Hall received from her gutsy post on Facebook and the subsequent blog posts and stories about her eating disorder haven’t always been positive, but as Hall explains, that wasn’t that point. Hall’s eating disorder is public information now, and this new level of accountability has helped her keep her eating habits on track.

Previously: Incorporating the family in helping teens overcome eating disordersA growing consensus for revamping anorexia nervosa treatmentPossible predictors of longer-term recovery from eating disordersGrieving on Facebook: A personal story and How patients use social media to foster support systems, connect with physicians
Photo by .craig

In the News, Medical Education, Mental Health, Surgery

Surgeon offers his perspective on balancing life and work

Surgeon offers his perspective on balancing life and work

5136926303_a3d0bb0767_bMany of us strive to balance our life and work so we can be successful, happy and healthy. Yet, for people with unpredictable work schedules, such as doctors who must treat medical emergencies that have no regard for the nine-to-five work week, it can be hard to achieve this balanced bliss.

Much has been written about this topic, but the candor of this recent blog post from Robert Sewell, MD, a general surgeon at Texas Health Harris Methodist Hospital, caught my eye. In the piece, which originally appeared on the Family Physician blog and was posted on KevinMD yesterday, Sewell gives a brief account of what it’s like to be a surgeon and discusses the challenges and rewards of this career choice. He starts by providing a bit of his own back story:

I got married during medical school, and like every surgeon back in those days I told my wife, “I will always have two wives, you and medicine.” While some spouses accepted that dictum, others, including mine, resented it. Shortly after starting my practice it became clear that our relationship had been strained to the breaking point by my singular focus on achieving my life’s goal.

Sewell acknowledges that it’s desirable to balance the amount of time you devote to your work and personal life, but that as a surgeon it’s not always possible to do so:

Perhaps the most important lesson I learned is that a successful life and marriage requires balance. Too much emphasis on any one aspect throws both you, and those around you, out of balance. This should have been obvious, but as a surgeon, it was an extremely difficult lesson to learn, largely because of the nature of what we do. A kid with acute appendicitis, or an accident victim who is bleeding out from a ruptured spleen, simply can’t wait for a recital or soccer game to be over.

In the last two decades I’ve witnessed a significant effort by many young physicians to push back against those career pressures, as they seek more balance in their lives. While that is certainly a good ideal, being a surgeon is simply not a nine to five job. It’s a calling, and if you are truly called to the profession it’s in your blood.

Previously: Helping those in academic medicine to both “work and live well”Program for residents reflects “massive change” in surgeon mentalityNew surgeons take time out for mental healthUsing mindfulness interventions to help reduce physician burnout and A closer look at depression and distress among medical students
Photo by Colin Harris

Mental Health, Nutrition, Pediatrics

Incorporating the family in helping teens overcome eating disorders

Incorporating the family in helping teens overcome eating disorders

Apple on plateLearning that your teen has an eating disorder is baffling and deeply troubling news for parents. Our instincts are to protect and try to help our children out of the morass, but for decades, families were kept out of the treatment loop for teens with conditions like anorexia and bulimia.

The team at the Comprehensive Eating Disorders Program at Lucile Packard Children’s Hospital Stanford, led by psychiatrist James Lock, MD, PhD, is integrating the family into helping teens overcome their eating disorders. Lock recently sat down with the Stanford Medicine Newsletter for an informative Q&A about teen eating disorders.  He spoke about the historic reasoning for cutting parents out of treatment plans:

For most of the early 20th century, parents were erroneously blamed for mental illnesses in their offspring: So-called refrigerator mothers (those lacking warmth) caused autism, and overcontrolling parents caused anorexia nervosa, experts claimed. These ideas about causation are without foundation.

Research at Stanford and elsewhere has shown that parents can play a big role in helping their teens recover from eating disorders. For example, we have demonstrated that a specific family-based therapy is twice as effective as individual psychotherapy for treating anorexia nervosa.

And what to watch for in teens:

Warning signs include changes in eating patterns, skipping meals, increased driven exercise or discussion about weight, avoidance of desirable but calorically dense foods, refusing to eat with the family, vomiting, large amounts of food missing from the refrigerator and increased irritability and emotionality. If a parent sees these signs, it would be a good idea to make an appointment for an evaluation and consultation.

The full Q&A is worth a read.

Previously: Families can help their teens recover from anorexia, new study showsA growing consensus for revamping anorexia nervosa treatmentPossible predictors of longer-term recovery from eating disordersWhat a teenager wishes her parents knew about eating disorders and Research links bulimia to disordered impulse control
Photo by daniellehelm

Health Costs, In the News, Mental Health, Research, Stanford News

Exploring the costs and deaths associated with workplace stress

Exploring the costs and deaths associated with workplace stress

6273248505_43d0b56424_oMany of us know that a stressful job or work environment can be hard on our physical and mental health. But what is less known – and less studied – is how work-related stress translates into deaths and dollars spent on health care. According to new research, work-related stress may be linked to more than 120,000 deaths per year and about $190 billion in health-care costs in the United States alone.

In a study submitted to Management Science, former Stanford doctoral student Joel Goh, PhD, and Stanford professors Jeffrey Pfeffer, PhD, and Stefanos A. Zenios, PhD, reviewed 228 studies to explore the relationships between ten common sources of workplace stress, mortality and healthcare expenses in the U.S.

The researchers found that a lack of health insurance and job insecurity were among the top stressors linked to poor physical and emotional health. From a recent Stanford Business story:

Job insecurity increased the odds of reporting poor health by 50%, while long work hours increased mortality by almost 20%. Additionally, highly demanding jobs raised the odds of a physician-diagnosed illness by 35%.

“The deaths are comparable to the fourth- and fifth-largest causes of death in the country — heart disease and accidents,” says Zenios, a professor of operations, information, and technology. “It’s more than deaths from diabetes, Alzheimer’s, or influenza.”

Perhaps the most surprising result, the researchers explain, was the strong effect of psychological stressors on overall health:

Employees who reported that their work demands prevented them from meeting their family obligations or vice versa were 90% more likely to self-report poor physical health, the researchers note. And employees who perceive their workplaces as being unfair are about 50% more likely to develop a physician-diagnosed condition.

The researchers acknowledge that the study has some limitations. For example, they were unable to make strong causal links between work-related stress, mortality and health-care expenses; and they only examined 10 sources of stress. The importance of the study, Pfeffer explains, is that it draws attention to the need to create positive work environments where people feel good about themselves and their work.

Previously: How the stress of our “always on” culture can impact performance, health and happinessStudy finds happy employees are 12 percent more productiveWorkplace stress and how it influences health and How work stress affects wellness, health-care costs
Photo by Bernard Goldbach

Mental Health, Parenting, Pregnancy, Women's Health

A telephone lifeline for moms with postpartum depression

A telephone lifeline for moms with postpartum depression

Van_Gogh_-_Madame_Augustine_Roulin_mit_BabyI’m currently pregnant and due in less than two weeks. It’s my second child, so I’m not as worried about caring for a newborn as I was the first time around. But one nagging worry I have is the risk of postpartum depression, sometimes called postnatal depression. I have a family history of depression and that puts me at higher risk. Luckily, it wasn’t a problem with my firstborn, but it can crop up in later pregnancies – and scientists don’t entirely understand the reasons for it.

Postpartum depression usually hits four to six weeks after delivery—though it can show up months later. It’s characterized by feeling overwhelmed, trapped, guilty or inadequate, along with crying, irritability, problems concentrating, loss of appetite or libido, or sleep problems. An estimated 9 to 16 percent of new mothers are affected by postpartum depression. Even men are known to suffer from it sometimes. PPD affects not just the mother (or father), but can have lasting effects on the child as well, so helping these parents through a difficult and isolating time is critical

Now, a study published in Journal of Advanced Nursing shows that providing a social network for new moms, via phone calls from other mothers who had recovered from PPD, could alleviate symptoms for moms in the study for up to two years after delivery. A news release summarized the findings:

For the present quasi-experimental study, researchers recruited 64 mothers with depression up to two years after delivery who were living in New Brunswick. Peer volunteers who recovered from postnatal depression were trained as peer support and provided an average of nine support calls. The average age of mothers was 26 years, with 77% reporting depressive symptoms prior to pregnancy and 57% having pregnancy complications. There were 16 women (35%) who were taking medication for depression since the birth.

I find the idea that this insidious problem could be tackled with a phone version of the ubiquitous and valuable moms’ groups an uplifting one. Compared to drug treatments, regular phone calls from a peer who’s gone through something similar is a relatively cheap treatment. Further studies are needed, but I’ll be watching to see whether this approach takes hold as a standard intervention for PPD.

Previously: “2020 Mom Project” promotes awareness of perinatal mood disorders,  Is postpartum depression more of an urban problem?, Helping moms emerge from the darkness of postpartum depression, Breastfeeding difficulties may lead to depression in new moms, and Dads get postpartum depression, too
Image by Van Gogh

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