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Education, Mental Health, Research, Surgery, Women's Health

Stereotype perception linked to psychological health in female surgeons

Stereotype perception linked to psychological health in female surgeons

8116089104_be12619731_oFemale surgeons who believe there’s a stereotype that men are better doctors are more likely to suffer from psychological distress, according to a recent study led by a former Stanford resident.

First author Arghavan Salles, MD, PhD, looked at the correlation between the perception of a stereotype — whether individuals think others believe certain groups are superior physicians — and the overall mental well-being of residents.

The team surveyed 382 residents from 14 medical specialties. To examine views on stereotypes, participants were asked: “Do you think residents in your program expect men or women to generally be better [doctors]?” They were also given standard psychological assessments.

Female surgeons were the only group where stereotype perception was correlated with psychological health. Surgery has traditionally been dominated by men and remains a specialty chosen by about twice as many men as women, leading to the persistence of gender stereotypes.

“As a surgical resident, I was aware of the stereotype that men are better surgeons than women. Although I found the stereotype upsetting, I didn’t think about it too much,” Salles told me. Then, after studying stereotype perception while pursuing a doctorate in education, Salles decided to combine her two specialties to determine whether residents experience stereotype threat; a question that no one had asked before.

The link she found has implications for physician productivity and patient care, Salles said.

“I think it’s important to realize that in the world of medicine, although the ratio of males to females is changing, some of these old stereotypes still have an impact on the practitioners,” said co-senior author Claudia Mueller, MD, PhD.

The belief that others think women aren’t good enough adds an unnecessary stressor to the female residents’ already harried lives, Mueller said. It could also contribute to the high attrition rate of females in surgical disciplines, the study states.

Mueller said the study, which appears in the Journal of the American College of Surgeonsis noteworthy for its rare integration of two quite disparate fields, surgery and psychology.

The authors suggest that simply increasing the number of female surgeons may help dissipate the stereotype. Sharing information about the stereotype may also help, as could investigating any practices that may have a differential effect on men and women, the researchers write.

Salles is now querying residents, faculty members and members of the public to see how prevalent stereotypes about gender-based differences in ability actually are.

Previously: How two women from different worlds are changing the face of surgery, Keeping an even keel: Stanford surgery residents learn to balance work and life and Stanford Medicine magazine opens up the world of surgery
Photo by Phalinn Ooi

In the News, Medicine and Society, Mental Health, Public Health

Turning loss into hope for others: New website teaches about mental health

Turning loss into hope for others: New website teaches about mental health

photoTEAM

Suicide slices close to the heart for me, and I remember well the story of Shelby Drazan, a Woodside, Calif. 17-year-old who died by suicide last year.

Now, the Drazan family is going public with their efforts to help others suffering from mental illness. A recent article in the Almanac explains their efforts:

The Drazans say they hope talking publicly about what happened to Shelby will ease some of the stigma attached to mental illness.

“A lot of people are struggling,” Stacy Drazan says, “a lot of people especially in this area. We’ve got to help get rid of the stigma so that people can seek help, and earlier.”

Her daughter Mackenzie has created an online trove of resources, Teaching Everyone About Mental Health or TEAM. “Hopefully we can lower the learning curve for everybody else,” Mackenzie said.

At the same time, Stacy Drazan is working to expand the number of adolescent beds for psychiatric patients in the San Francisco Bay area. Stanford’s Steven Adelsheim, MD, a child psychiatrist, is among those working with the family to expand local mental-health resources.

Previously: Advice and guidance on teen suicide, “Every life is touched by suicide:” Stanford psychiatrist on the importance of prevention and Stanford’s Keith Humphreys on Golden Gate Bridge suicide prevention: Get the nets
Photo courtesy of TEAM

Behavioral Science, Mental Health, Pediatrics, Stanford News

Beyond behavior: Stanford expert on recognizing and helping traumatized kids

Beyond behavior: Stanford expert on recognizing and helping traumatized kids

beyond_behavior_fullWhen Victor Carrion, MD, was a pediatric psychiatry fellow in the mid-1990s, he had an “a-ha” moment about some of his poorly behaved patients that set the trajectory of his career. These kids had been traumatized, and the adults around them didn’t recognize it.

He described what happened for my feature story in Stanford Medicine magazine:

“Kids were coming to see me with little notes from their teachers that said, ‘This child has ADHD. Please place on Ritalin,’” Carrion says. Chuckling slightly, he recalls his half-facetious reaction to these missives: “Wow: A diagnosis has been made; there’s a treatment plan; there’s not much for me to do here.”

But after carefully obtaining life histories for several patients, he realized that although some had ADHD, many others had been traumatized by such experiences as abuse, neglect or witnessing violence in their homes or communities. Their reactions — a triad of self-protective behaviors that experts summarize as “freeze, fight or flee” — were being misinterpreted as ADHD’s signature inattentiveness, hyperactivity, aggression and poor cooperation.

Childhood trauma, Carrion realized, was very poorly understood. People assumed kids were more resilient in the face of trauma than adults (they’re not), that you could deal with trauma by ignoring it (no) or that children traumatized before they had the vocabulary to describe what was going on would simply forget what had happened (no again). He wanted to understand what was really going on.

Now, 20 years later, his work and that of many other trauma experts across the country clearly shows we can’t afford to ignore the long shadow cast by early-life abuse, neglect, violence and other instability. “We need to address trauma because it impacts health, period,” Carrion told me. “Not just mental health; it impacts physical health as well.”

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Mental Health, Patient Care, Research

A detailed look at delirium, from the inside

A detailed look at delirium, from the inside

16070214393_8b9ce40d42_zFrom the outside it looks scary enough: A patient so ill their connection to reality has frayed.

Now, a paper in the American Journal of Critical Care provides an inside look at the experiences of patients in intensive care who have suffered delirium, which is characterized by altered consciousness and disorganized thoughts. The work confirms that delirium is frightening, disorienting and can lead to long-lasting anxiety and post-traumatic stress disorder.

Delirium is a common symptom of the severe brain dysfunction caused by many serious disorders that send patients to the ICU. A team of Canadian researchers interviewed 10 patients who had suffered from the condition, distilling four main themes that characterize the experience:

  • Memory loss — Some patients reported feeling anxiety and shame because they couldn’t recall what had occurred during some portions of their illness, the authors wrote.
  • Disconnection – Patients said they were frustrated and fearful when they were unable to communicate with family members and caregivers. One patient said, “It felt like I was living in a bubble; I couldn’t move my arms or legs. And, ah, people all around me but no one answering me… I would be calling out to people but no one would even look up.”
  • Processing – Both during and after the delirium, patients struggled to distinguish events that were real from hallucinations or other thoughts. Some of their hallucinations included, “frozen turkeys in a kitchen, car lights on the wall, large black birds, savage monkeys in the lights, fairies and a lady picking flowers.” Patients also often did not know if they were asleep or awake.
  • Fear — Nearly all patients experienced the sense that they or their family members were in danger. These feelings were so strong several patients developed habits to try to prevent a reoccurrence, such as avoiding surgery or sleeping pills.

“Delirium puts additional emotional and physical stress on a patient whose health is already compromised and our findings demonstrate how potentially psychologically harmful ICU delirium can be,” said lead author Karen Whitehorne, RN, a nurse therapist at Eastern Health in Newfoundland, Canada in a release. These findings add to existing knowledge about the condition and “can facilitate development of treatment plans,” she and her colleagues conclude in the paper.

Photo by Dean Hochman

Behavioral Science, Mental Health, Neuroscience, Stanford News

Decisions, Decisions: How mental-health issues alter decision-making

Decisions, Decisions: How mental-health issues alter decision-making

Research in neuroscience, psychology, business and economics tells us that a plethora of influences can alter the decisions we make. The author explored some of these factors in a Worldview Stanford course and wrote about them in a Stanford story package, Decisions, Decisions. This post is part of a series on what she learned. 

Here’s something truly unfair. People with mental-health issues have changes in their brains that make it harder for them to make decisions that will benefit their health.

Just when you need good decision-making the most, it fails you.

Child psychiatrist Kathleen Fitzpatrick, MD, works with kids who have anorexia. She said that in those people, their risk/reward pathways are aligned so that not eating is rewarding and eating is cause for anxiety. And, like anyone, they decide in favor of the rewarding experience.

Fitzpatrick put it like this, “I will work for the reward of a cupcake. They will work for the reward of removing all cupcakes.”

In my story I also talk with psychiatrist Manpreet Singh, MD, who says people with depression face similar issues. That’s in part why mental-health conditions are so hard to treat. They change a person’s brain in ways that make it even harder to recover.

Previously: Decisions, Decisions: How emotions alter our decisionsDecisions, Decisions: The way we express a decision alters the outcome and Decisions, Decisions: How decisions change with age
Video courtesy of Worldview Stanford

Mental Health, Public Health, Public Safety, Sleep, Stanford News

From A to ZZZZs: The trouble with teen sleep

From A to ZZZZs: The trouble with teen sleep

go_to_bed_fullWhen I recently began working on a story on teen sleep for Stanford Medicine magazine, I was afraid I might not find teens who were troubled by sleep issues and willing to talk about them. I need not have worried: Virtually every teen I encountered had a story to tell about consistently having late nights stressing out over tests or papers or texting friends and cruising the web. It also wasn’t unusual for teens to say that they kept their cell phones on at night in case they got a message from a friend who needed to talk.

Some were tortured by the lack of sleep, often nodding off in class, but said they felt compelled to stay up in order to compete academically in these high-pressure local communities that worship at the altar of academic achievement.

“I’ve heard horror stories of being sleep-deprived,” one 17-year-old told me. “You’re not able to focus on homework, you feel moody and are not able to pay attention in class.”

Another teen reinforced what the National Sleep Foundation found in a recent poll – that 87 percent of American teens are chronically sleep-deprived. “You could probably talk to any teen when they reach their breaking point,” she told me. “You’ve pushed yourself so much and not slept enough and you just lose it.”

In my research, I learned that these students pay a heavy price, potentially compromising their physical and mental health. Study after study in the medical literature sounded the alarm over what can go wrong when teens suffer chronic sleep deprivation: drowsy driving incidents, poor academic performance, anxiety, depression, suicidal thoughts and even suicide attempts.

“I think high school is the real danger spot in terms of sleep deprivation,” Stanford’s William Dement, MD, PhD, the famed sleep researcher, told me. “It’s a huge problem.”

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Genetics, In the News, Mental Health, Neuroscience, Research, Stanford News

Bright Young Mind: Stanford postdoc featured as a top young scientist

Bright Young Mind: Stanford postdoc featured as a top young scientist
100315_nobels_rajasethupathy_resizedYoung researchers don’t always get the accolades they deserve, so I was delighted to see a recent story that’s bucking this trend. This week Science News released its list of “10 scientists who are making their mark,” and Stanford neuroscientist Priya Rajasethupathy, MD, PhD, a postdoctoral research fellow in the lab of Karl Deisseroth, MD, PhD, was featured among them.

Rajasethupathy was nominated for this honor by another group of outstanding scientists: Science News polled 30 Nobel Prize winners to learn which young researchers are doing work that’s worth watching.

Rajasethupathy’s research on how memories are made and stored caught their eye because she’s found that long-term memories may leave lasting marks on DNA. (Her work “has been called groundbreaking, compelling and beautifully executed,” according to the piece.) By studying sea slugs, she and her colleagues have also identified a tiny molecule that may be involved in memory.

Now Rajasethypathy is expanding on this early work and investigating the neural circuits involved in memory recall. To do this, she’s exploring specific genetic mutations to see if they result in abnormal memory behavior. This work may offer insights into neurological disorders, she explains.

Previously: Exploring the role of prion-like proteins in memory disordersNo long-term cognitive effects seen in younger post-menopausal women on hormone therapy and Individuals’ extraordinary talent to never forget could offer insights into memory
Photo by Connie Lee; courtesy of Pryia Rajasethupathy

Clinical Trials, Mental Health, Parenting, Pediatrics, Research, Stanford News

Parents can help their teens recover from bulimia, say Stanford researchers

Parents can help their teens recover from bulimia, say Stanford researchers

Mom&teenTeenagers with bulimia nervosa benefit from their parents’ help in stopping their eating disorder. In fact, a therapy that involves parents works better for teens than one that does not, according to the first large head-to-head comparison in adolescents of two well-known bulimia treatments.

The findings are described in a study of 130 young people with bulimia that was published last week in the Journal of the American Academy of Child and Adolescent Psychiatry.

The research, which was jointly led by Stanford’s James Lock, MD, PhD, and a longtime collaborator, Daniel Le Grange, PhD, compared an approach tailored to teens with one commonly used in adults. In family-based therapy, the bulimia patient and a parent work together to stop the disordered eating behavior. In contrast, in cognitive behavioral therapy, which is widely recognized as the best approach for bulimic adults, there is more focus on changing abnormal thoughts about food and less emphasis on behavior change.

At the end of six months of treatment, 39 percent of patients in family-based therapy had abstained from the binge-and-purge cycle of bulimia for at least four weeks. Only 20 percent of those in the cognitive behavioral therapy group had done the same. The gap persisted six months after treatment ended, though it seemed to have closed by a year after the end of treatment.

Lock, who directs the Comprehensive Eating Disorders Program at Lucile Packard Children’s Hospital Stanford, said the findings are not surprising, given that teens are at a different stage of the illness and have different cognitive capabilities than adults with bulimia. But they are very important, since they suggest that the family-based approach is a faster way for young patients to recover from bulimia. From our press release about the study:

“The strategy for cognitive behavioral therapy requires a fair amount of abstract reasoning, motivation and persistence that often has not reached full capacity in teens,” [Lock] said, adding that doctors may need to decide on a case-by-case basis whether a teen would benefit from one treatment versus the other. “The cognitive and developmental context is very different for teens than for adult patients,” he said.

And it’s normal for teenagers to need their parents’ assistance in navigating difficult situations, he added. “The big take-home message is that families can really help their kids with bulimia nervosa.”

Previously: Family therapy an effective way to treat anorexic teens, Incorporating the family to help teens overcome eating disorders and Families can help their teens recover from anorexia, new study shows
Photo by J.K. Califf

Aging, Medicine and Society, Mental Health, Patient Care

Stanford longevity design winner brings dementia place setting into production

Stanford longevity design winner brings dementia place setting into production

eatwellprimaryHelping people live not just longer but better lives is the goal of Stanford’s Center on Longevity, and last year it held a Design Challenge to scope out great ideas for doing so. The winner of that competition is no longer just a design; Eatwell is moving into production.

Eatwell, a place setting for those with cognitive and motor impairments from dementia, features subtle alterations to the colors, textures, weight, and shape of traditional dishes and cutlery. For example, bright colors make food more appetizing, and blue surfaces make it less likely that users will confuse their food with the dish. Slanted bottoms help keep food together and make it easier to scoop, and weighted bottoms with skid-resistant texture make spills less likely. There are even placemat attachments for a napkin to catch drips.

I recently corresponded with Eatwell’s designer, Sha Yao, via email while she was in Asia overseeing the manufacturing of her innovative product. The 20 design features of the 9-piece set emerged from a four-year research process involving one-on-one observation and volunteering in adult day care centers. “Along the way,” Yao told me, “I had many opportunities to come in contact with people who work with people with Alzheimer’s. I did more than a hundred mock-ups and asked my target users to give me feedback.”

Yao was surprised by the number of things caregivers have to be aware of. “Our loved ones may have visual impairment, and they may have depth perception problems with gripping things in front of them. Simple tasks can become difficult for them and I didn’t even know that before I did research on it and watched them struggle to eat.”

Although Yao has worked on a variety of products while completing her MFA in industrial design, this is the first project she developed from an idea to mass-production. Her impetus was a close connection with her grandmother, who took care of Yao and her sister as children while their parents worked.

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Clinical Trials, Health Disparities, Mental Health, Research, Stanford News

How people with mental illness get left out of medical research studies

How people with mental illness get left out of medical research studies

One of the enduring challenges of evidence-based medicine is that the characteristics of people who participate in clinical trials can differ markedly from those of patients who ultimately access the treatment which the trial evaluates. One of the many reasons this occurs is that researchers often exclude patients with certain characteristics from participating in clinical trials.  In a new study in Journal of Psychiatric Research, my colleagues Laura Roberts, MD; Janet Blodgett, and I examine a particular population to whom this occurs: People with mental health and/or substance use disorders.

If scientists are to live up to their laudable commitment to sharing the benefits of health research with all citizens, they’ll have to more consistently include people with psychiatric problems in studies

In a sample of 400 highly-cited randomized trials across 20 common chronic disorders, we found that half had eligibility rules that prevented people with psychiatric problems from enrolling.   Those disease research areas with high rates of reported psychiatric exclusion criteria in clinical trials included low back pain (75 percent), osteoarthritis (57 percent), COPD (55 percent), and diabetes (55 percent).  People with conditions such as depression, anxiety disorders, alcohol problems and schizophrenia thus may face some added risk when they seek health care: People like them were often left out of the research that tells doctors what medical treatments work.

The study also raises questions about whether some clinical trials make much of a contribution to knowledge. For example, now that psychiatric and other substance use problems are virtually normative among smokers, what is the point of smoking cessation studies that continue to exclude the very populations that do most of the smoking?

Including people with psychiatric problems in medical research may require extra resources for researchers (e.g., people with serious mental illness may be harder to follow up) or pose other challenges in completing clinical trials. But if scientists are to live up to their laudable commitment to sharing the benefits of health research with all citizens, they’ll have to meet these challenges and more consistently include people with psychiatric problems in medical research studies.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He has served in the past as a senior advisor in the Office of National Drug Control Policy in Washington, DC. He can be followed on Twitter at @KeithNHumphreys.

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