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Relationship Effectiveness (G.I.V.E.) Relationships aren't only about getting what we need-they're also about the other person. The acronym G.I.V.E. will help you achieve relationship effectiveness by fostering positive interactions. Don't attack, threaten or express judgment during your interactions. Accept the occasional "no" for your requests. Show interest by listening to the other person without interrupting. Be outwardly validating to the other person's thoughts and Validate feelings. Acknowledge their feelings, recognize when your requests are demanding, and respect their opinions. Easy Have an easy attitude. Try to smile and act lighthearted. Self-Respect Effectiveness (F.A.S.T.) Sometimes in relationships you might find yourself betraying your own values and beliefs to receive approval or to get what you want. The acronym F.A.S.T. will help you achieve self-respect effectiveness. Learning to get along with others while also asserting your own needs is essential to healthy relationships. It can be difficult to balance your own needs and the needs of others. How can you get what you need without being aggressive or neglecting of the needs of others? There are three sets of skills you will learn to help achieve this goal: objective effectiveness, relationship effectiveness, and self-respect effectiveness. Objective Effectiveness (D.E.A.R.M.A.N.) What is the goal of an interaction? Objective effectiveness is about getting what you want out of a situation. The acronym D.E.A.R. M.A.N will remind you how to clearly express your needs or desires.

ADHD The risk for suicidality is high among children with attention-deficit hyperactivity disorder (ADHD) and may be mediated by family functioning, according to study data published in the Journal of Affective Disorders. A cross-sectional survey captured psychiatric diagnoses including ADHD, family functioning, and sociodemographic characteristics among 4739 schoolchildren age 7 to 15 years in Taiwan. Suicidality was assessed by the presence of 3 characteristics: suicidal ideation, a current suicide plan, and a history of suicide attempts. Logistic regression analyses were conducted to assess suicidality risk among children with ADHD. Serial multiple mediator models were used to capture the mediating effects of family function and psychiatric comorbidities on suicidality in ADHD. Of the total schoolchildren cohort, 412 (8.7%) had an ADHD diagnosis. The prevalence of ADHD differed between boys (12.3%) and girls (4.8%). Suicidality was present in 20% of children with ADHD. Among those who had current suicidal ideation, a suicide plan, and a history of suicide attempts, the prevalence of ADHD was 19.86%, 21.82%, and 22.86%, respectively. In the adjusted model, children with ADHD had nearly a 4-fold higher risk for suicidal ideation compared with children who did not have ADHD (adjusted odds ratio [AOR], 3.82; 95% CI, 2.73-5.34). Risks were similarly elevated for suicide attempts (AOR, 4.45; 95% CI, 1.99-9.93) and having a suicide plan (AOR, 4.18; 95% CI, 2.57-6.80). ADHD maintained a strong impact on suicidality risk even with the mediating effects of family function and psychiatric comorbidities. ADHD was significantly associated with lower family function (P <.001) and higher levels of anxiety/depression (P <.001). After considering these mediating pathways, the association between suicidal ideation and ADHD remained significant (P <.01). These data emphasize the elevated need for suicidality prevention in children with ADHD and highlight effective areas of interventions. Clinicians may find these data useful in considering the mediating effects of family function and psychiatric comorbidities among patients with ADHD.

The risk increased with labor epidural analgesia alone and labor epidural analgesia and oxytocin, compared with no exposure. HealthDay News — Maternal labor epidural analgesia (LEA) was associated with an increased risk for autism spectrum disorder (ASD) among offspring, according to a study published online July 21 in JAMA Network Open. Chunyuan Qiu, M.D., from Kaiser Permanente Baldwin Park Medical Center in California, and colleagues examined the independent associations of LEA and oxytocin during labor and delivery with ASD using data from 205,994 singleton births with vaginal deliveries in a single integrated health care system from 2008 to 2017. Children were followed through Dec. 31, 2021. Within the cohort, 153,880 and 117,808 children (74.7 and 57.2%, respectively) were exposed to maternal LEA and to oxytocin during labor and delivery. Researchers found that during follow-up, 5,146 (2.5%) had ASD diagnosed. Oxytocin exposure was higher among LEA-exposed than LEA-unexposed children (67.7 vs 26.1%). The risk for ASD associated with LEA was independent of oxytocin exposure (hazard ratio, 1.28; 95% confidence interval [CI], 1.18 to 1.38). After adjustment for LEA exposure, the risk for ASD associated with oxytocin was not significant (hazard ratio, 1.05; 95% CI, 0.99 to 1.12). There was a significant interaction observed for LEA and oxytocin on child ASD risk. Hazard ratios were 1.20 (95% CI, 1.09 to 1.32) for LEA alone and 1.30 (95% CI, 1.20 to 1.42) for LEA and oxytocin compared with no exposure, while the hazard ratio for oxytocin alone was not increased (0.90; 95% CI, 0.78 to 1.04). “Public benefit and risk need to be considered when selecting medical interventions given the benefits of LEA and oxytocin for labor and labor pain management and relatively low incidence and multifactorial risk factors for ASD,” the authors write. Full Article

Greater neighborhood disadvantage and lower household income were linked to microstructural differences, with link partly due to obesity and cognition. HealthDay News — Lower socioeconomic status (SES) is associated with children’s white matter microstructure, according to a study published online June 27 in JAMA Network Open. Zhaolong Adrian Li, from the Washington University School of Medicine in St. Louis, and colleagues conducted a cross-sectional study using baseline data from participants in the Adolescent Brain Cognitive Development (ABCD) study to examine whether and how neighborhood and household SES are independently associated with children’s white matter microstructure. A total of 8,842 children in the ABCD study were included in the analyses. Researchers found that greater neighborhood disadvantage was associated with lower restriction spectrum imaging restricted normalized directional (RSI-RND) diffusion in the left superior longitudinal fasciculus and forceps major. There was an association seen for lower parental education attainment with lower RSI-RND in the bilateral superior longitudinal fasciculus and bilateral corticospinal or pyramidal tract. The associations between SES and RSI-RND were partially explained by lower cognitive performance and greater obesity. In most tracts, lower household income was associated with higher RSI-restricted normalized isotropic (RNI) diffusion. Lower parental educational attainment was associated with higher RSI-RNI in the forceps major. These associations were partly explained by greater obesity. “In this large cross-sectional study, neighborhood and household socioeconomic adversity were independently associated with white matter microstructural differences in children,” the authors write. “These associations were partially explained by obesity and cognition.” Full Article

The Conversation — Anxiety disorders are common among Australian children, affecting nearly 7% of those aged 4–11 years. Children’s fears can focus on areas such as being alone, talking to strangers or going to sleep. In small amounts these fears can be helpful for survival; in large amounts they can become overwhelming and impairing. Childhood is the ideal time to treat these problems before they become severe, protracted or lead to other disorders. A variety of child anxiety treatments are on offer, yet not all treatments are the same or should be considered equal. So how do you face the daunting task of deciding which is best for your anxious child? First, Does My Child Need Help? The first step is to work out if your child needs treatment. It’s normal for children to experience irrational fears that pass with time. For example, many children and adults are more fearful of spiders than they should be, based on the level of danger. The main factor that determines whether a child has “clinical anxiety” is the extent to which the fear causes problems in their daily life. If a child who is fearful of spiders, for example, has ongoing trouble leaving home or sleeping because of their fear, they may need extra help. In younger children, anxiety can be seen as more cautious or avoidant behavior, which is especially visible when they are in unfamiliar situations. Keep in mind that anxious children often do not draw attention to themselves and can “go under the radar.” For example, anxious children are often quiet and well behaved at school, so teachers may not be aware they are struggling. Many anxious children also unfortunately experience other mental health problems, particularly depression, so it’s important to keep an eye out for other issues as well. What is the Best Treatment for My Anxious Child? Psychotherapy (talking therapy) for child anxiety can be highly effective. A therapist should empathize with your child and assess how their anxiety began and how it effects their life. Different health professionals may emphasize different ways to understand and treat a child’s anxiety, often using the approach they are more familiar with or trained in. Children can respond differently to these treatments, so you need to listen to what they find helpful. For example, a family systems therapist may focus on how family dynamics and communication impact on a child’s mental health. Some therapists focus on developing mindfulness skills, teaching children to observe and accept their anxious thoughts and feelings rather than responding to them. Different treatments have varying levels of evidence. Keep in mind that people often report some benefit from any treatment (like a “placebo effect”), so you need to work out what works best overall. With that said, treatments that teach children skills to manage their anxiety, such as cognitive behavior therapy (CBT), tend to be most effective. What is Cognitive Behavior Therapy? Cognitive behavior therapy (CBT) is a broad range of treatments based on the interaction between your child’s thoughts, feelings and behaviors. Therapists encourage children to alter the way they think, which can change how they behave and feel. CBT programs have been developed and tailored for anxious children and their families, such as the Cool Kids program. These treatments have been rigorously tested and are known to work for many children. CBT is also freely available online and this can be an easy way to access and try treatment for example, Fear-Less Triple P Online. These treatments teach the same CBT skills, however, they are delivered and assessed using an online platform, meaning treatment can take place at home. Does My Child Need Medication? Antidepressant medications can be highly effective for childhood anxiety but can also cause side effects, so they are often used when psychological therapies have not been effective. Their use should be monitored by a doctor. What Else Can I Do? Doing simple things, such as improving your child’s diet, sleep and exercise can have a big effect on their mental health. It’s important to be supportive and listen to your child when they are distressed, while encouraging them to face their fears. Their fears may seem silly to you, but they are very real for them. You may also want to involve your child’s school in their treatment, so teachers and parents are on the same page. Like most services, you may need to shop around to find a mental health professional and treatment that suits you and your child. A psychologist with specific clinical training, experience in CBT and child anxiety can be a good place to start. Doing some research or seeking a referral is definitely worth the effort. Is My Child Getting Better? The main way to know if your child is getting better is if they are resuming their normal life. Remember the goal of treatment is not for your child to be completely free of anxiety; it’s to help them manage their anxiety so they still live a full life. Childhood anxiety is distressing for your child and for the whole family, however, there is reason to be hopeful: there are effective treatments and these problems often pass with time. It may be a journey, but work with your child and skilled health professionals and you will find the help your family needs.

Highest prevalence of 4 or more adverse childhood experiences identified among females, adults aged 25 to 34 years, and adults with less than a high school education. HealthDay News — The prevalence of individual and total adverse childhood experiences (ACEs), defined as preventable, potentially traumatic events, varies by jurisdiction and sociodemographic characteristics, according to research published in the June 30 issue of the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. Elizabeth A. Swedo, M.D., from the CDC in Atlanta, and colleagues used 2011 to 2020 Behavioral Risk Factor Surveillance System data to provide estimates of ACEs prevalence among U.S. adults in all 50 states and the District of Columbia. The researchers found that 63.9 and 17.3 percent of U.S. adults reported at least one ACE and reported four or more ACEs, respectively. Experiencing four or more ACEs was most common among females and adults aged 25 to 34 years (19.2 and 25.2 percent, respectively), non-Hispanic American Indian or Alaska Native adults and non-Hispanic multiracial adults (32.4 and 31.5 percent, respectively), adults with less than a high school education (20.5 percent), and those who were unemployed or unable to work (25.8 and 28.8 percent, respectively). There was considerable variation observed in the prevalence of experiencing four or more ACEs across jurisdictions, from 11.9 to 22.7 percent in New Jersey and Oregon, respectively. “CDC has released prevention resources to help provide jurisdictions and communities with the best available strategies to prevent violence and other [adverse childhood experiences], and with guidance on how to implement those strategies for maximum impact,” the authors write. Full Article

Concerns about mental health and substance use remain elevated three years after the onset of the COVID-19 pandemic, with 90% of U.S. adults believing that the country is facing a mental health crisis, according to a recent KFF/CNN survey. The pandemic has affected the public’s mental health and well-being in a variety of ways, including through isolation and loneliness, job loss and financial instability, and illness and grief. Over the course of the pandemic, many adults reported symptoms consistent with anxiety and depression, with approximately four in ten adults reporting these symptoms by early 2021, before declining to approximately three in ten adults as the pandemic continued (Figure 1). Additionally, drug overdose deaths have sharply increased – largely due to fentanyl – and after a brief period of decline, suicide deaths are once again on the rise. These negative mental health and substance use outcomes have disproportionately affected some populations, particularly communities of color and youth. As the end of the declaration of the public health emergency nears – on May 11, 2023 – many people continue to grapple with worsened mental health and well-being and face barriers to care. Mental health and Substance use This brief explores mental health and substance use during, and prior to, the COVID-19 pandemic. We highlight populations that were more likely to experience worse mental health and substance use outcomes during the pandemic and discuss some innovations in the delivery of services. We analyze and present findings using the most recent data available at the time of this publication – including the Household Pulse Survey and the CDC WONDER database. Key takeaways include: Symptoms of anxiety and depression increased during the pandemic and are more pronounced among individuals experiencing household job loss, young adults, and women. Adolescent females have also experienced increased feelings of hopelessness and sadness compared to their male peers. Deaths due to drug overdose increased sharply across the total population coinciding with the pandemic – and more than doubled among adolescents. Drug overdose death rates are highest among American Indian and Alaska Native people and Black people. Alcohol-induced death rates increased substantially during the pandemic, with rates increasing the fastest among people of color and people living in rural areas. After briefly decreasing, suicide deaths are on the rise again as of 2021. From 2019 to 2021, many communities of color experienced a larger growth in suicide death rates compared to their White counterparts. Additionally, self-harm and suicidal ideation has increased faster among adolescent females compared to their male peers. Several changes have been implemented in the delivery of mental health and substance use services since the onset of the pandemic, including the utilization of telehealth, steps to improve access to treatment for opioid use disorders, expansion of school-based mental health care, and the rollout of the 988 crisis line. As the public health emergency declaration comes to an end, it is possible that some of these changes will be interrupted. Prevalence of Mental Illness and Substance Use During the Pandemic Anxiety and depression The pandemic was associated with a high prevalence of anxiety and depression symptoms in adults. Research suggests that these symptoms increased during the pandemic, but the extent of this increase is unclear.1 Throughout the pandemic, symptoms of anxiety and depression have been more pronounced among several populations. For example, individuals experiencing household job loss were more likely than their counterparts to report symptoms of anxiety and/or depression (53% vs. 30%) in February 2023 (Figure 2). Job loss and unemployment – which have long been associated with adverse mental health outcomes – increased substantially early on in the pandemic. Fifty percent of young adults (ages 18-24) reported anxiety and depression symptoms in 2023, making them more likely than older adults to experience mental health symptoms (Figure 2). Young adults have experienced a number of pandemic-related consequences – such as closures of universities, transitioning to remote work, and loss of income or employment – that may contribute to poor mental health. Additionally, young adults in college settings may encounter increased difficulty accessing treatment. Symptoms of anxiety and/or depression were also elevated among women (36%) compared to men (28%) in February 2023 (Figure 2). Even before the pandemic, women were more likely than men to report mental health disorders, including serious mental illness. Concerns about youth mental health further increased with the onset of the pandemic and the recent uptick in gun violence. In a recent KFF/CNN survey, roughly half of parents (47%) said the pandemic had a negative impact on their child’s mental health, including 17% who said it had a “major negative impact”. Poor mental health has been more pronounced among adolescent females in particular. As shown in Figure 3, the gap in the share of adolescent females and males reporting feelings of hopelessness and sadness – symptoms indicative of depressive disorder – widened from 2019 (47% vs. 27%, respectively) to 2021 (57% vs. 29%, respectively). Many female adolescents also reported adverse experiences in 2021, which can negatively impact mental health. Source: Kaiser Family Foundation (full article)

Peaks in suicidality were seen in April and October, and a nadir in July; seasonal patterns were disrupted coincident with school closures in spring 2020. HealthDay News — Seasonal patterns are seen in suicidality among children and adolescents, with peaks in April and October and a nadir in July, according to a study published online July 19 in JAMA Network Open. Youngran Kim, Ph.D., from the University of Texas Health Science Center at Houston, and colleagues examined recent trends in suicidality rates and quantified the seasonality in suicidality in a population-based, descriptive cross-sectional study using administrative claims data. Participants included children aged 10 to 12 years and adolescents aged 13 to 18 years. A total of 73,123 emergency department visits and hospitalizations for suicidality reported between 2016 and 2021 were included in the analysis. The researchers found that the mean annual incidence of emergency department visits and hospitalizations for suicidality was 964 per 100,000 children and adolescents, which increased from 760 to 1,006 per 100,000 from 2016 to 2019, then decreased to 942 per 100,000 in 2020 and increased to 1,160 per 100,000 in 2021. Peaks were seen in April and October compared with January (incidence rate ratios, 1.15 and 1.24, respectively), while there was a nadir in July during pre-COVID-19 years and in 2021 (incidence rate ratio, 0.63). Coincident with school closures, seasonal patterns were disrupted during the spring of 2020 and the lowest rates were exhibited in April and May. “We cautiously interpreted the unexpected decrease in suicidality rates during the school closures in spring 2020 as further support for the association between the school calendar and suicidality among children and adolescents,” the authors write. Full Article

HealthDay News — Lower maternal fiber intake during pregnancy is associated with an increased risk for neurodevelopmental delay in offspring, according to a study published online July 27 in Frontiers in Nutrition. Kunio Miyake, Ph.D., from the University of Yamanashi in Chuo, Japan, and colleagues examined the association between maternal dietary fiber intake during pregnancy and neurodevelopmental delay in offspring using data from 76,207 mother-infant pairs in a nationwide prospective cohort study. A food frequency questionnaire administered in midpregnancy was used to estimate maternal dietary fiber intake, which was classified into quintiles. The association between dietary fiber intake and developmental delay, measured in 5 domains at the age of 3 years, was assessed. Researchers found that compared with the highest intake group, the lowest intake group of total dietary fiber had a significantly increased risk for delayed communication, fine motor, problem-solving, and personal-social skills (adjusted odds ratios, 1.51, 1.45, 1.46, and 1.30, respectively). A similar trend was seen in an analysis that excluded the effects of insufficient folic acid intake during pregnancy. “Most pregnant women in Japan consume far less dietary fiber than what is the recommended intake; thereby, this maternal nutritional imbalance during pregnancy may adversely affect the neurodevelopment of their offspring,” the authors write. “Nutritional guidance for pregnant mothers is crucial to reduce the risk of future health problems for their children.” Full Article

Although research has demonstrated that physicians continue to be the most respected source of medical information for patients, they also frequently search the internet for information prior to an office visit.1 Ease of access to medical information websites and the significant growth in the amount of health information available means that patients can find information in a matter of seconds. However, not all of the information provided by medical information websites is reliable, which has the potential to significantly affect both patient care and public health. How Do Patients Seek Health Information? Once, physicians were the primary gatekeepers of reliable health information. Over time, this role has evolved to include such media as print, television, and radio, and now, the internet. Today, patients can access health information in a number of ways, including: Health care professionals (physicians, nurses, pharmacists, and other health care professionals) Friends and family Social media (eg, YouTube, Twitter, Facebook, and TikTok) Medical information websites (WebMD, Mayo Clinic, and Cleveland Clinic, among others) Health apps, including various fitness, nutrition, or mental health apps Television and radio As access to the internet has become more widespread over the past 20 years, researchers have documented the shift in patient health information-seeking behavior to include more online sources.2 More than two-thirds of people who use the internet use it to search for health information. Most of these users search using a general search engine, such as Google or Bing, instead of starting their search on a dedicated medical information website.3 Social media serves as a source of health information shared by not only friends and family, but also the pharmaceutical industry and news media, among others. In research conducted recently, social media was determined to be one of the top 10 ways online health information is spread. Why Do Patients Visit Medical Information Websites? Although searching for health information on the internet has been increasing over the past 20 years, the COVID-19 pandemic contributed to significant growth in this behavior. Without easy access to in-person medical advice, people turned to the internet for health information. A study conducted by researchers in Italy revealed that during the COVID-19 pandemic, the internet — not physicians — was the main source of health-related information. Additionally, one-third of people were found to have increased their health information-seeking behaviors during this time. Other factors that could contribute to this phenomenon include long wait times for in-person medical visits and the high cost of health care.

August 15, 2023 More than 50% of those with systemic autoimmune rheumatic diseases had never/rarely reported mental health symptoms to clinicians. HealthDay News — The prevalence of all self-reported neuropsychiatric symptoms is significantly higher in those with systemic autoimmune rheumatic diseases (SARDs) vs controls, according to a study published online July 27 in Rheumatology. Melanie Sloan, Ph.D., from the University of Cambridge in the United Kingdom, and colleagues examined a wider range of potential neuropsychiatric symptoms in SARDs than have been reported previously using data from 1,853 SARD patients, 463 controls, and 289 clinicians as part of the INSPIRE research project. A total of 113 in-depth interviews were analyzed thematically. The means of survey items were compared between patients and controls, 8 different SARD groups, and clinician specialties. Researchers found that compared with controls, SARDs had higher self-reported prevalence rates of all 30 neuropsychiatric symptoms investigated, including cognitive, sensorimotor, and psychiatric. Of SARD patients, validated instruments revealed that 55 and 57% currently had depression or anxiety, respectively. Limits to knowledge, guidelines, objective tests, and interspecialty cooperation; subjectivity, invisibility, and believability of symptoms; and under-eliciting, under-reporting, and under-documenting were barriers to identifying neuropsychiatric symptoms. The proportion of clinicians who reported never/rarely asking patients about mental health symptoms was much lower than the percentage of patients who reported never/rarely being asked in clinic (4 vs 74%). More than 50% of SARD patients had never/rarely reported their mental health symptoms to clinicians, which was underestimated by clinicians at less than 10%. “The low level of reporting we identified is a major concern as problems with mental health, fatigue, and cognition can be life-changing, and sometimes life-threatening,” Sloan said in a statement. Several authors disclosed ties to the pharmaceutical industry. Full Article

Brain A large brain imaging study of adults with six different psychiatric illnesses shows that heterogeneity in regional gray matter volume deviations is a general feature of psychiatric illness, but that these regionally heterogeneous areas are often embedded within common functional circuits and networks. The findings suggest that "targeting brain circuits, rather than specific brain regions, may be a more effective way of developing new treatments," study investigator Ashlea Segal told Medscape Medical News. The findings also suggest that it's "unlikely that a single cause or mechanism of a given disorder exists, and that a 'one-size-fits-all' approach to treatment is likely only appropriate for a small subset of individuals. In fact, one-size-doesn't-fit-all. It probably doesn't even fit most," said Segal, a PhD candidate with the Turner Institute for Brain and Mental Health's Neural Systems and Behaviour Lab at Monash University in Australia. "Focusing on brain alterations at an individual level allows us to develop more personally tailored treatments," Segal added. Regional heterogeneity, the authors write, "thus offers a plausible explanation for the well-described clinical heterogeneity observed in psychiatric disorders, while circuit- and network-level aggregation of deviations is a putative neural substrate for phenotypic similarities between patients assigned the same diagnosis." The study was published online August 14 in Nature Neuroscience. Beyond Group Averages For decades, researchers have mapped brain areas showing reduced gray matter volume (GMV) in people diagnosed with a variety of mental illnesses, but these maps have only been generated at the level of group averages, Sega l explained.