A Cambridge research first in teenage male depression

It probably comes as no surprise, just from looking within our own circles of acquaintance, that depression and anxiety among our young is on the increase.

According to the Centers for Disease Control in the States, 81% of deaths from suicide between the ages of 10 and 24 occur in males - that might be America, but like any good, virulent strain of flu we, in the UK, seem to catch whatever they do. Research from The Nuffield Foundation confirms this trend and cites changes in employment patterns and family life over the last several decades as possible contributing causes.

Recent findings by Professor Ian Goodyer and his team in the Department of Psychiatry at the University of Cambridge suggest that predicting the likelihood of clinical depression among teenage boys, at least, may become a reality in the near future.

The protocol entailed collecting saliva from hundreds of teenage boys and girls who were concurrently asked to self-report any symptoms of depression. The saliva samples were then measured for cortisol, a hormone released by the adrenals in response to stress. The cohort was then divided into four groups based on cortisol levels and depressive symptoms, and followed up for between 12 and 36 months.

Girls who started out with high cortisol levels and depressive symptoms were found to be four times more likely to develop clinical depression than those starting out with no symptoms and low cortisol levels (an interesting enough finding). Boys with elevated cortisol and depressive symptoms, however, were found to be fourteen times more likely to progress on to developing clinical depression than those with low cortisol titres and no symptoms.

Two obvious implications arise:
1. It would appear that gender difference does have a role to play in the evolution of clinical depression
2. Cortisol may be a reliable biomarker, which could be used to identify those at risk of developing clinical depression, especially among teenage boys

The work also raises the question of how cortisol might be contributing to the development and maintenance of depression and whether it may even be considered as a target for treatment.

This is useful research and let's hope it leads to early identification and prevention of depression in vulnerable young men. But let's not forget, for one minute, the need to address the social, environmental and many other complex factors in the aetiology of depression.

Written by Jacqui Hogan

One sure-fire cure for depression

The current debate in The Netherlands around doctor-assisted suicide for depression sends a shiver down my spine. It's all been triggered by a controversial new clinic, the pragmatically named Life-Ending Clinic, which is now proudly ending the lives of people with chronic depression. Clinic Director, Steven Pleiter, has said:

"We consider it self-evident that someone who is terminal can turn to euthanasia. Now we are entering a phase in which there will be more debate about about patients who are not terminally ill, among them psychiatric patients…" 

A jaunty press release from the clinic stated 'The figures over 2013 show a strong growth of euthanasia in these groups' (referring to those with dementia and psychiatric problems). If that kind of marketing sound-bite doesn't raise a red flag for you, I suggest you look into your heart and see whether some small part of it hasn't turned to stone. For when the day comes that business models and growth projections are applied to the practice of killing our fellow humans, we have truly turned out all the lights on truth and dignity.

Picture the scene: a board meeting at the Life-Ending Clinic, with share-holders seeking higher return on investment and demanding a greater recruitment drive from administrators, setting targets for increasing 'customer buy-in'; the advertising agencies weighing in, the PR machine cranking up, twisting and distorting the minds of those whose minds are most vulnerable.

The Dutch legalised euthanasia in 2001 The law, as implemented back then, allowed doctors to end the lives of patients, but only in close consultation family physicians who had known the patient over many years. Termination of life was intended to be limited to those with 'unbearable and hopeless suffering' who were in full command of their mental faculties and had no hope of relief.

Compare this model to one highly publicised case last year in which the Life-Ending Clinic terminated the life of a 63 year-old man described as having severe psychiatric problems. The customer in question, after an active career in government, could not face the prospect of his up-coming retirement. Gerty Casteelen, the clinic's psychiatrist, told Dutch newspaper NRC Handelsblad that the man:

"...managed to convince me that it was impossible for him to go on. He was all alone in the world. He'd never had a partner. He did have a family but was not in touch with them. It was almost like he'd never developed as a person. He felt like he didn't have the right to live. His self-hatred was all consuming."  

Hey Gerty, well that sounds like a good reason to bump him off then, doesn't it? Maybe your October quota was a little shy of where it needed to be and, well, it must be awful to be in such a terrible position in life, mustn't it? This sounds conspicuously like a man who needed help dealing with some very painful realities and feelings, but not a man who needed to be enabled to die.

We were warned, weren't we, that legalising euthanasia was the thin end of the wedge. And with moves afoot to allow the depressed to choose to die, it would appear that we that we are now boldly scaling that wedge, with barely a 'by your leave'. Anyone who knows anything about depression knows that it is often a wake-up call for a need to change, a precursor, when handled effectively, to a richer and more profound experience of life. Not only that, but those who have been depressed are graced with an empathy, an ability to help others which is a benefit and a gift.

It would appear that the Culture of Death is playing some serious trump cards. But the game isn't over yet.

Written by Jacqui Hogan

Talk is cheap - or is it?

I guess you all know that yesterday marked the first ever outing of Time to Talk Day, described on the official website as '24 hours in which to start conversations about mental health, raise awareness and share the message that mental illness is nothing to be ashamed of, and neither is talking about it.'

The idea was that for a whole day, people of all stripes would gather over a cuppa (in my opinion, the most reliable of all antidepressants) and strike up conversations which would include saying nice things about mental health issues - in environments as diverse as offices, libraries, schools and shopping centres. And goodness me, even people like AXA PPP, private medical insurers, were adding in their caring two-bob's worth!

Now call me a cynic, but I wonder how many of those with mental illness were chirpily flicking on the kettle for Elevenses and tweeting a shot of their cuppa at the appointed hour, while animatedly drilling down into the subject of say, their suicidal depression or bipolar affective disorder? And by contrast, how many of those who cannot come close to understanding the actual experience of living with mental illness were taking advantage of the latest pitch at self-promotion, the latest opportunity to associate themselves with a worthy cause?

In this context, talk is decidedly not cheap, but rather has a distinctive value, oiling the voracious wheels of the public relations industry. Gotta have something to talk about don't we, something to create a new logo for, something to make us look the part while we cash in on the referred glory that will come our way by association. How much of the money paid towards staging this day could have been used to help people with actual mental illness, like my friend, let's call her Veronica, who has been on the brink of suicide all week?

When I spoke to Veronica on the telephone last Sunday, she could barely talk, occasionally supplying faint, monosyllabic answers to my basic, by now anxious, questions about the state she was in. You see, Veronica has attempted suicide three times before, so she has form.

In this latest episode, her mother wound up taking her to hospital, where she was told, more or less, to 'get a grip' and that there are people who are much worse than her whom they had to prioritise. Veronica has been in the system for fifteen years and she will tell you that the system is broken at every level, from clinicians' basic understanding of mental illness to the barrage of drugs she's endured over the years. (On this note, she has told me that she survived this latest bout without the aid of antidepressants and that she can now see that antidepressants made, at best, no difference to her thinking and, at worst, made things worse.)

Oh yes, it's time to talk alright, but perhaps not in the frivolous, self-serving way that the 'powers that be' dream up to try to convince everyone that there's progress being made. Just how gullible are we? Do we not understand the vested interests in promoting mental illness? This is where the talk needs to be - in exposing those who have plenty to gain from the existence of the mentally ill.

Written by Jacqui Hogan

What men don't like - and why they're dying to let you know

The 'National Action Alliance for Suicide Prevention' Annual Report 2012-2013

You know things are not quite right when it becomes necessary to convene a consortium that goes by the name the National Suicide Prevention Alliance (which appears to be a new, improved version of the National Action Alliance for Suicide Prevention, referenced above - go figure). Because, let's face it, when members of our society are increasingly seeing self-murder as a viable solution to life's ills, it's time to wake up and take a look at what's going on.

According to the Office for National Statistics, there were 6,045 suicides in the UK in 2011 among those aged 15 and over, the highest rate since 2004. Of these, men aged 45 to 59 fared the least well - this group scored the highest suicide rate since 1986. So what's going on with our men?

Research by the Samaritans published in 2012 highlights that some of the reasons why middle-aged men take their own lives include:

• Comparing themselves with other men, who are perceived to be the 'gold standard' for power, control and invincibility
• Not being sure about their identity - should they be more like their strong, family-minded fathers or their individualistic, 'progressive' sons
• Loss of traditional work roles, with the decimation of the labour market
• Absence of one life-long female partner, on whom they remain overwhelmingly dependent - that is, they are more likely to live alone and lack the social and emotional skills to do so successfully

This strikes me as being extremely sad - must we continue to lose our men to the ravages of cultural feminisation? Whether we like it or not, we are now living in a world in which men are behaving more like women than women - and that's obviously not to say that there's anything wrong with being a woman! But what nobody seems to get is that men and women are equal in dignity, but have different and complementary roles to play, roles which are defined by their nature and biology as much as anything. 

The other day I was passing through an airport in Eastern Europe and I spied an advertisement for Nivea which would have made me laugh if it didn't want to make me cry. It was a close-up of two men, lying side by side, faces covered with cold-cream, hair towelled up and cucumber slices on their eyes - in Eastern Europe, for crying out loud! No wonder men are queuing up to hurl themselves into the abyss!

Now I'm not decrying the establishment of government support services for those affected by the tragedy of suicide and I wish the National Suicide Prevention Alliance every success with its new name and tidy cash injection. But if it is not accompanied by a long hard look at what is fuelling this Culture of Death, then I say shoot it now and put it out of its misery.

Written by Jacqui Hogan

Youth mental health now a priority for UK General Practitioners

Statistics from the Royal College of General Practitioners (RCGP) show that 50% of adults with mental health problems will have presented by the age of 15 and 75% by the age of 18 - this is powerful information which points to the importance of early intervention.

Juxtapose this with the fact that (according to Dr Maureen Baker, Chair of the RCGP) fewer than half of all General Practitioners in the UK are given the opportunity to undertake a paediatric or psychiatric placement during their training, and you see the massive opportunity for improving the treatment of mental health as it stands today.

The RCGP is therefore recommending that, in future, as part of an improved four-year training programme, all GP trainees should receive specialist-led training in the fields of both child health and mental health, and is working with the Royal College of Paediatrics and Child Health, the Royal College of Psychiatrists and Young Minds to identify ways that GPs and specialists might collaborate to work more effectively together.

Common problems among the young include poor mental resilience, anxiety, depression and self-harming behaviours - identifying suicide risk and early recognition of psychosis are among the target strategies for primary care. The RGCP is also undertaking initiatives to raise awareness about youth mental health, alerting GPs to simple actions that can be taken to ensure younger patients receive the support they need.

The College also notes that it is important that children and young people feel comfortable approaching their GP and that GPs are sufficiently prepared to discuss what are often sensitive issues with confidence. I don't know about you, but this all sounds like delicate work - let's hear it for our long-suffering GPs.

Written by Jacqui Hogan

A new peer counselling initiative for North London

My GP practice in North London is pretty switched on, by my estimation (which is, of course, not to say that it necessarily is). So I was intrigued to discover a new initiative starting up in which patients registered at the practice can join a group called 'Talk for Health', billed as 'a programme for emotional wellbeing'.

The idea is that those who wish to be involved are invited to participate in four training days, which will then lead into what is described as 'ongoing support in a peer counselling group'. The group will cover:

'...thinking about yourself, understanding and talking about your feelings and listening in a helpful way. It offers an opportunity to explore and resolve current dilemmas and struggles in your life.'

Clearly the practice is seeing a lot of people with mental health issues, and good for them for taking the bull by the horns and looking at creative ways of helping them process their difficulties. Group counselling, in my experience, is a powerful tool, but I do find myself wondering how this might play out among participants who are not necessarily in one-to-one counselling and will have only the benefit of four days of preparatory 'training'.

What kind of training might that be? Presumably a crash course in the principles of humanistic counselling, maybe some education around what constitutes a boundary - who can tell? What concerns me somewhat is the implication that anyone can be a counsellor after a few days of instruction - the democratisation of a vocational skill which takes years to develop and hone.

We see this happening in all walks of life now - in my own field of writing I note that people with very little experience and a one-day workshop under their belts are purporting to be professional writers. All of this is a consequence of the commoditisation and consequent mushrooming of vocational qualifications. That is to say, if you can pay for one of the vast number of qualifications now on parade, then you can have it, rather than there being a limited number of qualifications, delivered by bona fide institutions, which are earned by merit.

This effect is unlikely to go away any time soon, and so we will likely see more and more 'professionals' who are less and less qualified and a dumbing down of the quality of any particular service. In the case of counselling and psychotherapy, we are likely to see more individuals earning their (poor quality) qualifications simply by paying for them and, as we all know, it takes life experience, deep self-examination and many years' experience to become a truly helpful instrument in this field.

Don't get me wrong; I do believe there's a balance to be struck here - is it better to have some kind of forum to help people struggling with emotional difficulties than not? A resounding yes from where I stand. But let's not get the idea that after four days of training that these individuals can acquire the skills needed to  do very much more than provide a sounding board and fellowship for each other.

That said, the value of being among others who share similar kinds of difficulties cannot be underestimated, as is clearly shown by the 12-Step movement (the system upon which Alcoholics Anonymous is based). The simple act of coming together to form a community carries the potential for  considerable therapeutic benefit, which may indeed be the case with the peer counselling group due to start at my local practice.

Perhaps if we understood the value of communication within community, GPs would have no need for such limited solutions.

Written by Jacqui Hogan 

Greener pastures for the New Year

Happy New Year from all at 96 Harley Psychotherapy! May 2014 herald green shoots, steady growth and forward momentum.

Staying with the green theme, I couldn't help but notice a new study published by the Journal of Environmental Science and Technology which offers encouraging news for those who are planning to move to areas with more green space this coming year. The study shows that more green space in towns and cities, such as parks and gardens, could lead to significant improvements in mental health for the good burghers of our nation.

The study, conducted by Dr Ian Alcock at the University of Exeter Medical School, is one of the first to examine the effects of green space on mental health over time. Data was pooled from over one thousand participants in the British Household Panel Survey, householders who had completed questionnaires from across Great Britain.

The work focused on two main groups - those moving to greener urban areas and those moving to less green urban areas from their original location. On average, those who moved to greener areas reported an immediate improvement in mental health, the effects of which were still evident three years after the move. Participants relocating to less green areas experienced a decrease in mental health, though this parameter returned to baseline once the move was complete. The figures were adjusted to remove the bias of other factors that may have impacted the results, such as employment, income and personality variables.

This study is of particular interest given the mental health context in which we now live - in 2012, the World Health Organisation identified depression as the leading cause of disability worldwide. Obviously, anything which can help address or relieve this burden has to be taken seriously.

These findings remind me of something I was told by a priest recently, which was that the peace we feel when we step out of the urban environment is the experience of all of nature worshipping God - which, of course, it does effortlessly, simply by 'doing its thing' in the manner decreed by its Creator. By contrast, in an urban environment, the shadow of human creatures doing things their own way affects the level of peace and harmony available to all those in the immediate environment - negatively, of course.

If you've ever stood on a mountain top on a clear day, you'll know what I mean - perhaps when we relocate to greener climes we tap into a greater density of creatures simply worshipping God, thereby radiating peace and tranquility.

No matter what the mechanism, it seems to me that relocating to greener pastures (maybe even just getting out in nature once in a  while) is good for our mental health. I for one, will be adding such activities to my lengthening New Year's resolution list!

Written by Jacqui Hogan