American Psychiatric Association, May 18-22

The 172nd American Psychiatric Association Annual Meeting

The annual meeting of the American Psychiatric Association was held from May 18 to 22 in San Francisco and attracted approximately 10,000 participants from around the world, including clinicians, academicians, allied health professionals, and others interested in psychiatry. The conference highlighted recent advances in the prevention, detection, and treatment of psychiatric conditions.

In one study, Konstantinos Argyropoulos, M.D., Ph.D., of Hellenic Open University in Patras, Greece, and colleagues found that adherence to the Mediterranean diet may protect against developing late-life depression.

In a cross-sectional study among the members of day care centers for older people, the investigators found that 25 percent of the participants screened positive for depression. In addition, 64 percent of older adults presented moderate adherence and 35 percent high adherence to a Mediterranean-style diet. Mediterranean-diet eating habits were associated with a decreased risk for depression diagnosed by a physician.

"Older participants following a diet with increased consumption of vegetables, and low to moderate consumption of alcohol and poultry, were at lower risk of developing depressive symptoms. For every additional unit increase in the consumption of vegetables, the probability of developing depression falls by 20 percent, and for each unit reduction in the consumption of poultry and alcohol, the likelihood of depression falls by 36 and 28 percent, respectively," Argyropoulos said. "Although we should be cautious about the study findings (this is a cross-sectional study and no inference can be made), they represent another potential reason to adopt a healthier lifestyle which includes not only a Mediterranean diet but also plenty of physical activity and drinking alcohol only in moderation so as to be protected against depression regardless of age."

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Using data from semistructured individual interviews with 50 midlife women (ages 35 to 60 years) living in North Philadelphia, Jennifer Trinh, M.D., of Temple University Hospital in Philadelphia, and colleagues found that loneliness is common and can be widespread among midlife and older patients.

"Urban minority midlife women face unique life challenges and report loneliness due to strained family and romantic relationships, responsibilities as a caregiver, and trauma," Trinh said. "Though they may be involved in interpersonal relationships, the poor quality of these relationships leads to subjective feelings of loneliness and social isolation."

The investigators also found that supportive relationships were identified as protective against feelings of loneliness.

"Loneliness is a significant topic because it is associated with a number of comorbid mental and physical health issues. By identifying and characterizing these nuances in how women experience loneliness, targeted interventions and community initiatives can be devised and implemented," Trinh added. "Gathering information via individual interviews and focus groups is not only informative but can also be a way of empowering them to be part of the discussion and, hopefully, viable solutions."

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Using the experience of the 2017 hurricane season as an example, Zelde Espinel, M.D., M.P.H., and James M. Shultz, Ph.D., of the University of Miami Miller School of Medicine, emphasized that climate change is affecting both hurricane formation and strength, creating a need to better anticipate and respond to the psychological consequences of extreme weather events.

"Climate change is occurring because of warmer water temperatures and rising sea levels, which are making hurricanes stronger and may be increasing the intensity of storms, with models forecasting more category 3, 4, and 5 'major' hurricanes," Espinel explained.

The investigators noted that psychiatric consequences of major hurricanes have been tied to trauma, loss, and life changes.

"Individuals who experience major losses in a hurricane, including loss of home or employment, may have increased risks for depression, anxiety, and increased alcohol use. In addition, living conditions after a storm (i.e., living in a FEMA trailer for long periods of time) may also cause anxiety, depression, and delayed-onset posttraumatic stress disorder," Espinel said. "Psychiatrists need to make sure they educate patients with preexisting medical conditions and mental illness and their caregivers about taking precautions before storms strike. Patients should maintain their treatment during and after a storm and psychiatrists need to be prepared to deal with new-onset mental disorders occurring in previously healthy individuals who are exposed to strong storms."

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A new poll released during the conference by the APA, found that more than one in three workers are concerned about retaliation or being fired if they seek mental health care.

Darcy Gruttadaro, J.D., director of the Center for Workplace Mental Health at the APA Foundation in Washington, D.C., said that these concerns may cause patients to forego discussing mental health concerns with clinicians for fear that the information might get back to their employer through health claims data.

"Only about one-third (38 percent) of U.S. adults employed with benefits know how to access mental health care benefits through work and only 28 percent feel comfortable using mental health services through work," Gruttadaro said. "This suggests U.S. adults would benefit from guidance from clinical practitioners on strategies for inquiring at work about benefit coverage and reinforcing the importance of seeking mental health care when it's needed."

The poll revealed that younger workers are more comfortable than older workers discussing mental health issues.

"Clinicians are encouraged to engage older adults by asking about their mental health as part of standard clinical practice and not waiting for patients to raise mental health-related issues," Gruttadaro said. "We are making progress on stigma and the willingness of workers to help others who may be struggling with a mental health condition. However, more work must be done so workers are not worried that seeking mental health care could result in negative consequences for their careers. This leads to far too many people waiting to get help until a mental health condition is more serious and difficult to treat and negative consequences arise from the failure to get help early."

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