Sexual abuse in childhood increases the chances of high-risk pregnancy, shows a new study conducted by Prof. Rachel Lev-Wiesel, Head of the Graduate School of Creative Arts Therapies at the University of Haifa, Lee Yampolsky and Dr. Tzachi Ben Zion, Deputy Director of Soroka Hospital. “Even when a woman willingly and happily commences a pregnancy, it seems that the body relates the sexual act that created the pregnancy with the abuse trauma, evoking negative feelings which can then be expressed in physical and gynecological problems,” Prof. Lev-Wiesel explains.

The current study examined the possibility of sexual abuse experienced in childhood triggering retraumatization during wanted pregnancy. A group of 1,830 pregnant women participating in the study were divided into high- and low-risk groups, which were further divided into three subgroups: those who were victims of child sexual abuse, those who experienced other types of trauma in childhood, and those who had experienced no notable trauma. Compared with women who had not endured any notable trauma before, those who had been sexually abused in childhood, the study shows, suffered higher levels of depression and more post-traumatic symptoms.

According to Prof. Lev-Wiesel, the main post-traumatic symptoms that these women reported were detachment and avoidance. The study also found that the more severe the child sexual abuse, the stronger the correlation between the PTS symptoms and poor physical health during pregnancy. “Gynecological problems might be the body’s manifestation of the child sexual abuse trauma,” Prof. Lev-Wiesel explains.

“The current study’s findings have important practical implications for health care providers, practitioners and obstetrical gynecologists. There is a need to to recognize and address the psychological state of pregnant child sexual abuse survivors,” Prof. Lev-Wiesel says. “It is also important to remember that since the screening process itself may serve as a trigger to retraumatization, a specially trained team should provide a safe environment and psychological assistance.”

Obtaining therapy via teleconference is just as effective as face-to-face sessions, according to a new research by Stephane Guay, a psychiatry professor at the Universite de Montreal.

“Previous studies have shown that phobia therapy via teleconferencing was just as efficient as face to face contact,” says Dr. Guay, who is also director of the Trauma Studies Centre at the Louis-H. Lafontaine Hospital’s Fernand-Seguin Research Centre. “We wanted to see if the process could also be used for post-traumatic stress treatment.”

Until recently, telemedicine was limited to doctors using the technology to communicate with peers who would weigh-in on x-rays results or supervise a surgery. With teletherapy, patients could theoretically consult experts from the other side of the globe.

As part of this study, 17 post-traumatic stress victims from the Outaouais region underwent 16 to 25 sessions via teleconference with Montreal therapists. A control group consisted of patients receiving face-to-face therapy.

The teletherapy participants, however, still needed to visit a hospital equipped with the necessary equipment and supervised by medical personnel. “It would be ethically indefensible for them to stay home,” says Dr. Guay. “Post-traumatic stress therapies require that a patient relive certain traumatic events and should they become uncomfortable it is mandatory that someone be there to intervene.”

The teletherapy group and the control group equally benefited from their therapy. “The same number of patients in both groups saw a significant decrease in their post-traumatic stress, depression and anxiety symptoms,” says Dr. Guay. “In fact, 75 to 80 percent overcame their chronic post-traumatic stress.”

Patients were later evaluated and none were affected by distance to their therapist and none expressed discomfort about the technological aspects of the procedure. “In fact, comments were more in favor of tele-therapy,” says Dr. Guay. “It seems patients appreciate a certain distance from their therapist.”

Teletherapy could be increasingly used to provide access to treatments requiring specialists who are unavailable in remote regions. While Dr. Guay says teletherapy can’t be used for all types of rehabilitation, it would lend itself well to the treatment of depression, phobias and eating disorders.

There’s no doubt that meeting partners on the Internet is a growing trend. But can we trust the information that people provide about themselves via online dating services? And why is depression so dissatisfying in relationships? These two questions are explored in articles appearing in the latest issue of the Journal of Social and Personal Relationships, published by SAGE. The authors also discuss their findings in a new podcast series: Relationship Matters.

Jeffrey Hall of the University of Kansas is lead author of the paper on internet dating, which shows that people looking for romance online actually behave very much as they do in face to face dating and relationships. “Our findings dispel the myth that people using online dating are that different than any one else who might find a relationship through friends, school or work,” Hall explains.

His team investigated over 5000 individuals dating online in search of long-term partners, from all walks of life and over a wide age range (18 to over 60). The survey included questions on personality traits such as openness, extroversion, education and income. “We also asked a series of questions on an important trait that we call self monitoring,” Hall says. “Self monitoring is about how we try to present ourselves in a favourable light to others, to make people like us.” Someone who scores as ‘low’ on self monitoring is extremely authentic when describing themselves in all circumstances, and those who score ‘high’ are more prone to so-called white lies.

Self-monitoring scores turned out to be a major factor in the likelihood of people changing their presentation to others across all dating indicators (topics such as previous relationships, likes, dislikes, appearance, etc).

Whether a person is likely to lie about themselves online also depends on what kind of person they are: Someone who is very open to new experiences (e.g. foreign travel) is highly unlikely to misrepresent themselves about their experiences – because they are naturally interesting people. On the other hand extroverts are more likely to misrepresent themselves when describing past relationships. Extroverts tend to have many past relationships because they meet new people easily, but may play this down when looking for a new relationship.

The good news, according to Hall, is that the likelihood of people misrepresenting themselves overall is actually very low. The research also showed that not all men are from Mars and Women from Venus – the differences between individuals was far greater than any difference between the sexes. However women were somewhat more likely to fib about their weight, whereas men were more prone to tell white lies on other subjects, such as how many previous partners they had had, or how serious they were about finding a long-term relationship. “Men and women aren’t as different from one another as we might believe,” Hall says. Next up – Hall and his team are developing an inventory of flirting styles, which they aim to publish later this year.

Meanwhile twin sisters Leanne Knobloch of the University of Illinois, US and Lynne Knobloch-Fedders from The Family Institute at Northwestern University, US put their heads together to look at a longstanding question about what explains the association between depressive symptoms and relationship quality.

Over three decades of research have shown that people with depression are less satisfied in their romantic relationships. But questions remain about exactly why these go together. Now the sisters’ research shows that relational uncertainty could be one explanation.

Relational uncertainty is how sure individuals are about their perceptions of involvement in a relationship. It has three sources. Self uncertainty is the questions people have about their own relationship involvement, such as, “how certain am I about my view of this relationship?” Partner uncertainty involves questions about a partner’s relationship involvement, such as, “how certain am I about where my partner wants this to go?” Finally relationship uncertainty involves questions about the relationship status, such as “How certain am I about the future of this relationship?”

There were three main findings from the study of couples experiencing depressive symptoms or relationship problems: Those with more severe depressive symptoms reported more relationship distress; people experiencing more relational uncertainty were less satisfied with their relationship; and finally, women’s depressive symptoms predicted all three sources of their relational uncertainty, which in turn predicted both men’s and women’s relationship quality. For men, only the self source of relational uncertainty acted as a mediator.

This finding could suggest treatment options. For example, working through relational uncertainty issues in psychotherapy may help alleviate depressive symptoms. Alternatively treating depression might help individuals achieve more relational certainty, leading to more satisfying relationships.

“People suffering from depressive symptoms may wrestle with more questions about their romantic relationship, which may be dissatisfying,” says Knobloch. “If we find ways to help people address their uncertainty about their relationship, then their depressive symptoms might not be so debilitating for their romantic relationships.”

Some anti-depressant drugs are associated with an increased chance of developing cataracts, according to a new statistical study by researchers at the University of British Columbia, Vancouver Coastal Health Research Institute and McGill University.

The study, based on a database of more than 200,000 Quebec residents aged 65 and older, showed statistical relationships between a diagnosis of cataracts or cataract surgery and the class of drugs called selective serotonin reuptake inhibitors (SSRIs), as well as between cataracts and specific drugs within that class.

Published online in the journal Ophthalmology, the study does not prove causation but only reveals an association between the use of SSRIs and the development of cataracts. The study could not account for the possibility of smoking – which is a risk factor for cataracts – and additional population-based studies are needed to confirm these findings, the researchers say.

This study of statistical relationships is the first to establish a link between this class of drugs and cataracts in humans. Previous studies in animal models had demonstrated that SSRIs could increase the likelihood of developing the condition.

“When you look at the trade-offs of these drugs, the benefits of treating depression – which can be life-threatening – still outweigh the risk of developing cataracts, which are treatable and relatively benign,” says Dr. Mahyar Etminan, lead author of the article, a scientist and clinical pharmacist at the Centre for Clinical Epidemiology at Vancouver Coastal Health Research Institute and an assistant professor in the Dept. of Medicine at UBC.

Researchers found patients taking SSRIs were overall 15 per cent more likely to be diagnosed with cataracts or to have cataract surgery.

The degree of risk among specific and different types of SSRIs varied considerably. Taking fluvoxamine (Luvox) led to a 51 per cent higher chance of having cataract surgery, and venlafaxine (Effexor) carried a 34 per cent higher risk. No connection could be made between fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft) and having cataract surgery.

Co-author Dr. Frederick S. Mikelberg, professor and head of the Dept. of Ophthalmology and Visual Sciences at UBC and head of the Dept. of Ophthalmology at Vancouver General Hospital, notes that the average time to develop cataracts while taking SSRIs was almost two years.

“While these results are surprising, and might inform the choices of psychiatrists when prescribing SSRIs for their patients, they should not be cause for alarm among people taking these medications,” Mikelberg says.

Psychosurgery is making a comeback. Recently published case series have shown encouraging results of so-called deep brain stimulation (DBS) in treatment-resistant obsessive-compulsive disorder, depressive disorders, and Tourette syndrome. In the current issue of Deutsches Ärzteblatt International, authors Jens Kuhn (University of Cologne) and Theo P J Gründer (Max Planck Institute, Cologne) and their co-authors provide an introduction to the method (Dtsch Arztebl Int 2010; 107(7)105-13).

In order to determine the clinical utility of DBS in psychiatric disorders, the authors evaluated therapeutic studies from 1980 to 2009. They found improvement rates of between 35% and 70% in treatment-resistant obsessive-compulsive disorder, depression, and Tourette syndrome. The rate of side effects associated with DBS was usually low and mostly reversible by modulating the stimulation parameters.

This favourable side effect profile is not all that surprising because DBS is a procedure that is well known; it has been in use for 20 years. In Parkinson’s disease and essential tremor, the method has proved to be so effective that it has been licensed as a therapeutic option for many years. To administer DBS, two electrodes are implanted into the patient that deliver continuous, high frequency, short electrical impulses, enabling modulation of the functional neuronal circuits. The electrodes are connected via a cable to an impulse generator, which is usually implanted below the collarbone.

Although DBS seems to offer new perspectives for the treatment of psychiatric disorders, further studies into its efficacy, mechanisms of action, and side effect profile and especially its long term course are needed.

A daily dose of vitamin D may just be what Chicagoans need to get through the long winter, according to researchers at Loyola University Chicago Marcella Niehoff School of Nursing (MNSON). This nutrient lifts mood during cold weather months when days are short and more time is spent indoors.

“Vitamin D deficiency continues to be a problem despite the nutrient’s widely reported health benefits,” said Sue Penckofer, PhD, RN, professor, MNSON. “Chicago winters compound this issue when more people spend time away from sunlight, which is a natural source of vitamin D.”

Diet alone may not be sufficient to manage vitamin D levels. A combination of adequate dietary intake of vitamin D, exposure to sunlight, and treatment with vitamin D2 or D3 supplements can decrease the risk of certain health concerns. The preferred range in the body is 30 – 60 ng/mL of 25(OH) vitamin D.

Loyola faculty members plan to take vitamin D research a step further by evaluating whether weekly vitamin D supplements improve blood sugar control and mood in women with diabetes. Depression is associated with increased insulin resistance, so people with diabetes have a greater risk for the disease than those without depression. Women also tend to have greater rates of depression and poorer blood sugar control than men with diabetes.

“There is evidence to suggest that vitamin D supplementation may decrease insulin resistance,” said Dr. Penckofer. “If we can stabilize insulin levels, we may be able to simply and cost effectively improve blood sugar control and reduce symptoms of depression for these women.”

Loyola is currently enrolling women in this clinical trial. In order to enter the study, they must be 18 to 70 years of age, have stable type 2 diabetes, signs of depression and no other major medical illness. Eighty women with type 2 diabetes and signs of depression will be given a weekly dose of vitamin D (50,000 IU) for a period of six months. Study participants will be evaluated at three points during this time.

“Vitamin D has widespread benefits for our health and certain chronic diseases in particular,” Dr. Penckofer said. “Our research may shed greater light on the role this nutrient plays in managing two conditions that impact millions of Americans. If proven to be successful, vitamin D may an important addition to care for diabetes and depression.”

The next advance in treating major depression may relate to a group of brain chemicals that are involved in virtually all our brain activity, according to a study published in Biological Psychiatry. The study is co-authored by Drs. Andrea J. Levinson and Zafiris J. Daskalakis of the Centre for Addiction and Mental Health (CAMH).

This study shows that compared to healthy individuals, people who have major depressive disorder have altered functions of the neurotransmitter GABA (gamma-aminobutyric acid). In the study, individuals with the most treatment-resistant forms of illness demonstrated the greatest reductions of GABA levels in the brain.

This points to the possibility that medications which correct a GABA imbalance could advance the treatment of major depressive disorder. Approximately 4% of Canadians experience major depressive disorder each year.

Several current medications for mood disorders correct imbalances in neurotransmitters such as serotonin and dopamine. However, many patients do not benefit from these medications. “Our findings build on the idea that some current medications do not help many patients because those drugs don’t affect the GABA-related brain chemistry,” says study author Dr. Andrea Levinson.

Applying the brakes

The GABA neurotransmitter and its receptors are involved in many different brain functions. Imbalances in GABA also are relevant to bipolar disorder, schizophrenia, and anxiety disorder.

The GABA neurotransmitter and its receptors are critical to how humans think and act, Dr. Levinson adds. “We apply so many conscious and unconscious perceptions and judgments to our actions at every second, without even realizing that we are doing so,” she says. “GABA is part of the brain system that allows us to fine-tune our moods, thoughts, and actions with an incredible level of detail.”

“It’s a little like driving a car. You need the accelerator, but at every stage you need the brakes to work. Some of our neurotransmitters apply the spark and the gas to the engine, and GABA supplies the brakes,” she says. “GABA provides the necessary inhibitory effect that we need in order to block out excessive brain activity that in depression may lead to excessive negative thinking.”

In addition, this study points to the reason why electroconvulsive therapy is still the most efficacious therapy for major depressive disorder, Dr. Levinson adds. “Electroconvulsive therapy may act on GABA brain chemicals in a way that can reset the balance,” she says.

Largest study to date

This study of 85 people is the largest such research effort on GABA and major depressive disorder to date. It compared four groups: 25 individuals with treatment-resistant depression, 16 with major depression who were unmedicated, 19 individuals with major depression who were successfully treated with medication and had normal mood, and a control group of 25 healthy individuals.

In all groups, a thumb twitch response to transcranial magnetic (brain) stimulation (TMS) was used to measure how GABA acts physiologically in the brain. GABA receptors were found to be dysfunctional in the three groups with major depressive disorder when compared to healthy subjects. In people who were the least responsive (treatment-resistant) to medications, the physiological effect of GABA in the brain was at its lowest.

Personalized medicine

“We are advancing the goal of a truly personalized medicine,” says study co-author Dr. Daskalakis. “It is intriguing to think that we may soon be able to apply simple brain stimulation to identify which treatments are most likely to help the individual person, eliminating the guesswork. That is, through these findings we may be able to one day determine who is and who is not going to respond to traditional pharmacological approaches to depression.”

New research shows that migraine and depression may share a strong genetic component. The research is published in the January 13, 2010, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“Understanding the genetic factors that contribute to these disabling disorders could one day lead to better strategies to manage the course of these diseases when they occur together,” said Andrew Ahn, MD, PhD, of the University of Florida in Gainesville, who wrote an editorial accompanying the study and is a member of the American Academy of Neurology. “In the meantime, people with migraine or depression should tell their doctors about any family history of either disease to help us better understand the link between the two.”

The study involved 2,652 people who took part in the larger Erasmus Rucphen Family study. All of the participants are descendants of 22 couples who lived in Rucphen in the 1850s to 1900s.

“Genealogical information has shown them all to be part of a large extended family, which makes this type of genetic study possible,” said study author Gisela M. Terwindt, MD, PhD, of Leiden University Medical Center in the Netherlands.

Of the participants, 360 had migraine. Of those, 151 had migraine with aura, which is when headaches are preceded by sensations that affect vision, such as seeing flashing lights, and 209 had migraine with no aura. A total of 977 people had depression, with 25 percent of those with migraine also having depression, compared to 13 percent of those without migraine.

The researchers then estimated the relative contribution of genetic factors for both of the disorders. They found that for both types of migraine, the heritability was estimated at 56 percent, i.e., 56 percent of the trait is explained by genetic effects. For migraine with aura, the estimate was 96 percent. “This finding shows that migraine with aura may be a promising avenue to search for migraine genes,” Terwindt said.

Comparing the heritability scores for depression between those with migraine and those without showed a shared genetic component in the two disorders, particularly with migraine with aura. “This suggests that common genetic pathways may, at least partly, underlie both of these disorders, rather than that one is the consequence of the other,” Terwindt said.

Wives of soldiers deployed to Iraq and Afghanistan are more likely to be diagnosed with depression, anxiety, sleep disorders and other mental health conditions than women whose husbands are not deployed, according to a new study by researchers at the University of North Carolina at Chapel Hill and the Uniformed Services University of the Health Sciences.

The study, published Jan. 14, 2010, in The New England Journal of Medicine, examined medical records of the wives of active duty U.S. Army personnel, comparing those whose husbands were serving abroad with those whose husbands were not deployed.

“This study confirms what many people have long suspected,” said Alyssa Mansfield, Ph.D., the study’s lead author, who conducted the research as a doctoral student at the UNC Gillings School of Global Public Health and is now a research epidemiologist at RTI International. “It provides compelling evidence that Army spouses are feeling the impact of recent deployments to Iraq and Afghanistan. The result is more depression, more stress, more sleepless nights.”

Understanding the scope of the problem can help the U.S. military better plan mental health prevention and treatment programs for the families of active duty personnel, she said. The study also may provide insight into families’ long-term medical needs.

The researchers examined medical records of more than 250,000 female spouses of active duty Army personnel for outpatient care received between 2003 and 2006. About 31 percent of the wives’ husbands were not deployed during that period, while about 34 percent were overseas for between one and 11 months and 35 percent were deployed for longer.

Although the three groups were similar in size, the study found almost 3,500 more diagnoses of mental health conditions among wives of soldiers deployed for less than a year, compared to the group of wives of non-deployed soldiers. Also, there were more than 5,300 additional diagnoses among wives of soldiers deployed for a year or longer.

Depression, anxiety, sleep disorders and acute stress reaction and adjustment disorders were the most commonly diagnosed conditions among both groups.

Spouses of deployed military personal naturally fear for their loved ones’ safety, Mansfield said. But they also often face challenges maintaining a household, coping as a single parent and dealing with the marital strain that comes with being apart for an uncertain amount of time.

“The majority of active duty soldiers are married, so we need to pay attention to the needs of their families, both short and long term,” Mansfield said. “These findings should help the military medical system better plan mental health programs not only for treatment, but also for support and prevention.”

Adolescents and parents need help recognizing that suicide is a problem in their own communities, as well as help identifying teens who are suicidal, according to the study, “Attitudes and Beliefs of Adolescents and Parents Regarding Adolescent Suicide,” published in the February issue of Pediatrics (appearing online Jan. 11). In the United States in 2006, 1,771 children and adolescents ages 10 to 19 committed suicide, making suicide the third leading cause of death in this age group.

To design a better suicide prevention program, researchers set out to understand what interventions would be most effective. In focus groups in Chicago and Kansas City, both teenagers and their parents correctly identified many of the known risk factors for suicide, including mental illness, alcohol and substance abuse, relational or social loss, and hopelessness. However, study authors said it was concerning that some of the parents reported regular drug and alcohol use as being a normal part of adolescent development, rather than problem behavior.

Parents and teens suggested guns should be removed if an adolescent is known to be suicidal, but parents acknowledged they may not be able to identify a suicidal teen. Parents and teens didn’t think suicide was a problem in their communities. All groups were interested in learning how to identify and intervene with a suicidal adolescent. Study authors conclude pediatricians should regularly screen all adolescents in their offices and encourage families to be open to discussing depression and suicide.