Stress Free Holidays

This is time of year the family calendar tends to fill up quickly. On top of regular activities and commitments, any free time on evenings and weekends may be overloaded with parties, dinners, other social events, shopping, and possibly a school or religious program or two. You may find yourself thinking, “Just a month or two and this will pass.”

Parents often dream of giving their child(ren) the best or most memorable holiday. Sometimes we need to stop and ask ourselves, “What is the best? and What is the price?” Remember that the stress, excitement, and go, go, go feeling of the holiday season not only takes its toll on you, but also your family. Children will notice when you're stressed or tired. If you're not feeling best, your child may pick up this. If you're feeling irritable, chances are your child may get a case of his or her own grumpies.

Here are some tips that may be able to help your family ease through the extra stress of the season:
•Have limits. Keep in mind, when planning for the holidays, you should have limits or expectations of what will or will not happen. This includes all areas of holiday planning. If appropriate, set a budget for gifts. Let children know in advance what they can expect so there won't be any unrealistic requests.
•Don't spread yourself too thin. It's ok for you or your child not to be actively involved in everything the season offers. If there are certain things you enjoy, individually or as a family, make a list and plans to do these things. If you find your list getting too big or out of control, maybe alternate activities yearly. In addition, saying no to one or two activities a season does not make you a humbug.
•Keep the end in sight. You may feel like the stress is going to bring your holiday happiness to an end or that it will drag on forever. Keep in mind that all too soon, the season will be behind you and life will return to “normal”. Keep an eye on what's important now.

Similarly, keep an eye on your child. If you feel that you child is becoming overwhelmed by activity or just needs a little break go for it. The tears as a result of holiday breakdown, may just add more stress to an already hectic situation.
•Find a shoulder to lean on. Keeping in contact with family and friends may give you the extra support you need to make it though the season. You don't have to do it all on your own. Don't be afraid to delegate tasks or accept offers of assistance from those close to you. If grandma is willing to give you a hand with the little ones while you run to the grocery store, take her up on her offer. Alternate shopping days with a neighbor, so each may have time alone to run errands. Holiday baking can also offer a dose of much needed stress relief as you get together with “the girls (or guys)” and share recipes and laughter.
•Remember you. Most importantly this holiday season, don't forget about keeping track of you and your family. If you're feeling run down or irritable, find something to take your mind off of your stress. Take time for a relaxing bath, a cup of cocoa, or an hour on the treadmill. What ever you want, treat yourself to your own brand of stress relief.
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The same applies to your family. If your children are getting fussy at the holiday planning tasks, find something to lift their spirits. Stop what you're doing and make a quick holiday treat that involves everyone. Get down on the floor and play a game or color. Find an outdoor activity that the whole family enjoys and take the time to enjoy it. Do something fun and not related to your holiday tasks. •Don't worry about the “To Do” list. It will be there when you get back. If by chance an item gets overlooked, it probably wasn't worth the stress it was causing you anyway. Keep these things in mind through this holiday season and enjoy!

Getting Through Tough Economic Times

This guide provides practical advice on how to deal with the effects financial difficulties can have on your physical and mental health -- it covers:

•Possible health risks
•Warning signs
•Managing stress
•Getting help
•Suicide warning signs
•Other steps you can take
Possible Health Risks
Economic turmoil (e.g., increased unemployment, foreclosures, loss of investments and other financial distress) can result in a whole host of negative health effects - both physical and mental. It can be particularly devastating to your emotional and mental well-being. Although each of us is affected differently by economic troubles, these problems can add tremendous stress, which in turn can substantially increase the risk for developing such problems as:

•Depression
•Anxiety
•Compulsive Behaviors (over-eating, excessive gambling, spending, etc.)
•Substance Abuse
Warning Signs
It is important to be aware of signs that financial problems may be adversely affecting your emotional or mental well being --or that of someone you care about. These signs include:

•Persistent Sadness/Crying
•Excessive Anxiety
•Lack of Sleep/Constant Fatigue
•Excessive Irritability/Anger
•Increased drinking
•Illicit drug use, including misuse of medications
•Difficulty paying attention or staying focused
•Apathy - not caring about things that are usually important to you
•Not being able to function as well at work, school or home
Managing Stress
If you or someone you care about is experiencing these symptoms, you are not alone. These are common reactions to stress, and there are coping techniques that you can use to help manage it. They include:

•Trying to keep things in perspective - recognize the good aspects of life and retain hope for the future.
•Strengthening connections with family and friends who can provide important emotional support.
•Engaging in activities such as physical exercise, sports or hobbies that can relieve stress and anxiety.
•Developing new employment skills that can provide a practical and highly effective means of coping and directly address financial difficulties.
Getting Help
Even with these coping techniques, however, sometimes these problems can seem overwhelming and you may need additional help to get through "rough patches." Fortunately, there are many people and services that can provide help. These include your:

•Healthcare provider
•Spiritual leader
•School counselor
•Community health clinic
If you need help finding treatment services you can access our Mental Health Services Locator for information and mental health resources near you. Similarly, if you need help with a substance abuse problem you can use our Substance Abuse Treatment Facility Locator.

Specific help for financial hardship is also available, on issues such as:

•Making Home Affordable
•Foreclosure
•Reemployment
•Financial assistance
There are many other places where you can turn for guidance and support in dealing with the financial problems affecting you or someone you care about. These resources exist at the federal, state and community level and can be found through many sources such as:

•Federal and state government
•Civic associations
•Spiritual groups
•Other sources such as the government services section of a phone book
Suicide Warning Signs
Unemployment and other kinds of financial distress do not "cause" suicide directly, but they can be factors that interact dynamically within individuals and affect their risk for suicide. These financial factors can cause strong feelings such as humiliation and despair, which can precipitate suicidal thoughts or actions among those who may already be vulnerable to having these feelings because of life-experiences or underlying mental or emotional conditions (e.g., depression, bi-polar disorder) that place them at greater risk of suicide.

LCSW, MFT, LPC ceus suicide prevention
These are some of the signs you may want to be aware of in trying to determine whether you or someone you care about could be at risk for suicide:

•Threatening to hurt or kill oneself or talking about wanting to hurt or kill oneself
•Looking for ways to kill oneself
•Thinking or fantasying about suicide
•Acting recklessly
•Seeing no reason for living or having no sense of purpose in life
If you or someone you care about are having suicidal thoughts or showing these symptoms SEEK IMMEDIATE HELP. Contact your healthcare provider, mental health crisis center, hospital emergency room or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) for help.

Other Steps You Can Take
•Acknowledge that economic downturns can be frightening to everyone, but that there are ways of getting through them - from engaging in healthy activities, positive thinking, supportive relationships, to seeking help when needed from health professionals.


•Encourage community-based organizations and groups to provide increased levels of mental health treatment and support to those who are severely affected by the economy.


•Work together to help all members of the community build their resiliency and successfully return to healthy and productive lives.
For further information on mental health or substance abuse issues please visit The Substance Abuse and Mental Health Services Administration (SAMHSA).


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Special Note to Journalists
For ideas on how to best cover sensitive issues like suicide prevention in a thoughtful and constructive manner you can check out suggestions developed by the Annenberg Public Policy Center in conjunction with leading suicide prevention experts and journalists.

NIDA InfoFacts: Understanding Drug Abuse and Addiction

Many people do not understand why individuals become addicted to drugs or how drugs change the brain to foster compulsive drug abuse. They mistakenly view drug abuse and addiction as strictly a social problem and may characterize those who take drugs as morally weak. One very common belief is that drug abusers should be able to just stop taking drugs if they are only willing to change their behavior. What people often underestimate is the complexity of drug addiction—that it is a disease that impacts the brain and because of that, stopping drug abuse is not simply a matter of willpower. Through scientific advances we now know much more about how exactly drugs work in the brain, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and resume their productive lives.

Drug abuse and addiction are a major burden to society. Estimates of the total overall costs of substance abuse in the United States—including health- and crime-related costs as well as losses in productivity—exceed half a trillion dollars annually. This includes approximately $181 billion for illicit drugs,1 $168 billion for tobacco,2 and $185 billion for alcohol.3 Staggering as these numbers are, however, they do not fully describe the breadth of deleterious public health—and safety—implications, which include family disintegration, loss of employment, failure in school, domestic violence, child abuse, and other crimes.


What is drug addiction?

Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use despite harmful consequences to the individual who is addicted and to those around them. Drug addiction is a brain disease because the abuse of drugs leads to changes in the structure and function of the brain. Although it is true that for most people the initial decision to take drugs is voluntary, over time the changes in the brain caused by repeated drug abuse can affect a person’s self control and ability to make sound decisions, and at the same time send intense impulses to take drugs.

It is because of these changes in the brain that it is so challenging for a person who is addicted to stop abusing drugs. Fortunately, there are treatments that help people to counteract addiction’s powerful disruptive effects and regain control. Research shows that combining addiction treatment medications, if available, with behavioral therapy is the best way to ensure success for most patients. Treatment approaches that are tailored to each patient’s drug abuse patterns and any co-occurring medical, psychiatric, and social problems can lead to sustained recovery and a life without drug abuse.

Similar to other chronic, relapsing diseases, such as diabetes, asthma, or heart disease, drug addiction can be managed successfully. And, as with other chronic diseases, it is not uncommon for a person to relapse and begin abusing drugs again. Relapse, however, does not signal failure—rather, it indicates that treatment should be reinstated, adjusted, or that alternate treatment is needed to help the individual regain control and recover.

What happens to your brain when you take drugs?

Drugs are chemicals that tap into the brain’s communication system and disrupt the way nerve cells normally send, receive, and process information. There are at least two ways that drugs are able to do this: (1) by imitating the brain’s natural chemical messengers, and/or (2) by overstimulating the “reward circuit” of the brain.

Some drugs, such as marijuana and heroin, have a similar structure to chemical messengers, called neurotransmitters, which are naturally produced by the brain. Because of this similarity, these drugs are able to “fool” the brain’s receptors and activate nerve cells to send abnormal messages.

Other drugs, such as cocaine or methamphetamine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters, or prevent the normal recycling of these brain chemicals, which is needed to shut off the signal between neurons. This disruption produces a greatly amplified message that ultimately disrupts normal communication patterns.

Nearly all drugs, directly or indirectly, target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that control movement, emotion, motivation, and feelings of pleasure. The overstimulation of this system, which normally responds to natural behaviors that are linked to survival (eating, spending time with loved ones, etc.), produces euphoric effects in response to the drugs. This reaction sets in motion a pattern that “teaches” people to repeat the behavior of abusing drugs.

As a person continues to abuse drugs, the brain adapts to the overwhelming surges in dopamine by producing less dopamine or by reducing the number of dopamine receptors in the reward circuit. As a result, dopamine’s impact on the reward circuit is lessened, reducing the abuser’s ability to enjoy the drugs and the things that previously brought pleasure. This decrease compels those addicted to drugs to keep abusing drugs in order to attempt to bring their dopamine function back to normal. And, they may now require larger amounts of the drug than they first did to achieve the dopamine high—an effect known as tolerance.

Long-term abuse causes changes in other brain chemical systems and circuits as well. Glutamate is a neurotransmitter that influences the reward circuit and the ability to learn. When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to compensate, which can impair cognitive function. Drugs of abuse facilitate nonconscious (conditioned) learning, which leads the user to experience uncontrollable cravings when they see a place or person they associate with the drug experience, even when the drug itself is not available. Brain imaging studies of drug-addicted individuals show changes in areas of the brain that are critical to judgment, decisionmaking, learning and memory, and behavior control. Together, these changes can drive an abuser to seek out and take drugs compulsively despite adverse consequences—in other words, to become addicted to drugs.

mft continuing education, lcsw continuing education, ceus for mfts and lpcs
Why do some people become addicted, while others do not?

No single factor can predict whether or not a person will become addicted to drugs. Risk for addiction is influenced by a person’s biology, social environment, and age or stage of development. The more risk factors an individual has, the greater the chance that taking drugs can lead to addiction. For example:

Biology. The genes that people are born with––in combination with environmental influences––account for about half of their addiction vulnerability. Additionally, gender, ethnicity, and the presence of other mental disorders may influence risk for drug abuse and addiction.


Environment. A person’s environment includes many different influences––from family and friends to socioeconomic status and quality of life in general. Factors such as peer pressure, physical and sexual abuse, stress, and parental involvement can greatly influence the course of drug abuse and addiction in a person’s life.


Development. Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction vulnerability, and adolescents experience a double challenge. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it is to progress to more serious abuse. And because adolescents’ brains are still developing in the areas that govern decisionmaking, judgment, and self-control, they are especially prone to risk-taking behaviors, including trying drugs of abuse.


Prevention is the Key

Drug addiction is a preventable disease. Results from NIDA-funded research have shown that prevention programs that involve families, schools, communities, and the media are effective in reducing drug abuse. Although many events and cultural factors affect drug abuse trends, when youths perceive drug abuse as harmful, they reduce their drug taking. It is necessary, therefore, to help youth and the general public to understand the risks of drug abuse, and for teachers, parents, and healthcare professionals to keep sending the message that drug addiction can be prevented if a person never abuses drugs.

Substance Abuse and Inhalants CEUs

The percentage of adolescents (i.e., youths aged 12 to 17) who used inhalants in the past year was lower in 2007 (3.9 percent) than in 2003, 2004, and 2005 (4.5, 4.6, and 4.5 percent, respectively)

Among adolescents who used inhalants for the first time in the past year (i.e., past year initiates), the rate of use of nitrous oxide or "whippits" declined between 2002 and 2007 among both genders (males: 40.2 to 20.2 percent; females: 22.3 to 12.2 percent)

In 2007, 17.2 percent of adolescents who initiated illicit drug use during the past year indicated that inhalants were the first drug that they used; this rate remained relatively stable between 2002 and 2007

Adolescents have easy access to some dangerous substances—ordinary household products such as glue, shoe polish, and aerosol sprays. These products are safe when used as intended, but they can be dangerous and even deadly when sniffed or "huffed" to get high. Preventing and treating inhalant use problems, as well as raising awareness about the dangers of inhalant use, are important ongoing goals of the Substance Abuse and Mental Health Services Administration (SAMHSA). Monitoring trends in inhalant use is vital to assessing policies intended to reduce inhalant use.
This issue of The NSDUH Report examines trends in the use, dependence or abuse,1 and initiation of inhalants among adolescents (i.e., youths aged 12 to 17). The National Survey on Drug Use and Health (NSDUH) defines inhalants as "liquids, sprays, and gases that people sniff or inhale to get high or to make them feel good." NSDUH collects data not only about the use of any inhalant, but also about the use of specific types of inhalants. Respondents who used inhalants were asked when they first used them, and responses to this question were used to identify persons who had initiated use in the 12 months before the survey. This report uses data from the 2002 through 2007 NSDUHs.

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Use and Dependence or Abuse
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In 2007, almost 1.0 million adolescents used inhalants in the past year; this represents 3.9 percent of adolescents, which was lower than the rate in 2003, 2004, and 2005 (4.5, 4.6, and 4.5 percent, respectively) (Figure 1). Past year dependence on or abuse of inhalants remained relatively stable between 2002 and 2007, with 0.4 percent of adolescents (around 99,000 persons) meeting the criteria for dependence or abuse in 2007.

Figure 1. Trends in Past Year Inhalant Use and Dependence or Abuse among Adolescents: 2002 to 2007



Figure 1 Table. Trends in Past Year Inhalant Use and Dependence or Abuse among Adolescents: 2002 to 2007 Trend 2002 2003 2004 2005 2006 2007
Past Year Use 4.4% 4.5%* 4.6%* 4.5%* 4.4% 3.9%
Past Year Dependence or Abuse 0.4% 0.4% 0.5% 0.4% 0.4% 0.4%
Source: 2002 to 2007 SAMHSA National Surveys on Drug Use and Health (NSDUHs).



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Past Year Initiation of Inhalant Use
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In 2007, 2.1 percent of adolescents who had not previously used inhalants began using them during the 12 months prior to the survey (Figure 2). This rate was lower than the rates of initiation for 2002, 2003, 2004, and 2005.

Figure 2. Trends in Past Year Initiation of Inhalants among Adolescents Who Had Not Previously Used Inhalants: 2002 to 2007**



Figure 2 Table. Trends in Past Year Initiation of Inhalants among Adolescents Who Had Not Previously Used Inhalants: 2002 to 2007** Trend 2002 2003 2004 2005 2006 2007
Past Year Initiation of Inhalants 2.6%* 2.6%* 2.6%* 2.6%* 2.4% 2.1%
Source: 2002 to 2007 SAMHSA National Surveys on Drug Use and Health (NSDUHs).



NSDUH also provides data on the first illicit drug initiated among past year initiates.2 In 2007, 17.2 percent of past year illicit drug initiates indicated that inhalants were the first drug that they used (Table 1). Marijuana was the first drug used by 56.3 percent of past year illicit drug initiates; nonmedically used prescription-type drugs were the first type of drug used by 23.5 percent of past year illicit drug initiates. These rates remained relatively stable between 2002 and 2007.

Table 1. Trends for First Drug Initiated in the Past Year among Adolescents Who Initiated Illicit Drug Use in the Past Year: 2002 to 2007** First Drug Initiated*** 2002
(%) 2003
(%) 2004
(%) 2005
(%) 2006
(%) 2007
(%)
Marijuana and Hashish 59.9% 57.6% 57.3% 55.0% 57.1% 56.3%
Nonmedical Use of Prescription-Type Drugs 22.2% 20.4% 21.3% 22.0% 22.0% 23.5%
Inhalants 14.5% 19.4% 19.2% 19.6% 17.4% 17.2%
Hallucinogens 2.9% 2.3% 2.1% 2.5% 3.0% 2.3%
Cocaine 0.7% 0.4% 0.5% 1.0% 0.9% 0.8%
Source: 2002 to 2007 SAMHSA National Surveys on Drug Use and Health (NSDUHs).


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Use of Specific Inhalants among Past Year Inhalant Initiates
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Among past year inhalant initiates, the percentage using most specific types of inhalants in 2007 did not differ significantly from the percentage in 2002 (Table 2); however, there were a few exceptions. Among past year inhalant initiates, use of nitrous oxide or "whippits" was lower in 2007 than in 2002 (16.3 vs. 31.6 percent), and use of aerosol spray other than spray paint3 was higher in 2007 than 2002 (25.0 vs. 12.6 percent).

Table 2. Trends in Past Year Use of Specific Types of Inhalants among Past Year Inhalant Initiates Aged 12 to 17: 2002 to 2007** Type of Inhalant 2002
(%) 2003
(%) 2004
(%) 2005
(%) 2006
(%) 2007
(%)
Amyl Nitrite, "Poppers," Locker Room Odorizers,
or "Rush" 14.0% 17.0% 12.6% 16.4% 16.5% 19.3%
Correction Fluid, Degreaser, or Cleaning Fluid 15.7% 19.7% 19.6% 19.6% 22.5% 19.3%
Gasoline or Lighter Fluid 26.2% 23.2% 25.3% 26.7% 27.0% 28.1%
Glue, Shoe Polish, or Toluene 32.9% 30.2% 27.6% 31.3% 25.6% 28.8%
Halothane, Ether, or Other Anesthetics 2.9% 2.9% 4.5% 3.4% 4.5% 5.7%
Lacquer Thinner or Other Paint Solvents 13.9% 10.7% 10.8% 13.3% 14.2% 12.8%
Lighter Gases, Such as Butane or Propane 9.3% 9.7% 9.2% 8.1% 7.1% 9.9%
Nitrous Oxide or "Whippits" 31.6% 23.0% 20.1% 21.3% 17.7% 16.3%
Spray Paints 21.4% 23.3% 25.4% 23.9% 28.1% 25.1%
Aerosol Sprays Other than Spray Paints+ 12.6% 17.6% 23.6% 25.4% 23.5% 25.0%
Source: 2002 to 2007 SAMHSA National Surveys on Drug Use and Health (NSDUHs).


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Discussion
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Although the rates of inhalant use and inhalant initiation appeared to be on a downward trend, particularly since 2005, the rates of dependence on or abuse of these substances remained stable between 2002 and 2007. Rates of use of specific types of inhalants among past year initiates generally did not differ significantly from 2002 to 2007, although a few types showed significant changes. Use of nitrous oxide or "whippits" decreased by half, and use of aerosol sprays other than spray paints doubled. Over the period from 2002 to 2007, 15 to 20 percent of past year illicit drug initiates indicated that inhalants were the first illicit drug they had used.

These findings highlight the ongoing need for prevention and treatment of inhalant use and abuse. Continuing efforts are needed among adolescents and their parents, other family members, teachers, service providers, and policymakers to increase awareness of the dangers of inhalant use. Awareness campaigns and prevention efforts may need targeted messages about the use of specific inhalants, such as aerosol air fresheners, aerosol sprays, and aerosol cleaning products.



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End Notes
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1 Substance dependence or abuse is defined using criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which includes symptoms such as withdrawal, tolerance, use in dangerous situations, trouble with the law, and interference in major obligations at work, school, or home during the past year.
2 Illicit drugs refer to marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type drugs used nonmedically.
3 Aerosol sprays other than spray paint include products such as aerosol air fresheners, aerosol spray, and aerosol cleaning products (e.g., dusting sprays, furniture polish). The aerosol propellants in these products are commonly chlorofluorocarbons. By contrast, nitrous oxide is used as a propellant for whipped cream and is available in 2-inch tapered cylinders called "whippits" that are used to pressurize home whipped-cream charging bottles.


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Figure and Table Notes
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* Difference between this estimate and 2007 estimate is statistically significant at the .05 level.
** Past year initiates are defined as adolescents who used a drug for the first time during the 12 months prior to the survey.
*** First drug initiated is based on the date of the first use for each drug, with imputation for the day of the month and for the month of the year, if not reported. Respondents may be counted in more than one drug category if they reported initiating multiple drugs on the same day the first time that they used drugs.
+ See End Note 3.


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Suggested Citation
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Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (March 16, 2009). The NSDUH Report: Trends in Adolescent Inhalant Use: 2002 to 2007. Rockville, MD.

The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The 2002 to 2007 data used in this report are based on information obtained from 136,449 persons aged 12 to 17. The survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.

The NSDUH Report is prepared by the Office of Applied Studies (OAS), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI International is a trade name of Research Triangle Institute.)

Information on the most recent NSDUH is available in the following publication:

Office of Applied Studies. (2008). Results from the 2007 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 08-4343, NSDUH Series H-34). Rockville, MD: Substance Abuse and Mental Health Services Administration. Also available online: http://oas.samhsa.gov.

Genetic attribution for schizophrenia, depression, and skin cancer: impact on social distance.

Genetic attribution for schizophrenia, depression, and skin cancer: impact on social distance.
New Zealand Journal of Psychology| November 01, 2007 | Breheny, Mary | COPYRIGHT 1998New Zealand Psychological Society. This material is published under license from the publisher through the Gale Group, Farmington Hills, Michigan. All inquiries regarding rights should be directed to the Gale Group. (Hide copyright information)Copyright
Genetic explanations for mental and physical illness are increasingly common in both scientific research and in media reports generated from such research, however, the social impact of these explanations are less well understood. In this study it was predicted that both genetic attribution for illness and type of illness would be related to a desire for social distance. Participants were provided with a description of Jamie, who suffered from skin cancer, major depression, or schizophrenia. This illness was described as either having a strongly genetic basis, no genetic basis, or no causal explanation was provided. Participants then indicated their willingness to interact with Jamie using the Social Distance Scale. Type of illness described did significantly influence social distance score, with participants more willing to interact with Jamie when he was described as having skin cancer than schizophrenia or major depression. There was a significant interaction between illness type and genetic attribution for illness, with an increase in willingness to interact when schizophrenia was described as genetically caused and a decrease in willingness to interact when major depression was described as genetically caused. Genetic explanations may be suggested to reduce the stigma associated with mental illnesses, however, these explanations work in complex ways and may not uniformly reduce illness related stigma.

**********

The role o f genetics in determining health and wellbeing is increasingly discussed in scientific research (de Jong, 2000) and in media reports of such research (Conrad, 2001). The genetic component of complex traits is often investigated (de Jong, 2000), including the contribution of genetics to criminality (see Lowenstein, 2003; Martens, 2002; Retz, Retz-Junginger, Supprian, Thome & Rosler, 2004), and mental illness (see Thompson, Watson, Steinhauer, Goldstein & Pogue-Geile, 2005). Media representations contribute to lay explanations, and genetic factors are commonly identified as causing mental illness. Around two thirds of an Australian community sample attributed schizophrenia and depression to genetic causes (Jorm, Christensen & Griffiths, 2005). However, the impact of a claim of a genetic basis for complex psychological traits has received relatively little attention (Lemke, 2004), and may be a useful framework for understanding public attitudes towards those with mental illnesses (Zissi, 2006).

Genetic Attribution

Genetic explanations may influence understandings of human behaviour and the stigma associated with these behaviours (Phelan, 2005). Reframing mental illness as a brain disease with a genetic component has been suggested to reduce the stigma associated with mental illness; however, conversely, this may exacerbate experience of stigma (Bag, Yilmaz, Kirpinar, 2006; Corrigan & Watson, 2004). In support of this, Dietrich, Matschinger and Angermeyer (2006) found that biological or genetic causes of schizophrenia were associated with greater fear and reduced willingness to interact with people with schizophrenia. Phelan (2005) also found that genetic causes were associated with greater seriousness, persistence, and transmissibility of deviance. Research has found less blame attributed to those with genetically caused schizophrenia (Phelan, 2002), and less stigma associated with causes beyond the patients control, including genetic transmission (Martin, Pescosolido & Tuch, 2000; van't Veer, Kraan, Drosseart, & Modde, 2006). Phelan (2005) found some participants reported both reduced blame and increased associative stigma for genetically caused mental illnesses. Genetic causes for mental illness may have complex effects, ameliorating the blame associated with mental illness, bur increasing stigma.

Social Distance

Stigma is an attribute that discredits an individual, reducing them from a whole person to a discounted person in the eyes of others (Major & O'Brien, 2005). The evaluations of stigmatised others are widely shared, and are used as the basis for excluding or avoiding members of the discredited category (Major & O'Brien, 2005). Social distance is a way to assess attitudes towards those with a stigmatised identity, and is defined as the relative willingness to participate in relationships of varying intimacy with those who have a devalued social identity (Lauber, Nordt, Falcato & Rossler, 2004). Measures of social distance are widely used to assess attitudes to mental illness (Reinke, Corrigan, Leonhard, Lundin & Kubiak, 2004), by measuring participants' reported willingness to engage in relationships with a person described as having a particular illness (Lauber et al., 2004).

Depression and Mood Disorders Continuing Education CEU

Depression and Mood Disorders
The Prevalence of Major Depression and Mood Disorders in Suicide
Mental Health: A Report of the Surgeon General, states that "major depressive disorders account for about 20 to 35 percent of all deaths by suicide" (p. 244). This estimate is based on a review of psychological autopsies conducted by Angst, Angst, and Stassen (1999). This brief review is intended to address this prevalence estimate. It is important to note that this estimate refers only to the prevalence of major depressive disorder among those who commit suicide, not any other mood disorders (e.g., bipolar I & II, dysthymia, adjustment disorder with depressed mood). Prevalence estimates that include other mood disorders in addition to major depression are much higher.

Major depression in suicide
The lower bound of the 20-35% estimate of the prevalence of major depression in suicide is loosely based on one psychological autopsy study; a study where the reliability of the diagnoses are somewhat questionable. This study (Rich, Young & Fowler, 1986) of 204 subjects identified 15% of suicides as having major depressive disorder. However, an additional 30% were reported as having "atypical depression," defined in this study as having a depressive syndrome that followed the onset of substance use. If this ambiguously defined group were to be considered major depression, the estimate climbs to 45%. A number of other studies suggest that the prevalence of major depression in suicide is somewhat over 30%. The four other available psychological autopsy studies that include samples of suicides from the full age range and reliable diagnoses based on structured interviews (Arato, Demeter, Rihmer & Somogyi, 1988; Dorpat & Ripley, 1960; Foster, Gillespie, McClelland & Patterson, 1999; Henriksson et al., 1993) obtained prevalence estimates of major depression ranging from 30-34% of suicides. In addition, several psychological autopsy studies examining more specific subsamples (e.g., the elderly, adolescents, women) find even higher prevalence estimates. In three psychological autopsy studies of adolescents (Brent et al. 1988; Brent et al., 1999; Shaffer et al., 1996) 41%, 43%, and 32% of adolescent suicides were determined to have had major depression prior to death. Two studies of young adults (Lesage et al. 1994; Runeson, 1989) found a prevalence of 40% and 41%, respectively. A study of 104 women by Asgard (1990) found a 35% rate of major depression. One study of 54 older adults over age 65 found a prevalence of 54%. In summary, the available data suggest that the 20-35% estimate for the prevalence of major depressive disorder in completed suicide is probably somewhat conservative and that a 30-40% prevalence estimate is probably more accurate. This estimate includes both secondary and primary depression. Many of these individuals would also be comorbid with other disorders, especially substance abuse.

Mood disorders in suicide
Prevalence estimates for all mood disorders in suicide (including MDD, Bipolar I & II, dysthymia, and adjustment disorder with depressed mood) are much higher than for major depression alone. These rates are probably closer to 60%, although as noted below, this estimate varies because of inconsistency of the criteria used to define a "mood disorder" across investigations. Four studies examining the full age range of suicides estimate that 36%, 48%, and 66%, and 70% of suicides have some sort of "depressive disorder" or "depression" (Foster et al., 1999; Rich et al., 1986, Henriksson et al., 1993, Barraclough, Bunch, Nelson, & Sainsbury, 1974). Three studies of adolescents found prevalence estimates for "mood disorders" or "affective disorders" of 61%, 63%, and 67% respectively (Shaffer et al., 1996; Brent et al. 1988; Marttunen et al., 1992). Two studies of young adults (Lesage et al., 1994; Runeson, 1989) found estimates of 60% and 64%. A study of 104 women by Asgard (1990) found a 59% rate of "mood disorders." In a review of psychological autopsy studies that examined patterns of psychiatric diagnosis across age groups, Conwell and Brent (1995) concluded that depressive disorders increased with age. Overall estimates for the rates of mood disorders range from 36% to 70% with great interstudy variability. This variability is probably partly a combination of unreliable methods of diagnosis and different definitions of what constitutes a "mood disorder." Despite this variability, a number of studies have found a pattern for increasing mood disorders with aging.


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References

Angst, J., Angst, F., and Stassen, H. H. (1999). Suicide risk in patients with major depressive disorder. Journal of Clinical Psychiatry, 60(supp. 2), 57-62.

Arato, M., Demeter, E., Rihmer, Z., & Somogyi, E. (1988). Retrospective psychiatric assessment of 200 suicides in Budapest. Acta Psychiatrica Scandinavica, 77, 454-456.

Asgard, U. (1990). A psychiatric study of suicide among urban women in Sweden. Acta Psychiatrica Scandinavica, 82, 115-124.

Barraclough, B., Bunch, J., Nelson, B., & Sainsbury, P. (1974). A hundred cases of suicide: Clinical aspects. British Journal of Psychiatry, 125,355-373.

Brent, D.A., Perper, J.A., Goldstein, C.E., Kolko, D.J., Allan, M.J., Allman, C.J., & Zelenak, J.P. (1988). Risk factors for adolescent suicide: A comparison of adolescent suicide victims with suicidal inpatients. Archives of General Psychiatry, 45,581-588.

Brent, D. A., Perper, J. A., Moritz, G., Allman, C., Friend, A., Roth, C., Schweers, J., Balach, L., & Baugher, M. (1993). Psychiatric risk factors for adolescent suicide: A case-control study. Journal of the American Academy of Child and Adolescent Psychiatry, 32,521-529.

Clark, D. C. (1991). Final Report to the AARP Adrus Foundation: Suicide Among the Elderly.

Conwell, Y. & Brent, D. (1995). Suicide and aging I: Patterns of psychiatric diagnosis. International Psychogeriatrics, 7, 149-164.

Dorpat, T. L., & Ripley, H. S. (1960). A study of suicide in the Seattle area. Comprehensive Psychiatry, 1, 349-359

Foster, T., Gillespie, K., McClelland, R., & Patterson, C. (1999). Risk factors for suicide independent of DSM-III-R Axis I disorder. British Journal of Psychiatry, 175, 175-179.

Henriksson, M. M., Aro, H. M., Marttunen, M. J., Heikkinen, M. E., Isometa, E. T., Kuoppasalmi, K. I., & Lonqvist, J. K. (1993). Mental disorders and comorbidity in suicide. American Journal of Psychiatry, 150, 935-940.

Lesage, A., Boyer, R., Grunberg, F., Vanier, C., Morissette, R., Menard-Bueeau, C., & Loyer, M. (1994). Suicide and mental disorders: A case-control study of young men. American Journal of Psychiatry, 151, 1063-1068.

Marttunen, M. J., Hillevi, M., Aro, H.M., & Lonnqvist, J. K. (1992). Adolescent suicide: Endpoint of long-term difficulties. Journal of the American Academy of Child and Adolescent Psychiatry, 34(4), 649-654.

Rich, C. L., Young, D., & Fowler, R. C. (1986). San Diego suicide study: Young vs old subjects. Archives of General Psychiatry, 43, 577-582.

Runeson, B. (1989). Mental disorder in youth suicide: DSM-III-R Axes I and II. Acta Psychiatrica Scandinavica, 79, 490-497.

Shaffer, D., Gould, M. S., Fisher, P., Trautmann, P., Moeau, D., Kleinman, M., & Flory, M. (1996). Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 53, 339-348.

ACTION ALERT: MHSA Funding

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ACTION ALERT: MHSA Funding

Governor Schwarzenegger recently released his State Budget proposal for the fiscal year, 2010-2011. The 2010-2011 budget proposes to divert funding from the Mental Health Services Act (Prop. 63) funding into the general fund in order to help address the state’s budget deficit in 2010-11. This proposal would nearly eliminate state funding for the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program and significantly reduce state funding for the Medi-Cal Mental Health Managed Care program. As you recall from last year, 65 percent of California voters already rejected this proposal (Proposition 1E), which would have redirected $226 million away from the Mental Health Services Act.





On February 11, 2010, the Assembly Budget Subcommittee will hear and take public comment on the Governor's proposal to divert MHSA funding. This decision on whether to accept the Governor’s proposal will be made by the Legislature during the next few weeks.



If this proposal is adopted, the progress MHSA is making at reducing costly hospitalizations, incarceration, homelessness, school failure, and out-of-home placements could be destroyed. When community services are not available, patients utilize hospitals and emergency rooms imposing high costs on both the state and local governments. Without funds being distributed to combat mental illness, “state and county governments are forced to pay billions of dollars each year in emergency medical care, long-term nursing home care, unemployment, and housing.”[1] Inadequate access to mental health services forces law enforcement officers to serve as the mental health providers of last resort, and this misuse of the corrections’ system costs taxpayers’ money, and creates a lack of law enforcement where necessary. The MHSA is an exceptional first step towards addressing the problem of untreated mental illness for low income families within our society. We therefore urge our members to tell their Legislators that they oppose this proposal.



What can you do? Write a letter to the Assembly and Senate Budget Committees, as well as to the Assembly Members and Senators who represent your community and explain your opposition to cutting MHSA funding and encouraging your legislator to reject the Governor’s proposal to divert MHSA funds to the State General Fund.

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The contact information for the budget committees is as follows:

· Senate Budget Committee: Direct (916) 319-2099 or Fax (916) 323-8386

· Assembly Budget Committee: Direct (916) 651-4103 or Fax (916) 319-2199



If you wish to speak to your legislator directly, to find out which Legislators represent you and your community, simply enter your zip code here: http://www.leginfo.ca.gov/yourleg.html



You can also testify in person on February 11, 2010 at the State Capitol, when the Assembly Budget Committee will be taking public comment on this proposal. The Assembly Budget Committee will have a discussion and take public comment on Thursday, February 11th at their hearing, which will be held at 1:00 p.m. in Room 4202 of the State Capitol building in Sacramento .


We all can agree that the state has an economic crisis on its hands. But cutting mental health services to our state’s most vulnerable populations is not the answer. In fact, it will turn those currently receiving services out into the streets and emergency rooms. How can this be a solution to our state’s money problems?