Postcards from the Id

Possible Relationship Between IQ and Suicide

An article at Medical News Today reviews recent research published in Sweeden, suggesting lower IQ is related to more suicide attempts, even when controlling for many other factors.  However, the presence of psychosis increases the risk of suicide attempt, regardless of IQ.  This looks to be a study I would want more time to review in detail before drawing any conclusions, though the authors offer several theories that seem plausible:

Speculating on the reasons behind the link, they suggested perhaps because people with lower IQ tend to have lower socioeconomic status and income, they could face more social and financial hardship, leading to their having more suicidal thoughts and behaviours.

They also mentioned that unhealthy lifestyle (eg binge drinking) has also been linked with lower IQ, and this could also affect frequency of suicidal thinking, plus other studies have also linked lower IQ with lower problem solving skills, and this could affect resilience to stress.

Sort of seems like a perpetual cycle: the individuals who may be somewhat less able to handle certain stressors end up facing more of them, leading to more problems, etc.  In any event, this looks to be a good article to read.

The Relationship Between Depression and Pain

This article from ScienceDaily reviews new research into the relationship between depression and pain.  What was once thought to be an "either/or" proposition regarding the perception of pain (that is, it is either in your head, or in your body) is turning out to be more complicated.  From the article: 

Their findings revealed that inducing depressed mood disrupted a portion of the participants' neurocircuitry that regulates emotion, causing an enhanced perception of pain. In other words, as explained by Dr. Berna, "when the healthy people were made sad by negative thoughts and depressing music, we found that their brains processed pain more emotionally, which lead to them finding the pain more unpleasant."

The authors speculate that being in a sad state of mind and feeling low disables one's ability to regulate the negative emotion associated with feeling pain. Pain, then, has a greater impact. Rather than merely being a consequence of having pain, depressed mood may drive pain and cause it to feel worse.

From a clinical standpoint, I find this to be interesting, for a couple of reasons.  First, when it comes to depression, it is usually physical symptoms that prompt an individual to seek out treatment, rather than cognitive or emotional symptoms.  that is, it is physical discomfort resulting from depression that will more often trigger an individual to seek treatment, rather than feelings of depression, or depressive thoughts.  The impact of this research on depression and pain in the context of therapy would be an interesting area of further research.

The other issue has more to do with helping clients who are experiencing pain and depression.  I think I've blogged on this before, but it is often difficult to engage clients in the process of therapy when it comes to pain, because they often believe you are assuming their pain "isn't real."  I've addressed this issue in various ways with clients, but research like this ought to help clients bridge the mind-body gap even more, which is encouraging. 

More Sleep Decreases Depression in Adolescents

I like this article simply because, like many others I've linked to, it documents the important role adequate sleep plays in the overall functioning of people.  In this case, the researchers examined the rates of depression and suicidal thinking among teens whose bedtimes were set either 10 pm and earlier, or 12 am and later.  The two groups differed in both rates of depression and suicidal thinking, with those sleeping more showing better mood functioning.  From the article:

Lead author James E. Gangwisch, PhD, assistant professor at Columbia University Medical Center in New York, N.Y., said that the results strengthen the argument that short sleep duration could play a role in the etiology of depression.

"Our results are consistent with the theory that inadequate sleep is a risk factor for depression, working with other risk and protective factors through multiple possible causal pathways to the development of this mood disorder," said Gangwisch. "Adequate quality sleep could therefore be a preventative measure against depression and a treatment for depression."

Some other data:

Seven percent of participants (1,050) were found to have depression using the Centers for Epidemiologic Study-Depression Scale, and 13 percent (2,038) reported that they seriously thought about committing suicide during the past 12 months. Depression and suicidal ideation were associated with later parental set bedtime, shorter sleep duration, self-perception of not getting enough sleep, female sex, older age and lower self-perception of how much parents care.

The article does not go into detail regarding whether other variables were controlled, such as whether parents who set earlier bed times (which the article suggested was the primary method ensuring the most sleep) also engaged in other activities that might also reduce the risk of depression.  However, the accumulating data seems pretty clear: better sleep means better functioning.  I don't doubt this applies to teens who typically require more sleep than an adult anyway (nine hours per night is recommended).

What I've encountered more than a few times since becoming a parent are other parents who indicate they've had difficulty getting their kids to adhere to bed time schedules.  These are not adolescents we are talking about; we are talking about kids as young as three or four.  In terms of the other variables I wondered about before, this would be one of them.  If a parent can't instill (for whatever reason) a habit of going to bed at a healthy, reasonable hour when their kids are young, getting an adolescent to comply with bed time rules will be exponentially more difficult.  On the other hand, there may also be variables associated with the compliance on the part of the kids.  Lots of fodder for further research!

Self-Esteem - Book Quote - An Arsenal of Shoulds

From Self-Esteem, page 17:

"The critic has many weapons.  Among the most effective are the values and rules of living you grew up with.  the critic has a way of turning your"shoulds" against you.  He compares the way you are with the way you ought to be and judges you inadequate or wrong.  he calls you stupid if the A you should have had slips to a B.  He says, "A real man supports his family," and calls you a loser when you're laid off from work.  He says, "The kids come first," and calls you selfish when you crave some nights off."

In addressing many neurotic mental health issues, you'll come across the concept of rigid thinking, and how it contributes to depression, anxiety, etc.  The paragraph above demonstrates how this type of thinking leads to misinterpretations of environmental activities, which then leads to negative/maladaptive feelings, which in turn lead to less optimal behavioral responses.  Albert Ellis is generally credited with the modern therapeutic framework for addressing rigid thinking patterns and their unhealthy impact on our well-being (Rational-Emotive-Behavior Therapy, or REBT). 

When tackling low self-esteem, adressing rigid thinking patterns (as voiced by this "inner critic") is of paramount importance.  The book goes into some detail as to why, as well as how to confront these cognitive errors.  For now, let us just say that, in general, excessively rigid thinking is, first and foremost, wrong.  Period.  To consistently judge oneself against erroneous standards, then, puts us at a disadvantage.  This is why confronting the inner critic, and correcting the rigid beliefs inherent in the inner critics' statements, is so important.  Next up, I'll provide further quotes from the book, and provide a few examples.

Exercise Improves One's Body Image Regardless of Fitness Level

Interesting article here regarding the impact of exercise on one's own body image.  It seems that if an individual engages in exercise, they experience an improved sense of their body image, regardless of their overall fitness level.  From the article:

People who don't achieve workout milestones such as losing fat, gaining strength or boosting cardiovascular fitness feel just as good about their bodies as their more athletic counterparts, said Heather Hausenblas, a UF exercise psychologist. Her study is published in the September issue of the Journal of Health Psychology.

"You would think that if you become more fit that you would experience greater improvements in terms of body image, but that's not what we found," she said. "It may be that the requirements to receive the psychological benefits of exercise, including those relating to body image, differ substantially from the physical benefits."

The article also addresses the relevance of the research, in that dissatisfaction with one's body image has increased dramatically in this country over the last 20 years.  As a result, people spend tons of money on all sorts of products, diets, etc. in an effort to address their poor self-image.  According to this research, people will experience an improved sense of self regardless of whether they reach specific fitness markers, in terms of type/duration of exercise, or physiologic measurements.  Only frequency of participation appeared significant in the findings, which suggests that simply getting people to participate in some fitness-related activity regularly, regardless of length, will have a psychological benefit - one doesn't have to achieve certain thresholds before the benefits are experienced.

What is nice about this in the context of therapy is that, when exercise is a behavioral intervention (such as when treating depression), the only really important number one needs to worry about in terms of goal-setting is frequency of an activity.  The client can slide on some of the other goals (like the length of the workout, walk, jog, etc.); it is simply the act of engaging in the activity for some length of time on multiple occasions during the week that will trigger an improvement in this area.  Helping the client by adding the social/interpersonal dimension, such as "I will walk with my wife five days per week," will further increase the likelihood of initial compliance to the goal.  As improvement occurs, the other issues (such as the length of the walk) can be examined more specifically. 

In addition, this research may be important to provide as education to clients who have extremely poor body image, and/or are reluctant to initiate a workout routine due to concerns regarding "how they'll look in front of everyone."  I get that, and there can be ways to work around this issue (go for walks instead of going to the gym, for example).  However, there are certain exercise regimens that might be better for certain individuals, or certain exercises the client would otherwise prefer except for this one concern.  This research might help a client overcome their self-conciousness and facilitate their participation in an exercise routine they are otherwise more likely to participate in and enjoy. 

Self-Esteem - Book Quote - The Pathological Critic

“The pathological critic is a term coined by psychologist Eugene Sagan to describe the negative inner voice that attacks you.  Everyone has a critical inner voice.  But people with low self-esteem tend to have a more vicious and vocal pathological voice.

The critic blames you for things that go wrong.  The critic compares you to others - to their achievements and abilities - and finds you wanting.  The critic sets impossible standards of perfection and then beats you up for the smallest mistake.  The critic keeps an album of your failures, but never once reminds you of your strengths or accomplishments.  The critic has a script describing how you ought to live and screams that you are wrong and bad if your needs drive you to violate its rules.  The critic tells you to best the best - and if you’re not the best, you’re nothing.  He calls you names - stupid, incompetent, ugly, selfish, weal - and makes you believe that all of them are true.  The critic reads your friends’ minds and convinces you that they are bored, turned off, disappointed, or disgusted by you.  The critic exaggerates your weaknesses by insisting that you “always say stupid things,” or “always screw up a relationship,” or “never finish anything on time.”

- From Self-Esteem, page 15

In short, the more you grapple with an internal voice like this, the more likely it is you sense of self-worth is being compromised by this cognitive style.  The good news is, the inner critic is much like the loud, obnoxious drunk at a party; everyone listens to what he says because he is loud and obnoxious, but with a bit of confrontation and some logic, everything he says can be disproved.

Depression In College Students Increases Likelihood Of Dropping Out

I came across this article, which discusses the impact of depression, and to a lesser extent anxiety, on both the completion rate and academic performance of college students.  While it makes intuitive sense that students with depression might struggle with college more than those without depression, what I like about this research is its exploration of the types of depression involved.  In terms of academic performance, it is the loss of motivation, rather than the experience of depressed affect, which impairs the student’s academic performance.  From the article:

There are two core symptoms of depression---loss of interest and pleasure in activities, or depressed mood---but only loss of interest is associated with lower grade point averages.

"The correlation between depression and academic performance is mainly driven by loss of interest in activities," Eisenberg said. "This is significant because it means individuals can be very depressed and very functional, depending on which type of depression they have. I think that this can be true for many high achieving people, who may feel down and hopeless but not lose interest in activities.

"Lots of students who have significant depression on some dimension are performing just fine, but may be at risk and go unnoticed because there is no noticeable drop in functioning."

The article also discusses how comorbid anxiety (very common, as anxiety and depression tend to go together) increases the degree of academic impairment:

"If you take a student at the 50th percentile of the GPA distribution and compare them to a student with depression alone, the depressed student would be around the 37th percentile---a 13 percent drop," Eisenberg said. "However, a student with depression and anxiety plummets to about the 23rd percentile, a 50 percent drop."

There are some important insights to be gained from research like this.  First, depending on the type of depression one experiences, a change in behavior may not necessarily be evident.  Just because someone continues to maintain a certain degree of functioning does not mean they are not experiencing depression.  However, depression ought to be screened should a change in functioning occur, especially absent some other apparent cause.  It seems like colleges are dramatically improving in their ability to assess, recognize, and intervene with students who are experiencing mental health difficulties, which often emerge, or increase, during young adulthood.  This is especially important because the individuals who would normally be most familiar with a change in presentation - family members - are often no longer seeing their child on a regular basis.  The ability of school employees and fellow students to be informed and make educated observations can help pick up the slack.

Maternal Depression and Infant Sleep Disturbance

This article discusses the recent finding that infants born to mothers with depression exhibit sleep difficulties as soon as two weeks after birth.  This finding, though preliminary (this initial research only had 18 subjects) is important, in that early sleep difficulties are associated with the later development of early-onset depression.  From the article:

Results indicate that infants born to mothers with depression had significant sleep disturbances compared to low-risk infants; the high-risk group had an hour longer nocturnal sleep latency, shorter sleep episodes and lower sleep efficiency than infants who were born to mothers without depression. Although average sleep time in a 24 hours did not differ by risk group at eight two or four weeks, nocturnal total sleep time was 97 minutes longer in the low-risk group at both recording periods. High-risk infants also had significantly more daytime sleep episodes of a shorter average duration.

The article also discusses the potential reversibility of these sleep difficulties as a way of potentially reducing or eliminating the later development of depression.  I've posted several articles regarding the importance of sleep, and the assocation of sleep problems with other issues, and it is no surprise that sleep problems at infancy is associated with later mood difficulties.  Hopefully further research will allow for early detection and intervention.

Childhood Predictors of Adolescent Depression

Here’s an interesting article summing up recent research into the precursors of adolescent depression. For boys, it’s primarily anxiety, but with girls, it’s anxiety as well as antisocial behavior. Surprisingly, early depression did not predict later depression as much as these other warning signs. From the article:

"Anti-social behavior has typically been viewed as a big problem among boys, so it tends to be ignored among girls. Boys with early anti-social behavior typically go on to show more anti-social behavior while girls may turn inward with symptoms, morphing into other mental health problems such as depression eating disorders, anxiety and suicidal behavior during adolescence ," said James Mazza, a UW professor of educational psychology and lead author of the new study. He is currently serving as the past president of the American Association of Suicidology.

"When all the risk factors were analyzed, anti-social behavior and anxiety were the most predictive of later depression. It just may be that they are more prevalent in the early elementary school years than depression." He noted that depression and anxiety share a number of symptoms.

A couple of quick observations. First, it is a general trend that women display high incidences of “inward” mental health difficulties (e.g. depression, anxiety) while men tend to have higher incidences of “outward” mental health diagnoses (i.e. antisocial personality disorder). Interesting how the antisocial stuff continues to develop in boys, but with the girls, the focus shifts once adolescence is reached.

Also, this research again confirms the link between early anxiety and later depression, which I wrote about here. Again, if you are a parent or professional, please do not discount anxiety in kids: anxious kids grow up to be depressed adults, which is not a good thing. Nip these types of problems early, when the symptoms are more manageable, and a whole lot of discomfort and misery can be avoided.

What is also interesting about this study is that it demonstrates that children have some insight into their moods - the authors indicated the kids were able to successfully communicate their difficulties with the help of questionnaires. This is a good thing, insofar as we don’t have to rely solely on the observations of parents, teachers, and others. What this also means is that we need to take kids seriously - obviously, an over-reaction to the occasional stressor is one thing, but if a child is communicating regular discomfort with worry, it is worth it to examine it further.

Infants Placed In Incubators At Less Risk for Later Depression

According to new research, infants who require placement in incubators following birth are at less risk for later onset of depression than infants who aren’t placed in incubators. Girls in particular experience a significant decrease in later depression. Not much to add, aside from my interest in this article was in part personal (my son was born two months premature, which necessitated a significant amount of time in an incubator - that's him in the pics, then and now!). The article covers the thinking behind the results, which seems to make sense to me. Check it out.