Research Spotlights June 2019

Research Spotlights June 2019

Youth suicide rates in the U.S. increasing, especially in younger girls

Researchers funded by NIMH recently reported a disturbing trend in suicide rates in the United states. Suicide is the second leading cause of death in the U.S. for youth ages 10 to 19 years old. Historically, the rates of suicide have been higher in males than in female across all age groups, even though female youth attempt suicide and report contemplating it more often. This phenomenon is often referred to as the gender paradox in suicide. However, recent reports from the Centers for Disease Control have shown that this is now changing with female youth having a greater percent increase in completed suicides as compared to male youth.

The researchers in this study examined trends in U.S. youth suicide rates in a cross-sectional study of 85,051 youth suicide deaths. They examined age-specific data by sex, race/ethnicity, method of suicide, and U.S. region using national mortality data available through 2016.

Results showed that youth suicide deaths are not only increasing but also that the gender gap is significantly decreasing. Between 1975 and 2016, there were 85,051 teen suicide deaths, and approximately 80% were in male youth. In 2007, female suicide rates in 15 to 19-year-olds started to increase by almost 8% per year, while their male counterparts increased by 3.5 percent. Additionally, suicide rates for girls ages 10 to 14 started increasing annually by about 13%, compared to about 7% for boys. Additionally, female youth are increasingly using more lethal methods of suicide, including by hanging or suffocation.

This study did not assess reasons for the increase in suicide deaths in these populations. However, there is some speculation that social changes, such as the increase in social media use in these age groups, may play a factor. The narrowing gap between male and female youth suicide rates emphasizes the importance of early youth suicide prevention efforts and the consideration of both sex and developmental stage in developing approaches to prevention.

Citation:
Ruch DA, Sheftall AH, Schlagbaum P, Rausch J, Campo JV, Bridge JA. 2019. Trends in suicide among youth aged 10 to 19 years in the United States, 1975 to 2016. JAMA Netw Open. 3; 2(5):e193886

What has happened to the “golden rule”? Shifting moral rules and insights into social decision-making

Recently, a study supported by a grant from the NIMH was published where researchers characterized different moral strategies in the context of reciprocity behavior and the brain circuits involved. In societies with diverse populations, different individuals may use different sets of moral principles, and thus have differing moral strategies, which can influence everyday social behavior. The “golden rule” - treat others as you yourself would like to be treated - is based on reciprocity. Multiple moral motives may explain reciprocity behavior, such as seeking fairness (inequity aversion) and guilt aversion, which is motived by feelings of guilt in order to prevent harm to others. In research, it has been difficult to distinguish the type of prosocial motivation (guilt aversion or inequity aversion) that is responsible for a behavioral outcome, since they both often lead to similar behavioral predictions. This study investigated if it is possible to separate these two motivations and determine if people behave consistently in different contexts or if their behavior is context dependent.

The researchers designed a modified trust game called the Hidden Multiplier Trust Game (HMTG), which allowed for the classification of an individual's moral strategy. Fifty-seven participants (mean age = 21.3 ± 2.1 years, 39 women and 18 men) played the HMTG while undergoing functional magnetic resonance imaging (fMRI). A computational model was developed of the moral strategy and the associated brain activity patterns. Researchers then used a multivariate pattern analysis to map particular strategies to specific brain regions. A between-subjects design was employed using inter-subject representational similarity analysis to map variations in brain processes associated with HMTG decisions directly onto their moral strategy model to test if brain activity patterns are similar for participants who decide in a similar way (and dissimilar for participants with a dissimilar decision strategy).

They found that each of these moral strategies have unique brain activity patterns, even when they result in the same behavioral outcome. This study also demonstrated that some people may rely on multiple principles, such as both guilt and fairness, and that they may switch their moral strategy depending on the circumstances. This is contrary to prior research based on the premise that people are motivated by one moral principle, which remains constant over time. Additionally, the brain activity patterns of people with similar moral strategies are also similar. These results indicate that people on various sides of moral debates may make decisions about moral dilemmas using fundamentally different strategies.

Citation:
van Baar JM, Chang LJ, Sanfey AG. 2019. The computational and neural substrates of moral strategies in social decision-making. Nat Commun. 10:1483.

Researchers make strides in treating depression in Parkinson’s Disease

Depression is one of the most common and debilitating nonmotor complaints in patients with Parkinson's disease (PD). Recently, researchers supported by a grant from the NINDS examined the impact of cognitive behavioral therapy (CBT) on depressive symptoms in PD. Depression in PD is associated with a faster decline in cognition and physical health (including somatic symptoms such as pain, sleep disturbances, etc.), poorer quality of life, and more distress in those caring for patients with PD. Many patients with depression and PD do not receive optimal treatment for their depression symptoms and treatment guidelines have yet to be developed for this population. The researchers in this study hypothesized that the cognitive and behavioral symptoms targeted most intensively by the CBT protocol would show the most robust responses. In addition, since many patients with depression and PD are taking antidepressants, the extent to which stabilized use of antidepressants moderated specific changes in symptoms was explored.

This study was a randomized controlled trial of CBT in 80 patients (ages 35-85 years; 60% male) with depression and PD and their caregivers (ages 25-85 years). Patients were randomly assigned to 10 weeks of either CBT with clinical management or clinical management only. CBT sessions were performed weekly (60-90 min. per session) and included behavioral activation, cognitive restructuring, sleep hygiene, and anxiety management. The intervention arm included 4 biweekly psychoeducational sessions (30‐45 min. per session) for the caregivers during the study. Clinical management, regardless of depressive symptoms, entailed 6 detailed interviews (60-90 min. per session). The Hamilton Depression Rating Scale (HAMD) and Beck Depression Inventory (BDI) subscale scores were used to reflect the heterogeneity in depressive symptoms in individuals with PD.

Results indicated that a response to CBT was associated with significant improvements in mood, sleep, anxiety, negative attitudes toward self, performance impairment, and somatic symptoms. The largest effects were found in cognitive and behavioral symptoms of depression, as compared to somatic symptoms. The stabilized use of antidepressant medication(s) moderated the effect of CBT on somatic complaints. In conclusion, CBT may improve a diverse array of depressive symptoms in individual’s with PD, especially in cognitive and behavioral symptoms. Additionally, combining CBT with antidepressants may improve the management of somatic complaints in depression in individuals with PD.

Citation:
Dobkin RD, Mann SL, Interian A, Gara MA, Menza M. 2019 Cognitive-behavioral therapy improves diverse profiles of depressive symptoms in Parkinson’s disease. Int J Geriatr Psychiatry. 34(5):722-729.

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