MIL-OSI Australia: Regional Victorians Have Their Say On Mental Health Royal Commission

Source: Premier of Victoria

Mental health experts in regional and rural Victoria will get their say on the issues that matter to them as the Andrews Labor Government’s historic Mental Health Royal Commission starts to take shape.

Minister for Mental Health Martin Foley will hold regional roundtable discussions in Ballarat, Bendigo, Mildura and Shepparton today and tomorrow to hear from the people best placed to help shape the Terms of Reference for the Royal Commission.

The roundtables will include representatives from the mental health workforce, service providers, community support groups, academics and most importantly, people and their families who have lived experience with mental illness.

Every year, one in five Victorians experience a mental illness, but only about half of these receive treatment. Last year alone, we lost 621 Victorians to suicide.

The Royal Commission is the first of its kind in Australia and will provide comprehensive recommendations on how to best reform the current mental health system and support Victorians with mental illness, including those at risk of suicide.

Last month, the Labor Government gave all Victorians an opportunity to have their say over the Terms of Reference for the Royal Commission. Already, more than 5,000 Victorians have made a submission online.

Regional roundtables will also be held in Geelong and Traralgon over the next fortnight. To have your say on the Terms of Reference into Mental Health, visit engage.vic.gov.au

If you or someone you know is in crisis or needs support, call Lifeline on 13 11 14 or BeyondBlue on 1300 224 636.

Quotes attributable to Minister for Mental Health Martin Foley

“One in five Victorians experience mental illness every year. We know we don’t have all the answers to improve the system – only a Royal Commission will help us do that.”

“Regional Victorians are disproportionately affected by poor Mental Health. We want to know what matters to them – and what we can do better.”

“The Mental Health Royal Commission Terms of Reference won’t just be developed by the experts – it will be shaped by the everyday Victorians who count on the system to be the best it can be.”

MIL OSI Australia

MIL-OSI UK: expert reaction to study looking at statins and serious mental illnesses

Source: United Kingdom – Executive Government & Departments

Research published in JAMA Psychiatry provides evidence that exposure to statins might help people with serious mental illness.

Dr Derek Tracy, Royal College of Psychiatrists, said:

“The often limited effectiveness of existing medication treatments for schizophrenia are well known, as are their side effects. These remarkable results suggest that an entirely new class of medication – at least new in terms of mental health – may offer benefits.

“The study is well designed, with very large numbers of participants. The authors recognise that what remains to be determined is how such drugs might be benefiting people with serious mental illness, or if there are other variables affecting the results, such as the ‘type’ of person on medications or engaging well with medical care.

“Given the burden of schizophrenia, these results pave the way for further testing of the impact of statins, ideally using a scientific randomised controlled test.”

Prof. Guy Goodwin, Professor of Psychiatry, University of Oxford, said:

“The use of big data to examine real world drug effects is a very exciting recent development. Quasi-experimental designs that control for the most obvious sources of error in such studies give them power and credibility. The finding that statins, calcium antagonists and biguanides may reduce self-harm and psychiatric hospitalisation by substantial amounts in patients with bipolar disorder and psychosis (severe mental illness) is practically important and theoretically very interesting. Serendipity has served psychiatry well in the past and it appears set to do so again. These finding incidentally underline the need to include physical illness as the key co-morbidity of severe mental illness.”

Dr James MacCabe, Clinical Reader in Psychosis Studies, King’s College London’s Institute of Psychiatry, Psychology & Neuroscience, said:

“The study used Swedish population databases to determine whether using three commonly prescribed types of medicine (statins (which lower cholesterol), calcium channel blockers (which lower blood pressure) and metformin (which lowers blood glucose)) had any effect on reducing psychiatric hospital admissions and self-harm in people with severe mental illness.

“These findings are very compelling. There is a misconception that randomised controlled trials are the only form of evidence that can be trusted, but they are of relatively short duration and small size. By studying large populations over a long time in this way, one can detect effects on rare events, such as hospital admissions, that would be missed by clinical trials. There are pitfalls to such studies but the authors have convincingly ruled these out. In particular, these effects seems specific to these three classes of drug and for psychiatric outcomes.

“These findings will need to be independently replicated before any recommendations should be made to change practice, but the findings strongly suggest a potential role for repurposing these drugs to improve mental health outcomes. Given that people with severe mental illness have high rates of cardiovascular disease, these drugs could have a double effect: improving both mental and physical health.”

Prof Allan Young, Professor of Mood Disorders, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, said:

“This fascinating study suggests that statins might benefit the mental health of people with serious mental health problems.  Although this finding will need to be tested further in clinical trials it raises the prospect of “repurposing” these medicines as treatments for mental ill-health.  This seems credible for a number of reasons:  these drugs probably act on the brain as well as the body; there is already evidence that statins may confers extra benefits to antidepressants and, lastly, there is a venerable history of medicines for “physical” health disorders (including anaesthetics, TB drugs and anticonvulsants) being successfully repurposed to treat psychiatric disorders.”

Professor Daniel J. Smith, Professor of Psychiatry, University of Glasgow, said:

“This very large study used routinely-collected ‘real world’ clinical data from Sweden. It adds to a growing body of evidence that medications like statins may potentially be useful in the treatment of severe mental illness, when used alongside treatments such as antipsychotics and mood stabilisers. These findings are interesting and should simulate further work in this area but, as the authors acknowledge, it is difficult to establish conclusively that the ‘non-psychiatric’ medications were directly protective against self-harm and hospitalisation within the patient groups studied.

“Given the enormous complexity and expense associated with developing new medications for psychiatric disorders, studies of this nature that make use of routine data are very welcome. Also, people with severe mental illness are at higher risk of cardiovascular disease, so it is possible that low cost and well-tolerated medications like statins could be reasonable additional treatment options to improve both physical and mental health outcomes.”

Professor Naveed Sattar, Professor of Metabolic Medicine, University of Glasgow, said:

“I am somewhat sceptical of the headline findings here – intuitively, people are more like to take any drugs when they are in better mental health and less likely when they are not – so reverse causality (whereby periods of poor mental health lead to lower drug exposure for statins, metformin and blood pressure drugs) could be a likely explanation rather than any real effects of these drugs on mental health. Even though the authors claim they overcame this bias, I am not sure they did so fully.  Also, their explanations for how these drugs may improve mental health are highly speculative. So I would be strongly cautious with these findings and would only change my mind if effects are proven to be robust in a randomised trial setting.”

‘Association of Hydroxylmethyl Glutaryl Coenzyme A Reductase Inhibitors, L-Type Calcium Channel Antagonists, and Biguanides With Rates of Psychiatric Hospitalization and Self-Harm in Individuals With Serious Mental Illness’ by Hayes et al. was published in JAMA Psychiatry at 16:00 UK time on Wednesday 9th January 2019.

All our previous output on this subject can be seen at this weblink: http://www.sciencemediacentre.org/tag/statins/

Declared interests

Professor Daniel J. Smith: “No conflict of interest.”

Professor Naveed Sattar: “No COI”

Dr James MacCabe: “No Cis”

Professor Guy Goodwin: “I have advised and do advise pharmaceutical companies on the development of new drugs for severe mental illness, but not these drugs which are now cheaply available in generic formulations.”

None others received.

MIL-OSI UK News

MIL-OSI UK: expert reaction to study on depression and social media

Source: United Kingdom – Executive Government & Departments

Research published in EClinicalMedicine highlights potential issues with greater social media use in relation to young people’s mental health.

Prof Peter Fonagy, Head of the Division of Psychology and Language Sciences, University College London, said:

“This study, like many others over recent years, highlights a strong association between screen-time and symptoms of depression and the careful analysis of potential mediators offers intriguing potential explanatory hypotheses. However, the study does not investigate activities which are known to be important in promoting wellbeing, but are constrained by absorption in social media: in particular, mutually enjoyable shared activity with parents. Thus, in addition to drawing attention to the impact of social media use on adolescent wellbeing, we should also look at its negative impact on factors that have the potential to promote wellbeing such as family activities.”

Prof Andrew Przybylski, Associate Professor and Director of Research at the Oxford Internet Institute, University of Oxford, said:

“In this study the researchers draw on data from the Millennial Cohort Study to investigate the correlations between self-reported social media time and a range of indicators of psychological experience and behaviour. The study has a number of notable strengths including the use of very high quality self-report data, good use of control variables, and a relatively circumspect tone for what is typically an over-hyped research area. With this understood the paper goes well beyond the data where it makes direct policy recommendations on the basis of correlational data.

“First and foremost, the data are entirely based on self-reporting. With large sample sizes we would expect most variables to modestly correlate with one another (as they do in this paper). The authors should be credited for noting this as a limitation (few do).  That said, results from similar studies such as those conducted by NHS Digital suggest that high levels of social media use might be understood as a consequence, not cause, of low psychological well-being. This much simpler explanation for the correlation, that social media use is a symptom, for the pattern of findings is not seriously considered by the authors.

“Second, a very large number of statistical tests are performed because of analytic decisions taken by the researchers. For example, splitting the sample by gender, looking at a host of outcome variables, and by comparing multiple levels of social media use instead of using a more conservative statistical approach. Because the analyses are exploratory this means a number of the findings might be false positives as the analyses did not correct for multiple tests. This means that many of the comparisons, such correlations between high vs. low social media use might be spurious. Some causal language is used by the authors in how they describe these comparisons – that is not backed up by the data here, and readers could get the wrong impression if they take from this that we know one thing causes the other (we don’t).”

“Finally, and most importantly, the correlations between social media use and indicators of low psychological well-being are indirect. Other factors the authors include such as low levels of sleep, low self-esteem, harassment, and low body image explain most of these relationships. Further, the correlations between psychological well-being and these factors are far stronger than the links between any of these and social media. Because social media is so weakly correlated with either these factors or well-being I’m left to wonder about the wisdom of making social media use the focus of policy. Given social media is by far the least important factor in the central model; why not address sleep, self-esteem, harassment, and body image directly?”

Dr Dennis Ougrin, Clinical Senior Lecturer at the Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King’s College London, and Consultant Child and Adolescent Psychiatrist at the South London and Maudsley NHS Foundation Trust, said:

“This is not the first paper showing an association between heavy social media use and poor mental health. Although this type of study cannot prove unequivocally that heavy social media use causes poor mental health, it is still of great importance as another piece of much needed evidence pointing in the same direction. Together with other studies, it highlights possible mechanisms of the association. Of these mechanisms, perhaps the most striking is the impact of social media use on sleep, which is incredibly important for good mental health. Another important contribution of this study is demonstrating that the association is stronger in girls. This finding complements recent surveys showing an increase in the prevalence of emotional disorders in girls.”

Professor Stephen Scott, Director of the National Academy for Parenting Research at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, and Head of the National Conduct Problems & National Adoption and Fostering Services at the South London and Maudsley NHS Foundation Trust, said:

“This cross-sectional study takes data from the Millennium Cohort Study (MCS) of over 10,000 14-year-olds. This study was well carried out with a very large sample, good measures and appropriate analyses, although controlling for parental education would have been helpful. After controlling for family income and other confounders including single-parent families, it still finds an association between increased use of social media and low mood. Some of the effect was due to online harassment, dissatisfaction with body shape, and worse sleep. These are important findings which need to be taken seriously.

“Inevitably there is the chicken and egg question, as to whether more dissatisfied children, who to begin with are less pleased with their body shape and have fewer friends then spend more time on social media. Nonetheless, it is likely that excessive use of social media (and one third of children in lone parent families or in the poorest income group reported using social media for 5 hours or more a day, a huge amount of time) does lead to poorer confidence and mental health.

“To establish the facts, a randomised controlled trial would be almost impossible to carry out, but it would be possible to look at individuals over time and see if there are spontaneous variations between their usage of social media and well-being. It would also be possible to carry out experiments where usage is cut down, but then constructive alternative use of time would need to be strongly supported.”

Professor Sir Simon Wessely, Regius Chair of Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, said:

“It is established that the rates of anxiety and depression have increased in recent years in young people. It is also established that this is particularly true for young women between 16 and 24.  The reasons for this are unclear, but many people assume that this must be due to increased access to social media. However, there have been two problems with this. First, why does it predominantly affect young women? Second, how can one be sure that this cause and effect – in other words, it could be that depressed or anxious young people are more likely to use social media, rather than the other way round. This study takes us further forward in understanding the gender effect – which they find to be mediated by poor sleep, online harassment, body image issues and self-esteem.  But because it is largely cross sectional, they still cannot definitely say that social media usage causes poor mental health, although the evidence is starting to point in that direction.”

Dr Bob Patton, Lecturer in Clinical Psychology at the University of Surrey, said:

“The paper reports on the findings from a large scale cohort study of 14 years olds in the UK, exploring their use of social media and mental health. Results demonstrate a clear association between time spent on social media and symptoms of depression (it’s important to note that the study reports symptoms rather than a clinical diagnosis of depression), however as this was a cross sectional study it does not provide any evidence that social media use is the cause of the observed symptoms of depression. It was a well-designed study with almost 11000 participants, providing a representative sample of adolescents, and giving confidence on the reliability of the data and the findings.

“The associated press release presents a snapshot of the key findings of the study – that there is an association between social media use and depression, and that girls are more affected by this than boys. The study found that twice as many girls as boys were users of social media (of at least 3 hours per day), and for those using social media for more than 5 hours a day, girls reported twice as many depressive symptoms as boys (in the press release this is presented as the headline finding that “Girls are twice as likely to show signs of depressive symptoms linked to social media use compared to boys at age 14”). While this is correct overall, it does vary considerably depending on the total time engaged with social media – at lower levels of engagement, the difference between girls and boys is markedly lower.

“The press release also suggests that “At home, families may want to reflect on when and where it’s ok to be on social media and agree limits for time spent online. Curfews for use and the overnight removal of mobile devices from bedrooms might also be something to consider.” The evidence presented in the paper does support limiting the time spend on social media (not online as this can encompass a broader range of usage and this was not covered in the data collected). With regard to the “when and where”, this was not something that was reported in the study, and in fact the paucity of data on this is cited as a limitation of the study by the authors themselves in the discussion.

“Overall this is a useful study, adding to the evidence base in this area and supporting the findings of other studies that have linked social media usage and adolescent mental health.”

Prof Naomi Fineberg, Consultant Psychiatrist, Hertfordshire Partnership University NHS Foundation Trust, Visiting Professor, University of Hertfordshire and Chair of the COST Action group into Problematic Internet Usage, said:

“Studies such as this are important as they continue to indicate an association exists between the use of social media and mental wellbeing in young people. These kinds of cross sectional screening studies cannot by virtue of their design definitively tease out the link, such as attributing causation. Indeed, the relationship is likely to be complex and nuanced. The studies do however call out for investment in research designed to look in detail at the way young people use the internet and its consequences on wellbeing.”

* ‘Social media use and adolescent mental health: findings from the UK Millennium Cohort Study’ by Kelly et al. will be published in EClinicalMedicine at 00.01 UK time Friday 4 January 2019, which is also when the embargo will lift. 

All our previous output on this subject can be seen at this weblink: http://www.sciencemediacentre.org/tag/screen-tag/

Declared interests

Dr Andrew Przybylski: “I do not have any interests which might be regarded by a reasonable and objective third party as giving rise to a conflict with my role as an SMC expert in this story.”

Dr Dennis Ougrin: “No COI.”

Professor Sir Simon Wessely: On the board of trustees for the SMC. No other COI to declare.

Professor Stephen Scott: “No COI.”

Dr Bob Patton: “No COI.”

None others received.

MIL-OSI UK News