Wednesday, March 13, 2024

By Courtney Wise

Also, in today’s Daily, studies reveal links between domestic violence and traumatic brain injury. Medicare is failing to connect older Americans to the mental health care they need. And physician experts in transgender care move quickly to dispel misinformation that incorrectly links gender-affirming care to cancer and other serious health risks.

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Evidence of brain damage found in survivors of domestic violence

While watching a boxing match on TV one night, she connected her mother’s ailments to the symptoms boxers exhibit while fighting in the ring. They became pronounced decades later, after Garay-Serratos was finally able to help her mother escape the abuse. “She seemed like a different person,” Garay-Serratos said. “Her gait was different, her memory. The headaches seemed to be getting worse.” 

Years later, after her mother’s death, an autopsy confirmed what Garay-Serratos had long suspected. Pánfila’s brain had sustained more damage than Ann McKee, a neuropathologist, had ever seen in the brains of the athletes she examined. McKee is an expert in chronic traumatic encephalopathy – or CTE – which is most associated with former NFL players who suffered repeated head trauma during their football careers. In retirement, many went on to have impulse control problems and aggression and to attempt suicide. McKee, who directs the CTE Center at Boston University, diagnosed Pánfila with CTE, although other specialists disagreed. They did, however, find evidence of Alzheimer’s disease and brain injury in Pánfila’s brain.

Researchers have found clear connections between domestic violence and traumatic brain injuries that seem somewhat different from CTE. Football injuries come in fairly consistent forms, while different types of domestic violence can cause a variety of  injuries, each leaving a different mark. Strangulation impacts brain regions that support memory and balance; shaking interrupts connections between brain areas. “We have repetitive head impacts, we have nonfatal strangulation, we have that shaking,” said Kristen Dams-O’Connor, director of the Brain Injury Research Center at Mount Sinai in New York. “There are these multiple etiologies of injuries that are overlaid upon each other.”

A small study published last December by Dams-O’Connor and her team showed evidence of brain damage in 14 women who had survived years of domestic abuse. Many had a history of brain health challenges including stroke, psychiatric conditions and substance-use disorders. While researchers couldn’t definitively link these to their assaults, half of the women did have epilepsy. “It does make you wonder [whether] traumatic brain injury initiated the development of that seizure disorder,” Dams-O’Connor said. Unlike CTE, which can only be found in autopsies, the patterns of brain injury in survivors of domestic violence may be detectable while a person is still alive, said Rebecca Folkerth, a New York City medical examiner – and “obviously that’s our goal.” 

These days, Garay-Serratos runs Pánfila Domestic Violence HOPE Foundation, a nonprofit devoted to studying traumatic brain injury from domestic violence – and named for her mother. The Centers for Disease Control and Prevention recognize domestic abuse as a leading cause of TBI, and Garay-Serratos wants TBIs from domestic violence to get the same attention now being paid to brain injuries in sports and the military. “This is a hidden and unrecognized pandemic,” she said. “We need a massive campaign.”

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The Navy’s mental health and resiliency teams are going to the dogs 

Navy Times reports that the canines are helping sailors cope and adjust to the mental and emotional stressors they face at sea. They’re the faces of a pilot program that will determine if therapy dogs will become a permanent part of deployed ship crews moving forward. So far, so good. 

The dogs are just one part of a Navy-wide effort to address sailors’ mental health challenges and make it safer for them to ask for help. In the past, sailors have faced stigma and ridicule for mental health challenges and have struggled to find support. 

For now, canines are only being added to the crews of large-deck amphibious ships and aircraft carriers, but Lt. Cmdr. Dawn Stankus, a Navy spokeswoman, said Sage and her pooch comrades occasionally visit other ships in their strike group. For a therapy dog to join the ship, crews must identify a primary handler and three backup handlers who can complete the 120-hour training process to work with the dogs. Most of the trained handlers are chaplains, resiliency providers, and mental health professionals, and they get training from Mutts with a Mission, a nonprofit that teaches them how to care for the dogs and how to understand their behavior and body language. 

“We match each dog with the team they will be working with,” said Brooke Corson, Mutt’s executive director. “The dog must be able to adjust easily to the ship’s environment and all that will be required of them.”

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Older Americans have high rates of depression and suicide. Medicare isn’t offering much help

Medicare’s failings are easily explained: Only 55% of mental health providers accept traditional fee-for-service Medicare – far lower than other types of providers. And two-thirds of privately run Medicare Advantage plans have narrow networks of mental health providers. There are many reasons for this lack of access, write health policy and public health researchers from UCLA and Johns Hopkins. 

Traditional Medicare rates are set by the government, not negotiated, and providers participating in Medicare Advantage have less negotiating power than other specialists. And the nationwide shortage of mental health clinicians means that many providers can operate at or near capacity without taking Medicare patients. And since psychiatric issues tend to first appear in younger people (but can be more complex and costly to treat in the elderly), Medicare is a less important revenue source for mental health providers. The authors recommend raising mental health reimbursement rates in traditional Medicare, which already pays more than the average commercial plan, an action that would likely influence Medicare Advantage as well; reduce administrative burdens; expand the variety of providers that can provide mental health services, and facilitate access through telehealth and cross-state licensing. 

Another Forefront article examines why people 75 and older had the highest suicide rate of all age groups in 2021 and 2022. The number is largely driven by men, who die by suicide at far higher rates than women – 17 times higher among in those 85 and older. The authors, all affiliated with the Brookings Institution Center on Health Policy, note that older adults face a unique set of aging-related stressors: decline in physical health, reduced mental acuity, shrinking social networks, and losses of friends and loved ones. These stressors may compound the impacts of mental illness that elders first experienced when they were younger. 

These factors, often combined with reduced fixed incomes, may contribute to depression and suicide. Nearly a quarter of older adults living in community settings are socially isolated, and isolation and loneliness can have serious impacts on health and well-being. Pain from physical conditions can also put elders on a path toward depression. These issues aren’t always captured in clinical definitions of mental illness (met by 11.5% of adults 65 and older) or substance use disorder (8%) – one reason that 64% of older adults receiving mental health care in 2021 did not have a clinical diagnosis. 

Nearly all older adults interact with the health care system, yet they are seldom assessed for suicide risk. The authors recommend that older people be screened for suicidal ideation and intent when they are seen in primary care or during emergency room visits, as well as in non-traditional settings such as libraries or when getting pastoral counseling. Primary care clinicians can ask elders about issues such as forced retirement, social isolation, declining health, sadness from the death of a partner or the perception that they are a burden. Vulnerable patients might then be linked with resources like meal delivery, phone outreach, transportation assistance or help getting hearing aids. 

–Don Sapatkin

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In other news…

Leaked messages distort cancer risks from gender-affirming care, experts say. Messages from an internal chat board of a group of transgender health professionals were leaked and distorted by a libertarian think tank to suggest that hormone therapy is linked with cancer, STAT reports. The internal messages were leaked in a report by the think tank Environmental Progress, whose founder, Michael Shellenberger, has been vocal about his disdain for gender-affirming care. 

The Lost Patients podcast premiered yesterday. Its first episode features psychiatric patients who describe what psychosis feels like and the maze they must navigate – in emergency rooms, courts, homeless agencies, and jail – to seek help. Listen wherever you get your podcasts.

Tell yourself the truth about yourself. That’s what I got from this week’s mental health nugget published by psychologist Nedra Glover Tawwab. I’ve been struggling to let go of some things that are no longer serving me, mostly because I’m afraid of who I’ll be without them. Habits are hard to break, you know? Anyhow, the journal prompt she suggested, “Create a list of things that you are not interested in anymore,” challenged that part of my thoughts. She shares a bit more wisdom about honoring where you are in life in this recent blog post, too. 

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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