April 29, 2022
By Tom Insel, MD, and Matthew Hirschtritt, MD, MPH
Good morning, Research Roundup readers. With all the focus on the mental health crisis playing out among our young people, it’s refreshing to also be able to look at solutions. We do that in a MindSite News Original story released yesterday looking at young leaders who are working to make a difference on campuses. We also share some research today that explores the impact that young peer support specialists can have in working with people struggling with addiction and mental illness. We also take a look at a commentary from a leading mental health researcher who suggests that recent reported declines in suicide rates may be statistical blips. And then we ask that time-honored question: Is technology – in this case, video games – part of the problem or part of the solution. Read on!
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Coaching for Young Peer Support Specialists
There’s now abundant evidence of the many benefits that peer support can provide to people with conditions ranging from addiction to serious mental illness. When done well, peer support can be a win for all involved: The provider of peer support increases their self-confidence and sense of purpose. The recipient of peer support receives nonjudgmental encouragement that can boost their sense of belonging. Plus the health care system becomes less burdened by the demand for services.
But the success of a peer-support program relies, in large part, on the skills of the peer-support provider. What’s the best way to equip nonprofessionals who have invaluable lived experiences to support others – and to clearly define their role?
Janet Walker of Portland State University and colleagues addressed this issue in a small pilot project. The researchers partnered with adolescent and young adult (16-28 years old) peer-support specialists and other youth who’d had intensive psychiatric treatment to design a structured program to help them improve their support skills and to clarify their helping role.
The peer specialist helped the youth they were working with interact productively and assertively with their clinical treatment team, to identify and articulate their personal goals and strengthen their connection to others in the community. To do this, the specialists were all coached to use a semi-structured template for each support session that focused on the recipients’ goals and progress.
The researchers, who were experienced peer-support facilitators, coached the specialists for about 20 hours over 15 weeks and assigned video-based homework. The researchers then provided the specialists with tailored feedback on their performance.
After completion of the program, peer specialists felt significantly more confident in skills ranging from youth-driven practice to identification of strengths, passions, assets, and motivators. Concordant with these self-assessed improvements, scores on their video-recorded sessions also improved. They also felt less anxious about their role.
Even though this is a small pilot project, the results are promising and hint at a relatively low-intensity (but high impact) approach to helping the helpers.
Evaluation of a Skills Enhancement Training Intervention With Remote Coaching for Young Adults Providing Peer Support Psychiatric Services, April 20, 2022.
– Matthew Hirschtritt
Declining Suicide Rates – Cause for Skepticism?
When CDC data released Feb. 25 showed that the official rate of US deaths attributed to suicide unexpectedly fell from 14.8 per 100,000 in 2018 to 13.9 per 100,000 in 2019 and 13.5 per 100,000 in 2020, the decrease was heralded by some with cautious optimism. But is it premature to claim that the U.S. is starting to win the battle against suicide?
Mark Olfson of Columbia University and colleagues inject a note of caution into the CDC data in a new opinion piece. Specifically, they give three reasons to critically evaluate the very recent decreases in suicide rates:
- Recent numbers don’t account for long-term trends. Although it’s encouraging that suicide rates were lower in 2019 and 2020, they followed two decades of steadily increasing suicide rates for just about every patient subgroup except the elderly. Given random fluctuations in annual rates, we shouldn’t read too much into two years of modestly lower rates.
- The overall suicide rate obscures increased rates for vulnerable groups. Olfson points out that from 2019 to 2020, the suicide rate for Black males ages 15-24 increased from 21.6 to 24.3 per 100,000 and Hispanic males saw similar trends. The authors posit that this might reflect “the disproportionate burden of COVID-19 within Black and Hispanic communities.”
- Cause-of-death certificates are notoriously unreliable for suicide. There are multiple reasons why suicide deaths might be undercounted, including misclassification and the relatively high prevalence of undetermined causes of death. The authors show that even with small rates of misclassification, the observed decrease in suicide rates would disappear.
Olfson and colleagues call for “improved mortality surveillance information, which could inform a wide range of evaluation, monitoring, policy, and research.” There’s still a lot of work that needs to be done to achieve the aims of Zero Suicide – and it starts with collecting timely, accurate data.
Tempering Optimism Concerning the Recent Decline in US Suicide Deaths JAMA Psychiatry, April 20, 2022.
– Matthew Hirschtritt
Video games: Part of the Problem or Part of the Solution?
Parents who worry that video games are harming the mental health of their children might want to look at a new report in the American Journal of Psychiatry that uses a video game to treat depression. The idea comes from research on a video game, EndeavorRx, developed by Akili Interactive to improve attention in children with ADHD. EndeavorRx was approved by FDA in 2020 as the first digital therapeutic for ADHD.
The new study uses a similar video game in adults with depression. While depression is classified as a mood disorder, people with depression regularly describe trouble with attention, memory, decision making, and slow thoughts. These are collectively considered the cognitive symptoms of depression and they are generally not improved by antidepressant medication and often interfere with psychological treatments, such as cognitive behavior therapy. Could the same video game that enhances attention in children with ADHD benefit adults with depression?
Richard S.E. Keefe from Duke University and his colleagues, including collaborators from Akili Interactive, tested the impact of playing a video game, AKL-T03, that aims to improve attention by training the player to shoot at a target while ignoring interfering objects that emerge on the screen. Volunteers played the game at home for 25 minutes each day, five days per week for six weeks. A control group played a video game that connected letters on a screen to form words – a task that does not improve attention.
At the end of six weeks, volunteers who had played the attention training game showed a greater improvement in measures of attention, compared with the control group. Did this help their depression? Not really. Both groups improved on depression scores, without any hint that the training of attention conferred an antidepressant effect. Of course, the absence of a clear effect on mood could have been obscured by the overall improvement (subjects in both groups were also on antidepressant medications). It is also possible that both video games required activation, mastery, and daily practice that were helpful for coping with depression.
While this study does not recommend this particular digital therapeutic for depression, it suggests the potential for video games to become part of the treatment of disorders beyond ADHD. But if you think that this approach to treatment will have high engagement and adherence, you might be surprised. Unlike the addictive games that parents worry about, digital therapeutics focus on cognitive problem areas, like focused attention. Even if the format involves shooting lasers and blasting rockets, getting kids or adults to play for 25 minutes every day can be a challenge.
Digital Intervention for Cognitive Deficits in Major Depression: A Randomized Controlled Trial to Assess Efficacy and Safety in Adults American Journal of Psychiatry, April 12, 2022
–Tom Insel
If you or anyone you know is considering suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255. And if you’re a veteran, press 1.
Tom Insel, MD, is a psychiatrist, neuroscientist, and former director of the National Institute of Mental Health (NIMH). He is a donor to MindSite News and chair of its Editorial Advisory Board. Dr. Insel’s financial conflict of interest statement, which includes equity and advisory roles in several early-stage mental health technology companies, can be found here.
Matthew Hirschtritt, MD, MPH, is a clinical psychiatrist with the Permanente Medical Group, Inc., a mental health services researcher with the Division of Research, Kaiser Permanente Northern California, and assistant program director of the Kaiser Permanente Oakland Adult Psychiatry Training Program. His current research focuses on identification and treatment of patients with first-episode psychosis, as well as implementation of a telehealth-based mental health evaluation and referral program.
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