Mental health

Posted on ADHD, Autism, Mental health, Neurodiversity

Beyond labels: A new framework for neurodiversity and mental health

A new article introduces a dimensional approach to understanding the mental health needs of neurodivergent people
A new article introduces a dimensional approach to understanding the mental health needs of neurodivergent people.

A groundbreaking article published in the leading psychiatry journal World Psychiatry challenges the traditional approach to diagnosing neurodivergent conditions (also known as “neurodevelopmental disorders” in the medical literature), such as autism, ADHD, and learning disabilities. The research introduces a new transdiagnostic that views these conditions as points on a spectrum rather than distinct categories and recognizes their frequent overlap with mental health challenges, such as depression and anxiety. 

Around 15% of the global population is neurodivergent, often experiencing multiple conditions at the same time. Current diagnostic systems, such as the DSM-5 and ICD-11, separate these conditions into distinct categories or “labels,” overlooking their shared characteristics and complex interplay. Dr Giorgia Michelini, a Lecturer in Psychology at the Queen Mary University of London, is leading an international group of experts in the field to propose a more holistic approach that focuses on the commonalities among these conditions.

“Dr. Michelini stated, ‘By acknowledging the common features of neurodivergent conditions, we can gain a more precise and thorough understanding of their varied expressions. This fresh perspective has the potential to transform how we recognize, evaluate, and assist the mental health requirements of neurodivergent individuals.'”

The study introduces the concept of a “neurodevelopmental spectrum,” which encompasses the shared characteristics of various neurodivergent conditions. This approach acknowledges that individuals vary in the degree to which they exhibit these characteristics, allowing for a more nuanced and personalized assessment. It also provides a better way to identify and support additional mental health challenges, which affect the majority of neurodivergent people.

“Dr. Michelini explained that moving beyond rigid diagnostic labels will allow clinicians to provide more personalized support and interventions for the diverse range of difficulties experienced by neurodivergent individuals. By concentrating on an individual’s unique strengths and challenges, we can enhance their overall well-being and quality of life.”

This research represents a significant advancement in neurodiversity and mental health. Dr. Michelini’s work challenges the status quo and offers a fresh perspective, with the potential to transform the lives of millions of neurodivergent individuals.

Posted on Autism, Mental health

A new study reveals harrowing experiences of misdiagnosis of borderline personality disorder in autistic adults

In an innovative phenomenological study, researchers at Brighton and Sussex Medical School (BSMS) have explored the lived experiences of autistic adults who were previously diagnosed with Borderline Personality Disorder (BPD)
In an innovative phenomenological study, researchers at Brighton and Sussex Medical School (BSMS) explored the lived experiences of autistic adults previously diagnosed with Borderline Personality Disorder (BPD).

The study used interpretive phenomenological analysis and involved conducting one-to-one, semi-structured interviews with 10 participants. Each participant shared overlooked autistic traits from childhood and explained how being misdiagnosed with borderline personality disorder (BPD) had a significant impact on them. This research sheds light on the difficulties of differentiating between autism and BPD, particularly among autistic women who are frequently misdiagnosed.

In recent years, numerous studies have delved into the links between autism and BPD, revealing significant overlaps and challenges in differentiating between these two conditions. Notably, many individuals on the autism spectrum, especially women, have reported being misdiagnosed with BPD.

Stigma and diagnostic overshadowing

Many participants believed that being diagnosed with BPD (borderline personality disorder) led to significant stigma and diagnostic overshadowing, resulting in harmful experiences. They felt that healthcare professionals often neglected their true condition and imposed treatments that were not only unhelpful but also detrimental.

Harmful treatments and masking

“Treating BPD by encouraging the ‘masking’ of behaviours was found to be harmful. Masking, or hiding true autistic traits, has been linked to an increased risk of suicide among autistic individuals. Participants felt powerless, unable to challenge the BPD diagnosis even when they believed it was inaccurate.”

The transformative impact of correct diagnosis

Getting diagnosed with autism was described as “life-changing,” providing profound validation and enabling individuals to embrace their authentic selves. The autism diagnosis shifted the emphasis from attempting to alter their identity to recognizing and encouraging their unique qualities, leading to a considerable improvement in their mental health and overall well-being.

Barriers to autism diagnosis

Participants encountered significant obstacles in obtaining autism assessments after being diagnosed with BPD, leading to delayed access to appropriate support and prolonged struggles.

Comparing stigma

While autism is stigmatized in society, it is distinctly different from the severe stigma associated with BPD. Autism stigma often questions competence, whereas BPD stigma implies individuals are broken and potentially harmful.

Dr. Bruce Tamilson, the primary author of the study and a Psychiatry MSc student currently working as a consultant Neuropsychiatrist and Liaison Psychiatrist in London, added, “This research is crucial in understanding the issue of misdiagnosis and its significant impact on autistic individuals. By sharing these stories, the study aims to humanize and improve mental health services, nurturing a more inclusive and empathetic healthcare system. The experiences of the participants serve as a strong call to action for clinicians and researchers, highlighting the necessity for accurate diagnoses and appropriate support for all individuals.”

Posted on Mental health

Remember: just 10 minutes of mindfulness every day boosts well-being and helps combat depression.

Mindfulness meditation may ease fatigue, depression in multiple sclerosis
Mindfulness meditation may ease fatigue, depression

In a recent study published in the British Journal of Health Psychology, researchers from the Universities of Bath and Southampton have revealed that engaging in just 10 minutes of mindfulness practice daily can enhance well-being, alleviate depression and anxiety, and boost motivation to make positive lifestyle changes, such as adopting healthier exercise, eating, and sleeping habits.

The research enrolled 1247 adults from 91 countries. It demonstrates that brief daily mindfulness sessions, delivered through a free mobile app called Medito, can have profound benefits.

Most participants had no prior experience with mindfulness. They were randomly assigned to either a month-long mindfulness routine or a control condition, which involved listening to excerpts from Alice in Wonderland. The daily mindfulness sessions included relaxation exercises, intention-setting, body scans, breath-focused attention, and self-reflection.

Before beginning the 30 days of mindfulness training and after completing it, the participants filled out surveys about their mental health. The results were remarkable. Participants who used the mindfulness app reported the following changes:

  • Reduced Depression by 19.2% more than the control group.
  • Improved Well-being by 6.9% more.
  • Decreased Anxiety by 12.6% more.
  • Attitudes to Health got more Positive by 7.1% over the control group.
  • Behavioural Intentions to look after Health increased by 6.5% beyond control.

The positive effects of mindfulness were largely maintained after 30 days. In survey follow-ups one month later (Day 61), the mindfulness group showed sustained improvements in their well-being, depression, and attitudes and even reported better sleep quality.

In their feedback, participants highlighted numerous benefits from the mindfulness practice:

“Awareness, self-control, gratitude, I am more patient, and I take more joy from the present moment.”

“Clear mind. Feeling like everything’s under control and I’ll be able to do what I set my mind to.”

“After completing these meditation sessions, I have gained a better understanding of the function of my mind. They have helped me gain insight into many things and have shown me a different lens through which to view the world. Words that come to mind: helpful, insightful, and motivational.”

Excitingly, this trial was one of the first to show that mindfulness’s well-being and mental health benefits could arise from the changes to lifestyle behaviors it encourages. This highlights the potential of mindfulness practice for promoting healthier living, such as encouraging regular exercise. The research team is eager to explore this further.

Posted on Diabetes, Mental health

A recent study has found a solid two-way link between mental health and chronic diabetes complications.

Australian researchers have worked out how to fix a defect that causes lupus, and hope their world-first discovery will offer effective long-term treatment.

Heart attack, stroke, nerve damage.

These are just some of the complications for which millions of Americans with diabetes are at a higher risk.

According to a study led by the University of Michigan, individuals with chronic diabetes complications are more likely to have a mental health disorder, and vice versa.

Having a mental health condition also increases the risk of developing chronic complications of diabetes, meaning the relationship goes both ways.

“We wanted to determine whether chronic diabetes complications led to mental health disorders or if mental health disorders led to those diabetes complications. However, we found that both relationships are true,” said Brian Callaghan, M.D., M.S., senior author and Eva L. Feldman, M.D., Ph.D., Professor of Neurology at U-M Medical School.

“The findings highlight the importance of actively screening for mental health disorders in diabetes patients, in addition to screening for chronic complications, which is the recommended standard of care in diabetes.”

Three-times greater risk

The research team, led by Michigan Medicine and the Department of Biostatistics at the U-M School of Public Health, examined insurance claims data from over 500,000 individuals with type 1 or type 2 diabetes and 350,000 people without diabetes.

Results published in Diabetes Care indicate that individuals with chronic diabetes complications face an increased risk of experiencing a mental health condition such as anxiety or depression, with the risk rising as they age.

Those with mental health disorders were up to 2.5 times more likely to experience sustained diabetes complications.

In individuals under 60 years old, type 1 diabetes showed a stronger link to chronic complications, while type 2 diabetes was more associated with mental health challenges.

A possible reason for this bidirectional relationship, researchers say, may be that having a diabetes complication or mental health condition has direct effects on developing the other complication.

“For instance, a stroke causes detrimental effects on the brain, which may directly lead to depression,” Callaghan said. 

“And having a mental health condition and diabetes may affect a person’s self-management of their condition — like poor glycemic control or not taking medications — which, in turn, may increase their risk of diabetes complications.”

Common risk factors

The relationship may not always be straightforward. Diabetes complications and mental health conditions have common risk factors; obesity, glycemic control issues, and social determinants of health can all increase the likelihood of developing both comorbidities.

“First author Maya Watanabe, M.S., a biostatistician at the Harvard T.H. Chan School of Public Health and former graduate student research assistant at U-M, mentioned that the association we are seeing is most likely driven by a combination of direct and indirect effects as well as shared risk factors.”

Diabetes care providers can possibly prevent multiple complications by addressing shared risk factors simultaneously.

In an 18-month period, as many as 50% of individuals with diabetes may experience distress related to their condition, according to the CDC.

Several national diabetes centers have implemented screening for depression and distress in their patients, but there is no standardized mental health screening process in diabetes care.

The researchers point out that additional resources will be necessary to screen and manage mental health conditions, as many clinicians who manage diabetes lack specific training to accurately identify and treat them.

Mental health care

“The U.S. Preventive Services Task Force emphasizes that patients who screen positive for mental health conditions should receive appropriate diagnosis and evidence-based treatment, or be referred to a facility that can provide the necessary care.”

“Primary care providers and endocrinologists are already overworked. Therefore, systems of care need to be in place to help provide mental health care when needed,” said Dr. Eva Feldman, co-author of the statement. Dr. Feldman is the Director of the ALS Center of Excellence and James W. Albers Distinguished University Professor at U-M.

“These systems should include mental health screening, easily accessible insurance coverage for mental health services, and physician and patient education programs. Action is needed, and our new research further proves that this action must occur now.”

Posted on Diabetes, Mental health

Pandemic exacerbated depression in older adults with diabetes

Risk factors for depression included loneliness, chronic pain and being female.
Risk factors for depression included loneliness, chronic pain and being female.

 A recent study of more than 2,700 older Canadians reported older adults with diabetes faced a heightened risk of depression during the COVID-19 pandemic. In this cohort, almost 50% of those who had a pre-pandemic history of depression experienced depression during the pandemic.

Those who experienced loneliness were among the most impacted.

“During the pandemic, loneliness almost tripled the risk of depression in older adults with diabetes,” says clinical pharmacist and first author ZhiDi Deng. “This not only highlights the impact of quarantines and lock-downs on individuals’ mental health. It also shows us that there is room for improvement on how we can better deliver services to older adults with diabetes in future public health crises.”

Although not as severely impacted as those with a history of depression, one in eight older adults with diabetes who had no history of depression prior to the pandemic were depressed in the autumn of 2020. “The pandemic has taken a significant toll on the mental health of everyone, particularly older adults with chronic conditions such as diabetes,” says co-author Grace Li, a research assistant at the University of Toronto’s Institute for Life Course and Aging (ILCA). “It’s important for primary health providers to be vigilant for signs of depression among their older patients, even those who were doing well in the past.”

The researchers identified several other factors that were associated with a higher risk of depression among those with diabetes, such as being female, having functional limitations or chronic pain, and experiencing family conflict.

They also reported some unexpected findings. The researchers found that those who were separated, divorced, or widowed had lower odds of recurrent depression during the pandemic than those who were married or in common-law relationships. “This is different from research conducted before the pandemic that indicated married individuals usually are less depressed,” said co-author Dorina Cadar, Senior Lecturer in Neuroepidemiology and Dementia at the Centre for Dementia Studies at Brighton and Sussex Medical School and the director of the Cognitive Epidemiology, Dementia, and Ageing Research lab. “We hypothesized that participants who were married during the pandemic experienced worse mental health because the need to stay for extended periods of time in close living proximity during the lockdowns or quarantine could possibly exacerbate any relationship conflicts. Our findings indicate that those who were experiencing family conflict during the pandemic had more than triple the risk of depression during the pandemic.”

The second unexpected finding was that those with higher income prior to the pandemic had a greater risk of depression during the pandemic than those who were poorer.  In pre-pandemic research, higher income is associated with a lower prevalence of depression. 

“We hypothesized that this finding may have been influenced by the generous response of the Canadian government with the Canadian Emergency Response Benefit (CERB), which may have had a protective impact on the mental health of low-income Canadians. CERB provided Canadians who lost employment during the pandemic with a $2000 monthly income. For some low-income individuals and households, this would actually increase their monthly income, thereby reducing financial-related stress among this population,” said co-author Maria Rowsell, a research assistant at the University of Toronto’s ILCA.

The study was conducted using data from the Canadian Longitudinal Study on Aging (CLSA) surveys. The CLSA is a large national longitudinal study involving older Canadians with diabetes. This study identified 2,730 individuals with diabetes in the CLSA sample. In this group, 1,757 individuals had no pre-pandemic history of depression, and 973 had a pre-pandemic history of depression. The study was published online this month in the journal Archives of Gerontology and Geriatrics Plus.

“The long-term implications of the pandemic extend far beyond physical health,” said senior author Professor Esme Fuller-Thomson of the University of Toronto’s Factor-Inwentash Faculty of Social Work and Director of the ILCA. “It is important to improve access to mental health services for people with diabetes, particularly during periods of increased stress. Interventions that have shown promising results to support the mental health of individuals with comorbid depression and diabetes include cognitive behavioural therapy and psychoeducation.  We need to improve access to these important services.”