More than three in five American children do not receive timely mental health services after firearm injury
More mental health screening and follow-up needed in youth after firearm injury
Peer-Reviewed Publication
More than three in five children (63 percent) enrolled in Medicaid do not receive mental health services within six months after a firearm injury, according to a new study published in the journal Pediatrics.
In the United States, 11,258 youth experienced nonfatal firearm injuries in 2020. Children who survive firearm injuries are at increased risk for adverse mental health outcomes, such as newly diagnosed trauma-related disorders, substance use and disruptive disorders. In addition to these disorders, the study found that after injury, the percentage of children diagnosed with bipolar disorder, schizophrenia spectrum disorders, and suicidal ideation/self-injury nearly doubled.
“In our study, we found that while too many children did not receive mental healthcare follow-up, children with a new mental health diagnosis identified during the firearm injury encounter had over twice the odds of timely connection to outpatient mental healthcare,” said lead author Jennifer Hoffmann, MD, MS, Emergency Medicine physician at Ann & Robert H. Lurie Children’s Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “This shows that after a firearm injury, mental health screening and referral for youth at high risk are essential, as well as required by the 2022 American College of Surgeons standards for pediatric trauma centers. This best practice still needs wider implementation.”
The study also detected inequities in mental healthcare access after a firearm injury, with Black youth less likely to have any mental health follow-up than White youth.
“Mechanisms underlying these inequities may include stigma and costs related to accessing care, limited diversity in the mental health workforce, and shortages of mental health professionals in areas where Black children live,” said Dr. Hoffmann. “Attention is needed to address barriers at the individual, health system, and societal levels that may prevent Black youth from accessing mental health services.”
For the study, Dr. Hoffmann and colleagues examined Medicaid data of children aged 5-17 years with a nonfatal firearm injury, living in 11 geographically dispersed states from 2010-2018. They identified 2,613 children with firearm injuries. The objective was to analyze how timing of the first outpatient mental health visit after firearm injury varies by sociodemographic and clinical characteristics. They found that the first outpatient mental health visit after injury occurred sooner among children with prior mental health service use.
“For children without prior mental health service use, greater efforts are needed to connect them to mental health providers,” said Dr. Hoffmann. “To improve outcomes, it is important to prioritize early detection of mental health needs, equitable access to mental healthcare and timeliness of care.”
Dr. Hoffmann is the Children's Research Fund Junior Board Research Scholar.
Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is a nonprofit organization committed to providing access to exceptional care for every child. It is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. Lurie Children’s is the pediatric training ground for Northwestern University Feinberg School of Medicine. Emergency medicine-focused research at Lurie Children’s is conducted through the Grainger Research Program in Pediatric Emergency Medicine.
JOURNAL
PEDIATRICS
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Disadvantaged neighbourhoods and
depression symptoms associated with
premature aging
IMAGE: PARMINDER RAINA, PROFESSOR, DEPARTMENT OF HEALTH RESEARCH METHODS, EVIDENCE, AND IMPACT AT MCMASTER UNIVERSITY, LEAD PRINCIPAL INVESTIGATOR OF THE CANADIAN LONGITUDINAL STUDY ON AGING AND THE STUDY’S SENIOR AUTHOR. view more
CREDIT: MCMASTER UNIVERSITY
Disadvantaged neighbourhoods and depression symptoms associated with premature aging
Hamilton, ON (June 5, 2023) - Feeling depressed and living in a deprived urban neighbourhood could be making you age faster, according to a new study led by researchers at McMaster University.
The findings, published June 5 in The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, showed that living in urban environments marked by material and social inequities, and having depression symptoms, were independently associated with premature biological aging, even after accounting for individual-level health and behavioural risk factors, such as chronic conditions and poor health behaviours.
Parminder Raina, a professor in the Department of Health Research Methods, Evidence, and Impact at McMaster University, led the research team, which included investigators from the Netherlands, Norway and Switzerland.
“Our study used two DNA methylation-based estimators, known as epigenetic clocks, to examine aging at the cellular level and estimate the difference between chronological age and biological age,” said Divya Joshi, the study’s first author and a research associate in the Department of Health Research Methods, Evidence, and Impact at McMaster.
“Our findings showed that neighbourhood deprivation and depressive symptoms were positively associated with acceleration of the epigenetic age estimated using the DNAm GrimAge clock. This adds to the growing body of evidence that living in urban areas with higher levels of neighbourhood deprivation and having depression symptoms are both associated with premature biological aging.”
Depressive symptoms in the study were measured using a 10-item standardized depression scale. The researchers found an acceleration in the risk of death by one month for every point increase on the depressive symptom score. They theorized that emotional distress caused by depression may result in more biological wear and tear and dysregulation of physiological systems, which in turn could lead to premature aging.
The researchers assessed neighbourhood material and social deprivation using two indices that were developed by the Canadian Urban Environmental Health Research Consortium (CANUE) based on 2011 census.
Social deprivation reflects the presence of fewer social resources in the family and community, and material deprivation is an indicator of people’s inability to access goods and conveniences of modern life, such as adequate housing, nutritious food, a car, high-speed internet, or a neighbourhood with recreational facilities.
The researchers found an increase in the risk of death by almost one year for those exposed to greater neighbourhood deprivation compared to lower neighbourhood deprivation.
The study did not find that neighbourhood deprivation amplified the effect of depressive symptoms on epigenetic age acceleration.
“Our results showed that the effect of neighbourhood deprivation on epigenetic age acceleration was similar regardless of depression symptoms, suggesting that depression influences epigenetic age acceleration through mechanisms unrelated to neighbourhood deprivation,” Joshi said.
The research examined epigenetic data from 1,445 participants enrolled in the Canadian Longitudinal Study on Aging (CLSA), a research platform following more than 50,000 participants who were between the ages of 45 to 85 when recruited.
“Longitudinal studies, like the CLSA, are important to confirm associations like those found in this study,” said Raina, the study’s senior author and lead principal investigator of the CLSA.
“By following the same group of participants for 20 years, we will be able to determine whether epigenetic changes are stable or reversible over time. We will also gain insight into the mechanisms that are leading to accelerated epigenetic aging.”
Support for the CLSA is provided by the Government of Canada through the Canadian Institutes of Health Research and the Canada Foundation for Innovation. Additional support for this study was provided by the European Union Horizon 2020 Programme.
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Photos of Parminder Raina and Divya Joshi can be found here: https://macdrive.mcmaster.ca/d/458559692d224e69b2e3/
JOURNAL
The Journals of Gerontology Series A
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Association of Neighborhood Deprivation and Depressive Symptoms With Epigenetic Age Acceleration: Evidence From the Canadian Longitudinal Study on Aging
ARTICLE PUBLICATION DATE
5-Jun-2023
Neurotic people are more likely to suffer from mood swings
Study by Leipzig University on the connection between neuroticism and emotional experiences
Peer-Reviewed Publication“Previous studies are in agreement that neurotic people experience stronger negative emotions in everyday life. Because of new, contradictory studies, there has been disagreement about whether this is also associated with increased variability in emotional experiences, i.e. mood swings,” says the study’s first author, Nina Mader from the Wilhelm Wundt Institute of Psychology at Leipzig University. Personality psychologists at Leipzig University have developed a new approach to modelling data that solves previous methodological problems. “We use an approach from Bayesian statistics that allows additional flexibility in data modelling. We first successfully tested this approach in simulations and then re-examined 13 longitudinal data sets. The results suggest that neurotic people do indeed experience greater variability in negative emotions,” explains Mader. A total of 2,518 people were asked about their emotions.
Neuroticism is a personality trait. Personality traits are relatively stable and consistent across situations over time. They encompass both our experiences and our behaviour, including how we think (cognition) and how we feel (affect). People have different personalities and therefore different levels of neuroticism. “So there is not a black-and-white division between neurotic and non-neurotic people, but rather a dimensional continuum with many shades of grey,” says the psychologist.
People with high neuroticism scores not only experience negative emotions more strongly, but also more often than people with average or below-average scores. They are more often self-critical, react more poorly to external criticism, and are more likely to experience feelings of ‘not being good enough’. Studies have shown that neuroticism scores are highest in late adolescence and then decline and stabilise in adulthood. In addition, women and people with a low socio-economic status have higher neuroticism scores than other people.
Since the 1990s, personality psychologists have been interested in whether and how personality influences our emotional experiences. Several studies have assessed the personalities of large samples and observed emotional experiences over time. For example, respondents were asked several times a day how sad, angry or bored they felt on a scale of 1 to 7. This revealed a clear connection between neuroticism and the experience of negative emotions. “While negative emotions occur very rarely in the everyday lives of people with low neuroticism scores, people with high neuroticism scores report significantly more negative emotions in everyday life,” explains Mader. This is typically associated with a disproportionate reaction to triggering circumstances. For example, a minor difference of opinion could cause great anger in the latter, or even the mere thought that the train might be very crowded today could cause intense stress and worry.
Original title of the publication in PNAS:
“Emotional (in)stability: Neuroticism is associated with increased variability in negative emotion after all”, doi.org/10.1073/pnas.221215412
JOURNAL
Proceedings of the National Academy of Sciences
METHOD OF RESEARCH
Meta-analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Emotional (in)stability: Neuroticism is associated with increased variability in negative emotion after all
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