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Updated: 3 hours 13 min ago

Belief in God Can Improve Mental Health Outcomes

Fri, 04/26/2013 - 6:07am

A new study suggests belief in God may significantly improve the outcome of those receiving short-term treatment for psychiatric illness.

Researchers followed patients receiving care from a hospital-based behavioral health program to investigate the relationship between patients’ level of belief in God, expectations for treatment and actual treatment outcomes.

In the study, published in the current issue of Journal of Affective Disorders, researchers comment that people with a moderate to high level of belief in a higher power do significantly better in short-term psychiatric treatment than those without.

“Belief was associated with not only improved psychological well-being, but decreases in depression and intention to self-harm,” says David H. Rosmarin, Ph.D., an instructor in the Department of Psychiatry at Harvard Medical School.

The study looked at 159 patients, recruited over a one-year period. Each participant was asked to gauge their belief in God as well as their expectations for treatment outcome and emotion regulation, each on a five-point scale.

Levels of depression, well-being, and self-harm were assessed at the beginning and end of their treatment program.

Of the patients sampled, more than 30 percent claimed no specific religious affiliation yet still saw the same benefits in treatment if their belief in a higher power was rated as moderately or very high.

Patients with “no” or only “slight” belief in God were twice as likely not to respond to treatment as patients with higher levels of belief.

Investigators believe the study demonstrates that a belief in God is associated with improved treatment outcomes in psychiatric care.

“More centrally, our results suggest that belief in the credibility of psychiatric treatment and increased expectations to gain from treatment might be mechanisms by which belief in God can impact treatment outcomes.”

Investigators hope that the study will lead to additional investigation on the clinical implication of spirtual life as more than 90 percent of the U.S. population hold religious beliefs.

Source: McLean Hospital

Women’s Sexual Desire Tied to Hormone Variation

Fri, 04/26/2013 - 5:33am

Is it the time of the month for sex? If so, it probably means a woman’s estrogen level is high and they are at the peak of fertility.

If not, then a woman is more likely flush with progesterone with diminished desire and low fertility. Although researchers have long suspected a link between hormones and libido, new research has confirmed such an association.

In a new study, scientists at UC Santa Barbara have actually demonstrated hormonal predictors for sexual desire. Their findings appear in the current issue of the journal Hormones and Behavior.

“We found two hormonal signals that had opposite effects on sexual motivation,” said James Roney, Ph.D., the article’s lead author.

“Estrogen was having a positive effect, but with a two-day lag. Progesterone was having a persistent negative effect, both for current day, day before, and two days earlier.”

When hormone levels and sexual desire were factored against the menstrual cycles of test subjects — in this case, undergraduate students — the researchers saw a measurable increase in progesterone levels at the same time the subjects noted decreases in sexual motivation.

Progesterone, the researchers say, is mediating this drop in desire from the fertile window to the luteal phase — the second half of the menstrual cycle.

“Progesterone acting as a potential stop signal within cycles is a novel finding in humans,” noted Roney.

“We know in rhesus monkeys there is a strong negative correlation with progesterone and a positive correlation with estrogen. The patterns are actually comparable to what you see in non-human primates, but hadn’t been shown in humans.”

The researchers’ findings have potential implications on the treatment of low sexual desire and how hormone replacement trials are done.

“We’re not controlling hormones the way they do in the hormone replacement literature, so, in a sense, that literature is more directly applicable in terms of medical applications,” said Roney.

“But in the long run, it would be good to have a model of the combination of signals that operates in the natural cycle. The way hormone replacement trials are done now, there’s no model of the natural signals, so they’re sort of random –– let’s give estrogen, let’s give testosterone, let’s combine them this way or that way.”

Roney admits that the study needs to be replicated with women of different age groups.

“Undergraduates might be unique for a lot of reasons,” he said.

“Their hormone levels tend to be a bit different from those of women even just a little bit older. And married women in their 30′s are likely to be more consistently sexually active, and that might change the patterns in some ways. They also tend to have higher hormone secretion and more regular cycles than younger women,” he said.

Eventually, Roney continued, the goal would be to have a better model of the signals in a natural cycle that might then inform medical research.

Another interesting finding, according to Roney, was the impact — or lack thereof — of testosterone on the women’s sexual motivation.

“There’s a common belief in the medical literature that testosterone is the main regulator of women’s libido,” he explained. “Doctors tend to believe that, though the evidence isn’t that strong in humans. In the natural cycles, we weren’t finding effects of testosterone. It wasn’t significantly predicting outcomes.”

Roney doesn’t deny that testosterone does seem to have a positive effect in hormone replacement therapy, but suggests the effects may be pharmacological.

“Testosterone has those effects if you inject it externally in women who are menopausal, and there are a lot of reasons that might be the case,” he said. “For example, testosterone can be converted to estrogen through a particular enzyme.

“If you inject menopausal women with testosterone, it might be acting as a device that’s delivering estrogen to the target cells. So the fact that it works doesn’t necessarily mean it’s an important signal in the natural cycle.”

Source: University of California – Santa Barbara

Binge Drinking in College Can Lead to Later Cardiac Issues

Fri, 04/26/2013 - 5:30am

Students beware, a college habit of binge drinking can cause serious problems in later life.

A new study finds that regularly consuming multiple drinks in a short window of time can cause immediate changes in circulation that can increase the risk of developing cardiovascular disease later in life.

“Regular binge drinking is one of the most serious public health problems confronting our college campuses, and drinking on college campuses has become more pervasive and destructive,” said Shane A. Phillips, P.T., Ph.D. “Binge drinking is neurotoxic and our data support that there may be serious cardiovascular consequences in young adults.”

College students age 18 to 25 years old have the highest rates of binge drinking episodes, with more than half engaging in binge drinking on a regular basis. Prior studies have found that binge drinking among adults age 40 to 60 years old is associated with an increase in risk for stroke, sudden cardiac death and heart attack, but the effect on younger adults has not been studied.

In the study, found in the Journal of the American College of Cardiology, researchers looked at two groups of healthy nonsmoking college students — those who had a history of binge drinking and those who abstained from alcohol.

Binge drinking was defined as consuming five or more standard size drinks (12 ounces of beer, 5 ounces of wine, 1.5 ounces of 80 proof spirits or 8-9 ounces of malt liquor) in a two-hour period for males and four or more standard size drinks in a two-hour period for females.

On average, the students who binge drink had six such episodes each month over four years. Abstainers were defined as having consumed no more than five drinks in the prior year.

Students were also questioned about their medical history, diet, history of family alcohol abuse and frequency of binge drinking.

Researchers discovered that the binge drinkers had impaired function in the two main cell types (endothelium and smooth muscle) that control blood flow.

These vascular changes were equivalent to impairment found in individuals with a lifetime history of daily heavy alcohol consumption and can be a precursor for developing atherosclerosis, or hardening of the arteries, and other cardiovascular diseases such as heart attack and stroke.

However, binge drinkers were not found to have increased blood pressure or cholesterol — two well-established risk factors for heart disease.

Interestingly, both high blood pressure and cholesterol cause changes in vascular function similar to what the students demonstrated from binge drinking.

“It is important that young adults understand that binge drinking patterns are an extreme form of unhealthy or at-risk drinking and are associated with serious social and medical consequences,” said Mariann Piano, Ph.D., R.N., co-author of the study.

“Discoveries and advances in many different areas of medical science have cautioned against the notion that youth protects against the adverse effects of bad lifestyle behaviors or choices.”

According to the investigators, more research is needed to determine if damage caused by binge drinking in young adulthood can be reversed before the onset of cardiovascular disease and to determine the timeframe for onset of disease.

Source: American College of Cardiology

Morally ‘Tainted’ Money Seen as Devalued

Thu, 04/25/2013 - 8:30am

New research finds that morals and conscience play a role in how we view money.

In particular, researchers discover that when people perceive money as morally tainted, they also view it as having less value and purchasing power since it was obtained by immoral means.

This finding challenges the belief that “all money is green,” and that people will cross ethical boundaries to amass it.

In the new study, social scientists from University of California, Berkeley, and Stanford University discovered compelling evidence that the source of wealth really does matter. In fact, some people avoid ill-gotten gains — such as profits from unfair labor practices or insider trading — for fear of “moral contagion.”

The research findings are published in the online issue of the journal Social Psychological and Personality Science.

“Our work suggests morality is an important force shaping economic decision-making,” said Jennifer Stellar, a doctoral student in psychology and lead author of the study.

“Though we often think $50 is $50, these results demonstrate that when money takes on negative moral associations, its value is diminished.”

The findings help explain the psychology behind such economic trends as socially responsible investing and the boycotting of sweatshop-produced goods. They also shed some light on why companies go to great lengths to avoid the perception that they are accepting money from corrupt investors or are themselves profiting from illegal or unethical practices, researchers said.

“People possess powerful motivations to view themselves as fundamentally good and moral,” said Dr. Robb Willer, associate professor of sociology at Stanford University and co-author of the paper. “We find this motivation is so great that it can even lead people to disassociate themselves from money that has acquired negative moral associations.”

The first experiment involved 59 college-age participants who were told they could enter a raffle for a $50 cash prize sponsored by one of two corporations. They were then split into an “immoral money” group and a “neutral money” group.

The neutral money group was told that the raffle prize money was provided by the retail giant Target.

Meanwhile, the “immoral money” group was told that the source of the prize money was Walmart, and also given information on a 2005 lawsuit by the International Labor Rights Forum that alleged Walmart had failed to meet internationally mandated labor standards. It was suggested that the raffle prize money might be tied to the profits of Walmart’s labor practices.

The participants were then given 70 raffle tickets and told they could enter as many of them as they wished as long as they completed the tedious task of writing their names and contact information on each ticket. As predicted by the researchers, those in the “immoral money” group filled out fewer raffle tickets to win the Walmart cash prize.

In an effort to gauge the value of tainted prize money, participants were then asked to estimate how many of eight food or beverage items — such as a gallon of milk, bottle of Pepsi and Snickers bar — they could purchase with the $50. Those in the Walmart group consistently calculated that the $50 would buy them fewer items, compared to the Target group, indicating how they felt psychologically about the money they considered tainted.

In the second study, researchers sought to explain why people devalue morally tainted money.

One hundred and forty men and women ages 18-68 were recruited through a national research website and paid a small amount to participate in the study. They also were given the option of earning extra money by completing a series of word categorization tasks and were told the extra earnings would come from Walmart. The same information about the lawsuit alleging substandard labor practices was shown to them.

This time, the researchers used “moral licensing” on half of the participants, a technique in which people are primed to feel on solid moral ground by recounting the good deeds they had done. The researchers speculated that those groomed to feel more moral would consider their standing high enough to afford a little leeway in accepting morally tainted money.

Researchers discovered the hypothesis was accurate — participants did the extra work for more money.

The results suggest individuals believe that acquiring morally tainted money threatens their own moral character. But by removing those fears and making participants feel certain in their moral high ground, the researchers are able to diminish the threat of accepting morally tainted money, Willer said.

“Money is often believed to separate individuals from their moral values,” Willer said. “However, our results suggest that, for most people, morality is a powerful force that shapes economic decisions and even alters how we perceive the value of money itself.”

Source: UC Berkeley

Man holding money behind his back photo by shutterstock.

Coming of Age Linked to Activity in Specific Brain Area

Thu, 04/25/2013 - 6:59am

Moms and dads can take heart; new research suggest adolescence angst is merely a normal biological program of reorientation.

As parents know, adolescence is often a turbulent period when children consider their identity and social status. Research now suggests that during this transition period a specific region of the brain shows increased activity.

In a study of 27 neurologically typical children who underwent functional magnetic resonance imaging (fMRI) at ages 10 and 13, activity in the brain’s ventromedial prefrontal cortex increased dramatically when the subjects responded to questions about how they view themselves.

Researchers say the findings, published in the Journal of Neuroscience, confirm previous discoveries that specific brain networks support self-evaluations in the growing brain. Even more important is the evidence that basic biology may well drive some of these changes, said Dr. Jennifer H. Pfeifer, professor of psychology at the University of Oregon.

“This is a longitudinal fMRI study, which is still relatively uncommon,” Pfeifer said. “It suggests a link between neural responses during self-evaluative processing in the social domain, and pubertal development. This provides a rare piece of empirical evidence in humans, rather than animal models, that supports the common theory that adolescents are biologically driven to go through a social reorientation.”

Participants were scanned for about seven minutes at each visit. They responded to a series of attributes tied to social or academic domains — social ones such as “I am popular” or “I wish I had more friends” and academic ones such as “I like to read just for fun” or “Writing is so boring.”

Social and academic evaluations were made about both the self and a familiar fictional character, Harry Potter.

In previous research, Pfeifer had found that a more different region of the medial prefrontal cortex was more responsive in 10-year-old children during self-evaluations, when they were compared to adults.

The new study, she said, provides a more detailed picture of how the brain supports self-development by looking at change within individuals.

The fMRI analyses found it was primarily the social self-evaluations that triggered significant increases over time in blood-oxygen levels, which fMRI detects, in the ventral medial prefrontal cortex.

Additionally, these increases were strongest in children who experienced the most pubertal development over the three-year study period, for both girls and boys.

Increases in blood-oxygen levels during academic self-evaluations were negligible. Whole-brain analyses found no other areas of the brain had significant increases or decreases in activity related to pubertal development.

Thus, brain changes were principally centered around social orientations.

“Increased responses in this one region of the brain from age 10 to 13 were very evident in social self-evaluations, but not academic ones. This pattern is consistent with the enormous importance that most children entering adolescence place on their peer relationships and social status, compared to the relatively diminished value often associated with academics during this transition.”

In youth with autism spectrum disorders, this specialized brain response in ventral medial prefrontal cortex is missing.

In fact, the absence of this typical effect, Pfeifer said, might be related to the challenges these individuals often face in both self-understanding and social relations.

Source: University of Oregon

Abstract of the brain photo by shutterstock.

Slow Insurance Approvals Strand Mental Health Patients in ER

Thu, 04/25/2013 - 6:16am

A significant problem regarding health care access involves obtaining hospital admission for those experiencing a mental health crisis.

The backlog in obtaining insurance approval for admission to a hospital bed is problematic for the patient in crisis, other emergency room patients and physicians.

A research letter to be published in the May issue of the journal Annals of Emergency Medicine argues that pre-authorization process is akin to health care “rationing by hassle factor.”

“An emergency department is just about the worst place for a psychiatric patient to wait for an inpatient bed, and yet that is exactly what the pre-authorization process forces on millions of these vulnerable people,” said senior author J. Wesley Boyd, M.D., Ph.D.

“The thousands upon thousands of hours emergency physicians spend obtaining prior authorization for admission to the hospital are hours we are not spending on direct patient care. Only Medicare does not require prior authorization for us to admit psychiatric patients to the hospital; maybe they are onto something.”

In the study, researchers recorded data on 53 patients — most were in the emergency department because they were having suicidal thoughts.

Half of the authorization requests took under 20 minutes to be approved, but 10 percent of the patients’ authorizations took an hour or more. Only one of the 53 patients’ insurance carriers denied pre-authorization. There are approximately 2.5 million psychiatric admissions to hospitals every year in the U.S.

“Psychiatric care is really the poor stepchild in the world of insurance coverage,” said lead author Amy Funkenstein, M.D., of Brown University in Providence, R.I..

“Insurance carriers reimburse poorly and as a consequence, hospitals often have inadequate resources for patients who urgently need this care. The situation is so dire that ERs are now being designed and configured to house psychiatric patients awaiting placement as inpatients. These patients deserve better.”

Source: American College of Emergency Physicians

Man waiting in the Emergency Room photo by shutterstock.

National Survey Finds Big Jump in Teen Abuse of Prescription Drugs

Wed, 04/24/2013 - 8:30am

A new national survey finds that one in four teens has misused or abused a prescription drug at least once in their lifetime, a jump of 33 percent in just five years.

Using data from The Partnership Attitude Tracking Study (PATS), researchers found, for instance, that one in eight teens (13 percent) now report they have taken the stimulants Ritalin or Adderall when it was not prescribed for them, at least once in their lifetime.

“These data make it very clear: the problem is real, the threat immediate and the situation is not poised to get better,” said Steve Pasierb, president and CEO of The Partnership at Drugfree.org.

“Parents fear drugs like cocaine or heroin and want to protect their kids. But the truth is that when misused and abused, medicines — especially stimulants and opioids — can be every bit as dangerous and harmful as illicit street drugs.”

Researchers believe the sustained trend in teen medicine abuse is associated with inappropriate parental and caregiver oversight. Investigators say that nearly one-third of parents say they believe Rx stimulants like Ritalin or Adderall, normally prescribed for attention deficit hyperactivity disorder (ADHD), can improve a teen’s academic performance – even if the teen does not have ADHD.

Further, according to some, parents are often not communicating the dangers of Rx medicine misuse and abuse to their kids, nor are they safeguarding their medications at home and disposing of unused medications properly.

“Medicine cabinets are the number one access point for teens who want to misuse and abuse prescription drugs. That’s why we are making a concerted effort to let parents and caregivers know how important it is to safely dispose of their unused, unwanted or expired medicines. Doing so can literally save a life,” said Marcia Lee Taylor of The Partnership at Drugfree.org.

Trends in teen prescription drug abuse according to the new PATS data (2008-2012):

  • One in four teens (24 percent) reports having misused or abused a prescription drug at least once in their lifetime (up from 18 percent in 2008 to 24 percent in 2012), which translates to about 5 million teens;
  • Of those kids who said they abused Rx medications, one in five (20 percent) has done so before the age of 14;
  • More than a quarter of teens (27 percent) mistakenly believe that “misusing and abusing prescription drugs to get high is safer than using street drugs,” and one-third of teens (33 percent) say they believe “it’s okay to use prescription drugs that were not prescribed to them to deal with an injury, illness or physical pain.”

Experts say that medicine abuse is one of the most significant and preventable adolescent health problems that families face today. Rx stimulants a key area of concern, with misuse and abuse of Ritalin and Adderall in particular driving the noted increases in teen medicine abuse.

Stimulants are a class of drugs that enhance brain activity and are commonly prescribed to treat health conditions including ADHD and obesity. The 2012 data found:

  • One in eight teens (about 2.7 million) now reports having misused or abused the Rx stimulants Ritalin or Adderall at least once in their lifetime;
  • 9 percent of teens (about 1.9 million) report having misused or abused the Rx stimulants Ritalin or Adderall in the past year (up from 6 percent in 2008) and 6 percent of teens (1.3 million) report abuse of Ritalin or Adderall in the past month (up from 4 percent in 2008);
  • One in four teens (26 percent) believes that prescription drugs can be used as a study aid.

Although abuse of prescription pain medicine remains at unacceptably high levels among teens, the new PATS data shows that use may be flattening.

Teen abuse of prescription pain relievers like Vicodin and OxyContin has remained stable since 2011 with one in six teens (16 percent) reporting abuse or misuse of an Rx pain reliever at least once in their lifetime. One in 10 teens (10 percent) admits to abusing or misusing an Rx painkiller in the past year.

Nevertheless, the availability of prescription drugs (in the family medicine cabinet, in the homes of friends and family) makes them that much easier to abuse.

The new survey findings stress that teens are more likely to abuse Rx medicines if they think their parents “don’t care as much if they get caught using prescription drugs, without a doctor’s prescription, than they do if they get caught using illegal drugs.”

Some parents (one in six or 16 percent) believe that using prescription drugs to get high is safer than using street drugs.

Parents often fail to talk with teens about substance abuse (16 percent of parents); in comparison, a majority of teens (81 percent) say they have discussed the risks of marijuana use with their parents, 80 percent have discussed alcohol and nearly one-third of teens (30 percent) have discussed crack/cocaine.

Source: The Partnership at Drugfree.org/MetLife Foundation

Teenager holding a pill photo by shutterstock.

Novel Health Data Display Can Lead to Taking In Fewer Calories

Wed, 04/24/2013 - 7:48am

Would you eat that piece of pie if you knew you would have to perform a brisk walk of 4.5 miles to burn the associated calories? New research finds displaying such information can lead to fewer calories consumed.

Improving health by enhancing health literacy and motivating healthy behaviors has been an objective of health educators and policymakers for quite some time. But the the escalation of obesity and sedentary behaviors suggest new approaches may be required.

“We need a more effective strategy to encourage people to order and consume fewer calories from restaurant menus,” said Meena Shah, Ph.D., of Texas Christian University, senior researcher of a new study in The FASEB Journal.

“Brisk walking is something nearly everyone can relate to, which is why we displayed on the menu the minutes of brisk walking needed to burn food calories,” said Ashlei James, lead researcher and graduate student.

The study enlisted 300 men and women ages 18-30.

“The group was randomly assigned to a menu without calorie labels, a menu with calorie labels, or a menu with labels for the minutes of brisk walking needed to burn the food calories,” James said. “All menus contained the same food and beverage options, which included burgers, chicken sandwiches/tenders, salad, fries, desserts, soda, and water.”

The results indicate that the menu displaying the minutes of brisk walking needed to burn food calories led to fewer calories ordered and consumed compared with the menu without calorie labels.

Interestingly, there was no difference between the menu with calorie labels and the menu without calorie labels in the number of calories ordered and consumed by the subjects.

“This study suggests there are benefits to displaying exercise minutes to a group of young men and women. We can’t generalize to a population over age 30, so we will further investigate this in an older and more diverse group,” Shah said.

“This is the first study to look at the effects of displaying minutes of brisk walking needed to burn food calories on the calories ordered and consumed.”

The study was eye-opening for many of the subjects. “For example, a female would have to walk briskly for approximately 2 hours to burn the calories in a quarter-pound double cheeseburger,” said Shah.

Source: Federation of American Societies for Experimental Biology

Infant Responses May Predict Later Antisocial Behavior

Wed, 04/24/2013 - 7:41am

New research suggests an infant’s response to a scary situation predicts if they will be at risk for conduct disorders later in life.

Specifically, scientists discovered infants who sweat less in response to scary situations at age 1 show more physical and verbal aggression at age 3.

Lower levels of sweat, as measured by skin conductance activity (SCA), have been linked with conduct disorder and aggressive behavior in children and adolescents.

Researchers hypothesize that aggressive children may not experience as strong of an emotional response to fearful situations as their less aggressive peers do; because they have a weaker fear response, they are more likely to engage in antisocial behavior.

Psychological scientist Stephanie van Goozen, Ph.D., of Cardiff University and colleagues wanted to know whether the link between low SCA and aggressive behaviors could be observed even as early as infancy.

Researchers attached recording electrodes to infants’ feet at age 1 and measured their skin conductance at rest, in response to loud noises, and after encountering a scary remote-controlled robot. They also collected data on their aggressive behaviors at age 3, as rated by the infants’ mothers.

The results, published in the journal Psychological Science, revealed that 1 year-old infants with lower SCA at rest and during the robot encounter were more physically and verbally aggressive at age 3.

Interestingly, SCA was the only factor in the study that predicted later aggression. The other measures taken at infancy — mothers’ reports of their infants’ temperament, for instance — did not predict aggression two years later.

These findings suggest that while a physiological measure (SCA) taken in infancy predicts aggression, mothers’ observations do not.

“This runs counter to what many developmental psychologists would expect, namely that a mother is the best source of information about her child,” van Goozen notes.

At the same time, this research has important implications for intervention strategies.

“These findings show that it is possible to identify at-risk children long before problematic behavior is readily observable,” van Goozen concludes.

“Identifying precursors of disorder in the context of typical development can inform the implementation of effective prevention programs and ultimately reduce the psychological and economic costs of antisocial behavior to society.”

Source: Association for Psychological Science

Surprised and scared infant photo by shutterstock.

Humans Respond Emotionally to Robots

Wed, 04/24/2013 - 6:27am

Technology is on a roll as robots and other forms of simulation devices are now used in schools, home and work environments.

Robots and simulations can do just about anything from cleaning up after a spilled coffee to providing a platform for physicians to practice delivering babies — with all the bodily fluids and vocalizations included.

A new study shows just how much robotics are becoming part of society, as researchers found that humans have similar brain function when shown images of affection and violence being inflicted on robots and humans.

Affectionate relationships with robots have dominated the silver screen; think of R2D2 and C3-PO in the original “Star Wars” film, and even the Tin Man in “The Wizard of Oz.”

Historically, significant research in the field of human-robot interaction has concentrated on the implementation of emotion models in robotic systems. These studies test implementations with regard to their believability and naturalness, their positive influence on participants, or enjoyment of the interaction.

But there is little known on how people perceive “robotic” emotion and whether they react emotionally towards robots. People often have problems verbalizing their emotional state or find it strange to report on their emotions in human-robot interactions.

In an attempt to determine how humans really think about these inanimate creatures, German researchers Astrid Rosenthal-von der Pütten, Nicole Krämer, and Matthias Brand conducted two studies.

The studies were designed to utilize objective measures linked to emotion, such as physiological arousal and brain activity associated with emotional processing.

In the first study, 40 participants watched videos of a small dinosaur-shaped robot that was treated in an affectionate or a violent way and measured their level of physiological arousal and asked for their emotional state directly after the videos.

Participants reported feeling more negative watching the robot being abused and showed higher arousal during the negative video.

The second study used functional magnetic-resonance imaging (fMRI), to investigate potential brain correlations of human-robot interaction in contrast to human-human interaction.

The 14 participants were presented videos showing a human, a robot and an inanimate object, again being treated in either an affectionate or in a violent way.

Researchers found that individuals displayed similar neural activation patterns for affection, indicating that they elicit similar emotional reactions.

However, when comparing videos showing abusive behavior, participants showed more negative empathetic concern for humans.

Experts see robots as a potential tool helping elders or the physically challenged to remain independent and enhance quality of life.

“One goal of current robotics research is to develop robotic companions that establish a long-term relationship with a human user, because robot companions can be useful and beneficial tools.

“They could assist elderly people in daily tasks and enable them to live longer autonomously in their homes, help disabled people in their environments, or keep patients engaged during the rehabilitation process,” said Rosenthal-von der Pütten.

“A common problem is that a new technology is exciting at the beginning, but this effect wears off especially when it comes to tasks like boring and repetitive exercise in rehabilitation. The development and implementation of uniquely humanlike abilities in robots like theory of mind, emotion and empathy is considered to have the potential to solve this dilemma.”

Source: International Communication Association

Human and robotic hands photo by shutterstock.

Nature’s Balm Factors Into City Folks’ Well-Being

Tue, 04/23/2013 - 8:30am

Abundant parks and gardens seem to enhance the mental health and contentment of ubanites, according to a new study.

Researchers found those in an urban area with more green space tend to report greater well-being than city dwellers who don’t have parks, gardens, or other green space nearby.

The findings are published in Psychological Science.

Researchers examined household survey data from families in the UK and found that individuals reported less mental distress and higher life satisfaction when they were living in greener areas.

And this association held even after the researchers accounted for changes in participants’ income, employment, marital status, physical health, and housing type.

Mathew White, Ph.D., and colleagues at the University of Exeter Medical School were surprised by the scale of the effects of living in a greener area in comparison to major life events, such as marriage and employment.

“Living in an urban area with relatively high levels of green space compared to one with relatively low levels of green space was associated with a positive impact on well-being equivalent to roughly a third of the impact of being married vs. unmarried and a tenth of the impact of being employed vs. unemployed.”

Researchers report that when compared to other factors that contribute to life satisfaction, living in a greener area had a significant effect.

“These kinds of comparisons are important for policymakers when trying to decide how to invest scarce public resources, e.g. for park development or upkeep, and figuring out what ‘bang’ they’ll get for their buck,” says White.

Findings from previous research suggested a correlation between green space and well-being, but those studies weren’t able to rule out the possibility that people with higher levels of well-being simply move to greener areas.

White and colleagues were able to solve that problem by using longitudinal data from the national survey; that data were collected annually from over 10,000 people between 1991 and 2008.

The new research does not prove that moving to a greener area will necessarily cause increased happiness, but it does fit with findings from experimental studies showing that short bouts of time in a green space can improve people’s mood and cognitive functioning.

While the effect for any one person might be small, White points out that the potential positive effects of green space for society at large might be substantial.

“This research could be important for psychologists, public health officials and urban planners who are interested in learning about the effects that urbanization and city planning can have on population health and well-being,” White concludes.

Source: Association for Psychological Science

Trees and a park bench by shutterstock.

MDs Challenged to Build Rapport with Overweight Patients

Tue, 04/23/2013 - 7:45am

Several studies have documented the importance of a strong physician-patient relationship to foster behavioral change by the client.

Physicians may be presented with a teachable moment when life-changing advice can be delivered. However, this opportunity must be prefaced by mutual respect.

Unfortunately, a small study of physicians and their overweight and obese patients discovers physicians often have less emotional rapport with these clients than they do with patients of normal weight.

“If you aren’t establishing a rapport with your patients, they may be less likely to adhere to your recommendations to change their lifestyles and lose weight,” said Kimberly A. Gudzune, M.D., M.P.H., leader of the study published online in the journal Obesity.

“Some studies have linked those bonding behaviors with patient satisfaction and adherence, while other studies have found that patients were more likely to change their dietary habits, increase exercise and attempt to lose weight when their physicians expressed more empathy. Without that rapport, you could be cheating the patients who need that engagement the most.”

The researchers found that patient weight played no role in the quantity of physicians’ medical questions, medical advice, counseling, or treatment regimen discussions.

But when it came to things like showing empathy, concern and understanding, the doctors were significantly more likely to express those behaviors in interactions with patients of normal weight than with overweight and obese patients, regardless of the medical topic being discussed.

Obese patients may be particularly vulnerable to poorer physician-patient communications, Gudzune said, because studies show that physicians may hold negative attitudes toward these patients. Some physicians have less respect for their obese patients, which may come across during patient encounters.

“If patients see their primary care doctors as allies, I think they will be more successful in complying with our advice,” said Gudzune, whose practice focuses on weight-loss issues.

“I hear from patients all the time about how they resent feeling judged negatively because of their weight. Yes, doctors need to be medical advisors, but they also have the opportunity to be advocates to support their patients through changes in their lives.”

For the study, Gudzune and her colleagues analyzed recordings of visits by 208 patients with high blood pressure who saw 39 primary care doctors in Baltimore between 2003 and 2005. The recordings showed no difference related to body mass index (BMI), a ratio of height to weight, in terms of time spent with each patient or in weight counseling.

But when the recordings were analyzed for expressed words of empathy, concern or encouragement, the differences popped out. The researchers found more evidence of empathetic words and phrases — showing concern, reassurance and legitimation of patients’ feelings — in interactions with patients of normal weight.

An example of showing empathy would be a doctor who says: “I can see how frustrated you are by your slow progress — anyone would be.”

Gudzune said physicians should be mindful of any negative attitudes, make an effort to bond, and then spend time with overweight and obese patients discussing psychosocial and lifestyle issues. If they do, physicians may find their obese patients more responsive to weight-loss counseling.

“Patients want information and treatment, but they also need the emotional support and attention that can help them through the challenges that accompany weight loss and the establishment of a healthy lifestyle,” she said.

Source: Johns Hopkins

Tackling the ‘Dumb Jock’ Stereotype

Tue, 04/23/2013 - 7:04am

Despite the “student-athlete” label, college athletes are often viewed as being all brawn and no brain. A new initiative calls for proactive measures to improve an athlete’s academic self-image and change public perception of athletic aptitude.

In the new study, Michigan State University researchers found that an approach by college coaches to emphasize their players’ academic abilities appear to provide the best defense against the effects of “dumb jock” stereotypes. Researchers found that student-athletes were significantly more likely to be confident in the classroom if they believed their coaches expected high academic performance, not just good enough grades to be eligible for sports.

“Coaches spend a lot of time with their players, and they can play such an important role to build academic confidence in student-athletes,” said lead author and sports psychologist Dr. Deborah Feltz.

The study, found in the Journal of College Student Development, focuses on the concept of “stereotype threat.” This theory holds that stereotypes are self-fulfilling prophecies: They create anxiety in the stereotyped group, causing them to behave in the expected way.

For the investigation, Feltz and her graduate students wanted to see what factors influence student-athletes’ susceptibility to the “dumb jock” stereotype.

“It’s well-documented in the literature that many student-athletes hear prejudicial remarks from professors who say things like, ‘This test is easy enough that even an athlete could pass it,’” Feltz said.  “They’re kind of the last group of students who can be openly discriminated against.”

Investigators surveyed more than 300 student-athletes representing men’s and women’s teams from small and large universities and a range of sports, from basketball and football to cross-country and rowing.

They found the more strongly student-athletes identified themselves as athletes, the less confident they were with their academic skills, and the more keenly they felt that others expected them to do poorly in school. Players in high-profile sports were even more likely to feel they were weak students.

Feltz said the data suggest that coaches who put a premium on education may be in the best position to boost their players’ confidence in the classroom, but professors, academic advisers and classmates also have a part to play.

“They don’t have to do much,” she said. “It may be enough to just remind players they are college students, which is a big deal, you know? A lot of these students are the first in their family to go to college.”

Source: Michigan State University

Student ball player by shutterstock.

Starting Diet, Exercise Routine at Same Time May Be Optimal

Tue, 04/23/2013 - 6:22am

Beginning an exercise program and embarking on a diet are difficult behaviors independently, much less trying to do both at the same time. But new research suggests a person may be more compliant and successful with their program if both new behaviors are initiated at the same time.

The study, by Abby King, Ph.D., and colleagues from the Stanford School of Medicine is published in the journal Annals of Behavioral Medicine.

Medical professionals, health experts and policy advisers know that given the busy and stressful lives many people lead, advice on healthy eating or physical activity often ends up being just another source of stress.

Until now, health professionals were concerned that people would find multiple messages overwhelming and had encouraged making small changes, one at a time.

Researchers now believe this method may actually end up reducing compliance. Each subsequent change requires another bout of motivation which may, by then, be in short supply.

The current study was therefore designed to systematically test one method against the other to see which might be more beneficial long-term.

The researchers divided 200 participants into four groups. All participants were aged 45 years and older, did little exercise, ate fewer than five fruit and vegetable portions per day and had a higher than recommended saturated fat intake.

They also reported elevated stress levels. The four groups were given differing sequences of telephone-based advice: one group received exercise advice first, then nutrition advice was added after four months; a second group was given nutrition advice first, then exercise advice was added after four months; the third group received simultaneous delivery of nutrition and exercise advice; and a control group was advised on stress management only.

While all three groups showed positive increases in their dietary patterns relative to controls, there were differences in success when it came to physical activity.

Participants who had received the exercise advice first significantly increased their physical activity levels at four months relative to controls, whereas physical activity did not increase significantly in the ‘simultaneous’ group at this early stage.

However, by 12 months, both the exercise-first and simultaneous groups had increased their exercise to the nationally recommended levels.

In contrast, the group obtaining the nutrition advice first was not, on average, able to increase their exercise to the recommended levels by 12 months. Those in the simultaneous group were the only ones who succeeded in meeting the national recommendations for both dietary and physical activity behaviors at 12 months.

These results suggest that it may be easier to incorporate changes in eating habits than exercise, particularly when eating patterns are targeted at the beginning of a program.

This could be because eating is already a scheduled activity. Adding physical activity to an already busy schedule may be more difficult, especially when people are attempting to change their eating habits as well.

Experts believe that focusing similar attention on both health behaviors from the start may signal the importance of making both a priority.

Source: Springer

Woman exercising and eating healthy by shutterstock.

Societal Expectations Help Shape Grief

Mon, 04/22/2013 - 8:11am

New research suggests the way society relates to people who have suffered a loss is important to the way the grieving process is managed.

University of Haifa scientists propose that people who have never suffered the loss of a loved one tend to believe that the bereavement process has a far more destructive and devastating effect on a person compared to those who have actually suffered such a loss in the past.

“Loss is a personal experience, but it’s also a social and cultural one,” said researcher Shimshon Rubin, Ph.D.

“The way society relates to people who have suffered a loss is critical to the way the grieving process is managed, because the social component is very important in coping with bereavement.”

The study questioned more than 200 men and women of different ages, a portion of whom had suffered loss or trauma in the past.

Participants filled out a variety of questionnaires that included stories of people who had suffered different types of trauma or loss. The participants were asked to rank the severity of that person’s situation based on the way he coped with the painful event he had experienced.

The study found that events that happen to a loved one are perceived by society as causing a greater and more negative change in one’s life than suffering a personal trauma.

For example, losing a loved one was ranked as a greater emotional difficulty that has a more negative impact on one’s life than suffering a personal trauma, such as a road accident in which the person himself was involved.

Participants also said that an interpersonal trauma — an accident in which a relative was involved and remained alive — was perceived as more difficult and having more impact than a personal trauma.

According to Rubin, what was surprising was that most of the study participants didn’t ascribe any importance to the length of time that had passed since the loss occurred; in other words, whether the loss had occurred 18 months earlier or five years earlier, participants said the emotional impact and the assistance the bereaved requires don’t change.

“From studies we’ve conducted on people that suffered personal losses, we found that the length of time it takes for them to return to a regular routine is about five years,” said Rubin. “Thus the fact that society doesn’t ascribe importance to the passage of time is very significant.”

Researchers believe society’s sympathy toward the bereaved can be improved with an understanding that coping with loss includes several dimensions.

“The bereaved are seeking meaning in the life of the deceased and in the personal relationship they had with him,” Rubin explained.

“Today the environment is very sensitive to the personal suffering and the concern with the meaning of life that the bereaved person himself feels after a loss. But we tend not to ascribe enough importance to the bereaved person’s need to find meaning in the life of the deceased.

“Finding meaning in the life of those who have died is a very important component in enabling the bereaved to better adjust to their loss.”

Source: University of Haifa

Graveside grief photo available from Shutterstockt

Is Risk of Dementia Going Down?

Mon, 04/22/2013 - 7:22am

A surprising new Swedish study suggests the risk of developing dementia may have declined over the past 20 years.

That conclusion is based on improving cardiovascular detection and prevention and comes from data analysis of the SNAC-K, a longitudinal study on aging and health that started in 1987.

“We know that cardiovascular disease is an important risk factor for dementia. The suggested decrease in dementia risk coincides with the general reduction in cardiovascular disease over recent decades,” said researcher Chengxuan Qiu, M.D., Ph.D., of the Karolinska Institute medical university.

“Health check-ups and cardiovascular disease prevention have improved significantly in Sweden, and we now see results of this improvement reflected in the risk of developing dementia.”

Dementia is a constellation of symptoms characterized by impaired memory and other mental functions.

After age 75, dementia is commonly due to multiple causes, mainly Alzheimer’s disease and vascular dementia. In the Swedish review, published in the journal Neurology, more than 3,000 persons 75 years and older living in the central Stockholm neighborhood of Kungsholmen participated.

Of the participants, 523 were diagnosed with some form of dementia. The key members of the research group have been essentially the same since 1987, including the neurologist responsible for the clinical diagnoses of dementia. All study participants were assessed by a nurse, a physician, and a psychologist.

The result shows the prevalence of dementia was stable in both men and women across all age groups after age 75 during the entire study period (1987-1989 and 2001-2004), despite the fact that the survival of persons with dementia increased since the end of the 1980s.

This means that the overall risk of developing dementia must have declined during the period, possibly thanks to prevention and better treatment of cardiovascular disease.

“The reduction of dementia risk is a positive phenomenon, but it is important to remember that the number of people with dementia will continue to rise along with the increase in life expectancy and absolute numbers of people over age 75,” said Laura Fratiglioni, M.D., Ph.D., director of the Aging Research Center.

“This means that the societal burden of dementia and the need for medical and social services will continue to increase. Today there’s no way to cure patients who have dementia. Instead we must continue to improve health care and prevention in this area.”

Source: Karolinska Institutet

Senior gardener photo available from Shutterstock

Autistic Kids May Be Prone to Compulsive Video Gaming

Mon, 04/22/2013 - 6:36am

Researchers discover children and teens with autism spectrum disorders (ASD) are more likely to develop problematic video game habits.

A University of Missouri researcher found kids with ASD use screen-based media, such as television and video games, more often than their typically developing peers.

“Many parents and clinicians have noticed that children with ASD are fascinated with technology, and the results of our recent studies certainly support this idea,” said Micah Mazurek, an assistant professor of health psychology and a clinical child psychologist.

“We found that children with ASD spent much more time playing video games than typically developing children, and they are much more likely to develop problematic or addictive patterns of video game play.”

Mazurek studied screen-based media use among 202 children and adolescents with ASD and 179 typically developing siblings.

Compared to typically developing children, those with ASD spent more time playing video games and less time on social media, such as Facebook. Children with ASD also spent more time watching TV and playing video games than participating in pro-social or physical activities.

Conversely, typically developing children spent more time on non-screen activities than on TV or video games.

In another study of 169 boys with ASD, problematic video game use was associated with oppositional behaviors, such as refusing to follow directions or engaging in arguments.

Mazurek says carefully controlled research is needed to examine these issues in the future.

“Because these studies were cross-sectional, it is not clear if there is a causal relationship between video game use and problem behaviors,” Mazurek said.

“Children with ASD may be attracted to video games because they can be rewarding, visually engaging and do not require face-to-face communication or social interaction.

“Parents need to be aware that, although video games are especially reinforcing for children with ASD, children with ASD may have problems disengaging from these games.”

Even though too much screen time could be detrimental for children with ASD, learning what children with ASD enjoy about video games could help researchers and clinicians develop therapies using the technology.

“Using screen-based technologies, communication and social skills could be taught and reinforced right away,” Mazurek said.

“However, more research is needed to determine whether the skills children with ASD might learn in virtual reality environments would translate into actual social interactions.”

The study, “Television, Video Game and Social Media Use among Children with ASD and Typically Developing Siblings,” will be published in an upcoming issue of the Journal of Autism and Developmental Disorders.

“Video Game Use and Problem Behaviors in Boys with Autism Spectrum Disorders,” was published in the journal Research in Autism Spectrum Disorders.

Source: University of Missouri

Youngster playing video game photo available from Shutterstock

Alternative Medicine May Help Control Costs

Mon, 04/22/2013 - 5:53am

Use of complementary and alternative (CAM) treatment strategies has become a recognized option for many medical and mental conditions.

For chronic illness, CAM is often blended with traditional medical care as people believe the therapies help them better manage their lives.

A new major Nordic research project has scientifically mapped the use of alternative treatment among multiple sclerosis patients.

Researchers from five Nordic countries find that CAM users are often affluent, younger, and more educated than the general population. Also, young women often use CAM as a reflection of lifestyle choices.

As health care costs skyrocket across the world, expanded use of CAM potentially provides a cost-effective option for better care management.

Researchers found that in the case of multiple sclerosis (MS), people use alternative treatments such as dietary supplements, acupuncture and herbal medicine to facilitate their lives with this chronic disease.

“What we see is that patients do not usually use alternative treatments for treating symptoms, but as a preventative and strengthening element,” said Lasse Skovgaard, Ph.D., who has been involved in conducting the questionnaire-based study among 3,800 people with MS in Denmark, Sweden, Norway, Finland and Iceland.

Multiple sclerosis is a chronic disease which attacks the central nervous system, and which can lead to a loss of mobility and sight. Multiple sclerosis, as any chronic illness, is often accompanied by depression and anxiety.

The incidence of MS is increasing across the world with Denmark experiencing a high prevalence of the disease. Together with researchers from the five other Nordic countries, Skovgaard has spent three years gathering the new data.

“Within the field of health research, it is often a question of studying the extent to which a particular type of drug affects a particular symptom. However, it is equally as important to look at how people with a chronic disease, for example, use different treatments to cope with their situation.

“Here, MS patients offer valuable experience. Their experiences constitute a knowledge bank which we must access and learn from,” he says.

“There is a lot of talk about ‘self-care competence’, in other words patients helping themselves to get their lives to function. Here, many people with a chronic disease find they benefit from using alternative treatments, so we should not ignore this possibility,” said Skovgaard.

Furthermore, learning why patients choose particular treatments is important in relation to improving patient safety because of the possible risks involved in combining conventional and alternative medicine.

According to a 2010 Health and Sickness Study from the Danish National Institute of Public Health (NIPH), one in four Danes say that they have tried one or more types of alternative treatments within the past twelve months.

Among MS patients, the use of alternative medicine has been growing steadily over the past 15 years. In the researchers’ latest study, more than half of the respondents say that they either combine conventional and alternative medicine or only use alternative medicine.

“We cannot ignore the fact that people with chronic disease use alternative treatments to a considerable extent, and that many of them seem to benefit from doing so. It doesn’t help to only judge this from a medical point of view or say that alternative treatments are nonsense – rather, we must try to understand it.”

The study shows that, among MS patients using alternative treatments, there is a significantly bigger proportion of people with a high level of education compared to those who do not use alternative treatments. There is also a larger proportion of highly paid people and of younger women.

“Some critics are of the opinion that when alternative treatments are so popular, it is because they appeal to naïve people looking for a miraculous cure. But our results indicate that it is primarily the well-educated segment that is subscribing to alternative treatments. And that using alternative treatments is part of a lifestyle choice,” said Skovgaard.

He hopes that the new knowledge will improve communication regarding how the chronically ill use alternative treatments in combination with conventional medicine.

“We see that so many people are combining conventional medicine with alternative treatment that it should be taken seriously by the health service. Until now, there hasn’t been much focus on the doctor-patient dialogue in relation to the alternative methods used by the chronically ill to manage their lives,” says Skovgaard.

Additional research will assess how patients perceive the risks associated with using alternative medicine and explore why some patients turn their backs completely on conventional medicine.

Source: University of Copenhagen

Patient consultation photo available from Shutterstock

Teen Mentors Best Adults in Steering Kids Toward Healthy Lifestyle

Sun, 04/21/2013 - 8:04am

Elementary school kids who learned about obesity from teen mentors lost weight, lowered their blood pressure and took on healthy lifestyle changes, according to a new study by Ohio State University.

In contrast, children who received the same instruction from adults in a traditional classroom experienced no changes in their health. The findings suggest that school systems consider using teen mentors to instruct younger children in select health-related programs.

For one hour after school each week, teen mentors met one-on-one with students (ages 8-11) in a large gym setting while another group of students was taught in a classroom by school system employees, such as librarians or administrative staff.

The results showed that only the teen-mentored group had an increase in physical activity and marginal decreases in body mass index and diastolic blood pressure.

Kids mentored by teens also showed slight increases in nutrition knowledge and plans to change their behavior. Children taught by adults showed no improved health outcomes.

“The findings reaffirmed what I suspected, that the teens impacted physical activity for the kids rather than their nutrition. That makes sense because most kids don’t have a whole lot of control over what they eat. They rely on parents to provide food at home and otherwise rely on what the school provides,” said Laureen Smith, Ph.D., associate professor of nursing at Ohio State and lead author of the study.

Overall, 160 children in the third and fourth grades participated in the intervention, along with 32 teen mentors and five adult teachers. The study was held at three public schools in the same county, and teen mentors attended high schools affiliated with the participating elementary schools.

“Not only would this help schools deliver a curriculum, but this study supports the idea that this mentoring approach is a better way to impact younger kids, and it creates an infrastructure to improve health without it having to come from a classroom,” said Smith.

“I focused on diet and nutrition, but there’s no reason this can’t be used to address other health issues that a school identifies.  In order for this to be successful, there has to be good training and good support to the teens. But the right teens with the right help and support can make a big difference.”

Although specific teachers and mentors did not affect the kids’ outcomes, the school they attended did make a difference.  The best results were found in a school that had the most disadvantages based on such economic indicators as parental unemployment and student eligibility for free and reduced lunches.

“Younger kids look at older kids in their peer group as role models. Teens provide younger children perceived psychological safety and a social network,” she said.

“And this is helpful to adults. Using teen mentors removes some pressure on the staff and teachers of a school to reach students and have an impact on their health.”

The research is published in the Journal of School Nursing.

Source:  Ohio State University

Deep Brain Stimulation Shows Promise for Depression

Sun, 04/21/2013 - 7:03am

The extraordinary results of a recent pilot study for individuals with treatment-resistant depression are being met with cautious optimism by experts.

In the study, six out of seven patients experienced quick and dramatic improvement after receiving deep brain stimulation (DBS).

Major depression is a severe medical condition that affects one’s feelings, thoughts, behavior, mood and physical health. It is often a life-long illness in which periods of feeling well alternate with bouts of illness.

In the United States, depression affects 5 to 8 percent of adults each year.  This translates to about 25 million Americans having an episode of major depression in any given year. Clinical depression is characterized by unrelenting depressive feelings, lack of energy and motivation, difficulty concentrating or being motivated, and incredible sadness nearly every day.

During DBS treatment, an electrode is attached to a pacemaker-like device which delivers small pulses of currents to areas deep within the brain in an effort to help regulate the brain’s own signals that are not functioning properly.

Already FDA-approved for treatment of Parkinson’s disease, DBS is currently being tested in several areas of the brain linked to depression.

“Treatment-resistant depression is a horrible disease. It can result in death, and people who live with it often have very difficult lives,” said Rothschild. “These impressive findings in the medial forebrain bundle must now be replicated in a double-blind fashion, like the study we’re doing with Brodmann Area 25—that’s the way to prove it.”

More research is needed to verify the findings of the clinical trial, said UMass Medical School physician-scientist Anthony Rothschild, MD. The author himself notes the limitations of the study’s small size and the fact that it was unblinded.

“Every patient knew they were receiving the treatment, which increases the likelihood of a placebo effect” said Dr. Rothschild, the Irving S. and Betty Brudnick Endowed Chair and professor of psychiatry.

“Studies like these are important first steps but, until you do the double-blind study in which some patients have the device turned on, and some do not, and the patients don’t know which group they are in, you can come to inaccurate conclusions.”

Source:  Biological Psychiatry

Depressed man photo available from Shutterstock