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AUSTIN, TEX. – The risk of depression was more than doubled in women who were anemic during pregnancy, according to a recent retrospective cohort study of nearly 1,000 women. Among patients who had anemia at any point, the relative risk of screening positive for postpartum depression was 2.25 (95% confidence interval, 1.22-4.16).

“This was an unexpected finding,” said Shannon Sutherland, MD, of the University of Connecticut, Farmington, in an interview after she presented the findings at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

“Maternal suicide exceeds hemorrhage and hypertensive disease as a cause of U.S. maternal mortality,” wrote Dr. Sutherland and her collaborators in the poster accompanying the presentation. And anemia is common: “Anemia in pregnancy can be as high as 27.4% in low-income minority pregnant women in the third trimester,” they wrote.

“If we can find something like this that affects depression, and screen for it and correct for it, we can make a real big difference in patients’ lives,” said Dr. Sutherland in a video interview. “Screening for anemia ... is such a simple thing for us to do, and I also think it’s very easy for us to correct, and very cheap for us to correct.”

The 922 study participants were at least 16 years old and receiving postpartum care at an outpatient women’s health clinic. Patients who had diseases that disrupted iron metabolism or were tobacco users, and those on antidepressants, anxiolytics, or antipsychotics were excluded from the study. Other exclusion criteria included anemia that required transfusion, and intrauterine fetal demise or neonatal mortality.

To assess depression, Dr. Sutherland and her colleagues administered the Edinburgh Postnatal Depression Scale at routine postpartum visits. Dr. Sutherland and her coinvestigators calculated the numbers of respondents who fell above and below the cutoff for potential depression on the 10-item self-report scale. They then looked at the proportion of women who scored positive for depression among those who were, and those who were not, anemic.

Possible depression was indicated by depression scale scores of 9.2% of participants, while three quarters (75.2%) were anemic either during pregnancy or in the immediate postpartum period. Among anemic patients, 10.8% screened positive for depression, while 4.8% of those without anemia met positive screening criteria for postpartum depression (P = .007).

Dr. Sutherland and her collaborators noted that fewer women in their cohort had postpartum depression than the national average of 19%. They may have missed some patients who would later develop depression since the screening occurred at the first postpartum visit; also, “it is possible that women deeply affected by [postpartum depression] may have been lost to follow-up,” they wrote.

Participants had a mean age of about 26 years, and body mass index was slightly higher for those with anemia than without (mean, 32.2 vs 31.2 kg/m²; P = .025).

Postpartum depression was not associated with marital status, substance use, ethnicity, parity, or the occurrence of postpartum hemorrhage, in the investigators’ analysis.

Dr. Sutherland said that, in their analysis, she and her coinvestigators did not find an association between degree of anemia and the likelihood, or severity, of postpartum depression. However, they did find that anemia of any degree in the immediate peripartum period was most strongly associated with postpartum depression.

Though the exact mechanism of the anemia-depression link isn’t known, the fatigue associated with anemia may help predispose women to postpartum depression, said Dr. Sutherland. Also, she said, “iron can make a difference in synthesizing neurotransmitters” such as serotonin, “so it may follow that you might have some depressive symptoms.”

“The next step after this study, which was a launching point, is to see if we correct the degree of anemia and bring them to normal levels, if that can help decrease the risk of postpartum depression,” said Dr. Sutherland.

Dr. Sutherland and her coinvestigators reported that they had no relevant financial disclosures.

koakes@mdedge.com

SOURCE: Sutherland S et al. ACOG 2018. Abstract 35C.

AUSTIN, TEX. – The risk of depression was more than doubled in women who were anemic during pregnancy, according to a recent retrospective cohort study of nearly 1,000 women. Among patients who had anemia at any point, the relative risk of screening positive for postpartum depression was 2.25 (95% confidence interval, 1.22-4.16).

“This was an unexpected finding,” said Shannon Sutherland, MD, of the University of Connecticut, Farmington, in an interview after she presented the findings at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

“Maternal suicide exceeds hemorrhage and hypertensive disease as a cause of U.S. maternal mortality,” wrote Dr. Sutherland and her collaborators in the poster accompanying the presentation. And anemia is common: “Anemia in pregnancy can be as high as 27.4% in low-income minority pregnant women in the third trimester,” they wrote.

“If we can find something like this that affects depression, and screen for it and correct for it, we can make a real big difference in patients’ lives,” said Dr. Sutherland in a video interview. “Screening for anemia ... is such a simple thing for us to do, and I also think it’s very easy for us to correct, and very cheap for us to correct.”

The 922 study participants were at least 16 years old and receiving postpartum care at an outpatient women’s health clinic. Patients who had diseases that disrupted iron metabolism or were tobacco users, and those on antidepressants, anxiolytics, or antipsychotics were excluded from the study. Other exclusion criteria included anemia that required transfusion, and intrauterine fetal demise or neonatal mortality.

To assess depression, Dr. Sutherland and her colleagues administered the Edinburgh Postnatal Depression Scale at routine postpartum visits. Dr. Sutherland and her coinvestigators calculated the numbers of respondents who fell above and below the cutoff for potential depression on the 10-item self-report scale. They then looked at the proportion of women who scored positive for depression among those who were, and those who were not, anemic.

Possible depression was indicated by depression scale scores of 9.2% of participants, while three quarters (75.2%) were anemic either during pregnancy or in the immediate postpartum period. Among anemic patients, 10.8% screened positive for depression, while 4.8% of those without anemia met positive screening criteria for postpartum depression (P = .007).

Dr. Sutherland and her collaborators noted that fewer women in their cohort had postpartum depression than the national average of 19%. They may have missed some patients who would later develop depression since the screening occurred at the first postpartum visit; also, “it is possible that women deeply affected by [postpartum depression] may have been lost to follow-up,” they wrote.

Participants had a mean age of about 26 years, and body mass index was slightly higher for those with anemia than without (mean, 32.2 vs 31.2 kg/m²; P = .025).

Postpartum depression was not associated with marital status, substance use, ethnicity, parity, or the occurrence of postpartum hemorrhage, in the investigators’ analysis.

Dr. Sutherland said that, in their analysis, she and her coinvestigators did not find an association between degree of anemia and the likelihood, or severity, of postpartum depression. However, they did find that anemia of any degree in the immediate peripartum period was most strongly associated with postpartum depression.

Though the exact mechanism of the anemia-depression link isn’t known, the fatigue associated with anemia may help predispose women to postpartum depression, said Dr. Sutherland. Also, she said, “iron can make a difference in synthesizing neurotransmitters” such as serotonin, “so it may follow that you might have some depressive symptoms.”

“The next step after this study, which was a launching point, is to see if we correct the degree of anemia and bring them to normal levels, if that can help decrease the risk of postpartum depression,” said Dr. Sutherland.

Dr. Sutherland and her coinvestigators reported that they had no relevant financial disclosures.

koakes@mdedge.com

SOURCE: Sutherland S et al. ACOG 2018. Abstract 35C.

AUSTIN, TEX. – The risk of depression was more than doubled in women who were anemic during pregnancy, according to a recent retrospective cohort study of nearly 1,000 women. Among patients who had anemia at any point, the relative risk of screening positive for postpartum depression was 2.25 (95% confidence interval, 1.22-4.16).

“This was an unexpected finding,” said Shannon Sutherland, MD, of the University of Connecticut, Farmington, in an interview after she presented the findings at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

“Maternal suicide exceeds hemorrhage and hypertensive disease as a cause of U.S. maternal mortality,” wrote Dr. Sutherland and her collaborators in the poster accompanying the presentation. And anemia is common: “Anemia in pregnancy can be as high as 27.4% in low-income minority pregnant women in the third trimester,” they wrote.

“If we can find something like this that affects depression, and screen for it and correct for it, we can make a real big difference in patients’ lives,” said Dr. Sutherland in a video interview. “Screening for anemia ... is such a simple thing for us to do, and I also think it’s very easy for us to correct, and very cheap for us to correct.”

The 922 study participants were at least 16 years old and receiving postpartum care at an outpatient women’s health clinic. Patients who had diseases that disrupted iron metabolism or were tobacco users, and those on antidepressants, anxiolytics, or antipsychotics were excluded from the study. Other exclusion criteria included anemia that required transfusion, and intrauterine fetal demise or neonatal mortality.

To assess depression, Dr. Sutherland and her colleagues administered the Edinburgh Postnatal Depression Scale at routine postpartum visits. Dr. Sutherland and her coinvestigators calculated the numbers of respondents who fell above and below the cutoff for potential depression on the 10-item self-report scale. They then looked at the proportion of women who scored positive for depression among those who were, and those who were not, anemic.

Possible depression was indicated by depression scale scores of 9.2% of participants, while three quarters (75.2%) were anemic either during pregnancy or in the immediate postpartum period. Among anemic patients, 10.8% screened positive for depression, while 4.8% of those without anemia met positive screening criteria for postpartum depression (P = .007).

Dr. Sutherland and her collaborators noted that fewer women in their cohort had postpartum depression than the national average of 19%. They may have missed some patients who would later develop depression since the screening occurred at the first postpartum visit; also, “it is possible that women deeply affected by [postpartum depression] may have been lost to follow-up,” they wrote.

Participants had a mean age of about 26 years, and body mass index was slightly higher for those with anemia than without (mean, 32.2 vs 31.2 kg/m²; P = .025).

Postpartum depression was not associated with marital status, substance use, ethnicity, parity, or the occurrence of postpartum hemorrhage, in the investigators’ analysis.

Dr. Sutherland said that, in their analysis, she and her coinvestigators did not find an association between degree of anemia and the likelihood, or severity, of postpartum depression. However, they did find that anemia of any degree in the immediate peripartum period was most strongly associated with postpartum depression.

Though the exact mechanism of the anemia-depression link isn’t known, the fatigue associated with anemia may help predispose women to postpartum depression, said Dr. Sutherland. Also, she said, “iron can make a difference in synthesizing neurotransmitters” such as serotonin, “so it may follow that you might have some depressive symptoms.”

“The next step after this study, which was a launching point, is to see if we correct the degree of anemia and bring them to normal levels, if that can help decrease the risk of postpartum depression,” said Dr. Sutherland.

Dr. Sutherland and her coinvestigators reported that they had no relevant financial disclosures.

koakes@mdedge.com

SOURCE: Sutherland S et al. ACOG 2018. Abstract 35C.

AUSTIN, TEX. – Having a trained doula in attendance at labor and delivery for nulliparous women could be a cost-effective strategy to prevent hundreds of thousands of cesarean deliveries yearly, according to a new analysis of the practice.

“We were interested in looking at the cost-effectiveness of having a professional doula at labor and delivery,” said Karen Greiner, a medical student at Oregon Health and Sciences University, Portland. She and her colleagues had their interest sparked after reading a Cochrane review that found reduced rates of cesarean delivery and shortened labor times with continuous support during labor, she said in an interview.

The cost-effectiveness analysis, presented during a poster session of the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists, used a two-delivery model to track the effect of doula attendance at a nulliparous term labor and delivery. Since most women in the United States have two deliveries, the researchers analyzed what effect having a doula attend the first delivery would have on the subsequent pregnancy as well.

Ms. Greiner and her colleagues used a theoretical cohort of 1.8 million women, about the number of nulliparous women with term deliveries in the United States annually, to see what effect doula care would have on cost and maternal outcomes. “We found that there was a significant reduction in cesarean deliveries – almost 220,000 – when a woman had a professional doula with her during labor and delivery, versus not having that doula support,” Ms. Greiner said in a video interview. “We also found a reduction in maternal deaths ... a reduction in uterine rupture, also in hysterectomies.”

The 51 maternal deaths, 382 uterine ruptures, and 100 subsequent hysterectomies averted by use of doulas would result in an increase of 7,227 quality-adjusted life years, the effectiveness metric chosen for the analysis. However, this benefit would come at an increased cost of $207 million for the theoretical cohort.

“We did find that doulas are expensive, that they do cost money,” acknowledged Ms. Greiner. She and her coauthors allocated $1,000 per doula – the median cost for doula attendance at labor and delivery in Portland, Ore. – in the model used for cost-effectiveness analysis.

“Overall, we found that having a doula during a woman’s labor and delivery is cost-effective up to $1,286 for the cost of the doula” when quality-adjusted life years are taken into account, said Ms. Greiner.

She reported having no relevant financial disclosures.

koakes@mdedge.com

SOURCE: Greiner K et al. ACOG 2018. Abstract 25C.

AUSTIN, TEX. – Having a trained doula in attendance at labor and delivery for nulliparous women could be a cost-effective strategy to prevent hundreds of thousands of cesarean deliveries yearly, according to a new analysis of the practice.

“We were interested in looking at the cost-effectiveness of having a professional doula at labor and delivery,” said Karen Greiner, a medical student at Oregon Health and Sciences University, Portland. She and her colleagues had their interest sparked after reading a Cochrane review that found reduced rates of cesarean delivery and shortened labor times with continuous support during labor, she said in an interview.

The cost-effectiveness analysis, presented during a poster session of the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists, used a two-delivery model to track the effect of doula attendance at a nulliparous term labor and delivery. Since most women in the United States have two deliveries, the researchers analyzed what effect having a doula attend the first delivery would have on the subsequent pregnancy as well.

Ms. Greiner and her colleagues used a theoretical cohort of 1.8 million women, about the number of nulliparous women with term deliveries in the United States annually, to see what effect doula care would have on cost and maternal outcomes. “We found that there was a significant reduction in cesarean deliveries – almost 220,000 – when a woman had a professional doula with her during labor and delivery, versus not having that doula support,” Ms. Greiner said in a video interview. “We also found a reduction in maternal deaths ... a reduction in uterine rupture, also in hysterectomies.”

The 51 maternal deaths, 382 uterine ruptures, and 100 subsequent hysterectomies averted by use of doulas would result in an increase of 7,227 quality-adjusted life years, the effectiveness metric chosen for the analysis. However, this benefit would come at an increased cost of $207 million for the theoretical cohort.

“We did find that doulas are expensive, that they do cost money,” acknowledged Ms. Greiner. She and her coauthors allocated $1,000 per doula – the median cost for doula attendance at labor and delivery in Portland, Ore. – in the model used for cost-effectiveness analysis.

“Overall, we found that having a doula during a woman’s labor and delivery is cost-effective up to $1,286 for the cost of the doula” when quality-adjusted life years are taken into account, said Ms. Greiner.

She reported having no relevant financial disclosures.

koakes@mdedge.com

SOURCE: Greiner K et al. ACOG 2018. Abstract 25C.

AUSTIN, TEX. – Having a trained doula in attendance at labor and delivery for nulliparous women could be a cost-effective strategy to prevent hundreds of thousands of cesarean deliveries yearly, according to a new analysis of the practice.

“We were interested in looking at the cost-effectiveness of having a professional doula at labor and delivery,” said Karen Greiner, a medical student at Oregon Health and Sciences University, Portland. She and her colleagues had their interest sparked after reading a Cochrane review that found reduced rates of cesarean delivery and shortened labor times with continuous support during labor, she said in an interview.

The cost-effectiveness analysis, presented during a poster session of the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists, used a two-delivery model to track the effect of doula attendance at a nulliparous term labor and delivery. Since most women in the United States have two deliveries, the researchers analyzed what effect having a doula attend the first delivery would have on the subsequent pregnancy as well.

Ms. Greiner and her colleagues used a theoretical cohort of 1.8 million women, about the number of nulliparous women with term deliveries in the United States annually, to see what effect doula care would have on cost and maternal outcomes. “We found that there was a significant reduction in cesarean deliveries – almost 220,000 – when a woman had a professional doula with her during labor and delivery, versus not having that doula support,” Ms. Greiner said in a video interview. “We also found a reduction in maternal deaths ... a reduction in uterine rupture, also in hysterectomies.”

The 51 maternal deaths, 382 uterine ruptures, and 100 subsequent hysterectomies averted by use of doulas would result in an increase of 7,227 quality-adjusted life years, the effectiveness metric chosen for the analysis. However, this benefit would come at an increased cost of $207 million for the theoretical cohort.

“We did find that doulas are expensive, that they do cost money,” acknowledged Ms. Greiner. She and her coauthors allocated $1,000 per doula – the median cost for doula attendance at labor and delivery in Portland, Ore. – in the model used for cost-effectiveness analysis.

“Overall, we found that having a doula during a woman’s labor and delivery is cost-effective up to $1,286 for the cost of the doula” when quality-adjusted life years are taken into account, said Ms. Greiner.

She reported having no relevant financial disclosures.

koakes@mdedge.com

SOURCE: Greiner K et al. ACOG 2018. Abstract 25C.

Click here to view the articles published in May 2018.

Click here to view the articles published in May 2018.

Click here to view the articles published in May 2018.

NEW YORK – Veterans are not a homogeneous group, and when treating them for posttraumatic stress, it helps to consider their specific cohort, according to Elspeth Cameron Ritchie, MD.

Veterans from the first Gulf War, for example, have lingering concerns regarding medical illness (Gulf War syndrome); those from Vietnam are aging and might have medical problems or find that while they did well while working, now they are experiencing PTSD symptoms for the first time; and those returning from the conflicts in Iraq and Afghanistan might have physical injuries from blasts – the “signature weapon” of those wars. Such blasts can cause amputations, genital injuries, head trauma, and PTSD, said Dr. Ritchie, of the Uniformed Services University of the Health Sciences, Bethesda, Md.

In this video interview, Dr. Ritchie discusses these and other issues related to the treatment of PTSD among veterans as presented during a workshop entitled “Psychiatry and U.S. Veterans,” which she chaired at the annual meeting of the American Psychiatric Association.

The workshop covered the spectrum of treatments that might be helpful for veterans.

“One thing I find with veterans is that they really want to have control over their treatment. They don’t want it to just be the doctor giving them a pill,” she said. “Veterans are resilient; they’re tough; they don’t like to be thought of as victims ... and when you’re working with them, it’s very important to link into that dynamic resilient piece and capitalize on their strengths.”

Dr. Ritchie reported having no disclosures.

sworcester@mdedge.com

SOURCE: Ritchie EC et al. APA Workshop.

NEW YORK – Veterans are not a homogeneous group, and when treating them for posttraumatic stress, it helps to consider their specific cohort, according to Elspeth Cameron Ritchie, MD.

Veterans from the first Gulf War, for example, have lingering concerns regarding medical illness (Gulf War syndrome); those from Vietnam are aging and might have medical problems or find that while they did well while working, now they are experiencing PTSD symptoms for the first time; and those returning from the conflicts in Iraq and Afghanistan might have physical injuries from blasts – the “signature weapon” of those wars. Such blasts can cause amputations, genital injuries, head trauma, and PTSD, said Dr. Ritchie, of the Uniformed Services University of the Health Sciences, Bethesda, Md.

In this video interview, Dr. Ritchie discusses these and other issues related to the treatment of PTSD among veterans as presented during a workshop entitled “Psychiatry and U.S. Veterans,” which she chaired at the annual meeting of the American Psychiatric Association.

The workshop covered the spectrum of treatments that might be helpful for veterans.

“One thing I find with veterans is that they really want to have control over their treatment. They don’t want it to just be the doctor giving them a pill,” she said. “Veterans are resilient; they’re tough; they don’t like to be thought of as victims ... and when you’re working with them, it’s very important to link into that dynamic resilient piece and capitalize on their strengths.”

Dr. Ritchie reported having no disclosures.

sworcester@mdedge.com

SOURCE: Ritchie EC et al. APA Workshop.

NEW YORK – Veterans are not a homogeneous group, and when treating them for posttraumatic stress, it helps to consider their specific cohort, according to Elspeth Cameron Ritchie, MD.

Veterans from the first Gulf War, for example, have lingering concerns regarding medical illness (Gulf War syndrome); those from Vietnam are aging and might have medical problems or find that while they did well while working, now they are experiencing PTSD symptoms for the first time; and those returning from the conflicts in Iraq and Afghanistan might have physical injuries from blasts – the “signature weapon” of those wars. Such blasts can cause amputations, genital injuries, head trauma, and PTSD, said Dr. Ritchie, of the Uniformed Services University of the Health Sciences, Bethesda, Md.

In this video interview, Dr. Ritchie discusses these and other issues related to the treatment of PTSD among veterans as presented during a workshop entitled “Psychiatry and U.S. Veterans,” which she chaired at the annual meeting of the American Psychiatric Association.

The workshop covered the spectrum of treatments that might be helpful for veterans.

“One thing I find with veterans is that they really want to have control over their treatment. They don’t want it to just be the doctor giving them a pill,” she said. “Veterans are resilient; they’re tough; they don’t like to be thought of as victims ... and when you’re working with them, it’s very important to link into that dynamic resilient piece and capitalize on their strengths.”

Dr. Ritchie reported having no disclosures.

sworcester@mdedge.com

SOURCE: Ritchie EC et al. APA Workshop.

NEW YORK – Sustained peacekeeping operations are associated with unique psychological stressors, and understanding of these stressors on the part of both community and military psychiatrists can help make a difference at each stage of a deployment cycle, according to Elspeth Cameron Ritchie, MD.

During a workshop at the annual meeting of the American Psychiatric Association entitled “War and Peace: Understanding the Psychological Stressors Associated with Sustained Peacekeeping Operations (PKOs),” chaired by Dr. Ritchie of the Uniformed Services University of the Health Sciences, Bethesda, Md., various dimensions of salient psychological stress were discussed, as were approaches for minimizing any resultant impact on the psychological health of peacekeepers.

In this video interview, Dr. Ritchie discussed the differences and similarities between peacekeeping operations and military operations with respect to stressors and their effects, and the risk of posttraumatic stress disorder among peacekeepers.

Although treatment for PTSD is “pretty much the same,” it is important to “tailor the treatment for the situation,” she said.

“Lay out the different options, explain them to the patient, and partner with the patient in terms of what is the best option for them,” she said.

Dr. Ritchie reported having no relevant disclosures.

sworcester@mdedge.com

SOURCE: Ritchie EC et al. APA Workshop

NEW YORK – Sustained peacekeeping operations are associated with unique psychological stressors, and understanding of these stressors on the part of both community and military psychiatrists can help make a difference at each stage of a deployment cycle, according to Elspeth Cameron Ritchie, MD.

During a workshop at the annual meeting of the American Psychiatric Association entitled “War and Peace: Understanding the Psychological Stressors Associated with Sustained Peacekeeping Operations (PKOs),” chaired by Dr. Ritchie of the Uniformed Services University of the Health Sciences, Bethesda, Md., various dimensions of salient psychological stress were discussed, as were approaches for minimizing any resultant impact on the psychological health of peacekeepers.

In this video interview, Dr. Ritchie discussed the differences and similarities between peacekeeping operations and military operations with respect to stressors and their effects, and the risk of posttraumatic stress disorder among peacekeepers.

Although treatment for PTSD is “pretty much the same,” it is important to “tailor the treatment for the situation,” she said.

“Lay out the different options, explain them to the patient, and partner with the patient in terms of what is the best option for them,” she said.

Dr. Ritchie reported having no relevant disclosures.

sworcester@mdedge.com

SOURCE: Ritchie EC et al. APA Workshop

NEW YORK – Sustained peacekeeping operations are associated with unique psychological stressors, and understanding of these stressors on the part of both community and military psychiatrists can help make a difference at each stage of a deployment cycle, according to Elspeth Cameron Ritchie, MD.

During a workshop at the annual meeting of the American Psychiatric Association entitled “War and Peace: Understanding the Psychological Stressors Associated with Sustained Peacekeeping Operations (PKOs),” chaired by Dr. Ritchie of the Uniformed Services University of the Health Sciences, Bethesda, Md., various dimensions of salient psychological stress were discussed, as were approaches for minimizing any resultant impact on the psychological health of peacekeepers.

In this video interview, Dr. Ritchie discussed the differences and similarities between peacekeeping operations and military operations with respect to stressors and their effects, and the risk of posttraumatic stress disorder among peacekeepers.

Although treatment for PTSD is “pretty much the same,” it is important to “tailor the treatment for the situation,” she said.

“Lay out the different options, explain them to the patient, and partner with the patient in terms of what is the best option for them,” she said.

Dr. Ritchie reported having no relevant disclosures.

sworcester@mdedge.com

SOURCE: Ritchie EC et al. APA Workshop

NEW YORK – Legislation enacted in some states in the wake of mass shootings seeks to limit access to firearms for people with mental illness, but research presented at the annual meeting of the American Psychiatric Association raises questions about the value of that approach.

During a workshop entitled “The ‘Crazed Gunman’ Myth: Examining Mental Illness and Firearm Violence,” researchers from the Yale University in New Haven, Conn., presented new findings that support existing data calling into question whether laws considered to be “common-sense approaches” to stopping gun violence really can reduce the likelihood of mass shootings.

The research shows that, while such legislation might help reduce suicides and domestic violence, it is unlikely to prevent mass shootings. It appears, based on the frequency and context of firearm use in more than 400 crimes that resulted in an insanity acquittal in Connecticut, for example, that individuals with mental illness are less likely than others to misuse firearms.

In this video, workshop chair Reena Kapoor, MD, also of Yale University, discusses the findings and notes that she and her colleagues seek to move past politics and ideology to focus on science that can guide policy and legislative efforts in a potentially more effective direction.

“We’ve also found that in spite of the media narrative, there has also been a slight decrease in how often [mentally ill offenders] use guns, over the years in the study,” she said. “Although the data are preliminary, it doesn’t support this idea that mentally ill people are more dangerous than ever, that they’re using guns more often in their violence; it actually says quite the opposite.”

Dr. Kapoor reported having no disclosures.

sworcester@mdedge.com

SOURCE: Kapoor R et al. APA 2018 Workshop.

NEW YORK – Legislation enacted in some states in the wake of mass shootings seeks to limit access to firearms for people with mental illness, but research presented at the annual meeting of the American Psychiatric Association raises questions about the value of that approach.

During a workshop entitled “The ‘Crazed Gunman’ Myth: Examining Mental Illness and Firearm Violence,” researchers from the Yale University in New Haven, Conn., presented new findings that support existing data calling into question whether laws considered to be “common-sense approaches” to stopping gun violence really can reduce the likelihood of mass shootings.

The research shows that, while such legislation might help reduce suicides and domestic violence, it is unlikely to prevent mass shootings. It appears, based on the frequency and context of firearm use in more than 400 crimes that resulted in an insanity acquittal in Connecticut, for example, that individuals with mental illness are less likely than others to misuse firearms.

In this video, workshop chair Reena Kapoor, MD, also of Yale University, discusses the findings and notes that she and her colleagues seek to move past politics and ideology to focus on science that can guide policy and legislative efforts in a potentially more effective direction.

“We’ve also found that in spite of the media narrative, there has also been a slight decrease in how often [mentally ill offenders] use guns, over the years in the study,” she said. “Although the data are preliminary, it doesn’t support this idea that mentally ill people are more dangerous than ever, that they’re using guns more often in their violence; it actually says quite the opposite.”

Dr. Kapoor reported having no disclosures.

sworcester@mdedge.com

SOURCE: Kapoor R et al. APA 2018 Workshop.

NEW YORK – Legislation enacted in some states in the wake of mass shootings seeks to limit access to firearms for people with mental illness, but research presented at the annual meeting of the American Psychiatric Association raises questions about the value of that approach.

During a workshop entitled “The ‘Crazed Gunman’ Myth: Examining Mental Illness and Firearm Violence,” researchers from the Yale University in New Haven, Conn., presented new findings that support existing data calling into question whether laws considered to be “common-sense approaches” to stopping gun violence really can reduce the likelihood of mass shootings.

The research shows that, while such legislation might help reduce suicides and domestic violence, it is unlikely to prevent mass shootings. It appears, based on the frequency and context of firearm use in more than 400 crimes that resulted in an insanity acquittal in Connecticut, for example, that individuals with mental illness are less likely than others to misuse firearms.

In this video, workshop chair Reena Kapoor, MD, also of Yale University, discusses the findings and notes that she and her colleagues seek to move past politics and ideology to focus on science that can guide policy and legislative efforts in a potentially more effective direction.

“We’ve also found that in spite of the media narrative, there has also been a slight decrease in how often [mentally ill offenders] use guns, over the years in the study,” she said. “Although the data are preliminary, it doesn’t support this idea that mentally ill people are more dangerous than ever, that they’re using guns more often in their violence; it actually says quite the opposite.”

Dr. Kapoor reported having no disclosures.

sworcester@mdedge.com

SOURCE: Kapoor R et al. APA 2018 Workshop.

NEW YORK – A meta-analysis of 10 studies provides at least preliminary support for the use of gabapentin for the treatment of alcohol cravings and withdrawal.

In this video interview, Ali Mahmood Khan, MD, of Kings County Hospital, New York, discusses the findings – presented in a poster at the annual meeting of the American Psychiatric Association – which show that patients treated with gabapentin have significantly reduced alcohol craving and withdrawal. While the findings require further study, gabapentin has been used increasingly in this setting, is generally safe, and is worth considering as a treatment option, he said.

Gapapentin also can be used in combination with naltrexone, which was shown in a separate poster presented by Dr. Khan and his colleagues to be useful for treating alcohol use disorders – but mainly through reducing consumption rather than cravings.

In that meta-analysis of 30 studies, no significant added benefit was seen when psychotherapy was combined with naltrexone, he said, noting, however, that additional study is warranted given that various psychotherapies were used across the studies.

Dr. Khan reported having no disclosures.

sworcester@mdedge.com

NEW YORK – A meta-analysis of 10 studies provides at least preliminary support for the use of gabapentin for the treatment of alcohol cravings and withdrawal.

In this video interview, Ali Mahmood Khan, MD, of Kings County Hospital, New York, discusses the findings – presented in a poster at the annual meeting of the American Psychiatric Association – which show that patients treated with gabapentin have significantly reduced alcohol craving and withdrawal. While the findings require further study, gabapentin has been used increasingly in this setting, is generally safe, and is worth considering as a treatment option, he said.

Gapapentin also can be used in combination with naltrexone, which was shown in a separate poster presented by Dr. Khan and his colleagues to be useful for treating alcohol use disorders – but mainly through reducing consumption rather than cravings.

In that meta-analysis of 30 studies, no significant added benefit was seen when psychotherapy was combined with naltrexone, he said, noting, however, that additional study is warranted given that various psychotherapies were used across the studies.

Dr. Khan reported having no disclosures.

sworcester@mdedge.com

NEW YORK – A meta-analysis of 10 studies provides at least preliminary support for the use of gabapentin for the treatment of alcohol cravings and withdrawal.

In this video interview, Ali Mahmood Khan, MD, of Kings County Hospital, New York, discusses the findings – presented in a poster at the annual meeting of the American Psychiatric Association – which show that patients treated with gabapentin have significantly reduced alcohol craving and withdrawal. While the findings require further study, gabapentin has been used increasingly in this setting, is generally safe, and is worth considering as a treatment option, he said.

Gapapentin also can be used in combination with naltrexone, which was shown in a separate poster presented by Dr. Khan and his colleagues to be useful for treating alcohol use disorders – but mainly through reducing consumption rather than cravings.

In that meta-analysis of 30 studies, no significant added benefit was seen when psychotherapy was combined with naltrexone, he said, noting, however, that additional study is warranted given that various psychotherapies were used across the studies.

Dr. Khan reported having no disclosures.

sworcester@mdedge.com

AUSTIN, TEX. – Transgender patients face many barriers to care, including a lack of necessary expertise among providers, but a large majority of those surveyed in a study in which they were asked whether they would want to go to a transgender-only clinic said they would not.

Lauren Abern, MD, of Atrius Health, Cambridge, Mass., discussed the aims and results of her survey at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

The anonymous online survey consisted of 120 individuals, aged 18-64 years: 100 transgender men and 20 transgender women. Of these, 83 reported experiencing barriers to care. The most common problem cited was cost (68, 82%), and other barriers were access to care (47, 57%), stigma (33, 40%), and discrimination (23, 26%). Cost was a factor even though a large majority of the respondents had health insurance; a majority of respondents had an income of less than $24,000 per year.

The most common way respondents found transgender-competent health care was through word of mouth (79, 77%).

When asked whether they would want to go to a transgender-only clinic, a majority of both transgender women and transgender men respondents either answered, “no,” or that they were unsure (86, 77%). Some respondents cited a desire not to out themselves as transgender, and others considered the separate clinic medically unnecessary. One wrote: “You wouldn’t need a broken foot–only clinic.”

“Basic preventative services can be provided without specific expertise in transgender health. If providers are uncomfortable, they should refer [transgender patients] elsewhere.” said Dr. Abern.

The survey project was conducted in collaboration with the University of Miami and the YES Institute in Miami.

Dr. Abern also spoke about wider transgender health considerations for the ob.gyn. in a separate presentation at the meeting and in a video interview.

For example, transgender men on testosterone may have persistent bleeding and may be uncomfortable with pelvic exams.

Making more inclusive intake forms and fostering a respectful office environment (for example, having a nondiscrimination policy displayed in the waiting area) are measures beneficial to all patients, she said.

“My dream or goal would be that transgender people can be seen and accepted at any office and feel comfortable and not avoid seeking health care.”

dwatson@mdedge.com

AUSTIN, TEX. – Transgender patients face many barriers to care, including a lack of necessary expertise among providers, but a large majority of those surveyed in a study in which they were asked whether they would want to go to a transgender-only clinic said they would not.

Lauren Abern, MD, of Atrius Health, Cambridge, Mass., discussed the aims and results of her survey at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

The anonymous online survey consisted of 120 individuals, aged 18-64 years: 100 transgender men and 20 transgender women. Of these, 83 reported experiencing barriers to care. The most common problem cited was cost (68, 82%), and other barriers were access to care (47, 57%), stigma (33, 40%), and discrimination (23, 26%). Cost was a factor even though a large majority of the respondents had health insurance; a majority of respondents had an income of less than $24,000 per year.

The most common way respondents found transgender-competent health care was through word of mouth (79, 77%).

When asked whether they would want to go to a transgender-only clinic, a majority of both transgender women and transgender men respondents either answered, “no,” or that they were unsure (86, 77%). Some respondents cited a desire not to out themselves as transgender, and others considered the separate clinic medically unnecessary. One wrote: “You wouldn’t need a broken foot–only clinic.”

“Basic preventative services can be provided without specific expertise in transgender health. If providers are uncomfortable, they should refer [transgender patients] elsewhere.” said Dr. Abern.

The survey project was conducted in collaboration with the University of Miami and the YES Institute in Miami.

Dr. Abern also spoke about wider transgender health considerations for the ob.gyn. in a separate presentation at the meeting and in a video interview.

For example, transgender men on testosterone may have persistent bleeding and may be uncomfortable with pelvic exams.

Making more inclusive intake forms and fostering a respectful office environment (for example, having a nondiscrimination policy displayed in the waiting area) are measures beneficial to all patients, she said.

“My dream or goal would be that transgender people can be seen and accepted at any office and feel comfortable and not avoid seeking health care.”

dwatson@mdedge.com

AUSTIN, TEX. – Transgender patients face many barriers to care, including a lack of necessary expertise among providers, but a large majority of those surveyed in a study in which they were asked whether they would want to go to a transgender-only clinic said they would not.

Lauren Abern, MD, of Atrius Health, Cambridge, Mass., discussed the aims and results of her survey at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

The anonymous online survey consisted of 120 individuals, aged 18-64 years: 100 transgender men and 20 transgender women. Of these, 83 reported experiencing barriers to care. The most common problem cited was cost (68, 82%), and other barriers were access to care (47, 57%), stigma (33, 40%), and discrimination (23, 26%). Cost was a factor even though a large majority of the respondents had health insurance; a majority of respondents had an income of less than $24,000 per year.

The most common way respondents found transgender-competent health care was through word of mouth (79, 77%).

When asked whether they would want to go to a transgender-only clinic, a majority of both transgender women and transgender men respondents either answered, “no,” or that they were unsure (86, 77%). Some respondents cited a desire not to out themselves as transgender, and others considered the separate clinic medically unnecessary. One wrote: “You wouldn’t need a broken foot–only clinic.”

“Basic preventative services can be provided without specific expertise in transgender health. If providers are uncomfortable, they should refer [transgender patients] elsewhere.” said Dr. Abern.

The survey project was conducted in collaboration with the University of Miami and the YES Institute in Miami.

Dr. Abern also spoke about wider transgender health considerations for the ob.gyn. in a separate presentation at the meeting and in a video interview.

For example, transgender men on testosterone may have persistent bleeding and may be uncomfortable with pelvic exams.

Making more inclusive intake forms and fostering a respectful office environment (for example, having a nondiscrimination policy displayed in the waiting area) are measures beneficial to all patients, she said.

“My dream or goal would be that transgender people can be seen and accepted at any office and feel comfortable and not avoid seeking health care.”

dwatson@mdedge.com

AUSTIN, TEX. – Women with the highest levels of obesity were at higher odds of experiencing a composite serious maternal morbidity outcome, while women at all levels of obesity experienced elevated risks of some serious complications of pregnancy, compared with women with a body mass index (BMI) in the normal range, according to a recent study.

Looking at individual indicators of severe maternal morbidity, Marissa Platner, MD, and her study coauthors saw that women who fell into the higher levels of obesity had significantly elevated odds of some complications.

“Those risks are really impressive, with odds ratios of two and three times that of a normal-weight patient,” said Dr. Platner in a video interview.

The adjusted odds ratio of acute renal failure for women with superobesity (BMI of 50 kg/m² or more) was 3.62 (95% confidence interval, 1.75-7.52); odds ratios for renal failure were not significantly elevated for less-obese women.

Women with all levels of obesity had elevated risks of experiencing heart failure during a procedure or surgery, with adjusted odds ratios ranging from 1.68 (^{95% CI, 1.48-1.93}) for women with class I obesity (BMI, 30-34.9 kg/m²⁾ to 2.23 for women with superobesity (95% CI, 1.15-4.33).

Results from the retrospective cohort study were presented at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

Dr. Platner and her colleagues examined 4 years of New York City delivery data that were linked to birth certificates, identifying those singleton live births for whom maternal prepregnancy BMI data were available.

koakes@mdedge.com

SOURCE: Platner M et al. ACOG 2018, Abstract 39I.

AUSTIN, TEX. – Women with the highest levels of obesity were at higher odds of experiencing a composite serious maternal morbidity outcome, while women at all levels of obesity experienced elevated risks of some serious complications of pregnancy, compared with women with a body mass index (BMI) in the normal range, according to a recent study.

Looking at individual indicators of severe maternal morbidity, Marissa Platner, MD, and her study coauthors saw that women who fell into the higher levels of obesity had significantly elevated odds of some complications.

“Those risks are really impressive, with odds ratios of two and three times that of a normal-weight patient,” said Dr. Platner in a video interview.

The adjusted odds ratio of acute renal failure for women with superobesity (BMI of 50 kg/m² or more) was 3.62 (95% confidence interval, 1.75-7.52); odds ratios for renal failure were not significantly elevated for less-obese women.

Women with all levels of obesity had elevated risks of experiencing heart failure during a procedure or surgery, with adjusted odds ratios ranging from 1.68 (^{95% CI, 1.48-1.93}) for women with class I obesity (BMI, 30-34.9 kg/m²⁾ to 2.23 for women with superobesity (95% CI, 1.15-4.33).

Results from the retrospective cohort study were presented at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

Dr. Platner and her colleagues examined 4 years of New York City delivery data that were linked to birth certificates, identifying those singleton live births for whom maternal prepregnancy BMI data were available.

koakes@mdedge.com

SOURCE: Platner M et al. ACOG 2018, Abstract 39I.

AUSTIN, TEX. – Women with the highest levels of obesity were at higher odds of experiencing a composite serious maternal morbidity outcome, while women at all levels of obesity experienced elevated risks of some serious complications of pregnancy, compared with women with a body mass index (BMI) in the normal range, according to a recent study.

Looking at individual indicators of severe maternal morbidity, Marissa Platner, MD, and her study coauthors saw that women who fell into the higher levels of obesity had significantly elevated odds of some complications.

“Those risks are really impressive, with odds ratios of two and three times that of a normal-weight patient,” said Dr. Platner in a video interview.

The adjusted odds ratio of acute renal failure for women with superobesity (BMI of 50 kg/m² or more) was 3.62 (95% confidence interval, 1.75-7.52); odds ratios for renal failure were not significantly elevated for less-obese women.

Women with all levels of obesity had elevated risks of experiencing heart failure during a procedure or surgery, with adjusted odds ratios ranging from 1.68 (^{95% CI, 1.48-1.93}) for women with class I obesity (BMI, 30-34.9 kg/m²⁾ to 2.23 for women with superobesity (95% CI, 1.15-4.33).

Results from the retrospective cohort study were presented at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

Dr. Platner and her colleagues examined 4 years of New York City delivery data that were linked to birth certificates, identifying those singleton live births for whom maternal prepregnancy BMI data were available.

koakes@mdedge.com

SOURCE: Platner M et al. ACOG 2018, Abstract 39I.