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May is Mental Health Month

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Mental health is essential to everyone’s overall health and well-being, and mental illnesses are common and
treatable. So much of what we do physically impacts us mentally –it’s important to pay attention to both your
physical health and your mental health, which can help you achieve overall wellness and set you on a path to
recovery.
May is Mental Health Month; Mood for Life is raising awareness about the connection between
physical health and mental health, through the theme Fitness #4Mind4Body. The campaign is meant to educate and
inform individuals about how eating healthy foods, gut health, managing stress, exercising, and getting enough
sleep can go a long way in making you healthy all around.
A healthy lifestyle can help to prevent the onset or worsening of mental health conditions like depression and
anxiety, as well as heart disease, diabetes, obesity and other chronic health problems. It can also play a big role
in helping people recover from these conditions. Taking good care of your body is part of a before Stage Four
approach to mental health.
Getting the appropriate amount of exercise can help control weight, improve mental health, and help you live
longer and healthier. Recent research is also connecting your nutrition and gut health with your mental health.
Sleep also plays a critical role in all aspects of our life and overall health. Getting a good night’s sleep is important
to having enough physical and mental energy to take on daily responsibilities. And we all know that stress can
have a huge impact on all aspects of our health, so it’s important to take time to focus on stress-reducing activities
like meditation or yoga.
Mood for Life wants everyone to know that mental illnesses are real, and recovery is always the goal. Living a
healthy lifestyle may not be easy, but by looking at your overall health every day – both physically and mentally –
you can go a long way in ensuring that you focus on your Fitness #4Mind4Body.
For more information, visit http://www.mentalhealthamerica.net/may.

Fiber – the unrecognized macronutrient of evolution

by Richard Aiken MD PhD @rcaiken

fiber

Fiber

Fiber, although not considered a macronutrient, has a RDA of 25 – 38 gm/ day again according to the National Academy of Sciences Institute of Medicine’s Food and Nutrition Board and is only available from plants. We know that the most healthful diet is one that is high in fiber and low in rapidly digested carbohydrates. This regimen is referred to as a low-glycemic diet because it helps keep our blood glucose at optimum levels. Wild fruits and vegetables are the original low-glycemic foods[1].

It is estimated that 97% of Americans do not consume the recommended minimum amount of fiber[2].

Shown above are a few example foods and their fiber density, expressed as grams of fiber per total grams of dry weight of food substance.

Generalizing, fruit and vegetables are significant sources of fiber, but beans and cruciferous vegetables are best and starch and grains much less so.

[1] Robinson, J. (2013). Eating on the wild side: The missing link to optimum health (pp. 4-5).

[2] Moshfegh, A., & Goldman, J. (2005). What We Eat in America, NHANES 2001-2002: Usual Nutrient Intakes from Food Compared to Dietary Reference Intakes. U.S. Department of Agriculture, Agricultural Research Service.

Crisis: Murder of Very Young Children in the United States

by Richard Aiken MD PhD @rcaiken

I just read a news report titled “Father slashes son’s throat, nearly decapitating 2-year-old[1]”. This was so disturbing that I investigated murder of individuals by age groups.

The cause of death by “interpersonal violence”, i.e. murder, using the Global Burden of Disease data assembled by the Institute for Health Metrics and Evaluation at the University of Washington[2] is shown on Figure 1 for the time interval 2010 – 2016 (note EN means 0 – 6 days old and PN is 7 days to 1 year old; the line is the mean value).

murder 2010 - 2016

Figure 1 Murder of males in the US 2010 – 2016 by age

Several aspects of these data are shocking.  First, comparison to previous 5 year intervals reveals that the most likely age of those murdered is becoming younger.  For example, in the 5 year interval 1980 – 1984, the most likely age to be murdered was about 27 years old; from the data in Figure 1, it is about 15 years old.

Second, the curve is not Gaussian – it is bimodal with two peaks at 15 and at about 2 – 3 years old. This means that young adolescents and young children are being disproportionately murdered.  Let’s examine the first most likely peak in murder rate, that of young children.

Although the untimely deaths of children due to illness and accidents are closely monitored, deaths that result from physical abuse or severe neglect is more difficult to track.  This is particularly true of the very young, ages 0 – 5 years old prior to their introduction into communities through schools and community activities where there is a degree of monitoring outside the family environment. Child fatalities due to abuse and neglect are very likely underreported.

The highest risk of child homicide victimization is on the first day of life, known as “neonaticide”. Neonaticide is almost always committed by the mother acting alone; the biologic father is frequently no longer a part of the mother’s life. Neonaticidal mothers are often in their teens or 20s; unmarried; and of lower socioeconomic status[3] and the pregnancy is unwanted. Note these deaths are not reported in Figure 1.

An examination of child abuse and neglect resulting in death in the year 2015 from the U.S. Department of Health & Human Services, indicates that about three-quarters (74.8%) of child fatalities involved children younger than 3 years, and children younger than 1 year accounted for about 50% (49.4 %) of all fatalities as shown in Figure 2 [4].

abuse neglect fatalities children 2015

This is a crisis that must be recognized and then have the highest priority to eliminate.

[1] http://www.foxnews.com/us/2018/02/23/father-slashes-sons-throat-nearly-decapitating-2-year-old-police.html

[2] Institute for Health Metrics and Evaluation (IHME). Causes of Death (COD) Data Visualization. Seattle, WA: IHME, University of Washington, 2017. Available from http://vizhub.healthdata.org/cod. (Accessed February 18, 2018)

[3] Friedman, S. H., & Resnick, P. J. (2009). Neonaticide: Phenomenology and considerations for prevention. International Journal of Law and Psychiatry, 32(1), 43-47. doi:10.1016/j.ijlp.2008.11.006

[4] U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2017). Child Maltreatment 2015. Available from http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment.

 

Death by Firearms Increasing for Youth

 

Richard Aiken MD PhD @rcaiken

Cause of death by firearms is becoming more likely at younger ages in the United States.

The following data on the homicides by firearms [1] come from the Global Burden of Disease assembled by the Institute for Health Metrics and Evaluation at the University of Washington.

 

Males in the United States.

death homicides firearms 80 - 84 males US

In the interval 1980 – 1984, the most likely age for death by firearms was the mid to late twenties.  Since that time, the rates have shift toward younger ages.  The following graph indicates homicide death by firearms in the more recent interval 2010 – 2016.

Death by Firearm Homicide 2010 - 2016 males

More currently, then, the most likely age for death by firearm is about 15 years old, roughly 10 years younger than that 30 years ago.

[1] Institute for Health Metrics and Evaluation (IHME). Causes of Death (COD) Data Visualization. Seattle, WA: IHME, University of Washington, 2017. Available from http://vizhub.healthdata.org/cod. (Accessed February 18, 2018)

 

 

Death by Suicide of US Children in Epidemic Rates

by Richard Aiken MD PhD @rcaiken

Summary

The three most common causes of death in children, suicide, vehicular accidents, and neoplasms, are approximately of equal incidence but suicides are increasing at an alarming rate.

 

While even the definition of the age of an individual considered to be a “child” varies in the literature, consensus to group statistics that aggregates age in bands of 5 years would suggest a population under 15 leading to the age range considered here 10 to 14 years inclusive.

Suicide requires that the individual executing it understand the concept of death.  This appears to be the case generally for children older than 8 years old[1], and many of them are capable of planning, attempting and dying by suicide[2].

Deaths by suicide are generally under reported because of the associated stigma; this is particularly true of children[3] with cause of death reported as accidents rather than suicide.

The following data on the death of children by suicide[4] come from the Global Burden of Disease assembled by the Institute for Health Metrics and Evaluation at the University of Washington.

Death by Suicide: Male Children

suicide males US 10 - 14

Figure 1 Death by Suicide US Male Children

For male children ages 10 through and including 14 years old, Figure 1 indicates a recent sharp rise in the death rate by suicide. The most recent death rate is 15.6% from 2014 as reported by the National Center for Health Statistics. This compares to 6.2% in 2007 – a more than doubling the suicide rate in seven years.

Death by Suicide: Female Children

For female children in the US, the trend is similar as shown in Figure 2.  In 2014, 13.4% of the cause of death was by suicide, up from 3.8% in 2007 – more than tripling the rate in seven years.

suic females US 10-14

Figure 2 Death by Suicide US Female Children

Even disregarding outlier data, there is no doubt that suicide rates among our children is significantly on the rise.

Death by Vehicular Accidents: Males

Compare the cause of suicide death for male children to that of vehicular accidents, shown in Figure 3.  Note that fortunately this cause of death is declining and in 2014 was 16.7%, similar to the rate of suicide.

veh male 10-14

Figure 3 Death by Vehicular Accidents of US Male Children

Death by Vehicular Accidents: Females

Figure 4 shows the death rate of females by vehicular accidents. Note that fortunately this cause of death is declining and in 2014 was 15.4%, similar to the rate of suicide.

veh death female 10-14

Figure 4 Death by Vehicular Accidents in US Female Children

Other cause of death for US Children

Neoplasms cause about 15% of the deaths for male and female children in the US and appears to be rather steady over the past two decades.

Suicide rate shifting to younger age group

suicde age male 2000

Figure 5 Suicide Rate by Age US Males 2000 – 2004

suic age male 2010

Figure 6 Suicide Rate by Age US Males 2010 – 2016

Figures 5 and 6 illustrate the suicide rate of US males for various ages in 2000 – 2004 compared to that in 2010 – 2016.  In this rather short time interval, the most likely mean rate changed from about 25 to 15 years old. Data for females are very similar with the same approximate means for the two time intervals.

This is further indication of the crisis of suicides in our children.

 

References

[1] Mishara, B. L. (1998). Childhood conceptions of death and suicide: Empirical investigations and implications of suicide prevention. In D. De Leo, A. Schmidtke, & Diekstra, R. F. (Eds.), Suicide prevention: A holistic approach (pp. 111-119). Dordrecht: Kluwer Academic Publishers.

[2] Tishler, C. L., Reiss, N. S., & Rhodes, A. R. (2007). Suicidal behaviour in children younger than twelve: A diagnostic challenge for emergency department personnel. Academic Emergency Medicine, 14, 810-818.

[3] Crepeau-Hobson, F. (2010). The psychological autopsy and determination of child suicides: A survey of medical examiners. Archives of Suicide Research, 14, 24-34.

[4] Institute for Health Metrics and Evaluation (IHME). Causes of Death (COD) Data Visualization. Seattle, WA: IHME, University of Washington, 2017. Available from http://vizhub.healthdata.org/cod. (Accessed February 18, 2018)