Thursday, July 10, 2014

Diversity Mental Health Month: Why It is Needed and How It Came to Be

By Steve Koh, MD, MPH, MBA

July of 2014 is the very first APA Diversity Mental Health Month. This emphasis on mental health needs of diverse populations is much needed. While we have diversity oriented month observances for specific population groups like the Black History Month (February), National Women’s History Month (March), Asian Pacific American Heritage Month (May), Gay and Lesbian Pride Month (June), American Indian Heritage Month (August), and Hispanic Heritage Month (September), we have not had a dedicated month more broadly addressing diverse populations and mental health issues.

I cannot overemphasize the importance of this month. For the first time, together, we will bring attention to the unique and challenging needs of the diverse populations with mental illness and substance use disorders, work to decrease mental health disparities, and engage with diverse populations to help promote and grow future mental health champions in the communities.

The concept for Diversity Mental Health Month came from a group of participants in APA’s Minority Fellowship program.  The program’s goal is to eliminate racial and ethnic disparities in mental health and substance abuse care by providing specialized training and mentorship. The fellowship fosters those with diverse backgrounds who have chosen to become physicians specializing in mental health and to do this work with the diverse populations.  

But what happens when we go home? What then? We felt that it was easy to get lost when we left our APA meetings in Washington DC. How do we galvanize our colleagues at home to look at the importance of minority mental health issues? To recognize the stigma of being an ethnic and cultural minority and also suffering mental illness? To understand that many minority students do not consider going into field of medicine let alone mental health profession? To appreciate the importance of cultural competency and humility in working with diverse patient population?

Without involvement a coordinated effort by the APA, it was our belief that while we personally benefited from the fellowship experience, our impact would be limited. There needed to be a designated time for all of APA to bring attention to this important patient population.  So the idea was born to create a Diversity Mental Health Month. The APA Assembly asked APA staff to help create a month designated to minority mental health issues and for the APA to actively promote the month.

I hope that others are excited about this new endeavor of the APA as I am. The challenges are great but together we can bring the needed attention to this area of our profession.

Many resources, including an infographic with basic data on mental health disparities, and brochures and fact sheets on specific populations, suggested activities, video messages, and more, are available at

Wednesday, July 2, 2014

Depression & Cancer

By Brad Zehring, DO @DrZehringDO

“Cancer can take away all of my physical abilities. It cannot touch my mind, it cannot touch my heart, and it cannot touch my soul”  - Jim Valvano

But, what happens when it does?

Depression is a multifactorial disorder that requires acknowledgement of the biological, psychological, and social aspects of a person’s life. Professionals in the mental health community describe this as the biopsychosocial model. It provides an understanding of the factors influencing a person’s mental and physical state of being.

When mental health professionals talk about depression they often do so in regards to Major Depressive Disorder (MDD). According to DSM 5 (Diagnostic and Statistical Manual of Mental Disorders), 5 out of 9 criteria are needed to diagnose MDD. It requires a depressed mood or anhedonia (lack of enjoying what was previously enjoyed) for greater than 2 weeks including: disturbances in sleep, guilty/hopeless/worthless feelings, poor concentration, low energy, changes in appetite (weight loss or weight gain), psychomotor agitation or retardation, and suicidal ideation.
Depression affects your entire body. But, the physical aspects of depression are often overlooked. It is common for people with depression to experience weight changes, digestive problems, headaches, back pain, muscle and joint pain, and disruptions in sleep cycle. Many symptoms that are present in cancer.

Depression has been linked with many health problems, including cancer. Cancer is a heavy word. The enormity of the word brings many images to the forefront of our imagination: radiation, chemotherapy, losing hair, sickness, weakness, and death - among others. There is so much symptom overlap between cancer and depression it can be hard to recognize the etiology of the symptoms.

It is important that health care professionals, family members, and other caretakers are vigilant with a person’s mental well being after they are diagnosed with cancer. Even if a person has never experienced depression previously, their risk of depression is increased when they find out they have cancer. Research shows that the incidence of depression increases proportionately with the cancer’s progression. It is believed those with depression have increased likelihood of depression because of increased immune response (cytokines) within the body.

It is important not to assume that someone with cancer has an appropriate depressed mood due to his or her circumstances.  This is why it is important to screen for depression in those diagnosed with cancer. Screening for depression can help “tease out” symptoms related to depression and symptoms related to the cancer. Treating depression in patients with cancer can help them focus on their treatment and have the motivation to do everything needed to possibly achieve remission. Proper treatment gives them the ability to focus on their future. Cancer alone is enough, but when combined with untreated depression the results can be deadly.

After recognizing depression in someone with cancer, there are ways to treat depression in parallel with cancer treatment. There are two forms of treatment. One involves medication and the other involves psychotherapy, or talk therapy. The typical medications for depression are antidepressants like Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRI). These medications have been around for a long time and are generally well tolerated. They take anywhere from 2-6 weeks for clinical efficacy. These medications should be monitored with cancer treatment, as there can be drug interactions and side effects that may not be present in someone taking these medications without cancer. In addition to medications, psychotherapy can be effective. More specifically, Cognitive Behavioral Therapy (CBT) can help people change their negative thoughts about cancer and their future. For the most efficacious treatment a combination of both should be implemented.

Cancer is a serious illness and a well-developed multi-disciplinary approach is necessary to best treat the patient. Cancer can cause a lot of different disturbances in physical and mental health. It is important to have health professionals, like psychiatrists and psychologists, part of the treatment team to ensure proper treatment of the whole patient.