Author Interviews, JAMA, Mental Health Research / 23.07.2021
Diseases of Despair: Rural and Urban Sufferers See Same Structural Problems
This story explores suicide and conditions leading to despair. If you are at risk, please stop here and contact the National Suicide Prevention Lifeline for support. 800-273-8255
MedicalResearch.com Interview with:
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Dr. George[/caption]
Daniel George, MSc, PhD
Associate Professor, Department of Humanities
Associate Professor, Department of Public Health Sciences
Penn State
MedicalResearch.com: What is the background for this study? What are the common diseases of despair?
Response: Last decade, two Princeton economists, Anne Case and Angus Deaton, noted a precipitous rise in self-harming deaths (suicide, alcoholism, accidental poisonings, i.e., overdose) especially among poor whites in midlife with low educational attainment since the 1990s. These deaths were intimately linked with economic changes over the past several decades that have created more despairing conditions for the working class, made people more susceptible to seeking escape, numbness, and relief from physical, mental, and emotional pain. In recent years, the crisis has broadened, and we've seen rising excess mortality in other groups of working-class Americans as overall life expectancy has consistently fallen.
Our team at Penn State College of Medicine and Highmark Inc. has previously examined “diseases of despair”, these being patients who are experiencing suicidal ideation or substance use issues and seeking out clinical care before they convert to "deaths of despair". We published a study in BMJ in 2020 showing a marked rise in these clinical diseases of despair across a sample of 12 million insurance carriers in Appalachia and the Rust Belt, again spanning across demographic boundaries. For this study, we honed in on high prevalence census blocks we had identified in our hospital's service area in central Pennsylvania and organized 4 focus groups in both rural and urban areas. We wanted to learn more about what people felt was driving despair in their communities, and what solutions might look like
Dr. George[/caption]
Daniel George, MSc, PhD
Associate Professor, Department of Humanities
Associate Professor, Department of Public Health Sciences
Penn State
MedicalResearch.com: What is the background for this study? What are the common diseases of despair?
Response: Last decade, two Princeton economists, Anne Case and Angus Deaton, noted a precipitous rise in self-harming deaths (suicide, alcoholism, accidental poisonings, i.e., overdose) especially among poor whites in midlife with low educational attainment since the 1990s. These deaths were intimately linked with economic changes over the past several decades that have created more despairing conditions for the working class, made people more susceptible to seeking escape, numbness, and relief from physical, mental, and emotional pain. In recent years, the crisis has broadened, and we've seen rising excess mortality in other groups of working-class Americans as overall life expectancy has consistently fallen.
Our team at Penn State College of Medicine and Highmark Inc. has previously examined “diseases of despair”, these being patients who are experiencing suicidal ideation or substance use issues and seeking out clinical care before they convert to "deaths of despair". We published a study in BMJ in 2020 showing a marked rise in these clinical diseases of despair across a sample of 12 million insurance carriers in Appalachia and the Rust Belt, again spanning across demographic boundaries. For this study, we honed in on high prevalence census blocks we had identified in our hospital's service area in central Pennsylvania and organized 4 focus groups in both rural and urban areas. We wanted to learn more about what people felt was driving despair in their communities, and what solutions might look like
Dr. Correa[/caption]
Andres F. Correa, MD
Assistant Professor
Department of Surgical Oncology, and
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Dr. Bernstein[/caption]
Adrien Bernstein, MD
Second Year Urologic Oncology Fellow
Fox Chase Cancer Center
MedicalResearch.com: What is the background for this study?
Response: Unfortunately, it has been well-established that historically Black Americans experience increased cancer specific mortality compared to white patients. In prostate cancer specifically studies have shown that when access to care is equitable this gap resolves. This suggests that biological factors are not driving these differences but rather the result of the complex interplay of social determinants and systemic inequities in our healthcare system.
Early in the pandemic, multiple studies demonstrated that minority communities disproportionately shouldered poor COVID-19 outcomes. On March 13th 2020, the American College of Surgeons recommended against elective procedures; however, the definition of an elective oncologic case was left to the discretion of the provider. As prostate cancer treatment can be safely deferred up to a year follow diagnosis, management of prostate cancer during the initial lockdown period of the COVID-19 Pandemic provided a useful analysis of the differential restrictions placed on non-emergent health care during the Pandemic.
Dr. Seifi[/caption]
Ali Seifi, MD, FACP, FNCS, FCCM
Associate Professor
Director of Neuro Critical Care,
Fellowship Director, CAST Neurosurgery Critical Care
Department of Neurosurgery, Neurology, Anesthesiology and Medicine
The University of Texas Health Science Center at San Antonio
MedicalResearch.com: What is the background for this study?
Dr. Conner[/caption]
Christopher Conner, MD, PhD
Neurosurgery resident
McGovern Medical School
The University of Texas Health Science Center at Houston
MedicalResearch.com: What is the background for this study?
Response: There has been a growing understanding in medicine that the incidence of motor vehicle trauma is changing. We have watched as Friday and Saturday night emergencies have declined without a good explanation. Several other studies have investigated this, but the results were not conclusive.
We think that is due to a lack of data from the rideshare companies and hospitals directly
Dr. Chien-Wen Tseng[/caption]
Chien-Wen Tseng, M.D., M.P.H., M.S.E.E.
The Hawaii Medical Service Association Endowed Chair
Health Services and Quality Research
Professor, and Associate Research Director
Department of Family Medicine and Community Health
University of Hawaii John A. Burns School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Gaining weight during pregnancy is natural but gaining too little or too much weight can be harmful for pregnant people and their babies. For the first time, the Task Force reviewed the evidence and found that counseling pregnant people on healthy weight gain during pregnancy can lower their risk for diabetes during pregnancy, emergency cesarean deliveries, and babies born with a birth weight that is too high. Pregnant people may not know what amount of weight gain is healthy during pregnancy, or how weight gain can affect their pregnancy and baby.
We recommend that clinicians offer all pregnant people counseling on healthy weight gain throughout their pregnancy for healthier, safer pregnancies.
Dr. Andersson[/caption]
Niklas Worm Andersson, MD
Department of Epidemiology Research
Statens Serum Institut,
Copenhagen Denmark
MedicalResearch.com: What is the background for this study?
Response: "Findings from some previous fetal safety studies on topical corticosteroid use in pregnancy have raised concerns for an increased risk of newborns being small for gestational age or having low birth weight, in particular among pregnancies where larger amounts of potent to very potent agents have been used."
Dr. Wong[/caption]
John B. Wong, M.D.
Chief Scientific Officer
Vice chair for Clinical Affairs
Chief of the Division of Clinical Decision Making and
Primary care Clinician
Department of Medicine at Tufts Medical Center
MedicalResearch.com: What is the background for this study?
Response: Hypertension affects nearly half of all adults in the United States and is a major risk factor for many serious health conditions. Fortunately, by screening all adults for hypertension, clinicians can improve their patient’s health. The Task Force continues to recommend screening all adults for hypertension so that they can get the care they need to help prevent health conditions such as heart attack, stroke, and kidney failure.
Dr. Yun Liu[/caption]
Yun Liu, PhD
Google Health
Palo Alto, California
MedicalResearch.com: What is the background for this study? Would you describe the system? Does it use dermatoscopic images?
Response: Dermatologic conditions are extremely common and a leading cause of morbidity worldwide. Due to limited access to dermatologists, patients often first seek help from non-specialists. However, non-specialists have been reported to have lower diagnostic accuracies compared to dermatologists, which may impact the quality of care.
In this study, we built upon prior work published in
Prof. Papageorghiou[/caption]
Aris Papageorghiou MBChB, MRCOG
Professor of Fetal Medicine and the Clinical Research Director
Oxford Maternal and Perinatal Health Institute
University of Oxford
MedicalResearch.com: What is the background for this study?
Response: Our study was really guided by a key question: does Covid-19 in pregnancy increase the risk of adverse maternal and neonatal outcomes as compared with pregnant women who do not have the infection?
The question is highly relevant because of the known deleterious effects of other coronavirus infections in pregnancy, e.g. SARS (severe acute respiratory syndrome) and MERS-CoV (Middle East respiratory syndrome coronavirus).
In order to answer this question we undertook this multinational cohort study.
Dr. Virani[/caption]
Senior & Corresponding Author
Salim S. Virani, MD, PhD, FACC, FAHA, FASPC
Professor, Section of Cardiovascular Research
Director, Cardiology Fellowship Training Program
Baylor College of Medicine
Staff Cardiologist, Michael E. DeBakey Veterans Affairs Medical Center
Co-Director, VA Advanced Fellowship in Health Services Research & Development Michael E. DeBakey VA Medical Center, Houston, TX
Investigator, Health Policy, Quality and Informatics Program
Michael E. DeBakey Veterans Affairs Medical Center HSR&D Center of Innovation
Houston, TX
MedicalResearch.com: What is the background for this study?
Response: Atherosclerotic cardiovascular disease (ASCVD), defined as ischemic heart disease (IHD), ischemic cerebrovascular disease (ICVD), or peripheral arterial disease (PAD), is the leading cause of death globally. Particularly in young ASCVD patients, secondary prevention with antiplatelet therapy and statins are extremely important in reducing disease burden.
Dr. McPeek Hinz[/caption]
Eugenia McPeek Hinz MD MS FAMIA
Associate CMIO - DHTS
Duke University Health System
MedicalResearch.com: What is the background for this study?
Response: Clinician burnout rates have hovered around 50% for much of the past decade. Burnout is a significant concern in healthcare for its effects on care givers and associated downstream adverse implications on patient care for quality and safety. The ubiquitous presence of Electronic Health Records (EHR) along with the increased clerical components and after hours use has been a significant concern for contributing to provider burnout.
Dr. Sickbert-Bennett[/caption]
Emily Sickbert-Bennett PhD, MS, CIC, FSHEA
Director, Infection Prevention, UNC Hospitals
Administrative Director, Carolina Antimicrobial Stewardship Program, UNC Hospitals
Associate Professor of Medicine-Infectious Diseases, UNC School of Medicine
Associate Professor of Epidemiology, UNC Gillings School of Global Public Health
MedicalResearch.com: What is the background for this study?
Response: Recently public health officials have recommended doubling masks, although the