Anxious Mothers Breastfeed Less

Anxiety and depressive thoughts can lead breastfeeding women to worry about whether their baby is eating enough. They are likely to stop breastfeeding or supplement their own milk with infant formula or baby porridge. New results from the Mother and Child Cohort Study at the Norwegian Institute of Public Health indicate that personality traits can affect breastfeeding habits.


Researchers analysed data from nearly 28 000 women who completed questionnaires during pregnancy and six months post-partum.


One in seven exclusively breastfeeds


Norwegian health authorities recommend that babies are breastfed exclusively until six months old. However, the study shows that only 15 percent of mothers, or just one in seven, solely breastfed for so long. Amongst the participants, 85 percent still breastfed at six months - 15 percent of these only gave breast milk whilst the others supplemented with infant formula or porridge. The remaining 15 percent had ceased to breastfeed.


Affected by worries


Negative feelings and personality traits had an obvious effect on breastfeeding. Anxious women who had little confidence in their breastfeeding ability appeared to do so less than other women in the cohort. This conclusion was drawn from responses about negative feelings such as anxiety, self-confidence and melancholy. A high score for anxiety gave a 30 percent increased chance that a woman would stop breastfeeding before six months, or that she would supplement breast milk with baby porridge or infant formula.


- It could be that these women worry more easily that their babies aren't gaining weight. Therefore they may drop breastfeeding or choose to give supplements, says researcher Eivind Ystr??m at the Division of Mental Health, Norwegian Institute of Public Health.


During pregnancy, researchers also measured how women perceived their ability to cope with their new situation. Among the women who believed they could cope well, more breastfed exclusively for six months after birth compared to the group who believed they couldn't cope.


In addition to personality, researchers could confirm results from other studies - that a mother's smoking habits can affect breastfeeding. By six months, 5 percent of smoking mothers were exclusively breastfeeding but nearly 30 percent had stopped.


Many women who had a Caesarean section or were first-time mothers had also ceased to breastfeed or supplemented with infant formula by six months.


Become easily stressed


Earlier research also shows that people with negative emotions (affectivity) are easily stressed and worry about their health. Anxious women can find the demands of full breastfeeding more stressful than others so they begin to avoid it. Increased stress levels can even restrict the biological mechanisms that steer milk production and milk ejection (let-down) reflex in the breast.


- When women with negative emotions find breastfeeding difficult they will have a greater tendency to avoid it, says Ystr??m.


May require alternative guidance


- What can health professionals do to help these women?


- Health professionals should be alert when they meet anxious, pregnant women, or those with depressive thoughts. These women may need another form of guidance, addressing concerns about breastfeeding instead of focusing on pure health information. A dialogue with a health nurse can help them to be conscious of the anxious feelings, says Ystr??m.

The women in the study were on average 29.8 years old when they gave birth. Almost half were first-time mothers. Nearly 5 percent gave birth too early, 13 percent had a Caesarean section and 11 percent smoked after birth.


The study is published in the Journal of Pediatrics.



Related links


The Impact of Maternal Negative Affectivity and General Self-Efficacy on Breastfeeding: The Norwegian Mother and Child Cohort Study (Abstract from Journal of Pediatrics)




About the Norwegian Institute of Public Health


Our goal is to improve public health through promotion of good health and prevention of disease. The Norwegian Institute of Public Health is a national center of excellence in the areas of epidemiology, mental health, infectious disease control, environmental medicine, forensic toxicology and drug abuse. Our vision: A healthier society. Our motto: Knowledge for better public health.

Norwegian Institute of Public Health

Mental Illness Was One Of The Costliest Conditions Between 1996 To 2006

The number of Americans under care for depression and other mental illnesses nearly doubled between 1996 and 2006, and the overall cost of treating them jumped by nearly two-thirds, according to the latest News and Numbers from HHS' Agency for Healthcare Research and Quality.


According to the analysis by the federal agency, the number of patients treated for mental disorders, including depression and bipolar disease, increased from 19 million to 36 million. The overall treatment costs for mental disorders rose from $35 billion (in 2006 dollars) to nearly $58 billion, making it one of the top 5 costliest medical conditions between 1996 and 2006.


In addition, the study concluded that:
Heart disease, cancer, trauma-related disorders, and asthma were among the other five most costly conditions in both 1996 and 2006. Overall spending for heart disease treatment increased the least, from $72 billion in 1996 to $78 billion in 2006.

Spending for cancer treatment went from $47 billion to $58 billion; asthma costs rose from $36 billion to $51 billion; and the cost to treat trauma-related disorders climbed from $46 billion to $68 billion.

In terms of average per-patient cost, Cancer accounted for the highest, up slightly from $5,067 to $5,178, but treatment costs for trauma and asthma rose more steeply, increasing from $1,220 to $1,953 and from $863 to $1,059, respectively. In contrast, average per-patient spending for heart conditions and mental disorder fell from $4,333 to $3,964 and $1,825 to $1,591, respectively.
Citation:


Soni, Anita. The Five Most Costly Conditions, 1996 and 2006: Estimates for the U.S. Civilian
Noninstitutionalized Population. Statistical Brief #248. July 2009. Agency for Healthcare Research and
Quality, Rockville, MD. PDF.


Source
AHRQ

15.6% Of Hawaii's Public High School Students Obese - 5,600 Students Attempted Suicide Within Past Year

The latest Department of Health (DOH) data report on youth shows that an estimated
7,300 of Hawai'i's public high school students are obese (15.6%). Additionally, an estimated 5,600
students reported attempting suicide within the past year, a statistic that shows Hawai'i's youth are at
greater risk than the national average. However, the findings of the Youth Risk Behavior Survey (YRBS)
showed Hawai'i youth's decline in risky health behaviors, such as tobacco, alcohol and other drug use.
"While the survey shows Hawai'i's youth are doing well overall, we are concerned as public health
professionals about some key findings, particularly, poor nutrition, obesity and youth suicide," stated
Director of Health Chiyome Fukino, M.D. "These results show us that we need to continue to stress
primary prevention in the community and classrooms."


Overall Hawai'i's high school students report drinking less milk, eating fewer fruits and vegetables, and
being less physically active than students in the U.S. mainland. (See attached Table 1.) Data from the
YRBS illustrates the need for the continued implementation of policies and programs that promote good
nutrition and physical activity.


The DOH Healthy Hawai'i Initiative continues to provide funding and support for nutrition and physical
activity prevention and education strategies with schools, communities and the statewide health
promotion media campaign, Start Living Healthy. The DOH has partnered with the Department of Education to create and track the implementation of the Wellness Guidelines which help to create school
environments that make eating healthy and being physically active easier.


The percentage of Hawai'i's youth who contemplated suicide has decreased significantly since 1993
(27.8% in 1993 versus 18.5% in 2007). However, the percentage of Hawai'i's youth who have
contemplated suicide remains consistently higher than the U.S. average (14.5%). Moreover, the
percentage of Hawai'i youth who actually attempted suicide remains higher than the U.S. average (12%
versus 6.9%).


In response to the comparatively higher risk reported by Hawai'i youth, the DOH developed the Suicide
Prevention Program. Since its inception, the program has worked with its community partners to develop,
implement and evaluate strategies to prevent suicide, especially among youth. Established in October
2006, a statewide system to train gatekeepers in the Applied Suicide Intervention Skills Training
(ASSIST) has 46 trainers and over 475 trained gatekeepers across all islands. Last month, the DOH
received a $1.5 million grant ($500,000 per year for three years) from the Substance Abuse and Mental
Health Services Administration (SAMHSA) for youth suicide prevention and early intervention projects.
Additionally the DOH is hosting the 2nd Annual Statewide Suicide Prevention Conference on Friday,
November 21, 2008. Many of the sessions will focus on how to address the needs of teens at risk for
suicide.


The YRBS is an important tool to identify focus areas for prevention and treatment efforts; there is no
other tool that monitors the multitude of health risk behaviors of Hawai'i's youth on a regular basis. The
YRBS is completed every other year with the next administration to be conducted in Spring 2009.
Parents are notified several weeks prior to the survey date in their school, and parents are encouraged to
sign the parental consent form, so their child can participate in the survey. For the full report on the
YRBS visit hawaii/health.




Department of Health Hawai'i

healthuser.hawaii/health

Pain And Dysfunction Reduced By Acupuncture In Head And Neck Cancer Patients After Neck Dissection

New data from a randomized, controlled trial found that acupuncture provided significant reductions in pain, dysfunction, and dry mouth in head and neck cancer patients after neck dissection. The study was led by David Pfister, MD, Chief of the Head and Neck Medical Oncology Service, and Barrie Cassileth, PhD, Chief of the Integrative Medicine Service, at Memorial Sloan-Kettering Cancer Center (MSKCC). Dr. Pfister presented the findings at the annual meeting of the American Society for Clinical Oncology.



Neck dissection is a common procedure for treatment of head and neck cancer. There are different types of neck dissection, which vary based on which structures are removed and the anticipated side effects. One type - the radical neck dissection - involves complete removal of lymph nodes from one side of the neck, the muscle that helps turn the head, a major vein, and a nerve that is critical to full range of motion for the arm and shoulder.



"Chronic pain and shoulder mobility problems are common after such surgery, adversely affecting quality of life as well as employability for certain occupations," said Dr. Pfister. Nerve-sparing and other modified radical techniques that preserve certain structures without compromising disease control reduce the incidence of these problems but do not eliminate them entirely. Dr. Pfister adds, "Unfortunately, available conventional methods of treatment for pain and dysfunction following neck surgery often have limited benefits, leaving much room for improvement."



Seventy patients participated in the study and were randomized to receive either acupuncture or usual care, which includes recommendations of physical therapy exercises and the use of anti-inflammatory drugs. For all of the patients, at least three months had elapsed since their surgery and radiation treatments. The treatment group received four sessions of acupuncture over the course of approximately four weeks. Both groups were evaluated using the Constant-Murley scale, a composite measure of pain, function, and activities of daily living.



Pain and mobility improved in 39 percent of the patients receiving acupuncture, compared to a 7 percent improvement in the group that received usual care. An added benefit of acupuncture was significant reduction of reported xerostomia, or extreme dry mouth. This distressing problem, common among cancer patients following radiotherapy in the head and neck, is addressed with only limited success by mainstream means.



"Like any other treatment, acupuncture does not work for everyone, but it can be extraordinarily helpful for many," said Dr. Cassileth. "It does not treat illness, but acupuncture can control a number of distressing symptoms, such as shortness of breath, anxiety and depression, chronic fatigue, pain, neuropathy, and osteoarthritis."



"Cancer patients should use acupuncturists who are certified by the national agency, NCCAOM [National Certification Commission for Acupuncture and Oriental Medicine], and who are trained, or at least experienced, in working with the special symptoms and problems caused by cancer and cancer treatment," she added.



Acupuncture, a component of Traditional Chinese Medicine, originated more than 2,000 years ago. Treatment involves stimulation of one or more predetermined points on the body with needles, heat, pressure, or electricity for therapeutic effect. A report published by the Centers for Disease Control (CDC) indicated that more than 8 million Americans use acupuncture to treat different ailments. Acupuncture is being used in the palliative care of cancer to alleviate pain and chronic fatigue and to reduce postoperative chemotherapy-induced nausea and vomiting.







The study was funded in part from a grant by the National Cancer Institute. In addition to Drs. Pfister and Cassileth, other MSKCC contributors to the study include: Dr. Andrew Vickers, Dr. Gary Deng, Dr. Jennifer Lee, Mr. Donald Garrity, Dr. Nancy Lee, Dr. Dennis Kraus, Dr. Ashok Shaha, and Dr. Jatin Shah.



Memorial Sloan-Kettering Cancer Center is the world's oldest and largest private institution devoted to prevention, patient care, research, and education in cancer. Our scientists and clinicians generate innovative approaches to better understand, diagnose, and treat cancer. Our specialists are leaders in biomedical research and in translating the latest research to advance the standard of cancer care worldwide. For more information, go to mskcc/.

Mice Lacking Social Memory Molecule Take Bullying In Stride

The social avoidance that normally develops when a mouse repeatedly experiences defeat by a dominant animal disappears when it lacks a gene for a memory molecule in a brain circuit for social learning, scientists funded by the National Institutes of Health's (NIH) National Institute of Mental Health (NIMH) have discovered. Mice engineered to lack this memory molecule continued to welcome strangers in spite of repeated social defeat. Their unaltered peers subjected to the same hard knocks became confirmed loners - unless the researchers treated them with antidepressants.


"For both mice and men, social status is important; for mice, losing to a dominant mouse usually means that they avoid the dominant and they avoid social situations," explained NIMH director Dr. Thomas Insel. "These new findings add to a growing literature on the molecular basis of social behavior, helping us to know where as well as how social information is encoded in the brain."


The results reveal neural mechanisms by which social learning is shaped by psychosocial experience and how antidepressants act in this particular brain circuit. They also suggest new strategies for treating mood disorders such as depression, social phobia and post-traumatic stress disorder, in which social withdrawal is a prominent symptom. Drs. Olivier Berton and Eric Nestler, University of Texas Southwestern Medical Center (UTSMC), and colleagues, report on their study in the February 10, 2005 issue of Science.


Coursing from a hub in the center of the brain (ventral tegmental area), the relevant circuit mediates responses to emotionally important environmental stimuli via release of dopamine. Activity of this neurotransmitter is regulated in the circuit by brain derived neurotrophic factor (BDNF), which is known to play a key role in memory (nimh.nih/Press/prbdnf.cfm). Berton, Nestler and colleagues suspected that BDNF plays a similarly pivotal role in social learning.


To find out, they first subjected mice to a different dominant mouse daily for 10 days. Even 4 weeks later, the "socially defeated" animals vigorously avoided former aggressors or unfamiliar mice. BDNF and an indicator of gene expression increased markedly in their social memory circuit. Yet, the social avoidance behavior was reversible by giving the animals antidepressants.


Next, borrowing a page from gene therapy, the researchers injected mice with a kind of molecular magic bullet (using transgenic techniques and a virus) that selectively turned off BDNF expression in the social learning circuit. This exerted an antidepressant-like effect; the mice were spared from developing social avoidance behavior following repeated social defeat.


"Without BDNF in the circuit, an animal can't learn that a social stimulus is threatening and respond appropriately," explained Nestler.


He and his colleagues also discovered that social defeat triggered an upheaval in gene expression in the target area of the circuit, the nucleus accumbens, located deep in the front part of the brain - 309 genes increased in expression while 17 decreased. This pattern persisted even 4 weeks later, with 127 genes still increased and 9 decreased, paralleling the changes seen in social behavior. The researchers suggest that this alteration in gene expression encodes the motivational changes induced by aggression. When BDNF was deleted, or the animals were given antidepressants, most of the changes in gene expression reversed.


Identification of the products of the genes turned on and off by social defeat, BDNF and antidepressants revealed the workings of the molecular pathways involved in dopamine regulation of social motivational processes. The results suggest that chronic treatment with antidepressants restores social approach behaviors partly by interfering with the cascade of activity triggered by BDNF as the organism adapts to experience.


The researchers say the study "suggests new directions for antidepressant drug discovery."


Also participating in the study were: Colleen McClung, Vaishnav Krishnan, William Renthal, Scott Russo, Danielle Graham, Nadia Tsankova, Lisa Monteggia, David Self, UTSMC; Ralph Dileone, Yale University; Carlos Bolanos, Florida State University; Maribel Rios, Tufts University.


NIMH is part of the National Institutes of Health (NIH), the Federal Government's primary agency for biomedical and behavioral research.

NIH is a component of the U.S. Department of Health and Human Services.


Jules Asher

NIMHpressnih

NIH/National Institute of Mental Health

nimh.nih

Military Personnel Who Serve In War Zones Face Increased Risk For Alcohol Abuse, Anxiety Disorders, Depression, And Marital And Family Conflict

Military service in a war zone increases service members' chances of developing post-traumatic stress disorder (PTSD), other anxiety disorders, and depression, says a new report from the Institute of Medicine. Serving in a war also increases the chances of alcohol abuse, accidental death, and suicide within the first few years after leaving the war zone, and marital and family conflict, including domestic violence, said the committee that wrote the report at the request of the U.S. Department of Veterans Affairs, which asked for a comprehensive analysis of the scientific and medical evidence concerning associations between deployment-related stress and long-term, adverse effects on health.


Drug abuse, incarceration, unexplained illnesses, chronic fatigue syndrome, gastrointestinal symptoms, skin diseases, fibromyalgia, and chronic pain may also be associated with the stresses of being in a war, but the evidence to support these links is weaker. For other health problems and adverse effects that the committee reviewed, the data are lacking or contradictory; the committee could not determine whether links between these ailments and deployment-related stress exist.


Although the report cannot offer definitive answers about the connections between many health problems and the stresses of war, it is clear that veterans who were deployed to war zones self-report more medical conditions and poorer health than veterans who were not deployed. Those who were deployed and have PTSD in particular tend to report more symptoms and poorer health, the committee found. PTSD often occurs in conjunction with other anxiety disorders, depression, and substance abuse; its prevalence and severity is associated with increased exposure to combat.


A persistent obstacle to obtaining better evidence that would yield clearer answers is lack of pre- and post-deployment screenings of physical, mental, and emotional status. The U.S. Department of Defense should conduct comprehensive, standardized evaluations of service members' medical conditions, psychiatric symptoms and diagnoses, and psychosocial status and trauma history before and after they deploy to war zones. Such screenings would provide baseline data for comparisons and information to determine the long-term consequences of deployment-related stress. In addition, they would help identify at-risk personnel who might benefit from targeted intervention programs during deployment -- such as marital counseling or therapy for psychiatric or other disorders -- and help DOD and VA choose which intervention programs to implement for veterans adjusting to post-deployment life.


The study was sponsored by the U.S. Department of Veterans Affairs. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.

The National Academies

Psychiatrists Warn Men Face 'A Depressing Future'

Men face a 'depressing future' because of significant changes to the economic and social environment of Western countries, according to American psychiatrists.



Experts from Emory University School of Medicine in Atlanta, Georgia, USA, predict that rates of depressive disorders among men will increase as the 21st century progresses. They make their predictions in the March issue of the British Journal of Psychiatry.



Dr Boadie Dunlop, of Emory University School of Medicine, said: "Women are almost twice as likely to develop major depressive disorder in their lifetime as men. But we believe this difference may well change in the coming decades."



Dr Dunlop, with his colleague Tanja Mletzko, has identified two major societal shifts that are already underway in Western countries and which could increase rates of depression among men. First, they argue that society is encouraging men to discuss their feelings more, and stop being so tough and stoic. Second, Western economics are undergoing a 'profound restructuring', with traditional male jobs associated with manufacturing and physical labour being out-sourced to low- and middle-income nations, or becoming obsolete through technological advances.



Dr Dunlop said: "Dubbed by some the 'Mancession', the economic downturn has hit men particularly hard because of its disproportionate effect on traditional male industries such as construction and manufacturing. Research has shown that roughly 75% of jobs lost in the United States since the beginning of the recession in 2007 were held by men. There is little reason to believe that traditional male jobs will return in significant numbers with economic recovery.


"Furthermore, Western women are increasingly becoming the primary household earners, with 22% of wives earning more than their husbands in 2007, versus only 4% in 1970. Compared to women, men attach greater importance to their roles as providers and protectors of their families, and men's failure to fulfil the role of breadwinner is associated with greater depression and marital conflict."



Dr Dunlop concluded: "Western men will face a difficult road in the 21st century, particularly those with low levels of education. We believe economic and societal changes will have significant implications for men's mental health, and mental health practitioners need to be aware of these issues."

Cognitive therapy as good as antidepressants, effects last longer

Cognitive therapy to treat moderate to severe depression works just as well as antidepressants, according to an
authoritative report appearing today in the Archives of General Psychiatry. The study, conducted by researchers at the
University of Pennsylvania and Vanderbilt University, challenges the American Psychiatric Association's guidelines that
antidepressant medications are the only effective treatment for moderately to severely depressed patients.


Either form of treatment worked significantly better than a placebo, but the researchers demonstrated that cognitive therapy
was more effective than medication at preventing relapses after the end of treatment.


"We believe that cognitive therapy might have more lasting effects because it equips patients with the tools they need to
learn how to manage their problems and emotions," said Robert DeRubeis, professor and chair of Penn's Department of
Psychology. "Pharmaceuticals, while effective, offer no long term cure for the symptoms of depression. For many people,
cognitive therapy might prove to be the preferred form of treatment."


The study, which follows years of debate on the relative merits of cognitive therapy versus medication for more severe forms
of depression, is the largest trial yet undertaken on the topic; it involved 240 depressed patients. The patients were
randomly placed into groups that received cognitive therapy, antidepressant medication or a placebo. Patients in the
antidepressant group, which was twice as large as the other two, were treated with paroxetine (Paxil). Lithium or desipramine
was also given, as necessary.


After 16 weeks of treatment, patients in both the medication and cognitive therapy groups showed improvement at about the
same rate; however, cognitive therapy patients were less likely to relapse in the two years following the end of treatment.
According to the researchers, the return of symptoms might demonstrate that the medication may have blunted the appearance of
depression but did not affect underlying disease processes.


"Medication is often an appropriate treatment, but drugs have drawbacks, such as side effects or a diminished efficacy over
time," DeRubeis said. "Patients with depression are often overwhelmed by other factors in their life that pills simply cannot
solve. In many cases, cognitive therapy succeeds because it teaches the skills that help people cope."


The researchers also noted slight differences in the response to treatment between the two testing locations, with cognitive
therapy performing better at Penn and medications performing better at Vanderbilt. Researchers surmise that the medication
worked so well at the Vanderbilt clinic because more of the patients there were markedly anxious, in addition to being
depressed, and the medications used in the research have anti-anxiety properties.


The researchers further believe that cognitive therapy patients might have done better at Penn due to the experience level of
the therapists involved. Just as the experience of therapists may be important in cognitive therapy, so, too, can the
expertise of prescribing physicians play a role in the success of antidepressant medication treatment. Studies have shown
that antidepressant medication dosages are still largely a matter of physicians' discretion.


"Clearly, cognitive therapy is not for everyone, and its success could depend on variables such as the expertise of the
therapist and the patient's willingness or ability to take the therapy to heart," DeRubeis said. "The key to establishing any
form of treatment is rating its effectiveness in comparison to treatments currently in use, and this study has shown
cognitive therapy to be a viable alternative."


Clinical researchers at the Penn School of Medicine's Department of Psychiatry involved in the study were Jay D. Amsterdam,
Paula R. Young, John P. O'Reardon and Madeline M. Gladis. Vanderbilt researchers include Steven D. Hollon of the Department
of Psychology and Richard C. Shelton, Ronald M. Salomon, Margaret L. Lovett, and Laurel L. Brown of the Department of
Psychiatry. Contributing author Robert Gallop is with West Chester University's Department of Mathematics and Applied
Statistics.


The work was supported by a grant from the National Institutes of Health. GlaxoSmithKline provided medication and placebos.



Contact: Greg Lester

glesterpobox.upenn

215 573-6604

University of Pennsylvania

upenn


View drug information on Paxil CR.

The Psychology Of Fitness

It's only been a few weeks since you made that New Year's resolution to exercise more, but already you're finding reasons to skip days - maybe even weeks.



You know all the benefits of a healthy lifestyle: In addition to the weight loss, which would obviously be nice, exercise has been linked to reduced depressive symptoms and reduced risk for heart disease. Yet the temptation of sitting on the couch and watching TV instead of going for a short jog is just too great.



You're not alone. According to the surgeon general, more than 60 percent of American adults don't exercise regularly and 25 percent aren't active at all. The Center for Disease Control says that 34 percent of Americans are overweight and more than 72 million people were obese from 2005 to 2006. Inertia has become a national emergency.



For decades, psychologists around the world have studied why people exercise - and why they don't - and there's a growing body of work dedicated to helping you get up off the couch.



Preferring to be sedentary is not necessarily an innate human trait. In fact, most children are actually quite active, and people generally stay active all the way through high school. But many of them stop being active when they reach college.



McMaster University (Ontario, Canada) psychologist Steven Bray noticed this trend and decided to look at what was stopping students from continuing physical activity during the transition to college. He tracked 127 students and found that most students in their first year of college do, in fact, participate in significantly less exercise than they did the year before.



Bray found that about a third of college students were active in high school and continued to stay active throughout their first year of college. Another third was active in high school but was no longer active after going to college. And the final third is made up of people who were inactive in high school, the majority of which stay inactive.



"A lot of times it has to do with being too busy with school-related things, but it also comes down to changing social patterns," Bray says. "They get to be friends with people who are less active than they used to be. ??¦ And so there may be a culture of inactivity that starts to take place at first-year university."



But why do some freshmen manage to stay fit while others quickly put on the "freshman 15?" Bray found that students' sense of power in life - self-efficacy, in psychological jargon - is closely related to their level of physical activity. Their inability to cope with the environmental and social changes they face at college was a big reason why many stopped exercising. Many students, for example, are athletes in high school but are not talented enough to play on college sports teams.



Not only do they lose out on the vigorous exercise of playing sports, but they often lose their motivation to train, Bray says, which is why he argues that universities can help their students adapt by providing more intramural and club sport opportunities. For many, this change to a sedentary lifestyle then becomes something that persists through the rest of college and even into adulthood.
















"Personally, I believe that if we can teach people to adapt, that's going to be more successful and probably more efficient than having them adopt" new healthy habits later in life, he says.



And it's not just college. This rule applies to many of life's transitions - moving into the workforce, switching jobs or moving, getting married, having kids. In each of these moments, there is a chance for people to give up on exercise, possibly for good.



"What it comes down to at each of those points is if we have the skills to be flexible and keep believing that these things are good for us. ??¦ I can keep it a priority and make it something I schedule the rest of my life around," Bray says. "Unfortunately, [exercise] is one of the first things that goes when we get busy with other things."



Reasons for stopping exercise might not be the same across all age groups.



Rachel Newson, a psychologist at Flinders University in Australia, looked at this question of what motivates and prevents exercise in adults 63 and over. Barriers to exercise in Newson's study included "adverse weather conditions" and "not knowing what you're physically capable of." But the most common reason her participants didn't exercise was because of physical ailments and painful joints.



On the other hand, motivators for Newson's participants ranged from "I want to get out of the house" to "I want to be physically fit" to "I like to be competitive," and the most common responses were ones related to health and physical fitness, suggesting "that older adults are clearly aware of the potential health benefits of exercise," Newson writes.



Even adults who are fully healthy, have adapted to their environment, and live in a climate ideal for exercising, find plenty of reasons to sit on the couch instead. Clearly, other factors are at play. For one thing, it helps to have the right kind of intentions.



Jochen Ziegelmann, a psychologist at Berlin's Freie Universitat, has done work looking at goal-setting as it relates to exercise. He and a number of other psychologists who have done similar studies have found that participants who made implementation intentions ("I will walk to my friend's house and back every Monday, Wednesday, and Friday") were more likely to continue exercising after two weeks than were people who set goal-intentions ("I will exercise in my free time").



Once you have set your goals for implementing your exercise, it is easier to keep a certain exercise part of your routine. Then, you must be able to motivate yourself even on the days when you're feeling tired or bored or distracted. That's called self-control.



Roy Baumeister, a psychologist at Florida State University, has spent his career looking at self-control and decision making, and he has found that self-control is not an unlimited resource - the more you use your self-control, the more difficult it becomes to control your actions.



So if you spend all day trying to avoid the Snickers in the vending machine or trying not to say anything mean to your devilish child, you might not have the same stamina you normally would when you get home for an evening run.



"Stamina counts as a measure of self-control," Baumeister writes, "because it involves resisting fatigue and overriding the urge to quit."



Baumeister's team has done numerous experiments to test this theory, but many of them are similar. They have one set of participants complete an activity that depletes their self-control - such as watching a funny movie while trying not to laugh or resisting cookies and eating radishes instead - while another group does a similar activity that has no self-control component (they get to eat the cookies and laugh). Then, Baumeister tests the self-control of both groups with a second task, such as the mentally challenging Stroop test, a common tester of self-control, or by seeing how long participants can hold onto a handgrip, which focuses on physical stamina.



Baumeister relates the idea of self-control to a muscle that becomes more exhausted the more you use it, and his studies "all pointed toward the conclusion that the first self-control task consumed and depleted some kind of psychological resource that was therefore less available to help performance on the second self-control task."



A recent study by University of Kentucky psychologists Suzanne Segerstrom and Lise Solberg Nes supports this idea that controlling your emotions is hard work. They had participants either eat from a plate of cookies and chocolates while avoiding a plate of carrots or eat from the plate of carrots while avoiding the sweets. The heart rate variability of the participants who had to use their self control and avoid the tempting sweets (they even made the cookies warm and freshly baked) was higher than it was in those who didn't have to avoid that temptation. Then, all the participants were asked to work on difficult, or even impossible, anagrams.



The participants who had used up their self-control by avoiding the cookies and chocolates were less determined to finish the impossible anagrams.



"People are aware that they are sometimes vulnerable to saying the wrong thing, eating the wrong thing, or doing the wrong thing, but they may be unaware of their own self-regulatory capacity at any given time," Segerstrom and Solberg Nes write.



Baumeister says he doesn't know how far the muscle analogy goes for self-control. He says his team hasn't pushed anyone to the state of self-control exhaustion in the laboratory. But it appears that people begin to conserve their self-control as they approach exhaustion in the same way they would if they were getting physically tired. Plus, people seem to be able to exert self-control despite depletion if the stakes are high enough (like great athletes are able to do so even when they're exhausted).



There is even research suggesting that glucose depletion is related to depletion of self-control, much like a muscle. And, also similar to a muscle, research has shown that focusing on a task that requires self-control - exercising or managing your money, for example - improves other self-control-related tasks, such as cutting down on smoking and drinking or helping out with household chores.



"These peripheral improvements suggest that you're strengthening a core muscle rather than just working on the behavior," Baumeister says.



Recently, they have done work to test whether, like a muscle, you can exercise your self-control to make it stronger. They gave students a variety of self-control tasks to do every day - sit up and stand up straight whenever you think of it; do all minor activities, such as brushing your teeth, lifting a cup to your mouth, and using a computer mouse with your non-dominant hand; don't swear - and then they tested the students' progress on self-control tasks. Their results have been mixed so far. Many participants have been able to improve their self-control, but some have not. Baumeister says the results are promising, but it still needs more study.



"This has not only theoretical interest, but also practical," Baumeister says. "If we can actually make people stronger, then that would be a good, useful finding." And it might help you work up the strength to get off the couch.



Once you're off the couch, you have to figure out how to exercise to best meet your goals. That's what Thomas Plante has been working on for more than 20 years. Plante, a psychology professor at Santa Clara University, has looked at the psychological benefits of exercise in men and women. He focuses on keeping the exercise constant - 20 minutes at about 70 percent of the participants' maximum heart rate - and then he measures people's mood.



He has found that environment changes the type of psychological benefits one gets. Exercising indoors and alone is calming for many exercisers. However, if the goal of exercising is to feel energized, then participants are better off exercising outdoors and with friends.



"We think that's because you're enjoying it," Plante says. "You're experiencing more, you're enjoying the experience, and you're chatting and so forth during the exercise."



Many people look to personal trainers, not just to make exercise more fun but also to help them stay motivated. But this valuable exercise tool can also have unintended consequences.



Christopher Shields, a psychology professor at Acadia University in Canada, looked at people in group exercise classes and found that those with high proxy-efficacy (i.e. those who relied heavily on someone else to help them exercise) have low self-confidence when it comes to exercising on their own. This is an old psychological principle that goes back to Albert Bandura's self-efficacy theory, but it has real-life implications. It is insignificant if the people using the trainers have the ability to continue exercising with a trainer indefinitely. But if that is not possible, relying on a trainer can cause regular exercisers to lapse into a routine of indolence when the help disappears.



"Professionals working in the health and exercise field must recognize the potential dilemma that may arise when individuals use them as proxy-agents," Shields writes. He implores trainers to "actively collaborate with participants to encourage planned development for independence" while still under the trainer's supervision. If people who use trainers practice not just the exercises that they need to do but also the planning of the exercises, then, Shields says, they will be more prepared to continue their exercise routine after the trainer is no longer available.



Other tips are ones that you might already have as part of your exercising routine. Plante has done some preliminary work looking at the difference between exercising with a friend and exercising with an iPod. He has found that there is little difference between the enjoyment of the two forms of exercise. What matters is that you feel close with your friend and that you are listening to peppy music.



Plante has also done work with virtual reality, and his work has shown that people who wear a virtual reality headset while running or biking enjoy their experience more than people who do the same exercise while staring at a wall in a gym. Televisions provide a similar boost in enjoyment.



"We're always looking for ways that are going to get people to exercise regularly and what can make it more appealing to do," Plante says. "And this is some evidence to suggest that this can help people feel more engaged more rewarded by their exercise and so forth. And that's probably a good thing."



Though it's true that we are always looking for more ways to get people to exercise, Harvard professor Ellen Langer says it's possible that some people are already getting more exercise than they realize.



The surgeon general recommends at least 30 minutes a day of moderate exercise or 20 minutes of vigorous exercise three times a week. But those numbers are based on white-collar workers. Construction workers, for example, spend most of their day lifting and pushing and pulling. Trash collectors are often running from the truck to the sidewalk. And hotel cleaning attendants are running around rooms quickly and vigorously scrubbing bathrooms.



It's this last group that Langer and her student, Alia J. Crum, looked at in a 2007 study. Langer and Crum went to a variety of hotels to recruit volunteers from the cleaning staffs. They told one group that the work they were doing was already enough exercise to meet the surgeon general's daily requirements. Changing linen for 15 minutes burns approximately 40 calories, they told the attendants. And vacuuming for 15 minutes burns about 50 calories. The other group was not given this knowledge. When they returned to the hotels four weeks later, Langer and Crum found that the informed group showed a decrease in weight, blood pressure, body fat, waist-to-hip ratio, and body mass index.



It is possible that the people who were told about the health benefits of their work made other changes to their behavior, such as dieting or increased workload at the hotels. But all the room attendants were asked to report on these activities, and they did not report any changes. They simply became healthier just by being mindful of what they were doing.



"People are mindless with respect to most other exertion," Langer says. "People see themselves when they're eating. They don't pay attention to the amount of calories burned standing there and stirring. ??¦ I think this study reveals that we potentially have far more control over our psychological and physical functioning than most of us realize."



Langer has an anecdote that she tells when talking about this subject. She walks into a gym and sees a sign that says "Stairmaster on third floor." Many people, Langer hypothesizes, would consider their 20-minute Stairmaster workout - and not their three-flight walk up to it - their only exercise of the day.



So is it possible that most of us are actually getting more exercise than we think" Think about a typical day where you walk to the bus stop, walk to lunch, walk to the copying machine, walk through the supermarket on your way home, and walk around the kitchen while cooking dinner and setting the table. Even a Saturday of sitting around on your couch and watching college football probably involves a walk down to the store for some soda and chips and maybe a game of catch at halftime.



Think about that the next time you're talking about sitting on your couch all day.



Current Research on the Link between Exercise and Depression



Sure, you want to look good in those tight designer jeans, but the advantages of exercising don't stop at the waistline. There are obvious cardiovascular benefits to regular exercise that can help reduce the threat of heart disease. Plus, there is evidence suggesting it might aid in the prevention and treatment of nervous system disorders, and recent psychological research has shown that exercise can help reduce symptoms of patients with major depressive disorder.



Jim Blumenthal of Duke University noticed anecdotally that people felt better when they exercised and decided to look at whether exercise could reduce depressive symptoms in patients. He started out looking at non-depressed patients and found that regular exercise had a positive effect on depressive symptoms in these patients. "But the question was 'Really, what does that really mean?'" Blumenthal says. "If someone's not depressed to begin with and they have reduced symptoms, so what?"



So Blumenthal began to focus his research on patients with major depressive disorder. He assigned patients to one of three treatment groups: medication, exercise, or a combination of both. At the end of four months, the patients assigned to just exercise showed as much improvement as the other two groups. Just over 60 percent of the exercising patients no longer classified as clinically depressed at the end of the study, compared with 69 percent of the patients who were given only medication and 65.5 percent of those assigned to both.



What's more, in follow-up studies, Blumenthal found that patients who exercised had half the risk of being depressed six months after the experiment as those who didn't.



Blumenthal says he is not ready to recommend that people with major depression forgo their medicine in favor of exercise, but "I still remain very optimistic about exercise being an alternative to treatment for depression," he says.







Author: Ian Herbert



This article appears in the January 2008 issue of the Observer, the monthly magazine of the Association for Psychological Science.

Study Calculates Lost Wealth From Early Retirement Due To Mental Illness, Australia

People who retire early because of mental illness can find themselves with up to 93% less accumulated wealth than people who continue to work, according to an Australian study. This can leave them facing hardship and lower living standards in their old age.



Researchers from the University of Sydney and University of Canberra teamed up to quantify the cost of lost savings and wealth to Australians who retire early because of depression or other mental illness. Their findings are published in the February issue of the British Journal of Psychiatry.



The study was based on a survey of 8,864 people aged between 45 and 64 and an innovative economic model called Health&WealthMOD which together provided information about their employment, income, and wealth accumulated in savings, property and other financial investments. Of these people, 43 were not working because of depression, and 56 were not working because of other mental illnesses.



The mean total wealth accumulated by people who were employed full time and did not have any mental illness or other chronic health condition was AUS$398,098 (??218,954), while those who worked part time had accumulated a mean wealth of AUS$360,071 (??198,039).



In contrast, those who were not in the labour force due to depression had accumulated an average AUS$236,727 (??133,200), while those not in the labour force because of other mental illness had accumulated just AUS$148,771 (??81,824) on average.



Lead researcher Professor Deborah Schofield said: "Our study shows that people who retire early as a result of mental ill health not only have a loss of immediate income from employment, but also have a very low value of savings. We found that people who are not working because of depression or other mental illness have 78% and 93% less wealth accumulated respectively, compared with people of the same age, gender and education who are working and who have no mental health or other chronic health problems.



"We also found that people who are out of work because of depression or other mental illness are more likely to have the wealth they do have in cash, rather than in other higher-growth assets such as property or financial investments.



"This lower accumulated wealth is likely to result in lower living standards for these people, and the state may be required to provide financial support - a hefty financial burden. We believe that some of this financial burden could be avoided by investing more money in interventions to prevent the occurrence of mental illness in the first place."



References:


Schofield DJ, Shrestha RN, Percival R, Kelly SJ, Passey ME and Callander EJ. Quantifying the effect of early retirement on the wealth of individuals with depression or other mental illness.British Journal of Psychiatry 2011; 198: 123-128