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Serious gaps in mental health care in Washington prisons, report warns

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Inadequate psychiatric care in Washington prisons puts some prisoners at increased risk of self-harm and suicide and contributes to long stays in solitary confinement, according to a new report from the Ombudsman.

The report, which has been in the works for months, raises the alarm over numerous shortcomings, including high-case psychiatric staff and desperate prisoners waiting to see a psychologist.

Other issues identified by the Office of the Corrections Ombuds (OCO) include problems with prescribing psychiatric drugs and a disciplinary process that often fails to take into account the mental health of the detainee.

“The big realization is that we need more mental health services for incarcerated people,” said Joanna Carns, director of the OCO.

In response to the report, the Department of Corrections (DOC) recognized the continuing challenges in the delivery of mental health care to prisoners and pointed out the way it addresses many of the issues, including by working with outside prison reform groups.

The Ombuds Report is the latest in a series of OCO investigations that focus on the state of mental health care in Washington prisons – a strategic priority for the independent bureau, established in 2018.

Previous reports have focused on prisoners who have died from suicide, the effects of solitary confinement, and concerns related to the quarantine and isolation of prisoners due to COVID-19. Future OCO reports will examine the use of violence and restraints among prisoners with mental illness and the well-being of transgender prisoners.

The latest research paints a picture of a prison system that is ill-equipped to meet the mental health needs of a complex population of approximately 15,000 prisoners, spread across 12 prisons and 12 layoffs. Of particular concern to investigators is anecdotal evidence that inmates of color with mental disorders are treated differently. The report also highlights the particular challenges LQBTQ prisoners face.

A new report from the Office of Corrections Ombudsman finds evidence of numerous shortcomings in the availability of mental health care in Washington prisons. According to the report, prisoners in distress often have to wait to see a psychologist, and a lack of robust treatment options means that some prisoners end up in solitary confinement.

Washington State Department of Corrections /

The report is based on an analysis of more than 300 mental health complaints at the OCO between November 2018 and November 2020. In addition, investigators interviewed detainees, checked mental health data and spoke to DOC employees and administrations.

Countless problems

A key finding is that mental health professionals who are responsible for initial examinations of new prisoners are overwhelmed. According to the report, employees have to do an “extremely high” number of screenings each day and sometimes the location where the screenings are held is not private. This is an issue that the OCO previously reported.

Another persistent problem the report identifies is the lack of access to mental health professionals. This can manifest itself in a variety of ways, from delays after a prisoner sends a letter asking for a counselor to a lack of group therapy options.

Prisoners have also complained that DOC doctors reduced or stopped their existing psychiatric medication, or prescribed medication that was ineffective.

In terms of discipline, the report notes that when prisoners break the rules and get into trouble, “the process does not provide an adequate opportunity to take full account of a person’s mental health,” the report said.

In particular, the report describes a cycle in which an incarcerated person acts based on their mental health and then receives a sanction that does not address the root of the behavior. In some cases, individual prisoners suffer numerous violations due to untreated mental illness.

An example of this was included in the OCO’s 2020 annual report. It was a prisoner who injured himself. When the prison staff tried to hold the person, he hit one of the staff and attacked him. As a punishment, the prisoner was placed in solitary confinement and lost part of his “good time” credit for an earlier release.

Another major concern of the OCO is suicide in prison. Since last year, the OCO has published a number of reports of suicide in prisons, along with several recommendations on how to address the problem. This latest report urges the DOC to adopt these earlier recommendations and warns that in some cases the agency has not properly tracked and tracked prisoners who have harmed themselves or on suicide watch.

Another ongoing concern of the OCO is the use of solitary confinement, also known as intensive management or segregation. The report notes that people with serious mental illnesses are often kept in solitary cells for long periods of time.

“This practice contradicts years of research that have shown that time in solitary confinement exacerbates mental symptoms,” the report said.

DOC has worked with the Vera Institute of Justice, a national prison reform group, for the past few years to reduce the use of solitary confinement.

To address mental health deficiencies, the OCO report makes a number of recommendations, including that the DOC reduce the number of cases for staff examining incoming prisoners for mental health issues.

The report also calls on the DOC to increase its mental health staff to ensure timely treatment and expand opportunities for group therapy. As part of this effort, the report says, it is important that clinical staff reflect the racial and ethnic diversity of prison inmates.

Regarding the disciplining of inmates with severe mental illness, the report suggests that the DOC suggest alternatives to the standard sanctions and, if necessary, seek input from mental health workers.

The report also urges the DOC to reduce the time detainees with severe mental illnesses spend in solitary confinement and to investigate best practices for accommodation and treatment options that do not include segregation.

In addition to hiring more mental health staff, the OCO would also like the DOC to train its frontline detainees to better support the mental health needs of detainees. This includes training on mental health awareness and de-escalation tactics. In response, DOC said it is already prioritizing de-escalation, but there are recognized opportunities for more specific training for people in specialized occupational classes.

One final recommendation urges the DOC to work with the Department of Social and Health Services (DHSH) to facilitate the “temporary transfer” of prisoners in need of inpatient psychiatric care to western or eastern state hospitals.

DOC answers

In a lengthy, formal response to the report, DOC said it plans to ask lawmakers to fund two additional psychology positions as well as funds to improve the prisoner reception process next year.

In the meantime, the agency hopes to have a new assessment of the physical space available in prisons for group therapy sessions by September 30. However, DOC warned that finding suitable rooms and then staffing groups with a correctional officer to ensure security is an ongoing challenge. COVID-19 was another barrier to convening groups.

Next year, DOC plans to broadly roll out a new disciplinary program for people with severe mental illness that it has tested in two prisons. The program is modeled after a similar program by the Oregon Department of Corrections and requires the involvement of the inmate’s primary therapist in the disciplinary process.

The ministry also noted that since 2012 it has reduced the use of administrative segregation by a third and reduced the median stay in isolation by 33 percent. DOC said it has also stopped the use of segregation as a form of sanction and is trying alternatives to solitary confinement such as “transitional pods.”

In a statement on Wednesday, DOC said it was working with the OCO, acknowledging “known challenges related to the delivery of mental health services.”

“The department continues to work to equip and train its staff with the knowledge and skills necessary to support people with mental illness, and continues to review and revise its workforce to achieve adequate caseloads to maintain mental health services and to provide where the greatest patient needs are, ”the press release said.

The agency also said it is working with the University of California San Francisco’s AMEND program to bring a public health culture into the prison system. The DOC is also developing intensive outpatient treatment options that allow people with severe mental illness to receive treatment in the general prison population while in residence.

The current DOC secretary is Cheryl Strange, who previously ran DSHS and was previously CEO of Western State Hospital. Strange was appointed to the position in April. Carns, the ombudswoman, said she hoped Strange would prioritize the recommendations in the report given her mental health background.

“The goal is that people who are incarcerated are better off than when they entered Germany and receive psychiatric care [are] a critical component of that, ”said Carns.

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‘Anomie in post-Covid world reason for more urban suicides’ | Nagpur News

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Dr. Abhishek Somani, Professor, Department of Psychiatry, Indira Gandhi Government Medical College and Hospital, invokes the concept of “anomie” by French sociologist Emile Durkheim to explain the state of despair and hopelessness that many face after rounds of limitations and Go through isolation. An increasing sense of dejection is a very strong indicator of suicidal intent, adds a widespread sense of fear about the unpredictability of the disease, economic problems due to lockdown, an increase in alcohol and other substance use, resulting health problems, and verbal and physical violence added home. All of these are an important mix in leading a person to suicidal intent. In an interview with TOI, Dr. Somani, who is also the past president of the Psychiatric Society of Nagpur, elaborates on this burning issue.
Excerpts …
Q. What are your general observations on the upward trend in suicides?
A. The social fabric is getting weaker. The earlier concepts of shared families and extended families are now seen in fewer and fewer cases. That important safety net is now missing. With the world at your fingertips with the Internet, a Pandora’s box has been opened. So you are not only influenced by what is good, but also by things that are not so good. The Blue Whale game is a good example. The internet also draws attention to the lack of sophistication in one’s life. And since everyone publishes photos of the best time ever, a doubt creeps in: “Why am I not as happy as you are? Maybe I’m a failure. People got through the pandemic without any significant increase in suicide gestures in the immediate period. But the stress of the pandemic and its social, economic and personal effects will increase mental health problems in the long run, and we will see an increase unless urgent action is taken to alleviate these problems.
Q. Has the lockdown and Covid phase increased suicidality?
A. Surprisingly not. There was an immediate period of escalation in anxiety and depression as the pandemic level began to decline, but the incidence of self-harm and committed suicide was lower than expected. We can speculate that maybe everyone was in trouble together, so people drew strength from misery.
Q. Why are middle class people and even the financially secure people at the end of their lives?
A. Overall, the suicide rate tends towards cities. Large cities account for nearly 25% of suicide deaths in urban areas, according to NCRB 2019 data. The same data suggests that over 90% of suicides are committed by people from the lower social classes, but common sense suggests that it can be disgusting to have suicides reported by those who are better at hiding a shameful death .
Q. How do you justify this underreporting claim?
A. The French sociologist Emile Durkheim’s concept of “anomie” comes to mind. Anomie is a state of society in which generally accepted values ​​and meanings lose their acceptance, but new values ​​(with common consensus) have yet to be developed. People at risk develop a sense of senselessness and emotional emptiness. This feeling of helplessness and hopelessness is a strong indicator of suicidal intent. Financial stability is by no means a protection against psychological stress. Peace of mind emerges from feeling satisfied with everything one has. So money doesn’t do much to prevent suicide, but it definitely helps to hide it. Anomie can develop in the post-covid world where normal interactions and communication have become a risky activity. So putting on a mask and maintaining physical distance are not a natural part of our behavior.
Q. Are you suggesting that the mask and physical distancing need to go at some point?
A. We cannot maintain physical distance for life. You can see that people don’t put on their masks. Few of those who are very cautious or paranoid about Covid still adhere to the norms. Quiet, everyone has left. This is a kind of anomie that happens when normal social rules are given up or broken but nothing else could be picked up. This created a “I don’t know what to do” feeling. The normal structure of life is disturbed and there is no alternative. The mind cannot exist in an ambivalence. This ambivalence causes fear and fear has suicide as one of the results. You have to take sides, yes or no. There is a lot of indecision due to Covid. You don’t know when the pandemic will end, who will survive if you get infected.
Q. Is the pandemic the only cause of mental health problems?
A. All of the previous factors related to suicide have been accelerated by the stress caused by Covid and Lockdown. 33% of suicides are due to family problems, 17% to illness, 6% to addiction and 10% to money problems. Each of these factors increased during the lockdown. Some families have grown closer, but domestic violence has increased dramatically as any police officer will tell you. Alcohol consumption has risen sharply. Covid’s hospital stay has severely impacted the family’s savings. So overall, the pandemic has accelerated the fire of the mental health problems that people will face over the next few years. An increase in mental disorders would increase the number of episodes of self harm, unless we can make people aware of the importance of seeking help in a timely manner.
Q. What are the early signs and indicators of mental illness?
A. A noticeable change in a person’s behavior over a period of typically 2 weeks or more. He / she becomes more moody, loses interest in ordinary activities, appears withdrawn or aloof, sloppy looking, suddenly crying or flying in anger, talking about how better it would be if he / she wasn’t around, etc. But it requires a really keen eye to see that we often give a long rope to those who have recently suffered a traumatic event. We consider this part of normal sadness. Conversations about dying are not. The number of violent and homicidal offenses is increasing significantly, which can also be seen in the context of the lockdown-associated anomie, in which social rules and values ​​lose importance.
Q What are the solutions?
A. Prevention is easier said than done. It will take years of effort to create mental health professionals capable of meeting India’s tremendous needs. There are currently fewer than 10,000 psychiatrists in India, the overwhelming majority of whom serve urban areas. In the meantime, a sustained campaign in the media to highlight symptoms of mental illness, support and recognition from well-known personalities and simple things like a break from ambition, changes in a more balanced lifestyle, and sustainable life goals will help.

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She fought to save her child from an eating disorder. Now, she combats the misconceptions.

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Nine years ago, JD Ouellette almost lost her then 17-year-old daughter Kinsey to an almost fatal anorexia nervosa. Kinsey has since recovered, but her mother is still in the trenches helping other parents and children in San Diego teach the tools and strategies they need to win their own battle against eating disorders.

According to the National Eating Disorders Association, EDs will affect approximately 20 million women and 10 million men in America during their lifetime. These conditions include anorexia and bulimia nervosa, as well as binge eating and eating disorders that restrict avoidance. They can affect people of any age, ethnicity, and socio-economic group. They can occur in children as early as 7 years of age and are particularly common in women between the ages of 15 and 24. Unfortunately, only about 10 percent of people with eating disorders are ever treated.

Ouellette, a 57-year-old mother of four from Scripps Ranch, said parents may not be able to spot the signs due to widespread myth and outdated information online. New research over the past 20 years has dramatically changed scientists’ knowledge of these diseases and their treatments, Ouellette said that sharing this new information with families can save lives.

“What I’m telling parents is to trust their Spidey sense,” Ouellette said, referring to Spider-Man’s oversensitivity to danger. “If you feel like something is wrong, especially after reading it in the Union-Tribune, get a review right away.”

JD Oullette stands outside the UC San Diego Health Eating Disorders Center in La Jolla.

(Ariana Drehsler / The San Diego Union-Tribune)

In 2012, Kinsey Ouellette underwent treatment at the UC San Diego Eating Disorders Center for Treatment and Research in La Jolla, widely recognized as one of the leading eating disorder research organizations in the country. JD Ouellette said she was so grateful for her daughter’s recovery that she volunteered to look after other parents of children starting treatment. When the university where she worked as an administrative specialist was closed in 2018, she devoted herself entirely to her new calling.

Today she runs her own coaching service for parents and patients with eating disorders; serves as a parenting mentor on the University of California Center’s Parents Advisory Board at San Diego; is the mentor for EQUIP, a 2-year program for the treatment of fully virtual eating disorders in San Diego; is a co-founder of the International Eating Disorders Family Support Network and the World Eating Disorders Action Day; and is a former board member for Families Empowered and Supporting Treatment of Eating Disorders (FEAST).

Ouellette said that most Americans, and a surprising number of pediatricians, fail to realize that eating disorders is not a personal “choice” but an inherited, genetic, neurobiological disorder. Although they can be triggered by social or environmental factors (such as bodyshaming or the media promotion of thin body types), they should be understood as complex medical and psychiatric diseases.

“One of the greatest things I’ve learned is that everything I thought I knew about EDs was just plain wrong,” she said. “I was a teacher with a master’s degree and was wrong.”

Decades ago, traditional treatment for young people with severe eating disorders was removing them – or a “parental ectomy,” as Ouellette calls it – because parents were seen as the cause of the problem. Now, according to Ouellette, research has shown that the most effective method is called family-based treatment, where a patient’s family is part of the trained “team” that guides the patient to physical and emotional health at home.

“No family causes an eating disorder, but every family needs to change to fight an eating disorder,” said Ouellette. “Think of it this way: your family’s operating software does not have an ED control patch, so you need to update your software to the version that combats ED.”

Ouellette said teens with these disorders share temperamental traits in common. They are often great students and high performing athletes and artists who work hard, are internally motivated, and used to practicing perfectly.

“These are very valuable skills, but once you develop ED, the same discipline applies. There is a light and a dark side to these skills, ”she said.

That was the case with Kinsey, who was a top student and high school athlete. After graduation, she and a few friends decided to “re-model” a “healthy diet” to avoid the “new 15” pounds that students often put on in their freshman year of college, but within two months of starting the makeover, Kinseys became Health so precarious that her family urged her to seek treatment at UC San Diego.

“Some people burn slowly, but it was a long way from the cliff. It was amazing, ”said Ouellette. “She has said many times in the years since that if we hadn’t intervened, she would have been dead within a few months.”

“Think about your disorder as a person. If your child screams, yells, throws objects, refuses to eat, negotiates meals, whatever it is, you are not witnessing or interacting with your actual child. You are face to face with the personification of their disorder. “

Kinsey, the daughter of JD Oullette, as she wrote in an essay about her eating disorder

Ouellette said family-based treatment works, but it’s not easy. Marriages can break up and parent-child relationships can be permanently broken without the support of a comprehensive treatment program like the one at UC San Diego, Rady Children’s Hospital in San Diego, or EQUIP.

“If a plate of food is like a plate of snakes and spiders for a child, they will behave appropriately, and that’s hard for anyone,” Ouellette said. “It’s really easy for parents to feel like you are against their child, but in reality, it is you against the eating disorder your child is controlling.”

In an essay, Kinsey wrote about her battle with anorexia for FEAST, she said that children affected by an eating disorder will say and do almost anything if they believe their parents are in the way of their weight goal.

“Think about your disorder as a person,” wrote Kinsey. “If your child is screaming, yelling, throwing objects, refusing to eat, negotiating meals, whatever it is, you are not experiencing or dealing with your actual child. They face the personification of their disorder. That hatred comes from a losing eating disorder. So remember that the more hate you feel, the better you work. “

Treatment and recovery outcomes vary, but Ouellette said that in most cases, aggressive treatment can resolve the disorder in three to four months, but it can take one to three years to achieve full recovery. Relapses are common. Some studies show a relapse rate of 36 percent in anorexic patients and 35 percent in bulimic patients.

Ouellette said she advises parents who are having difficulty treating their child to focus on the end goal and stay on track.

“It is important that you approach this with compassion, consistency, and with the knowledge that whatever you do is protection, even if it feels like punishment or seems filtered,” she said. “Feeding our children and monitoring exercise and other behaviors in order to achieve and maintain their optimal physical and mental health is our right and responsibility as parents.”

Common warning signs of an eating disorder

  • Sudden weight loss or weight gain
  • Eating disorders, such as skipping breakfast or lunch habitually
  • Take part in fasting challenges or keep track of everything you eat in a day
  • Sudden change in mood or socializing habits
  • Self-esteem problems related to body image
  • Decision for vegans or vegetarians
  • Anxiety or depression
  • Exercise compulsion
  • Eating rituals (such as over-chewing or not touching food)
  • Girls experience irregular menstruation or a break in menstruation
  • Boys with focus on bodybuilding and body fat
  • Dizziness or fainting
  • Stomach cramps or acid reflux
  • Sleep disorder
  • Cuts and calluses on the top of the finger joints (from vomiting)
  • Yellow skin (eaten from too many carrots)
  • Difficulty concentrating
  • Dry skin and hair

– Source: National Association for Eating Disorders

Self-care tips for parents of a child with an eating disorder

  • Learn psychoeducation, which is a therapeutic intervention for patients and family members to understand and manage illness.
  • Work with providers to equip them with the same skills that you are teaching your child.
  • In order to avoid conflict, both parents should remain on the same side when treating their child.
  • Divide up the responsibilities in your family, ideally so that the father can take on a more active role.
  • Engage in bonding activities with your child in treatment.
  • Do guided meditation for at least five minutes a day.
  • Learn to play a musical instrument.
  • Go outside and take a walk.
  • Avoid activities that cause stress.

– Source: JD Ouellette

Resources:

National Association for Eating Disorders – nationaleatingdisorders.org
Families supports and supports the treatment of eating disorders (FEAST): fest-ed.org
UC San Diego Center for Treatment and Research for Eating Disorders – eatdisorders.ucsd.edu
Rady Children’s Hospital-San Diego Eating Disorders Treatment Unit – rchsd.org
EQUIP virtual family-based treatment program – equip.health
Parent and patient coaching by JD Ouellette: jdouellette.com

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How insulin resistance can lead to depression

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Stanford Medicine scientists have found that insulin resistance can increase the risk of developing major depressive disorder. The results of the study were published in the American Journal of Psychiatry. “If you are insulin resistant, your risk of developing major depressive disorder is twice that of someone who is not insulin resistant, even if you’ve never experienced depression before,” said Natalie Rasgon, MD, PhD, Professor of Psychiatry and Behavioral Sciences.

The WHO estimates that almost 5% of adults suffer from depression. Symptoms include incessant sadness, despair, sluggishness, trouble sleeping, and loss of appetite.

Also read: How I recognized OCD and what impact it had on my life

Some factors that contribute to this deeply debilitating disease – such as childhood trauma, the loss of a loved one, or the stress of the COVID-19 pandemic – we cannot prevent. But insulin resistance is preventable: it can be reduced or eliminated through diet, exercise and, if necessary, medication.

Rasgon shares lead authorship of the study with Brenda Penninx, MD, PhD, Professor of Psychiatric Epidemiology at the Medical Center of the University of Amsterdam. The study’s lead author is Kathleen Watson, PhD, a postdoctoral fellow in Rasgon’s group.

Studies have confirmed that at least 1 in 3 of us walk around with insulin resistance – often without knowing it. The condition is not caused by an inadequate ability of the pancreas to secrete insulin into the bloodstream, as is the case with type 1 diabetes, but rather by the decreased ability of cells throughout the body to obey this hormone’s command.

The job of insulin is to tell our cells that it is time for them to process the glucose that floods our blood from our food intake, its production in our liver, or both. Every cell in the body uses glucose as fuel, and each of these cells has receptors on their surface that, when bound to insulin, signal the cell to take in the precious source of energy.

But an increasing proportion of the world’s population is insulin resistant for a variety of reasons, including their insulin receptors that don’t bind properly to insulin, excessive caloric intake, sedentary lifestyle, stress, and lack of sleep. Eventually, their blood sugar levels become chronically high.

Once these levels stay above a certain threshold, the diagnosis is type 2 diabetes, a treatable but incurable disease that can lead to cardiovascular and cerebrovascular disease, neuropathy, kidney disease, limb amputation, and other unhealthy outcomes.

Associations between insulin resistance and several mental disorders have already been established. For example, about 40 percent of patients who suffer from mood disorders have been shown to be insulin resistant, Rasgon said. But these assessments are based on cross-sectional studies – snapshots of populations at a single point in time.

The question of whether one event was the cause or the result of the other – or whether both were the results of a different causal factor – is best clarified by longitudinal studies that people can typically track over years or even decades to determine which event occurred first.

Also Read: How Reflection Can Accelerate Growth

As part of a cross-institutional collaboration within the Rasgon research network, founded in 2015, the scientists received data from an ongoing longitudinal study in which more than 3,000 participants were closely observed in order to get to know the causes and consequences of depression: the Dutch study on depression and anxiety.

Rasgon is Stanford’s lead investigator and Penninx is the lead investigator. “The Dutch study, with its meticulous monitoring of a large test population for nine years and still growing, presented us with a great opportunity,” said Watson.

The Stanford team analyzed data from 601 men and women who served as controls for the Dutch study. At the time of their enrollment, they had never suffered from depression or anxiety. Their median age was 41 years. The team measured three proxies of insulin resistance: fasting blood sugar levels, waist circumference, and the ratio of circulating triglyceride levels to that of circulating high-density lipoprotein – or HDL, known as “good” cholesterol.

They examined the data to see if those who were diagnosed with insulin resistance were at an increased nine-year risk of developing major depressive disorder. The answer to all three measures was yes: they found that a moderate increase in insulin resistance, as measured by the triglyceride-to-HDL ratio, was associated with an 89 percent increase in new cases of major depressive disorders.

Similarly, every two-inch increase in belly fat was associated with an 11 percent higher rate of depression, and an increase in fasting plasma glucose of 18 milligrams per deciliter of blood was associated with a 37 percent higher rate of depression. “Some subjects were already insulin resistant at the start of the study – there was no way of knowing when they first became insulin resistant,” said Watson. “We wanted to be more specific about how quickly the connection started,” added Watson.

The researchers therefore limited the next phase of their analysis to the approximately 400 test subjects who not only had never experienced significant depression, but also showed no signs of insulin resistance at the start of the study. However, within the first two years of the study, nearly 100 of these participants became insulin resistant. The researchers compared the likelihood of this group of developing major depressive disorder within the next seven years with that of participants who had not become insulin resistant after two years.

Also read: Pressure is a privilege, believes soccer player Ashutosh Mehta

While the number of participants was too small to determine statistical significance for waist circumference and triglyceride-to-HDL ratio, the fasting glucose results were not only statistically significant – meaning they were not incidental – but Also clinically meaningful – that is, important enough to worry: Those who developed prediabetes within the first two years of the study were at 2.66 times the risk of major depression after the nine-year follow-up up compared to those who received normal fasting glucose test results. had the two year point.

Bottom line: Insulin resistance is a strong risk factor for serious problems, including not only type 2 diabetes but also depression. “It is time providers took into account the metabolic status of patients with mood disorders and vice versa by assessing mood in patients with metabolic disorders such as obesity and high blood pressure,” said Rasgon. “To prevent depression, doctors should check their patients’ insulin sensitivity. These tests are readily available in laboratories around the world and they are inexpensive. In the end, we can curb the development of lifelong debilitating diseases, ”concluded Rasgon.

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