The federal plan for health science and technology’s response to the opioid crisis: understanding sex and gender differences as part of the solution is overlooked

Abstract The Fast-Track Action Committee on (the) Health Science and Technology Response to the Opioid Crisis recently released their draft report for public comment. This report provides the “roadmap” for a coordinated federal research and development response to the opioid crisis. Other than noting the important concerns regarding maternal and neonatal exposure to opioids, the report overlooks the laboratory, clinical, and epidemiological data that inform the need for further research on sex and gender differences in opioid addiction that have critical gender-based treatment and prevention implications. As we embark on research and development, investigations into the neurobiology of pain, opioid use, and addiction must include both females and males in model systems and, similarly, psychological and sociocultural investigations must study women and men. All data should be reported by sex and gender so that gender-specific treatment and prevention strategies derived from this research are provided to practitioners and the public. We encourage biomedical researchers and clinical care providers, as well as the public, to insist that a successful response to the opioid crisis should highlight the importance of understanding sex and gender differences in the current opioid epidemic.https://deepblue.lib.umich.edu/bitstream/2027.42/146784/1/13293_2018_Article_215.pd

Investigating Veterans’ Pre-, Peri-, and Post-Deployment Experiences as Potential Risk Factors for Problem Gambling

Background and aims Gambling disorder and its comorbid diagnoses are observed at higher rates in military veterans than in the general population. A significant research gap exists regarding the relationships of veterans’ life and service experiences to problematic gambling. The present study explored pre-, peri-, and post-deployment factors associated with problem gambling in veterans. Methods Veterans of Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn (n = 738; 463 males, and 275 females) completed questionnaires via structured telephone interview. We conducted bivariate and multinomial logistic regression analyses exploring associations among problem-gambling severity and socio-demographic variables, psychiatric comorbidities, and 10 scales of the Deployment Risk and Resilience Inventory measuring experiences pre-, peri-, and post-deployment. Results Approximately 4.2% of veterans indicated at-risk or probable pathological gambling (ARPG) post-deployment (two or more DSM-IV criteria for pathological gambling). Bivariate analyses found more severe gambling in males, higher frequencies of post-traumatic stress disorder, substance dependence, traumatic brain injury, panic disorder, and depression in veterans with ARPG, and higher general harassment during deployment, and lower social support and more stressful life events post-deployment in those with ARPG. In multivariable models, both post-deployment factors remained significantly associated with ARPG. Discussion The study suggests that problem gambling among veterans is related to service experiences, and particularly to life experiences post-deployment. Conclusions Adverse service and life experiences and lack of social support may contribute to the risk of problem gambling in military veterans. Investigation of how Veterans Affairs clinical settings may serve veterans following deployment to prevent behavioral addictions is warranted

Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies

Funder: American Foundation for Suicide Prevention (AFSP); doi: https://doi.org/10.13039/100001455Funder: Brain and Behavior Research Foundation (Brain & Behavior Research Foundation); doi: https://doi.org/10.13039/100000874Funder: MQ Brighter Futures Award MQBFC/2, International Bipolar Foundation, For the Love of Travis Foundation, Women's Health Research at Yale, John and Hope Furth EndowmentFunder: U.S. Department of Health & Human Services | NIH | National Institute of Mental Health (NIMH)Funder: Brain and Behavior Research Foundation (Brain & Behavior Research Foundation)Funder: Robert E. Leet and Clara Guthrie Patterson Trust (Robert E. Leet & Clara Guthrie Patterson Trust); doi: https://doi.org/10.13039/100000938Funder: U.S. Department of Veterans Affairs (Department of Veterans Affairs); doi: https://doi.org/10.13039/100000738Abstract: Identifying brain alterations that contribute to suicidal thoughts and behaviors (STBs) are important to develop more targeted and effective strategies to prevent suicide. In the last decade, and especially in the last 5 years, there has been exponential growth in the number of neuroimaging studies reporting structural and functional brain circuitry correlates of STBs. Within this narrative review, we conducted a comprehensive review of neuroimaging studies of STBs published to date and summarize the progress achieved on elucidating neurobiological substrates of STBs, with a focus on converging findings across studies. We review neuroimaging evidence across differing mental disorders for structural, functional, and molecular alterations in association with STBs, which converges particularly in regions of brain systems that subserve emotion and impulse regulation including the ventral prefrontal cortex (VPFC) and dorsal PFC (DPFC), insula and their mesial temporal, striatal and posterior connection sites, as well as in the connections between these brain areas. The reviewed literature suggests that impairments in medial and lateral VPFC regions and their connections may be important in the excessive negative and blunted positive internal states that can stimulate suicidal ideation, and that impairments in a DPFC and inferior frontal gyrus (IFG) system may be important in suicide attempt behaviors. A combination of VPFC and DPFC system disturbances may lead to very high risk circumstances in which suicidal ideation is converted to lethal actions via decreased top-down inhibition of behavior and/or maladaptive, inflexible decision-making and planning. The dorsal anterior cingulate cortex and insula may play important roles in switching between these VPFC and DPFC systems, which may contribute to the transition from suicide thoughts to behaviors. Future neuroimaging research of larger sample sizes, including global efforts, longitudinal designs, and careful consideration of developmental stages, and sex and gender, will facilitate more effectively targeted preventions and interventions to reduce loss of life to suicide

Women, opioid use and addiction

In the midst of the current coronavirus pandemic, the United States continues to struggle with an ongoing opioid epidemic, initially fueled by widespread prescribing of opioid medications during the 1990s. The primary reason for prescribing opioids is to treat pain. Women have more acute and chronic pain and have been prescribed these drugs in significantly greater numbers than men. Comparison of women and men with chronic pain also shows that women receive the majority of prescription opioids, and the use of these prescribed medications became the major pathway to misuse and addiction for women. Yet, recognition of the extent of women’s exposure to opioids and the attendant consequences has been limited. Attempts to stem the overall tide of the epidemic focused on reducing the availability of prescription opioids. However, as these medications became more difficult to obtain and treatment opportunities were limited, many turned to other synthetic opioids, such as heroin and fentanyl. Thus, the public health crisis of opioid addiction has endured. This paper highlights the importance of understanding differences among women and men in opioid use and its biological and psychosocial effects to advance the gender‐based treatment approaches and effective public health policy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/166190/1/fsb221303.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/166190/2/fsb221303_am.pd

Research on Posttraumatic Stress Disorder in the Context of the COVID-19 Pandemic: A Review of Methods and Implications in General Population Samples

Increasing concern about the mental health sequelae to the COVID-19 pandemic has prompted a surge in research and publications on the prevalence of posttraumatic stress disorder in general population samples in relation to the pandemic. We examined how posttraumatic stress disorder in the context of the COVID-19 pandemic has been studied to date and found three general themes: (1) assessment of posttraumatic stress disorder and posttraumatic stress disorder symptoms relied on self-report measures and often did not determine direct trauma exposure as required by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Criterion A to diagnose posttraumatic stress disorder; (2) inadequate assessment of pre-existing mental disorders and co-occurring stress; and (3) the use of cross-sectional designs in most studies, often relying on snowball sampling strategies to conduct online surveys. Notwithstanding these methodological limitations, these studies have reported moderate to severe posttraumatic symptoms in 25.8% of the general population on average in relation to the pandemic (ranging from 4.6% to 55.3%). Opportunities for advancing future research that will inform public health planning are discussed

Differential Associations Between Excess Body Weight and Psychiatric Disorders in Men and Women.

peer reviewedBACKGROUND: The current investigation is the first large-scale population-based study from France that documents the association between excess body weight and common psychiatric disorders, and examines the influence of gender on the association between excess body weight and these disorders. A recent plan has been implemented in France to treat the rising rate of those who are overweight or obese, and we seek to demonstrate whether integrated treatment of excess weight and psychiatric conditions appears as indicated. MATERIALS AND METHODS: Data were drawn from a cross-sectional general population survey of 17,237 adults. Past-year psychiatric disorders were assessed using the Composite International Diagnostic Interview-Short Form. Body mass index was used to determine excess weight status. RESULTS: Overall, 3.7% of the sample were underweight, 57% were normal weight, 28% were overweight (35% of men, 22% of women), and 11% were obese (11% of men, 11% of women). Being overweight was more common in men than women, although obesity did not differ by gender. Sociodemographic variables significantly associated with weight status included, age, marital status, education, employment status, income level, and population density. Adjusting for these variables, being overweight was associated with major depression and other disorders among women and inversely associated with drug abuse and dependence among men. Obesity was associated with major depression, panic disorder, agoraphobia, social phobia, specific phobia, and obsessive-compulsive disorder among women. Only generalized anxiety was associated with obesity among men. CONCLUSION: Past year, mental disorders were more likely associated with being overweight or obese among women as compared with men. The prevalence of these co-occurring psychiatric disorders in the context of the rising rate of obesity in France indicates a clear need for psychiatric assessment and treatment in caring for those with excess weight, especially women. Preliminary reports suggest this need is unmet within the otherwise progressive move in France to assist those struggling with excess weight