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Talking therapies may reduce healthcare burden…

Referring patients with common mental health problems to talking therapies may cut their use of healthcare services and the amount of sick leave they take, according to research published online in the Journal of Epidemiology and Community Health.1

Researchers led by Dr Simon de Lusignan (Department of Health Care Management and Policy, University of Surrey, UK) assessed routinely collected healthcare data for more than 152,000 patients registered with family doctors in East London and in Yorkshire, in a bid to quantify the impact of common mental health problems, such as depression and anxiety, on health service use and sick leave.

They looked particularly at antidepressant prescriptions, use of emergency care and outpatient clinics, number and length of hospital admissions, and number of sick notes issued by family doctors. 

They compared use of healthcare resources among patients with and without common mental health problems at the same practices between 2007 and 2009, and six months before and after referral to talking therapies under the UK government’s Improving Access to Psychological Therapies (IAPT) scheme.

Around one in five patients had been diagnosed with depression or anxiety, one in 10 of whom was diagnosed during the study period. People with common mental health problems used significantly more health resources overall than those without. They had five times as many prescriptions for antidepressants and admissions to hospital. They stayed in hospital longer, had more outpatient appointments, used more emergency care services and were issued with 10 times as many sick notes.

Only just over 6% of patients with a common mental health problem were referred to IAPT during the study period. Virtually all of them were aged 20 to 54; nearly two thirds were women. They tended to be white and come from more socially deprived areas. 

Those referred to IAPT used fewer hospital services and were issued fewer sick notes. But they were prescribed more antidepressants, which may indicate that they stuck to their treatment plans better, or that they were referred soon after their condition had developed, suggest the authors.

“There were marked differences between those with [common mental health problems] and people referred to IAPT and the rest of the registered population,” say the authors. “At a time when there is pressure to control increasing health costs, this study suggests that IAPT may contribute to reducing health service usage.”

…and neurological study reveals ‘stress code’

Altering the levels of a certain protein produced by the brain may be the key to reducing levels of stress, according to findings2 published in the Proceedings of the National Academy of Sciences (PNAS).

Researchers at the University of Leicester, led by Dr Robert Pawlak, found that mice whose brains produced less lipocalin-2 were less ‘outgoing’ and preferred to ‘hide in the dark’.  Dr Robert Pawlak, lecturer in Neuroscience at the University of Leicester, said the breakthrough study had determined that production of the protein by the brain may help to protect individuals from “too much anxiety” and help organisms to cope with various adverse life events.

Dr Pawlak, from the University Department of Cell Physiology and Pharmacology, said: “Every day stress ‘reshapes’ the brain – nerve cells change their morphology, the number of connections with other cells and the way they communicate with other neurons. In most cases these responses are adaptive and beneficial – they help the brain to cope with stress and shape adequate behavioural reaction. However, upon severe stress things can get out of control, the brain ‘buffering’ capacity is exhausted and the nerve cells in the hippocampus – an area of the brain responsible for learning and memory – start to withdraw their processes, don’t effectively communicate with other cells and show signs of disease.

“One strategy that brain cells particularly like to use to cope with stress is changing the shape of tiny processes they normally employ to exchange information with other neurons, called dendritic spines. Spines can be as small as 1/1000 of a millimeter and have various shapes. Some spines (called “thin” spines) are like children – very mobile and inquisitive, constantly change shape and “conversation” partners  – they help us learn new things. Once spines learn, they change into  mature ‘couch potatoes’ – they are mushroom-shaped, have stable connections, do not change partners and do not like to move”.

“Mushroom spines help us remember things we once learned – but it is not always good. Some very stressful events would better be forgotten quickly or they may result in anxiety disorders. There is a constant battle of forces in our brain to help maintain the right balance of thin and mushroom spines – or how much to remember and what better to forget.

“We have identified a protein that the brain produces in response to stress in order to reduce the number of mushroom spines and therefore reduce future anxiety associated with stressful events. This protein, lipocalin-2, is normally not produced, but its fabrication dramatically increases in response to stress in the hippocampus. When we added lipocalin-2 to neurons in culture the way it occurs on stress, neurons started losing their ‘memory spines’ – the mature, mushroom-shaped ones.

“Identification of lipocalin-2 as a new player the brain uses to help us cope with stress is an important step forward. We are getting closer to deciphering molecular mechanisms of stress that, if not functioning properly, may lead to stress-related psychiatric diseases”.

The work was supported by a Marie Curie Excellence Grant from the European Commission.

References

1 de Lusignan S, Chan T, Parry G, Dent-Brown K, Kendrick T.  Referral to a new psychological therapy service is associated with reduced utilisation of healthcare and sickness absence by people with common mental health problems: a before and after comparison.  J Epidemiol Community Health 2011. (doi:10.1136/jech.2011.139873)

2 Mucha M, Skrzypiec AE, Schiavon E, Attwood BK, Kucerova E, Pawlak R.  Lipocalin-2 controls neuronal excitability and anxiety by regulating dendritic spine formation and maturation. Proceedings of the National Academy of Sciences 2011

Published on: November 3, 2011

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