Back to reality
The truth about cyberbullying. Plus: nitrous oxide for depression; creative arts for PTSD; and a major gap in suicide prevention research
Back to reality: the truth about cyberbullying
A new longitudinal cohort study in The Lancet Child and Adolescent Health makes for fascinating if dismal reading. To assess the effect of cyberbullying on mental health, the authors analysed data from the Environmental Risk Longitudinal Twin Study; this is a nationally representative cohort of 2232 British twins born between 1994 and 1995 (the authors got usable data from 2063 of these individuals). They were interested in two things: interviews after age 12 covering online and offline bullying, and mental health conditions at age 18.
It’s no surprise that cybervictimised adolescents were more likely than their non-victimised peers to report mental health problems at age 18: generalised anxiety disorder, major depressive disorder, self-harm or suicide attempts, PTSD, conduct disorder, and psychotic experiences. But the data suggests that an excessive focus on the “cyber” aspect of the bullying might be misleading; of the 419 who reported being cyberbullied, only 10 had exclusively been cyberbullied. And the authors report that “a meaningful proportion of this association [between cyberbullying and mental health problems] was accounted for by offline forms of victimisation”.
In other words, our rush to tackle new threats from mobile phones and social networks risks distracting us from the phenomenon of what the authors call “poly-victimisation”, that is, children’s lives being made a misery through any and all means available. Don’t target the cyber, at least not exclusively; target the bullying.
It’s a gas, gas, gas: N2O as a rapid-acting antidepressant
There’s a real need for antidepressant treatments that work faster than the two weeks or so that current medication takes. This is something I’m painfully aware of through my jobs in old age psychiatry, in which patients had genuinely, and alarmingly, life-threatening depressive conditions, and I and my colleagues did not have the luxury of time. The trouble is that the rapid antidepressant treatments we have—ECT and ketamine—are not without substantial adverse effects (or, indeed, controversy).
We need to bear two things in mind: first, side effects must be weighed up against the severity of the condition being treated; and second, no treatment will be side-effect free, but a wider range of treatments with different mechanisms makes it more likely that the patient can find something that is tolerable and acceptable for their specific needs and preferences.
So it is with great interest that I came across this meta in eBiomedicine on the use of nitrous oxide—aka N20, or laughing gas—as a rapid-acting antidepressant. The authors synthesised data from 247 patients in seven trials, and show that it appears to have an antidepressant effect with only mild and transient adverse effects. Unfortunately, the antidepressant effect is also pretty transient, and vanishes after a week. It’s certainly worth further investigation, but as ever with rapid treatments, maintenance of the effect remains a major challenge.
Creative arts versus PTSD in young people
There’s much to admire in this new Nature Mental Health meta (lay summary here) on creative arts therapies for PTSD in young people, not least the authors’ focus on non-Western settings and their interest in scalability. According to their analysis, trained facilitators are just as good as, if not better than, licenced therapists when it comes to effectiveness, which bodes well. But I worry whenever I see a large effect size in the context of somewhat patchy study quality; I agree with the authors that this paper should be the prompt for large, robust trials rather than immediate implementation.
Means restriction and suicide prevention
I have long been interested in suicide prevention as a key aim of mental health research and practice, so any new paper in the field usually catches my eye. This BMJ Mental Health article gives a useful overview of systematic reviews. While the nature of this study means that there is little surprising, it does point to a key gap: “With the exception of pesticide restrictions, lower and middle-income settings were not represented.” This really has to be prioritised: we need to see how well-established principles of means restriction can be made to work in global settings. Many, many lives could be saved.