Despite recent tragedies of modern-day bullying like those of Phoebe Prince and Carl J. Walker-Hoover, little research has been conducted on the effects of cyberbullying. Recently, a research team at Finland’s Turku University investigated the prevalence of cyberbullying and its consequences on adolescents’ health. In their study, researchers found that teenagers who are victims or perpetrators of cyberbullying, or both, experience a wide range of both physical and mental problems. The study, conducted by lead researcher Andre Sourander, MD, PhD and team, is available in the July open access issue of the Archives of General Psychiatry.

 The researchers surveyed 2,215 Finnish teenagers ages 13 to 16 in a cross-sectional study measuring their involvement in cyberbullying, cybervictimization, family situation, mental health, and substance use. Within the six months prior to the study, 4.8 percent of respondents were victims of cyberbullying, 7.4 percent of respondents were perpetrators of cyberbullying, and 5.4 percent of respondents were both bullies and victims of cyberbullying. The study showed that the majority of the cyberbullying was performed via instant messaging or discussion groups. Furthermore, victims and cyberbullies were most often of the same age and gender. When it came to cyberbullying, 16 percent of female respondents were harassed by boys, while only 5 percent of male respondents were harassed by girls.

The new threat of cyberbullying creates greater obstacles when it comes to protecting children. Unlike traditional bullying that usually involves physical confrontations and threats, rumors, cruel pranks, or social isolation, cyberbullying allows bullies to extend the playing field into more personal settings that can violate one’s sense of privacy. Cyberbullying can be performed instantaneously, in groups, and in multiple and simultaneous medias, allowing for hundreds of other individuals to join the ridicule, and making the harassment almost unavoidable. Most significantly, bullies may feel less inhibition when it comes to their aggressiveness since cyberbullying can virtually be performed anonymously. Sociality is somewhat removed in the technological arena, and teenagers can be victimized within the confines of their own homes and at all times of day. 

Researchers conclude that cyberbullying is associated with both psychosomatic and psychiatric problems in teenagers, and that more preventative and interventionist methods are needed to protect kids from a threat that can virtually be present at all times. Cyberbullying can come in hundreds of different forms using today’s technology, and practically anyone can partake in cyberbullying who normally would not engage in aggressive behavior in social settings. Researchers point to their study’s results as evidence for the need of new policies to monitor and protect children and teens from the dangers of cyberbullying in school and home environments.

Short-Term Planning

The first thing to do is to ensure the person is stable. This will most likely require hospitalization, depending on the method of the attempted suicide and how life-threatening the situation is at the present. The suicidal person cannot be left alone during the days immediately following the attempt. They are not rational, and, contrary to popular belief that once they’ve tried to commit suicide and failed, they won’t attempt it again, the truth is that many times they are likely to try it again at some time in the future.

For some persons admitted to the hospital following a suicide attempt, the greatest risk is the first few hours after admission. If possible, stay with the person as long as possible during visiting hours while he or she is in the hospital. If you can’t be there for the duration, ask others to help spell you. The idea is to monitor what’s going on with your loved one. This means asking lots of questions of the doctors and nurses, helping to comfort your loved one, and getting help for him or her if needed.

Suicide prevention experts caution that the person who has already attempted suicide may try death by suicide while they’re in the hospital. For others, this risk is greatest when they return home from the hospital.

Again, make sure that the individual is not left alone nor has access to any means of making good on their intention to do themselves in. This means sweeping the house for any prescription and over-the-counter drugs, poisons, knives and sharp objects, ropes and cords and, especially, firearms. If your loved one has been living alone, it’s best if you take him or her into your own home – or move in with them – to ensure their immediate safety.

If medications are prescribed, make sure that the individual takes them as directed. Many of the medications will help to stabilize mood, especially depression.

Pay attention to your loved one’s diet. Make it a point that he or she takes vitamins and supplements as recommended by the doctor in order to build up strength that’s probably been depleted. Often times, the suicidal person has neglected themselves to the extent that they are seriously malnourished.

Let Them Talk

During the time after the suicide attempt is when you want to engage the person in conversation as much as possible. Let him or her talk – as long and as often as they wish. In your comments, it’s important not to be judgmental or critical of the person. That is counter-productive and will discourage any opening up. It’s also very important to show how much you love the person. He or she is most likely devastated, feeling incredibly lost, ashamed, guilty, fearful of the future, and afraid, most of all, that you will withdraw your love.

Therapy Should Be First on the List

Your loved one needs professional counseling by a licensed and certified therapist. This must be primary on the list of short- and long-term priorities. In addition to individual counseling, group therapy may be recommended. Make sure the person attends every counseling session. Don’t allow them to slack off, since therapy takes time to work – and it’s often difficult and painful for the individual. The tendency is to minimize the risk, saying “I’m okay now. I don’t need any more therapy.” Don’t buy into this. Push, gently, for continued therapy.

Regular medical checkups are also a good idea. Following the suicide attempt, physical and/or mental changes occur, and healing takes time. If drugs and alcohol were also part of the individual’s lifestyle, these conditions need treatment as well.

Make Important Lifestyle Changes

Obviously, things can’t go back to the way they were before. This often means a severe change of lifestyle, but not always. In any case, some things have to change. Where there was no counseling, there now has to be. The suicidal person will not “get better” on their own. The reason they got to the point of despair, enough to want to end their life, won’t just go away. The underlying causes may not even be known or acknowledged by your loved one. All this has to be dealt with, and the best person to help in the recovery is a professional therapist.

Through therapy, your loved one will begin to discover the reasons that led him or her to attempt suicide. Depression, anxiety, fear, shame, disgust and other emotions will surface that are very powerful and very difficult and painful to deal with. The therapist will suggest short- and long-term behavioral changes that will help your loved one to better adjust to life.

There is no miraculous pill that will quell suicidal thoughts. There isn’t any set time period during which the person will be healed. Every person heals on their own timetable. Healing can’t be forced, no matter how much you or your loved one wants it.
Exercise plays an important part in rebuilding a healthy physical body. You, and other family members and friends, can help by encouraging your loved one to engage in sports, running, hiking, swimming, working out, or any strenuous physical activity. Be sure that this vigorous exercise takes place a minimum of four days a week, and for 30 minutes to an hour each day. Exercise produces endorphins, the body’s natural feel-good chemicals, which help to reduce feelings of depression.

Be aware that many persons who attempted suicide become withdrawn. They don’t want to talk. They don’t want any contact with others, including anyone from the outside world. Respect that feeling, but do encourage your loved one to go out and participate in activities again as he or she is ready to. Make sure you’re not too pushy on this point, however, as that can be misconstrued and backfire. When they are ready, take them out to activities and events – but don’t go anywhere that’s too stressful. Your loved one won’t be ready for that for quite a while.

Be Alert for Suicide Warning Signs

After the suicide attempt, it doesn’t mean you’re home free – no matter how much your loved one tells you not to worry. Although some individuals do not exhibit any warning signs prior to an attempted suicide, about 75 percent do show one or more signs. You do need to be alert for any of the following warning signs of suicide – as they can occur anytime during the days and weeks after the initial attempt:

• Depression or sadness all the time – Note that suicide prevention experts say untreated depression is the number one cause of suicide.
• Talking or writing about death or suicide
• Writing a will
• Giving away possessions, especially those the person holds most dear
• Dramatic mood changes
• Change in eating or sleeping habits
• Loss of interest in activities – especially those previously enjoyable
• Poor work or school performance
• Abuse of drugs or alcohol
• Change in personality
• Withdrawal from family members and friends
• Feelings of hopelessness, being helpless or feeling trapped
• Demonstrating strong feelings of anger or rage
• Acting impulsively or recklessly
• Feeling excessive shame and/or guilt

If your loved one is in immediate danger, call 911 without delay. Suicide prevention lifelines are available 24/7 – so make use of them if your loved one needs to talk with someone urgently. Call 1-800-SUICIDE (1-800-784-2433) or the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or in Spanish, 1-888-628-9454.

Here is a link to suicide prevention hotlines in the United States, as well as some International locations: http://www.suicide.org/suicide-hotlines.html.

Resources and Help

Keep yourself informed about things to do for your loved one. Helpful books and literature are readily available from a number of sources. The Feeling Blue Suicide Prevention Council is a non-profit community service organization serving Pennsylvania and the Tri-State Area. Their website contains a lot of helpful information and links. Here is a link to their booklet, “After an Attempt: The Emotional Impact of a Suicide Attempt on Families.” The booklet covers important Do’s and Don’ts, dealing with a traumatic event, what to say to the attempt survivor, ways the family can communicate their feelings, how an attempt affects spouses, siblings and parents, and additional resources.

The U.S. Department of Health and Human Services (HHS) National Suicide Prevention Lifeline has a downloadable booklet, “After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department.” The booklet covers what happens in the emergency department. First, there’s an assessment. The doctors determine any psychiatric or medical conditions present, determines if they are or have been treated, and if the suicidal thoughts or actions are the result of recent change or longstanding behavior. Next, the doctors seek to find out what the person did to harm themselves, and if there were previous attempts. They also ask if there are any current stressors, and/or anger in relationships. Doctors need to know what support systems there are, and who is or will be providing treatment, and what treatment programs are a good match for the individual and the family. The booklet further covers how you can help the emergency department, next steps after the emergency visit, what you need to know following the emergency department visit – how to keep your loved one safe, reduce risks, creating a safety plan, self care, moving forward and phone numbers for support groups.

The National Suicide Prevention Lifeline website has links to various suicide prevention organizations and peer support organizations where you can find more resources and help. Many of them have online libraries with downloadable publications, booklets and information to help family members following a suicide attempt by their loved one.

The Depression and Bipolar Support Alliance (DBSA) is the leading patient-directed organization in the United States focusing on depression and bipolar disorder. They operate a toll-free referral line 1-800-826-3632 and have a grassroots network of more than 1,000 patient-run support groups across the country.

The National Alliance for the Mentally Ill (NAMI), a nonprofit, grassroots, self-help, support and advocacy organization of consumers, family and friends of people with mental illnesses, has information on mental illnesses, programs, support groups, medication and treatment, and more. There are more than a thousand local affiliates in 50 states.

The Center for Mental Health Services (CMHS), of the Substance Abuse and Mental Health Services Administration (SAMHSA), maintains a mental health services locator, which you can use to help find services, facilities and resources in your state.

Should You Worry?

It’s natural to worry that your loved one may try another suicide attempt. But you can’t let this worry define you or derail your efforts to get professional help for him or her. You may also wish to undergo counseling yourself, to be better able to deal with the situation and feel better about helping your loved one on his or her journey to healing.

It’s important that you have your own support system in place. You can’t always be watching over your loved one, fearful that another attempt is imminent. This will just add to your stress level and make it impossible to maintain a serene environment. Get help around the house – whether that entails a friend or other family member coming over to be present while you take some needed away time, or while you work, or to transport your loved one to and from treatment or group meetings, or some other reason.

Remember that one of the most powerful emotions is love. The more you can show how much you love your family member that you nearly lost to suicide, the better off you both will be. Encourage other family members to be understanding, nonjudgmental and patient as well. It won’t be easy, and sometimes it may seem next to impossible. But your love and understanding will go a long way toward helping your loved one on the road to recovery.

Emotional distress may have a lot to do with it, along with physical disabilities or conditions, substance abuse, and other factors. We’ll look more in depth at some of the causes of suicide among the young and the old in a minute, but first, let’s examine some statistics.

Statistics on Suicide and Older Adults

Every year, the U.S. Census Bureau issues updated estimates of the total population of the United States. As of July 1, 2008, there were an estimated 39 million Americans aged 65 and older, or 13 percent of the total U.S. population of 304 million. Those aged 60 or over totaled 54 million, or 18 percent of the population.

A profile of older Americans for 2008 by the Administration on Aging (AOA) shows that:

• About 30 percent (10.9 million) of noninstitutionalized older people live alone (7.9 million women and 2.9 million men)
• Half of women (49 percent) age 75 and older live alone
• Persons reaching age 65 have an average life expectancy of an additional 19 years (20.3 years for females and 17.4 years for males)
• The population age 65 and older will increase from 35 million in 2000 to 40 million in 2010 (a 15 percent increase) and to 55 million in 2020 (a 36 percent increase for the decade)
• About 3.6 million elderly persons (9.7 percent) in 2007 were below the poverty level – a statistically significant increase from the 2006 poverty rate of 9.4 percent

Statistics released by the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS), reveal the following alarming points:

• Suicide accounts for twice as many deaths as HIV/AIDS
• Suicide has been among the 10 leading causes of death since 1975
• Firearms are the most common method of suicide, used in about 6 of every 10 suicides
• In the month prior to their suicides, 75 percent of elderly persons visited a physician
• Suicide rates remain the highest among Americans aged 65 and older
• Males are four times more likely to die from suicide than females
• There is an average of one suicide among the elderly every 90 minutes

Statistics on Suicide and Adolescents and Young Adults

A fact sheet released in 2006 by the National Adolescent Health Information Center (NAHIC) shows that:

• Suicide is the third leading cause of death (behind accidents and homicides) among adolescents and young adults (ages 10 through 24)
• Young males are more likely than their female peers to commit suicide – averaging more than five times the rate of same-age females
• The highest suicide rate exists among American Indian/Alaskan Native male adolescents
• The suicide rates for young adult males have fallen dramatically in the past decade
• Female adolescents are more likely to attempt suicide than their male adolescent peers – reporting sad feelings, suicidal thoughts and attempts twice as many times as their male counterparts

A brochure available from the American Psychiatric Association (APA), “Let’s Talk Facts About Teen Suicide” points out that among young people aged 15 to 24:

• Fifty-three percent of young people who commit suicide abuse substances
• Depression increases the risk of a first suicide attempt by at least 14-fold
• Over half of all kids suffering from depression will attempt suicide at least once, and more than 7 percent will die
• Firearms are used in a little more than half of all suicides

Depression – What is it?

According to a brochure on depression from the American Psychiatric Association (APA), depression is a serious mental illness that negatively affects the way you feel, how you think, and how you act. Depression is characterized by a feeling of deep sadness or a marked loss of interest or pleasure in activities.

Other symptoms of depression include sudden loss of appetite or significant weight loss unrelated to dieting, insomnia or oversleeping, increased fatigue or loss of energy, irritability or restlessness, inappropriate feelings of guilt or worthlessness, difficulty making decisions, thinking or concentrating, and thoughts of death or attempts at suicide.

The APA says that depression occurs to nearly one in 10 adults each year. It affects twice as many women as men. On average, depression first appears in the late teens to mid-20s, and is also common in older adults.

Risk Factors for Suicide

Whether young or old, risk factors for suicide include the following:

• Previous suicide attempts – If a person has tried to commit suicide before, they are at greater risk of trying to do so again.
• Psychiatric diagnosis – According to suicide prevention experts, any psychiatric diagnosis elevates the risk of suicide. Some psychiatric diagnoses, however, pose an even greater risk. These include depression, bipolar disorder substance use disorder, personality disorder, and co-occurring disorder (more than one at the same time).
• Family history – Any individual with a family history of suicide attempts or completed suicide is at a higher risk of suicide.
• Suicidal thoughts – Especially when the occurrence is sudden, any increase in suicidal thoughts is a cause for alarm. Most suicides occur within one year of the first thoughts about committing suicide.
• Significant loss or stressful event – Loss of a job, foreclosure, death of a loved one, financial disaster, or divorce may precipitate a suicide attempt. Many individuals who attempted suicide reported a loss or stressful event immediately prior to their attempt.
• Access to firearms – Since firearms are the most common suicide method, access to firearms significantly increases risk of suicide.
• Feelings of hopelessness – When a person feels completely hopeless, their thoughts may quickly turn to suicide as the only way out.
• Making a suicide plan – While putting down thoughts of suicide on paper or planning how to carry out a suicide attempt does not necessarily mean the person will actually commit suicide, it’s an indication that something is seriously wrong. If nothing else, it could signal that a suicide attempt is imminent.
• Incarceration – An individual facing jail time or who is serving time is at increased risk of suicide.
• Recent celebrity or other suicides – Suicide researchers have documented this phenomenon extensively. When celebrities commit suicide, or a friend, loved one or acquaintance does so, some individuals commit suicide themselves. This is known as “suicide by contagion” or “copycat suicide.”

In addition, there are some specific suicide signals that pertain to young people. These include frequent episodes of running away or incarceration, family instability or significant problems with parents, difficulties dealing with sexual orientation, unplanned pregnancy, impulsive and aggressive behavior or frequent expressions of rage. Other suicide signals among young people include substance abuse, withdrawal from friends and family, sudden drop in academic performance, giving away personal possessions, no interest in activities that once were pleasurable, talk of death or the afterlife when sad or bored.

Suicide and the Elderly

According to the National Strategy for Suicide Prevention, the risk factors for suicide among the elderly differ from those among the young. Depression has a much higher prevalence among the elderly. They are often isolated socially and frequently use highly lethal methods. Older persons make fewer attempts per completed suicide, have a higher male-to-female ratio than other groups, have more physical illnesses, and have recently visited a physician or health-care provider prior to attempting suicide.
The three most common suicide methods among the elderly are firearms (71 percent), overdose by means of liquids, pills or gas (11 percent), and suffocation (11 percent).

Factors relative to the population of those over 65 that play a role in future suicide rates include: increase in numbers of elderly population, status of health, availability of services, and overall attitudes about aging and suicide. Media accounts of terminally ill patients wanting an assisted suicide or op-ed pieces about the morality of helping a seriously ill person to die further add to the growing belief that ending one’s life by suicide may be an acceptable choice.

What Can Be Done?

Anyone, young or old, who exhibits signs of suicidal thoughts or behavior, or who has one or more risk factors for suicide, needs help. Parents, friends, teachers, loved ones, coworkers and others should take the initiative and try to get help for the person who is troubled. If they will talk, listen to what they have to say. Allow them to discuss their feelings of sadness or hopelessness, or the problems that are causing them so much emotional pain.

The American Psychiatric Association counsels that you should always take the concerns seriously when someone indicates they’re going to commit suicide, that they’d be better off dead, that others would be happier if they were gone. Don’t be afraid to question the individual about what they have planned. You can’t help prevent their suicide attempt if you don’t know what they plan to do – or if you do nothing. They need to know that you care, and that they are not alone. Do not leave the person alone to work things out. Strongly encourage them to seek professional help, but if you feel they are not likely to do so, or if you need immediate help, contact the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).

Someone who is contemplating suicide as the only way out needs to be reassured that depression and tendencies toward wanting to commit suicide are very treatable. You can find help for the individual through family physicians, local mental health associations, hospital department of psychiatry, family/social services agency, community mental health center, county medical society, or mood disorders program that’s affiliated with a university or medical school. Treatment may involve medication to stabilize depression or other mental and/or physical condition, talk therapy, or a combination of medication and counseling.

Be There to Help

More than anything, the person who is contemplating suicide needs the intervention of someone who cares. You need to be ready to listen and to act, without any thought of not wanting to get involved. Everyone has times in their life when things may seem too much to bear. We’ve all been there, whether it’s the loss of a parent or loved one, some unforeseen tragedy, our own stupidity, selfishness, greed or immersion in substance abuse, criminal activity or a physical or mental condition that renders us incapable of thinking clearly and rationally about our options. Sometimes we need help, too. Your compassion and action in a time of desperate need may mean the difference between life and death. Be there to help those at greatest risk of suicide – the young and the old. But be there for anyone who has reached such a point of despair. Be there to help.

Remember that giving the gift of life is one of the greatest services we can perform. And another point to remember is that sometimes just being willing to listen and to help is enough to turn that suicidal thought or contemplated action around. The test of time works well. If you can get the individual to see beyond the immediate sadness or hopelessness and get him or her into professional treatment, the crisis may well be averted. At the very least, you will have been successful in thwarting the current suicide attempt. Is this too much of a burden? Wouldn’t you want the same human kindness extended to you and/or your loved ones in a time of similar need?

Additional Resources

More information on suicide prevention is available from the following:

· National Suicide Prevention Lifeline

· National Suicide Prevention Lifeline Crisis Center Locator

· Mental Health America

· National Alliance on Mental Illness

· Suicide Prevention Action Network USA (SPAN USA)

· Teens Health (Nemours)

· Suicide Prevention Resource Center

· Preventing Suicide Network

· Suicide Hotlines

Science Daily recently posted a release that examined a report in the October issues of Archives of General Psychiatry, one of the JAMA/Archives journals.

Overall, organized treatment programs for depression that are integrated into primary care have proven to be effective across a wide range of patient populations and health care systems.

In their report, the authors wrote, "Broad implementation of improved depression care programs will depend on the balance of benefits and added costs. Depression has large economic effects outside the health care system, including disability, lost work productivity, reduced educational attainment and relationship disruption.”

A randomized trail compared two depression care programs with continued usual care. A group of 207 were assigned to telephone care management and 198 were assigned to telephone care management plus psychotherapy.

After a 24-month period, the telephone care management group experienced a gain of 29 depression-free days and a gain of $676 in costs. The care management plus psychotherapy group gained 46 depression-free days and a cost increase of $397.

"Willingness to pay for time free of depression is a simple (albeit far from perfect) method for summarizing various economic benefits of improved depression care," the authors wrote. "Our previous research suggests that primary care patients treated for depression are on average willing to pay approximately $10 (in 2000 U.S. dollars) for an additional day free of depression."
 

Although many people find the holiday season to be full of joy and merriment, millions of people find themselves depressed, lonely, and deeply sad during the holidays. This condition—commonly referred to as the holiday blues or holiday depression—can occur throughout the year, but becomes heightened during the months of November and December, when holiday cheer is in full bloom. The symptoms of holiday depression may resemble those of clinical depression, and there are several triggers.

Many people feel pressure to fill their calendars with holiday parties and family gatherings, and the failure to do so (or the anticipation of failing to do so) can lead to feelings of resentment and sorrow. The holidays can also be a difficult time for people who either don’t have a significant other or are struggling with a troubled relationship, as images of romantic gift-giving and couples snuggling up to a blazing fireplace abound.

The holiday season can also stir up memories of past holidays, both good and bad. If you had a negative experience during a previous holiday, you will likely be reminded of it every holiday season, or if you are currently depressed or experiencing troubles, memories of happy times during previous holidays can trigger depression. Holidays can also be very difficult for those who have lost a loved one of who are living far away from family and friends, as loneliness kicks in and hangs over even the most cheerful festivities.

If you suffer from the holiday blues, it’s important to know that you aren’t alone and that there are many steps you can take to lessen your feelings of depression or prevent them altogether. Be sure to get plenty of rest (but not too much, as excessive amounts of sleep can trigger depression), maintain a balanced and healthy diet, and exercise regularly.

You should also avoid drinking alcohol and smoking cigarettes, as these two substances have been found to contribute to depression. Plan to spend time with the positive people in your life who care about you, and make time to do things you enjoy.

If your holidays are contaminated with negative thoughts of past holidays, resolve to start a new tradition, try out a new recipe, or do something you’ve never done before—just for yourself. Volunteering or helping someone in need is a great way to alleviate depression because helping others often results in a feeling of satisfaction and greater self-worth. Volunteer work is also an excellent excuse to get out of the house and socialize.

Aside from avoiding drinking and smoking (as well as other substances of abuse), don’t overindulge on holiday foods that are in high in sugar, as sugar “crashes” can result in feelings of depression. Try to refrain from dwelling on the past or on what you don’t have and focus on what you do have and the positive things in your life. Also avoid spending money you don’t have—financial stress will only add to depression, not alleviate it. Finally, don’t put yourself down if you suffer from the holiday blues, and understand that people experience the holidays in their own unique ways.

Being aware that you’re not alone, focusing on the positive things in your life, and avoiding depression triggers can help you prevent the holiday blues and truly enjoy the season.

Most people will attest to the fact that friendships play an important role in one’s life. A good friend is there for you during the good times and the bad, through thick and thin, and during moments of despair and those filled with joy. Friends are priceless. But do friendships actually affect an individual’s psychological state and mental well-being? There is a new theory that friendships—whether good or bad—have an impact on an individual’s mental health for the positive and the negative.

Studies have shown that friendships are good for one’s mental health because they provide a support system to help people deal with the problems they are bound to come across in life. Friendships also provide some much-needed stress relief. Sharing one’s work woes or dishing about the latest celebrity gossip over dinner with friends helps relieve tension and also boosts your mood.

Friendships usually lift a person’s self esteem and provide a sense of security that is extremely important if an individual is suffering from mental health issues such as depression. Friendships also help you feel connected with others and those individuals who have a large circle of friends and/or close confidants are more likely to live longer than those who live a more secluded lifestyle. People with a strong circle of friends are generally happier than those who do not, and, as a result, have stronger immune systems. Studies have also shown that seniors who socialize frequently have lower cholesterol, lower blood pressure, and are less likely to be depressed than their less socially active peers.

Even though there are many benefits of having friends, friendships can also be detrimental to one’s mental health. Like unhealthy romantic relationships, unhealthy friendships are common. Perhaps you have a friend who loves to put you down or one who is constantly competing with you, but you still spend time with him or her. It’s the person who at times you really like and at other times you despise. These “frenemies” have been around for years, but the term has only recently been coined. A frenemy is a cross between a “friend” and an “enemy,” and almost everyone has had one.

Frenemies bring out the worst in a person because their “friendship” is based on jealousy, envy, and competition. This can cause unneeded stress, irritation, and anxiety—all the things healthy friendships avoid. Women in particular are more likely to hide or try to suppress feelings of jealousy toward a friend, which can lead to feelings of anger toward a particular individual, while also causing elevations in blood pressure.

There’s a lot to be said about having solid friendships as long as they are healthy, positive, and supportive. Next time you decline an invitation to meet up with friends, think twice. A night out with positive friends may just be what the doctor ordered.

“Dramatic changes in the U.S. labor market have weakened bonds between employers and employees and fueled perceptions of job insecurity,” said University of Michigan sociologist Sarah Burgard, in a Science Daily piece. Burgard is a research assistant professor at the U-M Institute for Social Research.

“This study provides the strongest evidence to date that persistent job insecurity has a negative impact on worker health. In fact, chronic job insecurity was a stronger predictor of poor health than either smoking or hypertension in one of the groups we studied.”

Burgard highlighted that chronically high job-insecurity is more strongly linked with health declines than actual job loss or unemployment. Reasons for this include ongoing ambiguity about the future, inability to take action unless the feared event actually happens, and the lack of organized support associated with this perceived insecurity.

At any given time during the study, as many as 18 percent of those surveyed reported they felt insecure about their jobs. Burgard argues that the findings have potential implications for both policy and intervention.

“Programs designed for displaced or unemployed workers are unlikely to solve the problems faced by workers who are still employed but are persistently insecure about their jobs,” she said. “When you consider that not only income but so many of the important benefits that give Americans some piece of mind—including health insurance and retirement benefits—are tied to employment for most people, it’s understandable that persistent job insecurity is so stressful.

LOCATION

If lithium is implicated in manic depression, or bipolar dysfunction, and lithium is found naturally in higher doses in some places than others, does it matter where you live?

Lithium is a naturally occurring element that shows up in soil, water, and certain plants. Doctors have used it successfully to treat bipolar mania for the last fifty years. Hirochika Ohgami and colleagues at Oita University analyzed the suicide rates in Japan’s Oita Prefecture, and found that cities with higher levels of lithium in their drinking water experienced lower rates of suicide, as reported recently in the British Journal of Psychiatry. The amounts of lithium were still much lower than those in conventional medication, but there is a statistically significant difference that may be important for those with bipolar disorders.

In a 1990 study of 27 Texas counties, researchers found an “inverse association of tap water lithium content in areas of Texas with the rates of mental hospital admissions, suicides, homicides, and certain other crimes.” It was also discovered that young men incarcerated for violent crimes in some parts of Texas had disproportionately low lithium levels. Schrauzer and Shrestha discovered that the negative correlation was confirmed, “ especially in the south-central region of the state where high suicide mortality rates correspond to low lithium concentrations.”

FOOD

Could some cultures eat combinations of just the right lithium-rich foods and foods with omega three fatty acids to keep bipolar illness at bay?

Foods rich in lithium include all kinds of dairy products, seaweed, potatoes, lemons, eggs, fish, grains, and vegetables. Natural mineral water and seawater also contain higher levels of lithium. While the amounts of lithium in these foods are far lower than clinical doses of lithium, a regular low dose of naturally occurring lithium may help to reduce bipolar illness. The Mediterranean diet, such as the traditional food eaten on the island of Crete, may provide an excellent combination of these foods. Likewise, the Japanese diets rich in fish and seaweed may also help prevent lithium deficiency.

In a study titled, “Cross-National Comparisons of Seafood Consumption and Rates of Bipolar Disorders”, scientists reported on the seafood consumption levels and rates of bipolar illness among nine countries. Their study showed the lowest lifetime prevalence rates of bipolar illness occurred in the countries with the highest levels of fish consumption, including Puerto Rico, Taiwan, Korea, and Iceland. Iceland had the highest rates of fish consumption – well above 200 pounds average per person per year—and the lowest rates of diagnosed bipolar disorders. In Germany, where the consumption of fish is much lower, the lifetime prevalence rate was much higher – 6.5 percent in Germany, versus 0.2 percent in Iceland.

The authors concluded, “There is some evidence that eating a lot of fish, or at least those rich in the omega-three fatty acids, may be able to combat the depression of bipolar disorder.” They note that it also may play “a preventive and therapeutic role” for depression.

SOCIAL STRUCTURE

Do some cultures have social structures that promote better mental health?

A series of well-known studies in the 1960s in the town of Roseto in Pennsylvania uncovered astonishing health statistics: no one was dying from heart attacks under age sixty-five, there were no suicides, no alcoholism, no drug addiction, and very little crime. Author Malcolm Gladwell notes, “The death rate from all causes in Roseto, in fact, was 30 to 35 percent lower than expected.” Roseto was named after a town in Italy, and most people were immigrants from that town. They had brought their culture with them. Physician Stewart Wolf and sociologist John Bruhn found that the family structure in the homes, and culture of work and egalitarian ethics, as well as close connections with each other, was the answer. The family homes often had three generations living under one roof, and showed great respect for the elders. In the tight knit community, which stressed an egalitarian social structure, extended family clans, people spending time together, chatting in the streets, respect for elders and the calming effect of the Church, these factors combined to provide better health insurance than anything money could buy.

With this study in mind, as well as many anthropological studies demonstrating the social strength of small face-to-face communities, it is possible to see another correlation in the nations showing lower rates of bipolar spectrum disorders. They are all island nations, or peninsular, and have numerous small tight-knit fishing communities. Because it takes years to learn to fish well on the ocean and even longer to gain the experience necessary to know where the fish will be, fishing is often a family business, with older generations teaching younger, and the younger family members showing respect, but also receiving support and direction. The community provides necessary support to the fishers and their families. Those who fish may be away from home for weeks at a time, plying a dangerous trade. Family members left behind build support networks in the community. Like Roseto, fishing communities with strong connections and generational family cohesion may provide an essential safety net that helps lessen the rates of bipolar spectrum disorders. It may be worth another study to find out.

Culture apparently does matter. People with bipolar spectrum disorders and those supporting them might want to consider living in one of those places with a blue horizon –on an island or in a coastal community with access to lots of seafood, or in a desert community in Arizona or Chile or Bolivia where levels of lithium in the soil are high. They might want to choose a community where the pace of life is a little slower, relationships and work are constant over time, and people have time for talking – a face-to-face community where people really get to know each other. That supportive network may be the best – and cheapest—investment people facing bipolar disorders can make.

Author Catherine Knott, Ph.D., teaches Anthropology and Sociology for the University of Alaska on the Kenai Peninsula. She has a Ph.D. in Anthropology, Natural Resources, and Education from Cornell University and a B.A. from Yale University.

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