One-minute bursts of activity during daily tasks could prolong your life

 In good news for those who don't like playing sport or going to the gym, new research finds just three to four one-minute bursts of huffing and puffing during daily tasks is associated with large reductions in the risk of premature death, particularly from cardiovascular disease.

Published in Nature Medicine today, the study is led by the University of Sydney's Charles Perkins Center in Australia. It is the first to accurately measure the health benefits of what researchers have termed "vigorous intermittent lifestyle physical activity" or VILPA.

VILPA is the very short bouts of vigorous activity (up to one to two minutes) we do with gusto each day, like running for the bus, bursts of power walking while doing errands or playing high-energy games with the kids.

The researchers found that just three to four one-minute bouts of VILPA every day is associated with up to 40 percent reduction in all-cause and cancer-related mortality, and up to a 49 percent reduction in death related to cardiovascular disease.

"Our study shows similar benefits to high-intensity interval training (HIIT) can be achieved through increasing the intensity of incidental activities done as part of daily living, and the more the better," said lead author Emmanuel Stamatakis, Professor of Physical Activity, Lifestyle and Population Health at the University of Sydney's Charles Perkins Center.

"A few very short bouts totaling three to four minutes a day could go a long way, and there are many daily activities that can be tweaked to raise your heart rate for a minute or so."

The majority of adults aged 40 and over do not take part in regular exercise or sport, but Professor Stamatakis said the study reveals how incidental physical activity can overcome many barriers.

"Upping the intensity of daily activities requires no time commitment, no preparation, no club memberships, no special skills. It simply involves stepping up the pace while walking or doing the housework with a bit more energy," he said.

What did they discover about exercise as part of daily life?

• About 89 percent of all participants did some VILPA.
• Among those who did VILPA:
  
  • 93 percent of all VILPA bouts last up to 1 minute.
  • On average each day participants did eight VILPA bouts of up to 1 minute each, totalling 6 minutes a day.
  • On average each VILPA bout lasted around 45 seconds.
• The steepest gains were seen when comparing those with around four to five bouts per day to those with no VILPA.
• However, larger benefits were found with larger VILPA amounts, suggesting the more the better.
• The maximum of 11 bouts per day was associated with a 65 percent reduction in cardiovascular death risk and 49 percent reduction in cancer-related death risk, compared to no VILPA.

Interestingly, a comparative analysis of the vigorous activity of 62,000 people who regularly engaged in exercise found comparable results. This implies that whether the vigorous activity is done as part of structured exercise or housework do not compromise the health benefits.\

How was the study conducted?

Researchers used wrist-worn tracker data from UK Biobank, a large-scale biomedical database, to measure the activity of over 25,000 'non-exercisers', participants who self-reported that they do not do any sports or exercise during leisure time.

By this method, the researchers could conclude that any activity recorded by this group was incidental physical activity done as part of everyday living.

The team then accessed health data that allowed them to follow participants over seven years.

The studies are observational, meaning they cannot directly establish cause and effect. However, the researchers took rigorous statistical measures to minimize the possibility that results are explained by differences in health status between participants.

"These findings demonstrate just how valuable detailed and objective measures of physical activity can be when collected on a large-scale population. We are incredibly grateful to all of the 100,000 UK Biobank participants who wore an activity monitor for 7 days to generate these valuable data," said Professor Naomi Allen, Chief Scientist of UK Biobank.

Call for an update to physical activity guidelines

The international team from the University of Sydney, the University of Oxford's Big Data Institute (UK), University College London (UK), University of Glasgow (UK), University of Southern Denmark and McMaster University (Canada) are calling for physical activity guidelines and clinical advice to be updated to keep pace with this evolving area.

Current global guidelines imply that the health benefits of vigorous-intensity physical activity are gained through structured physical activity such as sport or running during leisure time.

It was only in 2020 that the WHO global Guidelines on Physical Activity and Sedentary Behavior, co-chaired by Professor Stamatakis, acknowledged that 'all activity counts' and the stipulation that activity should be accumulated in 10-minute bouts was removed.

"Our previous knowledge about the health benefits of vigorous physical activity comes from questionnaire-based studies, but questionnaires cannot measure short bouts of any intensity," said Professor Stamatakis.

"The ability of wearable technology to reveal 'micropatterns' of physical activity, such as VILPA, holds huge potential for understanding the most feasible and time-efficient ways people can benefit from physical activity, no matter whether it is done for recreation or as part of daily living."

More information: Emmanuel Stamatakis, Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality, Nature Medicine (2022). DOI: 10.1038/s41591-022-02100-x. www.nature.com/articles/s41591-022-02100-x

https://medicalxpress.com/news/2022-12-one-minute-daily-tasks-prolong-life.html

How the most commonly used ADHD medication works

 For decades, doctors have treated kids with attention-deficit/hyperactivity disorder (ADHD) with methylphenidate, a stimulant drug sold as Ritalin and Concerta, making it one of the most widely prescribed medications aimed at the central nervous system. One might expect that researchers would know how methylphenidate works in the brain by now, but little is known about the drug's mechanism of action. Now, a new study seeks to close this gap and understand how methylphenidate interacts with cognitive control networks and attentional behavior.

The new study appears in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging.

What researchers do know is that individuals with ADHD have lower dopamine signaling activity than neurotypical individuals in the interconnected brain networks that control attention and goal-directed behaviors. Specifically, methylphenidate is hypothesized to ameliorate ADHD symptoms by increasing dopamine levels in the nucleus accumbens (NAc), a hub for dopamine signaling.

In the new study, researchers led by Yoshifumi Mizuno, MD, Ph.D., Weidong Cai, Ph.D., and Vinod Menon, Ph.D., used brain imaging to explore the effects of methylphenidate on the NAc and a so-called triple network system that plays a key role in behaviors that require adaptive control of attention.

The three networks include the salience, frontoparietal, and default mode networks. Aberrant activity was detected in the NAc and in multiple brain networks in children with ADHD, suggesting that dysregulation in the system may underlie ADHD symptoms, and that correcting the dysfunction might alleviate those symptoms.

"Our findings demonstrate in two independent cohorts that methylphenidate changes spontaneous neural activity in reward and cognitive control systems in children with ADHD. Medication-induced changes in cognitive control networks result in more stable sustained attention. Our findings reveal a novel brain mechanism underlying methylphenidate treatment in ADHD and inform biomarker development for evaluating treatment outcomes," noted Dr. Menon, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine.

The researchers used functional magnetic resonance imaging (fMRI) to measure the effects of methylphenidate on spontaneous brain activity in 27 children with ADHD and 49 typically developing controls. Children with ADHD were scanned during two different visits one to six weeks apart—once while receiving methylphenidate and once while receiving a placebo. (Typically developing children did not receive medication or placebo.)

Outside the scanner, children with ADHD also performed a standardized task to assess sustained attention. Additionally, the researchers tested the replicability of methylphenidate's effects on spontaneous brain activity in a second independent cohort.

Not surprisingly, children performed better on the attention tasks when they were medicated. And as the researchers hypothesized, they also saw greater spontaneous neural activity in the NAc and the salience and default mode networks when methylphenidate was administered. Children with ADHD who displayed enhanced changes in brain activity patterns in the default mode network with medication performed better on the attention tasks with medication.

Findings were replicated across two independent cohorts, providing further evidence that methylphenidate may alleviate ADHD symptoms by its actions on the NAc and the triple network cognitive system.

Cameron Carter, MD, editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, said of the study, "The findings, which used the widely available technique of resting-state functional MRI, confirm the positive effects of methylphenidate on attention in children with ADHD and reveal the likely mechanism of action, through improved coordinated brain network activity and a likely key role for enhanced dopamine effects in the NAc region of the brain."

The work advances researchers' understanding of how ADHD affects cognitive control networks in the brain and how methylphenidate interacts with these networks to shift behavior. The findings could guide future work using brain imaging as a clinically useful biomarker of response to treatments.

More information: Yoshifumi Mizuno et al, Methylphenidate enhances spontaneous fluctuations in reward and cognitive control networks in children with attention-deficit/hyperactivity disorder, Biological Psychiatry: Cognitive Neuroscience and Neuroimaging (2022). DOI: 10.1016/j.bpsc.2022.10.001

https://medicalxpress.com/news/2022-12-gain-commonly-adhd-medication.html

Suicidal thoughts surged as people struggled with finances and isolation during COVID-19

 The sudden economic fallout at the start of the COVID-19 pandemic affected millions of people and contributed to a three-fold rise in persistent or elevated depression in the United States. But the extent of this toll on mental health is still coming to light.

Now, a new study led by Boston University School of Public Health (BUSPH) researchers reveals that suicidal thoughts increased substantially, as well, during the pandemic.

Published in the journal PLOS One, the study found that suicidal ideation was nearly five times higher at the start of the pandemic and disproportionately affected people living in low-income households. People who had difficulty paying rent or who felt lonely—two problems that intensified during COVID due to social distancing to reduce spread of COVID-19 and the unprecedented shock to the economy—also reported a substantial rise in suicidal thoughts.

The study provides valuable insight into the short- and long-term mental health effects of the pandemic. As people continue to experience multiple COVID-related stressors, the researchers emphasize the need for policies and programs that provide financial and social support, particularly to vulnerable populations.

"Everyone felt the toll of mental distress from the challenges of the pandemic and unemployment crisis, and people who are low-income and housing insecure were most impacted," says study lead and corresponding author Dr. Julia Raifman, assistant professor of health law, policy & management at BUSPH. "Policies and programs that help people stay in their homes and avoid economic hardship may make a big difference for improving mental health. It is also key to ensure that there are mental health services and supports for low-income children and adults."

For the study, Raifman and colleagues examined nationally representative survey data on demographics, suicidality, and a variety of pandemic-related stressors, including COVID-19 illness and bereavement, income, job loss, financial distress, loneliness, and more. The data included responses from more than 1,400 participants in the COVID-19 Life Stressors Impact on Mental Health and Well-Being (CLIMB) survey from March 31, 2020 to April 13, 2020, and more than 5,000 participants in the 2017-2018 National Health and Nutrition Examination Survey (NHANES).

The prevalence of suicidal thoughts increased from 3.4 percent in 2017-2018 pre-pandemic, to 16.3 percent after the start of the pandemic. The spike was greatest among participants who earned less than $20,000 each year, Hispanic participants, and participants ages 18 to 29. Suicidal ideation also burdened 31 percent of people who had trouble paying their rent, and 25 percent of people who struggled with loneliness.

"It was striking that around a quarter of low-income persons, Hispanic persons, and people ages 18-29 years reported suicidal ideation in 2020," says study co-author Dr. Catherine Ettman, postdoctoral fellow in the Department of Mental Health at Johns Hopkins Bloomberg School of Public Health. "These findings add evidence to the growing body of work showing the mental health disparities experienced during the pandemic across asset and demographic groups. The early pandemic particularly affected the mental health of young people, persons with low assets, and groups that have been traditionally marginalized by society."

Job loss was not associated with suicidal ideation in the CLIMB survey, but further research could provide insight into the potential effects of prolonged COVID-related unemployment, and whether suicidality risks differ by wealth. In previous work, the researchers found links between assets and mental health, suggesting that people with higher income and savings are less likely to experience depression, a risk factor for suicidality.

"We are now starting to see the long term consequences of the COVID-19 pandemic," says study coauthor Dr. Salma Abdalla, research fellow at BUSPH. "The effects of the pandemic will be felt for a long time, particularly for young persons who will navigate the health and mental health consequences of this moment across the life course."

Policies that target populations experiencing financial distress and social isolation could serve as a valuable tool for suicide prevention, as well as policies that strengthen firearm restrictions—the primary means of suicide deaths—the researchers say.

"I hope we may see more research on how policies and programs that jointly maximize health and economic well-being," Dr. Raifman says. "After the period when we conducted this study, Congress implemented stimulus checks, the expanded child tax credit, and unemployment insurance expansion that led to record reductions in poverty—benefiting health and reducing economic hardship for millions of Americans. This shows us the best of what is possible with policies, and I hope we will see more enduring federal and state investments in similar policies."

More information: Julia Raifman et al, Economic precarity, loneliness, and suicidal ideation during the COVID-19 pandemic, PLOS ONE (2022). DOI: 10.1371/journal.pone.0275973

https://medicalxpress.com/news/2022-12-suicidal-thoughts-surged-people-struggled.html

Common sweetener linked with anxiety

 Florida State University College of Medicine researchers have linked aspartame, an artificial sweetener found in nearly 5,000 diet foods and drinks, to anxiety-like behavior in mice.

Along with producing anxiety in the mice who consumed aspartame, the effects extended up to two generations from the males exposed to the sweetener. The study is published in the Proceedings of the National Academy of Sciences.

"What this study is showing is we need to look back at the environmental factors, because what we see today is not only what's happening today, but what happened two generations ago and maybe even longer," said co-author Pradeep Bhide, the Jim and Betty Ann Rodgers Eminent Scholar Chair of Developmental Neuroscience in the Department of Biomedical Sciences.

The study came about, in part, because of previous research from the Bhide Lab on the transgenerational effects of nicotine on mice. The research showed temporary—or epigenetic—changes in mice sperm cells. Unlike genetic changes (mutations), epigenetic changes are reversible and don't change the DNA sequence; however, they can change how the body reads a DNA sequence.

"We were working on the effects of nicotine on the same type of model," Bhide said. "The father smokes. What happened to the children?"

The U.S. Food and Drug Administration (FDA) approved aspartame as a sweetener in 1981. Today, nearly 5,000 metric tons are produced each year. When consumed, aspartame becomes aspartic acid, phenylalanine and methanol, all of which can have potent effects on the central nervous system.

Led by doctoral candidate Sara Jones, the study involved providing mice with drinking water containing aspartame at approximately 15% of the FDA-approved maximum daily human intake. The dosage, equivalent to six to eight 8-ounce cans of diet soda a day for humans, continued for 12 weeks in a study spanning four years.

Pronounced anxiety-like behavior was observed in the mice through a variety of maze tests across multiple generations descending from the aspartame-exposed males.

"It was such a robust anxiety-like trait that I don't think any of us were anticipating we would see," Jones said. "It was completely unexpected. Usually you see subtle changes."

When given diazepam, a drug used to treat anxiety disorder in humans, mice in all generations ceased to show anxiety-like behavior.

Researchers are planning an additional publication from this study focused on how aspartame affected memory. Future research will identify the molecular mechanisms that influence the transmission of aspartame's effect across generations.

Other co-authors were Department of Biomedical Sciences faculty members Deirdre McCarthy, Cynthia Vied and Gregg Stanwood, and FSU Department of Psychology Professor Chris Schatschneider.

More information: Sara K. Jones et al, Transgenerational transmission of aspartame-induced anxiety and changes in glutamate-GABA signaling and gene expression in the amygdala, Proceedings of the National Academy of Sciences (2022). DOI: 10.1073/pnas.2213120119

https://medicalxpress.com/news/2022-12-links-common-sweetener-anxiety.html

Fears freed ‘Merchant of Death’ Viktor Bout would go back to arms dealing

 US officials acknowledged Thursday their worry that Russian arms dealer Viktor Bout — known as the “Merchant of Death,” — would return to his former ways after he was released in a prisoner swap that secured the return of WNBA player Brittney Griner to America.

“I think there is a concern that he would return to doing the same kind of work that he’s done in the past,” a senior defense official said, referring to Bout’s work in Africa, where his client list included Liberian warlord Charles Taylor, longtime Libyan dictator Muammar Gaddafi and both sides in Angola’s 26-year-long civil war.

“We heard the news, and you know, every Africanist who’s kind of been working on this for — for years and years for — you know, probably had a little — a little piece, a — a flutter of — of disappointment inside,” the official added.

Bout, who also reportedly helped arm bad actors like Al Qaeda, the Taliban and Hezbollah, was arrested in Thailand in 2008 after Drug Enforcement Administration agents posing as Colombian rebels lured him there to discuss a deal to sell up to $20 million in weapons to the FARC narco-terror group, including surface-to-air missiles to shoot down US helicopters.

He was convicted in 2011 of conspiracy to kill Americans and other charges and was sentenced to 25 years in prison the following year.

Some US officials fear released Russian “Merchant of Death” Viktor Bout will go back dealing arms after being freed in a prisoner swap for WNBA star Brittney Griner.

Fsb/TASS via ZUMA Press

Griner on a plane in Abu Dhabi after being released by Russia on December 8, 2022.

Fsb/TASS via ZUMA Press

“We cannot ignore that releasing Bout back into the world is a deeply disturbing decision,” Sen. Bob Menendez (D-NJ), the chairman of the Senate Foreign Relations Committee, said in a statement. “We must stop inviting dictatorial and rogue regimes to use Americans overseas as bargaining chips, and we must try do better at encouraging American citizens against traveling to places like Russia where they are primary targets for this type of unlawful detention.”

“I am relieved that Ms. Griner will be returned home safely,” said House Foreign Affairs Committee ranking member Michael McCaul (R-Texas). “However, trading Viktor Bout – a dangerous convicted arms dealer who was in prison for conspiring to kill Americans – will only embolden Vladimir Putin to continue his evil practice of taking innocent Americans hostage for use as political pawns.”

John Bolton, former President Donald Trump’s national security adviser, called the arrangement “an American surrender,” arguing that releasing a convicted international terrorist for a basketball player was “not a trade.”

Bout was previously arrested in Thailand in 2008.

AP Photo/Apichart Weerawong, File

“This is not what American strength looks like,” Bolton wrote on Twitter Thursday. “Terrorists and rogue states are smiling.”

A senior Biden administration official insisted, however, that other nations which assume such trades have now “become the norm” for the US “would be mistaken.”

“I don’t think governments around the world would be wise to draw that inference,” the official said. “But in the rare case when there is an imperative to bring Americans home – which is a real priority for this president – there sometimes are no alternatives left and a heavy price has to be has to be paid.”

A senior Biden administration official told The Post that prisoner swaps involving criminals like Bout will not “become the norm” for the US.

Fsb/TASS via ZUMA Press

The Biden administration official said this was a “rare case” and there were no “alternatives left” besides releasing Bout.

Photo by BRENDAN SMIALOWSKI/AFP via Getty Images“We’re going to make sure that we can defend this country against any and all threats,” National Security Council spokesman John Kirby told CNN Thursday. “And so, with Mr. Bout being back on the street, we’re going to stay focused on making sure we can defend this country.”

The Russian Foreign Ministry claimed it had negotiated with the White House to release Bout “for a long time” before Biden agreed to the deal.

“Washington was categorically refusing to engage in dialogue on putting the Russian national on the exchange scheme,” the ministry said in a statement Thursday. “Nevertheless, the Russian Federation continued to actively work towards the release of our fellow countryman.”

Bout’s mother, Raisa, thanked Russian President Vladimir Putin and the Foreign Ministry for freeing her son, according to the news agency Tass, which added that he would be invited to speak to lawmakers on the Duma’s International Affairs committee.

Bout speaking on the phone before leaving for Russia.

Fsb/TASS via ZUMA Press

Video released by the Kremlin showed Bout on board a private jet en route to Russia from the swap in Abu Dhabi, getting his blood pressure checked, speaking with his family by phone and saying, “I love you very much.”

https://nypost.com/2022/12/08/fears-freed-merchant-of-death-viktor-bout-would-go-back-to-arms-dealing/

NYC Bill Would Ban Firing Workers Without "Just Cause", Limit Employee Surveillance

 A bill in New York City set to be introduced on Wednesday would ban companies from firing workers without good reason, or "just cause."

Currently most US employees work "at-will," meaning they can be fired for just about any reason, or for no reason at all. Under the Wednesday bill, introduced by Democratic Socialist and City Council Member Tiffany Cabán, the power dynamic between workers and employees would radically shift - as jobs would be legally protected unless their boss can demonstrate misconduct, unsatisfactory performance, or a genuine economic need to eliminate their position, Bloomberg Law reports.

The new bill would expand on a pair of laws which took effect in July 2021 which protected non-union, private sector fast-food workers.

The fast-food bill has thus far withstood legal challenges from business groups, such as the NY State Restaurant Association, which is appealing a February ruling by a judge in the Southern District Court of New York who dismissed a lawsuit. Last year the Brooklyn Chamber of Commerce said the fast-food legislation called into question "how we encourage small-business owners who will be vital to New York’s economic recovery."

"We have no delusions about how hard this fight is going to be," said Cabán, who is set to introduce the bill on Wednesday amid substantial pushback.

In an interview before becoming City Council speaker, Adrienne Adams, a sponsor of the fast-food worker legislation, said she wanted to see its protections extended to other businesses. “We’ve got a lot of industries where people are just treated lesser than,” she said last year. 

A spokesperson for Speaker Adams said she wouldn’t comment on legislation that hadn’t yet been introduced. A spokesperson for Mayor Eric Adams said City Hall will review the legislation when it’s introduced. -Bloomberg

The bill would expand protections to employees in retail, finance and other sectors, and would provide carve-outs for construction companies and short-term positions.

It would also limit a company's ability to use technology to surveil and assess workers' performance, and would allow the city comptroller to bring cases on behalf of fired employees, Bloomberg reports.

"How can families feel economically safe and secure and build futures here in the city when they don’t know whether they’ll be fired on a whim tomorrow?" said Cabán, who also chairs the council’s Women and Gender Equality committee and co-chairs its LGBTQIA+ Caucus. "If you talk to everyday people, it seems like the most commonsense thing: Well, yeah, my boss should give me a valid reason before terminating my employment."

https://www.zerohedge.com/economics/nyc-bill-would-ban-firing-workers-without-just-cause-limit-employee-surveillance

Can NPs Offset Psychiatry Shortage, Tackle Mental Health Crisis?

 With many psychiatrists not accepting insurance, and fewer psychiatrists billing Medicare due to reimbursement cuts, psychiatric mental health nurse practitioners (PMHNPs) are seen lately as part of the solution to the shortage of mental healthcare providers in the United States. In many states, these specialized nurse practitioners can prescribe medication, unlike psychologists and other therapists, and their services are less expensive than doctors.

A recent report by Health Affairs indicates that the mental healthcare system relies more on PMHNPs to fill in the gap of Medicare patients with mental health needs. The study showed that from 2011 to 2019, PMHNPs provided almost one in three psychiatric visits to Medicare patients. While there was a 6% decrease in the number of psychiatrists billing Medicare, the number of PMHNPs increased by 162%, the report showed.

Study authors estimated there would be a 30% decline in mental health specialist visits in Medicare patients if not for PMHNPs. Because of the specially trained nurses, that decrease ended up being only 12%.

“Nurse practitioners (NPs) are often being relied on to fill in gaps due to the shortage of psychiatrists across the country and they are often less expensive,” Kristin Kroeger, chief of Policy, Programs, and Partnerships with the American Psychiatric Association (APA) told Medscape. Medicare reimburses NPs and other advanced practice providers at 85% the rate of doctors.

“APA supports direct supervision of NPs as they often do not have the training to treat people with mental health or substance use disorders.”

To become a PMHNP, nurses go through the same training as their peers. After a bachelor of science in nursing degree, PMHNPs can progress through master’s or doctoral paths (3 to 5 years, depending) which then leads to certification through the American Nurses Credentialing Center (ANCC). After academic requirements are fulfilled, students must take the ANCC certification exam. Certifications are valid for 5 years and professional continuing education is required for recertification.

Kathleen McCoy, PMHNP-BC

PMHNPs are trained to treat a wide variety of mental health disorders regardless of age, setting, or culture, said Kathleen McCoy, PMHNP-BC, associate professor at the University of South Alabama, Mobile, told Medscape Medical News. But PMHNPs will also refer to more appropriate specialists, services, and levels of care when these are available, she said.

The competency-based standards of today’s NP program accreditation requirements ensure NPs can provide high-quality patient care, according to Pamela Lusk, DNP, RN, FAANP, clinical associate professor of practice at The Ohio State University College of Nursing, Columbus.

Independent Practice

To date, half of the states and US territories have given NPs full practice authority (FPA). In FPA states, there is no need for a collaborative practice agreement between NPs and physicians to provide care. As defined by the American Association of Nurse Practitioners (AANP), FPA gives NPs the authority to evaluate, diagnose, and treat patients, as well as order and interpret diagnostic tests under the state board of nursing.

Wait times for appointments are also believed to be shorter for NPs than doctors.

During the pandemic, PMHNPs were providing comprehensive mental health services on the frontlines to all populations, especially in rural areas with populations who are underserved, explained Lusk.

In states where NPs don’t have FPA, they are required to work with a collaborating physician. This becomes trickier when there’s a lack of these psychiatric clinicians to provide oversight. More than one third of Americans live in areas the US Department of Health and Human Services deems to have a mental health professional shortage.

Susanne Astrab Fogger, DNP, CRNP, PMHNP-BC

“Managed care has made psychiatry a particularly challenging field, as visits are often time-driven. It’s difficult to connect to patients when the visit is only 15 minutes in length,” said Susanne Astrab Fogger, DNP, CRNP, PMHNP-BC, a professor at the School of Nursing at the University of Alabama at Birmingham. “There just aren't enough psychiatrists to care for the volume of patients who need treatment.”

Burnout and retirement are also factors affecting the psychiatrist shortage. Nearly 40% of psychiatrists are experiencing burnout.

Collaboration Is Key

The demand for PMHNPs can be seen in their earnings growth. PMHNPs earned the highest income among advanced practice registered nurses (APRNs), $132,000, according to Medscape’s 2022 APRN compensation report. That figure shows growth over the past 2 years, during which time those in the specialty also earned more than their APRN peers. The specialty is not the largest among APRNs surveyed, but it saw growth from 8% of those surveyed in 2021 to 9% in the latest report.

Despite the increased earnings, there’s a need for more PMHNPs to replenish those leaving the workforce, according to the American Psychiatric Nurses Association (APNA). More than half of PMHNPs are in their 50s and 60s, nearing retirement age, and the APNA is keeping an eye on whether the number of younger nurses entering the mental health nursing practice, which is increasing, is enough to balance those leaving it.  

“The growing field certainly presents an opportunity for registered nurses to pursue additional education and training to obtain advanced licensure as a PMHNP,” said Chizimuzo Okoli, PhD, APRN, PMHNP-BC, president of the APNA. He added that PMHNP programs have almost doubled in the last 8 years — from 114 programs in 2015 to 208 in 2021.

“The opportunity to obtain further specialization as a PMHNP is quite appealing to both nursing students and professional, or clinical, nurses who would like to advance their careers.” To attract more nursing students into the specialty, APNA offers advantages such as discounted student memberships and conference scholarships.

In terms of training more psychiatrists, APA continues to advocate for more federal funding for residency programs, Kroeger said. “However, even with that funding, it takes years to train a psychiatrist.”

The APA supports a collaborative care model to deliver mental health services into primary care. “The model provides early intervention of mental health and substance use disorders through screening in a primary care office,” she said. If a patient needs care, they’ll be treated by primary care in consultation with psychiatry and case management.

This collaborative care approach not only helps patients have better access to care, but insurance, including Medicare, is more likely to reimburse for it, compared to psychiatric care alone, the APA reported.

Receiving psychiatric care in a behavioral health integrated primary care clinic can help make it less stigmatizing to the patient, said Fogger. But she cautions that having too many psychiatrists in this type of setting might make integration too costly.

https://www.medscape.com/viewarticle/985259