Public Health Agency of Canada Offers Encouraging Response

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As readers of this blog may be aware, I have trying to raise awareness of an inaccuracy in Canadian mental health statistics.

Many Canadians have probably heard or read that 1 in 5 Canadians will experience mental illness in their lifetime. This number appears in official government reports and exists on numerous health websites, including the Canadian Mental Health Association and Health Canada. Bell Canada also popularized this figure in their "Let's Talk" campaign.

The problem is that 1 in 5 is inaccurate. I will not reiterate the reasons why this is inaccurate here, but I encourage those unfamiliar with this issue to read previous articles here and here. To give an idea of just how "off" this statistic is, consider that the American rate of lifetime mental illness is approximately 50%(1).

The Public Health Agency of Canada (PHAC) has been one of the few organizations to take my concerns seriously (I have contacted multiple organizations and even some media).

I was fairly unimpressed with PHAC's original response, as outlined here.

However, I recently received a follow-up email from a representative within the organization, who wrote:

You raise a valid point and concern around the statement that (more than) 1 in 5 or 20% of Canadians will experience a mental illness in their lifetime. The Public Health Agency of Canada will be precise on the seven mental illnesses (i.e., major depression, bipolar disorder, panic disorder, agoraphobia, social phobia, alcohol dependence or illicit drug dependence) on which this estimate is based to ensure accurate interpretation of this statistic.

We will also continue to explore options for adding other mental illnesses to our surveillance system. Our website content is currently under review and we will use consistent language in communicating this measure.

I am pleased with this response, and the PHAC agent also invited me to further discuss additional concerns with a psychologist working in their Chronic Disease and Surveillance Monitoring Division.

While I am encouraged at PHAC's response, I have been discouraged by the rather apathetic response of other agencies and individuals. If cancer rates were underestimated by at least half the true prevalence, there would be a public outcry. Unfortunately, mental illness apparently does not warrant such concern or consideration.

True change in mental health initiatives must start with an accurate understanding of the extent of the problem.

It is not the case that 1 in 5 Canadians will have a mental illness in their lifetime. Canadian research actually shows that this number (20%) is actually the number of people who will have a mental illness within a 1 year period(2).

It is embarrassing for Canadian health institutions to present such clearly contradictory statistics to the general public.

(1) Kessler et al. (2005). Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602.

(2)A Report on Mental Illness in Canada

The Need to be Liked - Paperback

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The Need to be Liked is now available in paperback at Amazon (click here to visit Amazon.com).

For those interested in downloading the e-book version, please visit here to learn how The Need to be Liked can be downloaded on various platforms (ex: iPad, Kindle, etc.)

If you have read my book, I would love to hear your feedback.

Sincerely,

Dr. Roger Covin (roger@drcovin.ca)

Tylenol for Rejection? Reducing the Pain of Rejection With Acetaminophen

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As readers of some of my previous blog posts (or book, “The Need to be Liked”) may remember, one of the very interesting findings from psychological research over the past decade has been the discovery of a strong association between physical and emotional pain responses.

For example, when we are injured in some way, an area of the brain that processes this pain information is the Anterior Cingulate Cortex (ACC). This same region of the brain becomes active following interpersonal rejection. The research evidence supporting the association between the two types of pain is remarkable, and beyond the scope of the present article. However, suffice to say that rejection from other people can actually ‘hurt.’

Well, some of the top researchers in the field of social psychology recently published some exciting follow-up work. They wanted to test the following hypothesis:

If acetaminophen (e.g., Tylenol) dulls physical pain, would it have the same effect on the emotional pain associated with rejection?

The researchers conducted two, well-designed experiments.

In the first experiment, research subjects were randomly assigned to one of two conditions: (1) acetaminophen or (2) placebo. The acetaminophen group took 1000 mg. of the drug everyday for 3 weeks. The placebo group took a placebo pill daily for the same length of time. All subjects were asked to keep track of the amount of social pain experienced in their daily lives (ex: whether their feelings were hurt that day).

Results from the first experiment showed that people in the acetaminophen group reported fewer amounts of pain from rejection relative to the placebo group. Presumably, both groups experiences a comparable amount of rejection and hurt feelings over the 3 week period, so the fact that the experimental group felt less pain indicates that the acetaminophen worked via the same processes that dull physical pain.

In the second experiment, subjects were again assigned to an acetaminophen or placebo group. However, in this experiment, the experimental group ingested 2000 mg. of the drug on a daily basis for 3 weeks. Afterwards, all subjects underwent an MRI evaluation of the brain – with a twist! Like previous experiments on rejection, subjects took part in a game where they were rejected. The researchers wanted to see what happened in the brain when the subjects felt hurt by the rejection.

Results showed that areas of the brain that typically “light up” during rejection (ex: ACC) were less active among the subjects that took acetaminophen relative to the placebo group. Again, the pain-relieving drug appeared to deactivate areas of the brain responsible for processing pain in general.

Conclusions?

First, these experiments add to the long list of research studies demonstrating that interpersonal pain (ex: from rejection) overlaps with physical pain in terms of neurological and biological processes.

Second, this research raises interesting clinical implications – namely, should psychologists start recommending that clients going through a divorce or break-up take Tylenol to ease the pain? As of now, I would say “no” this is not recommended for at least a few reasons.

First, there needs to be some follow-up research that confirms and validates these findings.

Second, this additional research will have to evaluate dosage and response in a more clear-cut manner, in order to facilitate decision making around the appropriate dosage and frequency. Ideally, after further research, an expert panel would make recommendations to professionals (i.e., clinical treatment guidelines, or something to that effect).

Third, there is an inherent risk in recommending to someone who could be depressed and even suicidal that taking Tylenol will ease their pain.

Finally, whenever professionals start recommending that a drug be used to take away pain, there is the potential for people to over-rely on such an approach, which can have consequences. This is similar to the issues that surround the overuse of prescription medication for depression and anxiety, where people lose the ability to cope with mild to moderate stress and pain.

I look forward to seeing where this research goes, and will be sure to provide updates through this site.