Light Skin and Lactose / Recent Adaptations to Cereal Diet

IFL Science

Why Do Europeans Have White Skin?

April 6, 2015 | by Stephen Luntz (shortened to get to the point)

The 1000 Genomes Project is comparing the genomes of modern individuals from specific regions in Europe with 83 samples taken from seven ancient European cultures. Harvard University’s Dr. Iain Mathieson has identified five features which  spread through Europe, indicating a strong selection advantage.

At the annual conference of the American Association of Physical Anthropologists, Mathieson said his team distinguished, “between traits that have changed consistently with population turnovers, traits that have changed apparently neutrally, and traits that have changed dramatically due to recent natural selection.”

… most people of European descent are lactose tolerant, to the extent that milk products not only form a major source of nutrition but are a defining feature of European cultures…that the capacity to digest lactose as an adult appeared in the population after the development of farming. Two waves of farmers settled Europe 7,800 and 4,800 years ago, but it was only 500 years later that the gene for lactose tolerance became widespread.

…hunter-gatherers in what is now Spain, Luxumberg and Hungary had dark-skinned versions of the two genes more strongly associated with skin color. The oldest pale versions of the SLC24A5 and SLC45A2 genes that Mathieson found were at Motala in southern Sweden 7,700 years ago. The gene associated with blue eyes and blond hair was found in bodies from the same site. H/T ScienceMag.



From: Civilization Fanatics Forum

Debunking the theory that lighter skin gradually arose in Europeans nearly 40,000 years ago, new research has revealed that it evolved recently – only 7,000 years ago

People in tropical to subtropical parts of the world manufacture vitamin D in their skin as a result of UV exposure. At northern latitudes, dark skin would have reduced the production of vitamin D. If people weren’t getting much vitamin D in their diet, then selection for pre-existing mutations for lighter skin (less pigment) would “sweep” the farming population.  

New scientific findings show that prehistoric European hunter-gatherers were dark-skinned, but ate vitamin D-rich meat, fish, mushrooms and fruits. With the switch to agriculture, the amount of vitamin D in the diet decreased – and resulted in selection for pale skin among European farmers.

Findings detailed today (Jan. 26, 2014) in the journal Nature, “also hint that light skin evolved not to adjust to the lower-light conditions in Europe compared with Africa, but instead to the new diet that emerged after the agricultural revolution”, said study co-author Carles Lalueza-Fox, a paleogenomics researcher at Pompeu Fabra University in Spain.

The finding implies that for most of their evolutionary history, Europeans were not what people today are known as  ‘Caucasian’, said Guido Barbujani, president of the Associazione Genetica Italiana in Ferrara, Italy, who was not involved in the study.





Who’s Safe With a Gun? Don’t Ask a Shrink

The Daily Beast, May 2013 Background Checks


Forget any guidance from psychiatry’s bible, the DSM-5, when it comes to background checks for gun buyers, writes the psychotherapist author of The Book of Woe. (Gary Greenburg)

Many years ago, a man I was seeing in therapy decided he wanted to take up a new hobby: high explosives. The state he lived in licensed purchasers of dynamite and other incendiaries only after a background check. He wanted to know: Would I write a letter declaring him fit to blow up stuff in his backyard for fun?

Aside from the fact that this was how he wanted to pass the weekend, I didn’t have any reason to think otherwise, so I gave him the note. He got the license. A few years after he stopped seeing me, I had occasion to visit him at his office. He had all his digits and limbs and, to my knowledge, had committed no antisocial acts with his legally obtained explosives. My note attesting to his mental health was framed on his wall.

I’ve been thinking about this guy recently, ever since our politicians’ imaginations have fastened upon background checks as the solution to our gun problems. I’ve also been thinking about a couple of other patients. One of them, a middle-aged professional, a ramrod-straight retired Marine, father of a little girl, faithful husband, the kind of man who buys a special lockbox just for transporting his weapon between home and gun club. The other: a 27-year-old hothead, an absentee father who never met a drug or a woman he didn’t like. His idea of fun was riding his motorcycle between lanes on the interstate at 100 mph, and he was the proud owner of (by his count) 37 guns. In the three years prior to arriving at my office, he’d been fired from four jobs, arrested for six or seven driving offenses and a few drug charges, and helped to bury three of his friends who met untimely and violent ends.

No one asked me which of these two men I’d rather was a gun owner, let alone which one ought to have a firearms license. But I know what my answer would have been. Or I would have known until about a year ago, when the ex-Marine, inexplicably and without warning (although he’d just been put on an antidepressant as part of a treatment for chronic pain), sat at the base of the tree holding his favorite deer perch and shot himself in the mouth. Meantime, the hothead has cooled down. He’s been with the same woman for two years and the same job for one. He sees his son faithfully twice a week. He’s sold his motorcycle and more than half of his guns, and become obsessed with bodybuilding and responsibility. The transformation is not complete—he’s still dead certain the government wants to come to his house and confiscate what’s left of his arsenal, for instance—and I can’t take too much credit for it. He’s pursuing the pleasures of self-control with the same manic intensity as he once chased adrenaline. But I’m not all that worried about his guns anymore, and I’m really glad no one asked me if he should have them.

Because one thing they don’t teach you in therapy school: how to tell the future. Clinicians can assemble a story out of the ashes of a person’s life; we might even be able to spot what we think are the seeds of catastrophe, but we generally do that best in retrospect. And that’s why, if one of us insists he or she knows for sure what’s coming next, you should find another therapist. It’s also why, to the extent that background checks involve people like me, it wouldn’t do much more than reassure politicians that they are doing something about gun violence without simultaneously threatening their National Rifle Association ratings.

But wait a minute, you may be saying. Don’t mental-health workers have a whole huge book of diagnoses to turn to that can help you assess a person’s fitness to own a gun? No, we don’t. We have the book, of course, the Diagnostic and Statistical Manual of Mental Disorders, which is about to come out in its fifth edition. But while some of those disorders seem incompatible with responsible gun ownership, even a diagnosis of a severe mental illness like schizophrenia or bipolar disorder isn’t a good predictor of who is going to become violent. Indeed, only about 4 percent of violent crimes are committed by mentally ill people. We are not going to diagnose our way to safety.

There’s a reason for this. A diagnosis of a mental disorder is only a description of a person’s troubles. A neurologist presented with a patient suffering loss of coordination and muscle weakness can run tests and diagnose amyotrophic lateral sclerosis or a brain tumor. They can explain the symptoms and predict with some accuracy what will happen as the disease takes its expected course. The 200 or so diagnoses in the DSM, on the other hand, explain little and predict less. Until the book contains a diagnosis called Mass Slaughter Disorder, whose criteria would include having committed mass slaughter, it’s not going to offer much guidance on the subject, and, obviously, what guidance it provides is going to come too late.

With the mentally disordered, as with all of us (and let’s remember that in any given year, something like 30 percent of us will meet criteria for a mental disorder, and 11 percent of us are on antidepressants right now), there is no telling what will happen next. No matter how many diagnoses are in the DSM, and no matter how astutely they are used, they will not tell us in whose hands guns are safe. The psyche is more unfathomable, and evil more wily, than any doctor or any book.




Guess Who’s Taking Over Mental Health Care? / Your smartphone

From NIH, National Institute of Mental Health

Director’s Blog: Look who is getting into mental health research

By on August 31, 2015

In the U.S., biomedical research funding has been estimated at $117 billion, following a rough law of thirds: about one-third government (mostly NIH), slightly more than one-third pharmaceutical companies, and the remainder a mix of biotech, foundations, and philanthropy.1 Support for research on mental disorders looks a little different. As pharmaceutical companies invest less in this area, government (especially NIMH) has become a larger fraction of the funding pool. Now there is a surprising new player in mental health research that is just beginning to emerge from the private sector.This summer I was invited to Apple, Google (now Alphabet), IBM, and Intel.
Why are technology companies inviting the NIMH director to visit? At first, I assumed their interest was purely financial. It’s hardly surprising that companies with large cash reserves have discovered a trillion dollar market (health care is now approaching 20 percent of the U.S. gross domestic product and mental health care is a significant part of those costs).2 But I quickly discovered two other factors that are driving tech companies into biomedical and mental health research.
One is big data. As genomics, imaging, and large health care studies generate terabytes of data daily, companies that know how to extract knowledge from data have become essential partners for progress towards new diagnostics and therapeutics. The data analytics from tech companies are becoming part of the engine of biomedical research. The other is the promise of technology to change health care, shifting it from episodic to continuous, from reactive to proactive, from physician-centered to patient-centered. (No longer in the system only when ill, the patient delivers profit 24/7, from conception to death.)

Even beyond wearable devices and online cognitive training, technology can offer information and interventions where and when someone needs it. Tech companies are realizing that mental health is, in their parlance, an excellent “use case.” Just as important, online health care (especially mental health care) creates data that can serve to improve quality, including monitoring the fidelity of psychotherapy.3 In the future, when we think of the private sector and health research, we may be thinking of Apple and IBM more than Lilly and Pfizer.

Coming to you a future near you: Individuals will be branded as potentially “socially aberrant, mentally ill, psychotic etc.” or having something diagnosable, and will be tracked 24/7 under the “lie” of preventative services.
Here are two fascinating previews of this new world I noted during my travels last week.

One was the publication of results from a collaboration between Columbia University and IBM.4 The team, led by Gillinder Bedi and Cheryl Corcoran, was looking for a biomarker to predict which clinically high-risk youth would convert to psychosis over a two- to three-year follow up period from an initial interview. Rather than depend on a protein in blood or a brain scan, they used an innovative big data approach to analyze the speech from the initial interview. The approach, developed by Guillermo Cecci at IBM, maps semantic coherence and speech complexity as a window into the earliest stages of disorganized thought. While analysis of previous clinical features have yielded, at best, 80 percent prediction, this automated analysis of unstructured speech was reported to be 100 percent accurate for identifying who would convert to psychosis during the follow up period. This is a small study (34 participants with 5 developing psychosis), but it serves as a preview of what we might see as the power of technology is applied to provide objective measures of behavior and cognition.

If this doesn’t scare you about the abuse of technology, what will?

Also last week I visited, an internet start-up housed on the nineteenth floor of an office building in San Francisco. The founders, Anmol Madan and Karan Singh, took me on a quick tour of their smartphone app, which tracks mood and anxiety to “deliver support to the right people at the right time.” Already used by thousands of people and adopted by several research groups, looks at everything from sleep and activity to social interaction and self-report to quantify mood. Their approach has enormous potential not only for research on mood and anxiety but for the development of interventions that can be deployed globally. While the app has mostly been used to link patients to providers, imagine a future when the app will empower patients with tools to become their own providers.

My summer tour of tech companies, large and small, left me with one unexpected conclusion. While the focus of wearable technology and online apps has thus far mostly been for managing heart disease and diabetes, the tech approach may be best suited for mental health. The biomarkers for depression and psychosis and post-traumatic stress disorder are likely to be objective measures of cognition and behavior, which can be collected by smartphones. Some of our most effective interventions are psychosocial treatments that can be delivered or extended by smartphones and tablets. Most important, the sensors and the interventions can be integrated into a closed loop so that care is continuous and iterative. Increasing symptoms, suicidal impulses, and paranoid thoughts lead immediately to an intervention. (BY WHOM? – The police? That’s who “provides” much of America mental health services, including throwing MH individuals in jail and depriving them of medication or care.  Population-based studies have shown that less than half of people with mental illness seek care. And workforce studies have shown that 55 percent of counties have no mental health care provider. Technology is not the answer to all problems, but it may help those with mental illness even more than those with other chronic, serious medical conditions.

Depression? / A Social Epidemic

The topic of Depression has been showing up quite a bit on sites that I frequent, and I realized that I don’t actually know much about Clinical Depression. I don’t find the description below to be very specific or medical. It’s self-diagnosis, isn’t it? You’re depressed if you think you are – the symptoms and criteria are offered to the patient to choose from; not an objective process. Five of these symptoms (why 5?) have to last for two weeks (why two weeks?) What if it’s not two weeks, but 13 days? Are you then not depressed? This seems a very short duration from what people with depression say – that it’s chronic.

There is an admonishment used to restrain this type of “bogus” quantification: Only count things that can be counted.  Making up” numbers (like 5 symptoms, 2 weeks) does not change the arbitrary social basis of diagnosis; useless quantification does not make a process “science”.

Call me a picky Asperger, but what is the cause?     Clinical Depression, if it’s real, must have cause(s).

Why bother with a charade of diagnosis? Just have people show up, say, “I’m depressed,” and dish out the prescriptions.  


From Mayo Clinic Online: Subscribe to Housecall Our general interest e-newsletter keeps you up to date on a wide variety of health topics.

What does the term “clinical depression” mean?

Answers from Daniel K. Hall-Flavin, M.D.

Depression ranges in seriousness from mild, temporary episodes of sadness to severe, persistent depression. Clinical depression is the more severe form of depression, also known as major depression or major depressive disorder. It isn’t the same as depression caused by a loss, such as the death of a loved one, or a medical condition, such as a thyroid disorder.

It’s easy to see that despite CD not having an environmental / medical cause, most of the symptoms CAN originate in economic and social fact – the social stress that the individual encounters in everyday existence. This stress is out of control, because it’s BUILT INTO the system. 

To be diagnosed with clinical depression, you must meet the symptom criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment. Are insurance companies co-writing the DSM, that is,  practicing medicine without a license? How do pharmaceutical companies influence who gets a diagnosis and which medication is prescribed?  The fact is, insurance industry “representatives” do “contribute” to what appears in the DSM. Do we have a case of the diagnosis creating the condition, the treatment and profit? 

For clinical depression, you must have five or more of the following symptoms over a two-week period, most of the day, nearly every day. At least one of the symptoms must be either a depressed mood or a loss of interest or pleasure. Signs and symptoms may include:

Depressed mood, such as feeling sad, empty or tearful (in children and teens, depressed mood can appear as constant irritability) (What teenager isn’t sad, empty, tearful or irritable at times?)

Significantly reduced interest or feeling no pleasure in all or most activities (Isn’t that the reality of  people at the bottom of the American Social Pyramid in the 21st C.? Drug addiction, violence, poverty and crime would likely both indicate and arise from depression.)

Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected) (Wow! that covers just about anyone!)

Insomnia or increased desire to sleep (Here we go again – any behavior on either side of an imaginary “normal.” In the U.S. we are bombarded daily by the message that even “normal” people have a sleep disorder. I’m not downplaying the absolute need for quality sleep. And how does one get adequate sleep time working more than one job, just to survive? )

Either restlessness or slowed behavior that can be observed by others (hearsay evidence; subjective.)

Fatigue or loss of energy (subjective; millions of Americans are exhausted by the stress and insecurity of chaotic social demands)

Feelings of worthlessness, or excessive or inappropriate guilt (socially induced symptoms)

Trouble making decisions, or trouble thinking or concentrating (Wow! I keep hoping for objective, provable symptoms, but it’s I guess they don’t exist!) 

Recurrent thoughts of death or suicide, or a suicide attempt (Look no farther than people who have been discarded by society: ex-military, the homeless, Native American young people, and the elderly.  

Your symptoms must be severe enough to cause noticeable problems in relationships with others or in day-to-day activities, such as work, school or social activities. Symptoms may be based on your own feelings or on the observations of someone else. (Wow! How scientific is that? It’s clear that clinical depression is a SOCIAL DIAGNOSIS, created by stressful conditions built into the social environment. Unhealthy social conditions of poverty, violence, financial distress, broken families, tyrannical bosses and demeaning work place conditions, do create physical changes and disease in the human animal, but “pills” simply mask the pain; they offer no cure for a toxic society that values profit over people; it is the “medico-pharma” greed that has created massive opioid addiction in the U.S.) 

Clinical depression can affect people of any age, including children. However, clinical depression symptoms, even if severe, usually improve with psychological counseling, antidepressant medications or a combination of the two. (Vague, relative, subjective – no money back guarantee!)  It’s all about $$$$$$$$.


It is important to understand that not only do we do horribly abuse animals, we are animals, and our modern social environments are the equivalent of zoos, circuses and research labs. And we wonder why human beings are depressed and ill? An outrageous number of American males (notably black) are being confined for years, and  many for life, for nonviolent offenses, in conditions considered cruel in zoos and circuses, where animals also become seriously disturbed / depressed.



Under pressure from a state court, California is building a psychiatric care unit at San Quentin prison in order to provide long-term mental health care for death row inmates. If you think about it, it's slightly ironic.

Under pressure from a state court, California is building a psychiatric care unit at San Quentin prison in order to provide long-term mental health care for death row inmates. If you think about it,  it’s cruel, insane and socially typical thinking.




Asperger Smarts / How not to deal with a predator

We’ve witnessed this scenario too many times :


Gray, 25, was taken into custody April 12 after police “made eye contact” with him and another man in an area known for drug activity, police said. Gray was handcuffed and put in a transport van. At some point during his roughly 30-minute ride, the van was stopped and Gray’s legs were shackled when an officer felt he was becoming “irate,” police said.

Grey died Sunday — a week after his arrest — of what police described as “a significant spinal injury.”

Do not make eye contact with a predator; this allows it to pick you out of the herd. Even worse is to RUN AWAY. This triggers the chase and kill instinct. Do not run.

The Chase: an instinct that is not going extinct.

The Chase: an instinct that is not going extinct.

I have thought quite a bit about socially dictated “rules” of eye contact that help define Aspergers as “developmentally disordered.” But – these rules are culturally subjective and diverse. I think it’s the instinctive response between animals that is causing huge problems. “Policing authorities” are designated predators-by-law and empowered to execute predatory behavior. Policing is not all about predation; police do “protect and serve.” It’s no surprise the individuals who are comfortable with being a predator gravitate toward specific jobs, but weaker individuals, who may be very uncomfortable with the task of wielding power, may end up in such jobs and that’s also a problem.

There are situations that trigger the predatory response, especially if the person stopped by the police unwittingly switches into prey behavior – notably, running away. A perfectly natural response (especially for young black males, who ARE prey) but one which also jump-starts predatory behavior in a police officer.

The racial aspect of this is huge. The history of White and African relationships is built on  predation of blacks by whites. There is something else that is overlooked: the stereotyping of black males by entertainment, the media, sports, etc. is utterly skewed: Big, black, aggressive, out-of-control and criminally active are adjectives that dominate the white view of black males: dangerous on all counts.

Stop and take one minute to examine this stereotype: black males are always the aggressor and always belong in jail? Ridiculous! These are human beings who way more often than not are frightened, intimidated, harassed, and tragically, are trying to live up to the “Bad Black” stereotype. Are black men allowed to feel fear, pain, and sorrow? Are they allowed to be gentle, caring and intelligent?


To the public observer, the act of running away is “non-threatening” and the police reaction is baffling and “over the top.” We are viewing the event rationally – a given situation has escalated way beyond what we would imagine ourselves doing. A person who is running away is obviously not a threat. It’s not about threat; it’s about acting like prey and pulling the predatory trigger.

As an Asperger, I can describe my reactions regarding eye contact. (I do not react well to  aggressive people.)

1. The other person is invading my comfort zone. It’s a breach of “boundary etiquette.” If the person stands too close (and stares) I will gain space in any number of benign ways, including calculated removal of myself from the area. I will avoid eye contact naturally, instinctively, because eye contact with predators rings their bell.

2. If the person is not aggressive, and a conversation takes place, I will switch to listening mode, because his or her appearance is no longer vital; my visual system has sized up the person and decided that he or she is “friendly.” This is intuitive. I will likely keep adjusting the “space” between us, which probably looks weird to other people.


Eye Contact / Submit or Die

untitledcomOdd bits from: Psychologist

“Scotland’s University of Stirling found that, in a question-and-answer study among children, those who maintained eye contact were less likely to come up with the correct answer to a question than those who looked away to consider their response.” Eye contact, as a socialising device, can take a surprising amount of effort to maintain when this energy could be spend on calculating, as opposed to perceptive, tasks.”


A garment that conceals all but the eyes…what does that say?


It seems that females are all about control of the male animal. Testing, testing…


“I have nothing else to offer: will trade boobs for any attention that makes me feel less worthless.”


Nothing is more depressing than turning humans into robotic lab rats!

Wow! Could it be that Asperger children who don’t maintain eye contact, are not “psychopaths” as determined by Simon Baron Cohen, but are simply using their brains to process information – AND to conserve energy?  

Both Animal Behaviorists and Human Behaviorists study animal behavior, but there is little evidence that they share their work. Perplexing.

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When a parent forces a child to experience a direct and angry stare, he or she is not “bonding.” They are intimidating the child by letting them know, on an animal level, that the parent is the predator and the child is prey:  the challenge to the child is “submit or die.” The child experiences fear. Is that so hard to understand? This act of domination instigates competitive predatory behavior in some children (the parent – child relationship becomes a war), and the child will likely turn their aggression toward other children, but most children who experience “domineering parenting” become prey animals.

Human behavior is animal behavior; a culture “utilizes” and simultaneously condemns animal behavior, which is reserved for predators who dominate every level of the social pyramid. To forbid animal behavior in a human society is to maintain a prey population; obedient, tame, neotenic.




What do Psych/Psych “Gods” look like?

It is claimed that ASD people and Aspergers can be ferreted out of the “normal” population by psychologists by “spotting” particular minute differences in physical appearance. On the other hand, psychologists and psychiatrists look remarkably the same. Ascension of the pyramid, authority and notoriety seem to rely on cultivating “the look” of Sigmund Freud. In order to bolster the pretense that psychology is science, it doesn’t hurt to be an Einstein impersonator. Do these “Gods” look healthy or happy?

Male gangs are everywhere – and don’t forget – they hate women and children.


People Faculty Emeritus Johnson-Laird,Philip

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As a practical matter, John Wayne has likely had more influence on the mind of the American male than any psychologist.

As a practical matter, John Wayne has likely had more influence on the mind of the American male than any psychologist.

Mental Health Care / The U.S. is Amazing

There is additional uplifting info from the Federal Government at Health & Human Services website. Be sure to take your antidepressant meds before reading.


Agency for Healthcare Resources and Quality.

Access to/Cost of Care

Access to mental health care is an ongoing problem for people in rural/frontier areas of the country as well as many other groups. For example, 4 percent of young adults reported foregoing mental health care in the past year, despite self-reported mental health needs. Commonly cited reasons ranged from inability to pay, belief that the problem would go away, and lack of time. Cost of mental health care is also a burden. For example, individuals nationwide spent an average of 10 percent of their family’s annual income out of pocket for mental health/substance abuse treatment. Also, mental disorders were one of the five most costly conditions in the United States in 2006, with expenditures at $57.5 billion. The curious fact is that there is no accountability for the effectiveness of treatment. Like public school teachers in the U.S., tracking of performance by outcome is “not acceptable.”

Mental disorders were one of the five most costly conditions for children in 2006.

  • The five most costly children’s conditions in 2006 were mental disorders, asthma, trauma-related disorders (fractures and other injuries), acute bronchitis, and infectious diseases, according to the latest data from AHRQ . Treating mental disorders in children, such as depression, cost the most at $8.9 billion compared with $8 billion for asthma and $6.1 billion for trauma-related disorders. Mean expenditures per child with expenses were highest for mental disorders at $1,931. Medicaid paid for more than one-third of the expenditures for mental disorders (35.2 percent), with private insurance paying the largest percentage of expenditures. Out-of-pocket payments were highest for mental disorders at 21.3 percent. These data are taken from the Medical Expenditure Panel Survey (MEPS), a detailed source of information on U.S. health services use, cost, and sources of payment. For more information, see MEPS Statistical Brief #242, The Five Most Costly Children’s Conditions, 2006: Estimates for the U.S. Civilian Noninstitutionalized Children, Ages 0 to 17, at Software Help)Americans seem to think that costs paid by insurance are “free” – but payments are a hidden tax on everyone: price of care, pharmaceuticals, insurance premiums, advertising, paperwork, ++ continue to skyrocket, while access to quality care, or any care in many locations is vanishing.

“Always the dollars…always the fucking dollars” – Nicky Santoro, Casino

  • Mental disorders led the list of the five most costly conditions overall in 2006.Mental disorders, heart conditions, cancer, trauma-related disorders, and asthma ranked highest in terms of direct medical spending in 1996 and 2006, according to the latest data from AHRQ. The number of people accounting for expenses for mental disorders nearly doubled from 19.3 million to 36.2 million during that period. Of the five conditions, out-of-pocket payments were highest for the treatment of mental disorders in both 1996 and 2006 (23.1 and 25 percent, respectively). These data are taken from the Medical Expenditure Panel Survey (MEPS), a detailed source of information on U.S. health services use, cost, and sources of payment. For more information, see MEPS Statistical Brief #248, The Five Most Costly Conditions, 1996 and 2006: Estimates for the U.S. Civilian Noninstitutionalized Population, at (Plugin Software Help)
  • People with psychotic disorders and bipolar disorder are 45 percent and 26 percent less likely, respectively, to have a primary care doctor than those without mental disorders Try finding a doctor who doesn’t have severe prejudice against “mental” people – they think you’re deaf, stupid, a child, or an axe murderer!Researchers compared access and barriers to medical care among 156,475 adults reporting psychotic and mood disorders or no mental disorders, who completed the National Health Interview Survey (NHIS) and NHIS-Disability Component for 1994 and 1995. People with psychotic disorders, bipolar disorder, or major depressive disorder had 2.5 to 7 times greater odds of any barriers to care, ranging from delaying medical care because of costs to being unable to get needed medical care or a needed prescription medication. However, those with major depression were as likely to report having a regular source of care as those who did not report psychiatric disorders. Bradford, Kim, Braxton, and others, “Access to medical care among persons with psychotic and major affective disorders,” Psychiatric Services 59(8), pp. 847-852, 2008 (AHRQ grant HS13353).
  • Young adults’ mental health problems are compounded by the number of barriers they face when accessing medical care.Four percent of young adults reported foregoing mental health care in the past year, despite self-reported mental health needs. Commonly cited reasons ranged from inability to pay, belief that the problem would go away, and lack of time. Among individuals suffering from depressive symptoms, young adults reported significantly lower rates of counseling use than adolescents. Female gender, high maternal education, school attendance, and receipt of routine physical exams were significantly predictive of counseling use among young adults. Young black adults were significantly less likely to receive counseling than their white counterparts. These findings were based on analysis of data from a sample of 10,817 participants in the National Longitudinal Study of Adolescent Health in 1995 and follow-up data 7 years later. Yu, Adams, Burns, et al., “Use of mental health counseling as adolescents become young adults,” Journal of Adolescent Health 43:268-276, 2008 (AHRQ grant HS00086).
  • A quality improvement (QI) program that improves access to psychotherapy (QI-therapy) and antidepressant medication (QI-meds) is cost-effective for managing depression in primary care patients.The researchers examined the cost effectiveness of managing care of 746 primary care patients with 12-month depressive disorder and 502 patients with current depressive symptoms but no disorder (sub-threshold depression). The patients were randomly assigned to enhanced usual care or to QI-Meds or QI-Therapy for 6 to 12 months.The cost of the QI program was $2,028 per quality-adjusted life year (QALY) for those with sub-threshold depression and $53,716 per QALY for those with depressive disorder. This is similar to the cost effectiveness of many widely used medical therapies. The researchers calculated that the costs of the intervention per se — as distinct from intervention effects on use of services and medication — were $86 per patient in the QI-Meds group and $79 per patient in the QI-Therapy group. Wells, Schoenbaum, Duan, et al., “Cost effectiveness of quality improvement programs for patients with subthreshold depression or depressive disorder,” Psychiatric Services 58(10):1269-1278, 2007 (AHRQ grant HS08349). Aye, yay, yai! “Care and Treatment” are bizarre word concepts that have nothing to do with “care and treatment” but become abstract financial fictions: and costs keep skyrocketing. 
  • Southerners bear a higher financial burden for mental health/substance abuse treatment.About 11 percent of people using outpatient mental health and substance abuse (MH/SA) treatment in the South used more than 5 percent of their family’s annual income to cover their out-of-pocket treatment costs from 2001 to 2005. Southerners paid the highest percentage of treatment costs out of their own pockets because they were most likely to use prescription medications for their treatment and they paid the greatest share (39 percent) of the costs of these medications. For other regions of the country, between 8 and 10 percent of MH/SA treatment recipients spent more than 5 percent of their family’s annual income, and 10 percent did nationwide. Patient out-of-pocket costs included fees for psychiatrists, psychologists, social workers, and other specialty providers; MH treatment provided by primary care physicians; and medications. Prescription medications accounted for almost two-thirds of out-of-pocket spending for outpatient MH treatment. Pill-Mill doctors, clinics and any one with a prescription pad, have created an epidemic of  prescription med addiction across the U.S. – Money, money, money made by “legal” drug dealers. Zuvekas and Meyerhoefer, “State variations in the out-of-pocket spending burden for outpatient mental health treatment,” Health Affairs 28(3):713-722, 2009 (AHRQ Publication No. 09-R056).*
  • Managed behavioral health care organizations have reduced the costs of specialty mental health and substance abuse treatment by shifting to outpatient services.There remains concern that managed behavioral health care organizations (MBHOs) may (a done deal) shift mental health treatment to primary care and prescription drugs (use of drugs instead of psychotherapy) in order to reach contractual cost-savings goals. However, this study of a single MBHO found no evidence to suggest that it shifted treatment costs in this way. Researchers analyzed claims data from 1991-1995 from an insurer that introduced an MBHO in 1992 to control treatment costs. The use of any psychotropic medication rose 64 percent over the 4-year period among enrollees of the large employer group that had parity for physical and mental health care and by 87 percent in the smaller groups without parity. Often these medications were prescribed in primary care settings. Introduction of the MBHO was not significantly associated with the use of any psychotropic medication alone, and for newer antidepressants, it was associated with a 2.4 percentage point decrease in medication use alone in the large group. Zuvekas, Rupp, and Norquist, “Cost shifting under managed behavioral health care,” Psychiatric Services 58(1):100-108, 2007 (AHRQ Publication No. 07-R036).*
  • Hospital cost and stay duration for the elderly with non-dementia psychiatric illnesses varies by care settings.General hospitals, psychiatric units, long-stay hospitals, and skilled nursing facilities (SNFs) are the inpatient settings where non-dementia psychiatric illnesses (NDPI), such as depression, bipolar disorders, and substance abuse, are treated. Medicare’s cost-cutting reimbursement strategies and caps on stay lengths in addition to treatment advances have affected how the elderly receive care for NDPI. Analysis of Centers for Medicare & Medicaid Services data from 1992 to 2002 found that mean inpatient length of stay for NDPI illnesses fell from nearly 14.9 days in 1992 to just 12.1 days in 2002. Similarly, mean Medicare expenditures per stay declined from $8,461 to $6,207. Each of the four types of facilities treating these patients was impacted differently during the 10-year period. For example, the portion of NDPI stays that were in general hospitals fell from 34.5 percent to 27.4 percent, and the portion in long-stay hospitals fell from 19.5 percent to 11.3 percent. However, mean Medicare-covered SNF days per NDPI stay remained stable, while mean Medicare-covered costs rose from $4,153 to $6,375. Hoover, Akincigil, Prince, et al., “Medicare inpatient treatment for elderly non-dementia psychiatric illnesses 1992-2002; length of stay and expenditures by facility type,” Administration and Policy in Mental Health 35(4): 231-240, 2008 (AHRQ grant HS16097).
  • States vary greatly in nursing home admissions for people with mental illnesses.State variation in services for people with mental illnesses and how they are admitted to nursing homes may result in longer-than-average stays for those individuals. Researchers analyzed 2005 data from the Centers for Medicare and Medicaid Services. They found that States varied widely in nursing home admission rates for people suffering from mental illness. For example, nursing homes in Wyoming, Nevada, Arkansas, and South Dakota had the lowest rates for admitting individuals with schizophrenia and bipolar disorder, while Connecticut, Ohio, and Massachusetts had the highest rates. What’s more, in 2004 nearly 46 percent of people with mental illnesses admitted to nursing homes in the United States remained in the facility 90 days after admission compared with 24 percent of people who did not have a mental illness. The way Medicaid pays nursing homes may be one reason for State variations in admissions for people with mental illnesses. For instance, Medicaid pays nursing homes higher rates for people with mental illnesses who have minimal physical problems. Thus, these higher rates may give nursing homes an incentive to admit these patients. Variation could also be a result of some States being able to offer home and community-based services or State psychiatric hospitals in lieu of nursing home care. Grabowski, Aschbrenner, Feng, and Mor, “Mental illness in nursing homes: Variations across States,” Health Affairs 28(3), pp. 689-700, 2009 (AHRQ grant T32 HS00011).
Page last reviewed October 2014

Internet Citation: Mental Health: Research Findings. October 2014. Agency for Healthcare Research and Quality, Rockville, MD.