Day: June 18, 2022

The World Health Organization is calling for a radical change in the treatment of mental health disorders, saying existing care systems are largely ineffective and often abusive. 

Nearly a billion people were living with a mental disorder in 2019. That number has grown, with new data showing conditions such as depression and anxiety increasing by more than 26 percent in the first year of the coronavirus pandemic.

The World Health Organization recently released its largest review of world mental health since the turn of the century. The report finds 14 percent, or one in seven adolescents, is suffering from a mental disorder. It says suicides account for one in 100 deaths, with 58 percent occurring before age 50.

Head of the WHO’s mental health unit, Mark Van Ommeren, says mental disorders are the leading cause of disability. He says depression and anxiety alone cost the world economy nearly $1 trillion a year in lost productivity. Despite the enormous socio-economic consequences, he says many people with mental health problems do not seek help for a variety of reasons.

“They fear the stigma of seeking help could be one reason. Another reason can be that they do not trust the services that are available because there has not been enough investment in it,” Van Ommeren said. “Third, it could be that they do not recognize the problem because their knowledge about mental health problems is limited.”

The WHO says only a small fraction of people in need have access to effective, affordable and quality mental health care. It says the gap between developed and developing countries is huge, noting 70 percent of people with psychosis are treated in richer countries, compared to 12 percent in poorer countries.

Van Ommeren says the current mental health care system is broken and must change. He says governments invest around two out of three dollars for mental health in large custodial psychiatric hospitals. He says that money would be better spent  on community-based mental health facilities because they are more accessible.

“It is less likely that there are human rights violations … the atmosphere in large hospitals easily becomes that the hospitals warehouse people with very severe problems,” Van Ommeren said. “In community settings with open doors, it is much less likely. Also, in community settings, many more people can easily be treated. The hospital has so much stigma around it that many people would never seek care there.”

The WHO says countries can provide better, more affordable treatment by strengthening community health services. It recommends integrating treatment into primary health care, in schools and in prisons. It says mental health should be covered by insurance plans.
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Weather disasters that happen more often because of climate change create conditions in which gender-based violence often spikes, according to new research.    

The study, published in the journal The Lancet Planetary Health, reviewed research from five continents and found increased violence against women and girls in the aftermath of floods, droughts, hurricanes and other extreme weather events that are becoming more frequent as the planet warms. Humanitarian organizations that respond to weather disasters should be aware of this troubling trend when planning their operations, the study authors said.  

“When we think of climate change effects, we think of some very drastic and very visual things, things like floods, disruptions of cities, supply chain disruptions — which are all very valid and very real risks of climate change,” said study author Sarah Savić Kallesøe, a public health researcher at Simon Fraser University in Canada. “But there are also some more veiled consequences that are not as easily visible or easily studied. And one of those things is gender-based violence.”  

The researchers scoured online databases to find studies on rape, sexual assault, child marriage and other forms of gender-based violence following extreme weather events.  

The initial search, based on broad keywords like “violence,” “women,” and “weather,” yielded more than 20,000 results, each of which Savić Kallesøe and her colleagues screened individually to determine whether they were relevant.  

Only 41 studies that assessed links between gender-based violence and extreme weather made the cut. The researchers then graded the robustness of each study’s methodology using standard rubrics for grading data quality. Although many of the papers were flawed and a few contradicted each other, most studies — especially the higher quality ones — reported a rise in gender-based violence following extreme weather, Savić Kallesøe said.  

For instance, one study found that new moms were more than eight times as likely to be beaten by their romantic partners after Hurricane Katrina if they had suffered storm damage than before the storm hit. Five studies of good or fair quality linked drought in sub-Saharan Africa to upticks in sexual and physical abuse by romantic partners, child marriage, dowry violence, and femicide.  

And interviews with survivors revealed that seeking disaster aid can make women more vulnerable: “The shelter is not safe for us. Young men come from seven or eight villages,” said one survivor to researchers following Cyclone Roanu in Bangladesh in 2016. “I feel frightened to stay in the shelters. I stay at my house rather than taking my teenage daughter to the shelters,” she added.

Lindsay Stark, a social epidemiologist at the Brown School of the Washington University in St. Louis, said the pattern “is something that those of us who are working in the humanitarian space know intrinsically, because we see it all the time. So, it is very nice to see this distillation of the evidence.”  

Savić Kallesøe emphasized that climate change itself doesn’t directly cause gender-based violence. Instead, she and her colleagues found that gender-based violence is “exacerbated by extreme weather events because it’s a type of coping strategy at the expense of women, girls, and sexual and gender minorities,” she said.  

Extreme weather can place people under enormous stress, displace them, force them into crowded relief camps, destroy their livelihoods, and expose them to strangers who might do them harm. Layered over the gender roles that often drive gender-based violence, these risk factors make women especially vulnerable. For instance, a family might marry off a daughter early to have one less mouth to feed after a flood, or a man stressed after a hurricane might snap and strike his wife.  

Researchers widely recognize that humanitarian crises, like conflict or forced migration, tend to expose women and girls to violence. That climate disasters would have similar consequences isn’t surprising, said Lori Heise, an expert on gender equity at the Johns Hopkins Bloomberg School of Public Health.  

However, the exact ways in which climate disasters lead to gender-based violence still aren’t clear from the data. Few high-quality studies are available — and almost no data has been collected on the challenges faced by LGBTQ people following extreme weather events. The new study highlights the need for more and better research and for humanitarian organizations to engage with women and girls in climate-stressed areas about how best to protect them when disaster strikes, Savić Kallesøe said.

“Gender-based violence is happening all the time, everywhere,” Stark said. “We need to be preventing gender-based violence now … and to understand that if we don’t act now, the situation is going to increase exponentially with the impending climate crisis that we all know is upon us.”
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More than 1,600 confirmed monkeypox cases and almost 1,500 suspected cases have been reported this year from seven countries where monkeypox has been detected for years and 32 newly affected countries, according to the World Health Organization director-general, Dr. Tedros Adhanom Ghebreyesus.

“Europe remains the epicenter of this escalating outbreak,” Dr. Hans Henri P. Kluge, WHO regional director for Europe, said, with “85% of the global total.”

WHO is convening an emergency meeting next week to discuss the mounting outbreak and whether the name of the disease should be changed.

A group of scientists said in a statement recently on virological.com, “In the context of the current global outbreak, continued reference to, and nomenclature of this virus being African is not only inaccurate but is also discriminatory and stigmatizing. The most obvious manifestation of this is the use of photos of African patients to depict the pox lesions in mainstream media in the global north. Recently, Foreign Press Association, Africa, issued a statement urging the global media to stop using images of African people to highlight the outbreak in Europe.”

Monkeypox, according to a description on WHO’s website, “is a zoonosis: a disease that is transmitted from animals to humans.”

Human-to-human transmission is limited, according to WHO, but can occur “through contact with bodily fluids, lesions on the skin or on internal mucosal surfaces, such as in the mouth or throat, respiratory droplets and contaminated objects.”
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People infected with the earliest version of the omicron variant of the coronavirus, first identified in South Africa in November, may be vulnerable to reinfection with later versions of omicron even if they have been vaccinated and boosted, new findings suggest.

Vaccinated patients with omicron BA.1 breakthrough infections developed antibodies that could neutralize that virus plus the original SARS-CoV-2 virus, but the omicron sublineages circulating now have mutations that allow them to evade those antibodies, researchers from China reported on Friday in Nature.

Omicron BA.2.12.1, which is now causing most of the infections in the United States, and omicron BA.5 and BA.4, which account for more than 21% of new U.S. cases, contain mutations not present in the BA.1 and BA.2 versions of omicron.

Those newer sublineages “notably evade the neutralizing antibodies elicited by SARS-CoV-2 infection and vaccination,” the researchers found in test-tube experiments.

The monoclonal antibody drugs bebtelovimab from Eli Lilly and cilgavimab, a component of AstraZeneca’s Evusheld, can still effectively neutralize BA.2.12.1 and BA.4/BA.5, the experiments also showed.

But vaccine boosters based on the BA.1 virus, such as those in development by Pfizer/BioNTech and Moderna, “may not achieve broad-spectrum protection against new omicron variants,” the researchers warned.

Previous research that has not yet undergone peer review has suggested that unvaccinated people infected with omicron are unlikely to develop immune responses that will protect them against other variants of the coronavirus.

“My personal bias is that while there may be some advantage to having an omicron-specific vaccine, I think it will be of marginal benefit over staying current with the existing vaccines and boosters,” said Dr. Onyema Ogbuagu, an infectious diseases researcher at Yale School of Medicine in New Haven, Connecticut, who was not involved in the new study.

“Despite immune evasion, the expectation can be that vaccines will still protect against serious disease,” Ogbuagu said. “If you’re due for a booster, get a booster. What we’ve learned clinically is that it’s most important to stay up to date with vaccines” to maintain high levels of COVID-19 antibodies circulating in the blood.

Adolfo Garcia-Sastre, a microbiology and infectious diseases researcher at the Icahn School of Medicine at Mount Sinai in New York City, suggested that better protection might be seen with vaccines that target multiple strains of the virus or with intranasal vaccines that would increase protection from infection and transmission by generating immunity in the lining of the nose, where the virus first enters.

Garcia-Sastre, who was not involved in the research, said by the time one variant-specific vaccine becomes available, a new variant may well have taken over.
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