Chelsie Derman is an assistant editor for 

who covers psychiatry, sleep medicine, and geriatrics. She joined MJH Life Sciences in September 2023 after graduating from The College of New Jersey with a bachelor’s degree in journalism and professional writing. In her free time, she enjoys creative writing and reading.

Chelsie Derman

was prevalent among adults long after the mass violence incidents occurred in their community.

“The present findings also have important implications for identifying those at most risk for developing PTSD following [mass violence incidents],” wrote investigators, led by Angela D. Moreland, PhD, from the department of psychiatry and behavioral sciences at Medical University of South Carolina.

According to Brady United, every day 327 people are shot in the US, with an average of 117 dying.

 Surviving a mass shooting can be traumatic, but it can also be traumatic for witnesses and people in the community who heard about it secondhand.

Although it is known direct survivors suffer long-lasting psychological consequences, the impact on the broader communities where the mass shooting took place is unknown.

Investigators conducted a cross-sectional survey study from February 2020 to September 2020 with a sample of adults from 6 communities who had most likely experienced a mass violence incidence between 2015 and 2019 at Dayton, Ohio; El Paso, Texas; Parkland, Florida; Pittsburgh, Pennsylvania; San Bernadino, California; and Virginia Beach, Virginia. The team used address-based sampling to identify randomly selected households, mail invitations, and select 1 adult per household to complete a self-administered print or online survey. Investigators analyzed the data from September to November 2023.

The primary outcome was a probable diagnostic-level past-year PTSD, and current (last month) PTSD determined using the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) PTSD criteria.

Among 6867 adults aged ≥ 18 years who accessed the survey website, 5991 (87.2%) agreed to participate and completed the survey, 343 (6.3%) partially completed the survey, and 443 (6.5%) did not meet eligibility criteria or refused to participate. More than half of the respondents were female (53.5%), and the sample had a mean age of 45.56 years.

In the survey 21% of respondents reported high exposure to the mass violence incident, meaning either themselves, a close friend, or a family member was on site during the shooting. Nearly one-quarter (23.7%) of participants met probable DSM-5

diagnosis criteria for past-year PTSD, and 8.9% met the criteria for current PTSD. Among the sample, approximately 1 in 4 individuals met PTSD criteria for past-year and 1 in 10 met the criteria for a current PTSD diagnosis.

Regression analyses demonstrated being female (odds ratio [OR], 2.32; 95% confidence interval [CI], 2.01 – 2.68) and having a history of both physical or sexual assault and other potentially traumatic events (OR, 9.68; 95% CI, 7.48 – 12.52) were associated with the greatest risk of past-year PTSD. People who were younger and had low social support also were more likely to have PTSD.

The team added the results were consistent with previous research on PTSD risk factors. Numerous studies found females were more vulnerable to PTSD, but the reasons for this are not fully known. This may be because females have greater rates of assault, are more vulnerable to stressors, and are often more willing than males to disclose symptoms.

Investigators pointed out several limitations including the self-reported data to determine probable PTSD, the address-based sampling method which could have impacted the response rate and created nonresponse bias, and a small number of participants reported being on the site during the mass shooting.

“It is also important to consider that the rates of community PTSD may be influenced by unique features of each [mass violence incident] and vulnerabilities inherent to the community,” investigators wrote. “Although the majority of PTSD cases occurred in those with high exposure to the [mass violence incident], many respondents with no direct exposure met the criteria for past-year (21.0%) and current (8.9%) PTSD. Community-level factors may be especially important to consider for [mass violence incident] sites with an extensive history of community violence.”

Moreland, A, Rancher, C, Davies, F. Posttraumatic Stress Disorder Among Adults in Communities with Mass Violence Incidents. 

. 2024;7(7):e2423539. doi:10.1001/jamanetworkopen.2024.23539

https://www.bradyunited.org/resources/statistics

Articles

A new study found probable PTSD was prevalent among adults in the community after a mass shooting, with greater prevalence among those previously assaulted.

1 in 4 Adults in the Community Meet PTSD Criteria Following Mass Shooting

Credit: Michigan Medicine, University of Michigan

 apps with personalized feedback provide similar benefits to apps incorporating mindfulness-based interventions or cognitive behavioral therapy.

“The findings highlight the potential for [digital mental health interventions] to be offered as supplemental or adjunctive tools within health care systems,” wrote investigators, led by Adam G. Horwitz, PhD, from the department of psychiatry at the University of Michigan Medical School.

Mental health services have a wide gap between supply and demand. For people who cannot get an appointment, or have to wait a long time, being able to use an effective mental health app can help individuals get the help they need earlier.

A 2022 meta-analysis supported the potential of using smartphone apps as a mental health intervention to improve depression and anxiety symptoms.

 However, little was known about how a mental health app would compare to actual therapies.

Investigators sought to compare whether digital mental health interventions based on cognitive behavioral therapy (CBT) or mindfulness would be more beneficial than enhanced personalized feedback.

“Contrary to our hypotheses, randomization to various [digital mental health interventions] did not result in differing outcomes with respect to depression, anxiety, suicidality, and substance use among adults scheduled for outpatient psychiatry services,” investigators wrote.

The team conducted a randomized clinical trial between May 13, 2020, and December 12, 2022, with a follow-up at 6 weeks. They recruited adult patients aged ≥ 18 years who had a scheduled or recent outpatient psychiatry appointment at various clinics within the University of Michigan Health System. Participants were randomized 1:5 to the intervention arms of enhanced personalized feedback, Silvercloud (designed to deliver CBT strategies), Silvercloud plus enhanced personalized feedback, Headspace (designed to deliver mindfulness strategies), and Headspace plus enhanced personalized feedback.

Silvercloud has a global user base of > 500,000 people and consists of psychoeducation and self-guided modules introducing CBT skills, such as mood monitoring, activity scheduling, and cognitive restructuring through text, videos, and journaling exercises. The app has demonstrated the benefits of reducing depression and anxiety symptoms (effect size range, 0.50 – 0.63) compared with controls.

As for Headspace, this app has > 2,000,0000 users and includes many guided mediations and strategies for improving sleep, reducing anxiety, and stress coping mechanisms. This app has also demonstrated benefits in reducing depression and anxiety symptoms (effect size range, 0.24 – 0.26) compared with controls.

The primary outcome was a change in depression symptoms, measured by the Patient Health Questionnaire-9 (PHQ-9). Secondary outcomes included changes in anxiety, suicidality, and substance use symptoms from baseline to a 6-week follow-up.

The study included 2079 participants with a mean age of 36.8 years and more than half women (68.4%). At baseline, the mean PHQ-9 score was 12.7.

Investigators found for all 6 intervention arms depression symptoms reduced by 2.5 points from baseline to the 6-week follow-up (marginal mean differences in mean change ranged from -2.1 (95% confidence interval [CI], -2.6 to -1.7) to -2.9 (95% CI, -3.4 to -2.4). Ultimately, the difference in depression symptom reduction was not significantly different across 5 arms (

Moreover, the arms did not significantly differ in their reduction in anxiety or substance use symptoms. However, compared with the Silvercloud arms, both Headspace groups reported significantly greater improvements on the suicidality measure subscale (mean difference in mean change, 0.63; 95% CI, 0.20 to 1.06;

“While the modest magnitude of improvement does not suggest [digital mental health interventions] can replace formal mental health care services, [digital mental health interventions] may serve an important role in supporting patients during waiting list–related delays in care,” investigators concluded.

Horwitz AG, Mills ED, Sen S, Bohnert ASB. Comparative Effectiveness of Three Digital Interventions for Adults Seeking Psychiatric Services: A Randomized Clinical Trial. 

 2024;7(7):e2422115. doi:10.1001/jamanetworkopen.2024.22115

Goldberg SB, Lam SU, Simonsson O, Torous J, Sun S. Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials. 

. 2022;1(1):e0000002. doi:10.1371/journal.pdig.0000002

A study demonstrated a smartphone app provides comparable benefits to cognitive behavior or mindfulness-based therapy, widening the supply gap for mental health care.

3 Mental Health Apps Comparable in Benefits

A recent study found physical activity engagement is inversely associated with reducing 

 symptoms, and the association was stronger among people with greater 

“While the holistic benefits of exercise to individuals with [

] is not a novel finding in itself, the demonstration that the highest levels of pain were associated with the most potential benefit in terms of reduction in symptoms of depression from engaging in physical activity is of significance,” wrote investigators led by Michaela C. Pascoe, PhD, from the Institute for Health and Sport at Victoria University in Australia. “This suggests that those who have the highest pain and are the least likely to engage in physical activity may have the most to gain.”

Osteoarthritis, the leading cause of chronic pain, is linked to high rates of depression. Previous research found one-fifth of people with osteoarthritis experience symptoms of depression. According to the Centers for Disease Control and Prevention, depression symptoms is more prevalent among adults with arthritis than adults without (12.1% vs 4.7%).

 Since physical activity reduces depression symptoms and pain levels, investigators wanted to see if physical activity is associated with reduced symptoms of depression, regardless of pain levels, in patients with osteoarthritis.

The team conducted a cross-sectional study to explore whether pain mediated or moderated the relationship between the amount of physical activity and depression symptoms. They recruited 552 individuals with osteoarthritis waiting for an orthopedic consultation at a public hospital in Melbourne, Australia. Approximately half were women (54.7%), and the mean age was 62.6 years.

Investigators collected data on age, gender, and affected joints from medical records. Data on depression symptoms, physical activity, and pain were self-reported from the Patient Health Questionnaire, the Active Australia Survey, and the 4-item pain intensity measurement, respectively.

The most common joints affected by osteoarthritis were the knee (44%), hip (15.5%), shoulder (14.4%), and foot (13%). Some participants had multiple joints affected (9%). In total, 33.9% of participants had moderate depression scores or greater; 18.8% reported a major depressive disorder and 10.8% reported another depressive syndrome.

Participants reported an average of 5.19 hours of total physical activity per day, and nearly half (47.8%) of participants were sufficiently active, based on the Australian Physical Activity Guidelines of ≥ 150 minutes of MVPA or 75 minutes of vigorous-intensity physical activity per week). However, 36.9% were insufficiently active, and 15.4% were sedentary with 0 minutes of MVPA per week. On average, participants reported a pain level of 27.70 out of 40.

The findings revealed an inverse association between physical activity and depression (

 < .001). The association between physical activity and depression was stronger in people with greater pain (

= .043). The greatest pain levels were associated with the most benefit in physical activity reducing depression symptoms.

Investigators highlighted several limitations, such as the cross-sectional design not allowing for examination of long-term relationships, not examining potential confounders such as comorbidities, body mass index, medication, and disease duration, and using self-reported data. Additionally, data was collected during the COVID-19 pandemic which could have impacted levels of physical activity and depression symptoms.

Ultimately, participating in physical activity can help reduce symptoms of depression in individuals with osteoarthritis, especially those with greater pain levels.

“This [study] highlights the need for education of both health professionals and patients on the importance of regular physical activity for pain management and mental health and access to appropriate self-management or clinical interventions to increase and maintain engagement in physical activity,” investigators wrote. “The current work indicates the importance of appropriate care plans and approaches to support individuals, who avoid physical activity due to pain, to safely engage in beneficial physical activity.”

Pascoe MC, Patten RK, Tacey A, et al. Physical activity and depression symptoms in people with osteoarthritis-related pain: A cross-sectional study. 

. 2024;4(7):e0003129. Published 2024 Jul 18. doi:10.1371/journal.pgph.0003129

Symptoms of Anxiety and Depression Among Adults with Arthritis — United States, 2015–2017. Centers for Disease Control and Prevention. October 5, 2018. 

https://www.cdc.gov/mmwr/volumes/67/wr/mm6739a2.htm#:~:text=Among%20adults%20with%20arthritis%2C%20age,4.7%25%20among%20adults%20without%20arthritis

A study found the association between physical activity engagement and reduction in depression symptoms is moderated by pain.

Physical Activity Linked to Reducing Depression Symptoms, Mediated by Pain

Adrian Quartel, MD: Next Steps for Evaluating KP1077 in Idiopathic Hypersomnia

revealed KP1077 (serdexmethylphenidate or SDX) meaningfully improves excessive daytime sleepiness, sleep inertia, brain fog, and patient-reported outcomes in patients with

. Zevra Therapeutics announced the positive results on June 3, 2024, during SLEEP 2024, the 38th annual meeting of the Associated Professional Sleep Societies in Houston.

The phase 2 proof-of-concept, placebo-controlled, double-blind trial sought to evaluate the efficacy and safety of KP1077 in patients with idiopathic hypersomnia. Patients (n = 50) were split into groups of once-a-day-dosing and twice-a-day dosing), followed by being randomized 2:1 to either the study or placebo group. Each arm only had 25 participants.

Investigators saw KP1077 was well-tolerated at all doses, even at the highest dose (320 mg). Adverse events were comparable to other methylphenidate products, and the most common ones were insomnia, headache, anxiety, decreased appetite, and nausea. Most adverse events appeared during the titration period and were mild.

“We are very confident in regards to the safety profile, both cardiovascular as well as neurological,” Adrian Quartel, MD, the Chief Medical Officer of Zevra Therapeutics, told 

. “This is a very clean drug. We know that it's the methylphenidate itself has been on the market for 20 plus years, serdexmethylphenidate has been used in thousands of patients, so we are confident that KP1077 is an appropriate and safe drug for patients.”

KP1077 provided clinically meaningful improvements in excessive daytime sleepiness from baseline, based on the Epworth Sleepiness Scale. The mean total Epworth Sleepiness Scales scores reduced by approximately 9 points after 5 weeks of treatment. The improvement was maintained during the 2-week double-blind withdrawal period for both dosing regimens.

The once-a-day-dosing group had greater reduced scores in the mean total Epworth Sleepiness Scales (reduction: 9.4 vs 8.8), mean total IH Severity Score (16.1 vs 12.3) Sleep Inertia Visual Analog Scale (25.9 vs 17.2), and Brain Fog Score (23.8 vs 22.3) than the twice-a-day dosing group.

As for morning and night doses, patients had a peak exposure of SDX-derived d-MPH after a nighttime dose of KP1077 during the next morning rather than the morning dose.

Zevra Therapeutics has requested an end-of-phase 2 meeting with the FDA to discuss plans for a phase 3 trial and address trial design questions. The company also met with patient advocacy groups, patients, and physicians to provide comments on how to interpret the data. Although this phase 2 trial was not intended to provide significant findings, hence the small sample, the study helped investigators with their primary objective of the study: building the groundwork to inform the next direction of this research.

“This would probably be one of the first drugs that is a stimulant that is being used in idiopathic, idiopathic hypersomnia,” Quartel said. This kind of is a bit different, right? So the different treatment modalities available do very different things, so this just provides patients and physicians with an alternative treatment modality that may be preferential for certain patients.”

Zevra Therapeutics Announces Positive Final Results from Phase 2 Clinical Trial of KP1077 For Idiopathic Hypersomnia At SLEEP 2024 Annual Meeting. Zevra Therapeutics. June 3, 2024. 

https://investors.zevra.com/news-releases/news-release-details/zevra-therapeutics-announces-positive-final-results-phase-2

In an interview Adrian Quartel, MD, discusses the next steps for evaluating KP1077 in idiopathic hypersomnia after the phase 2 study.