Congressional Quarterly (1/16, Bettelheim, Subscription Publication) reports that starting this month, many physicians “who were likely to expand basic medical care offered to low-income Americans — a goal of the 2010 health care law — could see Medicaid fees drop an average of almost 43 percent.” The pay cut comes after Congress declined to renew a temporary fee bump in the ACA designed to shrink the “historic gap” between what Medicaid and Medicare pay physicians. According to CQ, the drop in reimbursements puts access to care for millions of patients at stake. Physician lobbies “will try to persuade Congress this spring to retroactively restore the bonuses, but their best hope may be pressing states to step forward and pay the difference with their own money.”

Related Links:

— Congressional Quarterly (requires login and subscription)

The Los Angeles Times (1/15, Zarembo) reports that an analysis to appear in the February issue of the Annals of Epidemiology indicates that “recent veterans have committed suicide at a much higher rate than people who never served in the military.” The data indicated that “the rate was slightly higher among veterans who never deployed to Afghanistan or Iraq, suggesting that the causes extend beyond the trauma of war.” The analysis also found that “recent female veterans commit suicide at a rate more than twice as high as other women.”

Epidemiologist Michael Schoenbaum, PhD, of the National Institute of Mental Health, commented on the study’s findings, saying, “People’s natural instinct is to explain military suicide by the war-is-hell theory of the world.” He added, “But it’s more complicated.” Schoenbaum, an expert in military suicides, had no involvement with the study.

Related Links:

— “Detailed study confirms high suicide rate among recent veterans,” Alan Zerembo, Los Angeles Times, January 14, 2015.

The New York Daily News (1/15, Engel) reports that a study published online Jan. 14 in the journal Neurology suggests that individuals with Alzheimer’s “may experience depression and other behavioral changes before their memory starts to fade.” The study’s lead author explained, “While earlier studies have shown that an estimated 90% of people with Alzheimer’s experience behavioral or psychological symptoms such as depression, anxiety and agitation, this study suggests that these changes begin before people even have diagnosable dementia.” For the study, researchers tracked “2,416 people who had visited an Alzheimer’s center.” All of the people were at least 50 years old and did not display any difficulties with cognition at the start of the study.

TIME (1/15, Sifferlin) reports that the participants were followed for seven years, during which time 1,218 people were diagnosed with dementia. The researchers found that participants “with dementia had twice the risk of developing depression earlier – far before their dementia symptoms started – than people without the disease,” and had a 12 times higher likelihood of delusions. What’s more, “the symptoms appeared in consistent phases: first, irritability, depression, and nighttime behavior changes; followed by anxiety, appetite changes, agitation and apathy.” In the final phase, patients displayed “elation, motor disturbances, hallucinations, delusions and disinhibition.”

Related Links:

— “Alzheimer’s first may show itself as depression, mood changes: study,” Meredith Engel, New York Daily News, January 14, 2015.

In continuing coverage, Medscape (1/14, Melville) reports that a report from Mental Health America called “Parity or Disparity, the State of Mental Health in America 2015” reveals a “significant shortage of psychiatrists” in the US, particularly for youngsters, a need that will only increase under the Affordable Care Act. Renee Binder, MD, president-elect of the American Psychiatric Association, said, “The country will need an additional 30,000 child psychiatrists to meet the needs generated by the expanded coverage under the ACA, and we currently only have 8000, so we need to triple the number of child psychiatrists.”

Meanwhile, “the APA has been promoting new systems of collaborative care, with psychiatrists working together with other specialties, including primary care [clinicians] and pediatricians,” she added.

Related Links:

— Medscape (requires login and subscription)

The Los Angeles Times (1/14, Kaplan) “Science Now” blog reports that research published in BMJ indicated that people who “worked at least 49 hours a week were up to 13% more likely to engage in ‘risky alcohol use’ compared with those who were on the job for only 35 to 40 hours a week.” Investigators came to this conclusion after analyzing “data on more than 430,000 people.”

Bloomberg News (1/14, Cortez) reports on the BMJ study, and also points out that “in a 2012 survey by the” CDC, “71 percent of Americans said they’d had a drink in the past year, while about 56 percent had done so in the past month.” Bloomberg News adds that “there are a small and growing number of people who drink excessively at one sitting, and it’s not clear why, said George Koob, director of the National Institute on Alcohol Abuse and Alcoholism.” Koob said, “We’re seeing a higher number of drinks per individual.” He added, “What’s growing is the intensity of drinking in a single bout. We are concerned about that. We haven’t figured out how to address it.”

Related Links:

— “Workaholics are more likely to drink too much alcohol, study says,” Karen Kaplan, Los Angeles Times, January 13, 2015.

USA Today (1/14, Zoroya) reports that the number of suicides by active-duty US military personnel “last year was virtually unchanged from 2013, remaining at historically high numbers for a fifth year,” according to Pentagon statistics. Meanwhile, the Army “reported a decline” for the second consecutive year.

Related Links:

— “2014 military suicides stay high for 5th year straight,” Gregg Zoroya, USA Today, January 13, 2015.

On the front of its Personal Journal section, the Wall Street Journal (1/13, D1, Beck, Subscription Publication) reports in “Health Journal” that a growing number of pediatrician practices are incorporating mental health clinicians as part of integrated care. The National Institute of Mental Health estimates that some 21 percent of US youngsters and teens may have a diagnosable substance use or mental health issue.

Related Links:

— “http://www.wsj.com/articles/tot-therapy-psychiatrists-join-up-with-pediatricians-1421105535,” Melinda Beck, Wall Street Journal, January 12, 2015.

The AP (1/13, Daly) reports that the House of Representatives, “for the second time in five weeks…has approved a bill aimed at reducing a suicide epidemic that claims the lives of 22 military veterans every day.” HR 5059, the Clay Hunt SAV Act, “a bill named for…a 26-year-old veteran who killed himself in 2011, was approved unanimously” yesterday. The measure “would require the Pentagon and the Veterans Affairs Department to submit to independent reviews of their suicide prevention programs and would establish a website to provide information on mental health services available to veterans.”

The Washington Times (1/13, Klimas) reports that this same bill “stalled in the Senate last month” over the “objections by retired Sen. Tom Coburn, Oklahoma Republican, who said the $22 million price tag was too high for a bill that duplicated already-existing programs.” This time, however, the measure is anticipated “to easily reach the president’s desk.”

Related Links:

— “HOUSE AGAIN BACKS BILL TO LOWER SUICIDE RATE AMONG VETS,” Matthew Daly, Associated Press, January 12, 2015.

Medscape (1/13, Osterweil) reports that according to a study published online Jan. 12 in the journal Pediatrics, youngsters “referred to a specialist because of behavioral problems may have undiagnosed fetal alcohol spectrum disorders (FASD).” The study found that “among 547 foster or adopted children referred to a children’s mental health center for behavioral issues, 156 met criteria for FASD, but 125 (80.1%) had never been diagnosed with prenatal exposure to alcohol.” And, of the 31 kids “who had been diagnosed with prenatal alcohol exposure before referral, 10 had a change in their diagnosis to a different disorder within the fetal alcohol spectrum, which represents a 6.4% misdiagnosis rate, the investigators said.”

Related Links:

— Medscape (requires login and subscription)

In the New York Times (1/8) “Well” blog, psychiatrist Richard A. Friedman, MD, wrote, “Because some patients” with depression “respond better to psychotherapy than medication — and vice versa — or prefer one type of treatment over another, we need to learn much more about how various types of psychotherapy compare with medications clinically as well as at the level of the brain.”

At the moment, however, “we don’t have a clue, in part because of the current research funding priorities from the National Institutes of Mental Health, which strongly favor brain science over psychosocial treatments.” Nevertheless, “we owe it to our patients to try to answer” such “important questions.”

Related Links:

— “To Treat Depression, Drugs or Therapy?,” Richard A. Friedman, M.D., New York Times, January 8, 2015.