Garden your troubles away

The songbirds returned about a month early here in south-central Wisconsin, and in honor of spring, I’m updating a post from last year about gardening’s mental health benefits.

I hope this spring brings you fresh energy and many happy hours outside on — and in! — the earth.

Photo by Laura Berman.

When you’re stressed, when you go to the garden, you feel different.
It helps you hold onto life.
– Southeast Toronto resident, 2007 study on health benefits of community urban gardening

Summer’s finally here in south-central Wisconsin, ushered in by one of the coldest springs we’ve had in years. Though I grumbled about trudging through snow flurries on May 1, our garden loved the cool, wet weather. Now, in mid-June, Red Russian kale stands tall in raised beds, its smooth curled leaves jostling with green cabbages, Di Cicco broccoli and Early Snowball cauliflower. The heirloom tomatoes I grew from seed back in February are beginning to flower, and pea vines climb a trellis so fast I swear I can see them move.

When I’m in my garden, life’s troubles crumble away with the rich black soil between my fingers. I’m fully in my body, out of my head, my worries banished. My garden is my church, my time there sacred.

We 21st-century humans so often find ourselves adrift in technologies that wall us off even as they keep us connected. Our gardens are antidotes to that, places where we abandon the filters of cell phones and computers and contact life directly, sensually, touching and smelling plants and bugs and worms and the billions of microorganisms that make garden soil so rich. Biologist E.O. Wilson spoke to these feelings with his biophilia hypothesis, the idea that humans have an “innately emotional affiliation… to other living organisms.”

While far scarcer than studies on psychotherapy or psychiatric medications, research on gardening’s health benefits has found that working with plants can ease mental suffering. There’s even a term for this process — horticultural therapy. As we tend our gardens, sowing seeds, watering, pulling weeds, pruning and, months later, harvesting, so too we sow seeds of patience, hope and optimism within ourselves. A 2008 paper in Nursing Times called such hope “an intrinsic requirement of gardening,” and key to how this activity heals.

Gardening as a therapy for mental illness hasn’t been thoroughly researched, but what has been published shows promise. A paper from 2011 summarized two studies in which patients with depression who gardened for 12 weeks felt better at the end of the intervention and three months later (note that both studies lacked control groups, so we don’t know how much the patients might have improved on their own). In the United Kingdom, a program called Rethink Green Growers helps people with mental illness ranging from mild depression to schizophrenia grow their own food on land plots in Wiltshire, Somerset and Dorset. The program organizers say gardening not only gets the patients out of bed and into the sunshine, but  helps them connect with each other and eat healthier diets — which, in turn, further stabilizes their moods.

Horticultural therapy isn’t only being used as adjunctive treatment for mental illness. A 2005 study found gardening reduced stress in patients undergoing cardiac rehabilitation, and a study of patients with dementia found that gardening twice weekly for six weeks helped them interact more with others.

I’ll sign off for now — my garden beckons. How has gardening helped you feel better?  Please share your experiences! (And read more from a wonderful blog called The Storied Mind!)

Does depression cause obesity? Or does obesity cause depression? It’s not (even) that simple

Percent of adults globally who are overweight or obese. Source: World Health Organization.

If you’re severely overweight and have depression, you may have been told that if you’d “just” shed a few pounds, you’d feel better. Perhaps a health professional even gave you that advice.

But most clinicians and scientists agree the link between obesity and mood is too complex to merit such a simplistic approach.

Studies do show that obese teens and adults in the United States are more likely to have symptoms of depression than their peers who aren’t overweight.

But here’s the catch: when people are both depressed and obese, it can be unclear whether the obesity caused the depression (through chronic low self-esteem or physical health problems), whether the depression caused the obesity (because of antidepressant-induced weight gain or decreased physical activity), or some third factor — such as stress — caused both.

Depression has been clearly linked to weight gain in some studies. In one large U.S. study, for example, researchers reported that young adults with low mood gained substantially more belly fat in 15 years than peers who reported feeling happier.

But the association between excess body fat and depression seems to vary by culture, ethnicity, age and gender. The research summarized here shows just complex this can get.

• A study published this month in the journal Aging and Mental Health reported a decreased risk of depression in overweight and obese elderly women in Taiwan. The same study found that older men were underweight were more likely than their peers to have depression.
• A 2010 study from Korea found that obese women aged 60 to 85 years were less likely to report depression than normal weight peers.
• A 2004 study from Hong Kong reported that obese men and women aged 65 and older were less likely to have depression than peers of normal weight.
• A 2011 Harvard University study found that severely obese U.S. teens who were non-Hispanic white had a significant increase in depressive symptoms over three years. But no such increase was seen for severely obese teens of other races and ethnicities, including non-Hispanic blacks.
• And a 2010 study of more than 1,000 U.S. teenagers found that overweight girls were more likely to report poor body image and depression if they were Asian or were very assimilated into mainstream U.S. culture. But that wasn’t true for other girls, or for boys.

So what can we take from all this? Older people from non-Western countries may reflect the values and mores of cultures before they became weight-obsessed — before, for example, the Western version of anorexia swept Hong Kong. And that may explain, to some extent, why obese adults in these countries may be less prone to depression than their grandchildren in the United States, where images abound of skinny models, most of them Caucasian.

The obesity-depression connection needs to be teased out further. But these studies support the idea that factors like body image and social stigma play a crucial role in the effect of body weight on mood.

Does being gorgeous and successful require you to be thin?

Westerners didn't always think so.

Gaps persist in campus mental health services

My six-month investigative project on the University of Wisconsin’s mental health services ran today. Here’s the main story. You can also click here for the complete coverage.

Amid surge in demand, students take public role to combat stigma

 By Amy Karon, Kate Prengaman and Jenny Peek

Wisconsin Center for Investigative Journalism

Matt Vohl meets with Rachel Steidl in the Student Activity Center on East Campus Mall in Madison, Wis., Jan. 27, 2012. Vohl and Steidl help lead the UW-Madison campus chapter of the National Alliance on Mental Illness. Lukas Keapproth/Wisconsin Center for Investigative Journalism

A decade ago, Thomas Murphy was a college dropout who used alcohol and drugs to deal with undiagnosed depression. Now he’s back at the University of Wisconsin-Madison, where he co-leads a chapter of Active Minds, a national, student-run group promoting open conversations about mental illness.

Therapy made the difference for Murphy. But he can’t receive it at school. When he re-enrolled at UW-Madison and went to the counseling center, he walked out with no appointment and a list of referrals.

“They couldn’t help me because of my extensive history,” Murphy said. “So I go out and pay on my own for the services I need.”

Murphy’s story underscores a national dilemma: a surge in students seeking intensive counseling and psychiatric care, which college mental health centers often lack resources to provide. The problem has become even more urgent in the wake of mass shootings by troubled students at Virginia Tech and Northern Illinois universities.

In Wisconsin, understaffed counseling centers are prioritizing services for those with urgent needs, expanding group therapy options to reach more students, and referring patients off campus for long-term treatment. And students like Murphy are forming campus organizations to support peers and fight the stigma of mental illness.

A growing need

Step onto a U.S. college campus today and you’ll still find students rushing between classes or holding hands with first loves.

But 80 percent of college counseling center directors reported seeing more students in crisis during the past five years, according to a national survey in 2011. The same study found that students with severe psychological problems now account for nearly 40 percent of counseling center visits — more than double the proportion in 2000.

Last spring, 19 percent of college students surveyed by the American College Health Association said they’d been diagnosed with depression sometime in their lives, up from 12 percent a decade ago. Almost one in five students had seriously considered suicide.

These statistics aren’t all bad news, said psychologist Danielle Oakley, director of mental health services at UW-Madison, where counseling visits increased 10 percent last year alone. More people know about mental illness and are seeking help, and better psychiatric medications enable some to attend college who couldn’t have a generation ago.

But Oakley said the faltering economy is fueling worries about paying for school. Many students are stressed, overworked and sleep-deprived, which can cause mental health problems.

Though studies show people with serious mental illness usually aren’t violent, there have been tragic exceptions: In 2007 and 2008, troubled students shot themselves after killing 37 people and wounding dozens more at Virginia Tech and Northern Illinois universities.

Campuses across the country responded by revamping policies for handling disturbed students and staff. At UW campuses, threat assessment teams — whose members hail from deans’ offices, academic departments, campus police, and counseling centers — try to identify and help such people before they hurt themselves or others.

“If there is a silver lining in something like that happening, it’s put the spotlight on some needs on our campus,” said John Achter, counseling director at UW-Stout.

Still, most people with mental illness fly under the teams’ radar. And despite attempts to meet demand, Wisconsin students are being turned away — or told to wait weeks for care.

Long waits, but some improvements

UW-Madison senior Rachel Steidl was one such student. “I grew up really focused on helping other people,” she said. “When I had my own problems with depression, I didn’t feel like I had anyone to turn to. I was pretty lonely my freshman year.”

Steidl later saw a psychology intern at the campus counseling center. She learned to open up more and made friends. When she returned to the center this year, an intake provider saw her the same day to assess her needs.

That’s because at Oakley’s urging, UW-Madison began offering same-day assessments in early 2011.

“We don’t want any barriers to get to us,” Oakley said. “The day you decide that you want support, all you have to do is walk in.”

But what happened next frustrated Steidl. Because her immediate needs weren’t deemed urgent, she said, she was asked to wait three weeks for her next appointment.

“If my depression gets worse, it could escalate,” she said. “I want to avoid getting to the point where I have to call the crisis hot line.”

Most UW campuses use such triage systems to help students in crisis first. A UW-Eau Claire student, for example, was prescribed Paxil when she sought help for panic attacks in 2009. After she stopped eating and sleeping and went on a “financially disastrous” shopping spree, her campus counselor and psychiatrist correctly identified and treated her bipolar disorder — ending eight years of bouncing between clinicians who’d misdiagnosed her.

“They saved my life. Literally,” said the student, who works as a pet groomer and asked not to be named for privacy reasons. “I wasn’t able to complete a degree, but they gave me a brighter future than education.”

But Steidl’s wait time is more typical. Last fall, UW-Madison students went an average of 14 days between their intake appointment and first regular counseling session, said Dr. Sarah Van Orman, health services director. Other UW campuses report similar waits.

Such delays stem partly from inadequate staffing. A UW System audit found that five years ago, only UW-Madison met the international standard of one mental health professional for every 1,000 to 1,500 students. The auditors recommended that over the short term, UW institutions aim to employ one mental health staffer for every 2,000 students.

But as of 2011, just eight of 13 campuses had achieved that ratio, an analysis by the Wisconsin Center for Investigative Journalism showed. Of those, only two schools — UW-Stevens Point and UW-Superior — met the international standard.

To improve counselors’ availability, UW-Madison wait-lists students for earlier sessions, offers daily drop-in groups and confidential consultations in several campus locations, and has more than 25 process and support groups to help students deal with issues ranging from low self-esteem, grief and social anxiety to graduating or coming out as a sexual minority.

None of these options was right for Steidl, though. She found a therapist in private practice.

Referred off campus, some never find help

It took a violent mugging in the Dominican Republic in 2008 for Thomas Murphy to finally face his depression. During rehabilitation for a brain injury, he also got the counseling he’d needed.

Milwaukee native Mary Martinco sought help sooner, seeing a therapist for depression for two years in high school. But transitioning to UW-Madison was painful.

“Freshman year I felt so alone, crying all the time,” recalled Martinco, now a junior.

Like Murphy, Martinco sought help at UW-Madison’s counseling services and left with a list of off-campus referrals. But in her case, they either weren’t a good match or didn’t take her insurance. In the end, it was her mother, not her school, who helped her find a therapist.

Most UW counseling centers limit students’ counseling sessions. UW-Madison students like Martinco, who need more than the 10 permitted each academic year, are often asked to go elsewhere from the beginning.

Oakley said that’s because making students change therapists disrupts their treatment. But a 2006 University of California-Davis study found that 42 percent of students referred off campus never connected with providers — usually because of financial concerns.

To address that problem and help prevent tragedies like those at Northern Illinois and Virginia Tech, UW System officials recommended in 2008 that campus providers follow up with high-risk students to help ensure they’re successfully referred.

A half-time case manager now fills this role at UW-Oshkosh. And in 2010, after Martinco’s failed referral experience, UW-Madison hired a full-time case manager who saw 300 students her first year — five times more than expected.

Still, lack of health insurance “poses great barriers” for students referred off campus, Van Orman said. She cited campus surveys that show 6 to 8 percent of students at UW-Madison are uninsured and another 30 to 40 percent have no coverage in the Madison area.

The case manager connects these students to agencies that charge a fraction of the going rate or to the student health insurance plan. She also helps students navigate deductibles and co-pays.

Some students struggle to pay for psychiatric prescriptions. Martinco saw peers risk going off medication when short on cash. She and Murphy said they knew students who self-medicated with alcohol or illegal drugs because they couldn’t afford mental health care.

“The self-medication issue is complex,” Oakley said. “For example, students who use substances such as alcohol to treat anxiety can end up with substance abuse problems in addition to their anxiety.”

Alcohol withdrawal symptoms can mimic anxiety, Oakley added, leading students to drink more or use stronger drugs. In the end, she said, money spent on drugs and alcohol, lost time at work, medical treatment for accidents and legal consequences can far outstrip medication costs.

Student groups expand 

Frustrated by her experiences on campus, Steidl joined fellow student Matt Vohl two years ago in reviving the campus chapter of the National Alliance on Mental Illness.

“We saw a lack of resources available for students with mental illness or even just mental health problems,” Vohl said. “We wanted to offer an alternative.”

Students responded en masse: More than 70 signed up at the campus organizational fair last September, Vohl said. A month later, they peppered Bascom Hill with signs.

“The best way to reduce the stigma is by educating people,” Vohl said. “We want to let people know that (mental illness) is not this inherent condition that makes people freaks, it’s not demonizing, it shouldn’t be taboo. It’s something that can affect anyone.”

Steidl and Vohl are working with the counseling center to train students to provide confidential, face-to-face support for peers who want to talk about everyday problems.

“You can go there and know that people kind of understand you at least,” said a member with obsessive-compulsive disorder who asked not to be named for privacy reasons. “You get to know their struggles every day, whatever they are, and to be there to be support for them and other people as well.”

Murphy and Martinco now run UW-Madison’s branch of Active Minds, which promotes mental health awareness.Five other Wisconsin campuses also have chapters. At UW-Parkside last semester, members practiced yoga, colored and made squeezable stress balls.

“Finally I feel able to talk about it, and I want to help others talk about it too,” Martinco said.

“I had this deeper, darker side that I never talked about,” Murphy agreed. “For me, communicating my emotions, my struggles, and my successes has been vital.”

Amy Karon is a reporter for the Wisconsin Center for Investigative Journalism. Kate Prengaman, Jenny Peek and Sam Zastrow contributed as students in a UW-Madison journalism class taught by Professor Deborah Blum, in collaboration with the nonprofit, nonpartisan Center (www.WisconsinWatch.org). The Center also collaborates with Wisconsin Public Television, Wisconsin Public Radio and other news media. Works created, published, posted or disseminated by the Center do not necessarily reflect the views or opinions of UW-Madison or its affiliates.

Surviving the holidays when you’re grieving, stressed or living with mental illness

The holiday season is in full swing as I write this. Lights glitter from windows and rooftops. Parties abound. And when I stopped at the mall for coffee last Sunday, I thought I’d be overrun by throngs of irritable shoppers.

Image from Chicagonow.com

We all know the holidays can be stressful. Social and financial obligations pile up just when the days (in the northern hemisphere) are at their shortest and darkest. Meanwhile, we’re inundated with holiday carols and advertisements telling us we should be rich, beautiful, in love and deliriously happy.

It’s no wonder this time of year can be especially hard for people who struggle to keep their moods on an even keel. So much so, in fact, that one large study found a 40 percent increase in suicide attempts after Christmas.

When you’re grieving or sad or sick, it can hurt so much to contrast the season’s fervent hopes and expectations with your own experience. Perhaps a wish you’ve always carried — that your family would get along, that you could stop drinking, that an estranged child would return home — feels unbearable against all the tinsel.

Or perhaps you or your partner has been laid off, or you’re afraid one of you will be, and you’re weighing that possibility against your children’s gift lists. Or maybe you lost a loved one this year, and you can’t believe you’ll never celebrate New Year’s Eve with him or her again.

Perhaps you’re worried about spending future holidays alone.

Maybe you’re alone now, and wish you weren’t.

The internet teems with advice about how to care for yourself during the holidays. Eat healthily, exercise, drink in moderation, lower your expectations. It all makes sense, but really, who needs any more pressure at this time of year?

So here’s what I wish for you, if you’re stressed or sad, grieving or struggling with mental illness this holiday season. I hope you’ll let yourself cry as much as you need to. That you’ll take a walk and just feel your feet, solid on the earth. That you’ll tell someone you care about them, and why. And most of all, that you’ll remember that we all fear isolation, illness and death. None of us is as happy as we seem.

The holidays will pass, and crocuses will pop up again from the snow.

Deciding whether to take antidepressants? Careful of ‘expert’ advice

(Updated Dec. 29)

The idea that patients with depression should eschew antidepressants for other remedies has gained popularity lately, sparking vehement debates in some corners of the web.

Take an interview of Dr. Andrew Weil this week on NPR’s Science Friday. Weil promoted his new book recommending non-prescription remedies, such as exercise and supplements, for people with mild to moderate depression.

Research does suggest that both aerobic exercise and fish oil may ease symptoms of depression. But a number of listeners criticized Weil, who has trademarked himself as “Your Trusted Health Advisor” while also selling his own line of customized vitamins and supplements (just $74.99 for his 30-day “Energy Support” pack).

Weil, I noted, didn’t correctly answer Science Friday host Ira Flatow when asked whether farmed fish (the source of much fish oil) tend to be fed a diet low in omega-3 fatty acids, the component of fish oil thought to combat depression.

Instead, Weil answered an unrelated question, saying that most fish oil is free of contaminants like mercury and PCBs.

(Flatow was right, by the way, according to this National Academy of Sciences article. The authors state that during the last decade, farmed fish were increasingly fed vegetable oils, which cause fish to have lower concentrations of omega-3 fatty acids.)

While researching the excellent PBS series This Emotional Life, I also found this article on the series homepage decrying the use of antidepressants.

“Love — not drugs — can save you and your relationship,” wrote marriage and family therapist Deb Schwarz Hirschhorn, adding that “partners can learn how to inject serotonin into each other’s brains with just a well-placed smile and a thoughtful gesture.”

“That’s so much more powerful than drugs, isn’t it?” she asked.

Hirschhorn raised some important points: in some studies, antidepressants have performed no better than placebos; industry-funded research should generally be interpreted with caution; and antidepressants can increase risk of suicide, especially in adolescents.

But she didn’t acknowledge that the increase in risk appears to be small, and that talk therapy can’t effectively replace medication for everyone.

The true picture of both depression and its treatment appears far more complex than that portrayed by Weil or Hirschhorn.

In one health care consumer study, for example, patients tended to report the most benefit from a combination of medication and talk therapy. But other studies found that patients were more likely to get better if they received the type of treatment they asked for, whether or not that included medication.

And in yet another study published this month, depressed patients tended to respond no better to medication or talk therapy than to placebo pills — except African-American men, who responded best to talk therapy.

The bottom line? Watch out for ‘experts’ with straightforward answers about treating depression. No matter where they fall on the spectrum of debate about antidepressants, they’re probably not telling the whole story.

Read more: Buddhist communities in the West have long criticized antidepressants, but that’s changing. Check out this 2009 article by physicians and long-time meditators Roger Walsh, Robin Bitner, Bruce Victor, and Lorena Hillman, published in the quarterly magazine Buddhadharma.

Roundup of mental health news and research

Some recent developments in mental health research:

• About 24 in 1,000 people worldwide will develop bipolar disorder in their lifetime, and most won’t receive effective treatment, according to a 2011 study of more than 50,000 adults from Japan, Brazil, New Zealand, Romania and the United States. The United States had the highest prevalence of bipolar disorder — nearly twice the worldwide average.

• Researchers at the University of Canberra in Australia announced they’ve developed a computer program to diagnose depression by analyzing facial expressions. Researchers say the technology is 80 percent accurate and describe it as an important step toward developing more cost-effective and objective methods to diagnose mental illness. Scientists are now working on more advanced versions of the technology that will incorporate analyses of patient’s gaits and voices.

• Physical exercise spurs new brain cells to form, a process called neurogenesis.

  

  Antidepressants also trigger neurogenesis, leading researchers to speculate that neurogenesis may be the reason  physical exercise can help prevent and reduce depression. On NIH Radio in Bethesda, listen to Drs. Michael Lehmann and Robert Schloesser describe the results of a study in mice that’s the first to directly link neurogenesis to physical exercise’s antidepressant effects.

• News flash: integrating primary and mental health care can save lives and cut health care costs. Sound obvious? I thought so too, but in many U.S. health care systems, the concept of a “medical home” — in which providers communicate and coordinate on all aspects of patient care — remains largely a theory.

More on bipolar disorder: Bipolar Kids May Focus on Different Facial Features

Mental health programs help Hmong-American girls embrace bicultural identity

When she was in high school in Texas, Linda Kue Aroonsavath’s parents didn’t want her to be on the dance team or to hang out with classmates after school. They worried about her safety, believing that “roaming around” wasn’t appropriate for girls.

“It wasn’t like I was going out to do drugs or have sex,” said Kue Aroonsavath, now a counselor at Madison Area Technical College and a psychology doctoral student at the University of Wisconsin-Madison. “I just wanted to go to the football game with all my other friends.”

But Kue Aroonsavath’s parents, who were Hmong immigrants, told her to stay home and help care for her younger siblings. Torn between her family and her non-Hmong friends, she began sneaking out of the house. She felt confused and isolated.

Interpersonal and identity struggles are common themes of adolescence. But Hmong-American girls can face particular stress as they try to navigate the gap between their families’ values and mainstream U.S. culture. Such conflicts, and cultural taboos against talking about them, put girls at risk of developing emotional problems that go unrecognized for months or years.

Editors of HmoobTeen, a magazine for Hmong youth, in Minnesota

The issue is especially relevant now. In 2010, about 43 percent of the 260,000 ethnic Hmong in the United States were less than 18 years old.

To complicate matters, Hmong-American girls come from a community with high rates of mental illness — a legacy of post-war trauma, migration, acculturation, and family and social stressors, according to research conducted by the Wilder Foundation, a social service organization in St. Paul, Minn. An assessment by Minnesota’s Ramsey County Mental Health Center found that more than 60 percent of Hmong refugees had clinical depression, but less than one percent received Western mental health care.

Hmong story cloth depicting the war in Laos

Culturally-tailored programs like Hlub Zoo, formed in 2009 in St. Paul, Minn., and Southeast Asian Teen Villages in Madison, Wis. work closely with Hmong girls, their families and schools to help girls express themselves, access mental health services and embrace a bicultural identity.

Conflicting expectations

In traditional Hmong culture, children are taught to obey parents and respect teachers. But what happens when the most fundamental expectations of teachers and parents conflict?

“In Hmong society, we value the ability to control yourself, to be quiet until you’re called on,” said Shwaw Vang, a case manager at Kajsiab House in Madison who also educates school district staff about Hmong culture and etiquette. ”So parents might say, ‘when you go to school, be respectful and listen.’ But here (in the United States), teachers might encourage kids to speak out.”

Contradictory messages at school and home affect both sexes. But they can be especially distressing for girls, who defy traditional Hmong gender roles when they seek work outside the home or wait past adolescence to marry — choices non-Hmong teachers typically advocate.

Kue Aroonsavath, whose mother wanted her to marry after high school instead of going to college, also said parents may expect girls to perform well academically while shouldering most of the housework.

Hmong girls often feel frustrated by how many chores they’re expected to do compared to their brothers, agreed Tony Yang, director of the Wilder Foundation’s Southeast Asian Services program, which provides mental health services in the St. Paul, Minn. metropolitan area.

“They may go home, and the boys are playing outside or playing video games,” Yang said. “And mom and dad say to the girl, ‘you need to start cooking.’ And then when she’s done cooking, they say, ‘you need to do the dishes.’ ”

Hmong parents who didn’t attend school here also may think U.S. schools function differently than they do.

“In Hmong culture you give kids to teachers, and they become the parent,” said Kajsiab House’s Vang. “They teach not only academics, but how to be a good son or daughter to the family. So older parents especially may expect the teachers here to have the same mentality, but that’s not necessarily the case.”

A high regard for teachers in Hmong culture can prevent parents from asking questions or raising concerns. And schools don’t always communicate well with Hmong families.

Susan Hofer, coordinator and lead therapist for the Journey Mental Health Center’s Southeast Asian Teen Villages program, described a girl who she recommended be tested to see if she qualified for special education services. The law requires parents to request such testing, but in this case they spoke limited English. Despite Hofer’s efforts, the daughter never received services.

Suffering in silence

Kue Aroonsavath said part of why she didn’t ask for help as a teenager is that discussing emotional problems outside the family can be seen as shameful in Hmong culture.

“It’s a cultural thing for us not to ask for help. You don’t ask because it’s a sign of weakness, or you can ruin the reputation of the family,” she said.

Wilder Foundation staff who worked in St. Paul schools watched Hmong girls’ behavior change as they entered adolescence, said Yang. By junior or senior year, they might have missed a month or more of classes because they ran away from home. In his work as a therapist, Yang realized that many parents did not notice their daughters’ problems until months or even years after they began. And some teachers never caught on.

“With the boys, we tend to see more behavior issues, so we can pick up on the fact that they’re struggling. But the girls tend to just kind of disappear into the background,” he said.

This year, teachers at St. Paul’s Jackson Elementary School began referring Hmong girls for evaluation by mental health professionals at the Wilder Foundation. Some girls had shown only subtle cues that something was amiss, such as not participating in class.

Yet the professionals identified about 40 girls with undiagnosed major depression, anxiety and other signs of serious mental illness, such as hearing voices.

“Many felt they had nothing to look forward to,” Yang said. “They had thoughts of self-harm, and nobody had recognized it. These kids had just suffered in silence.”

Embracing both cultures

In response, the Wilder Foundation created a program called Hlub Zoo (which means “grow well, love well” in Hmong). The program serves 10- to 12-year-old girls at Jackson Elementary.

“We found that school-based services are a very good way to connect parents and youth and overcome some of the barriers related to transportation and stigma,” Yang said.

Girls in Hlub Zoo discuss their concerns in a support group led by a female Hmong-American social worker. The social worker, a Wilder Foundation staff member, is available at the school every day to meet with girls individually. Family counseling, formal psychotherapy and other mental health services are provided as needed.

Madison’s Southeast Asian Teen Villages mirrors Hlub Zoo’s approach. Formed in 1994, the program includes an eight-week support group for middle school girls and an ongoing therapy group for those in high school.

Led by psychotherapist Susan Hofer and a female Hmong-American “cultural broker,” the Southeast Asian Teen Villages provides what Hofer calls “psychospiritual support” to help girls feel comfortable in both Hmong and mainstream U.S. cultures.

Hmong-American students at a family appreciation event, St. Catherine University, Minn.

Each week, the girls eat a traditional Hmong meal, then begin group therapy by sprinkling rice in a bowl of water with candles and offering a blessing to set an intention for their work.

“Opening the circle that way normalizes conversations about spirituality that they might otherwise not be comfortable having,” Hofer said.

They end the session by blessing spirits and ancestors — important aspects of traditional Hmong religion.

The cultural broker provides a positive role model and answers questions about traditional Hmong culture, beliefs, and rituals. Hofer, for her part, sometimes helps debunk misconceptions about mainstream U.S. culture, such as the belief that non-Hmong teenagers can do whatever they want.

“I can also help families navigate systems that are unfamiliar to them,” she said. “My job is to provide a bridge between the family and school, or the family and doctor.”

The program also offers a weekend social program and a homework club at the local library.

Promising results, but unmet need

To evaluate the Hlub Zoo program, the Wilder Foundation collected data with the Strengths and Difficulties Questionnaire, a behavioral screening tool for children 3 to 16 years old. The program also surveyed girls about their emotions and asked them to draw themselves at the beginning and end of the 2009-2010 school year. So far, Yang said, the results look promising.

“The girls report feeling more confident, happier. They have less thoughts of self-harm,” he said.

And at the end of the year, more girls drew themselves smiling and in color. Their teachers also said they participated more in the class.

Last year, Southeast Asian Teen Villages began assessing participants with the Children’s Depression Inventory, the Trauma Symptom Checklist for Children, and the UCLA Post-Traumatic Stress Disorder Index to see if their scores improved by the time they left the program. The program also began tracking girls’ grades.

Results were pending, but Hofer said program participants had “overwhelmingly” reported the program made a difference in their lives.

“We’ve had several girls go on to college. Most of our girls graduate from high school. And the feedback that they give us is that (the group) was instrumental to their success,” she said.

Southeast Asian Teen Villages also helps girls feel more curious about their parents’ experiences and culture, Hofer said, adding that most parents support their daughters’ participation. She said Hmong community leaders have requested a similar program for boys, but Journey Mental Health Center lacks funds to support it.

The community needs more mental health providers who speak Hmong and understand the culture, Aroonsavath said. That’s one reason she decided to become a psychologist.

“Reflecting on the life experiences I had growing up,” she said, “I wanted to give back.”

On Minnesota Public Radio, hear the story of Kao Choua Vue, a young Hmong-American woman who defied traditional gender roles while giving back to her community.

Cultivating gratitude: final day

Today ends my weeklong experiment to see if a daily practice of writing, in some detail, about three things I’m grateful for can affect my mood and sense of well-being.

A few caveats: this was really a case study, not an experimental trial. And of course, I couldn’t hold all the other variables in my life constant. This week I also finished a major project, meaning I’m catching up on sleep.

But even so, a daily gratitude practice has made a noticeable difference.  It’s easier to get out of bed in the morning. I look forward to the day more. I thank my husband more often. I feel calmer and more grounded. I’m more likely to notice little things I enjoy — a cup of coffee, a cloudless sky, the feeling of soil under my hands or autumn leaves under my feet. I think more about people I’m fortunate to have in my life.

It’s not that I notice the hard stuff less. But I seem not to dwell on it as much because I’m paying more attention to life’s rewards.

After a week of gratitude practice, I’m also able to plan more effectively and make better decisions throughout the day. That fascinates me, because studies suggest that cultivating gratitude helps us feel brighter and more alert, according to neuroscientist Rick Hanson. Hanson notes that such alertness likely stems from increased production of the brain chemical dopamine, which also enables us to plan and experience rewards.

Hanson writes, too, that activities that increase our attention span — including meditation and gratitude practice — also enhance activity in a part of our brain called the left prefrontal cortex, which inhibits negative emotions, helping us feel happier. The left prefrontal cortex consistently shows abnormally low activity in those who are clinically depressed. Does that mean gratitude practice can combat depression? Studies suggest it can, especially for people who are naturally self-critical.

I’ll revisit this topic in a few weeks to gauge whether my seven days of formal gratitude practice have had lasting positive effects. In the meantime, here’s what I’m thankful for today:

• A half hour spent planting garlic with my husband under a clear fall sky.

Image by Macgyver Services

• The dinner he prepared of potatoes, kale and caramelized onions, all from our garden.
• The fact that I decided to try this practice and stuck it out. It took time and energy, and it wasn’t always easy to focus on what I was grateful for. But it was well worth it.

If you’d like to try a guided meditation on gratitude, I suggest this handout, also from neuroscientist Rick Hanson.

Seasonal affective disorder – choosing a light box and other tips for beating wintertime blues

Yesterday was the first day of fall — a season resplendent with colors, brimming with scents and sounds. Leaves crunch underfoot, apple crisp bubbles away in the oven, and here in the United States, fans shout and cheer at college football games.

Image courtesy of Sportige.com

But for about one to ten percent of people, fall’s shorter days trigger early symptoms of seasonal affective disorder (SAD) — an episodic depression in which you typically gain weight, sleep more than usual, and feel down and irritable during the year’s shorter months, according to PubMed Health.

The good news is that people with SAD can often feel much better without medication. In honor of fall, here’s a summary of what you should know if you or a loved one has SAD.*

Closing the gap: the best blogs on mental illness

Photo by David Fokos.

One of the great frustrations of having mental illness can be trying to explain your life to someone who doesn’t. Someone who wants to understand how you feel, but has never been severely depressed. Or manic. Or heard voices. Or spent their whole life struggling to correctly interpret facial expressions.

It’s a frustration that is, perhaps, matched by the feeling of trying and failing to understand what a beloved person who’s mentally ill experiences.

While perhaps no one can truly comprehend mental illness without personally enduring it, sharing the feelings matters as much as trying to understand. Reaching out this way takes us to the heart of life and what it means to be human, sowing seeds of trust, acceptance and compassion.

What’s more, when people describe — through words, pictures, or another medium — what it’s like to be mentally ill, they create their own narrative. Their story no longer belongs solely to doctors or pharmaceutical companies. It’s a powerful shift in perspective can foster respect and healing.

For all these reasons, PsychScoop combines mental health research with patients’ own experiences. I’ve written about Elyn Saks, Kay Redfield Jamison, Inez Holger and Amanda Wang. Today I recommend seven blogs that illustrate life with mental illness.