Health Bulletin-April 2022

This Health Bulletin consists of 2 parts.

PART-I

TOPIC: Teenage Depression in Indian Americans

PART-II

TOPIC: Lifestyle Changes and Cancer Prevention:

Author: Vishal Adma M.D. CMQ, CPE
President and CEO, Integrated Psychiatric Consultants, Kansas City

Mental health issues have been plaguing our society for a long. However, the exponential rise in cases in the recent past is a big thing to worry about. One population that is somewhat neglected from the main calculation is the immigrants. There is a large population of Indian Americans that have inhabited United States for work. This particular group needs to have an assessment for mental health and depression since the prevalence of depression amongst immigrants is greater (1.1%) than native US citizens (0.9%). The most unfortunate fact is that the teens of Indian American origin are falling prey to depression and committing suicide.

What Is Teen Depression?

Teen depression includes symptoms of depressed mood, sleep and/or appetite changes, isolation, lack of energy/motivation, and hopelessness or helplessness being present for 2 weeks or more period of time.

What are the Causes and Risk Factors?

According to an authentic study, teen depression is common amongst Asian Americans and is governed by multiple factors. However, females are definitely at a greater risk of developing depression and committing suicide. Many Indian youngsters have suicidal ideations along with depression owing to certain factors, including:

Peer Warmth

Getting accepted by peers at their school is defined as “peer warmth”. As per a study, depressed mood in Indian Americans is linked to lower levels of peer warmth. Coping with the school environment and studies can take a toll on young minds.

Bullying at school is also a triggering factor for depression amongst Indian teens living in America. This paired up with individual elements can trigger symptoms of depression. Increased peer pressure and bullying can ignite suicidal thinking.

Work Stress

Another essential element that pushes young Indian Americans into depression and suicidal thinking is “work stress”.

Discrimination

Racial discrimination is perhaps the most substantial penetrating factor for depression and suicide. According to the HELIUS study, offsprings of immigrants are more likely to be affected by depression due to the discrimination and socioeconomic issues they face daily.

Sexual Orientation

Differences in sexual orientation are not welcomed in Indian households. This is why many children refrain from expressing themselves in front of their parents. This very issue can topple the institution of the family. Therefore, many teens suffer through this silently, inculcating a feeling of insecurity eventually. These feelings don't take long to turn into depression, followed by suicide.

Family Relations

Poor family relations and a lack of communication between the parents and the kids are other causes of teen depression. As per a study published in SAGE journals, poor intergenerational relation between Indian American parents and children is directly linked to depression and anxiety. Unsupportive parents and parent-child alienation are trigger factors for child/teen depression too. Acculturation is to blame in most scenarios.

Substance Use in Indian American Teenage Populations

According to a study of several Asian American adolescent populations, young Indian Americans have the lowest prevalence for binge drinking, alcohol use disorder, and early initiation of use. However, problematic use of alcohol, including underage drinking, can indicate other underlying mental health issues as suicide rates within the South Asian community are higher than among other populations.

Indian American teenagers may also turn to marijuana and other controlled substances as an unhealthy coping mechanism for unaddressed depression and dealing with suicidal thoughts. This can lead to additional feelings of guilt as drug use is seen as a dishonor to one’s community, further discouraging the individual from being open about their mental health to their loved ones.

A health brief on South Asians in the United States found that there is limited data on mental health and substance use among South Asian teenagers. Nonetheless, second-generation immigrants are much more willing to seek professional mental health services – a healthier alternative to substance use. Older Indian American populations also normalize alcohol use socially to relieve feelings of stress, hopelessness and depression without having to talk about them. As a result, their children may be enticed to experiment with substances to achieve similar results.

Advise to Parents of Teenagers

1.Take time to talk to them and find out how they are doing?

2.Be non-judgmental in your thinking, keeping cultural and generational differences in mind

3.Show them you care

4.Show them that you are willing to listen

5.Be willing to seek professional help if necessary

Advise to Teenagers

1.See parents as your well wishers

2.See parents as people who have had various life experiences

3.Be open to talk to your parents

4.Be willing to express your emotions to your parents

5.Be willing to seek professional help if necessary

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TOPIC: Lifestyle Changes and Cancer Prevention:

Author: Satheesh Kathula, MD, FACP

Clinical Professor of Medicine

Hematologist/Oncologist, Dayton, OH

Secretary, AAPI

It is a well-known fact that cancers are caused by factors that are related to lifestyle such as smoking, alcohol, physical inactivity, high BMI, diet rich in meats, low in vegetables and fruit, and stress. It is very important to be aware of these risk factors to prevent cancer.

Smoking Cessation:

There are more than15 types of cancers that are caused by smoking including lung, kidney, bladder, cervix, and esophageal cancer. Smoking causes damage to DNA and the cancer risk increases proportionately with the amount and duration of smoking. Patients who continue to smoke, while receiving the cancer treatments do not respond well and have poorer outcomes. Smoking cessation is very important not only to prevent cancers but to decrease the recurrence rates, new cancers, and improve survival in patients who are already diagnosed with cancer.

Avoidance of Alcohol:

Alcohol use is a risk factor for numerous cancers such as head and neck, gastrointestinal cancers (esophageal, colorectal, pancreatic, liver) and breast cancers. Data suggests that continued drinking after cancer diagnosis may have worse prognosis. Alcohol may interfere with the metabolism of various medications resulting in increased side effects and decreased efficacy. While abstinence from alcohol is ideal, some societies recommend at least limiting the use, 1 drink/day for females and 2 drinks/day for males.

Nutrition:

Healthy dietary patterns are associated with a decreased risk of primary cancer development. A population study of 65,000 participants in England found that daily consumption of 7 or more servings of fruit and vegetables reduced cancer incidence by as much as 25%.

Plant-based diets are associated with a decrease in cancer recurrence and improved outcomes in survivors. For instance, in survivors of stage III colon cancer, a diet consisting of more fruits, vegetables, whole grains, poultry, and fish, and less red meat, refined grains, and concentrated sweets improved cancer recurrence and death, and overall survival.

In general, a healthy diet is rich in plant sources, such as fruit, vegetables, whole grains, legumes, avocados, seeds, and nuts. Fish and poultry are recommended, whereas red and processed meats/foods, and foods and beverages with added sugars or fats should be limited. 

Weight reduction:

High body mass index (BMI) or obesity is a well-established risk factor for many cancers including multiple myeloma, breast, and GI cancers (esophageal, gastric, colorectal, pancreatic, liver and gallbladder), kidney, uterine and ovarian cancers. It is estimated that 3.5% new cancers in men, and 9.5% new cancers in women are linked to high BMI.   

Studies have shown that breast cancer patients with high BMI not only have decreased survival, but impaired quality of life, increased cancer recurrence, etc. 

Physical Activity:

Sedentary lifestyle can be an independent risk factor for increased cancer mortality by about 14% when compared to patients who were considered active. The general recommendation is to do at least 30 minutes of exercise 3 times a week and resistance training at least twice weekly.

Coffee and Cancer:

Though initially coffee was felt to be a risk factor, recent research has shown that coffee may, in fact, reduce the risk of certain cancers. However, coffee may have other health risks and one should avoid excess amounts.

Stress Management:

Stress can initiate cancer by releasing certain harmful hormones that can facilitate cancer growth. Relaxation techniques including meditation, reading, exercise may help alleviate stress and improve quality of life. Positive social interactions may be helpful.

Conclusion:

Cancer is a complex disease with many lifestyle factors influencing the occurrence and outcome as outlined above. A clear understanding and measures to help modify these risk factors may help prevent cancers.

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This Health Bulletin is Coordinated By

Sujeeth R. Punnam, MD
Chair, ATA Health Committee

(Dr. Sujeeth R. Punnam is a cardiologist in Stockton, California and is affiliated with multiple hospitals in the area, including Dameron Hospital and St. Joseph's Medical Center-Stockton. He received his medical degree from Kakatiya Medical College NTR and has been in practice for more than 20 years.)