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Medscape
6 days ago
- Business
- Medscape
Spesolimab Provides Sustained Improvement of GPP and QOL
In a secondary analysis of phase 2b spesolimab data in generalized pustular psoriasis (GPP), nearly two-thirds of patients who received 300 mg monthly doses maintained clear or nearly clear skin through 48 weeks' follow-up, and nearly one quarter of treated patients maintained minimal GPP impact on quality of life (QOL). Nevertheless, investigators said, the presence of moderate QOL impairment despite clear or nearly clear skin at baseline highlighted the chronic nature of GPP and patients' need for effective long-term treatment. Similar observations emerged from a separate study that characterized GPP flares and treatment patterns. Skin Symptoms and QOL In the post hoc analysis of Effisayil 2 data, investigators led by Kenneth B. Gordon, MD, professor of dermatology, Medical College of Wisconsin, Milwaukee, found that overall, 20.0% of patients who received monthly subcutaneous spesolimab 300 mg (after a 600 mg subcutaneous loading dose) had sustained improvement in both GPP Physician Global Assessment (GPPGA) and Dermatology Life Quality Index (DLQI) scores through week 48 compared with 3.2% of the placebo cohort. Regarding skin manifestations, 63.3% of patients treated with spesolimab experienced sustained improvement, which investigators defined as having a GPPGA score of 0/1 at all Effisayil 2 study visits through week 48 without other investigator-prescribed medications. The corresponding figure among patients on placebo was 29.0%. The study recently appeared in the Journal of the American Academy of Dermatology ( JAAD ). As for QOL, 24.1% of spesolimab-treated patients maintained DLQI scores of 0/1 through week 48 vs 3.2% for placebo. Patients reported at baseline that GPP's biggest impact on QOL stemmed from itch, soreness, and pain; embarrassment; and the disease's effects on social activities and clothing choices. Although patients in Effisayil 2 had GPPGA 0/1 at baseline, Gordon and colleagues noted that the mean baseline DLQI scores of 11.1 and 7.2 in the 300 mg monthly and placebo groups, respectively, indicated that despite patients' having clear or nearly clear skin, moderate QOL burden persisted. Spesolimab, a monoclonal antibody that blocks interleukin (IL)-36 signaling known to be involved in GPP, was first approved by the US Food and Drug Administration in 2022 for treating flares in adults with GPP. Approval was expanded in 2024 for the treatment of GPP in adults and in pediatric patients aged ≥ 12 years who weigh ≥ 40 kg. Real-World Data In a separate study also recently published in JAAD , investigators found that among 638 eligible patients with GPP from the OMNY Health real-world data platform, 63% experienced at least one GPP flare between January 2017 and January 2023. The mean annualized flare rate was 0.91 per patient per year, with a mean inter-flare interval of 5.9 months. Patients who experienced flares were more likely to be women, younger than 65 years, non-White, Hispanic, or Latino, and had moderate or severe GPP and a history of infectious or parasitic disease. Treatment strategies were diverse, nonstandardized, and off-label, with patients frequently switching or discontinuing biologics and/or nonsteroidal systemic treatments. 'GPP patients continue to experience frequent flares with traditional off-label therapies in the real-world setting,' wrote authors led by Jamie W. Rhoads, MD, MS, of the University of Utah School of Medicine, Salt Lake City. Among patients who experienced multiple flares, they added, 66% had a second flare within 6 months of their first. Together, said James G. Krueger, MD, PhD, the D. Martin Carter professor in clinical investigation and co-director of the Center for Clinical and Translational Science at The Rockefeller University, New York City, the two papers examine how patients view their health status between flares and what the frequency of reflaring might be. He was not involved with the studies but provided comments in an interview with Medscape Medical News . Fear of Flaring Patients worry about GPP flares, said Krueger, because such flares constitute a medical emergency with potentially severe, life-threatening symptoms that could require hospitalization for weeks while receiving traditional immunosuppressants. And GPP is so rare that a practicing dermatologist may see only a few cases in their career. 'Given that almost no center takes in this type of patient,' he added, 'there's a lack of knowledge about the natural course of GPP and how best to manage patients with this disease.' James G. Krueger, MD, PhD Before spesolimab's approval for GPP, he said, broadly acting immunosuppressants targeted GPP indirectly. The fact that doctors could quell flares using such medications did not mean that patients' inflammation had resolved, Krueger added. 'It means their inflammatory state may have been suppressed to the point that they didn't need hospitalization. But many of these patients report significant symptoms or quality-of-life issues between flares.' Mechanistically, Krueger said, only around one quarter of patients with GPP possess a genetic mutation in a control protein called the IL-36 receptor antagonist, which normally would prevent the overblown IL-36 response that characterizes GPP. Nevertheless, he said, the mutation spotlights the IL-36 cytokine family as the most important, consistent aberration in causing GPP. 'This is one of the instances where a rare disease has a known genetic association, and that genetic problem can be fixed to a large extent by a therapeutic antibody. This antibody essentially replaces the function of the missing protein by binding to a receptor for IL-36 in a way that prevents it from being activated.' Accordingly, said Krueger, spesolimab approximates a molecular replacement therapy for GPP. 'And I believe that's why spesolimab works remarkably fast.' Ultimately, Krueger said, both articles mainly address medical dermatologists at referral centers who treat patients with more complicated GPP flares. 'The general practitioner should be aware that there are care pathways for acute and chronic GPP that may keep people under enough control that they can avoid recurrent emergency visits to either a dermatologist or an emergency room.' The new information about the likelihood that a patient will have lifelong disease 'helps with getting into the mindset that you're going to need to manage most of these patients over a long time period, not episodically,' he added. The spesolimab study was supported by Boehringer Ingelheim, maker of spesolimab; authors reported financial relationships with many companies that manufacture psoriasis drugs, including AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, and others. The second study was also supported by Boehringer Ingelheim. Rhoads had received consulting fees from Boehringer Ingelheim, Eli Lilly, and Genentech. Another author of the second study is an employee of OMNY Health, a contractor to Boehringer Ingelheim for the real-world study, and had received consulting fees from Boehringer Ingelheim, Eli Lilly, and Genentech. Two authors are Boehringer Ingelheim employees, and another author had received research grants and is a consultant to and had received honoraria from Boehringer Ingelheim. Krueger has been a consultant and lecturer for Boehringer Ingelheim and has analyzed biopsy samples from Effisayil 1 and 2 for future publications, but he is not an Effisayil author.
Yahoo
23-05-2025
- Health
- Yahoo
Gun violence in Milwaukee costs taxpayers millions; what we learned
The Brief We're getting a new look at the cost of gun violence in Milwaukee. New research shows each homicide costs the city about $2 million. That money goes to health care, investigation, incarceration, victim compensation and social service assistance. MILWAUKEE - Gun violence is costing taxpayers millions of dollars. That is the message as a gun violence prevention program enters a new phase in Milwaukee. What we know Violence is Reggie Moore's focus in his work for Medical College of Wisconsin. "Gun violence is so high in the area," Moore said. "Each homicide costs the city of Milwaukee $2 million." FREE DOWNLOAD: Get breaking news alerts in the FOX LOCAL Mobile app for iOS or Android The crime dashboard from Milwaukee police says there have been 47 homicides to date in 2025. By Moore's calculations, that is a cost of about $94 million – taxpayer money that goes to health care, investigation, incarceration, victim compensation and social service assistance. What they're saying On Thursday, Moore gave Milwaukee's Public Safety and Health Committee new information about costs as part of a partnership to prevent gun violence. "If we save one life, the internal investment is clear. The prevention is smart public safety," Moore said. Dig deeper You might have heard of the program, 414 Life. It started in 2018 and treats gun violence as a disease. The city helps fund the effort to prevent reinjury after gun violence, support people through recovery, and educate young people with the hope they avoid violence in the first place. SIGN UP TODAY: Get daily headlines, breaking news emails from FOX6 News "Since the program launched in 2018, there has been over 250 high risk situations where guns may have been presented or someone's house was shot up or threatened, so being able to intervene and descalate those situations is critically important," Moore said. What's next The next phase is now kicking off – evaluating the community impact of the program. The Source The information in this post came from the Milwaukee Police Department and 414 Life.
Yahoo
22-05-2025
- Politics
- Yahoo
When George Floyd was killed, policing and diversity changes came. Five years later, is that change at risk?
Police violence had been captured on video before. But the video of George Floyd's final nine minutes of life was different. It captured Floyd, a 46-year-old Black man, dying as Derick Chauvin, a White Minneapolis police officer, held him down with his knee on Floyd's neck. Video captured Floyd pleading for his mother, as onlookers were pleading for his life. Usually homicides by police officers involve a firearm, with the incidents captured over in a matter of seconds, minutes at most, said Reggie Moore, the Medical College of Wisconsin's director of violence prevention policy and engagement. 'This was a slow and methodical murder that would shake any caring individual to their core,' Moore said. 'Thankfully, millions across the globe, from all walks of life, were not only shaken but inspired to take to the streets and demand change.' Chanting Floyd's dying words, 'I can't breathe,' and "Black Lives Matter," thousands took to the streets of Milwaukee, at one point closing a section of Interstate 43, encircling a law enforcement building in Racine and setting it on fire. In Madison, long a liberal bastion for rallies, police began deploying tear gas, night-after-night, as crowds turned their anger to destruction, smashing windows and vandalizing businesses along State Street, tearing down two iconic statues on Capitol grounds and assaulting state Sen. Tim Carpenter, D-Milwaukee. Signaling a need to maintain safety, control crowds and protect businesses from looting, more than 1,400 Wisconsin National Guard troops were deployed to Milwaukee, Madison, Green Bay, Racine and Kenosha, The rallies in the United States were replicated overseas, with thousands marching in cities like London, Berlin and Toronto. Not even the new, fast-spreading COVID-19 virus could keep people away from rallies. Millions took to the streets, masked, to decry racial injustices and hold Chauvin accountable. These forces were colliding with a presidential campaign already underway: President Donald Trump's first administration saw protests as a need for police crackdowns. Presidential candidate Joe Biden reached out to Floyd's family and said the moment was a call to social reckoning. Biden won and soon signed executive orders aimed at advancing equity, civil rights and racial justice. Now, five years after Floyd's death on May 25, 2020, Trump is back. A jackhammer was taken to the words "Black Lives Matter,' removing the phrase on the boulevard leading to the White House. Under the Trump administration, diversity, equity and inclusion policies are systematically losing funding and are viewed as no longer relevant. 'I ended all of the lawless, so-called diversity, equity and inclusion bullshit all across the entire federal government and the private sector,' Trump said at an April 29 rally in Michigan that marked his 100th day in office. The public is skeptical the period after Floyd created meaningful improvements for Black Americans, according to the Pew Research Center. In May, the organization released results of a survey that found 72% of respondents did not feel the focus on race after Floyd's killing led to improvements. And those who did feel progress was made fear it could be lost. 'Those battles won't stay won,' said William Sulton, a defense attorney and president of the American Civil Liberties Union Wisconsin. "You have to continue to talk about these issues because there can be a rollback, and that's what we're experiencing, a major rollback in gains that were made in 2020." Changes to police reforms have been swift during the first five months of Trump's second term. Five days prior to the five-year anniversary of Floyd's death the U.S. Department of Justice announced its plans to drop police-accountability agreements with Minneapolis and Louisville, Kentucky, where Breonna Taylor was shot and killed by police officers. The move abandons Biden-era attempts to reshape law enforcement in cities with high-profile killings by officers. Trump has deleted a federal database of police misconduct incidents, overturned executive orders signed by Biden, and canceled funding for programs or agencies that existed to promote diversity, equity and inclusion. In April, Trump issued an executive order directing the attorney general to use all legal remedies against state and local officials who engage in diversity, equity and inclusion policies in law enforcement, and he has done the same in "virtually all aspects of federal government.' Earlier this year, the president called DEI a 'tyranny' on the federal government, public sector and military. 'Our country will be woke no longer,' Trump said during a joint address to Congress in March. The corporate sector has followed Trump's lead. Wisconsin-based Kohl's Corp. dropped the term DEI from its annual report, replacing it with 'inclusion and belonging.' Harley-Davidson, a Milwaukee-based company, also backed away from diversity initiatives. Many in Trump's party support the changes. 'The words diversity, equity and inclusion, they all sound good, but what results from that mentality?' said state Rep. Bob Donovan, R-Greenfield. 'I wholeheartedly support merit-based promotions and hiring.' Tanya McLean is executive director of Leaders of Kenosha, a group that advocates for social and restorative justice and equal access to resources for Black residents of Kenosha and Wisconsin. It's been her experience that police are receptive to the idea of more diversity within the force. Police departments in Kenosha, Madison and Milwaukee became more diverse in the years since Floyd's murder, records show. Although the Trump agenda calls for rollback, local governments have passed laws already that 'reduced negative police encounters,' said Sulton, the state ACLU official. Sulton said he's optimistic that DEI policies and policing reforms he advocates for will remain. That's because people are simply putting in the work. 'You're going to have swings from Democrats being in power to swings of Republicans being in power, which is why I think it's important for people stay on the job every day,' he said. The Floyd protests led to change across every sector, but no profession came under more scrutiny and change than law enforcement. Underscoring it all was the way police engaged with people of color, with Floyd's murder underscoring what many believed to be indicative of racial bias. 'Defund the police' became a common refrain, alongside "re-envision policing," as people advocated for funding to go to communities directly and for dollars to be funneled to things meant to prevent crime, rather than to police departments responding to it. Policy changes soon followed. Milwaukee's Fire and Police Commission passed policies that tightened use-of-force, banned chokeholds and banned no-knock warrants. Three months after Floyd was killed, police in Kenosha shot Jacob Blake, Black man, in the back as he got into a car. A neighbor caught the incident on video, which went viral. Blake's shooting, which left him paralyzed, reignited protests and led to body cameras being mandated for Kenosha police officers. In Madison, police adopted dozens of changes after undergoing an external review through University of Pennsylvania. Fred Royal, a former president of the local NAACP, called the Fire and Police Commission's changes part of one of the 'most progressive use-of-force policies currently being employed or discussed' when they occurred. "All of these different processes got us to where we are now," said Milwaukee activist Vaun Mayes, who organized one of the first protests in the city in 2020. "Clearly we're not where we want to be completely." At the state level, bills were passed that banned chokeholds in most instances, required reporting of no-knock warrants (a response to Breonna Taylor's death in Louisville, Kentucky), and tracked use-of-force incidents. Wisconsin's legislative changes were 'in the middle' for states that did make changes, said Brandon Garrett, a law professor at Duke University and director of its Wilson Center for Science and Justice. The Wilson Center tracked police reform changes nationally in the years that followed Floyd's death. He cited Colorado as a state that took more steps than Wisconsin by removing qualified immunity for police officers accused of wrongdoing. 'You don't want to make policy because of one case and one incident,' Garrett said. '(But it was) a catalyst to reexamine some kind of policies that people had known for a long time weren't great.' While the emphasis on diversity, equity and inclusion at the federal level didn't see real backlash until Trump's second term, the pushback came swiftly in Wisconsin, due in large part to GOP control of the Legislature. Take the passage of Act 12 in 2023. Milwaukee was on the brink of a fiscal crisis. Lawmakers agreed to help out the state's largest city, but the help came with stipulations: among those were DEI restrictions and policing requirements. Milwaukee Mayor Cavalier Johnson said at the time the city's fiscal situation was effectively used to strip away DEI efforts made by the city. The law prohibited Milwaukee from using tax money to fund 'any position for which the principal duties consist of promoting individuals or groups on the basis of their race, color, ancestry, national origin, or sexual orientation." It also prohibited local governments in Wisconsin from using preferences in hiring or contracting. "Milwaukee's fiscal cliff opened the door to Republican demands that would have never passed muster for me or at the city's Common Council," Johnson said in 2023. "No matter how loudly I said no, the steamroller of political reality moved forward." When Wisconsin Act 12 passed, it came with hefty stipulations on policing in the city as well. The Fire and Police Commission lost the power to create policy for the departments, with that responsibility moving to the chiefs of both departments. Act 12 also dictated the oversight commission have two members from lists provided by the police and firefighter unions. The current executive director of the Fire and Police Commission previously told the Milwaukee Journal Sentinel the law's FPC provisions were passed in backlash to policy changes. "Where the board diverged from what the Police Department and, more importantly, the police union wanted ... that's what led to the Act 12 changes," director Leon Todd said in late February. The ACLU's Sulton said DEI and policy backtracking was a direct result of conservative backlash. 'I think (Trump) and the Republicans, even before summer of 2020, really resisted and took steps to undo anything that would address past discrimination and current discrimination,' he said. Changes to law enforcement policies have taken hold in Milwaukee. Nate Hamilton continues pushing for more. Hamilton is the brother of Dontre Hamilton, whom Milwaukee police shot and killed in 2014 after they responded to a report of a sleeping man in a public park downtown. Police officers were fired, but ultimately not charged in the incident. It sparked years of activism for him and his family. Hamilton now is chair of a city commission meant to offer community input on police reform. The group helped craft the the Milwaukee Police Department's community policing policy and is working with the department on updating it. Hamilton is optimistic progress will continue, in part, because the department has improved the way it listens to the community under Police Chief Jeffrey Norman. 'We just need to stay steady. We don't need to overwhelm the system,' he said. McLean, executive director of the advocacy group Leaders of Kenosha, said it seems as though the country is in an endless cycle of police killings that may not get a lot of attention but continue to happen. She believes the best way forward is open communication with law enforcement and lawmakers. "The powers that be need to be addressing the root causes of why and how we got here," she said. "That is most important and that work still needs to continue. Those conversations still need to be had.' Dr. Christopher Ford, an emergency medicine doctor in Milwaukee, was doing his residency in Minneapolis when a police officer was found not guilty of manslaughter in the shooting death of Philando Castile. Castile was killed by a police officer in a Minneapolis suburb in 2016, four years before Floyd. Castile, 32, was in the car with his girlfriend and her 4-year-old son. Talk quickly circulated in the media regarding what he had done — was he intoxicated, how did he provoke the officer? The questions about Castile's alcohol consumption were enough to make Ford, now 39, change his own behavior. He quit drinking. He added it to the list of behaviors to alter when encountered by police — don't make any sudden movements, show your hands, if you have a weapon, have a permit — that his grandfather had taught his dad and both had taught him. 'I can't have any wiggle room when I am out or that could happen to me,' said Ford, who identifies as African American. For all that has changed since Floyd, and for all that has been rolled back, some things haven't changed at all. Ford says he speaks to his two sons, ages 5 and 7, every day the same way his father and grandfather did to him. Unfortunately, that is the way it is, he said. 'That's something that my kids are going to have to live with for the rest of their lives," Ford said. "The society that they grow up in sees them differently than mom and dad does." David Clarey is a public safety reporter at the Milwaukee Journal Sentinel. He can be reached at dclarey@ Drake Bentley is a general assignment and breaking news reporter at the Milwaukee Journal Sentinel. He can be reached at dbentley1@ Jessica Van Egeren is a general assignment reporter and assistant breaking news editor with the Milwaukee Journal Sentinel. She can be reached at jvanegeren@ This article originally appeared on Milwaukee Journal Sentinel: Will changes driven by George Floyd's murder five years ago stay?
Medscape
21-05-2025
- Health
- Medscape
Beyond the Glasgow Coma Scale: New TBI Framework Proposed
After more than half a century, assessment of acute traumatic brain injury (TBI) is getting a makeover. A newly proposed framework expands assessment of acute TBI beyond the Glasgow Coma Scale (GCS) to include biomarkers, CT and MRI scans, and 'modifiers' such as other medical conditions and how the injury occurred. 'Multiple factors prompted this initiative. First was a growing consensus among clinicians, researchers, and patients alike around the need for an improved system for the characterization of TBI,' co-senior author Michael McCrea, PhD, co-director of the Center for Neurotrauma Research at the Medical College of Wisconsin in Milwaukee, told Medscape Medical News . 'Second, was the recognition that a multidimensional framework could better guide individualized treatments that give TBI patients the best chance of survival, recovery, and return to life function.' 'Finally, this movement is now enabled by decades of progress in translational research that informed the components of a multidimensional framework for classification of TBI,' he added. The proposed framework was published online on May 20 in The Lancet Neurology . Beyond Level of Consciousness Since 1974, the clinical TBI severity has been classified according to the GCS sum score as mild, moderate, or severe, based largely on a patient's level of consciousness. Given its limitations, in 2022, the US National Institute of Neurological Disorders and Stroke (NINDS) launched an international initiative to develop a multidimensional classification system for acute TBI. The so-called 'CBI-M framework' is made up of four pillars — clinical, biomarker, imaging, and modifiers — and was developed by TBI experts, implementation scientists, people with lived experience, and partners from 14 countries. The clinical pillar retains the full GCS total score as a central element of assessment, measuring consciousness along with pupil reactivity as an indication of brain function. The framework recommends including the scale's responses to eye, verbal, and motor commands or stimuli, as well as the presence of amnesia and symptoms such as headache, dizziness, and sensitivity to noise. The clinical pillar 'should be assessed as first priority in all patients. Research has shown that the elements of this pillar are highly predictive of injury severity and patient outcome,' co-senior author Andrew Maas, MD, PhD, emeritus professor of neurosurgery, University of Antwerp, Antwerp, Belgium, said in a news release. Other Critical Clues to Recovery The second pillar uses blood-based biomarkers to provide objective indicators of tissue damage. Measurement of one or more of the following three biomarkers is recommended in the first 24 hours after injury: Glial fibrillary acidic protein, ubiquitin C-terminal hydrolase L1, or S100 calcium-binding protein B. The working group noted that this recommendation was based on the diagnostic and prognostic utility of these biomarkers demonstrated in acute care settings. Low levels of each of the three biomarkers accurately indicate a very low risk for traumatic intracranial injury on head CT scans and can be used to rule out the need for CT imaging. The third pillar of the CBI-M framework is neuroimaging, which offers a 'great source' of information about the type and extent of brain injury, the authors reported. This pillar focuses on CT, the most widely used imaging modality within the first 24 h of injury, but recognizes that MRI is more sensitive than CT and can provide additional information while acknowledging certain practicalities around its use in the acute phase. The final pillar in the CBI-M framework is 'modifiers,' which includes assessment of injury-related factors (how the injury happened) and patient- and society-related factors (such as medications, healthcare access, prior TBI, substance abuse, and living circumstances). 'This pillar summarizes the factors that research tells us need to be considered when we interpret a patient's clinical, blood biomarker, and neuroimaging exams,' co-first author Kristen Dams-O'Connor, PhD, professor in the Department of Rehabilitation and Human Performance and Department of Neurology, and director of the Brain Injury Research Center at the Icahn School of Medicine at Mount Sinai in New York City, said in the release. 'One example is a patient with underlying cognitive impairment who may require acute monitoring for risk of clinical deterioration, regardless of findings on the initial clinical exam,' she said. Testing and Validation The proposed framework is being phased in at trauma centers on a trial basis. It will be refined and validated before it is fully implemented. The authors of a linked Comment in The Lancet Neurology , led by Junfeng Feng, MD, Shanghai Institute of Head Trauma in Shanghai, China , offer several cautionary notes on the proposed CBI-M framework for acute TBI assessment. The new assessment model is a 'substantial advancement' in integrating the characterization of acute TBI but is 'not yet ideal,' they wrote. In their view, the biomarker pillar is limited in that testing for biomarkers requires time, their specificity for the diagnosis of TBI is not high, and the use of biomarkers is minimal in low-income and middle-income countries. 'Similar to the biomarker pillar, the modifier pillar — an individual's biopsychosocial characteristics — can be valuable for predicting outcomes in patients with TBI but has minimal effect on decision-making, particularly during the acute phase of TBI,' Feng and co-authors said. 'Another deficiency of the CBI-M framework is that it cannot quantitatively or semiquantitatively assess the condition of patients with TBI yet,' they pointed out. 'To gain recognition and application in countries around the world, the CBI-M framework requires improvement and practical testing through global multicenter, large-scale, prospective cohort studies,' Feng and colleagues cautioned. Another concern the Comment authors have is that the CBI-M framework does not consider intracranial pressure monitoring, which 'should be conducted in specific patients, if possible, and be eventually incorporated into the CBI-M framework for characterization of acute TBI,' they wrote. Asked why intracranial pressure monitoring was not included in the framework, McCrea said that 'while intracranial pressure monitoring is an important element of care for patients in the intensive care unit after TBI, the aim of this movement was to develop a multidimensional framework for characterization of acute TBI across the full spectrum of injury severity and all care settings.'
Yahoo
21-04-2025
- Health
- Yahoo
Fewer friends, outlets and direction: Why boys are dying by suicide at an inordinate pace.
If you or someone you know is dealing with suicidal thoughts, call the National Suicide Prevention Lifeline at 988 or text "Hopeline" to the National Crisis Text Line at 741-741. When Dr. Jeffrey Karst sits down with boys for therapy sessions, he sometimes has to peel back extra layers of behaviors learned over time. There's the veil of stoic indifference, what it means to be a man, and the sense that sharing feelings is a sign of weakness. That hasn't been helped by the recent culture wars dictating the definitions of masculinity, said Karst, an associate professor of pediatrics at the Medical College of Wisconsin. "That can make some boys feel very hopeless about their future if they don't match what is expected of them in our current society," Karst said. "It's really hard for a lot of the boys I talk to to think about what values are important to (them) and what is actually going to be valued in society. They feel very alone." Breaking through to access the child's radical authentic self, as Karst describes it, is increasingly important at a time when young men aged 18 to 24 in Wisconsin are nearly four times more likely to die by suicide than young women in that same age range, according to data published by the state Office of Children's Mental Health Tuesday. Even prior to new adulthood, however, boys between 10 and 17 were more than twice as likely than girls to die by suicide, the factsheet found. Part of the challenge with boys, said Karst, comes down to combatting traditional masculine stereotypes. Another challenge, Karst said, is access to firearms, the most lethal means of suicide. "There's been a few inflection points, including the pandemic, but a lot of these are long-standing challenges," Karst said. While men make up 50% of the U.S. population, research shows that four out of five suicide deaths from 2023 were men. What's more, the youngest generations of men, Gen Z (18-23) and Zillennial (24-30), are reporting the highest levels of emotional distress and suicidal thoughts compared to other generations of men. Surveys also revealed that, compared to men 30 years prior, more than a quarter of young men don't have meaningful social connections. At the same time, most young men feel misunderstood by women. Men also express their emotional distress differently than women. Typically, boys and men present with a more brusque exterior: irritability and anger on one end, withdrawal on the other. In Wisconsin, anxiety, depression, self-harm and suicidal thoughts have increased among high school boys, according to the 2023 Wisconsin Youth Risk Behavior Report. More than a third of high school boys said they were anxious; another quarter reported feeling a persistent sadness or hopelessness. The picture of a traditional male breadwinner and protector of the family has shifted dramatically over the decades. And while redefining those traditions has helped expand narrow ideas of gender and broaden career possibilities for girls and young women, some boys may feel they are at an impasse. For Linda Hall, executive director of the Wisconsin Office of Children's Mental Health, this comes through as boys and young men not seeing a place for themselves in the future. "We're not looking at boys for those traditional roles anymore, so the question becomes, 'What are we building towards?' and 'Where are we trying to go?'" Hall said. That sense of loss pans out in a few ways. Fewer boys are graduating from college, if they go at all, Hall said. Where Wisconsin women aged 25-34 received their college degrees 42% of the time, just 32% of Wisconsin men in that same age group received theirs, according to the Brookings Institute. It also conjures existential dread, Karst said. For the boys Karst treats, if they are unable to see their value in society, they won't feel value in themselves. That opens the door to other vulnerabilities. "When they don't feel value, when they feel alone, sometimes they're drawn into these fringe groups where misogyny and scapegoating occur, rather than actually just finding support," Karst said. Compounding that, boys and young men typically don't reach out to one another when they're struggling, Karst said. Some of that is the result of not having close connections in the first place. Karst noted that, even 15 years ago, playing video games was a social hobby. Now, most boys play video games with people they know, but they're doing so with headphones on alone in their rooms. If they talk, it tends to be online, which robs young people of seeing the consequences of their words. For example, if you're teasing someone and see them react tearfully, chances are you'll change your tone, Karst said. But missing those basic cues can build into a larger problem. "They're really missing that opportunity to connect with friends on an actual emotional level," Karst said. When one of Hall's sons was struggling in school, he went to a school psychologist. At first, it didn't go well. He didn't open up. Talking about feelings in an office space wasn't comfortable. The psychologist decided to turn the appointment into a walking session. They went outside and walked the perimeter of the school. "That was fundamental. That was life-changing, because he felt a connection to her," Hall said. Later, when he got to high school, he recommended the same psychologist to his other male friends. On another occasion, when Hall suggested a therapist put a basketball hoop in his office, her son felt able to open up because he had another activity he could put some of that tension toward. Hall and Karst both said that when adults, and especially male adults, model healthy behaviors, it can help normalize emotional expressions. That might look like verbalizing your own feelings and asking your son, without judgment, about his feelings. For Karst, modeling is the biggest way to help boys and young men reach out. In-person socializing through hobbies and extracurriculars, can also create a sense of solidarity and bonding. Taking time, more generally, to go outside offers natural serotonin boosts and is really easy to do, Hall said. "Adults really need to see beyond what can present as just disruptive or combative behavior," Karst said. "It can really represent true emotional suffering." Natalie Eilbert covers mental health issues for the Milwaukee Journal Sentinel. She welcomes story tips and feedback. You can reach her at neilbert@ or view her X (Twitter) profile at @natalie_eilbert. This article originally appeared on Milwaukee Journal Sentinel: In Wisconsin, young men die by suicide at 4 times the rate of girls
