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Rhee TG, Bommersbach TJ, Rosenheck RA, Nierenberg AA, McIntyre RS. National trends and correlates of treatment resistance in major depressive episode and associated suicidal ideation and behaviors among adults in the United States. J Affect Disord 2024; 358:342-349. [PMID: 38734245 DOI: 10.1016/j.jad.2024.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE To examine recent 12-year trends in prevalence of suicidal ideation and behaviors (SIBs) among US adults experiencing a past-year treatment-resistant depression (TRD). METHODS Using data from the National Survey of Drug Use and Health, we estimated the annual percentage of individuals aged ≥18 with TRD who reported past-year SIBs, and estimated linear trends adjusting for potentially confounding factors from 2009 to 2020. RESULTS Of estimated 237.5 million US adults, 7.1 % met diagnostic criteria for a past-year major depressive episode (MDE) between 2009 and 2020. Of these, 9.7 % met criteria for TRD. The proportion reporting past-year suicidal ideation in TRD ranged from 39.5 % (95 % confidence interval [CI], 32.1-47.3 %) in 2009-2010 to 43.4 % (95 % CI, 36.7-503 %) in 2019-2020, with an average annual percent change (AAPC) of 1.3 % (95 % CI, -0.7 % to 3.3 %). The prevalence of past-year suicide attempts in TRD was 7.3 % across the study period (AAPC, 0.1 %; 95 % CI, -4.3 % to 4.7 %). Past-year SIBs were significantly associated with an increased likelihood of meeting criteria for TRD among adults with MDE (adjusted odds ratio [AOR], 1.53; 95 % CI, 1.35-1.75 for suicidal ideation; AOR, 2.17; 95 % CI, 1.79-2.62 for suicide attempts). No significant differences were observed between 2019 and 2020, reflecting the COVID-19 pandemic. CONCLUSION Among individuals with TRD, proportions of SIBs are high. These findings underscore an urgent need for suicide prevention efforts in this high-risk population, including preventive services across diverse settings and accessibility to evidence-based pharmacological and non-pharmacological interventions.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA; Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, USA.
| | | | - Robert A Rosenheck
- VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
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2
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Wang Z, Tang Y, Wang G, Deng Y, Jiang Y, Sun W, Sun X, Ip P, Owens J, Zhao M, Xiao Y, Jiang F, Wang G. Insufficient Sleep is Associated With Increasing Trends in Adolescent Suicidal Behaviors. J Adolesc Health 2024:S1054-139X(24)00066-1. [PMID: 38506779 DOI: 10.1016/j.jadohealth.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/03/2023] [Accepted: 01/12/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE Youth suicide has been increasing and became a public health concern worldwide. Identifying insufficient sleep as the potential risk factor is critical to reducing suicide risk and increasing trends. This study aimed to determine whether insufficient sleep is associated with increasing trends in suicidal behaviors and disparities by sex, age, and race/ethnicity among school adolescents. METHODS The present study used biennial data from the US nationally representative Youth Risk Behavior Survey from 2007 to 2019. Joinpoint regression models were used to estimate biennial percent changes (BPCs) and average BPCs (ABPCs) of suicidal behaviors by sleep duration. Logistic regression models were used to examine the association between insufficient sleep and suicidal behaviors. RESULTS Of 73,356 adolescent students included (mean [standard deviation] age, 16.11 [1.23] years), 50.03% were female. Suicidal ideation and suicide plan among insufficient sleep group increased from 2007 to 2019 (BPC = 2.88% [95% confidence interval {CI}: 1.65%, 4.13%]; BPC = 3.42% [95% CI: 2.09%, 4.77%]), but were nonsignificant among sufficient sleep group. Trends in suicidal ideation (ABPC = 3.03% [95% CI: 1.35%, 4.73%]) and suicide plan (ABPC = 4.03% [95% CI: 2.47%, 5.62%]) among female adolescents with insufficient sleep increased, but nonsignificant among male adolescents with insufficient sleep. Suicidal ideation (ABPC = 1.73% [95% CI: 0.51%, 2.97%]) and suicide plan (ABPC = 2.31% [95% CI: 0.70%, 3.95%]) increased among younger adolescents only with insufficient sleep, whereas suicide trends by sleep duration were similar among older adolescents. Suicide plan among insufficient sleep group increased across the four racial groups, with BPC highest for the White (BPC = 3.48% [95% CI: 1.31%, 5.69%]), and lowest for the Hispanic/Latino (BPC = 1.18% [95% CI: 0.15%, 2.23%]), but were nonsignificant among sufficient sleep group except for the White (BPC = 2.83% [95% CI: 0.62%, 5.09%]). DISCUSSION Insufficient sleep was disproportionately associated with increasing trends in suicidal behaviors among female, younger, and non-White adolescent students. Ensuring sufficient sleep can potentially reduce suicide among school adolescents.
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Affiliation(s)
- Zijing Wang
- Department of Developmental and Behavioral Pediatrics, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijia Tang
- Department of Developmental and Behavioral Pediatrics, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guangshuai Wang
- Faculty Artificial Intelligence in Education, National Engineering Research Center of Educational Big Data, Central China Normal University, Wuhan, Hubei, China
| | - Yujiao Deng
- Department of Neurology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanrui Jiang
- Department of Developmental and Behavioral Pediatrics, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wanqi Sun
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoning Sun
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Psychology and Behavioral Science, Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong, China
| | - Judith Owens
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China; CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Sciences, Shanghai, China
| | - Yunyu Xiao
- Department of Population Health Sciences, Weill Cornell Medicine|NewYork-Presbyterian, New York, New York.
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Center for Brain Science and Brain-Inspired Technology, Shanghai, China.
| | - Guanghai Wang
- Department of Developmental and Behavioral Pediatrics, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Center for Brain Science and Brain-Inspired Technology, Shanghai, China.
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3
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Escobar LE, Liew M, Yirdong F, Mandelos KP, Ferraro-Diglio SR, Abraham BM, Polanco-Roman L, Benau EM. Reduced attentional control in individuals with a history of suicide attempts compared to those with suicidal ideation: Results from a systematic review and meta-analysis. J Affect Disord 2024; 349:8-20. [PMID: 38169241 DOI: 10.1016/j.jad.2023.12.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/01/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Neurocognitive profiles may be especially useful to identify factors that facilitate transitioning from contemplating suicide to attempting suicide. Generally, those who attempt suicide show greater disruptions in neurocognitive ability compared to those who think about suicide but do not proceed to attempt. The goal of this systematic review and meta-analysis is to test whether this pattern is observed with attentional control. METHODS We systematically searched PubMed, PsychINFO, CINAHL, and Google Scholar to find pertinent studies. All included studies compared attentional functioning using neutral stimuli. Each sample featured adults with a history of suicidal ideation (SI) and no history of suicide attempts (SA) compared to those with a history of SA. RESULTS We identified 15 studies with 32 effect sizes (N = 931; n = 506 with SI only; n = 425 with SA). SA groups, compared to SI groups, exhibited worse accuracy yet similar reaction time, suggesting a comparatively blunted speed-accuracy tradeoff. Relative to SI, SA groups performed worse on Stroop-like and Go/NoGo tasks. SA performed better than SI on Trail Making Test B, but not A. LIMITATIONS There were few available studies. Most samples were small. We did not differentiate current vs. past SI or high vs. low lethality SA. Only English and Spanish language articles were included. CONCLUSIONS Disrupted attentional control may convey risk for transitioning to SA from SI. More work is needed to determine which components of attention are most associated with suicide risk.
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Affiliation(s)
- Lesly E Escobar
- Department of Psychology, SUNY Old Westbury, Old Westbury, NY, USA
| | - Megan Liew
- Department of Psychology, SUNY Stony Brook, Stony Brook, NY, USA; Department of Psychology, University of Missouri, Columbia, MO, USA
| | - Felix Yirdong
- Department of Psychology, CUNY Graduate Center, New York, NY, USA
| | | | | | - Blessy M Abraham
- Department of Psychology, SUNY Old Westbury, Old Westbury, NY, USA
| | | | - Erik M Benau
- Department of Psychology, SUNY Old Westbury, Old Westbury, NY, USA.
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Keyes KM, Kandula S, Martinez-Ales G, Gimbrone C, Joseph V, Monnat S, Rutherford C, Olfson M, Gould M, Shaman J. Geographic Variation, Economic Activity, and Labor Market Characteristics in Trajectories of Suicide in the United States, 2008-2020. Am J Epidemiol 2024; 193:256-266. [PMID: 37846128 DOI: 10.1093/aje/kwad205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
Suicide rates in the United States have increased over the past 15 years, with substantial geographic variation in these increases; yet there have been few attempts to cluster counties by the magnitude of suicide rate changes according to intercept and slope or to identify the economic precursors of increases. We used vital statistics data and growth mixture models to identify clusters of counties by their magnitude of suicide growth from 2008 to 2020 and examined associations with county economic and labor indices. Our models identified 5 clusters, each differentiated by intercept and slope magnitude, with the highest-rate cluster (4% of counties) being observed mainly in sparsely populated areas in the West and Alaska, starting the time series at 25.4 suicides per 100,000 population, and exhibiting the steepest increase in slope (0.69/100,000/year). There was no cluster for which the suicide rate was stable or declining. Counties in the highest-rate cluster were more likely to have agricultural and service economies and less likely to have urban professional economies. Given the increased burden of suicide, with no clusters of counties improving over time, additional policy and prevention efforts are needed, particularly targeted at rural areas in the West.
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5
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Botha F, Morris RW, Butterworth P, Glozier N. Generational differences in mental health trends in the twenty-first century. Proc Natl Acad Sci U S A 2023; 120:e2303781120. [PMID: 38011547 DOI: 10.1073/pnas.2303781120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/27/2023] [Indexed: 11/29/2023] Open
Abstract
Given the observed deterioration in mental health among Australians over the past decade, this study investigates to what extent this differs in people born in different decades-i.e., possible birth cohort differences in the mental health of Australians. Using 20 y of data from a large, nationally representative panel survey (N = 27,572), we find strong evidence that cohort effects are driving the increase in population-level mental ill-health. Deteriorating mental health is particularly pronounced among people born in the 1990s and seen to a lesser extent among the 1980s cohort. There is little evidence that mental health is worsening with age for people born prior to the 1980s. The findings from this study highlight that it is the poorer mental health of Millennials that is driving the apparent deterioration in population-level mental health. Understanding the context and changes in society that have differentially affected younger people may inform efforts to ameliorate this trend and prevent it continuing for emerging cohorts.
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Affiliation(s)
- Ferdi Botha
- Australian Research Council Centre of Excellence for Children and Families over the Life Course, University of Queensland, Brisbane, QLD 4068, Australia
- Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Richard W Morris
- Australian Research Council Centre of Excellence for Children and Families over the Life Course, University of Queensland, Brisbane, QLD 4068, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Peter Butterworth
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT 0200, Australia
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Burwood, VIC 3125, Australia
| | - Nick Glozier
- Australian Research Council Centre of Excellence for Children and Families over the Life Course, University of Queensland, Brisbane, QLD 4068, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
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6
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Ruork AK, Maimone JS, Bentley KH, Kleiman EM. Latent Profile Analysis of Urges for Suicidal and Self-Harming Behavior: The Role of Social Support Instability. Arch Suicide Res 2023:1-11. [PMID: 37997436 DOI: 10.1080/13811118.2023.2280225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
College counseling centers are seeing increasing rates of suicidal thoughts and behaviors, and nonsuicidal self-injury (NSSI) among students. The high degree of need and limited resources underscores the need for novel approaches to identify at-risk students. We used latent profile analysis (LPA) to identify subgroups of students (n = 371) with different patterns of interpersonal factors and examine whether these subgroups differed by risk for self-injurious thoughts and behaviors. The best-fitting LPA had three profiles, which differed in urges to die by suicide and engage in NSSI. The profile with low average social support and higher instability (greater day-to-day fluctuations of self-reported social support and rejection) was associated with greatest risk, suggesting that this combination leaves individuals more vulnerable to suicide and NSSI.
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7
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Polanco-Roman L, DeLapp RCT, Dackis MN, Ebrahimi CT, Mafnas KSW, Gabbay V, Pimentel SS. Racial/ethnic discrimination and suicide-related risk in a treatment-seeking group of ethnoracially minoritized adolescents. Clin Child Psychol Psychiatry 2023; 28:1305-1320. [PMID: 36210796 PMCID: PMC10082132 DOI: 10.1177/13591045221132682] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND AIMS Despite growing evidence demonstrating the negative mental health effects of racism-related experiences, racial/ethnic discrimination is seldom examined in youth suicide risk. The present study tested the association between racial/ethnic discrimination and well-supported correlates of suicide-related risk including emotion reactivity and dysregulation, and severity of psychiatric symptoms in a sample of ethnoracially minoritized adolescents receiving outpatient psychiatric services. METHODS Participants were adolescents (N = 46; 80.4% female; 65.2% Latinx) who ranged in age from 13-20 years old (M=15.42; SD=1.83) recruited from a child outpatient psychiatry clinic in a low-resourced community in Northeast US. Youth completed a clinical interview and a battery of surveys. RESULTS Findings from separate linear regression models show that increases in frequency of racial/ethnic discrimination were associated with increases in severity of suicidal ideation (SI), independent of emotion reactivity and dysregulation, and symptoms of PTSD and depression. Discriminatory experiences involving personal insults, witnessing family being discriminated, and school-based contexts were uniquely associated with SI. DISCUSSION AND CONCLUSION Preliminary findings support the association between racial/ethnic discrimination and increased severity of suicide-related risk in ethnoracially minoritized adolescents. Accounting for racial/ethnic discrimination may improve the cultural responsiveness of youth suicide prevention strategies within outpatient psychiatric care.
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Affiliation(s)
| | - Ryan CT DeLapp
- Psychiatry and Behavioral Sciences, Montefiore Medical Center, USA
- Albert Einstein College of Medicine, USA
| | | | | | | | - Vilma Gabbay
- Psychiatry and Behavioral Sciences, Montefiore Medical Center, USA
- Albert Einstein College of Medicine, USA
- Nathan Kline Institute for Psychiatric Research, USA
| | - Sandra S Pimentel
- Psychiatry and Behavioral Sciences, Montefiore Medical Center, USA
- Albert Einstein College of Medicine, USA
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8
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Molock SD, Boyd RC, Alvarez K, Cha C, Denton EG, Glenn CR, Katz CC, Mueller AS, Meca A, Meza JI, Miranda R, Ortin-Peralta A, Polanco-Roman L, Singer JB, Zullo L, Miller AB. Culturally responsive assessment of suicidal thoughts and behaviors in youth of color. Am Psychol 2023; 78:842-855. [PMID: 36913280 PMCID: PMC10497725 DOI: 10.1037/amp0001140] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
The significance of youth suicide as a public health concern is underscored by the fact that it is the second-leading cause of death for youth globally. While suicide rates for White groups have declined, there has been a precipitous rise in suicide deaths and suicide-related phenomena in Black youth; rates remain high among Native American/Indigenous youth. Despite these alarming trends, there are very few culturally tailored suicide risk assessment measures or procedures for youth from communities of color. This article attempts to address this gap in the literature by examining the cultural relevancy of currently widely used suicide risk assessment instruments, research on suicide risk factors, and approaches to risk assessment for youth from communities of color. It also notes that researchers and clinicians should consider other, nontraditional but important factors in suicide risk assessment, including stigma, acculturation, and racial socialization, as well as environmental factors like health care infrastructure and exposure to racism and community violence. The article concludes with recommendations for factors that should be considered in suicide risk assessment for youth from communities of color. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Sherry D Molock
- Department of Psychological and Brain Sciences, George Washington University
| | - Rhonda C Boyd
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia
| | - Kiara Alvarez
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Christine Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University
| | - Ellen-Ge Denton
- Department of Psychology, College of Staten Island, City University of New York
| | | | - Colleen C Katz
- Silberman School of Social Work, Hunter College, City University of New York
| | | | - Alan Meca
- Department of Psychology, University of Texas at San Antonio
| | - Jocelyn I Meza
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Regina Miranda
- Department of Psychology, Hunter College, City University of New York
| | - Ana Ortin-Peralta
- Department of Psychology, Hunter College, City University of New York
| | | | | | - Lucas Zullo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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Pless Kaiser A, Chennapragada L, Andrusier S, Silver C, Padgett C, Beaudreau SA, Fairchild JK, Goodman M. Firearm Safety and Suicide Prevention for Medically Complex Older Veterans: Perspectives of VA Home-Based Primary Care Directors and Psychologists. Clin Gerontol 2023:1-12. [PMID: 37767999 DOI: 10.1080/07317115.2023.2263218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
OBJECTIVES Determine strategies and resources used by VA Home-Based Primary Care (HBPC) teams to discuss firearm safety and suicide risk with older veterans and their families or caregivers. Training and resource needs for promoting firearm safety with older veterans were also ascertained. METHODS Ten focus groups (N = 37) were conducted virtually in 2022 with HBPC directors and psychologists. Qualitative rapid response coding identified domains and themes within transcripts. RESULTS Analysis revealed three major domains: firearm safety, suicide risk, and resources/trainings. Firearm safety themes included discussions during clinical procedures, firearm-related challenges, veteran culture, and barriers and facilitators to effective conversations. Suicide risk themes included assessment procedures, frequency/types of risk conversations, factors related to suicidal ideation/behavior, challenges, and strategies to enhance communication. Resource/training themes included those currently used and perceived needs. CONCLUSIONS Participants described strategies for facilitating firearm safety and suicide prevention discussions with older veterans, their families, and caregivers. Using respectful language and attending to values related to firearm ownership were identified as essential. CLINICAL IMPLICATIONS Additional clinician/staff training/resources are needed for addressing older veteran firearm safety and suicide risk, including how to conduct more effective conversations with older veterans on these topics and better engage families/caregivers in prevention efforts.
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Affiliation(s)
- Anica Pless Kaiser
- Behavioral Science Divison, National Center for PTSD, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Lakshmi Chennapragada
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J Peters Veteran Affairs Medical Center, Bronx, New York, USA
| | - Sarah Andrusier
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J Peters Veteran Affairs Medical Center, Bronx, New York, USA
| | - Chana Silver
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J Peters Veteran Affairs Medical Center, Bronx, New York, USA
| | - Cameron Padgett
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J Peters Veteran Affairs Medical Center, Bronx, New York, USA
| | - Sherry A Beaudreau
- Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - J Kaci Fairchild
- Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Marianne Goodman
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J Peters Veteran Affairs Medical Center, Bronx, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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10
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Joseph VA, Kreski NT, Keyes KM. Sleep deprivation and suicide risk among minoritized US adolescents. BMC Psychiatry 2023; 23:638. [PMID: 37653474 PMCID: PMC10472686 DOI: 10.1186/s12888-023-05074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES To assess (1) the prevalence of suicide ideation/behavior among adolescents with short sleep by race/ethnicity and (2) the association between sleep duration and suicidal ideation and behavior among American youth by race/ethnicity from 2007 to 2019. METHODS Data were drawn from the Youth Risk Behavior Surveillance System (YRBSS). Logistic regression analyses were used to assess the relationship between sleep duration and suicidal ideation/behavior. RESULTS Overall, suicide ideation/behavior increased among U.S. adolescents of all racial groups from 2007 to 2019. Adjusting for race/ethnicity, sexual identity, age, sex, substance use, trauma, and bullying, those with short sleep had approximately twice the odds [OR: 1.92 (95% CI: 1.65, 2.23)] of suicide ideation/consideration compared to those with long sleep. Stratified analyses indicated that Black students with short sleep had higher odds of making a suicide plan (OR = 1.51, 95% C.I.: 1.27, 1.79) compared with Black students with long sleep. A similar pattern was observed across other racial/ethnic groups (e.g., Hispanic: (OR = 1.74, 95% C.I.: 1.53, 1.97). CONCLUSION Emphasis on suicide interventions is of the essence, especially with increasing rates. Sleep duration significantly predicts suicide risk among all adolescents. Additional research is needed to assess factors that predict suicide among minoritized adolescents, specifically Black and Hispanic adolescents.
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Affiliation(s)
- Victoria A Joseph
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA.
| | - Noah T Kreski
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
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11
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Polanco-Roman L, Ebrahimi CT, Mafnas KSW, Hausmann-Stabile C, Meca A, Mazzula SL, Duarte CS, Lewis-Fernández R. Acculturation and suicide-related risk in ethnoracially minoritized youth in the US: a scoping review and content analysis of the empirical evidence. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1121-1137. [PMID: 37270726 PMCID: PMC10366293 DOI: 10.1007/s00127-023-02494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Among Asian-American/Pacific Islander, Hispanic/Latinx, and Black youth, the US born have higher risk of suicidal thoughts and behaviors (attempts and death-by-suicide) than first-generation migrants. Research has focused on the role of acculturation, defined as the sociocultural and psychological adaptations from navigating multiple cultural environments. METHODS Using content analysis, we conducted a scoping review on acculturation-related experiences and suicide-related risk in Asian-American/Pacific Islander, Hispanic/Latinx, and Black youth (henceforth described as "ethnoracially minoritized adolescents"), identifying 27 empirical articles in 2005-2022. RESULTS Findings were mixed: 19 articles found a positive association between acculturation and higher risk for suicide ideation and attempts, namely when assessed as acculturative stress; 3 articles a negative association; and 5 articles no association. Most of the research, however, was cross-sectional, largely focused on Hispanic/Latinx youth, relied on demographic variables or acculturation-related constructs as proxies for acculturation, used single-item assessments for suicide risk, and employed non-random sampling strategies. Although few articles discussed the role of gender, none discussed the intersections of race, sexual orientation, or other social identities on acculturation. CONCLUSION Without a more developmental approach and systematic application of an intersectional research framework that accounts for racialized experiences, the mechanisms by which acculturation may influence the risk of suicidal thoughts and behavior remain unclear, resulting in a dearth of culturally responsive suicide-prevention strategies among migrant and ethnoracially minoritized youth.
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Affiliation(s)
- Lillian Polanco-Roman
- The New School, Department of Psychology, 80 Fifth Avenue, Room 617, New York, NY, 10011, USA.
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
| | - Chantel T Ebrahimi
- The New School, Department of Psychology, 80 Fifth Avenue, Room 617, New York, NY, 10011, USA
| | - Katherine S W Mafnas
- The New School, Department of Psychology, 80 Fifth Avenue, Room 617, New York, NY, 10011, USA
| | | | - Alan Meca
- Department of Psychology, University of Texas at San Antonio, San Antonio, USA
| | - Silvia L Mazzula
- Department of Psychology, John Jay College for Criminal Justice, CUNY, New York, NY, USA
| | - Cristiane S Duarte
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Roberto Lewis-Fernández
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
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Polanco-Roman L, Williams SZ, Ortin-Peralta A. Study Preregistration: Does State-level Structural Racism Impact Risk for Suicidal Thoughts and Behaviors Among US Adolescents Across Race and Ethnicity? J Am Acad Child Adolesc Psychiatry 2023; 62:829-830. [PMID: 37385715 DOI: 10.1016/j.jaac.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/29/2023] [Accepted: 03/08/2023] [Indexed: 07/01/2023]
Abstract
In the United States, suicide deaths have disproportionately increased among Black and Hispanic youth over the past 2 decades.1 Despite the critical need for more culturally responsive suicide prevention strategies, there has been only sparse research into unique risk factors commonly experienced among ethnoracially minoritized youth, such as racism-related experiences. Experiences of racial and ethnic discrimination (ie, a behavioral manifestation of racism via unfair treatment predicated on an individual's racial and/or ethnic group affiliation) have been associated with higher rates of suicidal thoughts and behaviors (STBs) in Black and Hispanic adolescents.2,3 This research has largely focused on individual-level racism (ie, interpersonal exchanges) assessed via subjective self-report surveys. Thus, less is known about the impact of structural racism, which is enacted at the system level.
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Rheinberger D, Shand F, McGillivray L, McCallum S, Boydell K. Parents of Adolescents Who Experience Suicidal Phenomena-A Scoping Review of Their Experience. Int J Environ Res Public Health 2023; 20:6227. [PMID: 37444075 PMCID: PMC10340647 DOI: 10.3390/ijerph20136227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023]
Abstract
High prevalence rates of self-harm and suicide in adolescence provide unique challenges for parents. The aim of this scoping review was to explore key gaps in our understanding of the current scientific literature on the experience of parents who have adolescent children experiencing suicide crisis or self-harm. Four academic databases were searched using three broad concepts: self-harming behaviour or suicidal crisis; adolescents or young people; and the experiences or behaviour of parents, between journal inception and March 2022. Information reporting on the parents' experience was extracted and a qualitative synthesis was conducted. Twenty-two articles met inclusion criteria and were assessed in detail. The experience of parents with an adolescent engaged in self-harm or suicidal crisis were classified into three temporal themes: discovery of the suicidal phenomena, management of suicidal phenomena, and after the suicidal phenomena had ceased. Parents caring for an adolescent experiencing self-harm or suicidal crisis experience poorer psychological wellbeing, difficulty accessing support services, and changes in the parent-child relationship. Parents desire greater support for both themselves and their child and further investigation is required to understand specifically which supports would be most appropriate at each stage.
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Affiliation(s)
- Demee Rheinberger
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW 2031, Australia; (F.S.); (L.M.); (K.B.)
- Tyree Foundation Institute of Health Engineering, University of New South Wales, Sydney, NSW 2052, Australia
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW 2031, Australia; (F.S.); (L.M.); (K.B.)
| | - Lauren McGillivray
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW 2031, Australia; (F.S.); (L.M.); (K.B.)
| | - Sonia McCallum
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT 2600, Australia;
| | - Katherine Boydell
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW 2031, Australia; (F.S.); (L.M.); (K.B.)
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Lee LK, Fleegler EW, Goyal MK, Doh KF, Laraque-Arena D, Hoffman BD, Injury Violence And Poison Prevention CO. Firearm-Related Injuries and Deaths in Children and Youth. Pediatrics 2022; 150:189687. [PMID: 36207778 DOI: 10.1542/peds.2022-060071] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Firearms are the leading cause of death in children and youth 0 to 24 years of age in the United States. In 2020, firearms resulted in 10,197 deaths (fatality rate 9.91/100,000 youth 0-24 years old). Firearms are the leading mechanism of death in pediatric suicides and homicides. Increased access to firearms is associated with increased rates of firearm deaths. Substantial disparities in firearm injuries and deaths exist by age, gender, race, ethnicity, and sexual orientation and gender identity and for deaths related to legal intervention. Barriers to firearm access can decrease the risk to youth for firearm suicide, homicide, or unintentional shooting injury and death. Given the high lethality of firearms and the impulsivity associated with suicidal ideation, removing firearms from the home or securely storing them-referred to as lethal means restriction of firearms-is critical, especially for youth at risk for suicide. Primary care-, emergency department-, mental health-, hospital-, and community-based intervention programs can effectively screen and intervene for individuals at risk for harming themselves or others. The delivery of anticipatory guidance coupled with safety equipment provision improves firearm safer storage. Strong state-level firearm legislation is associated with decreased rates of firearm injuries and death. This includes legislation focused on comprehensive firearm licensing strategies and extreme risk protection order laws. A firm commitment to confront this public health crisis with a multipronged approach engaging all stakeholders, including individuals, families, clinicians, health systems, communities, public health advocates, firearm owners and nonowners, and policy makers, is essential to address the worsening firearm crisis facing US youth today.
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Affiliation(s)
- Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Kiesha Fraser Doh
- Division of Pediatrics and Emergency Medicine, Emory University/Children's Healthcare of Atlanta, Atlanta, GA
| | - Danielle Laraque-Arena
- New York Academy of Medicine, Mailman School of Public Health at Columbia University, Departments of Epidemiology and Pediatrics, New York, NY
| | - Benjamin D Hoffman
- Division of General Pediatrics, Oregon Health and Science University, Portland, OR
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Clark KA, Hatzenbuehler ML, Bränström R, Pachankis JE. Sexual orientation-related patterns of 12-month course and severity of suicidality in a longitudinal, population-based cohort of young adults in Sweden. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1931-1934. [PMID: 35829726 PMCID: PMC9378663 DOI: 10.1007/s00127-022-02326-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 06/20/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE We assessed sexual orientation-related patterns in the 1-year longitudinal course (i.e., onset, remittance, persistence) and severity of suicidality. METHOD Data were obtained from a prospective, population-based cohort representing nearly 2.4 million Swedish young adults. RESULTS A higher proportion of sexual minorities remitted (14.6%) compared to heterosexuals (9.5%). However, over twice as many sexual minorities (35.1%) experienced persistent suicidality as heterosexuals (15.0%). Plurisexual (e.g., bisexual, pansexual) young adults and sexual minorities aged 17-25 were at greatest risk for persistent and more severe suicidality. CONCLUSION Findings call for the identification of sexual orientation-related predictors of chronic suicidality to inform responsive clinical interventions.
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Affiliation(s)
- Kirsty A Clark
- Department of Medicine, Health and Society, Vanderbilt University, 2201 West End Ave, Nashville, TN, 37235, USA.
| | | | - Richard Bränström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Platt JM, Pamplin JR, Gimbrone C, Rutherford C, Kandula S, Olfson M, Gould MS, Martínez-Alés G, Shaman J, Keyes K. Racial Disparities in Spatial and Temporal Youth Suicide Clusters. J Am Acad Child Adolesc Psychiatry 2022; 61:1131-1140.e5. [PMID: 35031449 PMCID: PMC9271532 DOI: 10.1016/j.jaac.2021.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 12/20/2021] [Accepted: 01/04/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Deaths by suicide correlate both spatially and temporally, leading to suicide clusters. This study aimed to estimate racial patterns in suicide clusters since 2000. METHOD Data from the US National Vital Statistics System included all International Classification of Diseases, Tenth Revision (ICD-10)-coded suicide cases from 2000-2019 among American Indian/Alaska Native (AI/AN), Asian/Pacific Islander (A/PI), Black, or White youth and young adults, aged 5-34 years. We estimated age, period, and cohort (APC) trends and identified spatiotemporal clusters using the SaTScan space-time statistic, which identified lower- and higher-than-expected suicide rates (cold and hot clusters) in a prespecified area (150 km) and time interval (15 months). We also calculated the average proportion of deaths by suicide contained in clusters, to quantify the relative importance of spatiotemporal patterning as a driver of overall suicide rates. RESULTS From 2010-2019, suicide rates increased from between 37% among AI/AN (95% CI = 1.22, 1.55) to 81% among A/PI (95% CI = 1.65, 2.01) groups. Suicide clusters accounted for 0.8%-10.3% of all suicide deaths, across racial groups. Since 2000, the likelihood of detecting cluster increased over time, with considerable differences in the number of clusters in each racial group (4 among AI/AN to 72 among White youth). Among Black youth and young adults, 27 total clusters were identified. Hot clusters were concentrated in southeastern and mid-Atlantic counties. CONCLUSION Suicide rates and clusters in youth and young adults have increased in the past 2 decades, requiring attention from policy makers, clinicians, and caretakers. Racially distinct patterns highlight opportunities to tailor individual- and population-level prevention efforts to prevent suicide deaths in emerging high-risk groups.
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Affiliation(s)
| | - John R Pamplin
- Center for Urban Science and Progress, New York University, New York; Grossman School of Medicine, New York University, New York
| | | | | | | | - Mark Olfson
- Mailman School of Public Health, Columbia University, New York; Columbia University Irving Medical Center and New York State Psychiatric Institute, New York
| | - Madelyn S Gould
- Mailman School of Public Health, Columbia University, New York; Columbia University Irving Medical Center and New York State Psychiatric Institute, New York
| | | | - Jeffrey Shaman
- Mailman School of Public Health, Columbia University, New York
| | - Katherine Keyes
- Mailman School of Public Health, Columbia University, New York
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17
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Alvarez K, Polanco-Roman L, Breslow AS, Molock S. Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems. Am J Psychiatry 2022; 179:422-433. [PMID: 35599542 PMCID: PMC9765395 DOI: 10.1176/appi.ajp.21101001] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Suicide rates among ethnoracially minoritized youth (i.e., youth of color) peak before the age of 30, and striking disparities in access to mental health services have been identified in this age group. However, suicide prevention strategies have yet to fully address structural racism as a mechanism in producing disparities in risk, protective factors, and access to quality effective intervention for youth of color. Such an approach is critical to provide more culturally responsive mental health care. Through an adapted socio-ecological model, the authors propose the Structural Racism and Suicide Prevention Systems Framework and illustrate pathways through which structural racism impacts suicide prevention and intervention for youth of color in the United States. The authors contextualize the impact of structural racism in three key settings where youth suicide prevention occurs: mental health services, schools, and the interface between crisis care and law enforcement. The authors posit that critical attention must be paid to the intersection of mutually reinforcing, interdependent systems rather than to systems in isolation. The authors then propose recommendations to address structural racism in suicide prevention, including macro-level interventions to improve societal conditions, research strategies to inform structural solutions, training approaches to address institutional racism, and clinical approaches to address the impact of racism and racial trauma on youths and families.
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Affiliation(s)
- Kiara Alvarez
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA, USA,Correspondence: Kiara Alvarez, Massachusetts General Hospital Disparities Research Unit, Department of Medicine, 50 Staniford Street, Suite 830, Boston, MA 02114; ; Phone: 617-724-1237; Fax: 617-726-4120
| | | | - Aaron Samuel Breslow
- PRIME Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY,Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, USA
| | - Sherry Molock
- Department of Psychological & Brain Sciences, The George Washington University, Washington, DC
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18
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Martínez-Alés G, Gimbrone C, Rutherford C, Keyes K, López-Cuadrado T. Role of Foreign-Born Status on Suicide Mortality in Spain Between 2000 and 2019: An Age-Period-Cohort Analysis. Int J Public Health 2022; 67:1604538. [PMID: 35664647 PMCID: PMC9156625 DOI: 10.3389/ijph.2022.1604538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: To examine recent age-period-cohort effects on suicide among foreign-born individuals, a particularly vulnerable sociodemographic group in Spain. Methods: Using 2000-2019 mortality data from Spain's National Institute of Statistics, we estimated age-period-cohort effects on suicide mortality, stratified by foreign-born status (native- vs. foreign-born) and, among the foreign-born, by Spanish citizenship status, a proxy for greater socioeconomic stability. Results: Annual suicide mortality rates were lower among foreign- than native-born individuals. There was heterogeneity in age-period-cohort effects between study groups. After 2010, suicide mortality increased markedly among the foreign-born-especially for female cohorts born around 1950, and slightly among native-born women-especially among female cohorts born after the 1960s. Among native-born men, suicide increased linearly with age and remained stable over time. Increases in suicide among the foreign-born were driven by increases among individuals without Spanish citizenship-especially among cohorts born after 1975. Conclusion: After 2010, suicide in Spain increased markedly among foreign-born individuals and slightly among native-born women, suggesting an association between the downstream effects of the 2008 economic recession and increases in suicide mortality among socioeconomically vulnerable populations.
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Affiliation(s)
- Gonzalo Martínez-Alés
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Instituto de Investigacion Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Catherine Gimbrone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Caroline Rutherford
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Katherine Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Teresa López-Cuadrado
- National Centre of Epidemiology, Carlos III Health Institute (ISCIII), Madrid, Spain
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Abstract
Suicide is a major public health concern in the United States. Between 2000 and 2018, US suicide rates increased by 35%, contributing to the stagnation and subsequent decrease in US life expectancy. During 2019, suicide declined modestly, mostly owing to slight reductions in suicides among Whites. Suicide rates, however, continued to increase or remained stable among all other racial/ethnic groups, and little is known about recent suicide trends among other vulnerable groups. This article (a) summarizes US suicide mortality trends over the twentieth and early twenty-first centuries, (b) reviews potential group-level causes of increased suicide risk among subpopulations characterized by markers of vulnerability to suicide, and (c) advocates for combining recent advances in population-based suicide prevention with a socially conscious perspective that captures the social, economic, and political contexts in which suicide risk unfolds over the life course of vulnerable individuals.
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Affiliation(s)
- Gonzalo Martínez-Alés
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; ,
- Department of Psychiatry, La Paz University Hospital, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Tammy Jiang
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA;
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; ,
| | - Jaimie L Gradus
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA;
- Department of Psychiatry, School of Medicine, Boston University, Boston, Massachusetts, USA;
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Abstract
This article is part of a Festschrift commemorating the 50th anniversary of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Established in 1970, first as part of the National Institute of Mental Health and later as an independent institute of the National Institutes of Health, NIAAA today is the world's largest funding agency for alcohol research. In addition to its own intramural research program, NIAAA supports the entire spectrum of innovative basic, translational, and clinical research to advance the diagnosis, prevention, and treatment of alcohol use disorder and alcohol-related problems. To celebrate the anniversary, NIAAA hosted a 2-day symposium, "Alcohol Across the Lifespan: 50 Years of Evidence-Based Diagnosis, Prevention, and Treatment Research," devoted to key topics within the field of alcohol research. This article is based on Dr. Keyes' presentation at the event. NIAAA Director George F. Koob, Ph.D., serves as editor of the Festschrift.
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Affiliation(s)
- Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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21
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Martínez-Alés G, Gimbrone C, Rutherford C, Kandula S, Olfson M, Gould MS, Shaman J, Keyes KM. Role of Firearm Ownership on 2001-2016 Trends in U.S. Firearm Suicide Rates. Am J Prev Med 2021; 61:795-803. [PMID: 34420829 PMCID: PMC8608719 DOI: 10.1016/j.amepre.2021.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION In the U.S., state-level household firearm ownership is strongly associated with firearm suicide mortality rates. Whether the recent increases in firearm suicide are explained by state-level household firearm ownership rates and trends remains unknown. METHODS Mortality data from the U.S. National Vital Statistics System and an estimate of state-level household firearm ownership rate were used to conduct hierarchical age-period-cohort (random-effects) modeling of firearm suicide mortality between 2001 and 2016. Models were adjusted for individual-level race and sex and for state-level poverty rate, unemployment rate, median household income in U.S. dollars, population density, and elevation. RESULTS Between 2001 and 2016, the crude national firearm suicide mortality rate increased from 6.8 to 8.0 per 100,000, and household firearm ownership rate remained relatively stable, at around 40%. Both variables were markedly heterogeneous and correlated at the state level. Age-period-cohort models revealed period effects (affecting people across ages) and cohort effects (affecting specific birth cohorts) underlying the recent increases in firearm suicide. Individuals born after 2000 had higher firearm suicide rates than most cohorts born before. A 2001-2006 decreasing period effect was followed, after 2009, by an increasing period effect that peaked in 2015. State-level household firearm ownership rates and trends did not explain cohort effects and only minimally explained period effects. CONCLUSIONS State-level firearm ownership rates largely explain the state-level differences in firearm suicide but only marginally explain recent increases in firearm suicide. Although firearms in the home increase firearm suicide risk, the recent national rise in firearm suicide might be the result of broader, more distal causes of suicide risk.
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Affiliation(s)
- Gonzalo Martínez-Alés
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York; Department of Psychiatry, La Paz University Hospital, Madrid, Spain.
| | - Catherine Gimbrone
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Caroline Rutherford
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Sasikiran Kandula
- Department of Environmental Health Sciences (EHS), Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Mark Olfson
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York; Department of Psychiatry, Columbia University, New York, New York
| | - Madelyn S Gould
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York; Department of Psychiatry, Columbia University, New York, New York
| | - Jeffrey Shaman
- Department of Environmental Health Sciences (EHS), Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York
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Assari S, Boyce S, Bazargan M, Caldwell CH. Race, Family Conflict and Suicidal Thoughts and Behaviors among 9-10-Year-Old American Children. Int J Environ Res Public Health 2021; 18:5399. [PMID: 34070158 DOI: 10.3390/ijerph18105399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 01/09/2023]
Abstract
Family conflict is known to operate as a major risk factor for children’s suicidal thoughts and behaviors (STBs). However, it is unknown whether this effect is similar or different in Black and White children. Objectives: We compared Black and White children for the association between family conflict and STBs in a national sample of 9–10-year-old American children. Methods: This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) study. This study included 9918 White or Black children between the ages of 9 and 10 living in married households. The predictor variable was family conflict. Race was the moderator. The outcome variable was STBs, treated as a count variable, reflecting positive STB items that were endorsed. Covariates included ethnicity, sex, age, immigration status, family structure, parental education, and parental employment, and household income. Poisson regression was used for data analysis. Results: Of all participants, 7751 were Whites, and 2167 were Blacks. In the pooled sample and in the absence of interaction terms, high family conflict was associated with higher STBs. A statistically significant association was found between Black race and family conflict, suggesting that the association between family conflict and STBs is stronger in Black than White children. Conclusion: The association between family conflict and STBs is stronger in Black than White children. Black children with family conflict may be at a higher risk of STBs than White children with the same family conflict level. These findings align with the literature on the more significant salience of social relations as determinants of mental health of Black than White people. Reducing family conflict should be regarded a significant element of suicide prevention for Black children in the US.
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