Suicidal risk and protective factors in major affective disorders: A prospective cohort study of 4307 participants

BACKGROUND

Suicidal behavior is strongly associated with major affective disorders, but there is a need to quantify and compare specific risk and protective factors in bipolar disorder (BD) and major depressive disorder (MDD).

METHODS

In 4307 extensively evaluated major affective-disorder participants with BD (n = 1425) or MDD (n = 2882) diagnosed by current international criteria, we compared characteristics among those with versus without suicidal acts from illness-onset through 8.24 years of follow-up.

RESULTS

Suicidal acts were identified in 11.4 % of participants; 25.9 % were violent and 6.92 % (0.79 % of all participants) were fatal. Associated risk factors included: diagnosis (BD > MDD), manic/psychotic features in first-episodes, family history of suicide or BD, separation/divorce, early abuse, young at illness-onset, female sex with BD, substance abuse, higher irritable, cyclothymic or dysthymic temperament ratings, greater long-term morbidity, and lower intake functional ratings. Protective factors included marriage, co-occurring anxiety disorder, higher ratings of hyperthymic temperament and depressive first episodes. Based on multivariable logistic regression, five factors remained significantly and independently associated with suicidal acts: BD diagnosis, more time depressed during prospective follow-up, younger at onset, lower functional status at intake, and women > men with BD.

LIMITATIONS

Reported findings may or may not apply consistently in other cultures and locations.

CONCLUSIONS

Suicidal acts including violent acts and suicides were more prevalent with BD than MDD. Of identified risk (n = 31) and protective factors (n = 4), several differed with diagnosis. Their clinical recognition should contribute to improved prediction and prevention of suicide in major affective disorders.

The prevalence and excess mortality risk of driving with children

INTRODUCTION

The presence of passengers can affect the driving behavior of motor-vehicle operators. Child passengers present unique motivations to drive more safely, as well as opportunities to distract drivers. Because motor-vehicle crashes are an important cause of premature childhood mortality, this study assesses whether adult drivers with child passengers are more or less likely to cause a fatal crash.

METHOD

Data include fatal crashes involving one or two vehicles from 2007 to 2017 in the U.S. Fatality Analysis Reporting System. We apply methods developed by Levitt and Porter (2001) and Dunn and Tefft (2020) -the LPDT approach- to estimate the risk that adult drivers (21 years or older) with at least one child passenger (15 year or younger) cause a fatal crash relative to adults without child passengers.

RESULTS

Childhood crash exposure when traveling with an adult driver is low: 0.78% of vehicle miles traveled by adults included a child passenger. Nevertheless, adult drivers with child passengers were significantly more likely to cause a fatal crash than adult drivers without child passengers. The estimated risk of causing a single-vehicle crash was 6.2 times higher among the full sample of adults, 7.2 times higher among female drivers, and 5.0 times higher among drivers 25-44 years old.

CONCLUSIONS

Despite their relatively low crash exposure, child passengers are associated with much greater risk of causing a fatal crash.

PRACTICAL APPLICATIONS

This study not only informs about the need to develop interventions to remind parents and adult drivers of the risks associated with driving children, but also reminds researchers about the enormous potential of the LPDT approach when applied to traffic safety issues.

Evaluation of the role of vaccination in the COVID-19 pandemic based on the data from the 50 U.S. States

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The use of vaccines can significantly reduce COVID-19 deaths and mortality.

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The use of vaccines cannot reduce the risk of COVID-19 infection.

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The SARS-CoV-2 Delta variant may weaken the effect of vaccines on lessening the severity of COVID-19.

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Vaccine usage remains effective in reducing the severity of COVID-19 caused by the SARS-CoV-2 Delta variant infection.

Vaccination is considered as the ultimate weapon to end the pandemic. However, the role of vaccines in the pandemic remains controversial. To explore the impact of vaccination on the COVID-19 pandemic, we used logistic regression models to predict numbers of population-adjusted confirmed cases, deaths, intensive care unit (ICU) cases, case fatality rates and ICU admission rates of COVID-19 in the 50 U.S. states, based on 17 related variables. The logistic regression analysis showed that percentages of people vaccinated correlated inversely with the numbers of COVID-19 deaths and case fatality rates but showed no significant correlation with numbers of confirmed cases or ICU cases, or ICU admission rates. The Spearman correlation analysis showed that the percentages of people vaccinated correlated inversely with the numbers of COVID-19 deaths, ICU cases, ICU case rates, and case fatality rates but showed no significant correlation with numbers of confirmed cases. The number of deaths and mortality in the group after the vaccine usage were significantly lower than those in the group before the vaccine usage. However, after delta became the dominant strain, there were no longer significant differences in the number of deaths and the mortality rate between before and after delta became the dominant strain, although vaccines were used in both periods. Vaccination can significantly reduce COVID-19 deaths and mortality, while it cannot reduce the risk of COVID-19 infection. In addition to vaccination, other measures, such as social distancing, remain important in containing COVID-19 transmission and lower the risk of COVID-19 severe outcomes.

[Emotional exhaustion and job satisfaction among teaching staff during the COVID-19 pandemic]

BACKGROUND AND OBJECTIVE

The COVID-19 pandemic has significantly changed the everyday professional life of teaching staff. The purpose of this paper is to examine the effects of the pandemic on teachers' emotional exhaustion and job satisfaction.

METHODS

A sample of 2531 school administrators and teachers from North Rhine-Westphalia was recruited in October 2020. Changes in emotional exhaustion during the pandemic were directly measured with nine items of the Maslach Burnout Inventory and changes in job satisfaction with six items. Adjusted regression models were used to determine risk and protective factors associated with changes in emotional exhaustion and job satisfaction.

RESULTS

Risk factors associated with both more frequently perceived symptoms of exhaustion and reduced job satisfaction were as follows: the additional workload during the pandemic, the stress of uncertainty, the perceived change in workload, concerns about the students, and being employed at an elementary school. A supportive school environment was associated with both fewer perceived symptoms of exhaustion and stable job satisfaction.

DISCUSSION

From the perspective of the teaching staff, the COVID-19 pandemic was related to subjective changes in emotional exhaustion and job satisfaction. The COVID-19 pandemic was associated with higher emotional exhaustion for more than half of the teaching staff and with reduced job satisfaction for one in five teachers. Due to the study design, causal conclusions are not possible.

Cognitive outcome in children with infantile spasms using a standardized treatment protocol. A five-year longitudinal study

AIM

To evaluate the long-term developmental trajectory of children with infantile spasms (IS) and identify the clinical protective and risk factors associated with their cognitive outcome.

METHODS

We analyzed the five-year follow-up results of 41 children (13 female) from the previously published cohort (n = 68) recruited in a multicenter randomized controlled trial for 2-years, examining the effect of an adjunctive therapy (Flunarizine) on standardized IS treatment. The children were subsequently monitored in an open-label study for additional 3 years.  The Vineland Adaptive Behavior Scale, second edition, and either the Stanford-Binet Intelligence Scale, Fifth Edition (SB5) or the Bayley Scales of Infant Development, second edition (BSID-II) were used as cognitive outcome measures.

RESULTS

Etiology was the strongest predictor of outcome. Children with no identified etiology (NIE) showed a progressive improvement of cognitive functions, mostly occurring between 2 and 5 years post-diagnosis.  Conversely, symptomatic etiology was predictive of poorer cognitive outcome. Developmental delay, other seizure types (before and after IS diagnosis), and persistent electroencephalographic abnormalities following treatment were predictive of poor cognitive outcome.

INTERPRETATION

Given the 5-year cognitive improvement, children with IS should undergo a developmental assessment before school entry. Factors influencing their cognitive outcome emphasize the importance of thorough investigation and evidence-based treatment.

Reasons for living and dying in suicide attempters: a two-year prospective study

BACKGROUND

The internal suicide debate hypothesis assumes that in a suicidal crisis, individuals are involved in an internal struggle over whether to live or die. Reasons for living (RFL) and Reasons for dying (RFD) are important individual reasons for staying alive (e.g. family) or wanting to die (e.g. hopelessness) and reflect this internal motivational conflict of the suicidal mind. The aim of this study was to explore the association between RFL and RFD of suicide attempters and current and future suicide ideation and behavior.

METHOD

The sample consisted of 60 patients who were admitted at a psychiatric emergency unit in Switzerland following an attempted suicide. They received treatment as usual, participated in an assessment interview and completed self-report questionnaires. Additionally, they were instructed to write down up to five individual RFL and RFD. The number of RFL and RFD responses, depressive symptoms, and suicide ideation were assessed at baseline and 6, 12, and 24 months follow-up. Outcome measures were suicide ideation and repeated suicide attempts. Multiple imputations were used in order to address missing data.

RESULTS

The number of RFD responses was the strongest predictor for increased suicide ideation at baseline. The number of RFL responses was not associated with suicide ideation and reattempts. RFD, depressive symptoms, and baseline suicide ideation predicted subsequent suicide reattempt up to 12 months later in simple regression analyses. Mediation analyses suggested that RFD mediated the effect of depressive symptoms at baseline on suicide ideation at 12-months follow-up.

CONCLUSION

RFL were unrelated to the mental health of study participants and did not function as protective factor against suicide risk. RFD may be an important motivational driver in the suicidal process. Clinical interventions should focus more on the reduction of RFD than on RFL in suicidal individuals.

Risk factors for recurrent wheezing in the first year of life in the city of Córdoba, Argentina

BACKGROUND

Wheezing is a very common respiratory symptom in infants. The prevalence of wheezing in infants, conducted in developed countries shows prevalence rates ranging between 20% and 30%. However, we do not know the risk factors in our population of wheezing infants.

METHODS

A standardised written questionnaire (WQ-P1-EISL) in infants between 12 and 18 months of age residing in the city of Cordoba was used; population/sample included 1031 infants. Recurrent wheezing (RW) was defined as three or more episodes of wheezing reported by the parents during the first 12 months of life. Data obtained were coded in Epi-Info™ (version 7) and statistically analysed with SPSS (version 17.5) software in Spanish. Parametric tests (one-way ANOVA) were performed for identifying significantly associated variables.

RESULTS

The prevalence of wheezing infants was 39.7%; recurrent wheezing 33%; and severe wheezing 14.7%; 13.7% had pneumonia before the first year and of these 6.3% were hospitalised, multiple variables as risk factors for wheezing were found such as: >6 high airway infections and bronchiolitis in the first three months of life, smokers who smoke in the home among other risk factors and protective factors in those who have an elevated socioeconomic status.

CONCLUSION

It is known that persistent respiratory problems in children due to low socioeconomic status is a risk factor for wheezing, pneumonia and could be a determining factor in the prevalence and severity of RW in infants. Research suggests that there are areas for improvement in the implementation of new educational strategies.

Nature and determinants of suicidal ideation among U.S. veterans: Results from the national health and resilience in veterans study

BACKGROUND

Suicidal thoughts and behaviors among U.S. military veterans are a major public health concern. To date, however, scarce data are available regarding the nature and correlates of suicidal ideation (SI) among U.S. veterans. This study evaluated the prevalence and correlates of suicidal ideation in a contemporary, nationally representative, 2-year prospective cohort study.

METHOD

Data were analysed from a total of 2157 U.S. veterans who participated in the National Health and Resilience Veterans Study (NHRVS; Wave 1 conducted in 2011; Wave 2 in 2013). Veterans completed measures assessing SI, sociodemographic characteristics, and potential risk and protective correlates.

RESULTS

The majority of veterans (86.3%) denied SI at either time point, 5.0% had SI onset (no SI at Wave 1, SI at Wave 2), 4.9% chronic SI (SI at Waves 1 and 2), and 3.8% had remitted SI (SI at Wave 1, no SI Wave 2). Greater Wave 1 psychiatric distress was associated with increased likelihood of chronic SI (relative risk ratio [RRR]=3.72), remitted SI (RRR=3.38), SI onset (RRR=1.48); greater Wave 1 physical health difficulties were additionally associated with chronic SI (RRR=1.64) and SI onset (RRR=1.47); and Wave 1 substance abuse history was associated with chronic SI (RRR 1.57). Greater protective psychosocial characteristics (e.g., resilience, gratitude) at Wave 1 were negatively related to SI onset (RRR=0.57); and greater social connectedness at Wave 1, specifically perceived social support and secure attachment style, was negatively associated with SI onset (RRR=0.75) and remitted SI (RRR=0.44), respectively.

LIMITATIONS

Suicidal ideation was assessed using a past two-week timeframe, and the limited duration of follow-up precludes conclusions regarding more dynamic changes in SI over time.

CONCLUSIONS

These results indicate that a significant minority (13.7%) of U.S. veterans has chronic, onset, or remitted SI. Prevention and treatment efforts designed to mitigate psychiatric and physical health difficulties, and bolster social connectedness and protective psychosocial characteristics may help mitigate risk for SI.