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Joshi DS, Lebrun-Harris LA, Shaw E, Pilkey D, Collier A, Kinsman S. The Need for Improved Collaboration between Schools and Child Death Review Teams. J Sch Health 2023; 93:135-139. [PMID: 35906765 DOI: 10.1111/josh.13225] [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: 05/16/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Schools are essential public health partners for safeguarding students' health. Child Death Review (CDR) is one public health activity where collaboration with schools is integral for developing strategies to prevent child death but the degree of collaboration is unknown. This study assessed school participation in CDR and the prevalence of school problems in reviewed child death cases, comparing non-suicide and suicide-related deaths. METHODS Using the National Fatality Review-Case Reporting System, we created a dataset of school-aged children (5 to 20 years) whose death was reviewed from 2005 to 2017 and used frequencies, proportions, and chi-squared statistics on selected measures. RESULTS Educational representatives infrequently participated in CDRs (24.9%). School records were rarely accessed for reviewed deaths (5.2%). Less than half (41.2%) of reviewed deaths had any school information and of these, 35.5% of children were indicated as having problems in school. Compared with non-suicide deaths, a larger proportion of suicide deaths had school representatives attend CDRs (28.4% vs 24.1%, P < .0001), and access to educational records (4.2% vs 9.2%, P < .0001). IMPLICATIONS Efforts are needed to address potential barriers to systems integration, including state policies and federal educational privacy laws. CONCLUSIONS School participation in CDRs is lacking for both suicide and non-suicide deaths.
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Affiliation(s)
- Deepa S Joshi
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Epidemiology and Research, Rockville, MD, United States
| | - Lydie A Lebrun-Harris
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Epidemiology and Research, Rockville, MD, United States
| | - Esther Shaw
- National Center for Fatality Review and Prevention, Okemos, MI, United States
| | - Diane Pilkey
- National Center for Fatality Review and Prevention, Okemos, MI, United States
| | - Abby Collier
- National Center for Fatality Review and Prevention, Okemos, MI, United States
| | - Sara Kinsman
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Division of Child, Adolescent and Family Health, Rockville, MD, United States
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2
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Berrigan J, Miller M, Zhang W, Azrael D, Barber C. Hospital visit histories of suicide decedents: a study in Utah. Inj Prev 2022; 28:259-261. [PMID: 35273068 DOI: 10.1136/injuryprev-2022-044524] [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] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/26/2022] [Indexed: 11/05/2022]
Abstract
The study aims to describe the 3-year hospital visit histories of suicide decedents in Utah grouped by the suicide method they used. Hospital visit histories from the Utah Office of Health Care Statistics were linked to a census of suicide mortality data from the National Violent Death Reporting System in 2014 and 2015. Overall, 14% of suicide decedents had visited a hospital for deliberate self-harm (DSH) and 49% for a behavioural health issue (BHI), including DSH, suicidal ideation, mental health and substance abuse, prior to their death. Firearms suicide decedents made up over half of all suicides but were the least likely to have a history of DSH or BHI prior to their death (8% and 41%, respectively). Few suicide decedents visited a hospital for DSH prior to their death, although half had visits for BHI. Hospital-based interventions that aim to prevent suicide should not be limited to visits for DSH.
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Affiliation(s)
- John Berrigan
- University of Kansas School of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA .,Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Wilson Zhang
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Catherine Barber
- Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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3
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Wulz AR, Law R, Wang J, Wolkin AF. Leveraging data science to enhance suicide prevention research: a literature review. Inj Prev 2022; 28:74-80. [PMID: 34413072 PMCID: PMC9161307 DOI: 10.1136/injuryprev-2021-044322] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/31/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this research is to identify how data science is applied in suicide prevention literature, describe the current landscape of this literature and highlight areas where data science may be useful for future injury prevention research. DESIGN We conducted a literature review of injury prevention and data science in April 2020 and January 2021 in three databases. METHODS For the included 99 articles, we extracted the following: (1) author(s) and year; (2) title; (3) study approach (4) reason for applying data science method; (5) data science method type; (6) study description; (7) data source and (8) focus on a disproportionately affected population. RESULTS Results showed the literature on data science and suicide more than doubled from 2019 to 2020, with articles with individual-level approaches more prevalent than population-level approaches. Most population-level articles applied data science methods to describe (n=10) outcomes, while most individual-level articles identified risk factors (n=27). Machine learning was the most common data science method applied in the studies (n=48). A wide array of data sources was used for suicide research, with most articles (n=45) using social media and web-based behaviour data. Eleven studies demonstrated the value of applying data science to suicide prevention literature for disproportionately affected groups. CONCLUSION Data science techniques proved to be effective tools in describing suicidal thoughts or behaviour, identifying individual risk factors and predicting outcomes. Future research should focus on identifying how data science can be applied in other injury-related topics.
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Affiliation(s)
- Avital Rachelle Wulz
- Oak Ridge Associated Universities (ORAU), Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Royal Law
- Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jing Wang
- Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy Funk Wolkin
- Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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4
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Rowhani-Rahbar A, Haviland MJ, Azrael D, Miller M. Perceptions of firearm-related harm among US adults living in firearm-owning households: a nationally representative study. Inj Prev 2021; 28:86-89. [PMID: 34887332 DOI: 10.1136/injuryprev-2021-044389] [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] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/26/2021] [Indexed: 11/04/2022]
Abstract
Decision-making on having firearms at home may be contingent on perceptions of the likelihood of their negative and positive outcomes. Using data from a nationally representative survey (n=4030) conducted during 30 July 2019 to 11 August 2019, we described how US adults living in firearm-owning households perceived the relative likelihood of firearm-related harm by injury intent ('accidentally harm self or someone else with a gun', 'injure self on purpose with a gun' and 'injure someone else on purpose with a gun') for groups at risk of compromised decision-making (children; adolescents and individuals with mental health issues, substance use disorders or cognitive impairment). We found that US adults living in firearm-owning households believe that unintentional firearm injuries are more likely than intentional self-inflicted or assault-related firearm injuries, despite evidence to the contrary. Prior evidence indicates that communicating risk in relative terms can motivate behaviour change; therefore, findings from this study might helpfully inform health communications around firearm safety.
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Affiliation(s)
- Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington, Seattle, Washington, USA .,Firearm Injury and Policy Research Program, University of Washington, Seattle, Washington, USA
| | - Miriam Joan Haviland
- Firearm Injury and Policy Research Program, University of Washington, Seattle, Washington, USA
| | - Deborah Azrael
- Harvard Injury Control Research Center, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA.,Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
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5
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Abstract
Reducing access to lethal means of self-harm is a cornerstone of suicide prevention, and temporary, voluntary gun storage outside the home is one recommended approach. With the goal of facilitating access to gun storage outside the home in Maryland, we developed an online map of gun shops and law enforcement agencies willing to offer temporary, voluntary gun storage on a case-by-case basis. This project was modelled off of prior work by the Colorado Firearm Safety Coalition. As of July 2020, 32 gun shops and 3 law enforcement agencies agreed to be listed on our map. Others were hesitant to participate due to perceived legal and logistical barriers to temporary firearm storage. We demonstrate the feasibility of creating an online map that lists organisations offering temporary gun storage in Maryland. This brief report details our process, barriers encountered, and future considerations to improve access to offsite gun storage options.
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Affiliation(s)
- Diana M. Bongiorno
- Johns Hopkins Center for Gun Policy and Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric N. Kramer
- Johns Hopkins Center for Gun Policy and Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marisa D. Booty
- Johns Hopkins Center for Gun Policy and Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cassandra K. Crifasi
- Johns Hopkins Center for Gun Policy and Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Abstract
INTRODUCTION There has been little research into at-home suicide cases globally, and particularly in Asian regions. This study aimed to investigate the differences in characteristics between suicide cases in Hong Kong that occurred at home and elsewhere; identify at-home suicide hotspots in the community and compare the differences in area-level characteristics between suicide hotspots and other areas. METHODS Suicide cases (2013-2017) were identified from Hong Kong Coroner's Court reports. Area-level socioeconomic data were retrieved from the 2016 Hong Kong census. Wilcoxon signed-rank tests, χ2 tests and multiple logistic regression models were applied to compare differences in characteristics between people committing suicide at home and elsewhere. Global hotspot tests (Moran's I and Getis-Ord General G) and local analysis (Getis-Ord Gi*) identified at-home suicide community hotspots. The Wilcoxon signed-rank test was used to compare differences in area-level characteristics between at-home suicide hotspots and non-hotspots. RESULTS About 60% of suicide cases in Hong Kong occurred at home. Being female, widowed and/or living alone were significant predictors of at-home suicide cases. A U-shaped association between age and at-home suicide was identified, with 32 years of age being the critical turning point. An at-home suicide hotspot was identified in the north-western region of Hong Kong, which had lower median household income, higher income inequality and higher percentages of households with single elderly people, and new arrivals, compared with other areas. CONCLUSION Suicide prevention should start at home by restricting access to suicide methods. Community-based suicide prevention interventions with improvement of social services should target vulnerable members in identified suicide hotspots.
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Affiliation(s)
- Cheuk Yui Yeung
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Yu Men
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Yu-Chih Chen
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Paul Siu Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR .,Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong SAR
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7
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Yip PSF, Zheng Y, Wong C. Demographic and epidemiological decomposition analysis of global changes in suicide rates and numbers over the period 1990-2019. Inj Prev 2021; 28:117-124. [PMID: 34400542 DOI: 10.1136/injuryprev-2021-044263] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/09/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Suicide presents an ongoing public health challenge internationally. Nearly 800 000 people around the world lose their life to suicide every year, and many more attempt suicide. METHODS A decomposition analysis was performed using global suicide mortality and population data from the Global Burden of Disease Study 2019. RESULTS Despite a significant decrease in age-specific suicide rate between 1990 and 2019 (-4.01; from 13.8% to 9.8% per 100 000), the overall numbers of suicide deaths increased by 19 897 (from 738 799 to 758 696) in the same time period. The reductions in age-specific suicide rates (-6.09; 152%) contributed to the overall reductions in suicide rates; however, this was offset by overtime changes in population age structure (2.08; -52%). The increase in suicide numbers was partly attributable to population growth (300 942; 1512.5%) and population age structure (189 512; 952.4%), which was attenuated by the significant reduction in overall suicide rates (-470 556; 2364.9%). The combined effect of these factors varied across the World Bank income level regions. For example, in the upper-middle-income level region, the effect of the reduction in age-specific suicide rates (-289 731; -1456.1%) exceeded the effect of population age structure (124 577; 626.1%) and population growth (83 855; 421.4%), resulting in its substantial decline in total suicide deaths (-81 298; -408.6%). However, in lower-middle income region, there was a notable increase in suicide death (72 550; 364.6%), which was related to the net gain of the reduction in age-specific suicide rates (-115 577; -580.9%) and negated by the increase in the number of suicide deaths due to population growth (152 093; 764.4%) and population age structure (36 034; 181.1%). CONCLUSION More support and resources should be deployed for suicide prevention to the low-income and middle-income regions in order to achieve the reduction goal. Moreover, suicide prevention among older adults is increasingly critical given the world's rapidly ageing populations in all income level regions.
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Affiliation(s)
- Paul Siu Fai Yip
- HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Yan Zheng
- The School of Nursing, The Hong Kong Polytechnic University, Kowloon, People's Republic of China
| | - Clifford Wong
- Social Work and Social Administration, The University of Hong Kong, Hong Kong, People's Republic of China
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8
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Tessler RA, Haviland MJ, Bowen A, Bowen D, Rivara FP, Rowhani-Rahbar A. Association of state-level intoxicated driving laws with firearm homicide and suicide. Inj Prev 2021; 28:32-37. [PMID: 33687929 DOI: 10.1136/injuryprev-2020-044052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine if an association exists between the number of driving under the influence (DUI) convictions required to activate federal firearms prohibitions and annual firearm homicide and suicide rates by state. METHODS Ecological cross-sectional study of all US states from 2013 to 2017. We collected DUI law data from Thomson Reuters Westlaw database and firearm mortality data from the Centers for Disease Control and Prevention Vital Statistics programme. RESULTS Five states had laws such that one or two DUI convictions could result in prohibitions to firearms access according to federal law. Four states had no legal framework that would restrict firearms access because of DUI convictions; the remaining states could activate federal restrictions at three or more DUI convictions. Firearm-specific homicide (victimisations) rates were 19% lower among women in states where federal restrictions of firearms access occurred after one or two DUI offences (incidence rate ratio (IRR) 0.81; 95% CI 0.64 to 1.01) and 18% lower in states with firearm prohibitions after three or more offences (IRR 0.82; 95% CI 0.71 to 0.95) compared with the states with no legal framework for prohibiting firearms after DUI convictions. There was no association between number of DUI activations and overall, or firearm-specific, suicide among the entire population (men and women) or among only women, or only men. CONCLUSIONS DUI penalties that activate federal firearms prohibitions may be one pathway to reduce firearm homicide of female victims.
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Affiliation(s)
- Robert A Tessler
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA .,The Firearm Injury & Policy Research Program at Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Miriam Joan Haviland
- The Firearm Injury & Policy Research Program at Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Andrew Bowen
- The Firearm Injury & Policy Research Program at Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Deidre Bowen
- The Firearm Injury & Policy Research Program at Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,School of Law, Seattle University, Seattle, Washington, USA
| | - Frederick P Rivara
- The Firearm Injury & Policy Research Program at Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- The Firearm Injury & Policy Research Program at Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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9
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Murata S, Rezeppa T, Thoma B, Marengo L, Krancevich K, Chiyka E, Hayes B, Goodfriend E, Deal M, Zhong Y, Brummit B, Coury T, Riston S, Brent DA, Melhem NM. The psychiatric sequelae of the COVID-19 pandemic in adolescents, adults, and health care workers. Depress Anxiety 2021; 38:233-246. [PMID: 33368805 PMCID: PMC7902409 DOI: 10.1002/da.23120] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [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: 08/19/2020] [Revised: 10/30/2020] [Accepted: 11/21/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic is the most serious global public health crisis since the 1918 influenza pandemic. This study is the first to assess its mental health impact across the lifespan in the United States in adolescents, adults, and health care workers. METHODS We recruited 4909 participants through an online survey advertising on Facebook and Instagram to assess exposure to COVID-19 and psychiatric symptoms from April 27 to July 13. We also recruited through the University of Pittsburgh, University of Pittsburgh Medical Center, and other health care systems around Pittsburgh. The primary outcomes were clinically significant depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms, suicidal ideation or behavior, and grief reactions since COVID-19. RESULTS Adolescents were significantly more likely to report moderate to severe symptoms of depression (55% vs. 29%; χ2 = 122, df = 1; p < .001), anxiety (48% vs. 29%; χ2 = 73; df = 1; p < .001), PTSD (45% vs. 33%; χ2 = 12; df = 1; p < .001), suicidal ideation or behavior (38% vs. 16%; χ2 = 117; df = 1; p < .001), and sleep problems (69% vs. 57%; χ2 = 26; df = 1; p < .001) compared to adults. The rates of intense grief reactions among those who lost someone to COVID-19 was 55%. Loneliness was the most common predictor across outcomes and higher number of hours spent on social media and exposure to media about COVID-19 predicted depression symptoms and suicidal ideation or behavior in adolescents. CONCLUSIONS The COVID-19 pandemic is associated with increased rates of clinically significant psychiatric symptoms. Loneliness could put individuals at increased risk for the onset of psychiatric disorders.
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Affiliation(s)
| | | | - Brian Thoma
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | | | | | | | | | - Meredith Deal
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Tiffany Coury
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Sarah Riston
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Nadine M. Melhem
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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10
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Abstract
Newly released 2019 Youth Risk Behavior Surveillance System data and the Center for Disease Control and Prevention's (CDC)'2019 Youth Risk Behavior Survey Data Summary and Trends Report show that US adolescents continue to suffer from poor mental health and suicidality at alarming rates. These data alone would be cause for concern, but the COVID-19 pandemic has the potential to further erode adolescent mental health, particularly for those whose mental health was poor prior to the pandemic. Given the status of adolescent mental health prior to COVID-19 and the impact of COVID-19, health professionals and schools must partner together now to mitigate potentially deleterious health, mental health and education impacts for children and adolescents.
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Affiliation(s)
- Marci F Hertz
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Cohen Barrios
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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11
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Rockett IRH, Caine ED, Connery HS, Nolte KB. Overcoming the limitations of 'accident' as a manner of death for drug overdose mortality: case for a death certificate checkbox. Inj Prev 2020; 27:375-378. [PMID: 32917742 DOI: 10.1136/injuryprev-2020-043830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 01/21/2023]
Abstract
Collectively, the epidemic increases in the United States of opioid-related deaths and suicides during the first two decades of the 21st century have exposed shortcomings in current forensic and epidemiological approaches for determining and codifying manner of death-a vital function fulfilled by medical examiners, coroners and nosologists-the foundation for the National Violent Death Reporting System (NVDRS), an incident-based surveillance system providing individual-level information on decedent characteristics, manner, cause and circumstances of suicide, homicide and other violent injury deaths. Drug intoxication deaths are generally classified as 'accidents' or unintentional, a fundamental mischaracterisation; most arose from repetitive self-harm behaviours related to substance acquisition and misuse. Moreover, given the burden of affirmative evidence required to determine suicide, many of these 'accidents' likely reflected unrecognised intentional acts-that is, suicides. Addition of a simple checkbox for self-injury mortality on the death certificate would enrich the National Death Index and NVDRS, and in turn, inform prevention and clinical research, and enhance the evaluation of prevention programmes and therapeutic regimens.
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Affiliation(s)
- Ian R H Rockett
- Epidemiology, West Virginia University, Morgantown, West Virginia, USA .,Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric D Caine
- Injury Control Research Center for Suicide Prevention, University of Rochester Medical Center, Rochester, New York, USA.,Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Hilary S Connery
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA.,Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kurt B Nolte
- Pathology and Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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12
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Kohlbeck S, Fumo N, Hargarten S. Systems change for suicide prevention among adolescents: a rural Wisconsin county approach. Inj Prev 2020; 27:131-136. [PMID: 32111725 DOI: 10.1136/injuryprev-2019-043525] [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] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/20/2020] [Accepted: 01/25/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Suicide is the tenth leading cause of death in Wisconsin. Between the years 2012 and 2016, rural counties in Wisconsin had statistically significantly higher rates of suicide than urban counties. Counties in northern and western Wisconsin have some of the highest rates of suicide, with several counties having rates nearly double the state suicide rate for the same time period. STUDY AIM This study investigates the utility of a systems-level, primary prevention suicide prevention strategy in reducing suicide in a rural Wisconsin county. This project focuses upstream to promote behavioural health resiliency and decrease risk factors for suicide. RESULTS County-level suicide rates decreased over time. Youth Risk Behaviour Survey results demonstrate that the percentage of students in the high school who report that they have an adult in the school to turn to for support increased by 11%. In addition, the number of students reporting a suicide attempt over the past 12 months decreased from 8.4% to 7.2%. Trust among project partners remained above 75% across the three survey timepoints, and the results demonstrated that power became more equally dispersed over time. There was an increase in community knowledge in where to go for help in an emotional crisis. DISCUSSION Systems change to prevent suicide is a complex undertaking but can affect change at the county level. In our study county, we learnt that a strong implementation body (our Partnership Council) and buy-in from key partners is essential in creating change at the systems level.
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Affiliation(s)
- Sara Kohlbeck
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nicole Fumo
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stephen Hargarten
- Emergency Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
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13
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Pia T, Galynker I, Schuck A, Sinclair C, Ying G, Calati R. Perfectionism and Prospective Near-Term Suicidal Thoughts and Behaviors: The Mediation of Fear of Humiliation and Suicide Crisis Syndrome. Int J Environ Res Public Health 2020; 17:ijerph17041424. [PMID: 32098414 PMCID: PMC7068323 DOI: 10.3390/ijerph17041424] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 02/07/2020] [Accepted: 02/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Perfectionism has been linked to suicide. According to the Narrative-Crisis Model of suicide, individuals with trait vulnerabilities are prone to develop a certain mindset, known as a Suicidal Narrative, which may precipitate the Suicide Crisis Syndrome (SCS), culminating in suicide. The purpose of this study was to investigate the association between perfectionism (trait vulnerability), fear of humiliation (component of the Suicidal Narrative), SCS, and prospective near-term suicidal thoughts and behaviors (STB). METHODS Adult psychiatric outpatient participants (N = 336) were assessed at baseline with the Suicidal Narrative Inventory for perfectionism and fear of humiliation. The questions used to assess perfectionism were adapted from the Multidimensional Perfectionism Scale. The severity of the SCS was calculated using the Suicide Crisis Inventory. STB were assessed at baseline and after one month using the Columbia Suicide Severity Rating Scale. Serial mediation analyses were conducted using PROCESS version 3.3 in SPSS. RESULTS While the direct effect of perfectionism on prospective STB was not significant (b = 0.01, p = 0.19), the indirect effect of perfectionism on STB, through serial mediation by fear of humiliation and the SCS, was significant (indirect effect p = 0.007, 95% CI [0.003,0.013]). The indirect effect was not significant for models that did not include both mediators. LIMITATIONS Variables were assessed at one time only. CONCLUSION Perfectionism did not directly modulate STB. Perfectionism may be related to suicidal behavior through fear of humiliation, leading to the SCS. These results support the Narrative-Crisis Model of suicide and clarify the role of perfectionism in the etiology of suicide.
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Affiliation(s)
- Tyler Pia
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY 10003, USA; (T.P.); (I.G.); (A.S.); (C.S.); (G.Y.)
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY 10003, USA; (T.P.); (I.G.); (A.S.); (C.S.); (G.Y.)
- Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | - Allison Schuck
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY 10003, USA; (T.P.); (I.G.); (A.S.); (C.S.); (G.Y.)
| | - Courtney Sinclair
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY 10003, USA; (T.P.); (I.G.); (A.S.); (C.S.); (G.Y.)
| | - Gelan Ying
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY 10003, USA; (T.P.); (I.G.); (A.S.); (C.S.); (G.Y.)
| | - Raffaella Calati
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY 10003, USA; (T.P.); (I.G.); (A.S.); (C.S.); (G.Y.)
- Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
- Department of Psychology, University of Milan-Bicocca, 20126 Milan, Italy
- Department of Adult Psychiatry, Nîmes University Hospital, 30029 Nîmes, France
- Correspondence:
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14
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Saade YM, Nicol G, Lenze EJ, Miller JP, Yingling M, Wetherell JL, Reynolds CF, Mulsant BH. Comorbid anxiety in late-life depression: Relationship with remission and suicidal ideation on venlafaxine treatment. Depress Anxiety 2019; 36:1125-1134. [PMID: 31682328 PMCID: PMC6891146 DOI: 10.1002/da.22964] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 03/18/2019] [Revised: 07/14/2019] [Accepted: 09/13/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The purpose of this study was to examine the influence of comorbid anxiety symptoms on antidepressant treatment remission in older adults with major depressive disorder (MDD). METHOD In this multisite clinical trial, 468 older adults aged 60 years or older with MDD received open-label protocolized treatment with venlafaxine extended release (ER) titrated to a maximum of 300 mg daily. At baseline, anxiety was assessed with the Anxiety Sensitivity Index, the Brief Symptom Inventory (BSI) anxiety subscale, and the Penn State Worry Questionnaire. To measure treatment response, depressive symptoms and suicidality were assessed every 1-2 weeks with the Montgomery-Asberg Depression Rating Scale and the 19-item Scale for Suicide Ideation; anxiety was assessed with the BSI. Logistic regression and survival analysis were used to evaluate whether anxiety symptoms predicted depression remission. We also examined the relationships between anxiety scores and suicidality at baseline. RESULTS Baseline anxiety symptoms did not predict remission or time to remission of depressive symptoms. Depressive, worry, and panic symptoms decreased in parallel in patients with high anxiety. Anxiety symptoms were associated with the severity of depression and with suicidality. CONCLUSION In older adults with MDD, comorbid anxiety symptoms are associated with symptom severity but do not affect antidepressant remission or time to remission.
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Affiliation(s)
- Yasmina M Saade
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - Ginger Nicol
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - Eric J Lenze
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - J Philip Miller
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO
| | - Michael Yingling
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - Julie Loebach Wetherell
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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15
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Miranda-Mendizabal A, Castellví P, Alayo I, Vilagut G, Blasco MJ, Torrent A, Ballester L, Almenara J, Lagares C, Roca M, Sesé A, Piqueras JA, Soto-Sanz V, Rodríguez-Marín J, Echeburúa E, Gabilondo A, Cebrià AI, Bruffaerts R, Auerbach RP, Mortier P, Kessler RC, Alonso J. Gender commonalities and differences in risk and protective factors of suicidal thoughts and behaviors: A cross-sectional study of Spanish university students. Depress Anxiety 2019; 36:1102-1114. [PMID: 31609064 DOI: 10.1002/da.22960] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 04/29/2019] [Revised: 08/12/2019] [Accepted: 09/07/2019] [Indexed: 11/07/2022] Open
Abstract
AIM To assess gender differences in the association between risk/protective factors and suicidal thoughts and behaviors (STB); and whether there is any gender-interaction with those factors and STB; among Spanish university students. METHODS Data from baseline online survey of UNIVERSAL project, a multicenter, observational study of first-year Spanish university students (18-24 years). We assessed STB; lifetime and 12-month negative life-events and family adversities; mental disorders; personal and community factors. Gender-specific regression models and gender-interactions were also analyzed. RESULTS We included 2,105 students, 55.4% women. Twelve-month prevalence of suicidal ideation (SI) was 10%, plans 5.7%, attempts 0.6%. Statistically significant gender-interactions were found for lifetime anxiety disorder, hopelessness, violence between parents, chronic health conditions and family support. Lifetime mood disorder was a common risk factor of SI for both genders (Females: OR= 5.5; 95%CI 3.3-9.3; Males: OR= 4.4; 95%CI 2.0-9.7). For females, exposure to violence between parents (OR= 3.5; 95%CI 1.7-7.2), anxiety disorder (OR= 2.7; 95%CI 1.6-4.6), and alcohol/substance disorder (OR= 2.1; 95%CI 1.1-4.3); and for males, physical childhood maltreatment (OR= 3.6; 95%CI 1.4-9.2), deceased parents (OR= 4.6; 95%CI 1.2-17.7), and hopelessness (OR= 7.7; 95%CI 2.8-21.2), increased SI risk. Family support (OR= 0.5; 95%CI 0.2-0.9) and peers/others support (OR= 0.4; 95%CI 0.2-0.8) were associated to a lower SI risk only among females. CONCLUSIONS Only mood disorder was a common risk factor of SI for both genders, whereas important gender-differences were observed regarding the other factors assessed. The protective effect from family and peers/others support was observed only among females. Further research assessing underlying mechanisms and pathways of gender-differences is needed.
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Affiliation(s)
- Andrea Miranda-Mendizabal
- Health Services Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.,Department of Health & Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Pere Castellví
- Department of Psychology, University of Jaén, Jaén, Spain
| | - Itxaso Alayo
- Health Services Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.,Program 6: Health Services Evaluation, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Gemma Vilagut
- Health Services Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.,Program 6: Health Services Evaluation, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria Jesús Blasco
- Health Services Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.,Program 6: Health Services Evaluation, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Aina Torrent
- Health and Life Sciences Faculty, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Laura Ballester
- Health Services Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.,Program 6: Health Services Evaluation, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Psychology, Girona University (UdG), Girona, Spain
| | - José Almenara
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz (UCA), Cádiz, Spain
| | - Carolina Lagares
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz (UCA), Cádiz, Spain
| | - Miquel Roca
- Department of Psychology, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands (UIB), Palma de Mallorca, Spain
| | - Albert Sesé
- Department of Psychology, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands (UIB), Palma de Mallorca, Spain
| | - José Antonio Piqueras
- Department of Health Psychology, Miguel Hernandez University of Elche (UMH), Alicante, Spain
| | - Victoria Soto-Sanz
- Department of Health Psychology, Miguel Hernandez University of Elche (UMH), Alicante, Spain
| | - Jesús Rodríguez-Marín
- Department of Health Psychology, Miguel Hernandez University of Elche (UMH), Alicante, Spain
| | - Enrique Echeburúa
- Department of Personality, Psychological Evaluation and Treatment, University of the Basque Country (UPV-EHU), Bilbao, Spain
| | - Andrea Gabilondo
- Department of Mental Health and Psychiatric Care, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, Biodonosti Health Research Institute, San Sebastian, Spain
| | - Ana Isabel Cebrià
- Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell, Spain
| | - Ronny Bruffaerts
- Department of Psychiatry, Universitair Psychiatrisch Centrum, KU Leuven (UPC-KUL), Leuven, Belgium
| | - Randy P Auerbach
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Department of Child and Adolescent Psychiatry, Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts
| | - Philippe Mortier
- Health Services Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Jordi Alonso
- Health Services Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.,Department of Health & Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain.,Program 6: Health Services Evaluation, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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16
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Ebert DD, Buntrock C, Mortier P, Auerbach R, Weisel KK, Kessler RC, Cuijpers P, Green JG, Kiekens G, Nock MK, Demyttenaere K, Bruffaerts R. Prediction of major depressive disorder onset in college students. Depress Anxiety 2019; 36:294-304. [PMID: 30521136 PMCID: PMC6519292 DOI: 10.1002/da.22867] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/16/2018] [Accepted: 08/19/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) in college students is associated with substantial burden. AIMS To assess 1-year incidence of MDD among incoming freshmen and predictors of MDD-incidence in a representative sample of students. METHOD Prospective cohort study of first-year college students (baseline: n = 2,519, 1-year follow-up: n = 958) RESULTS: The incidence of MDD within the first year of college was 6.9% (SE = 0.8). The most important individual-level predictors of onset were prior suicide plans and/or attempts (OR = 9.5). The strongest population-level baseline predictors were history of childhood-adolescent trauma, stressful experience in the past 12 months, parental psychopathology, and other 12-month mental disorder. Multivariate cross-validated prediction (cross-validated AUC = 0.73) suggest that 36.1% of incident MDD cases in a replication sample would occur among the 10% of students at highest predicted risk (24.5% predicted incidence in this highest-risk subgroup). CONCLUSIONS Screening at college entrance is a promising strategy to identify students at risk of MDD onset, which may improve the development and deployment of targeted preventive interventions.
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Affiliation(s)
- David D. Ebert
- Department of Clinical Psychology and PsychotherapyFriedrich–Alexander University Erlangen–NüurembergErlangenGermany
| | - Claudia Buntrock
- Department of Clinical Psychology and PsychotherapyFriedrich–Alexander University Erlangen–NüurembergErlangenGermany
| | - Philippe Mortier
- Department of NeurosciencesUniversitair Psychiatrisch Centrum KU LeuvenBelgium
| | - Randy Auerbach
- Department of PsychiatryHarvard Medical SchoolBostonMAUSA
- Center for Depression, Anxiety and Stress Research, McLean HospitalBelmontMAUSA
| | - Kiona K. Weisel
- Department of Clinical Psychology and PsychotherapyFriedrich–Alexander University Erlangen–NüurembergErlangenGermany
| | | | - Pim Cuijpers
- EMGO Institute for Health and Care Research, VU University AmsterdamAmsterdamthe Netherlands
| | | | - Glenn Kiekens
- Department of NeurosciencesUniversitair Psychiatrisch Centrum KU LeuvenBelgium
| | | | - Koen Demyttenaere
- Department of PsychiatryHarvard Medical SchoolBostonMAUSA
- Center for Depression, Anxiety and Stress Research, McLean HospitalBelmontMAUSA
| | - Ronny Bruffaerts
- Department of PsychiatryHarvard Medical SchoolBostonMAUSA
- Center for Depression, Anxiety and Stress Research, McLean HospitalBelmontMAUSA
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17
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Berrigan J, Azrael D, Hemenway D, Miller M. Firearms training and storage practices among US gun owners: a nationally representative study. Inj Prev 2019; 25:i31-i38. [PMID: 30878975 DOI: 10.1136/injuryprev-2018-043126] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/11/2019] [Accepted: 02/15/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To describe firearm storage practices among US adults and examine the relationship between having received formal firearms training and firearm storage. METHODS In 2015 we asked a nationally representative online sample of 2072 gun owners how they stored household firearms, their reasons for owning guns, the number and types owned, had they carried a loaded handgun in the prior month and whether they had formal firearms training (and if so, whether training covered suicide prevention, accident prevention, firearm theft prevention, safe handling and safe storage). Unadjusted associations between gun owner characteristics and storage practices were estimated using Pearson's χ2 tests; adjusted associations used multivariate logistic regressions. Final survey weights that combined presample and study-specific poststratification weights account for oversampling of firearm owners and survey non-response. RESULTS 29.7% (95% CI 27.4% to 32.1%) stored ≥1 firearm loaded and unlocked. Of the 61.4% (95% CI 58.9% to 63.9%) of gun owners with firearms training, 32.3% (95% CI 29.4% to 35.3%) stored ≥1 firearm loaded and unlocked, compared with 25.8% (95% CI 22.3% to 29.7%) of those without training. Storage did not differ by training component, age, sex or race. However, firearms were more likely stored loaded and unlocked when respondents owned for protection, owned >1 firearm, owned handguns or carried a loaded gun. After adjusting for firearm-related characteristics, firearms training was not associated with storing firearms loaded and unlocked (adjusted OR=1.11, 95% Cl 0.80 to 1.53). CONCLUSION Firearms training, as currently provided, is unlikely to reduce unsafe firearm storage.
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Affiliation(s)
- John Berrigan
- Harvard Injury Control Research Center, Boston, Massachusetts, USA
| | - Deborah Azrael
- Harvard Injury Control Research Center, Boston, Massachusetts, USA
| | - David Hemenway
- Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Matthew Miller
- Department of Health Science, Northeastern University, Boston, Massachusetts, USA
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18
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Hawes M, Galynker I, Barzilay S, Yaseen ZS. Anhedonia and suicidal thoughts and behaviors in psychiatric outpatients: The role of acuity. Depress Anxiety 2018; 35:1218-1227. [PMID: 30107636 DOI: 10.1002/da.22814] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 03/27/2018] [Revised: 06/16/2018] [Accepted: 07/01/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Anhedonia-impairment related to the experience of pleasure-has been identified as a potential risk factor for suicide, with some mixed findings. The current study sought to clarify the role of acuity of anhedonia in the relationship between anhedonia and suicidal thoughts and behaviors by comparing acutely and chronically anhedonic subjects on severity of suicidal ideation (SI) and suicide attempt (SA) history. METHODS Psychiatric outpatients (N = 395) were administered the Columbia Suicide Severity Rating Scale, the Beck Scale for Suicidal Ideation and a modified version of the Snaith-Hamilton Pleasure Scale (SHPS); SI measures were readministered at a 1-month follow-up (N = 289, 73%). Participants were classified as acutely anhedonic, chronically anhedonic and nonanhedonic based on their responses to the SHPS at initial assessment. RESULTS Controlling for symptoms of anxiety and depression, acute anhedonia was cross-sectionally and prospectively associated with greater severity of SI compared to the nonanhedonic group; no differences in severity of SI were found between the chronically anhedonic and nonanhedonic group at either time point. Anhedonia grouping was not associated with SA history. CONCLUSION Changes in capacity to experience pleasure may be more informative of near-term SI than typically low pleasure levels. Future investigation should focus on the relationship between acute anhedonia and imminent suicidal behavior.
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Affiliation(s)
- Mariah Hawes
- Department of Psychiatry, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Shira Barzilay
- Department of Psychiatry, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Zimri S Yaseen
- Department of Psychiatry, Mount Sinai Beth Israel Medical Center, New York, New York
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19
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Lachaud J, Donnelly P, Henry D, Kornas K, Fitzpatrick T, Calzavara A, Bornbaum C, Rosella L. Characterising violent deaths of undetermined intent: a population-based study, 1999-2012. Inj Prev 2018; 24:424-430. [PMID: 28986429 PMCID: PMC6287566 DOI: 10.1136/injuryprev-2017-042376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 02/15/2017] [Revised: 08/15/2017] [Accepted: 08/30/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Violent deaths classified as undetermined intent (UD) are sometimes included in suicide counts. This study investigated age and sex differences, along with socioeconomic gradients in UD and suicide deaths in the province of Ontario between 1999 and 2012. METHODS We used data from the Institute for Clinical Evaluative Sciences, which has linked vital statistics from the Office of the Registrar General Deaths register with Census data between 1999 and 2012. Socioeconomic status was operationalised through the four dimensions of the Ontario Marginalization Index. We computed age-specific and annual age-standardised mortality rates, and risk ratios to calculate risk gradients according to each of the four dimensions of marginalization. RESULTS Rates of UD-classified deaths were highest for men aged 45-64 years residing in the most materially deprived (7.9 per 100 000 population (95% CI 6.8 to 9.0)) and residentially unstable (8.1 (95% CI 7.1 to 9.1)) neighbourhoods. Similarly, suicide rates were highest among these same groups of men aged 45-64 living in the most materially deprived (28.2 (95% CI 26.1 to 30.3)) and residentially unstable (30.7 (95% CI 28.7 to 32.6)) neighbourhoods. Relative to methods of death, poisoning was the most frequently used method in UD cases (64%), while it represented the second most common method (27%) among suicides after hanging (40%). DISCUSSION The similarities observed between both causes of death suggest that at least a proportion of UD deaths may be misclassified suicide cases. However, the discrepancies identified in this analysis seem to indicate that not all UD deaths are misclassified suicides.
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Affiliation(s)
- James Lachaud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - David Henry
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tiffany Fitzpatrick
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Calzavara
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Catherine Bornbaum
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Health and Rehabilitation Sciences, Western University, Toronto, Ontario, Canada
| | - Laura Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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20
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McClure JR, Tal I, Macera CA, Ji M, Nievergelt CM, Lee SY, Kayman J, Zisook S. Agreement between self and psychiatrist reporting of suicidal ideation at a Veterans Administration psychiatric emergency clinic. Depress Anxiety 2018; 35:1114-1121. [PMID: 30102445 DOI: 10.1002/da.22813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/09/2017] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND With suicide rising in the United States, identifying and preventing suicides is increasingly important. To provide a valuable step toward achieving effective suicide risk assessment, this study examines the agreement between self-report measures and psychiatrist documentation of suicidal ideation and behaviors (SI) at a Veterans Administration (VA) psychiatric emergency clinic. METHODS A total of 377 veterans presenting at a VA psychiatric emergency clinic completed a self-report survey on SI and other acute risk factors for suicidal behavior. We examined agreement between veterans' self-reported SI and psychiatrists' clinical notes regarding SI. RESULTS A total of 199 veterans (53%) self-reported SI; 80 psychiatrist notes (21%) indicated SI. Psychiatrists and veterans differed in 44% (164/377) of cases. Among the discordant cases, the veterans' self-report was more severe than the psychiatrists' in 97% of cases. Of the 120 veterans with SI and documented as having no SI by psychiatrists, 31 (26%) reported having a suicide plan and 18 (15%) plan preparations. Findings were similar when controlling for presenting problem, current depression, presence of a standardized suicide risk assessment, psychiatrist training level, past suicide attempt, homelessness, diagnosis of personality, or substance use disorder. CONCLUSIONS Agreement between veterans' self-reports and psychiatrists' documentation of SI was generally low, with veterans self-reporting SI significantly more often than psychiatrists documented SI in their clinical notes. This suggests that inclusion of a self-report questionnaire provides an additional source of data to complement information gleaned from the clinical interview for a more comprehensive risk assessment, but only if actually examined by the clinician.
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Affiliation(s)
- Janet R McClure
- Department of Research, VA San Diego Healthcare System, San Diego, California
| | - Ilanit Tal
- Department of Research, VA San Diego Healthcare System, San Diego, California
| | - Caroline A Macera
- School of Public Health, San Diego State University, San Diego, California.,Department of Medicine, University of California, San Diego, California
| | - Ming Ji
- College of Nursing, University of South Florida, Tampa, Florida
| | - Caroline M Nievergelt
- Department of Research, VA San Diego Healthcare System, San Diego, California.,Department of Psychiatry, University of California, San Diego, California
| | - Soo Yong Lee
- Department of Psychiatry, University of California, San Diego, California
| | | | - Sidney Zisook
- Department of Research, VA San Diego Healthcare System, San Diego, California.,Department of Medicine, University of California, San Diego, California.,Department of Psychiatry, University of California, San Diego, California.,Department of Psychiatry, VA San Diego Healthcare System, San Diego, California
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21
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Min JY, Min KB. Night noise exposure and risk of death by suicide in adults living in metropolitan areas. Depress Anxiety 2018; 35:876-883. [PMID: 29953702 DOI: 10.1002/da.22789] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 10/15/2017] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Noise is defined as "sound that is unwanted, unpleasant, or harmful to health." It may induce negative emotions and mental health problems and even may leads to increased suicide risk. Little attention has been paid so far to a potential link between noise and suicide. We investigated the association between nighttime environmental noise and suicide death in adults in the Republic of Korea. METHODS We analyzed the data from the National Health Insurance Service-National Sample Cohort, with a 4-year baseline (2002-2005) and an 8-year follow-up (2006-2013) assessment. A total of 155,492 adults constituted the study sample: younger adults (20-54 years, n = 124,994), or older adults (≥55 years, n = 30,498), and adults with mood and anxiety disorders (n = 34,615). Suicide death was defined as per International Classification of Diseases-10 code X60-X84. Data on nighttime noise were obtained from the National Noise Information System. RESULTS During the study period, 315 (0.2%) died of suicide. The incidence of suicide per 100,000 person-years was 25.71. With interquartile range increases in nighttime noise, the adjusted hazard ratio (HR) for suicide death was significantly increased: 1.32 (95% confidence interval [CI]: 1.02-1.70) for younger adults, 1.43 (95% CI: 1.01-2.02) for older adults, and 1.55 (95% CI: 1.10-2.19) for adults with mental illness. In the penalized regression spline models, the HRs for suicide death were gradually increased with environmental noise levels, and the risk was the highest for adults with mental illness. CONCLUSIONS We found a significant association between exposure to nighttime noise and the risk of suicide death in adults in the Republic of Korea.
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Affiliation(s)
- Jin-Young Min
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Kyoung-Bok Min
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
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22
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Alonso J, Mortier P, Auerbach RP, Bruffaerts R, Vilagut G, Cuijpers P, Demyttenaere K, Ebert DD, Ennis E, Gutiérrez-García RA, Green JG, Hasking P, Lochner C, Nock MK, Pinder-Amaker S, Sampson NA, Zaslavsky AM, Kessler RC. Severe role impairment associated with mental disorders: Results of the WHO World Mental Health Surveys International College Student Project. Depress Anxiety 2018; 35:802-814. [PMID: 29847006 PMCID: PMC6123270 DOI: 10.1002/da.22778] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [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: 12/29/2017] [Revised: 04/25/2018] [Accepted: 05/12/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND College entrance is a stressful period with a high prevalence of mental disorders. AIMS To assess the role impairment associated with 12-month mental disorders among incoming first-year college students within a large cross-national sample. METHODS Web-based self-report surveys assessing the prevalence of DSM-IV mental disorders and health-related role impairment (Sheehan Disability Scale) were obtained and analyzed from 13,984 incoming first-year college students (Response = 45.5%), across 19 universities in eight countries. Impairment was assessed in the following domains: home management, work (e.g., college-related problems), close personal relationships, and social life. RESULTS Mean age of the sample was 19.3 (SD = 0.59) and 54.4% were female. Findings showed that 20.4% of students reported any severe role impairment (10% of those without a mental disorder vs. 42.9% of those with at least one disorder, P < 0.01). In bivariate analyses, panic disorder, and mania were associated most frequently with severe impairment (60.6% and 57.5%, respectively). Students reporting three or more mental disorders had almost fivefold more frequently severe impairment relative to those without mental disorders. Multiple logistic regression showed that major depression (OR = 4.0; 95%CI = 3.3, 4.8), generalized anxiety (OR = 3.9; 95%CI = 3.1, 4.8), and panic disorder (OR = 2.9; 95%CI 2.4, 4.2) were associated with the highest odds of severe impairment. Only minimal deviations from these overall associations were found across countries. CONCLUSION Mental disorders among first-year college students are associated with substantial role impairment. Providing preventative interventions targeting mental disorders and associated impairments is a critical need for institutions to address.
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Affiliation(s)
- Jordi Alonso
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Philippe Mortier
- Universitair Psychiatrisch Centrum-Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Randy P Auerbach
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum-Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Gemma Vilagut
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Koen Demyttenaere
- Universitair Psychiatrisch Centrum-Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - David D Ebert
- Department for Psychology, Clinical Psychology and Psychotherapy Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany
| | - Edel Ennis
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | | | | | - Penelope Hasking
- School of Psychology & Speech Pathology, Curtin University, Perth, Australia
| | - Christine Lochner
- SAMRC/UCT/SU Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Stephanie Pinder-Amaker
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Miguel EM, Chou T, Golik A, Cornacchio D, Sanchez AL, DeSerisy M, Comer JS. Examining the scope and patterns of deliberate self-injurious cutting content in popular social media. Depress Anxiety 2017; 34:786-793. [PMID: 28661053 DOI: 10.1002/da.22668] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 12/13/2016] [Revised: 06/05/2017] [Accepted: 06/08/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Social networking services (SNS) have rapidly become a central platform for adolescents' social interactions and media consumption patterns. The present study examined a representative sample of publicly accessible content related to deliberate self-injurious cutting across three SNS platforms: Twitter, Tumblr, and Instagram. METHODS Data collection simulated searches for publicly available deliberate self-injury content on Twitter, Tumblr, and Instagram. Over a six-month period at randomly generated time points, data were obtained by searching "#cutting" on each SNS platform and collecting the first 10 posts generated. Independent evaluators coded posts for presence of the following: (a) graphic content, (b) negative self-evaluations, (c) references to mental health terms, (d) discouragement of deliberate self-injury, and (e) recovery-oriented resources. Differences across platforms were examined. RESULTS Data collection yielded a sample of 1,155 public posts (770 of which were related to mental health). Roughly 60% of sampled posts depicted graphic content, almost half included negative self-evaluations, only 9.5% discouraged self-injury, and <1% included formal recovery resources. Instagram posts displayed the greatest proportion of graphic content and negative self-evaluations, whereas Twitter exhibited the smallest proportion of each. CONCLUSIONS Findings characterize the graphic nature of online SNS deliberate self-injury content and the relative absence of SNS-posted resources for populations seeking out deliberate self-injurious cutting content. Mental health professionals must recognize the rapidly changing landscape of adolescent media consumption, influences, and social interaction as they may pertain to self-harm patterns.
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Affiliation(s)
- Elizabeth M Miguel
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami, FL, USA
| | - Tommy Chou
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami, FL, USA
| | - Alejandra Golik
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami, FL, USA
| | - Danielle Cornacchio
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami, FL, USA
| | - Amanda L Sanchez
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami, FL, USA
| | - Mariah DeSerisy
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Jonathan S Comer
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami, FL, USA
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24
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Galynker I, Yaseen ZS, Cohen A, Benhamou O, Hawes M, Briggs J. Prediction of suicidal behavior in high risk psychiatric patients using an assessment of acute suicidal state: The suicide crisis inventory. Depress Anxiety 2017; 34:147-158. [PMID: 27712028 DOI: 10.1002/da.22559] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [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: 06/08/2016] [Revised: 08/24/2016] [Accepted: 09/04/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We have developed the Suicide Crisis Inventory (SCI) to evaluate the intensity of the Suicidal Crisis Syndrome, an acute state hypothesized to precede suicide attempt. The psychometric properties of the SCI, including predictive validity for suicidal behavior (SB), were assessed. METHODS Adult psychiatric patients (n = 201) hospitalized for high suicide risk were assessed. Logistic regression models assessed the SCI's predictive validity for SB in the 4-8 weeks following hospital discharge and its incremental predictive validity over traditional risk factors (n = 137, 64% f/u rate). Internal structure, reliability, convergent and discriminant validity, and state versus trait properties were also assessed. RESULTS The SCI had excellent internal consistency (Cronbach's α 0.970). The SCI total score at discharge predicted short-term SB with 64% sensitivity 88% specificity (OR = 13, P = .003) at its optimal cut score. In a test of its incremental predictive validity, SCI total score at discharge improved prediction of SB over traditional risk factors (Chi-squared 5.597, P = .024, model P = .001), with AOR 2.02 (P = .030). The SCI admission versus discharge test-retest reliability and score distributions showed it to be an acute state measure. CONCLUSION The SCI was predictive of future SB in high-risk psychiatric inpatients during the crucial weeks following their hospital discharge. Further validation in diverse patient populations is needed.
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Affiliation(s)
- Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Zimri S Yaseen
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Abigail Cohen
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Ori Benhamou
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Mariah Hawes
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Jessica Briggs
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
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25
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Hébert M, Cénat JM, Blais M, Lavoie F, Guerrier M. CHILD SEXUAL ABUSE, BULLYING, CYBERBULLYING, AND MENTAL HEALTH PROBLEMS AMONG HIGH SCHOOLS STUDENTS: A MODERATED MEDIATED MODEL. Depress Anxiety 2016; 33:623-9. [PMID: 27037519 PMCID: PMC5587202 DOI: 10.1002/da.22504] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [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: 10/30/2015] [Revised: 03/09/2016] [Accepted: 03/12/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Child sexual abuse is associated with adverse outcomes, including heightened vulnerability that may translate into risk of revictimization. The aims of the study were: (1) to explore the direct and indirect links between child sexual abuse and cyberbullying, bullying, and mental health problems and (2) to study maternal support as a potential protective factor. METHODS Teenagers involved in the two first waves of the Quebec Youths' Romantic Relationships Survey (N = 8,194 and 6,780 at Wave I and II, respectively) completed measures assessing child sexual abuse and maternal support at Wave I. Cyberbullying, bullying, and mental health problems (self-esteem, psychological distress, and suicidal ideations) were evaluated 6 months later. RESULTS Rates of cyberbullying in the past 6 months were twice as high in sexually abused teens compared to nonvictims both for girls (33.47 vs. 17.75%) and boys (29.62 vs. 13.29%). A moderated mediated model revealed a partial mediation effect of cyberbullying and bullying in the link between child sexual abuse and mental health. Maternal support acted as a protective factor as the conditional indirect effects of child sexual abuse on mental health via cyberbullying and bullying were reduced in cases of high maternal support. CONCLUSIONS Results have significant relevance for prevention and intervention in highlighting the heightened vulnerability of victims of child sexual abuse to experience both bullying and cyberbullying. Maternal support may buffer the risk of developing mental health distress, suggesting that intervention programs for victimized youth may profit by fostering parent involvement.
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Affiliation(s)
- Martine Hébert
- Département de sexologie, Université du Québec à Montréal, Montréal, Canada
| | - Jude Mary Cénat
- Département de sexologie, Université du Québec à Montréal, Montréal, Canada
| | - Martin Blais
- Département de sexologie, Université du Québec à Montréal, Montréal, Canada
| | | | - Mireille Guerrier
- Département de sexologie, Université du Québec à Montréal, Montréal, Canada
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26
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Betz ME, Miller M, Barber C, Beaty B, Miller I, Camargo CA, Boudreaux ED. LETHAL MEANS ACCESS AND ASSESSMENT AMONG SUICIDAL EMERGENCY DEPARTMENT PATIENTS. Depress Anxiety 2016; 33:502-11. [PMID: 26989850 PMCID: PMC4800489 DOI: 10.1002/da.22486] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [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: 12/15/2015] [Revised: 02/12/2016] [Accepted: 02/22/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Reducing access to lethal means (especially firearms) might prevent suicide, but counseling of at-risk individuals about this strategy may not be routine. Among emergency department (ED) patients with suicidal ideation or attempts (SI/SA), we sought to describe home firearm access and examine ED provider assessment of access to lethal means. METHODS This secondary analysis used data from the Emergency Department Safety Assessment and Follow-up Evaluation, a three-phase, eight-center study of adult ED patients with SI/SA (2010-2013). Research staff surveyed participants about suicide-related factors (including home firearms) and later reviewed the ED chart (including documented assessment of lethal means access). RESULTS Among 1,358 patients with SI/SA, 11% (95% CI: 10-13%) reported ≥1 firearm at home; rates varied across sites (range: 6-26%) but not over time. On chart review, 50% (95% CI: 47-52%) of patients had documentation of lethal means access assessment. Frequency of documented assessment increased over study phases (40-60%, P < .001) but was not associated with state firearm ownership rates. Among the 337 (25%, 95% CI: 23-27%) patients discharged to home, 55% (95% CI: 49-60%) had no documentation of lethal means assessment; of these, 13% (95% CI: 8-19%; n = 24) actually had ≥1 firearm at home. Among all those reporting ≥1 home firearm to study staff, only half (50%, 95% CI: 42-59%) had provider documentation of assessment of lethal means access. CONCLUSIONS Among these ED patients with SI/SA, many did not have documented assessment of home access to lethal means, including patients who were discharged home and had ≥1 firearm at home.
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Affiliation(s)
- Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine; Aurora, CO
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA
| | - Catherine Barber
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA
| | - Brenda Beaty
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Edwin D. Boudreaux
- Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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27
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Yin H, Galfalvy H, Pantazatos SP, Huang YY, Rosoklija GB, Dwork AJ, Burke A, Arango V, Oquendo MA, Mann JJ. GLUCOCORTICOID RECEPTOR-RELATED GENES: GENOTYPE AND BRAIN GENE EXPRESSION RELATIONSHIPS TO SUICIDE AND MAJOR DEPRESSIVE DISORDER. Depress Anxiety 2016; 33:531-540. [PMID: 27030168 PMCID: PMC4889464 DOI: 10.1002/da.22499] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 09/16/2015] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION We tested the relationship between genotype, gene expression and suicidal behavior and major depressive disorder (MDD) in live subjects and postmortem samples for three genes, associated with the hypothalamic-pituitary-adrenal axis, suicidal behavior, and MDD; FK506-binding protein 5 (FKBP5), Spindle and kinetochore-associated protein 2 (SKA2), and Glucocorticoid Receptor (NR3C1). MATERIALS AND METHODS Single-nucleotide polymorphisms (SNPs) and haplotypes were tested for association with suicidal behavior and MDD in a live (N = 277) and a postmortem sample (N = 209). RNA-seq was used to examine gene and isoform-level brain expression postmortem (Brodmann Area 9; N = 59). Expression quantitative trait loci (eQTL) relationships were examined using a public database (UK Brain Expression Consortium). RESULTS We identified a haplotype within the FKBP5 gene, present in 47% of the live subjects, which was associated with increased risk of suicide attempt (OR = 1.58, t = 6.03, P = .014). Six SNPs on this gene, three SNPs on SKA2, and one near NR3C1 showed before-adjustment association with attempted suicide, and two SNPs of SKA2 with suicide death, but none stayed significant after adjustment for multiple testing. Only the SKA2 SNPs were related to expression in the prefrontal cortex (pFCTX). One NR3C1 transcript had lower expression in suicide relative to nonsuicide sudden death cases (b = -0.48, SE = 0.12, t = -4.02, adjusted P = .004). CONCLUSION We have identified an association of FKBP5 haplotype with risk of suicide attempt and found an association between suicide and altered NR3C1 gene expression in the pFCTX. Our findings further implicate hypothalamic pituitary axis dysfunction in suicidal behavior.
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Affiliation(s)
- Honglei Yin
- now at Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, New York
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University, New York
,Department of Biostatistics, Columbia University
| | | | - Yung-yu Huang
- Department of Psychiatry, Columbia University, New York
,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, New York
| | - Gorazd B. Rosoklija
- Department of Psychiatry, Columbia University, New York
,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, New York
| | | | - Ainsley Burke
- Department of Psychiatry, Columbia University, New York
| | - Victoria Arango
- Department of Psychiatry, Columbia University, New York
,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, New York
| | | | - J. John Mann
- Department of Psychiatry, Columbia University, New York
,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, New York
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Stange JP, Kleiman EM, Sylvia LG, Vieira da SilvaMagalhães P, Berk M, Nierenberg AA, Deckersbach T. SPECIFIC MOOD SYMPTOMS CONFER RISK FOR SUBSEQUENT SUICIDAL IDEATION IN BIPOLAR DISORDER WITH AND WITHOUT SUICIDE ATTEMPT HISTORY: MULTI-WAVE DATA FROM STEP-BD. Depress Anxiety 2016; 33:464-72. [PMID: 26756163 PMCID: PMC4889534 DOI: 10.1002/da.22464] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 09/10/2015] [Revised: 12/04/2015] [Accepted: 12/12/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Little is known about specific mood symptoms that may confer risk for suicidal ideation (SI) among patients with bipolar disorder (BD). We evaluated prospectively whether particular symptoms of depression and mania precede the onset or worsening of SI, among adults with or without a history of a suicide attempt. METHODS We examined prospective data from a large (N = 2,741) cohort of patients participating in the Systematic Treatment Enhancement Program for BD (STEP-BD). We evaluated history of suicide attempts at baseline, and symptoms of depression and mania at baseline and follow-up visits. Hierarchical linear modeling tested whether specific mood symptoms predicted subsequent levels of SI, and whether the strength of the associations differed based on suicide attempt history, after accounting for the influence of other mood symptoms and current SI. RESULTS Beyond overall current depression and mania symptom severity, baseline SI, and illness characteristics, several mood symptoms, including guilt, reduced self-esteem, psychomotor retardation and agitation, increases in appetite, and distractibility predicted more severe levels of subsequent SI. Problems with concentration, distraction, sleep loss and decreased need for sleep predicted subsequent SI more strongly among individuals with a suicide attempt history. CONCLUSIONS Several specific mood symptoms may confer risk for the onset or worsening of SI among treatment-seeking patients with BD. Individuals with a previous suicide attempt may be at greater risk in part due to greater reactivity to certain mood symptoms in the form of SI. However, overall, effect sizes were small, suggesting the need to identify additional proximal predictors of SI.
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Affiliation(s)
- Jonathan P. Stange
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Evan M. Kleiman
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Louisa G. Sylvia
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Pedro Vieira da SilvaMagalhães
- National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia,Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia
| | - Andrew A. Nierenberg
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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29
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Kline A, Weiner MD, Interian A, Shcherbakov A, St Hill L. MORBID THOUGHTS AND SUICIDAL IDEATION IN IRAQ WAR VETERANS: THE ROLE OF DIRECT AND INDIRECT KILLING IN COMBAT. Depress Anxiety 2016; 33:473-82. [PMID: 27030031 DOI: 10.1002/da.22496] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 10/20/2015] [Revised: 02/17/2016] [Accepted: 02/20/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although research has identified numerous risk factors for military suicide, the contribution of combat exposure to suicide risk has not been clearly established. Previous studies finding no association of suicidality with combat exposure have employed overgeneral measures of exposure, which do not differentiate among the varieties of combat experiences. This study disaggregated the forms of combat exposure to assess the contribution of combat-related killing to morbid thoughts and suicidal ideation (MTSI) in National Guard troops deployed to Iraq. METHODS We conducted parallel analyses of two related samples: a cross-sectional sample (n = 1,665) having postdeployment interview data only and a longitudinal subsample (n = 922) having pre- and postdeployment data. We used multiple logistic regression to examine the role of killing-related exposures, after controlling for general combat and other suicide risks, and examined interactions between killing and other suicide vulnerability factors. RESULTS Killing-related exposure approximately doubled the risk of MTSI in the cross-sectional multivariate model (Adjusted Odds Ratio [AOR] = 1.87; CI = 1.26-2.78) and the longitudinal model (AOR = 2.02; CI = 1.06-3.85), which also controlled for predeployment risks. Killing exposures further increased the MTSI risk associated with other suicide vulnerability factors, including depression (AOR = 14.89 for depression and killing vs. AOR = 9.92 for depression alone), alcohol dependence (AOR = 5.63 for alcohol and killing vs. 1.91 for alcohol alone), and readjustment stress (AOR = 4.90 for stress and killing vs. 1.48 for stress alone). General combat exposure had no comparable effects. CONCLUSIONS The findings underscore a need for assessment and treatment protocols that address the psychological effects of killing-related and other potentially "morally injurious" experiences among combat soldiers.
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Affiliation(s)
- Anna Kline
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey.,Veterans Administration, New Jersey Health Care System, Lyons, New Jersey
| | - Marc D Weiner
- Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, New Jersey
| | - Alejandro Interian
- Veterans Administration, New Jersey Health Care System, Lyons, New Jersey
| | - Anton Shcherbakov
- Veterans Administration, New Jersey Health Care System, Lyons, New Jersey
| | - Lauren St Hill
- Veterans Administration, New Jersey Health Care System, Lyons, New Jersey
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30
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van Loo HM, Cai T, Gruber MJ, Li J, de Jonge P, Petukhova M, Rose S, Sampson NA, Schoevers RA, Wardenaar KJ, Wilcox MA, Al-Hamzawi AO, Andrade LH, Bromet EJ, Bunting B, Fayyad J, Florescu SE, Gureje O, Hu C, Huang Y, Levinson D, Medina-Mora ME, Nakane Y, Posada-Villa J, Scott KM, Xavier M, Zarkov Z, Kessler RC. Major depressive disorder subtypes to predict long-term course. Depress Anxiety 2014; 31:765-77. [PMID: 24425049 PMCID: PMC5125445 DOI: 10.1002/da.22233] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [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: 11/19/2013] [Revised: 12/05/2013] [Accepted: 12/07/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Variation in the course of major depressive disorder (MDD) is not strongly predicted by existing subtype distinctions. A new subtyping approach is considered here. METHODS Two data mining techniques, ensemble recursive partitioning and Lasso generalized linear models (GLMs), followed by k-means cluster analysis are used to search for subtypes based on index episode symptoms predicting subsequent MDD course in the World Mental Health (WMH) surveys. The WMH surveys are community surveys in 16 countries. Lifetime DSM-IV MDD was reported by 8,261 respondents. Retrospectively reported outcomes included measures of persistence (number of years with an episode, number of years with an episode lasting most of the year) and severity (hospitalization for MDD, disability due to MDD). RESULTS Recursive partitioning found significant clusters defined by the conjunctions of early onset, suicidality, and anxiety (irritability, panic, nervousness-worry-anxiety) during the index episode. GLMs found additional associations involving a number of individual symptoms. Predicted values of the four outcomes were strongly correlated. Cluster analysis of these predicted values found three clusters having consistently high, intermediate, or low predicted scores across all outcomes. The high-risk cluster (30.0% of respondents) accounted for 52.9-69.7% of high persistence and severity, and it was most strongly predicted by index episode severe dysphoria, suicidality, anxiety, and early onset. A total symptom count, in comparison, was not a significant predictor. CONCLUSIONS Despite being based on retrospective reports, results suggest that useful MDD subtyping distinctions can be made using data mining methods. Further studies are needed to test and expand these results with prospective data.
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Affiliation(s)
- Hanna M. van Loo
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen The Netherlands
| | - Tianxi Cai
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Michael J. Gruber
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Junlong Li
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Peter de Jonge
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen The Netherlands
| | - Maria Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Sherri Rose
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Robert A. Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen The Netherlands
| | - Klaas J. Wardenaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen The Netherlands
| | - Marsha A. Wilcox
- Johnson and Johnson Pharmaceutical Research and Development, Titusville, NJ, USA
| | | | - Laura Helena Andrade
- Section of Psychiatric Epidemiology-LIM 23 Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Evelyn J. Bromet
- State University of New York at Stony Brook, Stony Brook, New York, USA
| | - Brendan Bunting
- Psychology Research Institute, University of Ulster, Londonderry, UK
| | - John Fayyad
- Institute for Development Research, Advocacy, and Applied Care and St.George Hospital University Medical Center, Beirut, Lebanon
| | - Silvia E. Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Oye Gureje
- University College Hospital, Ibadan, Nigeria
| | - Chiyi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Guangdong Province, People's Republic of China
| | - Yueqin Huang
- Institute of Mental Health, Peking University, Beijing, People's Republic of China
| | - Daphna Levinson
- Research and Planning, Mental Health Services, Ministry of Health, Jerusalem, Israel
| | | | - Yoshibumi Nakane
- Department of Social Work, The Faculty of Human Sociology, Nagasaki International University, Nagasaki, Japan
| | | | - Kate M. Scott
- Department of Psychological Medicine, Otago University, Dunedin, New Zealand
| | - Miguel Xavier
- Department of Mental Health, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Zahari Zarkov
- National Center of Public Health and Analyses Department Mental Health, Sofia, Bulgaria
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA,Address correspondence to Ronald C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115. Tel. (617) 432-3587, Fax (617) 432-3588,
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Price RB, Iosifescu DV, Murrough JW, Chang LC, Al Jurdi RK, Iqbal SZ, Soleimani L, Charney DS, Foulkes AL, Mathew SJ. Effects of ketamine on explicit and implicit suicidal cognition: a randomized controlled trial in treatment-resistant depression. Depress Anxiety 2014; 31:335-43. [PMID: 24668760 PMCID: PMC4112410 DOI: 10.1002/da.22253] [Citation(s) in RCA: 221] [Impact Index Per Article: 22.1] [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: 12/16/2013] [Revised: 01/14/2014] [Accepted: 01/18/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Preliminary evidence suggests intravenous ketamine has rapid effects on suicidal cognition, making it an attractive candidate for depressed patients at imminent risk of suicide. In the first randomized controlled trial of ketamine using an anesthetic control condition, we tested ketamine's acute effects on explicit suicidal cognition and a performance-based index of implicit suicidal cognition (Implicit Association Test; IAT) previously linked to suicidal behavior. METHOD Symptomatic patients with treatment-resistant unipolar major depression (inadequate response to ≥3 antidepressants) were assessed using a composite index of explicit suicidal ideation (Beck Scale for Suicidal Ideation, Montgomery-Asberg Rating Scale suicide item, Quick Inventory of Depressive Symptoms suicide item) and the IAT to assess suicidality implicitly. Measures were taken at baseline and 24 hr following a single subanesthetic dose of ketamine (n = 36) or midazolam (n = 21), a psychoactive placebo agent selected for its similar, rapid anesthetic effects. Twenty four hours postinfusion, explicit suicidal cognition was significantly reduced in the ketamine but not the midazolam group. RESULTS Fifty three percent of ketamine-treated patients scored zero on all three explicit suicide measures at 24 hr, compared with 24% of the midazolam group (χ(2) = 4.6; P = .03). Implicit associations between self- and escape-related words were reduced following ketamine (P = .01; d = .58) but not midazolam (P = .68; d = .09). Ketamine-specific decreases in explicit suicidal cognition were largest in patients with elevated suicidal cognition at baseline, and were mediated by decreases in nonsuicide-related depressive symptoms. CONCLUSIONS Intravenous ketamine produces rapid reductions in suicidal cognition over and above active placebo. Further study is warranted to test ketamine's antisuicidal effects in higher-risk samples.
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Affiliation(s)
- Rebecca B. Price
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Dan V. Iosifescu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James W. Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lee C. Chang
- Department of Anesthesiology, Baylor College of Medicine, Houston, Texas
| | - Rayan K. Al Jurdi
- Mental Health Care Line, Michael E. Debakey VA Medical Center, Houston, Texas,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Syed Z. Iqbal
- Mental Health Care Line, Michael E. Debakey VA Medical Center, Houston, Texas,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Laili Soleimani
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dennis S. Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York,Pharmacology & Systems Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexandra L. Foulkes
- Department of Anesthesiology, Baylor College of Medicine, Houston, Texas,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Sanjay J. Mathew
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas,Correspondence to: Sanjay J. Mathew, M.D., Michael E. Debakey VA Medical Center & Baylor College of Medicine, Houston, Texas 77030.
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Miranda R, De Jaegere E, Restifo K, Shaffer D. Longitudinal follow-up study of adolescents who report a suicide attempt: aspects of suicidal behavior that increase risk of a future attempt. Depress Anxiety 2014; 31:19-26. [PMID: 24105789 DOI: 10.1002/da.22194] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 03/07/2013] [Revised: 07/19/2013] [Accepted: 08/27/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Previous studies have noted that a past suicide attempt (SA) predicts a future SA, but few studies have reported whether previous SAs that predict a future attempt differ from those that do not. Knowing which characteristics of previous SAs predict future attempts would assist in evaluating adolescents at risk of attempt repetition. This longitudinal study of an unreferred sample examined which characteristics of adolescent SAs increased risk for repeat attempts. METHODS Fifty-four adolescents who had attempted suicide were identified through a two-stage screening of 1,729 high school students. Adolescents reported details of their past SA on the Adolescent Suicide Interview and were reassessed 4-6 years later by telephone. RESULTS Eighteen of the 54 teens (33%) reported that they had made another SA since baseline, and 17 of these reported characteristics of their later attempt. The odds of a further attempt were significantly increased by being alone (OR = 6.1, 95% CI = 1.1-34.8), retrospectively reporting a serious wish to die (OR = 5.2, 95% CI = 1.2-22.7), and planning the attempt for an hour or more (OR = 5.1, 95% CI = 1.1-25.0). The method of attempt remained consistent from baseline to follow-up attempt (κ = .67). CONCLUSIONS Screening high school students to identify those who are at risk for making future SAs should include questions about number of previous SAs and such indicators of risk as isolation, wish to die, and extent of planning prior to a SA.
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Affiliation(s)
- Regina Miranda
- Department of Psychology, Hunter College and the Graduate Center, City University of New York, New York; Division of Child and Adolescent Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
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Katz C, Bolton SL, Katz LY, Isaak C, Tilston-Jones T, Sareen J. A systematic review of school-based suicide prevention programs. Depress Anxiety 2013; 30:1030-45. [PMID: 23650186 DOI: 10.1002/da.22114] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [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: 07/02/2012] [Revised: 01/17/2013] [Accepted: 03/09/2013] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Suicide is one of the leading causes of death among youth today. Schools are a cost-effective way to reach youth, yet there is no conclusive evidence regarding the most effective prevention strategy. We conducted a systematic review of the empirical literature on school-based suicide prevention programs. METHOD Studies were identified through MEDLINE and Scopus searches, using keywords such as "suicide, education, prevention and program evaluation." Additional studies were identified with a manual search of relevant reference lists. Individual studies were rated for level of evidence, and the programs were given a grade of recommendation. Five reviewers rated all studies independently and disagreements were resolved through discussion. RESULTS Sixteen programs were identified. Few programs have been evaluated for their effectiveness in reducing suicide attempts. Most studies evaluated the programs' abilities to improve students' and school staffs' knowledge and attitudes toward suicide. Signs of Suicide and the Good Behavior Game were the only programs found to reduce suicide attempts. Several other programs were found to reduce suicidal ideation, improve general life skills, and change gatekeeper behaviors. CONCLUSIONS There are few evidence-based, school-based suicide prevention programs, a combination of which may be effective. It would be useful to evaluate the effectiveness of general mental health promotion programs on the outcome of suicide. The grades assigned in this review are reflective of the available literature, demonstrating a lack of randomized controlled trials. Further evaluation of programs examining suicidal behavior outcomes in randomized controlled trials is warranted.
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Affiliation(s)
- Cara Katz
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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Nye JA, Purselle D, Plisson C, Voll RJ, Stehouwer JS, Votaw JR, Kilts CD, Goodman MM, Nemeroff CB. Decreased brainstem and putamen SERT binding potential in depressed suicide attempters using [11C]-zient PET imaging. Depress Anxiety 2013; 30:902-7. [PMID: 23526784 DOI: 10.1002/da.22049] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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: 08/09/2012] [Revised: 11/28/2012] [Accepted: 12/02/2012] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Deficits in serotonergic neurotransmission have been implicated in the pathogenesis of depression and suicidality. The present study utilized a novel positron-emission tomography (PET) ligand to quantitate and compare brain regional serotonin transporter (SERT) binding potential in depressed patients with a past history of suicide attempts to that of healthy comparison subjects. METHOD We used [(11) C]-ZIENT PET to label SERT in the serotonergic cell body rich brainstem, and forebrain projection fields. Quantitative PET emission data from 21 adults (10 healthy controls and 11 drug-free patients with major depression) was used for group comparison. SERT binding potential (BPND ) in eight MRI-based brain regions of interest (ROI) were compared in high-resolution PET images. RESULTS SERT binding potential was significantly decreased in the midbrain/pons (P = .029) and putamen (P = .04) of depressed patients with a past suicide attempt relative to comparison subjects. Forebrain SERT binding was also reduced in the patient sample, though these region effects did not survive a multiple comparison correction. CONCLUSION These results suggest that decreased availability of the brainstem and basal ganglia SERT represents a biomarker of depression and thus confirm and extend the role of dysregulation of brain serotonergic neurotransmission in the pathophysiology of depression and suicide.
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Affiliation(s)
- Jonathon A Nye
- Departments of Radiology, Emory University School of Medicine, Atlanta, Georgia
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