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Thompson AJ, Henrich CC, Steelesmith DL, Hughes J, Ruch D, Bridge JA, Campo JV, Fontanella CA. Identifying Subgroups of Youth Suicide Decedents Based on Clinical Profiles of Psychiatric and Medical Diagnoses: A Latent Class Analysis. J Adolesc Health 2024; 74:1191-1197. [PMID: 38520430 DOI: 10.1016/j.jadohealth.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE To identify risk subgroups of youth suicide decedents using demographic and clinical psychiatric and medical diagnostic profiles to inform tailored youth suicide prevention efforts. METHODS This study linked Ohio Medicaid and death certificate data for Medicaid enrolled youth aged 8-25 years who died by suicide between January 1, 2010, and December 31, 2020 (N = 511). Latent class analysis was used to identify distinct clinical risk subgroups. RESULTS Three latent classes were identified. Internalizing problems were common across all classes, but especially prevalent in class 1, the High Internalizing + Multiple Comorbidities group (n = 152, 30%). A prior history of suicidal behavior was confined to class 1 decedents, who were otherwise characterized by substance misuse, and multiple psychiatric and medical comorbidities. Class 2 decedents, the Internalizing + Externalizing group (n = 176, 34%), were more often younger, male, Black, and unlikely to have a history of substance misuse. Decedents in class 3, the Internalizing + Substance Misuse group (n = 183, 36%), were more often older and likely to have a history of substance misuse, but unlikely to exhibit other externalizing problems. DISCUSSION Internalizing psychopathology is particularly common among youth who die by suicide, with comorbid externalizing psychopathology, substance misuse, and medical problems contributing to youth suicide risk. Because less than a third of youth who die by suicide have a prior history of recognized suicidal thinking or behavior, universal screening for youth suicide risk should be considered, particularly in younger children, and efforts to integrate suicide prevention in traditional health care settings should be prioritized.
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Affiliation(s)
- Amanda J Thompson
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
| | | | - Danielle L Steelesmith
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer Hughes
- Big Lots Behavioral Health Services and Division of Child and Family Psychiatry, Nationwide Children's Hospital, Columbus, Ohio; Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio
| | - Donna Ruch
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Jeffrey A Bridge
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - John V Campo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cynthia A Fontanella
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio
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Ruch DA, Bridge JA, Tissue J, Madden SP, Galfavy H, Gorlyn M, Sheftall AH, Szanto K, Keilp JG. Alterations in performance and discriminating power of the death/suicide implicit association test across the lifespan. Psychiatry Res 2024; 335:115840. [PMID: 38492262 DOI: 10.1016/j.psychres.2024.115840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/02/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
The Death/Suicide Implicit Association Test (d/s-IAT) has differentiated individuals with prior and prospective suicide attempts in previous studies, however, age effects on test results remains to be explored. A three-site study compared performance on the d/s-IAT among participants aged 16-80 years with depression and prior suicide attempt (n = 82), with depression and no attempts (n = 80), and healthy controls (n = 86). Outcome measures included the standard difference (D) score, median reaction times, and error rates. Higher D scores represent a stronger association between death/suicide and self, while lower scores represent a stronger association between life and self. The D scores differed significantly among groups overall. Participants with depression exhibited higher scores compared to healthy controls, but there was no difference between participants with and without prior suicide attempts(F[2,242]=8.76, p<.001). Response times for participants with prior attempts differed significantly from other groups, with no significant differences in error rates. The D score was significantly affected by age (β =-0.007, t = 3.65, p<.001), with slowing of response times in older ages. Results suggest reaction time d/s-IAT D scores may not distinguish implicit thinking about suicide as response times slow with age, but slowed response times may be sensitive to suicide risk potentially indicating basic information processing deficits.
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Affiliation(s)
- Donna A Ruch
- The Abigail Wexner Research Institute at Nationwide Children's Hospital Center for Suicide Prevention and Research, 444 Butterfly Gardens Dr., Columbus, OH 43215, United States; Department of Pediatrics, The Ohio State University Wexner Medical Center College of Medicine, 370W. 9th Avenue, Columbus, OH 43210, United States.
| | - Jeffrey A Bridge
- The Abigail Wexner Research Institute at Nationwide Children's Hospital Center for Suicide Prevention and Research, 444 Butterfly Gardens Dr., Columbus, OH 43215, United States; Department of Pediatrics, The Ohio State University Wexner Medical Center College of Medicine, 370W. 9th Avenue, Columbus, OH 43210, United States; Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370W. 9th Avenue, Columbus, OH 43210, United States
| | - Jaclyn Tissue
- The Abigail Wexner Research Institute at Nationwide Children's Hospital Center for Suicide Prevention and Research, 444 Butterfly Gardens Dr., Columbus, OH 43215, United States
| | - Sean P Madden
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051, Riverside Drive, New York, NY 10032, United States
| | - Hanga Galfavy
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051, Riverside Drive, New York, NY 10032, United States; Department of Biostatistics, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, United States
| | - Marianne Gorlyn
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051, Riverside Drive, New York, NY 10032, United States
| | - Arielle H Sheftall
- Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, United States
| | - Katalin Szanto
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA 15213, United States
| | - John G Keilp
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051, Riverside Drive, New York, NY 10032, United States
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Ryan PC, Lowry NJ, Boudreaux E, Snyder DJ, Claassen CA, Harrington CJ, Jobes DA, Bridge JA, Pao M, Horowitz LM. Chronic Pain, Hopelessness, and Suicide Risk Among Adult Medical Inpatients. J Acad Consult Liaison Psychiatry 2024; 65:126-135. [PMID: 38030078 DOI: 10.1016/j.jaclp.2023.11.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Medically ill adults are at elevated risk for suicide. Chronic pain and hopelessness are associated with suicide; however, few studies have examined the interaction between chronic pain and hopelessness in predicting suicide risk among hospitalized adults. OBJECTIVE This study aimed to describe the association between chronic pain, hopelessness, and suicide risk, defined as recent suicidal ideation or lifetime suicidal behavior. In addition, we examined the interaction between chronic pain and hopelessness. METHODS This was a secondary analysis of a multisite study to validate the Ask Suicide-Screening Questions (ASQ) among adult medical inpatients. Participants reported if they experienced chronic pain that impacted daily life and if they felt hopeless about their medical condition and provided their current pain rating on a 1 to 10 scale, with 10 being the most severe pain. A t-test compared pain severity scores by ASQ outcome. A binary logistic regression model described the association between chronic pain, hopelessness, and suicide risk; parameter estimates are expressed as odds ratios (OR) for interpretation. The interaction between chronic pain and hopelessness was examined in both the transformed (logit) and natural (probability) scales of the generalized linear model. RESULTS The sample included 720 participants (53.2% male, 62.4% White, mean age: 50.1 [16.3] years, range = 18-93). On the ASQ, 15.7% (113/720) of patients screened positive. Half (360/720) of the sample self-reported chronic pain. Individuals who screened positive had higher pain rating scores than those who screened negative (t = -4.2, df = 147.6, P < 0.001). Among all patients, 27.2% (196/720) felt hopeless about their medical condition. In the logistic regression model, patients with chronic pain (adjusted OR: 2.29, 95% confidence interval [CI]: 1.21-4.43, P = 0.01) or hopelessness (adjusted OR: 5.69, 95% CI: 2.52-12.64, P < 0.001) had greater odds of screening positive on the ASQ. The interaction effect between pain and hopelessness was not significant in the transformed (B = -0.15, 95% CI: -1.11 to 0.82, P = 0.76) or natural (B = 0.08, 95% CI: -0.07 to 0.23, P = 0.28) scale. CONCLUSIONS There were significant independent associations between (1) chronic pain and suicide risk and between (2) hopelessness and suicide risk. Future research should examine the temporality and mechanisms underlying these relationships to inform prevention efforts for medically ill adults.
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Affiliation(s)
- Patrick C Ryan
- Office of the Clinical Director, National Institute of Mental Health, NIH, Bethesda, MD
| | - Nathan J Lowry
- Office of the Clinical Director, National Institute of Mental Health, NIH, Bethesda, MD
| | - Edwin Boudreaux
- Department of Emergency Medicine, Chan School of Medicine, University of Massachusetts, Worcester, MA
| | - Deborah J Snyder
- Office of the Clinical Director, National Institute of Mental Health, NIH, Bethesda, MD
| | | | - Colin J Harrington
- Department of Psychiatry, Alpert Medical School, Brown University, Providence, RI
| | - David A Jobes
- Department of Psychology, The Catholic University of America, Washington, D.C
| | - Jeffrey A Bridge
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Maryland Pao
- Office of the Clinical Director, National Institute of Mental Health, NIH, Bethesda, MD
| | - Lisa M Horowitz
- Office of the Clinical Director, National Institute of Mental Health, NIH, Bethesda, MD.
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Adrian M, McCauley E, Gallop R, Stevens J, Jobes DA, Crumlish J, Stanley B, Brown GK, Green KL, Hughes JL, Bridge JA. Advancing Suicide Intervention Strategies for Teens (ASSIST): study protocol for a multisite randomised controlled trial. BMJ Open 2023; 13:e074116. [PMID: 38086585 PMCID: PMC10729238 DOI: 10.1136/bmjopen-2023-074116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Brief interventions that reduce suicide risk following youth's experience with acute care due to suicidality are needed. METHODS AND ANALYSIS The study will use a three-arm randomised controlled trial designed to test the effectiveness of the Safety Planning Intervention with structured follow-up (SPI+) and the Collaborative Assessment and Management of Suicidality (CAMS) compared with enhanced usual care. The primary outcomes measure will be suicidal events, defined as death by suicide, attempted suicide, preparatory acts toward imminent suicidal behaviour or suicidal ideation resulting in a change in emergency evaluation or inpatient admission. Secondary measures will be the number of suicide attempts and severity of suicidal ideation. The experimental interventions, SPI+ and CAMS, consist of up to eight sessions over approximately 8 weeks that are designed to manage (SPI+) or treat (CAMS) patient-identified 'drivers' of suicidal thoughts and behaviours. Mechanisms and moderators of change will be evaluated to understand treatment impacts. ETHICS AND DISSEMINATION This study has been approved by the Seattle Children's Institutional Review Board and is monitored by external agencies including the University of Washington Institute for Translational Health Sciences, and a National Institute of Mental Health (NIMH)-appointed Data Safety and Monitoring Board. Trial results will help establish evidence towards safe and effective treatment strategies for youth transitioning from acute to outpatient care due to a suicidal crisis. The data will be shared with the NIMH Data Archives and disseminated through publications and conferences. TRIAL REGISTRATION NUMBER NCT05078970.
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Affiliation(s)
- Molly Adrian
- University of Washington, Seattle, Washington, USA
| | | | - Robert Gallop
- West Chester University, West Chester, Pennsylvania, USA
| | | | - David A Jobes
- The Catholic University of America, School of Arts and Sciences, Washington, DC, USA
| | - Jennifer Crumlish
- The Catholic University of America, School of Arts and Sciences, Washington, DC, USA
| | | | | | - Kelly L Green
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Jeffrey A Bridge
- The Ohio State University College of Medicine, Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
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Rodante DE, Papávero EB, Ingratta AV, Gorrini A, Ralli E, Rodante ED, Arismendi M, Lowry N, Ryan P, Jian-Ping H, Bridge JA, Horowitz L, Daray FM. Validation of the Spanish ASQ translation: Screening pediatric patients for suicide-risk in Argentina. Gen Hosp Psychiatry 2023; 85:191-198. [PMID: 37952326 DOI: 10.1016/j.genhosppsych.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The high frequency of suicide risk in adolescents necessitates the development and validation of specific tools for systematic screening. To date, there are translated, but not validated suicide risk screening tools in Spanish. OBJECTIVE To validate the Spanish version of the Ask Suicide-Screening Questions (ASQ) for suicide risk screening in pediatric patients in Argentina. METHOD Using a cross-sectional multicenter design, a convenience sample of pediatric patients aged 10 to 18 years old were recruited from outpatient/inpatient medical settings and private psychiatric clinics. The Spanish version of the Suicidal Ideation Questionnaire (SIQ) assessment tool was used as a standard criterion to validate the ASQ. RESULTS A total of 301/380 pediatric patients were screened for suicide risk. Twentyeight percent of the entire sample (83/301) of youth screened positive on the ASQ, and 21% (62/301) screened positive on the SIQ/SIQ-JR and were considered "at risk" for suicide. Compared with the SIQ, the Spanish ASQ yielded a sensitivity of 96.8% (95% Confidence Interval [CI]: 88.8-99.6%), specificity of 90.4% (95% CI: 85.9-93.8%), positive predictive value of 72.3% (95 CI: 61.4-81.6%), and negative predictive value of 99.1% (95% CI: 96.7-99.9%). The positive Likelihood Ratio (LR) was 10.1 (95% CI: 6.1-14.0), and the negative LR was 0.03 (95% CI: -0.01-0.09). Kappa was 0.77 (95% CI: 0.69-0.86), and the Area Under the Curve was 0.94 (95% CI: 0.91-0.97). CONCLUSION The Spanish language ASQ demonstrated strong psychometric properties, providing initial evidence that it is a valid tool for identifying Spanish-speaking youth at risk for suicide.
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Affiliation(s)
- Demian Emanuel Rodante
- Universidad de Buenos Aires, Facultad de Medicina, Instituto de Farmacología, Argentina; Hospital Neuropsiquiátrico Braulio A. Moyano, Ciudad de Buenos Aires, Argentina
| | - Eliana Belén Papávero
- Universidad de Buenos Aires, Facultad de Medicina, Instituto de Farmacología, Argentina; Hospital General de Niños Pedro de Elizalde, Ciudad de Buenos Aires, Argentina
| | | | - Antonio Gorrini
- Hospital Federico Falcon, Pilar, Provincia de Buenos Aires, Argentina
| | - Eugenia Ralli
- Clinica Santa Rosa, Ciudad de Buenos Aires, Argentina
| | | | - Mariana Arismendi
- Hospital Federico Falcon, Pilar, Provincia de Buenos Aires, Argentina
| | - Nathan Lowry
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Patrick Ryan
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - He Jian-Ping
- Genetic Epidemiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Jeffrey A Bridge
- Center for Suicide Prevention Research, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Lisa Horowitz
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Federico Manuel Daray
- Universidad de Buenos Aires, Facultad de Medicina, Instituto de Farmacología, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.
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Chen Q, Armstrong SE, Vakil F, Bridge JA, Keilp JG, Sheftall AH. Neurocognitive and clinical characteristics of elementary school-aged children with a history of suicidal thoughts and behaviors. J Affect Disord 2023; 339:318-324. [PMID: 37442443 PMCID: PMC10530242 DOI: 10.1016/j.jad.2023.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/16/2023] [Accepted: 07/08/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Suicidal thoughts and behaviors (STBs) in elementary school-aged youth have increased in recent years. Understanding the risks associated with childhood STBs is necessary for prevention efforts. METHODS The current study examined clinical and neurocognitive characteristics of a community sample of elementary school-aged children with (STB+) and without (STB-) a history of STBs. The final sample included 93 families with children average age of 7.8 years (SD = 1.3). Children in this sample were racially diverse, evenly split by sex, and most identified as non-Hispanic. Neurocognitive functioning was assessed using computerized behavioral measures. Child clinical characteristics were assessed using self-report measures and STB history was assessed using semi-structured interviews. RESULTS Of the 93 families, 64 STB- children and 29 STB+ children participated. On average, STB+ children were older, reported higher levels of depressive and anxiety symptoms, and were more likely to have a parental history of suicidal behavior (PH+). Regarding neurocognitive functioning, STB+ children exhibited lower raw scores for both the NIH Dimensional Change Card Sort Task (NIH-DCCS) and NIH Flanker Inhibitory Control and Attention Test (NIH-Flanker). Multivariable regression analyses revealed raw scores for NIH-DCCS and NIH-Flanker, PH+ status, and child age were associated with childhood STBs. LIMITATIONS Prospective data is needed to confirm cross-sectional findings. CONCLUSIONS Poorer neurocognitive functioning and PH+ status may serve as risk markers for STBs in elementary school-aged children. Targeting prevention programming for these risks may reduce the likelihood of STBs in at-risk elementary school-aged youth.
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Affiliation(s)
- Qi Chen
- Columbia University, NY, New York, United States of America
| | | | - Fatima Vakil
- Abdul Latif Jameel Poverty Action Lab (J-PAL) North America, Massachusetts Institute of Technology (MIT), Cambridge, MA, United States of America
| | - Jeffrey A Bridge
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America; Departments of Pediatrics and Psychiatry & Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - John G Keilp
- Department of Psychiatry, Columbia University, NY, New York, United States of America
| | - Arielle H Sheftall
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States of America.
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Hari S, Ruch DA, Bridge JA, Brink FW. The evaluation of emotional maltreatment's effect on family dynamics and suicidal behaviors. Child Abuse Negl 2023; 144:106351. [PMID: 37515917 DOI: 10.1016/j.chiabu.2023.106351] [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: 09/01/2022] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Emotional maltreatment and poor family functioning are known risks for youth suicide, but few studies have examined these issues as prospective predictors of future attempts. OBJECTIVES Examine family functioning and suicide risk associated with emotional maltreatment in youth with a lifetime history of major depressive disorder (MDD) and the prospective association of emotional maltreatment and family functioning with future suicide attempts. PARTICIPANTS AND SETTING Participants included 321 youth aged 12-15 years (251 with emotional maltreatment; 70 with no emotional maltreatment) recruited from a metropolitan children's hospital from 2011 to 2018. Prospective analyses included 280 youths (221 with emotional maltreatment; 59 without emotional maltreatment). METHODS Semi-structured interviews and self-reports assessed family functioning and suicidal thoughts and behaviors in youth with and without emotional maltreatment at baseline, 6-month, 1-year, and 2-year follow-up. Multivariate analyses examined whether emotional maltreatment predicted future suicide attempts, beyond the effect of prior suicide attempts. RESULTS Emotionally maltreated youth reported significantly lower scores for family adaptability, cohesion, and family alliance, and higher rates of suicidal ideation and suicide attempts, compared to youth without emotional maltreatment. Youth experiencing multiple forms of abuse were significantly more likely to attempt suicide at future timepoints, however this association was attenuated after controlling for prior suicide attempts. CONCLUSION Youth who experienced emotional maltreatment had a significantly higher percentage of past suicidal thoughts and behaviors and significantly less favorable scores for family functioning associated with an increased suicide risk. Findings support family-focused suicide prevention strategies as a promising approach to reduce youth suicide.
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Affiliation(s)
- Shilpa Hari
- The Center for Family Safety and Healing at Nationwide Children's Hospital, 655 East Livingston Avenue, Columbus, OH 43205, USA.
| | - Donna A Ruch
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 444 Butterfly Gardens Drive, Columbus, OH 43215, USA.
| | - Jeffrey A Bridge
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 444 Butterfly Gardens Drive, Columbus, OH 43215, USA; The Ohio State University College of Medicine, 370 W 9(th) Ave, Columbus, OH 43210, USA.
| | - Farah W Brink
- The Center for Family Safety and Healing at Nationwide Children's Hospital, 655 East Livingston Avenue, Columbus, OH 43205, USA; The Ohio State University College of Medicine, 370 W 9(th) Ave, Columbus, OH 43210, USA.
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Wastler HM, Llamocca E, Moe AM, Steelsmith DL, Brock G, Bridge JA, Campo JV, Fontanella CA. Impact of Treatment Initiation and Engagement on Deliberate Self-Harm Among Individuals With First-Episode Psychosis. Psychiatr Serv 2023; 74:921-928. [PMID: 36852553 DOI: 10.1176/appi.ps.20220372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Individuals with psychosis are at increased risk for suicide, with the greatest risk being present during the first few months after diagnosis. The authors aimed to examine whether treatment initiation within 14 days of diagnosis and treatment engagement within 90 days of initiation reduce the risk for deliberate self-harm (DSH) among individuals with first-episode psychosis (FEP). METHODS A retrospective longitudinal cohort design was adopted by using Ohio Medicaid claims for 6,349 adolescents and young adults ages 15-24 years with FEP. Logistic regression was used to examine factors associated with treatment initiation and engagement. Cox proportional hazard models were used to estimate the impact of treatment initiation and engagement on DSH. Propensity score weighting was used to control for sociodemographic and clinical covariates. RESULTS Approximately 70% of the sample initiated treatment, 55% of whom engaged in treatment. Treatment initiation and engagement were associated with both demographic and clinical variables. Treatment initiation significantly reduced the hazard of DSH (average treatment effect in the entire population: hazard ratio [HR]=0.62, 95% CI=0.47-0.81; average treatment effect among those treated: HR=0.64, 95% CI=0.52-0.80). In contrast, treatment engagement was not significantly associated with DSH. CONCLUSIONS These results suggest that the initial treatment contact is essential for reducing DSH among adolescents and young adults with FEP. Additionally, the finding that treatment engagement did not reduce DSH suggests that standard clinical care may not be sufficient for reducing DSH in this population. These findings highlight the need for suicide-specific interventions for individuals with FEP.
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Affiliation(s)
- Heather M Wastler
- Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo)
| | - Elyse Llamocca
- Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo)
| | - Aubrey M Moe
- Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo)
| | - Danielle L Steelsmith
- Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo)
| | - Guy Brock
- Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo)
| | - Jeffrey A Bridge
- Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo)
| | - John V Campo
- Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo)
| | - Cynthia A Fontanella
- Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo)
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Mitchell RHB, Kozloff N, Sanches M, Goldstein BI, Amini J, Bridge JA, Sinyor M. Sex Differences in Suicide Trends Among Adolescents Aged 10 to 14 Years in Canada. Can J Psychiatry 2023; 68:547-549. [PMID: 37132039 PMCID: PMC10408560 DOI: 10.1177/07067437231173370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Rachel H. B. Mitchell
- Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Nicole Kozloff
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Canada
| | - Marcos Sanches
- Biostatistics Core, Centre for Addiction and Mental Health, Toronto, Canada
| | - Benjamin I. Goldstein
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Youth Bipolar Disorder, Center for Addiction and Mental Health, Toronto, Canada
| | - Jasmine Amini
- Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Toronto, Canada
| | - Jeffrey A. Bridge
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mark Sinyor
- Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Horowitz LM, Mournet AM, Sheftall A, He JP, Lowry NJ, Aguinaldo LD, Sullivant SA, Wharff EA, Merikangas KR, Pao M, Bridge JA. Assessing the Validity of the Ask Suicide-Screening Questions in Black Youth. J Acad Consult Liaison Psychiatry 2023; 64:332-335. [PMID: 36273745 PMCID: PMC10115908 DOI: 10.1016/j.jaclp.2022.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/14/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Given the increasing rates of suicide and nonfatal suicide attempts among Black youth in the United States, it is crucial that screening tools are valid in identifying Black youth at risk of suicide. OBJECTIVE This study assessed the validity of the Ask Suicide-Screening Questions (ASQ) among Black youth. METHODS This analysis used pooled data from 3 ASQ validation studies of pediatric medical patients aged 10-21 years. All participants completed the ASQ and the gold standard Suicidal Ideation Questionnaire. RESULTS Of the 1083 participants, 330 (30.5%) were non-Hispanic Black and 753 (69.5%) were non-Hispanic White. ASQ psychometric properties for Black and White participants were equivalent (sensitivity = 94% vs. 90.9%; specificity = 91.4% vs. 91.8%, respectively). CONCLUSIONS There were no significant differences in ASQ psychometric properties between Black and White youth, indicating that the ASQ is valid for screening Black youth at risk of suicide.
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Affiliation(s)
- Lisa M Horowitz
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD.
| | - Annabelle M Mournet
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD
| | - Arielle Sheftall
- The Center for Suicide Prevention and Research at the Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Jian-Ping He
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD
| | - Nathan J Lowry
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD
| | - Laika D Aguinaldo
- Department of Psychiatry, University of California, San Diego, San Diego, CA
| | - Shayla A Sullivant
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, MO; University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO
| | | | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD
| | - Maryland Pao
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD
| | - Jeffrey A Bridge
- The Center for Suicide Prevention and Research at the Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; Departments of Pediatrics and Psychiatry & Behavioral Health, The Ohio State University College of Medicine, Columbus, OH
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11
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Affiliation(s)
- Jeffrey A. Bridge
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Departments of Pediatrics and Psychiatry & Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania
| | - David A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania
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12
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Llamocca EN, Steelesmith DL, Ruch DA, Bridge JA, Fontanella CA. Association Between Social Determinants of Health and Deliberate Self-Harm Among Youths With Psychiatric Diagnoses. Psychiatr Serv 2023; 74:574-580. [PMID: 36377368 PMCID: PMC10948010 DOI: 10.1176/appi.ps.20220180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The authors sought to examine the association between adverse social determinants of health (SDoHs) and risk for self-harm among youths. METHODS The authors performed a retrospective longitudinal analysis of Ohio Medicaid claims data (April 1, 2016-December 31, 2018) of 244,958 youths (ages 10-17 years) with a primary psychiatric diagnosis. SDoHs were identified from ICD-10 codes and classified into 14 categories, encompassing abuse and neglect, child welfare placement, educational problems, financial problems, exposure to violence, housing instability, legal issues, disappearance or death of a family member, family disruption by separation or divorce, family alcohol or drug use, parent-child conflict, other family problems, social and environmental problems, and nonspecific psychosocial needs. Cox proportional hazards analysis was used to examine the association between SDoHs and self-harm (i.e., nonsuicidal self-injury or suicide attempt). Analyses controlled for demographic characteristics and comorbid psychiatric and general medical conditions. RESULTS During follow-up after an index claim event, 51,796 youths (21.1%) had at least one adverse SDoH indicator, and 3,262 (1.3%) had at least one self-harm event. Abuse and neglect (hazard ratio [HR]=1.90, 99% CI=1.70-2.12), child welfare placement (HR=1.32, 99% CI=1.04-1.67), parent-child conflict (HR=1.52, 99% CI=1.23-1.87), other family problems (HR=1.25, 99% CI=1.01-1.54), and nonspecific psychosocial needs (HR=1.41, 99% CI=1.06-1.89) were associated with significantly increased hazard of self-harm. CONCLUSIONS Adverse SDoHs were significantly associated with self-harm, even after controlling for demographic and clinical characteristics, underscoring the need for capturing SDoH information in medical records to identify youths at elevated suicide risk and to inform targeted interventions.
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Affiliation(s)
- Elyse N. Llamocca
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Danielle L. Steelesmith
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Donna A. Ruch
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Jeffrey A. Bridge
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH USA
| | - Cynthia A. Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
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Wang C, Keilp JG, Galfalvy H, Bridge JA, Sheftall AH, Szanto K. Entrapment and social problem-solving in suicidal behavior across the adult lifespan. J Affect Disord 2023; 329:176-183. [PMID: 36842650 PMCID: PMC10033364 DOI: 10.1016/j.jad.2023.02.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Feelings of entrapment and deficits in social problem-solving skills have been associated with risk for suicidal behavior in the context of depression. However, few studies have examined the effect of age on the association between these risk factors and suicidal behavior across most of the adult lifespan. METHODS In a three-site study, we tested interactions of age with feelings of entrapment and social problem-solving style in 105 depressed patients with a recent suicide attempt, 95 depressed patients with no history of suicide attempt, and 97 demographically similar non-psychiatric participants (age 16-80). Attempter/non-attempter differences, age interactions, and the relative contribution of entrapment and social problem-solving style to past attempter were examined. RESULTS Entrapment significantly interacted with age such that it discriminated past attempters from depressed non-attempters better at older ages. Social Problem-Solving Inventory (SPSI) total score and most subscales did not distinguish past attempters, but the SPSI Impulsive Style Problem-Solving was an effective discriminator of past suicide attempts across the full adult lifespan and did not interact with age. In a multipredictor model, both the entrapment by age interaction and SPSI Impulsive Style Problem-Solving score were significant predictors for the classification of attempters. LIMITATIONS The cross-sectional nature of our research design limited conclusions that may be drawn about individual change over time or cohort effects. CONCLUSIONS Entrapment did not distinguish past attempters at younger ages but became a better discriminator in middle to late adulthood. An impulsive problem-solving style was associated with past suicide attempts across the full adult lifespan.
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Affiliation(s)
- C Wang
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - J G Keilp
- Columbia University, Department of Psychiatry, New York, NY, USA; Columbia University, Department of Biostatistics, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - H Galfalvy
- Columbia University, Department of Psychiatry, New York, NY, USA; Columbia University, Department of Biostatistics, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - J A Bridge
- The Abigail Wexner Research Institute at Nationwide Children's and The Ohio State University College of Medicine, Departments of Pediatrics and Psychiatry & Behavioral Health, Columbus, OH, USA
| | - A H Sheftall
- University of Rochester Medical Center, School of Medicine and Dentistry, Department of Psychiatry, Rochester, NY, USA
| | - K Szanto
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA.
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Abstract
Suicide is the fourth leading cause of death among young people worldwide and the third leading cause of death among those in the US. This review outlines the epidemiology of suicide and suicidal behavior in young people. It discusses intersectionality as an emerging framework to guide research on prevention of suicide in young people and highlights several clinical and community settings that are prime targets for implementation of effective treatment programs and interventions aimed at rapidly reducing the suicide rate in young people. It provides an overview of current approaches to screening and assessment of suicide risk in young people and the commonly used screening tools and assessment measures. It discusses universal, selective, and indicated evidence based suicide focused interventions and highlights components of psychosocial interventions with the strongest evidence for reducing risk. Finally, the review discusses suicide prevention strategies in community settings and considers future research directions and questions challenging the field.
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Affiliation(s)
- Jennifer L Hughes
- Big Lots Behavioral Health Services at Nationwide Children's Hospital, Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lisa M Horowitz
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - John P Ackerman
- Big Lots Behavioral Health Services at Nationwide Children's Hospital, Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Molly C Adrian
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - John V Campo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey A Bridge
- Departments of Pediatrics and Psychiatry and Behavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital and The Ohio State University Wexner Medical Center College of Medicine, Columbus, OH
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15
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Horowitz LM, Ryan PC, Wei AX, Boudreaux ED, Ackerman JP, Bridge JA. Screening and Assessing Suicide Risk in Medical Settings: Feasible Strategies for Early Detection. Focus (Am Psychiatr Publ) 2023; 21:145-151. [PMID: 37201144 PMCID: PMC10172561 DOI: 10.1176/appi.focus.20220086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Early detection of risk is a key suicide prevention strategy. Given that most individuals who die by suicide visit a health care provider in the year leading up to their death, medical settings are ideal venues for identifying those at elevated risk and bridging them to life-saving care. Clinicians are presented with an opportunity to engage in proactive suicide prevention efforts through practical and adaptable suicide risk screening, assessment, and management processes. Psychiatrists and mental health clinicians are well positioned to assist nonpsychiatric clinicians on the frontlines of this public health problem. This article discusses the importance of identifying people at elevated suicide risk through screening, differentiates screening from assessment procedures, and presents practical strategies for implementing evidence-based screening and assessment tools into practice as part of a three-tiered clinical pathway. Specifically, this article discusses key components that guide embedding suicide prevention strategies into the workflows of busy medical settings.
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Affiliation(s)
- Lisa M Horowitz
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
| | - Patrick C Ryan
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
| | - August X Wei
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
| | - Edwin D Boudreaux
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
| | - John P Ackerman
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
| | - Jeffrey A Bridge
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
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16
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Bridge JA, Ruch DA, Sheftall AH, Hahm HC, O'Keefe VM, Fontanella CA, Brock G, Campo JV, Horowitz LM. Youth Suicide During the First Year of the COVID-19 Pandemic. Pediatrics 2023; 151:190657. [PMID: 36789551 DOI: 10.1542/peds.2022-058375] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To identify potential differential changes in youth suicide deaths associated with the coronavirus disease (COVID-19) pandemic to better inform suicide prevention strategies. METHODS This cross-sectional study analyzed national suicide data for US youth aged 5 to 24 years from 2015 to 2020. Annual and monthly numbers of suicides were extracted overall and by sex, age, race and ethnicity, and method. Expected suicides were modeled from the trend in monthly deaths before COVID-19 (January 1, 2015-February 29, 2020), by using interrupted time-series analyses with quasi-Poisson regression. Rate ratios (RR) and corresponding 95% confidence intervals (CI) were used to compare expected and observed suicides during the first 10 months of COVID-19 (March 1, 2020-December 31, 2020). RESULTS Among 5568 identified youth suicides during the 2020 pandemic, 4408 (79.2%) were male, 1009 (18.1%) Hispanic, 170 (3.3%) non-Hispanic American Indian/Alaska Native, 262 (4.7%) Asian/Pacific Islander, 801 (14.4%) Black, and 3321 (59.6%) white. There was a significant increase in overall observed versus expected youth suicides during the COVID-19 pandemic (RR = 1.04, 95% CI = 1.01-1.07), equivalent to an estimated 212 excess deaths. Demographic subgroups including males (RR = 1.05, 95% CI = 1.02-1.08), youth aged 5 to 12 years (RR = 1.20, 95% CI = 1.03-1.41) and 18 to 24 years (RR =1.05, 95% CI = 1.02-1.08), non-Hispanic AI/AN youth (RR = 1.20, 95% CI = 1.03-1.39), Black youth (RR = 1.20, 95% CI = 1.12-1.29), and youth who died by firearms (RR = 1.14, 95% CI = 1.10-1.19) experienced significantly more suicides than expected. CONCLUSIONS Suicide deaths among US youth increased during COVID-19, with substantial variation by sex, age, race and ethnicity, and suicide method. Suicide prevention strategies must be tailored to better address disparities in youth suicide risk.
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Affiliation(s)
- Jeffrey A Bridge
- The Abigail Wexner Research Institute at Nationwide Children's Hospital Center for Suicide Prevention and Research, Columbus, Ohio.,Departments of bPsychiatry and Behavioral Health and.,Pediatrics, The Ohio State University Wexner Medical Center College of Medicine, Columbus, Ohio
| | - Donna A Ruch
- The Abigail Wexner Research Institute at Nationwide Children's Hospital Center for Suicide Prevention and Research, Columbus, Ohio
| | - Arielle H Sheftall
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | | | - Victoria M O'Keefe
- Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Department of International Health
| | - Cynthia A Fontanella
- The Abigail Wexner Research Institute at Nationwide Children's Hospital Center for Suicide Prevention and Research, Columbus, Ohio.,Departments of bPsychiatry and Behavioral Health and
| | - Guy Brock
- Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Department of International Health
| | - John V Campo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa M Horowitz
- National Institute of Mental Health, Intramural Research Program, Bethesda, Maryland
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17
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Brent DA, Horowitz LM, Grupp-Phelan J, Bridge JA, Gibbons R, Chernick LS, Rea M, Cwik MF, Shenoi RP, Fein JA, Mahabee-Gittens EM, Patel SJ, Mistry RD, Duffy S, Melzer-Lange MD, Rogers A, Cohen DM, Keller A, Hickey RW, Page K, Casper TC, King CA. Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments. JAMA Netw Open 2023; 6:e2255986. [PMID: 36790810 PMCID: PMC9932829 DOI: 10.1001/jamanetworkopen.2022.55986] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
IMPORTANCE Screening adolescents in emergency departments (EDs) for suicidal risk is a recommended strategy for suicide prevention. Comparing screening measures on predictive validity could guide ED clinicians in choosing a screening tool. OBJECTIVE To compare the Ask Suicide-Screening Questions (ASQ) instrument with the Computerized Adaptive Screen for Suicidal Youth (CASSY) instrument for the prediction of suicidal behavior among adolescents seen in EDs, across demographic and clinical strata. DESIGN, SETTING, AND PARTICIPANTS The Emergency Department Study for Teens at Risk for Suicide is a prospective, random-series, multicenter cohort study that recruited adolescents, oversampled for those with psychiatric symptoms, who presented to the ED from July 24, 2017, through October 29, 2018, with a 3-month follow-up to assess the occurrence of suicidal behavior. The study included 14 pediatric ED members of the Pediatric Emergency Care Applied Research Network and 1 Indian Health Service ED. Statistical analysis was performed from May 2021 through January 2023. MAIN OUTCOMES AND MEASURES This study used a prediction model to assess outcomes. The primary outcome was suicide attempt (SA), and the secondary outcome was suicide-related visits to the ED or hospital within 3 months of baseline; both were assessed by an interviewer blinded to baseline information. The ASQ is a 4-item questionnaire that surveys suicidal ideation and lifetime SAs. A positive response or nonresponse on any item indicates suicidal risk. The CASSY is a computerized adaptive screening tool that always includes 3 ASQ items and a mean of 8 additional items. The CASSY's continuous outcome is the predicted probability of an SA. RESULTS Of 6513 adolescents available, 4050 were enrolled, 3965 completed baseline assessments, and 2740 (1705 girls [62.2%]; mean [SD] age at enrollment, 15.0 [1.7] years; 469 Black participants [17.1%], 678 Hispanic participants [24.7%], and 1618 White participants [59.1%]) completed both screenings and follow-ups. The ASQ and the CASSY showed a similar sensitivity (0.951 [95% CI, 0.918-0.984] vs 0.945 [95% CI, 0.910-0.980]), specificity (0.588 [95% CI, 0.569-0.607] vs 0.643 [95% CI, 0.625-0.662]), positive predictive value (0.127 [95% CI, 0.109-0.146] vs 0.144 [95% CI, 0.123-0.165]), and negative predictive value (both 0.995 [95% CI, 0.991-0.998], respectively). Area under the receiver operating characteristic curve findings were similar among patients with physical symptoms (ASQ, 0.88 [95% CI, 0.81-0.95] vs CASSY, 0.94 [95% CI, 0.91-0.96]). Among patients with psychiatric symptoms, the CASSY performed better than the ASQ (0.72 [95% CI, 0.68-0.77] vs 0.57 [95% CI, 0.55-0.59], respectively). CONCLUSIONS AND RELEVANCE This study suggests that both the ASQ and the CASSY are appropriate for universal screening of patients in pediatric EDs. For the small subset of patients with psychiatric symptoms, the CASSY shows greater predictive validity.
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Affiliation(s)
- David A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania
| | - Lisa M. Horowitz
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | | | - Jeffrey A. Bridge
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Robert Gibbons
- Department of Medicine, The University of Chicago, Chicago, Illinois
- Department of Public Health Sciences (Biostatistics), The University of Chicago, Chicago, Illinois
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
- Department of Comparative Human Development, The University of Chicago, Chicago, Illinois
| | - Lauren S. Chernick
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York
| | - Margaret Rea
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California
| | - Mary F. Cwik
- Department of International Health, Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rohit P. Shenoi
- Division of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Joel A. Fein
- Center for Violence Prevention, Children’s Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shilpa J. Patel
- Division of Pediatric Emergency Medicine, Children’s National Hospital, Washington, DC
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Rakesh D. Mistry
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Susan Duffy
- Hasbro Children’s Hospital, Department of Pediatrics, Alpert Medical School at Brown University, Providence, Rhode Island
| | | | - Alexander Rogers
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Department of Pediatrics, University of Michigan, Ann Arbor
| | - Daniel M. Cohen
- Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Allison Keller
- Department of Pediatric Emergency Medicine, University of Utah and Primary Children’s Hospital, Salt Lake City
| | - Robert W. Hickey
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kent Page
- Department of Pediatrics, University of Utah, Salt Lake City
| | | | - Cheryl A. King
- Department of Psychiatry, Michigan Medicine, Ann Arbor
- Injury Prevention Center, The University of Michigan, Ann Arbor
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Lowry NJ, Ryan PC, Mournet AM, Snyder DJ, Claassen C, Jobes D, Harrington C, Pao M, Horowitz LM, Bridge JA. Non-Suicidal Self-Injury and Suicide Risk Among Adult Medical Inpatients. Journal of Affective Disorders Reports 2023. [DOI: 10.1016/j.jadr.2023.100474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Horowitz LM, Bridge JA. Upstream Prevention Strategies to Prevent Suicidal Ideation-Related ED Visits. Pediatrics 2022; 150:e2022058151. [PMID: 36373283 PMCID: PMC9724168 DOI: 10.1542/peds.2022-058151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Lisa M. Horowitz
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, NIH, Bethesda, Maryland
| | - Jeffrey A. Bridge
- The Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
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Lowry NJ, Stanley IH, Mournet AM, Wharff EA, Sullivant SA, Teach SJ, Pao M, Horowitz LM, Bridge JA. Firearms Access among Pediatric Patients at Risk for Suicide. Arch Suicide Res 2022:1-10. [PMID: 35924876 PMCID: PMC9898460 DOI: 10.1080/13811118.2022.2106924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Approximately 2,900 youth who die by suicide each year in the United States use a firearm. To inform lethal means safety counseling efforts, this study aimed to describe firearm access among youth deemed at risk for suicide in pediatric medical settings. METHODS Youth who presented to one of four urban pediatric medical centers were screened for suicide risk and access to firearms. Suicide risk was determined by a positive screen on the Ask Suicide-Screening Questions (ASQ) tool. Firearm access was assessed via a structured questionnaire. RESULTS This secondary analysis analyzed data from 1065 youth aged 10 to 17 years. Overall, 110 (10.3%) participants screened positive for suicide risk. Among those at risk, 28% (31/110) reported guns kept in or around their home, 8% (9/110) had access to a firearm, and 5% (6/110) reported that bullets were not stored separately from the guns. CONCLUSIONS Over a quarter of youth at risk for suicide reported a firearm stored in or around their home. To ensure the safety of young people at risk for suicide, clinicians should assess whether youth have access to firearms and conduct lethal means safety counseling with youths, as developmentally appropriate, and their parent/caregivers.HIGHLIGHTS28% of pediatric patients deemed "at risk" for suicide in this study reported a firearm kept in or around their home.Among youth at risk for suicide, 8% reported having access to a firearm.These results add further evidence that it is important for clinicians to conduct lethal means safety counseling with patients and their families.
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Mournet AM, Bridge JA, Ross A, Powell D, Snyder DJ, Claassen CA, Wharff EA, Pao M, Horowitz LM. A Comparison of Suicide Attempt Histories of Pediatric and Adult Medical Inpatients and Implications for Screening. Arch Suicide Res 2022; 26:1541-1555. [PMID: 34101537 DOI: 10.1080/13811118.2021.1931596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE A suicide attempt is the most potent predictor of future suicidal behavior, yet little is known about how to manage and respond to reports of attempt histories in hospitalized medical patients. This study aims to describe the prevalence and characteristics of pediatric and adult medical inpatients who report a past suicide attempt. METHOD Participants were medical inpatients, aged 10-93 years, enrolled in two suicide risk screening instrument validation studies. Participants completed the Ask Suicide-Screening Questions (ASQ) and the Patient Health Questionnaire (PHQ). RESULTS A total of 1324 medical inpatients (624 pediatric, 700 adult) completed the ASQ, with 114 participants (8.6%) reporting a past suicide attempt (51 pediatric; 63 adults). Comparing youth to adults, there was no significant difference between attempt rates (χ2=0.29, p = 0.59). Youth with a past attempt were significantly more likely to report past week suicidal ideation (OR = 28.22; 95% CI = 5.90, 135.06) and have a history of mental health care (OR = 9.11; 95% CI = 2.59-32.10), compared to those without a past attempt. Adults with a past attempt were significantly more likely to screen positive for depression, compared to those without attempt histories (OR = 5.00; 95% CI = 2.31-10.83). CONCLUSIONS Nearly 9% of hospitalized medical patients endorsed a past suicide attempt when screened. Since adolescence is a critical time for detecting suicide risk, screening that includes past suicidal behavior may be an important means to identify youth with recent suicidal thoughts. By assessing recency of suicide attempts in adults, medical settings may optimize the effectiveness of how positive suicide risk screens are managed.HIGHLIGHTSRoughly 9% of medical patients reported a past suicide attempt when screened.Adolescence is a critical time for detecting suicide risk and intervening.Assessing past suicide attempts in adults can help with managing positive screens.
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Chavez LJ, Steelesmith DL, Bridge JA, Fontanella CA. Predictors of substance use disorder treatment initiation and engagement among adolescents enrolled in Medicaid. Subst Abus 2022; 43:1260-1267. [PMID: 35670769 DOI: 10.1080/08897077.2022.2074603] [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] [Indexed: 10/18/2022]
Abstract
Background: Adolescents with substance use disorders (SUD) should receive timely access to treatment to improve lifelong outcomes. The Healthcare Effectiveness Data and Information Set (HEDIS) initiation and engagement in treatment (IET) performance measure was intended to promote quality improvement for patients with SUD. Yet, few studies have assessed predictors of measure performance among adolescents or other engagement in mental health services, which is critical to understanding disparities in treatment quality or opportunities for targeted improvement strategies. The present study reports the rates and predictors of IET among adolescents with SUD, as well as receipt of any mental health services. Methods: The sample included adolescents enrolled in Medicaid in 14 states who had a qualifying diagnosis for SUD (2009-2013) and met HEDIS IET performance measure eligibility criteria. Three outcomes were assessed, including initiation of SUD treatment within 14 days of qualifying diagnosis, engagement in SUD treatment (2 or more encounters) within 30 days of initiation, and receipt of any mental health services (1 or more encounters) within 30 days of initiation. Logistic regression was used to identify demographic and clinical characteristics associated with outcomes. Results: Among 20,602 adolescents who met eligibility criteria, 49.5% initiated SUD treatment, 48.5% engaged in SUD treatment, and 70% received any mental health service. Adolescents with higher levels of clinical need (e.g., medical complexity, mental health comorbidity, and multiple SUD diagnoses) had significantly higher odds of initiating, but lower odds of engaging in treatment or receiving any mental health service. Conclusions: To increase the delivery of SUD treatment, efforts should target adolescents with co-occurring mental health needs, many of whom are receiving mental health services after SUD diagnosis. Integrating addiction and mental health services could address these missed opportunities.
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Affiliation(s)
- Laura J Chavez
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Danielle L Steelesmith
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jeffrey A Bridge
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Cynthia A Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
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Campo JV, Bridge JA. Editorial: The Enigma of Suicide Risk in Childhood and Its Evolution Across Development. J Am Acad Child Adolesc Psychiatry 2022; 61:604-605. [PMID: 34823026 DOI: 10.1016/j.jaac.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
The problem of suicide can appear incomprehensible at any stage of the life cycle, but little is more puzzling than suicidal thinking and behavior in young children. Despite preadolescent suicide being rare in comparison to suicide later in life, it is the fifth leading cause of death for children ages 5 to 12 in the United States1 and a serious public health problem deserving of study. The study of preadolescent suicide risk also has potential to inform our understanding of suicide across the lifespan. In an important effort to expand our limited understanding of the developmental aspects of suicidal thoughts and behaviors (STBs), Whalen and colleagues2 report on the longitudinal trajectories of STBs for a sample of more than 300 preschool children recruited between the ages of 3 and 6 years and followed prospectively through age 17 years. Longitudinal studies allow researchers to collect more detailed information than could be obtained from a single cross-sectional survey and can offer insights into how psychopathology and associated risks evolve over time. This study is relatively unique in prospectively assessing STBs and associated risk and protective factors from the preschool period through adolescence.
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Affiliation(s)
- John V Campo
- Johns Hopkins University School of Medicine and Kennedy Krieger Institute, Johns Hopkins Children's Center, Baltimore, Maryland.
| | - Jeffrey A Bridge
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, and The Ohio State University College of Medicine, Columbus
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Sheftall AH, Vakil F, Ruch DA, Boyd RC, Lindsey MA, Bridge JA. Black Youth Suicide: Investigation of Current Trends and Precipitating Circumstances. J Am Acad Child Adolesc Psychiatry 2022; 61:662-675. [PMID: 34509592 PMCID: PMC8904650 DOI: 10.1016/j.jaac.2021.08.021] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/10/2021] [Accepted: 09/01/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Suicide among Black youth is a significant public health concern, yet research investigating the epidemiology of suicide in this population is limited. This study examines current trends and precipitating circumstances of suicide by sex and age group in Black youth 5 to 17 years of age, using 2 national databases. METHOD Data from the Web-based Injury Statistics Query and Reporting System (WISQARS) and the National Violent Death Reporting System (NVDRS) were used to investigate trends and precipitating circumstances of Black youth suicide from 2003 to 2017. We hypothesized suicide rates would increase over time for both sexes and all age groups (5-11, 12-14, and 15-17 years), and precipitating circumstances would differ by sex and age group. Trend analyses were conducted using Joinpoint regression software, version 4.8.0.01 (Surveillance Research Program, National Cancer Institute). Sex and age group comparisons of characteristics and precipitating circumstances were conducted using standard univariate statistical tests. RESULTS From 2003 to 2017, Black youth experienced a significant upward trend in suicide with the largest annual percentage change in the 15- to 17-year age group and among girls (4.9% and 6.6%, respectively). Mental health problems, relationship problems, interpersonal trauma and life stressors, and prior suicidal thoughts/behavior were the most common clinical characteristics and precipitating circumstances, with several varying by sex and age group. CONCLUSION Increases in Black youth suicide calls for the prioritization of research aimed at identifying specific risk and protective factors as well as developmental mechanisms associated with Black youth suicidal behavior. To implement effective suicide prevention programming, understanding targets for intervention is necessary.
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Affiliation(s)
- Arielle H Sheftall
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus.
| | - Fatima Vakil
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Donna A Ruch
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Rhonda C Boyd
- Children's Hospital of Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Michael A Lindsey
- Silver School of Social Work, New York University, New York; McSilver Institute for Poverty Policy and Research, New York
| | - Jeffrey A Bridge
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus
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DeVylder J, Yang LH, Goldstein R, Ross AM, Oh H, Zhou S, Horowitz L, Bridge JA. Mental health correlates of stigma among college students with suicidal ideation: Data from the 2020–2021 Healthy Minds Study. Stigma and Health 2022. [DOI: 10.1037/sah0000376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Llamocca EN, Fristad MA, Bridge JA, Brock G, Steelesmith DL, Axelson DA, Fontanella CA. Correlates of deliberate self-harm among youth with bipolar disorder. J Affect Disord 2022; 302:376-384. [PMID: 35066010 PMCID: PMC8957063 DOI: 10.1016/j.jad.2022.01.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/15/2021] [Accepted: 01/19/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Youth with bipolar disorder (BD) are at high risk for deliberate self-harm (DSH) and suicide. However, research regarding factors associated with DSH, a key suicide risk factor, among youth with BD is limited. In a population-based sample of youth with BD, we therefore investigated associations between demographic, clinical, and service utilization factors and DSH incidence and compared suicide, unintentional injury, and all-cause mortality to the general population. METHOD We analyzed a retrospective cohort of youth aged 5 to 19 years with a new BD episode between 2010 and 2017 (n = 25,244) using Ohio Medicaid claims and death certificate data. Cox proportional hazards models examined associations between different factors and DSH. Mortality rates were compared to the general population using standardized mortality ratios. RESULTS During follow-up, 1,517 (6.0%) youth had at least one DSH event. Older index age, female sex, comorbid psychiatric/medical conditions, prior DSH/suicidal ideation, and prior ER mental healthcare were associated with increased DSH risk. Prior DSH was most strongly associated with increased DSH risk for 3 months after a new BD episode. Being non-Hispanic Black (vs. White, non-Hispanic) and prior psychiatric hospitalization were associated with decreased DSH hazard. DSH risk was highest for 3 months after a new BD episode. Suicide, unintentional injury, and all-cause mortality rates were elevated in youth with BD. LIMITATIONS May not generalize to other states or non-Medicaid populations; claims data cannot distinguish suicidal intent of self-harm CONCLUSION: Early intervention following a new BD episode, particularly among high-risk groups, is key to prevent DSH.
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Affiliation(s)
- Elyse N Llamocca
- Division of Epidemiology, The Ohio State University, Columbus, OH, USA; Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Mary A Fristad
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA; Big Lots Behavioral Health Services and Division of Child and Family Psychiatry, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jeffrey A Bridge
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA; Department of Pediatrics, The Ohio State University, Columbus, OH, USA; Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Guy Brock
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Danielle L Steelesmith
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - David A Axelson
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA; Department of Psychiatry, Nationwide Children's Hospital, Columbus, OH, USA
| | - Cynthia A Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA.
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Horowitz LM, Bridge JA, Tipton MV, Abernathy T, Mournet AM, Snyder DJ, Lanzillo EC, Powell D, Schoenbaum M, Brahmbhatt K, Pao M. Implementing Suicide Risk Screening in a Pediatric Primary Care Setting: From Research to Practice. Acad Pediatr 2022; 22:217-226. [PMID: 35248306 PMCID: PMC8908796 DOI: 10.1016/j.acap.2021.10.012] [Citation(s) in RCA: 6] [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: 05/04/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To describe the methodological development and feasibility of real-world implementation of suicide risk screening into a pediatric primary care setting. METHODS A suicide risk screening quality improvement project (QIP) was implemented by medical leadership from a suburban-based pediatric (ages 12-25 years) primary care practice in collaboration with a National Institute of Mental Health (NIMH) suicide prevention research team. A pilot phase to acclimate office staff to screening procedures preceded data collection. A convenience sample of 271 pediatric medical outpatients was screened for suicide risk. Patients, their parents, and medical staff reported their experiences and opinions of the screening procedures. RESULTS Thirty-one (11.4%) patients screened positive for suicide risk, with 1 patient endorsing imminent suicide risk (3% of positive screens; 0.4% of total sample). Over half of the patients who screened positive reported a past suicide attempt. Most patients, parents, and medical staff supported the implementation of suicide risk screening procedures into standard care. A mental health clinical pathway for suicide risk screening in outpatient settings was developed to provide outpatient medical settings with guidance for screening. CONCLUSIONS Screening for suicide risk in pediatric primary care is feasible and acceptable to patients, their families, and medical staff. A clinical pathway used as guidance for pediatric health care providers to implement screening programs can aid with efficiently detecting and managing patients who are at risk for suicide.
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Affiliation(s)
- Lisa M. Horowitz
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD, USA
| | - Jeffrey A. Bridge
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mary V. Tipton
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD, USA
| | - Ted Abernathy
- Pediatric & Adolescent Health Partners, Richmond, VA, USA
| | - Annabelle M. Mournet
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD, USA
| | - Deborah J. Snyder
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD, USA
| | - Elizabeth C. Lanzillo
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD, USA
| | - Daniel Powell
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD, USA
| | - Michael Schoenbaum
- Division of Services and Intervention Research, National Institute of Mental Health (NIMH), Bethesda, MD, US
| | - Khyati Brahmbhatt
- University of California, San Francisco, UCSF Benioff Children’s Hospital, Department of Psychiatry and Behavioral Science, San Francisco, CA, USA
| | - Maryland Pao
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD, USA
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Tsypes A, Szanto K, Bridge JA, Brown VM, Keilp JG, Dombrovski AY. Delay discounting in suicidal behavior: Myopic preference or inconsistent valuation? J Psychopathol Clin Sci 2022; 131:34-44. [PMID: 34843269 PMCID: PMC8893041 DOI: 10.1037/abn0000717] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Prior studies sought to explain the predisposition to suicidal behavior in terms of myopic preference for immediate versus delayed reward, generating mixed evidence. Data from gambling and bandit tasks, however, suggest that suboptimal decisions in suicidal individuals are explained by inconsistent valuation rather than myopic preferences. We tested these two alternative hypotheses using a delay discounting task in 622 adults (suicide attempters with depression, suicide ideators with depression, nonsuicidal participants with depression, and healthy controls) recruited across three sites through inpatient psychiatric units, mood disorders clinics, primary care, and advertisements. Multilevel models revealed group differences in valuation consistencies in all three samples, with high-lethality suicide attempters exhibiting less consistent valuation than all other groups in Samples 1 and 3 and less consistent valuation than the healthy controls or participants with depression in Sample 2. In contrast, group differences in preference for immediate versus delayed reward were observed only in Sample 1 and were due to the high-lethality suicide attempters displaying a weaker preference for immediate reward than low-lethality suicide attempters. The findings were robust to confounds such as cognitive functioning and comorbidities. Seemingly impulsive choices in suicidal behavior are explained by inconsistent reward valuation rather than a true preference for immediate reward. In a suicidal crisis, this inconsistency may result in a misestimation of the value of suicide relative to constructive alternatives and deterrents. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Aliona Tsypes
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Katalin Szanto
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Jeffrey A. Bridge
- Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH,Department of Pediatrics, Psychiatry & Behavioral Health, The Ohio State University College of Medicine, Columbus, OH
| | - Vanessa M. Brown
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - John G. Keilp
- Department of Psychiatry, Columbia University, New York, NY
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Powell DS, Lanzillo EC, Jay SY, Tanenbaum M, Bridge JA, Wharff EA, Ballard E, Pao M, Horowitz LM. Self-reported Symptoms of Anxiety Predict Positive Suicide Risk Screening in Adolescents Presenting to the Emergency Department. Pediatr Emerg Care 2022; 38:22-25. [PMID: 32925705 PMCID: PMC9773526 DOI: 10.1097/pec.0000000000002234] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The objective of this study was to assess whether patient-reported anxiety symptoms are associated with suicide risk in pediatric emergency department (ED) patients. An additional objective was to examine differences between patients presenting for medical/surgical or psychiatric complaints. METHODS Pediatric patients aged 10 to 21 years were recruited from 3 pediatric EDs. Participants completed self-report questionnaires assessing for suicidal ideation and behavior, in addition to questions of interest about recent feelings of unbearable anxiety and depression. Adjusted odds ratios were calculated to assess the relationship between endorsement of recent anxiety and screening positive for suicide risk. RESULTS Data were analyzed from 522 participants, including 344 presenting with medical/surgical chief complaints and 178 presenting with psychiatric complaints. Overall, 28.9% of participants screened positive for suicide risk, 29.9% endorsed recent feelings of anxiety, and 24.3% endorsed recent feelings of depression. Patients who self-reported recent anxiety symptoms were 5 times more likely to screen positive for suicide risk (adjusted odds ratios = 5.18, 95% confidence interval = 3.06-8.76). Analysis of the 344 medical/surgical patients revealed that this subsample was also 5 times more likely to screen positive for suicide risk if they endorsed recent anxiety (adjusted odds ratios = 4.87, 95% confidence interval = 2.09-11.36). CONCLUSIONS Self-reported suicidal ideation and feelings of unbearable anxiety are prevalent among patients presenting to pediatric EDs. Patients who self-report recent feelings of unbearable anxiety are significantly more likely to screen positive for suicide risk, regardless of whether their presenting complaint is medical/surgical or psychiatric in nature.
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Affiliation(s)
| | | | | | - Mira Tanenbaum
- Virginia Tech Carilion School of Medicine and Research Institute, Roanoke, VA
| | - Jeffrey A Bridge
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH and The Ohio State University, Columbus, OH
| | | | | | - Maryland Pao
- National Institute of Mental Health, North Bethesda, MD
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Ruch DA, Steelesmith DL, Brock G, Boch SJ, Quinn CR, Bridge JA, Campo JV, Fontanella CA. Mortality and Cause of Death Among Youths Previously Incarcerated in the Juvenile Legal System. JAMA Netw Open 2021; 4:e2140352. [PMID: 34940865 PMCID: PMC8703246 DOI: 10.1001/jamanetworkopen.2021.40352] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/26/2021] [Indexed: 11/15/2022] Open
Abstract
Importance More than 50 000 youths are incarcerated in the United States on any given day, and youth incarceration has been linked to lasting adverse outcomes, including early mortality. Improving our understanding of the factors associated with early mortality among incarcerated youths can inform appropriate prevention strategies. Objective To examine mortality rates and causes of death among youths previously incarcerated in the juvenile legal system. Design, Setting, and Participants This retrospective longitudinal population-based cohort study compared mortality rates between youths aged 11 to 21 years incarcerated from 2010 to 2017 with same-aged nonincarcerated Medicaid-enrolled youths in the state of Ohio. Data from January 2017 to December 2019 were collected from juvenile incarceration, Medicaid, and death certificate information in Ohio. Exposure Incarceration in the state of Ohio's juvenile legal system. Main Outcomes and Measures Number, characteristics, and causes of deaths. Poisson regression incidence rate ratios (IRRs) compared mortality rates between previously incarcerated and Medicaid-enrolled youths. Results Among 3645 incarcerated youths, 3398 (93.2%) were male, 2155 (59.1%) Black, 1307 (35.9%) White, and 183 (5.0%) other race and ethnicity. Overall, 113 youths (3.1%) died during the study period. Homicide was the leading cause of death in formerly incarcerated youths (homicide: 63 [55.8%]; legal intervention [ie, death due to injuries inflicted by law enforcement]: 3 [2.7%]). All-cause mortality rates were significantly higher among previously incarcerated youths than Medicaid-enrolled youths (adjusted IRR [aIRR], 5.91; 95% CI, 4.90-7.13) in every demographic subgroup. Compared with Medicaid-enrolled youths, mortality rates for previously incarcerated youths were highest for homicide (aIRR, 11.02; 95% CI, 8.54-14.22), overdose (aIRR, 4.32; 95% CI, 2.59-7.20), and suicide (aIRR, 4.30; 95% CI, 2.22-8.33). Formerly incarcerated Black youths had a significantly higher risk of homicide (aIRR, 14.24; 95% CI, 4.45-45.63) but a lower risk of suicide (aIRR, 0.18; 95% CI, 0.04-0.89) and overdose (aIRR, 0.31; 95% CI, 0.10-0.99) than White youths who were incarcerated. Previously incarcerated youths aged 15 to 21 years were significantly more likely to die than youths aged 22 to 29 years, irrespective of cause of death (aIRR for youths aged 22-29 years, 0.09; 95% CI, 0.06-0.14). Conclusions and Relevance In this study, youths with a history of incarceration were significantly more likely to experience early mortality compared with nonincarcerated Medicaid-enrolled youths. Delinquency and violence prevention strategies that incorporate a culturally informed approach and consider sex and developmental level are critical.
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Affiliation(s)
- Donna A. Ruch
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Danielle L. Steelesmith
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
| | - Guy Brock
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus
| | - Samantha J. Boch
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | - Jeffrey A. Bridge
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - John V. Campo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cynthia A. Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
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Cullen SW, Marcus SC, Xie M, Caterino JM, Bridge JA, Olfson M. Hospital and Community Correlates of Recommended Emergency Department Mental Health Care for Patients Presenting With Self-Harm. Psychiatr Serv 2021; 72:1332-1336. [PMID: 34235948 PMCID: PMC8570966 DOI: 10.1176/appi.ps.202000779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Emergency departments (EDs) are well positioned to deliver suicide prevention services. This study examined hospital and community correlates of recommended practices. METHODS This study examined results from a national survey of ED nursing directors (N=513) focusing on hospital- and community-level variation in the routine provision of four recommended practices: suicide risk screening, access to means assessment, safety planning, and follow-up referrals. RESULTS Few significant differences existed between hospitals that routinely provided these practices and hospitals that did not. Routine scheduling of follow-up appointments was associated with presence of formal contractual relationships with outpatient mental health facilities (p=0.005). Routine provision of safety planning was associated with higher levels of psychiatrist or psychologist staffing (p=0.032). CONCLUSIONS There were few differences in the hospital and community characteristics between EDs that routinely provided recommended care and those that did not, suggesting few structural barriers to implementation of these recommended services for high-risk ED patients.
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Affiliation(s)
- Sara Wiesel Cullen
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Cullen, Marcus, Xie);Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus (Caterino);The Abigail Wexner Research Institute at Nationwide Children's Hospital, andDepartments of Pediatrics, Psychiatry, and Behavioral Health, The Ohio State University, Columbus (Bridge);New York State Psychiatric Institute and Clinic, and College of Physicians and Surgeons, Columbia University, New York City (Olfson)
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Cullen, Marcus, Xie);Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus (Caterino);The Abigail Wexner Research Institute at Nationwide Children's Hospital, andDepartments of Pediatrics, Psychiatry, and Behavioral Health, The Ohio State University, Columbus (Bridge);New York State Psychiatric Institute and Clinic, and College of Physicians and Surgeons, Columbia University, New York City (Olfson)
| | - Ming Xie
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Cullen, Marcus, Xie);Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus (Caterino);The Abigail Wexner Research Institute at Nationwide Children's Hospital, andDepartments of Pediatrics, Psychiatry, and Behavioral Health, The Ohio State University, Columbus (Bridge);New York State Psychiatric Institute and Clinic, and College of Physicians and Surgeons, Columbia University, New York City (Olfson)
| | - Jeffrey M Caterino
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Cullen, Marcus, Xie);Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus (Caterino);The Abigail Wexner Research Institute at Nationwide Children's Hospital, andDepartments of Pediatrics, Psychiatry, and Behavioral Health, The Ohio State University, Columbus (Bridge);New York State Psychiatric Institute and Clinic, and College of Physicians and Surgeons, Columbia University, New York City (Olfson)
| | - Jeffrey A Bridge
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Cullen, Marcus, Xie);Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus (Caterino);The Abigail Wexner Research Institute at Nationwide Children's Hospital, andDepartments of Pediatrics, Psychiatry, and Behavioral Health, The Ohio State University, Columbus (Bridge);New York State Psychiatric Institute and Clinic, and College of Physicians and Surgeons, Columbia University, New York City (Olfson)
| | - Mark Olfson
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Cullen, Marcus, Xie);Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus (Caterino);The Abigail Wexner Research Institute at Nationwide Children's Hospital, andDepartments of Pediatrics, Psychiatry, and Behavioral Health, The Ohio State University, Columbus (Bridge);New York State Psychiatric Institute and Clinic, and College of Physicians and Surgeons, Columbia University, New York City (Olfson)
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Moe AM, Llamocca E, Wastler HM, Steelesmith DL, Brock G, Bridge JA, Fontanella CA. Risk Factors for Deliberate Self-harm and Suicide Among Adolescents and Young Adults With First-Episode Psychosis. Schizophr Bull 2021; 48:414-424. [PMID: 34651178 PMCID: PMC8886578 DOI: 10.1093/schbul/sbab123] [Citation(s) in RCA: 8] [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] [Indexed: 11/13/2022]
Abstract
Little is known about the risk factors for deliberate self-harm (DSH) and suicide among adolescents and young adults with first episode psychosis (FEP) and the longitudinal course of DSH following the initial onset of illness. This study identifies risk factors for DSH and suicide death among Medicaid-covered adolescents and young adults with FEP along with the periods of greatest risk for DSH after diagnosis. A retrospective longitudinal cohort analysis was performed using Medicaid claims data merged with death certificate data for 19 422 adolescents and young adults (aged 15-24 years) diagnosed with the onset of FEP between 2010 and 2017. DSH per 1000 person-years and standardized mortality rates for suicide were determined. Hazard ratios of DSH and suicide were estimated by Cox proportional hazard models. During follow-up, 2148 (11.1%) individuals had at least one self-harm event and 22 (0.1%) died by suicide. The hazards of DSH were significantly higher for those with a previous DSH, suicidal ideation, child abuse and neglect, comorbid medical and psychiatric diagnoses, and prior mental health care. The median follow-up time for those who had DSH was 208.0 days (SD: 526.5 days) in adolescents and 108.0 days (SD: 340.0 days) in young adults. Risk of DSH was highest in the first 3 months following FEP. Individuals with FEP are at high risk for self-harm and suicidal behavior, and recognition of who among these individuals and when following illness onset they are at greatest risk may guide more precise clinical recognition and intervention.
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Affiliation(s)
- Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA,Department of Psychology, The Ohio State University, Columbus, OH, USA,To whom correspondence should be addressed; The Ohio State University Wexner Medical Center, 1670 Upham Drive, Columbus, OH 43210, USA; tel: 614-293-6039, fax: 614-293-4949, e-mail:
| | - Elyse Llamocca
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA,Division of Epidemiology, The Ohio State University, Columbus, OH, USA
| | - Heather M Wastler
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Danielle L Steelesmith
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Guy Brock
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Jeffrey A Bridge
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Cynthia A Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
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Abstract
A quantitative assessment of publications in suicidology has not been conducted yet. Web of Science was used to identify publications on suicidal behavior between 1989 and 2018. 41,276 items were retrieved. Over 30 years, the number of annual publications has been multiplied by 6. Psychiatry and psychology were the dominant research areas. Three-quarters of all publications were produced by high-income countries. A significant gap between male and female researchers persisted over time. Reported funding was largely public with a significant share from the private sector. Overall, suicidology appears as a dynamic field of research. This study also underlines two priorities: bridging the gender gap and encourage research in low- and middle-income countries where 80% of suicides occur.
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Stevens J, Bridge JA. Editorial: Household Firearms, Child Access Prevention Laws, and Adolescent Suicide. J Am Acad Child Adolesc Psychiatry 2021; 60:1059-1061. [PMID: 33307125 DOI: 10.1016/j.jaac.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022]
Abstract
In the United States, suicide is the second leading cause of death among adolescents aged 14-18 years, and the rate of suicide increased 61% from 2009 to 2018.1 During that period, 15,951 14- to 18-year-olds died by suicide, with 6,794 deaths (42.6%) occurring with a firearm.1 Most firearm suicide deaths in adolescents occur in the home with a firearm owned by the parent.2 An aspirational goal of the National Strategy for Suicide Prevention is to reduce access to lethal means that people use to attempt suicide. The American Foundation for Suicide Prevention has identified firearms as one of 4 critical areas to address in Project 2025, the nationwide initiative to reduce the suicide rate 20% by 2025.3.
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Affiliation(s)
- Jack Stevens
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Jeffrey A Bridge
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
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Horowitz LM, Wharff EA, Mournet AM, Ross AM, McBee-Strayer S, He JP, Lanzillo EC, White E, Bergdoll E, Powell DS, Solages M, Merikangas KR, Pao M, Bridge JA. Validation and Feasibility of the ASQ Among Pediatric Medical and Surgical Inpatients. Hosp Pediatr 2021; 10:750-757. [PMID: 32826283 DOI: 10.1542/hpeds.2020-0087] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To validate the use of a brief suicide risk screening tool, the Ask Suicide-Screening Questions (ASQ) instrument, in pediatric inpatient medical and surgical settings. METHODS Pediatric patients (10-21 years) hospitalized on inpatient medical and surgical units were recruited through convenience sampling for participation in a cross-sectional instrument validation study. The Suicidal Ideation Questionnaire was used as a standard criterion to validate the ASQ. Patient opinions about screening and parent consent to enroll in a suicide risk screening study were assessed to determine the feasibility of administering the ASQ in this venue. RESULTS A total of 600 pediatric medical inpatients were screened. Compared with the gold standard, the ASQ had strong psychometric properties, with a sensitivity of 96.67% (95% confidence interval [CI]: 82.78 to 99.92), a specificity of 91.05% (95% CI: 88.40 to 93.27), a negative predictive value of 99.81% (95% CI: 98.93 to 99.99), and an area under curve of 0.94 (95% CI: 0.90 to 0.97). Only 3 participants (0.5%) had acute positive screen results on the ASQ, endorsing current suicidal ideation, whereas 77 participants (12.8%) screened nonacute positive, and 48 participants (8.0%) reported a past suicide attempt. CONCLUSIONS The brief 4-item ASQ is a valid tool to detect elevated suicide risk in pediatric medical and surgical inpatients. Our findings also reveal that screening is feasible in terms of detection of suicidal thoughts and behaviors and is acceptable to parents and patients.
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Affiliation(s)
| | | | | | | | - Sandra McBee-Strayer
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Jian-Ping He
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, Maryland;
| | | | - Erina White
- Boston Children's Hospital, Boston, Massachusetts
| | - Emory Bergdoll
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Martine Solages
- Children's National Hospital, Washington, District of Columbia; and
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, Maryland
| | | | - Jeffrey A Bridge
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio.,College of Medicine, The Ohio State University, Columbus, Ohio
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36
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Conner KR, Chapman BP, Beautrais AL, Brent DA, Bridge JA, Conwell Y, Falter T, Holbrook A, Schneider B. Introducing the Psychological Autopsy Methodology Checklist. Suicide Life Threat Behav 2021; 51:673-683. [PMID: 33559215 PMCID: PMC8378509 DOI: 10.1111/sltb.12738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Case-control psychological autopsy studies are the research standard for the postmortem, quantitative study of ongoing or recent risk factors for suicide. We aimed to develop a reliable checklist of methodological quality of these studies. METHOD We adapted items from a validated checklist to address general methodological elements and created novel items to address the unique aspects of psychological autopsy research to generate a 16-item checklist assessing reporting, external validity, internal validity, and power. We used percent agreement and kappa to evaluate inter-rater reliability of the items and overall checklist based on independent ratings of 26 case-control psychological autopsy studies conducted internationally. We also summed the items to generate overall quality ratings, assessing internal consistency with coefficient alpha (α). RESULTS Inter-rater reliability for the overall checklist was high (percent agreement, 86.5%) and that based conservatively on kappa was substantial (κ .71) whereas internal consistency was low (α = 0.56). The inter-rater reliability of the individual items showed acceptable to high agreement. CONCLUSION A novel checklist provides a reliable means to assess the methodological quality of specific elements of quantitative case-control psychological autopsy studies, providing detailed guidance in planning such studies. Lower internal consistency may limit its utility as a summary measure of study quality.
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Affiliation(s)
- Kenneth R. Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Benjamin P. Chapman
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA,Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | - David A. Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey A. Bridge
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Tyler Falter
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Amanda Holbrook
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Barbara Schneider
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Centre of Psychiatry, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany
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Schlagbaum P, Tissue JL, Sheftall AH, Ruch DA, Ackerman JP, Bridge JA. The impact of peer influencing on adolescent suicidal ideation and suicide attempts. J Psychiatr Res 2021; 140:529-532. [PMID: 34167026 DOI: 10.1016/j.jpsychires.2021.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/11/2020] [Revised: 04/09/2021] [Accepted: 06/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the role of peer influence on adolescent suicidal ideation and attempts within youth seeking emergency care or outpatient mental health services. We examined whether affiliation with peers reporting suicidal thoughts/behaviors was associated with an adolescent's own suicidal ideation and/or suicide attempt beyond individual risk factors. METHODS One hundred and eighteen adolescents, ages 13-18, were recruited from the emergency department and outpatient mental health clinics at a large, metropolitan children's hospital. Adolescents with suicidal ideation in the past six months (ideators, n=19) and with a suicide attempt in the past year (attempters, n=40) were matched with controls with no history of ideation or attempt on age (±1 year), sex, and race. Adolescents and parents completed semi-structured interviews and self-report questionnaires to examine individual and peer associated risk factors. RESULTS Both ideators and attempters were more likely to affiliate with peers with suicidal behavior compared to their matched controls. However, affiliation with suicidal peers was only associated with attempter group status after controlling for individual risk factors. CONCLUSION Affiliation with peers reporting suicidal thoughts/behaviors was linked to an adolescent's own history of suicide attempt. Through understanding peer affiliation, peers may be an important resource for both identifying and preventing youth suicidal behavior. Evidence-based programs that focus and utilize peer influence may be invaluable for prevention efforts.
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Affiliation(s)
- Paige Schlagbaum
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jaclyn L Tissue
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Arielle H Sheftall
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Donna A Ruch
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - John P Ackerman
- Department of Behavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jeffrey A Bridge
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.
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38
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Kemper AR, Hostutler CA, Beck K, Fontanella CA, Bridge JA. Depression and Suicide-Risk Screening Results in Pediatric Primary Care. Pediatrics 2021; 148:peds.2021-049999. [PMID: 34099503 DOI: 10.1542/peds.2021-049999] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Depression is common, and suicide rates are increasing. Adolescent depression screening might miss those with unidentified suicide risk. Our primary objective in this study was to compare the magnitude of positive screen results across different approaches. METHODS From June 2019 to October 2020, 803 mostly Medicaid-enrolled adolescents aged ≥12 years with no recent history of depression or self-harm were screened with the Patient Health Questionnaire-9 Modified for Adolescents (PHQ-9A) and the Ask Suicide-Screening Questions (ASQ) across 12 primary care practices. Two PHQ-9A screening strategies were evaluated: screening for any type of depression or other mental illness (positive on any item) or screening for major depressive disorder (MDD) (total score ≥10). RESULTS Overall, 56.4% of patients screened positive for any type of depression, 24.7% screened positive for MDD, and 21.1% screened positive for suicide risk. Regardless of PHQ-9A screening strategy, the ASQ identified additional subjects (eg, 2.2% additional cases compared with screening for any type of depression or other mental illness and 8.3% additional cases compared with screening positive for MDD). Of those with ≥6 month follow-up, 22.9% screened positive for any type of depression (n = 205), 35.6% screened positive for MDD (n = 90), and 42.7% with a positive ASQ result (n = 75) had a depression or self-harm diagnosis or an antidepressant prescription. CONCLUSIONS Suicide risk screening identifies cases not identified by depression screening. In this study, we underscore opportunities and challenges in primary care related to the high prevalence of depression and suicide risk. Research is needed regarding optimal screening strategies and to help clinicians manage the expected number of screening-identified adolescents.
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Affiliation(s)
- Alex R Kemper
- Division of Primary Care Pediatrics .,Department of Pediatrics, College of Medicine
| | - Cody A Hostutler
- Department of Pediatrics, College of Medicine.,Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio
| | - Kristen Beck
- Division of Primary Care Pediatrics.,Department of Pediatrics, College of Medicine
| | - Cynthia A Fontanella
- Department of Psychiatry and Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Jeffrey A Bridge
- Department of Pediatrics, College of Medicine.,Department of Psychiatry and Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio.,Center for Suicide Prevention and Research, Abigail Wexner Research Institute
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Ruch DA, Heck KM, Sheftall AH, Fontanella CA, Stevens J, Zhu M, Horowitz LM, Campo JV, Bridge JA. Characteristics and Precipitating Circumstances of Suicide Among Children Aged 5 to 11 Years in the United States, 2013-2017. JAMA Netw Open 2021; 4:e2115683. [PMID: 34313741 PMCID: PMC8317003 DOI: 10.1001/jamanetworkopen.2021.15683] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Suicide is the eighth leading cause of death among children aged 5 to 11 years, with rates increasing during the past decade. A better understanding of factors associated with childhood suicide can inform developmentally appropriate prevention strategies. OBJECTIVE To examine characteristics and precipitating circumstances of childhood suicide. DESIGN, SETTING, AND PARTICIPANTS This qualitative study examined restricted-use data from the National Violent Death Reporting System (NVDRS) regarding child suicide decedents aged 5 to 11 years in the US from 2013 to 2017. The NVDRS is a state-based surveillance system that collects data on suicide and violent deaths in 50 states, with restricted-use data available from 37 states. Details and context related to suicide deaths were identified through a content analysis of case narratives from coroner or medical examiner and law enforcement reports associated with each incident. EXPOSURES Characteristics and precipitating circumstances associated with suicide cited in the coroner, medical examiner, and law enforcement case narratives. MAIN OUTCOMES AND MEASURES Suicide incidence and risk factors for suicide including mental health, prior suicidal behavior, trauma, and peer, school, or family-related problems. RESULTS Analyses included 134 child decedents (101 [75.4%] males; 79 [59.0%] White individuals; 109 [81.3%] non-Hispanic individuals; mean [SD] age, 10.6 [0.8] years). Most suicides occurred in the child's home (95.5% [n = 128]), and more specifically in the child's bedroom. Suicide by hanging or suffocation (78.4% [n = 105]) was the most frequent method, followed by firearms (18.7% [n = 25]). Details on gun access were noted in 88.0% (n = 22) of suicides by firearm, and in every case, the child obtained a firearm stored unsafely in the home. Findings revealed childhood suicide was associated with numerous risk factors accumulated over time, and suggest a progression toward suicidal behavior, especially for youth with a history of psychopathology and suicidal behavior. An argument between the child and a family member and/or disciplinary action was often a precipitating circumstance of the suicide. CONCLUSIONS AND RELEVANCE This qualitative study found that childhood suicide was associated with multiple risk factors and commonly preceded by a negative precipitating event. Potential prevention strategies include improvements in suicide risk assessment, family relations, and lethal means restriction, particularly safe firearm storage. Future research examining the myriad aspects of childhood suicide, including racial/ethnic and sex differences, is needed.
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Affiliation(s)
- Donna A. Ruch
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus
| | - Kendra M. Heck
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus
| | - Arielle H. Sheftall
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Cynthia A. Fontanella
- The Ohio State University Wexner Medical Center Department of Psychiatry and Behavioral Health, Columbus
| | - Jack Stevens
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Motao Zhu
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Lisa M. Horowitz
- National Institute of Mental Health, National Institutes of Health, Office of the Clinical Director, Bethesda, Maryland
| | - John V. Campo
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland
| | - Jeffrey A. Bridge
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
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40
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Arnold TS, Siekmann T, Thackeray JD, Bridge JA, Cohen DM. Discrepancies in Physician and Coroner Findings in Cases of Fatal Suspected Physical Child Abuse. Pediatr Emerg Care 2021; 37:e367-e371. [PMID: 34140452 DOI: 10.1097/pec.0000000000002476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES As mandated reporters of suspected abuse, physicians must consider abuse when a child dies unexpectedly. Subsequently, a coroner or medical examiner determines the manner of death (MOD) and cause of death (COD). Accurate diagnoses and determinations are important for social safety and justice. This study described discrepancies between physicians' and coroners' findings in cases of fatal suspected physical child abuse. METHODS This study was a single-institution, retrospective review. All children 6 years or younger who died in a pediatric emergency department from October 2006 to January 2013 with a coroner report were included in this study. Coroner reports, MODs, and CODs were reviewed. Skeletal survey results were compared with coroners' findings. RESULTS One hundred twenty-nine children were included. The MODs included the following: undetermined, 63 (49%); accident, 32 (25%); natural, 31 (24%); and homicide, 3 (2%). Thirty-three (26%) of the 129 patients had abuse suspected at the time of death in the emergency department; in this subset, MODs were as follows: undetermined, 16 (48%); accident, 8 (24%); natural, 6 (18%); and homicide, 3 (9%). Sudden infant death syndrome or sudden unexpected death was the most common COD in all children (68, 55%). Skeletal surveys were positive in 12 children with 29 fractures identified; 8 (28%) of the 29 fractures were corroborated on autopsy findings. Of the 12 children with positive skeletal survey findings, only 1 was ruled a homicide. CONCLUSIONS We found discrepancies between coroner determination of homicide and abuse suspected by physicians, especially among children with fractures. Improved communication between agencies in cases of fatal child abuse is needed.
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Affiliation(s)
| | | | | | - Jeffrey A Bridge
- Departments of Pediatrics, Psychiatry and Behavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Daniel M Cohen
- From the Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH
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41
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Sheftall AH, Vakil F, Armstrong SE, Rausch JR, Feng X, Kerns KA, Brent DA, Bridge JA. Clinical risk factors, emotional reactivity/regulation and suicidal ideation in elementary school-aged children. J Psychiatr Res 2021; 138:360-365. [PMID: 33930615 PMCID: PMC8192478 DOI: 10.1016/j.jpsychires.2021.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Suicidal behavior (SB) in young children is rare yet in 2019, suicide was the fifth leading cause of death in 5-12-year-old youth. Understanding the risks associated with childhood suicidal ideation (SI) and SB will determine which factors should be targeted for prevention programming. This study examined clinical characteristics and emotional reactivity/regulation (ERR) in children with (SI+) and without (SI-) SI. METHOD One hundred seventeen children, 6-9 years, and one biological parent were enrolled. Children completed interviews concerning SI/SB and parents completed interviews/self-reports about SI/SB, psychiatric distress, and history of abuse/neglect and their child's SI/SB, mental health, and ERR. Independent t-tests and Chi-square analyses using Bonferroni correction were conducted to examine SI group differences. Variables were then screened using forward stepwise logistic regression to determine association with SI + status. The final logistic regression included variables that survived screening procedures only. RESULTS Univariate analyses revealed SI + children were more likely to have a parental history of suicide attempt (PH+), higher rates of current psychotropic medication use, higher scores on the CBCL-DSM oriented scales (e.g., ADHD problems), and higher negative affect compared to SI- children. After analytic screening procedures, PH+, anxiety problems, ADHD problems, and anger survived. The final logistic regression revealed PH + status and anxiety problems were associated with SI + status. CONCLUSION Long-term follow-up is needed to determine if these factors are predictive of a first-time suicide attempt in this at-risk group.
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Affiliation(s)
- Arielle H Sheftall
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, USA; Department of Pediatrics, The Ohio State University, College of Medicine, USA.
| | - Fatima Vakil
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, USA
| | - Sarah E Armstrong
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, USA
| | - Joseph R Rausch
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, USA
| | - Xin Feng
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, USA
| | - Kathryn A Kerns
- Department of Psychological Sciences, Kent State University, USA
| | - David A Brent
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, USA
| | - Jeffrey A Bridge
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, USA; Departments of Pediatrics and Psychiatry & Behavioral Health, Ohio State University College of Medicine, USA
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Humphries KD, Li L, Smith GA, Bridge JA, Zhu M. Suicide Attempts in Association With Traditional and Electronic Bullying Among Heterosexual and Sexual Minority U.S. High School Students. J Adolesc Health 2021; 68:1211-1214. [PMID: 33546984 DOI: 10.1016/j.jadohealth.2020.12.133] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this study was to compare the association between bullying (traditional, electronic, and both) and suicide attempt in heterosexual and lesbian, gay, or bisexual (LGB) U.S. high school students. METHODS Data were obtained from 2015-2017 National Youth Risk Behavior Survey. RESULTS Nearly 25% of students reported experiencing bullying. Approximately 5.9% of heterosexual and 25.7% of LGB students attempted suicide. Heterosexual students who experienced either traditional or electronic bullying had a higher risk of attempting suicide (1.54 [95% confidence interval 1.19-1.98] and 1.64 [1.23-2.19], respectively). The associations were similar but weaker among LGB students (1.49 [1.08-2.04] and 1.43 [.90-2.27], respectively). Students who experienced both forms of bullying had the highest prevalence of suicide attempt, but the interaction was not statistically significant. CONCLUSIONS LGB students had higher rates of both suicide attempts and experiencing bullying. Traditional and electronic bullying are not synergistic in the risk of attempting suicide, although each form increases that risk.
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Affiliation(s)
- Kayleigh D Humphries
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Li Li
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Gary A Smith
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Jeffrey A Bridge
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Motao Zhu
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio.
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Mournet AM, Stanley IH, Snyder DJ, Claassen CA, Pao M, Horowitz LM, Bridge JA. Suicide risk and perceived burden among adult medical inpatients. Gen Hosp Psychiatry 2021; 70:141-142. [PMID: 33810884 DOI: 10.1016/j.genhosppsych.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Annabelle M Mournet
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD, United States of America
| | - Ian H Stanley
- Department of Psychiatry, Boston University School of Medicine & National Center for PTSD and VA Boston Healthcare System, Boston, MA, United States of America
| | - Deborah J Snyder
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD, United States of America
| | - Cynthia A Claassen
- John Peter Smith Health Network, Fort Worth, TX, United States of America
| | - Maryland Pao
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD, United States of America
| | - Lisa M Horowitz
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD, United States of America.
| | - Jeffrey A Bridge
- The Abigail Wexner Research Institute at Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, United States of America
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Ruch DA, Steelesmith DL, Warner LA, Bridge JA, Campo JV, Fontanella CA. Health Services Use by Children in the Welfare System Who Died by Suicide. Pediatrics 2021; 147:peds.2020-011585. [PMID: 33685986 PMCID: PMC8015154 DOI: 10.1542/peds.2020-011585] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine characteristics and health service use patterns of suicide decedents with a history of child welfare system involvement to inform prevention strategies and reduce suicide in this vulnerable population. METHODS A retrospective matched case-control design (120 suicide decedents and 1200 matched controls) was implemented. Suicide decedents included youth aged 5 to 21 who died by suicide and had an open case in Ohio's Statewide Automated Child Welfare Information System between 2010 and 2017. Controls were matched to suicide decedents on sex, race, and ethnicity. Comparisons were analyzed by using conditional logistic regressions to control for matching between the suicide and control groups. RESULTS Youth in the child welfare system who died by suicide were significantly more likely to experience out-of-home placements and be diagnosed with mental and physical health conditions compared with controls. Suicide decedents were twice as likely to access mental health services in the 1 and 6 months before death, regardless of the health care setting. A significantly higher percentage of suicide decedents used physical health services 6 months before their death or index date. Emergency department visits for both physical and mental health conditions were significantly more likely to occur among suicide decedents. CONCLUSIONS Suicide decedents involved in the child welfare system were more likely to use both mental and physical health care services in the months before their death or index date. Findings suggest that youth involved in the child welfare system may benefit from suicide prevention strategies in health care settings.
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Affiliation(s)
- Donna A. Ruch
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
| | - Danielle L. Steelesmith
- Department of Psychiatry and Behavioral Health, The Ohio State University Medical Center, The Ohio State University, Columbus, Ohio
| | - Lynn A. Warner
- School of Social Welfare, State University of New York at Albany, Albany, New York
| | - Jeffrey A. Bridge
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio;,Department of Pediatrics, The Ohio State University, Columbus, Ohio; and
| | - John V. Campo
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Cynthia A. Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University Medical Center, The Ohio State University, Columbus, Ohio
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Fontanella CA, Steelesmith DL, Brock G, Bridge JA, Campo JV, Fristad MA. Association of Cannabis Use With Self-harm and Mortality Risk Among Youths With Mood Disorders. JAMA Pediatr 2021; 175:377-384. [PMID: 33464286 PMCID: PMC7816117 DOI: 10.1001/jamapediatrics.2020.5494] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022]
Abstract
Importance Cannabis use and cannabis use disorder (CUD) are common among youths and young adults with mood disorders, but the association of CUD with self-harm, suicide, and overall mortality risk is poorly understood in this already vulnerable population. Objective To examine associations of CUD with self-harm, suicide, and overall mortality risk in youths with mood disorders. Design, Setting, and Participants A population-based retrospective cohort study was performed using Ohio Medicaid claims data linked with death certificate data. The analysis included 204 780 youths (aged 10-24 years) with a diagnosis of mood disorders between July 1, 2010, and December 31, 2017, who were followed up to 365 days from the index diagnostic claim until the end of enrollment, the self-harm event, or death. Statistical analysis was performed from April 4 to July 17, 2020. Exposure Physician-diagnosed CUD defined using outpatient and inpatient claims from 180 days prior to the index mood disorder diagnostic claim through the 365-day follow-up period. Main Outcomes and Measures Nonfatal self-harm, all-cause mortality, and deaths by suicide, unintentional overdose, motor vehicle crashes, and homicide. Marginal structural models using inverse probability weights examined associations between CUD and outcomes. Results This study included 204 780 youths (133 081 female participants [65.0%]; mean [SD] age at the time of mood disorder diagnosis, 17.2 [4.10] years). Cannabis use disorder was documented for 10.3% of youths with mood disorders (n = 21 040) and was significantly associated with older age (14-18 years vs 10-13 years: adjusted risk ratio [ARR], 9.35; 95% CI, 8.57-10.19; and 19-24 years vs 10-13 years: ARR, 11.22; 95% CI, 10.27-12.26), male sex (ARR, 1.79; 95% CI, 1.74-1.84), Black race (ARR, 1.39; 95% CI, 1.35-1.44), bipolar or other mood disorders (bipolar disorders: ARR, 1.24; 95% CI, 1.21-1.29; other mood disorders: ARR, 1.20; 95% CI, 1.15-1.25), prior history of self-harm (ARR, 1.66; 95% CI, 1.52-1.82), previous mental health outpatient visits (ARR, 1.26; 95% CI, 1.22-1.30), psychiatric hospitalizations (ARR, 1.66; 95% CI, 1.57-1.76), and mental health emergency department visits (ARR, 1.54; 95% CI, 1.47-1.61). Cannabis use disorder was significantly associated with nonfatal self-harm (adjusted hazard ratio [AHR], 3.28; 95% CI, 2.55-4.22) and all-cause mortality (AHR, 1.59; 95% CI, 1.13-2.24), including death by unintentional overdose (AHR, 2.40; 95% CI, 1.39-4.16) and homicide (AHR, 3.23; 95% CI, 1.22-8.59). Although CUD was associated with suicide in the unadjusted model, it was not significantly associated in adjusted models. Conclusions and Relevance Cannabis use disorder is a common comorbidity and risk marker for self-harm, all-cause mortality, and death by unintentional overdose and homicide among youths with mood disorders. These findings should be considered as states contemplate legalizing medical and recreational marijuana, both of which are associated with increased CUD.
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Affiliation(s)
- Cynthia A. Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
| | - Danielle L. Steelesmith
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
| | - Guy Brock
- Department of Biomedical Informatics, The Ohio State University, Columbus
| | - Jeffrey A. Bridge
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
| | - John V. Campo
- Rockefeller Neuroscience Institute, Behavioral Medicine and Psychiatry, West Virginia University, Morgantown
| | - Mary A. Fristad
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
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Mournet AM, Smith JT, Bridge JA, Boudreaux ED, Snyder DJ, Claassen CA, Jobes DA, Pao M, Horowitz LM. Limitations of Screening for Depression as a Proxy for Suicide Risk in Adult Medical Inpatients. J Acad Consult Liaison Psychiatry 2021; 62:413-420. [PMID: 34219655 DOI: 10.1016/j.jaclp.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/18/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Medically ill hospitalized patients are at elevated risk for suicide. Hospitals that already screen for depression often use depression screening as a proxy for suicide risk screening. Extant research has indicated that screening for depression may not be sufficient to identify all patients at risk for suicide. OBJECTIVE The present study aims to determine the effectiveness of a depression screening tool, the Patient Health Questionnaire-9, in detecting suicide risk among adult medical inpatients. METHODS Participants were recruited from inpatient medical/surgical units in 4 hospitals as part of a larger validation study. Participants completed the Patient Health Questionnaire-9 and 2 suicide risk measures: the Ask Suicide-Screening Questions and the Adult Suicidal Ideation Questionnaire. RESULTS The sample consisted of 727 adult medical inpatients (53.4% men; 61.8% white; mean age 50.1 ± 16.3 years). A total of 116 participants (116 of 727 [16.0%]) screened positive for suicide risk and 175 (175 of 727 [24.1%]) screened positive for depression. Of the 116 patients who screened positive for suicide risk, 36 (31.0%) screened negative for depression on the Patient Health Questionnaire-9. Of 116, 73 (62.9%) individuals who were at risk for suicide did not endorse item 9 (thoughts of harming oneself or of being better off dead) on the Patient Health Questionnaire-9. CONCLUSION Using depression screening tools as a proxy for suicide risk may be insufficient to detect adult medical inpatients at risk for suicide. Asking directly about suicide risk and using validated tools is necessary to effectively and efficiently screen for suicide risk in this population.
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Affiliation(s)
- Annabelle M Mournet
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD
| | - Jarrod T Smith
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD
| | - Jeffrey A Bridge
- Abigail Wexner Research Institute at Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Edwin D Boudreaux
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Deborah J Snyder
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD
| | | | - David A Jobes
- Department of Psychology, Catholic University of America, Washington, DC
| | - Maryland Pao
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD
| | - Lisa M Horowitz
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD.
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Backes CH, Rivera BK, Pavlek L, Beer LJ, Ball MK, Zettler ET, Smith CV, Bridge JA, Bell EF, Frey HA. Proactive neonatal treatment at 22 weeks of gestation: a systematic review and meta-analysis. Am J Obstet Gynecol 2021; 224:158-174. [PMID: 32745459 DOI: 10.1016/j.ajog.2020.07.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The objective of this study was to provide a systematic review and meta-analysis to quantify prognosis and identify factors associated with variations in reported mortality estimates among infants who were born at 22 weeks of gestation and provided proactive treatment (resuscitation and intensive care). DATA SOURCES PubMed, Scopus, and Web of Science databases, with no language restrictions, were searched for articles published from January 2000 to February 2020. STUDY ELIGIBILITY CRITERIA Reports on live-born infants who were delivered at 22 weeks of gestation and provided proactive care were included. The primary outcome was survival to hospital discharge; secondary outcomes included survival without major morbidity and survival without neurodevelopmental impairment. Because we expected differences across studies in the definitions for various morbidities, multiple definitions for composite outcomes of major morbidities were prespecified. Neurodevelopmental impairment was based on Bayley Scales of Infant Development II or III. Data extractions were performed independently, and outcomes agreed on a priori. STUDY APPRAISAL AND SYNTHESIS METHODS Methodological quality was assessed using the Quality in Prognostic Studies tool. An adapted version of the Grading of Recommendations Assessment, Development and Evaluation approach for prognostic studies was used to evaluate confidence in overall estimates. Outcomes were assessed as prevalence and 95% confidence intervals. Variabilities across studies attributable to heterogeneity were estimated with the I2 statistic; publication bias was assessed with the Luis Furuya-Kanamori index. Data were pooled using the inverse variance heterogeneity model. RESULTS Literature searches returned 21,952 articles, with 2034 considered in full; 31 studies of 2226 infants who were delivered at 22 weeks of gestation and provided proactive neonatal treatment were included. No articles were excluded for study design or risk of bias. The pooled prevalence of survival was 29.0% (95% confidence interval, 17.2-41.6; 31 studies, 2226 infants; I2=79.4%; Luis Furuya-Kanamori index=0.04). Survival among infants born to mothers receiving antenatal corticosteroids was twice the survival of infants born to mothers not receiving antenatal corticosteroids (39.0% vs 19.5%; P<.01). The overall prevalence of survival without major morbidity, using a definition that includes any bronchopulmonary dysplasia, was 11.0% (95% confidence interval, 8.0-14.3; 10 studies, 374 infants; I2=0%; Luis Furuya-Kanamori index=3.02). The overall rate of survival without moderate or severe impairment was 37.0% (95% confidence interval, 14.6-61.5; 5 studies, 39 infants; I2=45%; Luis Furuya-Kanamori index=-0.15). Based on the year of publication, survival rates increased between 2000 and 2020 (slope of the regression line=0.09; standard error=0.03; P<.01). Studies were highly diverse with regard to interventions and outcomes reported. CONCLUSION The reported survival rates varied greatly among studies and were likely influenced by combining observational data from disparate sources, lack of individual patient-level data, and bias in the component studies from which the data were drawn. Therefore, pooled results should be interpreted with caution. To answer fundamental questions beyond the breadth of available data, multicenter, multidisciplinary collaborations, including alignment of important outcomes by stakeholders, are needed.
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Affiliation(s)
- Carl H Backes
- Centers for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH; Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH; The Heart Center, Nationwide Children's Hospital, Columbus, OH.
| | - Brian K Rivera
- Centers for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Leanne Pavlek
- Centers for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Lindsey J Beer
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Molly K Ball
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Eli T Zettler
- Centers for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Charles V Smith
- Center for Integrated Brain Research, Seattle Children's Research Institute, Seattle, WA
| | - Jeffrey A Bridge
- Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Edward F Bell
- Department of Pediatrics, University of Iowa; Iowa City, IA
| | - Heather A Frey
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH
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Aguinaldo LD, Sullivant S, Lanzillo EC, Ross A, He JP, Bradley-Ewing A, Bridge JA, Horowitz LM, Wharff EA. Validation of the ask suicide-screening questions (ASQ) with youth in outpatient specialty and primary care clinics. Gen Hosp Psychiatry 2021; 68:52-58. [PMID: 33310014 PMCID: PMC7855604 DOI: 10.1016/j.genhosppsych.2020.11.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [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: 09/10/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Validate the Ask Suicide-Screening Questions (ASQ) with youth in outpatient specialty and primary care clinics. METHOD This is a cross sectional instrument validation study assessing the validity of the ASQ with respect to the standard criterion, Suicidal Ideation Questionnaire (SIQ/SIQ Jr.). The sample included 515 English speaking youth ages 10-21 years old from outpatient specialty and primary care clinics. ASQ sensitivity, specificity, positive and negative predictive values (PPV/NPV), positive and negative likelihood ratios, c statistic and respective receiver operating characteristic curves were assessed. RESULTS A total of 335 outpatient specialty and 180 primary care clinic participants completed the study. In outpatient specialty clinics, the ASQ showed a sensitivity of 100.0% (95% CI: 80.5-100.0%), specificity of 91.2% (95% CI: 87.5-94.1%), and NPV of 100.0% (95% CI: 98.7-100.0). In the primary care clinic, the ASQ showed a sensitivity of 100.0% (95% CI: 59.0-100.0%), specificity of 87.9% (95% CI: 82.0-92.3%), and NPV of 100.0% (95% CI: 97.7-100.0). Forty-five (13.4%) outpatient specialty clinic participants and 28 (15.6%) primary care clinic participants screened positive for suicide risk on the ASQ. CONCLUSIONS The ASQ is a valid screening tool for identifying youth at elevated suicide risk in outpatient clinical settings.
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Affiliation(s)
- Laika D. Aguinaldo
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (MC 0862), La Jolla, California, USA, 92093
| | - Shayla Sullivant
- Children’s Mercy Kansas City, 2401 Gillham Rd, Kansas City, Missouri, USA, 64108
| | - Elizabeth C. Lanzillo
- National Institute of Mental Health, 10 Center Drive, Bethesda, Maryland, USA, 20892
| | - Abigail Ross
- Graduate School of Social Service, Fordham University, 113 W 60th St #7, New York, New York, USA, 10023
| | - Jian-Ping He
- National Institute of Mental Health, 10 Center Drive, Bethesda, Maryland, USA, 20892
| | - Andrea Bradley-Ewing
- Children’s Mercy Kansas City, 2401 Gillham Rd, Kansas City, Missouri, USA, 64108
| | - Jeffrey A. Bridge
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, Ohio, USA, 43215,Department of Pediatrics, Ohio State University, 370 W. 9th Avenue, Columbus, Ohio, USA, 43210
| | - Lisa M. Horowitz
- National Institute of Mental Health, 10 Center Drive, Bethesda, Maryland, USA, 20892
| | - Elizabeth A. Wharff
- Department of Psychiatry, Boston Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts, USA, 02115,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, Massachusetts, USA, 02215
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Bridge JA, Greenhouse JB, Kelleher KJ, Campo JV. Formal Comment: Romer study fails at following core principles of reanalysis. PLoS One 2020; 15:e0237184. [PMID: 33206659 PMCID: PMC7673571 DOI: 10.1371/journal.pone.0237184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jeffrey A. Bridge
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America
- The Ohio State University College of Medicine, Columbus, OH, United States of America
- * E-mail:
| | | | - Kelly J. Kelleher
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - John V. Campo
- West Virginia University, Morgantown, WV, United States of America
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Abstract
Abstract. Background: Suicide is a leading cause of death among youth in the United States. Multiple factors have been shown to increase risk for suicidal behavior, including depressed mood. Aims: The purpose of this study was to examine individual characteristics and precipitating circumstances of suicide in youth decedents with and without depressed mood at the time of death. Method: Data from the National Violent Death Reporting System (NVDRS) were analyzed for 17 US states from 2003 to 2012. Participants included suicide decedents aged 10–19 years ( N = 4,053). Analyses compared youth suicide decedents with depressed mood at time of death with those without depressed mood using logistic regression. Sex-specific differences in youth with depressed mood were also explored. Results: Youth suicide decedents with depressed mood were more likely than those without depressed mood to exhibit clinical characteristics and precipitating circumstances associated with suicide. Comparison of males and females with depressed mood found unique sex-specific differences. Limitations: Data were limited to 17 states, analyses did not include a control group, and data were collected through postmortem reporting. Conclusion: Findings support a significant association between depressed mood and factors associated with suicidal behavior in youth and offer potential areas to focus prevention strategies.
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Affiliation(s)
- Paige Schlagbaum
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Donna A. Ruch
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jaclyn L. Tissue
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Arielle H. Sheftall
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Jeffrey A. Bridge
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, College of Medicine, Columbus, OH, USA
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