Adverse Outcomes, Polysubstance Use, and Polypharmacy in Older Veterans

Abstract This session will provide information about adverse health outcomes, including suicide, suicide attempts and unintended death, that may be related to polysubstance use and polypharmacy in older adults, particularly older veterans. It will further provide information that will help support late-life suicide prevention and intervention efforts. Older veterans (age50 and older) have the highest number of lives lost to suicide, make up majority of the veteran population, and are highly likely to experience conditions (e.g., chronic pain, sleep disorders, musculoskeletal) associated with commonly prescribed medications that are potential markers for suicide risk (hereafter referred to as “high-risk” drug categories), including benzodiazepines, sedative-hypnotics, opioids, antidepressants, antipsychotics, and antiepileptics. The research presented in this session will highlight important patterns in high-risk drug prescribing and use and related outcomes in late life. The presentations will underscore various groups of older veterans that may be important to consider and, yet, neglected in the polysubstance and polypharmacy and suicide prevention conversation, including those who recently attempted suicide, veterans with late-life posttraumatic stress disorder (PTSD), and older veterans transitioning from prison to community. Drs. Maust and Morin will present findings on prescribing and use of high-risk medications in late life, including an overview of trends in polypharmacy and associations with suicide attempts. Drs. Byers and Barry will speak about older veterans with PTSD and those with a history of incarceration, with information on suicide, unintended death by overdose, and substance use disorder-related emergency department visits and hospitalizations, emphasizing importance of care transition models for prevention. Aging, Alcohol and Addictions Interest Group Sponsored Symposium.

Download Full-text

Suicide Prevention Through Online Gatekeeping Using Search Advertising Techniques

Crisis ◽

10.1027/0227-5910/a000322 ◽

2015 ◽

Vol 36 (4) ◽

pp. 267-273 ◽

Cited By ~ 8

Author(s):

Hajime Sueki ◽

Jiro Ito

Keyword(s):

Suicidal Ideation ◽

Suicide Prevention ◽

Help Seeking ◽

Service Use ◽

Web Search ◽

Suicide Attempts ◽

Consultation Service ◽

Search Advertising ◽

Internet Users ◽

History Of

Abstract. Background: Nurturing gatekeepers is an effective suicide prevention strategy. Internet-based methods to screen those at high risk of suicide have been developed in recent years but have not been used for online gatekeeping. Aims: A preliminary study was conducted to examine the feasibility and effects of online gatekeeping. Method: Advertisements to promote e-mail psychological consultation service use among Internet users were placed on web pages identified by searches using suicide-related keywords. We replied to all emails received between July and December 2013 and analyzed their contents. Results: A total of 139 consultation service users were analyzed. The mean age was 23.8 years (SD = 9.7), and female users accounted for 80% of the sample. Suicidal ideation was present in 74.1%, and 12.2% had a history of suicide attempts. After consultation, positive changes in mood were observed in 10.8%, 16.5% showed intentions to seek help from new supporters, and 10.1% of all 139 users actually took help-seeking actions. Conclusion: Online gatekeeping to prevent suicide by placing advertisements on web search pages to promote consultation service use among Internet users with suicidal ideation may be feasible.

Download Full-text

Suicide attempts preceding completed suicide

The British Journal of Psychiatry ◽

10.1192/bjp.173.6.531 ◽

1998 ◽

Vol 173 (6) ◽

pp. 531-535 ◽

Cited By ~ 167

Author(s):

Erkki T. Isometsä ◽

Jouko K. Lönnqvist

Keyword(s):

Suicide Attempt ◽

Suicide Prevention ◽

Suicide Risk ◽

Suicide Attempts ◽

Early Recognition ◽

Preventive Measure ◽

Time Interval ◽

Psychological Autopsy ◽

Autopsy Study ◽

History Of

BackgroundThis study investigated three questions with major implications for suicide prevention: the sensitivity of the history of previous suicide attempt(s) as an indicator of suicide risk, the time interval from a preceding suicide attempt to the fatal one, and switching of suicide methods by those eventually completing suicide.MethodThe lifetime history of suicide attempts and the methods the victims (n=1397) used were examined in a nationwide psychological autopsy study comprising all suicides in Finland within a 12-month research period in 1987–1988.ResultsOverall, 56% of suicide victims were found to have died at their first suicide attempt, more males (62%) than females (38%). In 19% of males and 39% of females the victim had made a non-fatal attempt during the final year. Of the victims with previous attempts, 82% had used at least two different methods in their suicide attempts (the fatal included).ConclusionsMost male and a substantial proportion of female suicides die in their first suicide attempt, a fact that necessitates early recognition of suicide risk, particularly among males. Recognition of periods of high suicide risk on the grounds of recent non-fatal suicide attempts is likely to be important for suicide prevention among females. Subjects completing suicide commonly switch from one suicide method to another, a finding that weakens but does not negate the credibility of restrictions on the availability of lethal methods as a preventive measure.

Download Full-text

Abstract P179: Comparison of Earlier versus Later Orthostatic Hypotension Assessment Times in Middle-Age Adults of the Atherosclerosis Risk in Communities Study (ARIC)

Circulation ◽

10.1161/circ.135.suppl_1.p179 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Stephen P Juraschek ◽

Natalie Daya ◽

Andreea M Rawlings ◽

Lawrence J Appel ◽

Edgar R Miller ◽

...

Keyword(s):

Orthostatic Hypotension ◽

Standing Position ◽

Adverse Outcomes ◽

Cox Models ◽

Atherosclerosis Risk In Communities ◽

Adverse Health Outcomes ◽

History Of ◽

Risk Of Fall

Background: Guidelines recommend assessing orthostatic hypotension (OH) 3 minutes after rising from supine to standing positions. Hypothesis: Measurements performed immediately after standing will be as informative as measurements performed closer to 3 minutes after standing with regards to symptoms of dizziness or risk of adverse outcomes. Methods: OH, defined as a drop in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) from the supine to standing position, was measured up to five times at 25 seconds intervals in middle-aged (range 44 to 66 years) ARIC participants (1987-1989). Associations between each measurement and history of dizziness upon standing were examined via logistic regression. We used Cox models to examine the association between each of five measurements with risk of fall, fracture, syncope, and all-cause mortality over a median follow-up of 23 years. Results: In 11,449 participants (mean age 54 years, 54% women, 26% black) 10% reported a history of dizziness upon standing. OH assessed at measurement 1 (performed at a mean of 28 seconds after standing) was associated with risk of fall ( P = 0.03), fracture ( P = 0.05), syncope ( P <0.001), and mortality ( P < 0.001) ( Table ). Furthermore, measurement 1 was the only measurement associated with higher odds of dizziness upon standing (OR: 1.5; P = 0.001). Measurement 2 (performed on average 53 seconds after standing) was associated with all long-term outcomes. Measurements 4 and 5 (mean 100 and 116 seconds after standing) were generally less informative with regards to prospective outcomes than earlier measurements and were not statistically associated with history of dizziness. Conclusions: OH measurements obtained, on average, within the first 30 seconds of standing were predictive of long-term adverse health outcomes and were the most strongly related to symptoms of dizziness compared to later measurements. These findings suggest that BP measurements for determining orthostatic hypotension should be performed immediately after standing.

Download Full-text

Mortality in Prisons: The Experience of the Bureau of Legal Medicine of Milan (Italy) (1993–2017)

Medicine Science and the Law ◽

10.1177/0025802420934266 ◽

2021 ◽

Vol 61 (1_suppl) ◽

pp. 67-76

Author(s):

Guendalina Gentile ◽

Marta Nicolazzo ◽

Rachele Bianchi ◽

Paolo Bailo ◽

Michele Boracchi ◽

...

Keyword(s):

High Risk ◽

Suicide Attempts ◽

Early Death ◽

Healthcare Services ◽

Psychiatric Disease ◽

Quality Healthcare ◽

History Of ◽

The University ◽

Different Characteristics ◽

Detention Facilities

We undertook a retrospective analysis of deaths that took place in prisons in Milan between 1993 and 2017, by identifying cases from a total of 24,101 autopsies that were performed at the Section of Forensic Medicine of the University of Milan. From the archives of this institution, we found 227 autopsy reports relating to deaths that had taken place in one of Milan’s three detention facilities. These deaths were divided into two types: natural deaths ( n=135; 59.5%) and violent deaths ( n=92; 40.5%). The groups have different characteristics: while natural deaths mostly resulted from cardiovascular diseases, suicides were mainly the result of hanging. Further, people who died by suicide often had a history of psychiatric disease and/or drug abuse, and over a quarter of them had previous suicide attempts and/or had declared suicidal intentions. This study confirms the need for good quality healthcare services for prisoners, given that they remain a population at high risk of early death.

Download Full-text

Nine Psychiatric Inpatients who Leaped from a Height*

The Canadian Journal of Psychiatry ◽

10.1177/070674378402900209 ◽

1984 ◽

Vol 29 (2) ◽

pp. 129-131 ◽

Cited By ~ 6

Author(s):

Gary W. Small ◽

Jerrold F. Rosenbaum

Keyword(s):

High Risk ◽

Social Isolation ◽

Suicide Attempts ◽

Treatment Plan ◽

Psychiatric Inpatients ◽

Recent Change ◽

Hospital Treatment ◽

Common Features ◽

History Of ◽

Chronic Psychosis

The authors describe nine psychiatric inpatients from the same hospital who leaped from a height. Common features included youth, social isolation, diagnosis of schizophrenia, and chronic psychosis despite neuroleptic therapy. All had prolonged hospitalizations and a history of assaults, suicide attempts, or both. The authors suggest that these characteristics in conjunction with a recent change in hospital treatment plan or loss of social sup-ports may identify patients at high-risk for violent self-destructive acts.

Download Full-text

Influencing Factors of Multiple Adverse Outcomes Among Schizophrenia Patients Using Count Regression Models: A Cross-Sectional Study

10.21203/rs.3.rs-926929/v1 ◽

2021 ◽

Author(s):

Lichang Chen ◽

Wenyan Tan ◽

Xiao Lin ◽

Haicheng Lin ◽

Junyan Xi ◽

...

Keyword(s):

Risk Factor ◽

Influencing Factors ◽

Violent Crime ◽

Regression Models ◽

Negative Binomial ◽

Suicide Attempts ◽

Adverse Outcomes ◽

Different Types ◽

History Of ◽

Self Harm

Abstract Background: Schizophrenia patients have increased risks of several adverse outcomes, including violent crime, aggressiveness and suicide. However, studies of different adverse outcomes in the same population are rare and the influencing factors for these outcomes need clarification by appropriate models. This study aimed to identify influencing factors of these adverse outcomes by examining and comparing different count regression models.Methods: This study included schizophrenia patients who had at least once follow-up record in the Guangdong Mental Health Center Network Medical System during 2020. Three types of adverse outcomes including a) aggressiveness with police dispatch or violence crime, b) aggressiveness without police dispatch, and c) self-harm or suicide attempts. First, we investigated the incidence of these adverse outcomes in each type. Second, the Poisson, negative binomial (NB), zero-inflated Poisson (ZIP), and zero-inflated negative binomial (ZINB) regression models were fitted and compared for their intensity. Finally, We analysed associations between these adverse outcomes intensity and sociodemographic, clinical factors with the best model. Results: A total of 130474 schizophrenia patients were selected. Each type of adverse outcomes was reported by less than 1% of schizophrenia patients in 2020. NB regression model is the best model for fitting the number of aggressiveness without police dispatch because of the best goodness of fit and relatively simple interpretation, whereas ZINB models for the other two outcomes. Age, sex, and history of adverse outcomes were influencing factors shared across these adverse outcomes. Higher educational level, employment were protective factors shared between aggressiveness with police dispatch or violent crime , and aggressiveness without police dispatch. Aggressiveness without police dispatch , and self-harm or suicide attempts shared older onset age (≥18 years) as a risk factor. Family history of mental disease was a risk factor of self-harm or suicide attempts individually.Conclusions: NB and ZINB models were selected for fitting the number of adverse outcomes in our studies. Influencing factors for adverse outcomes intensity included both those shared across different types and those individual to specific types. Therefore, combined and customized tools in risk assessment and intervention for different types of these outcomes might be necessary.

Download Full-text

Gender and Racial Differences for Suicide Attempters and Ideators in a High-Risk Community Corrections Population

Crisis ◽

10.1027/0227-5910/a000160 ◽

2013 ◽

Vol 34 (1) ◽

pp. 50-62 ◽

Cited By ~ 11

Author(s):

Cheryl B. McCullumsmith ◽

C. Brendan Clark ◽

Adam Perkins ◽

Jessaka Fife ◽

Karen L. Cropsey

Keyword(s):

Risk Factors ◽

African American ◽

High Risk ◽

Psychotropic Medication ◽

Suicide Attempts ◽

Community Corrections ◽

History Of ◽

And Gender ◽

Gender Groups ◽

Corrections Population

Background: Community corrections populations are a high-risk group who carry multiple suicide risk factors. Aims: To identify factors correlated with historical suicide attempts and ideation among African-American men, African-American women, White men, and White women in a community corrections population. Method: Self-report data from 18,753 enrollees in community corrections were analyzed. Multinomial logistic regression analyses were conducted to determine associations between historical suicidal ideation and attempts among the four demographic groups. Results: Participants with historical suicide attempts tended to be younger, White, female, be taking psychotropic medication, have a history of physical or sexual abuse, and meet criteria for dependence on alcohol, amphetamines, cocaine, opioids, or sedatives. Five variables were commonly associated with suicide attempts for all four race/gender groups: younger age, being on disability or retirement, taking psychotropic medication, history of sexual or physical abuse, and cocaine dependence. Other demographic variables had race or gender specificities as risk factors for suicide attempts. Conclusions: Participants had high rates of historical suicide attempts with unique correlates differentiating attempters from ideators among different racial and gender groups. Cocaine dependence was universal predictor of suicide attempts, while other substance dependencies show specific racial and gender profiles associated with suicide attempts.

Download Full-text

Risk factors of the previa placenta formation

Journal of obstetrics and women s diseases ◽

10.17816/jowd65325-31 ◽

2016 ◽

Vol 65 (3) ◽

pp. 25-31

Author(s):

Natalya I Fadeeva ◽

Olga A Belnitskaya ◽

Irina A Myadelets ◽

Galina V Serdyuk ◽

Maria G Nikolaeva

Keyword(s):

Risk Factors ◽

Comparative Analysis ◽

High Risk ◽

Placenta Previa ◽

Intrauterine Device ◽

Adverse Outcomes ◽

Second Trimester ◽

Gynecological Disorders ◽

History Of ◽

Autoimmune Processes

Placenta previa is associated with a high risk of adverse outcomes for the fetus and mother. The aim of our study was to identify risk factors form a complete placenta previa. A comparative analysis of clinical and paraclinical characteristics of 70 patients with placenta previa in time delivery, 150 women with favorable migration in the second trimester placenta previa at baseline and 100 women with physiological placentation. It was found that a history of hormone-dependent gynecological disorders (p < 0.001), infertility (p < 0.001), contraceptive intrauterine device (p < 0.05), as well as hypertensive syndrome (p < 0.001), presence of hemostasis and folate metabolism defective alleles genes associations (p < 0.01) hepatitis B and C (p < 0.001), and autoimmune processes (p < 0.001) are risk factors of conservation of total placenta previa to delivery.

Download Full-text

A Comparison of Attitudes Toward Suicide Among Individuals With and Without Suicidal Thoughts and Suicide Attempts in South Korea

Crisis ◽

10.1027/0227-5910/a000528 ◽

2019 ◽

Vol 40 (1) ◽

pp. 27-35 ◽

Cited By ~ 2

Author(s):

Sang-Uk Lee ◽

Mina Jeon ◽

Jong-Ik Park

Keyword(s):

Suicide Attempt ◽

South Korea ◽

Suicide Prevention ◽

Suicide Attempts ◽

Suicidal Thought ◽

Suicidal Thoughts ◽

Cross Sectional ◽

Suicidal Person ◽

History Of ◽

Attitudes Toward Suicide

Abstract. Background: A suicidal person can go through different stages that include suicidal thoughts and suicide attempts. For a few individuals, these can end up with suicide. However, there have been no studies investigating any differences in attitudes toward suicides among individuals with no suicidal thoughts, those with suicidal thoughts, and those with suicide attempts. Aims: This study was carried out to compare attitudes toward suicide among three different groups: individuals with a history of no suicidal thoughts, those with a history of suicidal thoughts, and those with a history of suicide attempts. Method: To examine Koreans' attitudes toward suicide, we analyzed the data from the 2013 National Suicide Survey involving 1,500 participants aged between 19 and 75 years. Results: Different attitudes toward suicide were found among the three groups. Persons reporting that they had made a suicide attempt in their life showed the most permissive attitudes toward suicide. Limitations: Since this research is based on cross-sectional data, it is difficult to eliminate the possibility of changes in attitude toward suicide completely after having a suicidal thought and suicide attempt. Conclusion: These results can be a useful source for constructing effective messages for suicide prevention campaigns and can ultimately contribute to an improvement in the public's perceptions of suicide in the future.

Download Full-text

Prevention of Suicidal Behavior in Prisons

Crisis ◽

10.1027/0227-5910/a000394 ◽

2016 ◽

Vol 37 (5) ◽

pp. 323-334 ◽

Cited By ~ 38

Author(s):

Lisa Marzano ◽

Keith Hawton ◽

Adrienne Rivlin ◽

E. Naomi Smith ◽

Mary Piper ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Suicide Prevention ◽

Suicide Risk ◽

Suicide Attempts ◽

Psychiatric Morbidity ◽

Clinical Factors ◽

Factors Associated ◽

Self Harm ◽

Specific Factors

Abstract. Background: Worldwide, prisoners are at high risk of suicide. Research on near-lethal suicide attempts can provide important insights into risk and protective factors, and inform suicide prevention initiatives in prison. Aims: To synthesize findings of research on near-lethal attempts in prisons, and consider their implications for suicide prevention policies and practice, in the context of other research in custody and other settings. Method: We searched two bibliographic indexes for studies in any language on near-lethal and severe self-harm in prisoners, supplemented by targeted searches over the period 2000–2014. We extracted information on risk factors descriptively. Data were not meta-analyzed owing to heterogeneity of samples and methods. Results: We identified eight studies reporting associations between prisoner near-lethal attempts and specific factors. The latter included historical, prison-related, and clinical factors, including psychiatric morbidity and comorbidity, trauma, social isolation, and bullying. These factors were also identified as important in prisoners' own accounts of what may have contributed to their attempts (presented in four studies). Conclusion: Factors associated with prisoners' severe suicide attempts include a range of potentially modifiable clinical, psychosocial, and environmental factors. We make recommendations to address these factors in order to improve detection, management, and prevention of suicide risk in prisoners.

Download Full-text