Added value of buccal cell FISH analysis in the diagnosis and management of Turner syndrome

2020 ◽  
Vol 35 (10) ◽  
pp. 2391-2398 ◽  
Author(s):  
A Graff ◽  
B Donadille ◽  
H Morel ◽  
M C Villy ◽  
N Bourcigaux ◽  
...  
Keyword(s):  
Turner Syndrome ◽  
Blood Lymphocyte ◽  
Added Value ◽  
Buccal Cell ◽  
National Database ◽  
Invasive Technique ◽  
Fish Analysis ◽  
Registration Number ◽  
Competing Interest ◽  
X Cells

Abstract STUDY QUESTION Is there an added diagnosis value of buccal cell FISH analysis compared with blood lymphocyte chromosomal investigations in patients with Turner syndrome (TS)? SUMMARY ANSWER Buccal cell FISH analysis, a non-invasive technique, modified the chromosomal results obtained with the blood karyotype in 17 patients (12%) of our cohort. WHAT IS KNOWN ALREADY Few studies have evaluated buccal cell FISH analysis and compared them with blood karyotype in patients with TS. STUDY DESIGN, SIZE, DURATION A prospective, monocentric cohort study was conducted in a rare diseases centre (CMERC) between July 2017 and August 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 142 adult patients with TS, and at least 5% 45,X cells in a previous blood karyotype, were recruited. All the patients’ files were included in the CEMARA database. This national database has been declared to the French data protection agency (CNIL approval number 1187326). In compliance with French law, consent regarding non-opposition to collect and use the data was obtained from each patient. A FISH analysis on a buccal smear was performed. MAIN RESULTS AND THE ROLE OF CHANCE The percentage of 45,X cells was identical between the two tissues in only 32.4% of cases. The discrepancy was higher than 41% for 12% of the cohort. The percentage of 45,X cells was higher in blood in 53 (37.3%) patients, and higher in buccal cells in 43 (30.3%) of cases. In 17 (12%) cases, the blood karyotype had to be reconsidered in regard to the buccal cell analysis. LIMITATIONS, REASONS FOR CAUTION It would have been interesting to evaluate karyotypes in cells from other tissues such as cells from skin biopsy or from the urinary tract and even from blood vessels or gonads in case of surgery and to compare them with each patient’s phenotype. However, most of the time, these tissues are not available. WIDER IMPLICATIONS OF THE FINDINGS Although blood lymphocyte karyotype remains the gold standard for the diagnosis of TS, buccal cell FISH analysis is an efficient tool to evaluate the global chromosomal constitution in these patients, thus allowing them to have better care and follow-up. For instance, identifying a Y chromosome can prevent the occurrence of a gonadoblastoma, as gonadectomy should be discussed. On the other hand, finding normal XX cells in a patient with a previous diagnosis of homogenous 45,X TS, may be psychologically helpful and relevant for gynaecological care. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was sought for the study. The authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A

Maternal age at birth and daughter’s fecundability

2021 ◽  
Author(s):  
Olga Basso ◽  
Sydney K Willis ◽  
Elizabeth E Hatch ◽  
Ellen M Mikkelsen ◽  
Kenneth J Rothman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Maternal Age ◽  
Limited Information ◽  
Loss To Follow Up ◽  
Older Mothers ◽  
Registration Number ◽  
The Usa ◽  
Competing Interest

Abstract STUDY QUESTION Do daughters of older mothers have lower fecundability? SUMMARY ANSWER In this cohort study of North American pregnancy planners, there was virtually no association between maternal age ≥35 years and daughters’ fecundability. WHAT IS KNOWN ALREADY Despite suggestive evidence that daughters of older mothers may have lower fertility, only three retrospective studies have examined the association between maternal age and daughter’s fecundability. STUDY DESIGN, SIZE, DURATION Prospective cohort study of 6689 pregnancy planners enrolled between March 2016 and January 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS Pregnancy Study Online (PRESTO) is an ongoing pre-conception cohort study of pregnancy planners (age, 21-45 years) from the USA and Canada. We estimated fecundability ratios (FR) for maternal age at the participant’s birth using multivariable proportional probabilities regression models. MAIN RESULTS AND THE ROLE OF CHANCE Daughters of mothers ≥30 years were less likely to have previous pregnancies (or pregnancy attempts) or risk factors for infertility, although they were more likely to report that their mother had experienced problems conceiving. The proportion of participants with prior unplanned pregnancies, a birth before age 21, ≥3 cycles of attempt at study entry or no follow-up was greater among daughters of mothers <25 years. Compared with maternal age 25–29 years, FRs (95% CI) for maternal age <20, 20–24, 30–34, and ≥35 were 0.72 (0.61, 0.84), 0.92 (0.85, 1.00), 1.08 (1.00, 1.17), and 1.00 (0.89, 1.12), respectively. LIMITATIONS, REASONS FOR CAUTION Although the examined covariates did not meaningfully affect the associations, we had limited information on the participants’ mother. Differences by maternal age in reproductive history, infertility risk factors and loss to follow-up suggest that selection bias may partly explain our results. WIDER IMPLICATIONS OF THE FINDINGS Our finding that maternal age 35 years or older was not associated with daughter’s fecundability is reassuring, considering the trend towards delayed childbirth. However, having been born to a young mother may be a marker of low fecundability among pregnancy planners. STUDY FUNDING/COMPETING INTEREST(S) PRESTO was funded by NICHD Grants (R21-HD072326 and R01-HD086742) and has received in-kind donations from Swiss Precision Diagnostics, FertilityFriend.com, Kindara.com, and Sandstone Diagnostics. Dr Wise is a fibroid consultant for AbbVie, Inc. TRIAL REGISTRATION NUMBER n/a

FISH analysis of 15 chromosomes in human day 4 and 5 preimplantation embryos: the added value of extended aneuploidy detection

2006 ◽  
Vol 27 (1) ◽  
pp. 55-63 ◽  
Author(s):  
E. B. Baart ◽  
I. van den Berg ◽  
E. Martini ◽  
H. J. Eussen ◽  
B. C. J. M. Fauser ◽  
...  
Keyword(s):  
Added Value ◽  
Preimplantation Embryos ◽  
Fish Analysis

scholarly journals Mosaic Turner Syndrome Presenting with a 46,XY Karyotype

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Melody Rasouli ◽  
Katherine McDaniel ◽  
Michael Awadalla ◽  
Karine Chung
Keyword(s):  
Turner Syndrome ◽  
Fish Analysis ◽  
Male To Female

Although Turner syndrome is most commonly associated with a 45,X genotype, other mosaic genotypes are present in approximately half of all cases. We describe a case of Turner syndrome with a 46,XY genotype by conventional 5-cell karyotype who was subsequently found to have a mosaic genotype of 18% 45,X and 82% 46,XY by 50-cell FISH analysis. Individuals with a mosaic 45,X/46,XY genotype have a variety of phenotypic presentations ranging from male to female which are not correlated with the percentage of mosaicism. Our case represents an extreme example where the genotype is predominately 46,XY and the phenotype typical of Turner syndrome.

scholarly journals Added value of functional neuroimaging to assess decision-making capacity of older adults with neurocognitive disorders: protocol for a prospective, monocentric, single-arm study (IMAGISION)

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e053549
Author(s):  
Thomas Tannou ◽  
Aurelie Godard-Marceau ◽  
Sven Joubert ◽  
Serge Daneault ◽  
Marie-Jeanne Kergoat ◽  
...  
Keyword(s):  
Decision Making ◽  
Cognitive Abilities ◽  
Neuropsychological Tests ◽  
Functional Neuroimaging ◽  
Real Life ◽  
Added Value ◽  
Care Plan ◽  
Informed Consent Form ◽  
Decision Making Capacity ◽  
Registration Number

IntroductionAssessment of decision-making capacity (DMC) is essential in daily life as well as for defining a person-centred care plan. Nevertheless, in ageing, especially if signs of dementia appear, it becomes difficult to assess decision-making ability and raises ethical questions. Currently, the assessment of DMC is based on the clinician’s evaluation, completed by neuropsychological tests. Functional MRI (fMRI) could bring added value to the diagnosis of DMC in difficult situations.Methods and analysisIMAGISION is a prospective, monocentric, single-arm study evaluating fMRI compared with clinical assessment of DMC. The study will begin during Fall 2021 and should be completed by Spring 2023. Participants will be recruited from a memory clinic where they will come for an assessment of their cognitive abilities due to decision-making needs to support ageing in place. They will be older people over 70 years of age, living at home, presenting with a diagnosis of mild dementia, and no exclusion criteria of MRI. They will be clinically assessed by a geriatrician on their DMC, based on the neuropsychological tests usually performed. Participants will then perform a behavioural task in fMRI (Balloon Analogue Risk Task) to analyse the activation areas. Additional semistructured interviews will be conducted to explore real life implications. The main analysis will study concordance/discordance between the clinical classification and the activation of fMRI regions of interest. Reclassification as ‘capable’, based on fMRI, of patients for whom clinical diagnosis is ‘questionable’ will be considered as a diagnostic gain.Ethics and disseminationIMAGISION has been authorised by a research ethics board (Comité de Protection des Personnes, Bordeaux, II) in France, in accordance with French legislation on interventional biomedical research, under the reference IDRCB number 2019-A00863-54, since 30 September 2020. Participants will sign an informed consent form. The results of the study will be presented in international peer-reviewed scientific journals, international scientific conferences and public lectures.Trial registration numberNCT03931148

scholarly journals Uterus transplantation: joys and frustrations of becoming a ‘complete’ woman—a qualitative study regarding self-image in the 5-year period after transplantation

2020 ◽  
Vol 35 (8) ◽  
pp. 1855-1863 ◽  
Author(s):  
Stina Järvholm ◽  
Anders Enskog ◽  
Catrina Hammarling ◽  
Pernilla Dahm-Kähler ◽  
Mats Brännström
Keyword(s):  
Small Sample Size ◽  
Small Sample ◽  
Post Transplantation ◽  
Uterus Transplantation ◽  
Self Image ◽  
Registration Number ◽  
Competing Interest ◽  
The Government

Abstract STUDY QUESTION How is a women’s self-image affected by uterus transplantation (UTx)? SUMMARY ANSWER Women experienced receiving a uterus in both positive and negative ways, but in general, their self-image was positively affected; regardless of whether they have given birth to a child or not, recipients describe themselves as being ‘back to normal’ after the hysterectomy to remove the transplanted uterus. WHAT IS KNOWN ALREADY UTx has repeatedly proved to be a successful treatment for absolute uterine factor infertility. However, there has been no previous qualitative long-term research into the self-image of women undergoing UTx. STUDY DESIGN, SIZE, DURATION This complete, prospective cohort study included the nine recipients of the first UTxs performed in Sweden mostly in 2013. Interviews took place in the 5 years following surgery. PARTICIPANTS/MATERIALS, SETTING, METHODS Eight out of the nine recipients had congenital absence of the uterus, a characteristic of Mayer–Rokitansky–Küster–Hauser syndrome, and one recipient lacked a uterus after a radical hysterectomy due to cervical cancer. The mean age of participants was 31.5 years at inclusion and at this time they all lived in stable marital relationships. Post-transplantation, interviews were performed annually for 5 years, comprising a total of 43 interviews. The interview followed a semi-structured guide. All interviews (median duration of around 25 minutes) were recorded, transcribed verbatim and then analysed by thematic approach. MAIN RESULTS AND THE ROLE OF CHANCE The joys and frustrations of becoming a ‘complete’ woman are seen as a master theme, which influences the three underlying subthemes, a changed self-perception, a changed body and a changed sexuality. Each of these subthemes have three underlying categories. LIMITATIONS, REASONS FOR CAUTION The small sample size is a limitation. WIDER IMPLICATIONS OF THE FINDINGS The results provide information that will be helpful in pre-operative screening procedures and in the psychological support offered both to women who experienced successful and unsuccessful outcomes following UTx. STUDY FUNDING/COMPETING INTEREST(S) Funding was received from the Jane and Dan Olsson Foundation for Science; the Knut and Alice Wallenberg Foundation; an ALF grant from the Swedish state under an agreement between the government and the county councils; the Swedish Research Council; a Ferring Pharmaceuticals scholarship in memory of Robert Edwards; and the Iris Jonzén-Sandblom and Greta Jonzén Foundation. The authors have no competing interests. TRIAL REGISTRATION NUMBER NCT01844362.

scholarly journals Peri-implantation intercourse does not lower fecundability

2020 ◽  
Vol 35 (9) ◽  
pp. 2107-2112
Author(s):  
Joseph B Stanford ◽  
Jared L Hansen ◽  
Sydney K Willis ◽  
Nan Hu ◽  
Alun Thomas
Keyword(s):  
Cycle Length ◽  
Time Window ◽  
Credible Interval ◽  
Cervical Mucus ◽  
Sensitivity Analyses ◽  
Fertility Awareness ◽  
Implantation Time ◽  
Registration Number ◽  
Competing Interest

Abstract STUDY QUESTION Does sexual intercourse in the implantation time window (5–9 days after ovulation) reduce fecundability? SUMMARY ANSWER After adjustment for intercourse in the fecund window and clustering by couple, there was no association between intercourse in the implantation time window and fecundity. WHAT IS KNOWN ALREADY Previous research has suggested an association between intercourse in the peri-implantation time window (5–9 days after estimated ovulation) and reduced fecundability. STUDY DESIGN, SIZE, DURATION We used data from the FERTILI study, a prospective observational study conducted in five European countries, with data collected from 1992 to 1996. PARTICIPANTS/MATERIALS, SETTING, METHODS Women who were experienced in fertility awareness tracking kept a daily diary of cervical mucus observations, basal body temperature measurements, coitus and clinically identified pregnancy. We estimated the day of ovulation as cycle length minus 13 days. From 661 women, 2606 cycles had intercourse during the fecund window (from 5 days before to 3 days after the estimated day of ovulation), resulting in 418 pregnancies (conception cycles). An established Bayesian fecundability model was used to estimate the fecundability ratio (FR) of peri-implantation intercourse on fecundability, while adjusting for each partner’s age, prior pregnancy, the couple’s probability of conception and intercourse pattern(s). We conducted sensitivity analyses estimating ovulation as cycle length minus 12 days, or alternatively, as the peak day of estrogenic cervical mucus. MAIN RESULTS AND THE ROLE OF CHANCE There was no effect of peri-implantation intercourse on fecundability: adjusted FR for three or more acts of peri-implantation intercourse versus none: 1.00, 95% credible interval: 0.76–1.13. Results were essentially the same with sensitivity analyses. There was an inverse relationship between frequency of intercourse in the fecund window and intercourse in the peri-implantation window. LIMITATIONS, REASONS FOR CAUTION Women with known subfertility were excluded from this study. Many couples in the study were avoiding pregnancy during much of the study, so 61% of otherwise eligible cycles in the database were not at meaningful risk of pregnancy and did not contribute to the analysis. Some couples may not have recorded all intercourse. WIDER IMPLICATIONS OF THE FINDINGS We believe the current balance of evidence does not support a recommendation for avoiding intercourse in the peri-implantation period among couples trying to conceive. STUDY FUNDING/COMPETING INTEREST(S) No external funding. The authors have no potential competing interests. TRIAL REGISTRATION NUMBER N/A.

scholarly journals Effect of different financial competing interest statements on readers’ perceptions of clinical educational articles: a randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e025029 ◽  
Author(s):  
Sara Schroter ◽  
Julia Pakpoor ◽  
Julie Morris ◽  
Mabel Chew ◽  
Fiona Godlee
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Analysis Of Covariance ◽  
Survey Analysis ◽  
Significant Difference ◽  
Registration Number ◽  
Competing Interest ◽  
Context Specific ◽  
Randomised Controlled ◽  
Perceptions Of Education

ObjectivesTo investigate how different competing interest (COI) statements affect clinical readers’ perceptions of education articles.DesignRandomised controlled trial.Setting and participantsRandom sample of UK doctors.InterventionsWe created four permutations of each of two clinical reviews (on gout or dyspepsia), which varied only in terms of the COI statement. Volunteers were blinded and randomised to receive one review and asked to complete a questionnaire after reading it. Blinded factorial analyses of variance and analyses of covariance were carried out to assess the influence of each review and type of COI on outcomes.Primary and secondary outcomesConfidence in the article’s conclusions (primary outcome), its importance, their level of interest in the article and their likelihood to change practice after reading it.ResultsOf 10 889 doctors invited to participate, 1065 (10%) volunteered. Of these, 749 (70%) completed the survey. Analysis of covariance (adjusting for age, sex, job type, years since qualification) showed no significant difference between the groups in participants’ confidence in the article (gout: p=0.32, dyspepsia: p=0.78) or their rating of its importance (gout: p=0.09, dyspepsia: p=0.79). For the gout review, participants rated articles with advisory board and consultancies COI as significantly less interesting than those with no COI (p=0.028 with Bonferroni correction). Among participants indicating that they treat the condition and that the article’s recommendations differed from their own practice, there was no significant difference in likelihood to change practice between groups (gout: p=0.59, n=59; dyspepsia: p=0.56, n=80).ConclusionsDoctors’ confidence in educational articles was not influenced by the COI statements. Further work is required to determine if doctors do not perceive these COIs as important in educational articles or if they do not pay attention to these statements. More meaningful COI disclosure practices may be needed, which highlight context-specific potential sources of bias to readers.Trial registration numberNCT02548312; Results.

scholarly journals Families with children resulting from ART: psychosocial and financial implications

2020 ◽  
Vol 2020 (2) ◽  
Author(s):  
Virginia Miller ◽  
Michael P Diamond ◽  
Karl R Hansen ◽  
Anne Z Steiner ◽  
Marcelle Cedars ◽  
...  
Keyword(s):  
Higher Order ◽  
Fertility Treatment ◽  
Stress Index ◽  
Structured Interviews ◽  
Registration Number ◽  
Competing Interest ◽  
Negative Impacts ◽  
Families With Children ◽  
Nih Funding ◽  
The Impact

Abstract STUDY QUESTION What are the psychosocial and financial issues experienced among families with children 2–12 years of age conceived by ART? SUMMARY ANSWER Our results suggest that families with children, 2–12 years of age, conceived via ART are doing well, although impacts were identified on parents of twins and higher-order multiples. WHAT IS KNOWN ALREADY Multiple births have been associated with higher morbidity and mortality of children, as well as financial costs to families and society. STUDY DESIGN, SIZE, DURATION This study was an assessment of familial response to birth of singletons, twins and higher order multiples at child’s ages of 2–12. PARTICIPANTS/MATERIALS, SETTING, METHODS Semi-structured interviews and surveys were conducted with mothers (n = 348) and fathers (n = 338) of singletons, twins and higher-order multiple gestations who received fertility services. MAIN RESULTS AND THE ROLE OF CHANCE No significant differences were observed between the groups in domains of primary caregiving or parental separation/divorce. Impacts were identified on parent’s ability to maintain employment. The revised 15-item scores of the Impact on Family Scale were significantly lower, reflecting more negative impacts, among families with twins (beta = −2.6, 95% confidence interval (CI), −4.7, −0.5, P = 0.014) and multiples (beta = −7.4, 95% CI, −10.4, −4.5, P < 0.001) than among families with singletons. Similarly, the Parenting Stress Index total scores were significantly lower among families with twins and multiples, indicating greater levels of stress, when compared to those with singletons. In addition, the Beck Depression Inventory total score were significantly higher for twins and multiples, and the Child Behaviour Checklist for ages 1.5–5 total problem score was significantly higher for twins when compared to singletons. LIMITATIONS, REASONS FOR CAUTION The study was limited to families who received fertility treatment and constitutes a population that was well educated and had higher incomes. Additionally, interview data was self-reported. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by National Institutes of Health (NIH)/Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) U10 HD39005 (to M.P.D.), U10 HD077680 (to K.R.H.), U10 HD077844 (to A.Z.), U10 HD077841 (to M.C.), U10 HD38992 (to R.S.L.), U10 HD27049 (to C.C.), U10 HD055925 (to H.Z.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NICHD or NIH. Dr Virginia Miller—no conflicts; Dr Michael P. Diamond—NIH Funding, AbbVie, Bayer and ObsEva Funding; Board of Directors and Stockholder for Advanced Reproductive Care; Dr Karl R. Hansen—Yale University/Reproductive Medicine Network/NICHD, Roche Diagnostics and Ferring International Pharmascience Center US funding; Dr Anne Steiner—NIH Funding; Dr Marcelle I. Cedars—no conflicts; Dr Richard Legro—consultant for Ogeda, Millendo, Kindex and Bayer; Ferring and Astra Zeneca funding; Dr Stephen A. Krawetz—no conflicts; Dr Christos Coutifaris—NIH Funding; Dr Hao Huang—no conflicts; Dr Nanette Santoro—no conflicts; Dr Heping Zhang—NIH Funding. TRIAL REGISTRATION NUMBER N/A

Effects Of Mechanical In-Exsufflation On Mucus Clearance In Critically Ill Patients On Invasive Mechanical Ventilation

2020 ◽  
Author(s):  
Roberto Martinez-Alejos ◽  
Joan-Daniel Martí ◽  
Gianluigi Li Bassi ◽  
Daniel Gonzalez-Anton ◽  
Xabier Pilar-Diaz ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Invasive Technique ◽  
Pulmonary Mechanics ◽  
Post Intervention ◽  
Mucus Clearance ◽  
Registration Number ◽  
Clinically Significant

Abstract Background: Mechanical insufflation-exsufflation (MI-E) is a non-invasive technique performed through the CoughAssist In-Exsufflator to simulate cough and remove mucus from proximal airways. To date, the effects of MI-E on critically ill patients on invasive mechanical ventilation (MV) are not fully elucidated. The purpose of this study was to compare the efficacy and safety of MI-E combined or not to manual chest physiotherapy (CPT) in these patients.Methods: This cross-over clinical study enrolled consecutive patients who were sedated, intubated and on MV > 48h with expected maintenance of these criteria > 24h. Over a 24-hour period, patients randomly performed two sessions of manual CPT with or without additional MI-E before tracheal suctioning. Following each procedure, volume of retrieved mucus (ml) was assessed to evaluate efficacy. We evaluated respiratory flows, pulmonary mechanics and hemodynamics before, during, and after treatment. In addition, safety of MI-E was also appraised.Results: 26 patients were included. In comparison to CPT, mucus volume retrieved was significantly higher during CPT+MI-E (0.42 [0; 1.39] ml vs 2.29 [1; 4.67] ml; p < 0.001). The respiratory system compliance immediately improved from pre and post Crs values in CPT+MI-E group (55.7 ml/cmH2O [38.3; 67.4] vs. 68.6ml/cmH2O [47.8;94.9]; p<0.001). Although, such increase was not significantly different between CPT and CPT+MI-E group (p=0.057). Heart rate significantly increased in both groups (p < 0.005) immediately after each intervention. Additionally, a significant impact on oxygenation was observed in the CPT+MI-E group when comparing the baseline values with the values one-hour post-intervention (p<0.05). Finally, several transitory hemodynamic variations occurred during both interventions, but these were non-significant and considered clinically irrelevant.Conclusion: In mechanically ventilated patients, MI-E increases the amount of secretions that can be retrieved post-CPT, without causing clinically significant adverse events.Clinical Trials Registration Number: NCT03316079 (24/11/2015; retrospectively registered)

scholarly journals PTSD symptoms related to COVID-19 as a high risk factor for suicide - Key to prevention

2020 ◽  
Author(s):  
Toshinori Chiba ◽  
Taiki Oka ◽  
Toshitaka Hamamura ◽  
Nao Kobayashi ◽  
Masaru Honjo ◽  
...  
Keyword(s):  
Mental Health ◽  
High Risk ◽  
Online Survey ◽  
Mental Health Problems ◽  
Surrogate Endpoint ◽  
Risk Groups ◽  
Added Value ◽  
National Database ◽  
Ptsd Symptoms ◽  
The Impact

SummaryBackgroundRising rates of suicide, the most dreadful consequence of mental health effects elicited by the coronavirus pandemic (COVID-19) are cause for grave concern. However, the exact association between mental health problems and suicide remains largely unknown in relation to COVID-19.MethodsTo determine the impact of COVID-19 on suicide trajectory, we used an interrupted time-series design to analyze monthly suicides rates extracted from Japan’s national database. We next used mixed-effects regression models to investigate the relationship between the nationwide suicide increase in August 2020 and psychiatric states of 4,348 individuals from an online survey performed immediately before (December 2019) and during (August 2020) the pandemic. Psychiatric states included depression, anxiety, and COVID-19-related PTSD, a form of severe event-related stress.FindingsIn Japan, suicides had gradually decreased before COVID-19 (β = −0·7×10−3, t57 = −14·2, p = 8·6×10−46), but increased drastically after a state of emergency was declared in April 2020 (β = 0·9×10−2, t57 = 17·3, p = 2·3×10−67). We found that PTSD symptoms reliably predict COVID-19’s impact on suicide rates (β = 6·3×10−4, t3936 = 5·96, p = 2·7×10−9). In contrast, depression scores are a reliable indicator of stress vulnerability (i.e. future suicide increases, β = 0·001, t3936 = 6·6, p = 4·5×10−11). Simulations revealed that a one-point reduction in PTSD score could decrease suicides by up to 3·1 per ten million people per month in Japan.InterpretationPTSD symptoms may help to identify high-risk groups so as to increase efficacy of prevention policies.FundingKDDI collaborative research contract, the Innovative Science and Technology Initiative for Security (JPJ004596), ATLA and AMED (JP20dm0307008).Research in contextEvidence before this studyWe searched PubMed on December 2, 2020, for “COVID” and “suicid*” in the titles or abstracts of published articles and obtained 269 hits. No language restrictions were applied to the search. Nearly all previous articles on suicide and COVID-19 have reported simulation studies of suicide counts and rates in case studies, editorials, letters, and commentaries. To date, no study has analyzed the association between psychiatric states and suicide increases in the context of the COVID-19 pandemic.Added value of this studyTo the best of our knowledge, this is the first study reporting a concrete approach to predict suicide rate increases from psychiatric states during the COVID-19 pandemic. Our findings indicate that PTSD symptoms are a reliable surrogate endpoint of pandemic-related suicide increase.Implications of all available evidenceThis work provides a new perspective on preparing guidelines for suicide prevention. Efforts should focus on reducing PTSD severity for single individuals and populations to reduce the overall suicide risk.

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