scholarly journals A Population-Based Analysis of Interpersonal Trauma, Psychosis, and Suicide: Evidence, Pathways, and Implications

2020 ◽  
pp. 088626052091259
Author(s):  
David Boyda ◽  
Danielle McFeeters ◽  
Katie Dhingra ◽  
Ian Kelleher
Keyword(s):  
Life Span ◽  
Latent Class ◽  
Suicide Ideation ◽  
Psychiatric Morbidity ◽  
Population Based ◽  
Poor Quality ◽  
Traumatic Experiences ◽  
Social Disconnection ◽  
Person Centered Approach ◽  
The Impact

Subthreshold psychotic experiences (PEs) are known to confer a risk for suicidality. Yet, despite evidence of a strong etiological trauma–psychosis pathway, the coalesced effect of such concurrences on suicide risk is largely discounted. Our aims were to examine the impact of different manifestations of life span trauma and PEs on the risk of suicidal thoughts and attempts, using an exploratory person-centered approach. Data from the Adult Psychiatric Morbidity Survey ( N = 7,403) were analyzed. PEs were assessed using the Psychosis Screening Questionnaire (PSQ) alongside items probing childhood and adult trauma, in addition to 12-month suicide thoughts and attempt. A manual three-step latent class analysis elicited four distinct profiles, namely, a socially disconnected/high PE, a sexual victimization/moderate PE, a life span trauma/low PE, and a baseline class. The socially disconnected class, characterized by a moderate likelihood of social disconnection, a high probability of various PE endorsements, yet a low likelihood of other significant trauma, showed the greatest risk of 12-month suicide ideation (odds ratio [OR] = 13.0, 95% confidence interval [CI] = [8.539, 19.021) and attempt (OR = 24.2, 95% CI = [10.349, 56.860). Neither multiple nor recurrent traumatic experiences invariably result in the emergence of PEs. Instead, a sense of social disconnection may be either resultant of PEs or alone sufficient to cultivate such symptom presentations, even in the absence of prior traumas. Moreover, just as traumatic encounters increase the risk of suicidality, so too might seemingly more innocuous adversities, such as poor-quality social relationships, further elevate the risk, particularly when proximal and coupled with the simultaneity of PEs.

The impact of psychiatric and medical comorbidity on the risk of mortality: a population-based analysis

2019 ◽  
pp. 1-9
Author(s):  
Simon J. C. Davies ◽  
Tomisin Iwajomo ◽  
Claire de Oliveira ◽  
Judith Versloot ◽  
Robert J. Reid ◽  
...  
Keyword(s):  
Depressive Disorder ◽  
Excess Mortality ◽  
Psychiatric Morbidity ◽  
Health Service Delivery ◽  
Population Based ◽  
Future Research ◽  
Medical Disorders ◽  
Medical Disorder ◽  
Stable Conditions ◽  
The Impact

Abstract Background As life expectancy increases, more people have chronic psychiatric and medical health disorders. Comorbidity may increase the risk of premature mortality, an important challenge for health service delivery. Methods Population-based cohort study in Ontario, Canada of all 11 246 910 residents aged ⩾16 and <105 on 1 April 2012 and alive on 31 March 2014. Secondary analyses included subjects having common medical disorders in 10 separate cohorts. Exposures were psychiatric morbidity categories identified using aggregated diagnosis groups (ADGs) from Johns Hopkins Adjusted Clinical Groups software® (v10.0); ADG 25: Persistent/Recurrent unstable conditions; e.g. acute schizophrenic episode, major depressive disorder (recurrent episode), ADG 24: Persistent/Recurrent stable conditions; e.g. depressive disorder, paranoid personality disorder, ADG 23: Time-limited/minor conditions; e.g. adjustment reaction with brief depressive reaction. The outcome was all-cause mortality (April 2014–March 2016). Results Over 2 years' follow-up, there were 188 014 deaths (1.7%). ADG 25 conferred an almost threefold excess mortality after adjustment compared to having no psychiatric morbidity [adjusted hazard ratio 2.94 (95% CI 2.91–2.98, p < 0.0001)]. Adjusted hazard ratios for ADG 24 and ADG 23 were 1.12 (95% CI 1.11–1.14, p < 0.0001) and 1.31 (95% CI 1.26–1.36, p < 0.0001). In all 10 medical disorder cohorts, ADG 25 carried significantly greater mortality risk compared to no psychiatric comorbidity. Conclusions Psychiatric disorders, particularly those graded persistent/recurrent and unstable, were associated with excess mortality in the whole population, and in the medical disorder cohorts examined. Future research should examine whether service design accounting for psychiatric disorder comorbidity improves outcomes across the spectrum of medical disorders.

Prevalence and estimated trend in chemotherapy use near death from population-based studies on cancer patients: A systematic review and meta-analysis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6590-6590
Author(s):  
Pei-Chun Chou ◽  
Chen Hsiu Chen ◽  
Tsang-Wu Liu ◽  
Siew Tzuh Tang
Keyword(s):  
Cancer Patients ◽  
Meta Analysis ◽  
Population Based ◽  
Poor Quality ◽  
National Guidelines ◽  
Payment Reform ◽  
Effective Interventions ◽  
The Us ◽  
Before And After ◽  
The Impact

6590 Background: Chemotherapy (CMT) use near death, based on US national guidelines, is an indicator of aggressive treatment and poor quality of end-of-life (EOL) care. US law also decreased Medicare payments for outpatient CMT since 2005-2006. To evaluate the impact of US payment reform and guidelines on CMT use at EOL, we estimated and compared the overall prevalence of CMT use at EOL in the US and other countries as well as before and after 2007 in the US. Methods: Six databases were systematically searched to January 2017 for population-based studies of CMT use at EOL for patients in all cancer groups. Two reviewers independently extracted data.Overall CMT use prevalence was pooled by a random-effects model. Differences in prevalence of CMT use were compared by meta-regression between subgroups (US vs non-US countries; before and after 2007 in the US). Results: We identified 9 and 7 articles from the US and non-US countries, respectively. CMT was provided to 28.9% [95% confidence interval (CI) 26.2%-31.8%], 23.2% [95% CI 21.7%- 24.8%], 10.0% [95% CI 8.5%-11.8%], and 4.5% [95% CI 3.9%- 5.2%] of cancer patients in their last 6, 3, and 1 months as well as 14 days of life, respectively. CMT use in the last 6 months was more common in the US than in non-US countries (32.4% vs. 26.2%, p = 0.015) but similar to that of other countries in the last month (9.3% vs.11.2%, p = 0.179) and last 14 days (4.6% vs.5.6%, p = 0.683) of life. Prevalence of CMT use in the last 14 days of life in the US did not differ significantly before and after 2007 (5.1% vs. 5.2%, p = 0.967). Conclusions: Many cancer patients worldwide receive CMT at EOL, and the prevalence of CMT use in US patients’ last 14 days of life was virtually unchanged over time. Effective interventions should be developed and provided to offset the trend of continuing CMT use at EOL.

Flour fortification with iron has no impact on anaemia in urban Brazilian children

2012 ◽  
Vol 15 (10) ◽  
pp. 1796-1801 ◽  
Author(s):  
Maria CF Assunção ◽  
Iná S Santos ◽  
Aluísio JD Barros ◽  
Denise P Gigante ◽  
Cesar G Victora
Keyword(s):  
Venous Blood ◽  
Transferrin Saturation ◽  
Nationwide Survey ◽  
Population Based ◽  
Poor Quality ◽  
Fe Deficiency ◽  
Local Study ◽  
The Impact ◽  
Brazilian Children

AbstractObjectiveTo verify the impact of flour fortification on anaemia in Brazilian children. The survey also investigated the role of Fe deficiency as a cause of anaemia and estimated the bioavailability of the Fe in the children's diet. This local study was complemented by a nationwide survey of the types of Fe compounds added to flour.DesignSeries of population-based surveys conducted in 2004 (baseline study), 2005, 2006 and 2008.SettingPelotas, Rio Grande do Sul, Brazil.SubjectsChildren under 6 years of age residing in the urban area of the city of Pelotas, Southern Brazil (n 507 in 2004; n 960 in 2005; n 893 in 2006; n 799 in 2008). In 2008, a sub-sample of children (n 114) provided venous blood samples to measure body Fe reserve parameters (ferritin and transferrin saturation).ResultsWe found no impact of fortification, with an increase in anaemia prevalence among children under 24 months of age. Hb levels decreased by 0·9 g/dl in this age group between 2004 and 2008 (10·9 g/dl to 10·0 g/dl; P < 0·001). Roughly 50 % of cases of anaemia were estimated to be due to Fe deficiency. Half of the mills surveyed used reduced Fe to fortify wheat flour. Total Fe intake from all foodstuffs was adequate for 88·6 % of the children, but its bioavailability was only 5 %.ConclusionsThe low bioavailability of the Fe compounds added to flours, combined with the poor quality of children's diets, account for the lack of impact of mandatory fortification.

The impact of wildfires on mental health of residents in a rural area of Greece. A case control population based study

2011 ◽  
Vol 26 (S2) ◽  
pp. 1188-1188 ◽  
Author(s):  
D. Adamis ◽  
V. Papanikolaou ◽  
R.C. Mellon ◽  
G. Prodromitis
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Psychological Symptoms ◽  
Adult Population ◽  
Psychiatric Morbidity ◽  
Population Based ◽  
Case Control ◽  
Cross Sectional ◽  
The Impact ◽  
Of Greece

IntroductionPsychopathological disturbances are common in the aftermaths of a disaster. The consequences of these disorders can be long lasting. In August of 2007 an intense and destructive wildfire broke out in the Peloponnesus peninsula in Greece.ObjectivesTo investigate psychological and psychiatric morbidity in individuals who had experienced severe exposure to a wildfire disaster in a part of Greece and to indentify risk factors for the post disaster psychological problems.AimsTo investigate a broader spectrum of mid-term psychological and psychiatric morbidity in victims, to evaluate the proportion of psychopathology that could be accredited to the disaster, to estimate the association of losses with different psychological symptoms, to indentify risk factors for psychopathology.MethodsA Cross sectional case control study of adult population (18–65 years old). Data collected among others were demographic, Symptom Checklist 90-Revised for assessment of psychological difficulties, type and number of losses.ResultsThose damnified from the disaster scored significantly higher (p < 0.05) in the symptoms of somatisation, depression, anxiety, hostility, phobic anxiety, paranoia, and had significantly more symptoms (PST) and were more distressed by them (GSI) compared to controls. In addition risk factors for someone to be a psychiatric case were to be a victim from the fire, to have finished primary school, to be windowed and to have damages to his property.ConclusionsWildfires can cause considerable psychological symptoms in victims and there are reasons for public health policy makers to create services in order to help and improve the mental health of those affected.

Psychiatric Morbidity and Survival After Surgery for Esophageal Cancer: A Population-Based Cohort Study

2015 ◽  
Vol 33 (5) ◽  
pp. 448-454 ◽  
Author(s):  
Anna Wikman ◽  
Rickard Ljung ◽  
Asif Johar ◽  
Ylva Hellstadius ◽  
Jesper Lagergren ◽  
...  
Keyword(s):  
Risk Factors ◽  
Esophageal Cancer ◽  
Patient Care ◽  
Psychotropic Drugs ◽  
Cumulative Incidence ◽  
Psychiatric Morbidity ◽  
Tumor Stage ◽  
Population Based ◽  
Health Care Use ◽  
The Impact

Purpose To determine the cumulative incidence of and risk factors for psychiatric morbidity and establish the impact on survival among surgically treated patients with esophageal cancer. Patients and Methods A nationwide Swedish cohort of 1,615 patients who underwent surgery for esophageal cancer between 1987 and 2010 with follow-up until 2012 was linked to national health registries for information on psychiatric morbidity (inferred from mental health care use). Multivariable logistic regressions were used to determine potential risk factors for postoperative psychiatric morbidity. A multivariable-adjusted Cox proportional hazard model was used to analyze overall survival. Results In patients without a history of psychiatric morbidity, the 2-year cumulative incidence for treatment in psychiatric in-patient care was 2.5%, for psychiatric out-patient care was 4.2%, and for treatment with psychotropic drugs was 32.3%. Married patients were less likely to be treated postoperatively in psychiatric in-patient care (odds ratio [OR], 0.42; 95% CI, 0.22 to 0.80) or out-patient care (OR, 0.41; 95% CI, 0.17 to 1.02), whereas patients with higher tumor stage were more likely to be treated in psychiatric out-patient care (OR, 4.99; 95% CI, 1.16 to 21.38) or with psychotropic drugs (OR, 2.78; 95% CI, 1.10 to 7.01). Bearing in mind possible residual confounding, new-onset psychiatric morbidity was associated with mortality (hazard ratio [HR], 1.65 [95% CI, 1.17 to 2.33] for treatment in psychiatric in-patient care; HR, 1.93 [95% CI, 1.18 to 3.16] for treatment in psychiatric out-patient care; and HR, 2.77 [95% CI, 1.72 to 4.44] for treatment with psychotropic drugs). Conclusion These results highlight the importance of recognizing and addressing psychiatric morbidity in surgically treated patients with esophageal cancer.

Efficacy of Crisis Intervention

Crisis ◽  
1999 ◽  
Vol 20 (2) ◽  
pp. 78-85 ◽  
Author(s):  
Thomas Reisch ◽  
Petra Schlatter ◽  
Wolfgang Tschacher
Keyword(s):  
Crisis Intervention ◽  
Intervention Program ◽  
Suicide Ideation ◽  
Indirect Evidence ◽  
Well Being ◽  
Term Therapy ◽  
Contributing Factors ◽  
Step Therapy ◽  
Long Term Therapy ◽  
The Impact

This study assesses the efficacy of the treatment approach implemented in the Bern Crisis Intervention Program, where particular emphasis is placed on the remediation of suicide ideation and suicidal behavior, and depression, fear, and phobia are generally considered to be contributing factors. Four questionnaires addressing psychopathology, emotional well-being, social anxiety, and personality were administered prior to and after the treatment of 51 patients over a period of 2 to 3 weeks. The reduction of symptoms contributing to suicidal ideation and behavior was interpreted as indirect evidence of an antisuicidal effect of the program. Significant improvements were found in the psychopathology ratings, with depression and anxiety showing the largest reductions. The impact on personality and social phobia, however, was only moderate, and on average patients still exhibited symptoms after attending the program. This residual symptomatology points to the necessity of introducing a two-step therapy approach of intensive intervention targeted at the precipitating causes of the crisis, augmented by long-term therapy to treat underlying problems.

The Impact of Missing and Error-Prone Auxiliary Information on Sparse-Matrix Sub-Population Parameter Estimates

Methodology ◽  
2015 ◽  
Vol 11 (3) ◽  
pp. 89-99 ◽  
Author(s):  
Leslie Rutkowski ◽  
Yan Zhou
Keyword(s):  
Sparse Matrix ◽  
Small Body ◽  
Auxiliary Information ◽  
Poor Quality ◽  
Quality Data ◽  
Estimation Methods ◽  
Parameter Estimates ◽  
Population Parameter ◽  
Conditioning Model ◽  
The Impact

Abstract. Given a consistent interest in comparing achievement across sub-populations in international assessments such as TIMSS, PIRLS, and PISA, it is critical that sub-population achievement is estimated reliably and with sufficient precision. As such, we systematically examine the limitations to current estimation methods used by these programs. Using a simulation study along with empirical results from the 2007 cycle of TIMSS, we show that a combination of missing and misclassified data in the conditioning model induces biases in sub-population achievement estimates, the magnitude and degree to which can be readily explained by data quality. Importantly, estimated biases in sub-population achievement are limited to the conditioning variable with poor-quality data while other sub-population achievement estimates are unaffected. Findings are generally in line with theory on missing and error-prone covariates. The current research adds to a small body of literature that has noted some of the limitations to sub-population estimation.

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