Prediction of suicidal ideation risk in a prospective cohort study of medical interns

The purpose of this study was to identify individual and residency program factors associated with increased suicide risk, as measured by suicidal ideation. We utilized a prospective, longitudinal cohort study design to assess the prevalence and predictors of suicidal ideation in 6,691 (2012–2014 cohorts, training data set) and 4,904 (2015 cohort, test data set) first-year training physicians (interns) at hospital systems across the United States. We assessed suicidal ideation two months before internship and then quarterly through intern year. The prevalence of reported suicidal ideation in the study population increased from 3.0% at baseline to a mean of 6.9% during internship. 16.4% of interns reported suicidal ideation at least once during their internship. In the training dataset, a series of baseline demographic (male gender) and psychological factors (high neuroticism, depressive symptoms and suicidal ideation) were associated with increased risk of suicidal ideation during internship. Further, prior quarter psychiatric symptoms (depressive symptoms and suicidal ideation) and concurrent work-related factors (increase in self-reported work hours and medical errors) were associated with increased risk of suicidal ideation. A model derived from the training dataset had a predicted area under the Receiver Operating Characteristic curve (AUC) of 0.83 in the test dataset. The suicidal ideation risk predictors analyzed in this study can help programs and interns identify those at risk for suicidal ideation before the onset of training. Further, increases in self-reported work hours and environments associated with increased medical errors are potentially modifiable factors for residency programs to target to reduce suicide risk.

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756 The Moderating Influence of Depression on Insomnia and Suicidal Ideation in a Military Sample

SLEEP ◽

10.1093/sleep/zsab072.753 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A294-A295

Author(s):

Emma Palermo ◽

Jennifer Goldschmied ◽

Elaine Boland ◽

Elizabeth A Klingaman ◽

Philip Gehrman ◽

...

Keyword(s):

Depressive Symptoms ◽

Suicidal Ideation ◽

Research University ◽

Negative Binomial ◽

Suicide Attempts ◽

Risk And Resilience ◽

Depression Severity ◽

Significant Interaction Effect ◽

Increased Risk ◽

The Impact

Abstract Introduction Military personnel are at an increased risk for suicide compared to the general population, making it important to develop a deeper understanding of which factors contribute to this elevated risk. Given that suicidal ideation (SI) is one of the strongest predictors of suicide attempts, understanding factors that underlie SI may improve prevention efforts. Insomnia and depression both serve as independent risk factors for SI, and therefore the aim of this study was to examine the extent to which depressive symptoms moderate the association between insomnia and SI. Methods Data were obtained from the All Army Study of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS). Soldiers (n=21,450) completed questions related to suicidal ideation (5 items), depressive symptoms (9 items), and insomnia (5 items) based on symptom presence in the past 30 days. Items in each domain were summed to create a total severity score. GEE models using a negative binomial linking function were conducted to examine the impact of depression, insomnia, and their interaction on SI. Results Both depression (χ2 =117.56, p<0.001) and insomnia (χ2=11.79, p=0.0006) were found to have significant main effects on SI, and there was a significant interaction effect (χ2=4.52, p=0.0335). Follow up simple effects revealed that insomnia was no longer significantly associated with SI when depression severity was low, but was associated with SI in the presence of greater depression severity (χ2=2.91, p=0.0882). Conclusion In a large sample of Army soldiers, depression significantly moderated the association between SI and insomnia, such that insomnia seems to amplify the effects of depression on SI. These findings highlight the importance of addressing insomnia severity as a mean of reducing SI in those with depression, potentially allowing for intervention prior to a suicide attempt. Support (if any) Perlis: K24AG055602 & R01AG041783. This publication is based on public use data from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan- http://doi.org/10.3886/ICPSR35197-v1), funded by U.S. NIMH-U01MH087981.

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Altitude and risk of sudden unexpected infant death in the United States

Scientific Reports ◽

10.1038/s41598-021-81613-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Richard Johnston ◽

Xiaohan Yan ◽

Tatiana M. Anderson ◽

Edwin A. Mitchell

Keyword(s):

United States ◽

Logistic Regression ◽

Infant Death ◽

The United States ◽

Sudden Infant ◽

Data Set ◽

Live Births ◽

Sudden Unexpected Infant Death ◽

Increased Risk ◽

Unexpected Infant Death

AbstractThe effect of altitude on the risk of sudden infant death syndrome (SIDS) has been reported previously, but with conflicting findings. We aimed to examine whether the risk of sudden unexpected infant death (SUID) varies with altitude in the United States. Data from the Centers for Disease Control and Prevention (CDC)’s Cohort Linked Birth/Infant Death Data Set for births between 2005 and 2010 were examined. County of birth was used to estimate altitude. Logistic regression and Generalized Additive Model (GAM) were used, adjusting for year, mother’s race, Hispanic origin, marital status, age, education and smoking, father’s age and race, number of prenatal visits, plurality, live birth order, and infant’s sex, birthweight and gestation. There were 25,305,778 live births over the 6-year study period. The total number of deaths from SUID in this period were 23,673 (rate = 0.94/1000 live births). In the logistic regression model there was a small, but statistically significant, increased risk of SUID associated with birth at > 8000 feet compared with < 6000 feet (aOR = 1.93; 95% CI 1.00–3.71). The GAM showed a similar increased risk over 8000 feet, but this was not statistically significant. Only 9245 (0.037%) of mothers gave birth at > 8000 feet during the study period and 10 deaths (0.042%) were attributed to SUID. The number of SUID deaths at this altitude in the United States is very small (10 deaths in 6 years).

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Real-world safety of palbociclib in breast cancer patients in the United States: a new user cohort study

BMC Cancer ◽

10.1186/s12885-021-07790-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Daniel C. Beachler ◽

Cynthia de Luise ◽

Aziza Jamal-Allial ◽

Ruihua Yin ◽

Devon H. Taylor ◽

...

Keyword(s):

Breast Cancer ◽

United States ◽

Pulmonary Embolism ◽

Cohort Study ◽

Real World ◽

The United States ◽

Elevated Risk ◽

Breast Cancer Patients ◽

Increased Risk ◽

Serious Infections

Abstract Background There is limited real-world safety information on palbociclib for treatment of advanced stage HR+/HER2- breast cancer. Methods We conducted a cohort study of breast cancer patients initiating palbociclib and fulvestrant from February 2015 to September 2017 using the HealthCore Integrated Research Database (HIRD), a longitudinal claims database of commercial health plan members in the United States. The historical comparator cohort comprised patients initiating fulvestrant monotherapy from January 2011 to January 2015. Propensity score matching and Cox regression were used to estimate hazard ratios for various safety events. For acute liver injury (ALI), additional analyses and medical record validation were conducted. Results There were 2445 patients who initiated palbociclib including 566 new users of palbociclib-fulvestrant, and 2316 historical new users of fulvestrant monotherapy. Compared to these historical new users of fulvestrant monotherapy, new users of palbociclib-fulvestrant had a greater than 2-fold elevated risk for neutropenia, leukopenia, thrombocytopenia, stomatitis and mucositis, and ALI. Incidence of anemia and QT prolongation were more weakly associated, and incidences of serious infections and pulmonary embolism were similar between groups after propensity score matching. After adjustment for additional ALI risk factors, the elevated risk of ALI in new users of palbociclib-fulvestrant persisted (e.g. primary ALI algorithm hazard ratio (HR) = 3.0, 95% confidence interval (CI) = 1.1–8.4). Conclusions This real-world study found increased risks of several adverse events identified in clinical trials, including neutropenia, leukopenia, and thrombocytopenia, but no increased risk of serious infections or pulmonary embolism when comparing new users of palbociclib-fulvestrant to fulvestrant monotherapy. We observed an increased risk of ALI, extending clinical trial findings of significant imbalances in grade 3/4 elevations of alanine aminotransferase (ALT).

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Beyond Fundamental Dimensions of Mood in Predicting Depressive Symptoms and Suicidal Ideation in Victims of Interpersonal Violence: Examining the Role of Dispositional Optimism in Chinese Females With and Without Experience of Victimization

Violence Against Women ◽

10.1177/10778012211030951 ◽

2021 ◽

pp. 107780122110309

Author(s):

Yifeng Du ◽

Olivia D. Chang ◽

Mingqi Li ◽

Misu Kwon

Keyword(s):

Depressive Symptoms ◽

Suicidal Ideation ◽

Prediction Model ◽

Interpersonal Violence ◽

Suicide Risk ◽

Negative Affectivity ◽

Dispositional Optimism ◽

Hierarchical Regression ◽

Regression Analyses

The present study tested a prediction model involving affectivity and dispositional optimism as predictors of suicide risk (i.e., depressive symptoms and suicidal ideation) in young adult Chinese females with and without prior interpersonal violence (IPV) victimization (294 nonvictimized and 94 victimized females). Results of hierarchical regression analyses indicated that negative affectivity was a significant predictor of both depressive symptoms and suicidal ideation for Chinese females, regardless of IPV victimization. Beyond affectivity, dispositional optimism was found to further add to the prediction model of depressive symptoms in both groups, but only for suicidal ideation in the IPV victimized group.

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Association between acute psychiatric bed availability in the Veterans Health Administration and veteran suicide risk: a retrospective cohort study

BMJ Quality & Safety ◽

10.1136/bmjqs-2020-012975 ◽

2021 ◽

pp. bmjqs-2020-012975

Author(s):

Peter J Kaboli ◽

Matthew R Augustine ◽

Bjarni Haraldsson ◽

Nicholas M Mohr ◽

M Bryant Howren ◽

...

Keyword(s):

Mental Health ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Suicide Risk ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Bed Occupancy ◽

Increased Risk

BackgroundVeteran suicides have increased despite mental health investments by the Veterans Health Administration (VHA).ObjectiveTo examine relationships between suicide and acute inpatient psychiatric bed occupancy and other community, hospital and patient factors.MethodsRetrospective cohort study using administrative and publicly available data for contextual community factors. The study sample included all veterans enrolled in VHA primary care in 2011–2016 associated with 111 VHA hospitals with acute inpatient psychiatric units. Acute psychiatric bed occupancy, as a measure of access to care, was the main exposure of interest and was categorised by quarter as per cent occupied using thresholds of ≤85%, 85.1%–90%, 90.1%–95% and >95%. Hospital-level analyses were conducted using generalised linear mixed models with random intercepts for hospital, modelling number of suicides by quarter with a negative binomial distribution.ResultsFrom 2011 to 2016, the national incidence of suicide among enrolled veterans increased from 39.7 to 41.6 per 100 000 person-years. VHA psychiatric bed occupancy decreased from a mean of 68.2% (IQR 56.5%–82.2%) to 65.4% (IQR 53.9%–79.9%). VHA hospitals with the highest occupancy (>95%) in a quarter compared with ≤85% had an adjusted incident rate ratio (IRR) for suicide of 1.10 (95% CI 1.01 to 1.19); no increased risk was observed for 85.1%–90% (IRR 0.96; 95% CI 0.89 to 1.03) or 90.1%–95% (IRR 0.96; 95% CI 0.89 to 1.04) compared with ≤85% occupancy. Of hospital and community variables, suicide risk was not associated with number of VHA or non-VHA psychiatric beds or amount spent on community mental health. Suicide risk increased by age categories, seasons, geographic regions and over time.ConclusionsHigh VHA hospital occupancy (>95%) was associated with a 10% increased suicide risk for veterans whereas absolute number of beds was not, suggesting occupancy is an important access measure. Future work should clarify optimal bed occupancy to meet acute psychiatric needs and ensure adequate bed distribution.

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Anxiety and depression among racial/ethnic minorities and impoverished women testing positive for BRCA1/2 mutations in the United States

10.21203/rs.3.rs-887893/v1 ◽

2021 ◽

Author(s):

Kate E Dibble ◽

Avonne E Connor

Keyword(s):

United States ◽

Depressive Symptoms ◽

Hispanic Women ◽

Ethnic Disparities ◽

The United States ◽

Medically Underserved ◽

Increased Risk ◽

Poverty Status ◽

Race Ethnicity ◽

Severe Anxiety

Abstract PurposeTo outline the association between race/ethnicity and poverty status and perceived anxiety and depressive symptomologies among BRCA1/2-positive United States (US) women to identify high-risk groups of mutation carriers from medically underserved backgrounds.Methods211 BRCA1/2-positive women from medically underserved backgrounds were recruited through national Facebook support groups and completed an online survey. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression for associations between race/ethnicity, poverty status, and self-reported moderate-to-severe anxiety and depressive symptoms.ResultsWomen ranged in age (18–75, M = 39.5, SD = 10.6). Most women were non-Hispanic white (NHW) (67.2%) and were not impoverished (76.7%). Hispanic women with BRCA1/2 mutations were 6.11 times more likely to report moderate-to-severe anxiety (95% CI, 2.16–17.2, p = 0.001) and 4.28 times more likely to report moderate-to-severe depressive symptoms (95% CI, 1.98–9.60, p = < 0.001) than NHW women with BRCA1/2. Associations were not statistically significant among other minority women. Women living in poverty were significantly less likely to report moderate-to-severe depressive symptoms than women not in poverty (aOR, 0.42, 95% CI, 0.18–0.95, p = 0.04).ConclusionHispanic women with BRCA1/2 mutations from medically underserved backgrounds are an important population at increased risk for worse anxiety and depressive symptomology. Our findings among Hispanic women with BRCA1/2 mutations add to the growing body of literature focused on ethnic disparities experienced across the cancer control continuum.

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Analysis of Suicidal Behavior and Chronicity of Depressive Symptoms in the Presence of Hypovitaminosis D

Current Psychiatry Research and Reviews ◽

10.2174/2666082217666211122155401 ◽

2021 ◽

Vol 17 ◽

Author(s):

Catarina Magalhães Porto ◽

Natalia Santos Barbosa da Silva ◽

Cecília Magalhães Porto Lira ◽

Rayana Porpino Magalhães ◽

José Luiz Oliveira Magalhães ◽

...

Keyword(s):

Vitamin D ◽

Depressive Symptoms ◽

Suicidal Ideation ◽

Depressive Disorder ◽

Suicidal Behavior ◽

Suicide Risk ◽

Hypovitaminosis D ◽

Serum Levels ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D

Background: One of the risk factors for suicide includes the presence of depressive disorder and symptoms, which may be related to the reduction of 25-hydroxyvitamin D serum levels. In this scenario, evidence shows vitamin D deficiency as an important aspect, directly related to depressive disorder chronicity. Objective: To assess the association between Vitamin D serum levels and the intensity of depressive symptoms and suicidal behavior in a clinical sample of depressed patients. Methods: A cross-sectional study with 146 patients aged between 18 and 59, seen in two psychiatry ambulatories. Data collection involved measurement of serum 25-hydroxyvitamin D levels and assessment of the intensity of depressive symptoms and suicide risk. Results: In the sample, 35% presented low Vitamin D serum levels and, in these individuals, the incidence of family history of Depressive Disorder (95.2%) and chronicity of severe depressive symptoms (47.8%) was higher. As to suicidal behavior, both groups presented high active suicide risk, with higher rates in the group with hypovitaminosis D. Only suicidal ideation was linked to lower Vitamin D levels (67.4% p= 0,005). Conclusion: In this study, hypovitaminosis D was associated with negative mental health outcomes, such as more severe chronicity of depressive symptoms and suicidal behavior, characterized by active suicidal ideation.

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Injury Risk Associated With Sports Specialization and Activity Volume in Youth

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119870124 ◽

2019 ◽

Vol 7 (9) ◽

pp. 232596711987012 ◽

Cited By ~ 5

Author(s):

Alison E. Field ◽

Frances A. Tepolt ◽

Daniel S. Yang ◽

Mininder S. Kocher

Keyword(s):

Physical Activity ◽

Cohort Study ◽

Injury Risk ◽

Cruciate Ligament ◽

The United States ◽

Level Of Evidence ◽

Sports Activity ◽

Risk Of Injury ◽

Increased Risk ◽

Anterior Cruciate

Background: Sports specialization has become increasingly common among youth. Purpose/Hypothesis: To investigate the relative importance of specialization vs volume of activity in increasing risk of injury. Hypotheses were that specialization increases the risk of injury and that risk varies by sport. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective analysis was conducted with data collected from 10,138 youth in the Growing Up Today Study—a prospective cohort study of youth throughout the United States—and their mothers. Activity was assessed via questionnaires in 1997, 1998, 1999, and 2001. Sports specialization was defined as engaging in a single sport in the fall, winter, and spring. Injury history was provided by participants’ mothers via questionnaire in 2004. The outcome was incident stress fracture, tendinitis, chondromalacia patella, anterior cruciate ligament tear, or osteochondritis dissecans or osteochondral defect. Results: Females who engaged in sports specialization were at increased risk of injury (hazard ratio [HR], 1.31; 95% CI, 1.07-1.61), but risk varied by sport. Sports specialization was associated with greater volume of physical activity in both sexes ( P < .0001). Total hours per week of vigorous activity was predictive of developing injury, regardless of what other variables were included in the statistical model (males: HR, 1.04; 95% CI, 1.02-1.06; females: HR, 1.06; 95% CI, 1.05-1.08). Among females, even those engaging in 3 to 3.9 hours per week less than their age were at a significantly increased risk of injury (HR, 1.93; 95% CI, 1.34-2.77). In males, there was no clear pattern of risk. Conclusion: Sports specialization is associated with a greater volume of vigorous sports activity and increased risk of injury. Parents, coaches, and medical providers need to be made aware of the volume threshold above which physical activity is excessive.

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FEASIBILITY OF A MANUALIZED FAMILY-BASED SUICIDE PREVENTION STRATEGY TO REDUCE ADOLESCENT SUICIDE RISK AMONG EMERGENCY DEPARTMENT REFERRED YOUTH: A QUALITY IMPROVEMENT PROJECT

Paediatrics & Child Health ◽

10.1093/pch/pxy054.136 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e54-e54

Author(s):

Matthew Tracey ◽

Gillian Rowney ◽

Antonio Pignatiello ◽

Suneeta Monga ◽

Daphne Korczak

Keyword(s):

Emergency Department ◽

Depressive Symptoms ◽

Suicidal Ideation ◽

Suicide Prevention ◽

Controlled Trial ◽

Standard Of Care ◽

Improvement Project ◽

Care Clinic ◽

Ensure Patient Safety ◽

Increased Risk

Abstract BACKGROUND Suicide is the second leading cause of death among Canadian children and adolescents. Youth who present at an Emergency Department (ED) for suicidal ideation and risk behaviours (SRB) are at increased risk for eventual suicide. Despite this risk, current approaches to standard of care are referral to community resources or primary care where waitlists are common, and interventions may not be evidence-based or incorporate crisis management or family participation. OBJECTIVES To determine the feasibility and acceptability of a manualized, family-centered suicide prevention intervention administered in an outpatient clinic for ED-referred youth. DESIGN/METHODS Youth (aged 12 – 18) and parents presenting to the ED for SRB and referred to the Urgent Psychiatry Care clinic were eligible for the QI program, consisting of weekly individual and family sessions delivered over a 6-week period. The therapist addressed common symptoms and concerns of suicidal youth, sources of conflict within the family, and ways to improve communication and ensure patient safety. Patients were excluded if they did not have a parent or caregiver able to participate. Suicidal ideation and behavior were assessed using youth-report measures, the Suicidal Ideation Questionnaire-Junior (SIQ-JR) and the Harkavy-Asnis Suicide Scale (HASS), at baseline and following program completion. The Mood and Feeling Questionnaire (MFQ) was used to measure depressive symptoms. Participant and therapist feedback was collected at follow-up using quantitative and qualitative measures. RESULTS Ten patients were enrolled and completed baseline measures, however four participants withdrew prior to 6 week completion: two withdrew at week 2 and one participant each withdrew at weeks 3 and 6. As such, 7/10 completed 5 weeks of the intervention. Significant improvement in both suicidal ideation (SIQ-JR, x̅ = -16.67; t(5) = 3.125, p = .026) and SRB (HASS, x̅ = -20.17; t(5) = 3.204, p = .024) were observed. Depressive symptoms also decreased (MFQ, x̅ = -15.5, t(5) = 2.724, p = .042). Youth and caregivers rated the program favorably. Improved family communication was most frequently reported by both patients and caregivers as a main benefit of the program. CONCLUSION These preliminary data indicate that SRB may be improved by a brief manualized, family-focused therapy. Early data suggest that the protocol is feasible and acceptable for adolescents presenting to the ED with safety concerns, and warrant further examination in a controlled trial.

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Suicide Risk in Cancer Patients – Are We Prepared?

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1137 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S667-S667

Author(s):

M. Alves ◽

A. Tavares

Keyword(s):

Suicidal Ideation ◽

General Population ◽

Cancer Patients ◽

Suicide Risk ◽

Active Listening ◽

Suicidal Thoughts ◽

Increased Risk ◽

Wish To Die ◽

Physical Risk Factors ◽

Competing Interest

IntroductionIndividuals with cancer are at increased risk for suicidal ideation and behaviour when compared to the general population. Suicidal thoughts are sometimes minimized and considered by clinicians as a normal reaction to diagnosis of oncological disease. Less severe forms of suicidal ideation, such a fleeting wish to die may happen in all stages of the disease.ObjectivesWe aim to highlight the cases of cancer patients that present an imminent suicide risk and its related psychopathological aspects, psychosocial and physical risk factors that may increase the probability of suicidal attempt.MethodsNon systematic literature review through the Medline and Clinical Key databases, with time constraints.ResultsIndividuals with cancer have twice the risk of suicide compared to the general population. It was found that suicidal thoughts are more common in patients with advanced disease, in hospital or in palliative care settings or in those who are experiencing severe pain, depression, cognitive impairment or delirium. The first months following the diagnosis are the period of greatest risk and the highest suicide risk occurs in men with respiratory cancers. Death by suicide occurs more often in cancer patients in the advanced stages of disease.ConclusionsAn appropriate therapeutic response should include empathy, active listening, management of realistic expectations and permission to discuss psychological distress. The first intervention should focus on determining imminent risk of suicidal behaviour and act for patient safety.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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