Depression

BROOKLYN, N.Y. – Intervening effectively for children and adolescents at suicide risk involves watching for triggers such as personal loss, sleep disturbances, or interpersonal conflict, an expert said at a pediatric psychopharmacology update held by the American Academy of Child and Adolescent Psychiatry.

It is important to distinguish the distal risks, which are factors known to increase suicidal ideation, and proximal risk factors, which predict attempts, according to Tina R. Goldstein, PhD, associate professor of psychiatry and psychology at the University of Pittsburgh. “We know that the optimal targets for preventing suicidal behavior are proximal,” Dr. Goldstein said. Treatment of distal risks, such as depression or substance use, is a foundation for risk management, but suicidal events are driven by acute crises that appear to require individualized intervention.

Dr. Goldstein said she had just “one sad slide” to summarize drug treatments aimed at controlling suicidal behavior. That slide included citations for studies associating neuroleptics and antidepressants with a reduction in aggressive or impulsive behavior in children. The only study associating a drug with a reduction in suicide attempts was performed with lithium in adults.

However, intensive cognitive and dialectical behavior interventions involving the family have been shown to reduce suicide attempts in randomized controlled trials, said Dr. Goldstein, who also is affiliated with the university’s Child and Adolescent Bipolar Spectrum Services Research Program. Those trials underscore the messages that personalizing therapy is essential, as are addressing specific triggers and helping patients develop defenses against suicidal thoughts.

Dr. Goldstein described a recently published, National Institutes of Health–funded study that focused on suicide reduction. The study was conducted in adolescents who were being discharged from a brief hospitalization for acute suicidal ideation or a suicide attempt (J Adolesc Health. 2018 Nov. 8. doi: 10.1016/j.jadohealth.2018.09.015). “We know that there is this really high-risk period after discharge from the hospital for which we could potentially do things better,” said Dr. Goldstein, whose center was involved in the study.

The tested intervention, called As Safe As Possible (ASAP), involved “front-loading some coping skills and giving [the patients] a good safety plan even before they are discharged,” Dr. Goldstein said. For risk management after discharge, the adolescents were provided with a smartphone app called BRITE that contained the safety plan as well as a summary of personalized coping skills, including reminders that the patients themselves had provided for reasons for living. The app was augmented as appropriate with favorite songs, photos of the patients’ pet, or other customized aids to provide support during the typical delay between the time of discharge and the next step in care.

In 6 months of follow-up, the rate of suicide attempts was 8.7% of those enrolled in the intensive outpatient program, compared with 27.3% (P = .08) for those who received treatment as usual. Dr. Goldstein called this trend promising, particularly in the context of other favorable results, including a significantly longer (P = .03) time to a suicide attempt in the ASAP group.

In patients at imminent risk of a suicide attempt, it is logical to assume that treatment must be personalized to the issues behind increased suicidal ideation. However, a study published by Dr. Goldstein and her associates several years ago suggested that evidence of deteriorating mental health can signal a need for intensification of suicide risk management (Arch Gen Psychiatry. 2012;69:1113-22). In one part of that study, risk factors for suicide were evaluated in the 8 weeks before a suicide attempt in 413 children with bipolar disorder. During that time, depression scores increased as did substance use, but, surprisingly, so did use of mental health services.

“The way we have come to think of these data is that the kids, their parents, and their providers were recognizing that things were getting worse and they needed more services,” Dr. Goldstein said. “The bad news is that the services we were giving them were not particularly effective.”

Those data underscore some of the challenges facing clinicians who treat pediatric patients with mental illness. “Our field has not yet developed ... gold standard treatments for preventing suicidal behavior in kids with mood disorder,” Dr. Goldstein said. However, she thinks that some progress has been made and that some of the personalized approaches are demonstrating efficacy – particularly in children and adolescents who exhibit signs of imminent risk.

BROOKLYN, N.Y. – Intervening effectively for children and adolescents at suicide risk involves watching for triggers such as personal loss, sleep disturbances, or interpersonal conflict, an expert said at a pediatric psychopharmacology update held by the American Academy of Child and Adolescent Psychiatry.

It is important to distinguish the distal risks, which are factors known to increase suicidal ideation, and proximal risk factors, which predict attempts, according to Tina R. Goldstein, PhD, associate professor of psychiatry and psychology at the University of Pittsburgh. “We know that the optimal targets for preventing suicidal behavior are proximal,” Dr. Goldstein said. Treatment of distal risks, such as depression or substance use, is a foundation for risk management, but suicidal events are driven by acute crises that appear to require individualized intervention.

Dr. Goldstein said she had just “one sad slide” to summarize drug treatments aimed at controlling suicidal behavior. That slide included citations for studies associating neuroleptics and antidepressants with a reduction in aggressive or impulsive behavior in children. The only study associating a drug with a reduction in suicide attempts was performed with lithium in adults.

However, intensive cognitive and dialectical behavior interventions involving the family have been shown to reduce suicide attempts in randomized controlled trials, said Dr. Goldstein, who also is affiliated with the university’s Child and Adolescent Bipolar Spectrum Services Research Program. Those trials underscore the messages that personalizing therapy is essential, as are addressing specific triggers and helping patients develop defenses against suicidal thoughts.

Dr. Goldstein described a recently published, National Institutes of Health–funded study that focused on suicide reduction. The study was conducted in adolescents who were being discharged from a brief hospitalization for acute suicidal ideation or a suicide attempt (J Adolesc Health. 2018 Nov. 8. doi: 10.1016/j.jadohealth.2018.09.015). “We know that there is this really high-risk period after discharge from the hospital for which we could potentially do things better,” said Dr. Goldstein, whose center was involved in the study.

The tested intervention, called As Safe As Possible (ASAP), involved “front-loading some coping skills and giving [the patients] a good safety plan even before they are discharged,” Dr. Goldstein said. For risk management after discharge, the adolescents were provided with a smartphone app called BRITE that contained the safety plan as well as a summary of personalized coping skills, including reminders that the patients themselves had provided for reasons for living. The app was augmented as appropriate with favorite songs, photos of the patients’ pet, or other customized aids to provide support during the typical delay between the time of discharge and the next step in care.

In 6 months of follow-up, the rate of suicide attempts was 8.7% of those enrolled in the intensive outpatient program, compared with 27.3% (P = .08) for those who received treatment as usual. Dr. Goldstein called this trend promising, particularly in the context of other favorable results, including a significantly longer (P = .03) time to a suicide attempt in the ASAP group.

In patients at imminent risk of a suicide attempt, it is logical to assume that treatment must be personalized to the issues behind increased suicidal ideation. However, a study published by Dr. Goldstein and her associates several years ago suggested that evidence of deteriorating mental health can signal a need for intensification of suicide risk management (Arch Gen Psychiatry. 2012;69:1113-22). In one part of that study, risk factors for suicide were evaluated in the 8 weeks before a suicide attempt in 413 children with bipolar disorder. During that time, depression scores increased as did substance use, but, surprisingly, so did use of mental health services.

“The way we have come to think of these data is that the kids, their parents, and their providers were recognizing that things were getting worse and they needed more services,” Dr. Goldstein said. “The bad news is that the services we were giving them were not particularly effective.”

Those data underscore some of the challenges facing clinicians who treat pediatric patients with mental illness. “Our field has not yet developed ... gold standard treatments for preventing suicidal behavior in kids with mood disorder,” Dr. Goldstein said. However, she thinks that some progress has been made and that some of the personalized approaches are demonstrating efficacy – particularly in children and adolescents who exhibit signs of imminent risk.

BROOKLYN, N.Y. – Intervening effectively for children and adolescents at suicide risk involves watching for triggers such as personal loss, sleep disturbances, or interpersonal conflict, an expert said at a pediatric psychopharmacology update held by the American Academy of Child and Adolescent Psychiatry.

It is important to distinguish the distal risks, which are factors known to increase suicidal ideation, and proximal risk factors, which predict attempts, according to Tina R. Goldstein, PhD, associate professor of psychiatry and psychology at the University of Pittsburgh. “We know that the optimal targets for preventing suicidal behavior are proximal,” Dr. Goldstein said. Treatment of distal risks, such as depression or substance use, is a foundation for risk management, but suicidal events are driven by acute crises that appear to require individualized intervention.

Dr. Goldstein said she had just “one sad slide” to summarize drug treatments aimed at controlling suicidal behavior. That slide included citations for studies associating neuroleptics and antidepressants with a reduction in aggressive or impulsive behavior in children. The only study associating a drug with a reduction in suicide attempts was performed with lithium in adults.

However, intensive cognitive and dialectical behavior interventions involving the family have been shown to reduce suicide attempts in randomized controlled trials, said Dr. Goldstein, who also is affiliated with the university’s Child and Adolescent Bipolar Spectrum Services Research Program. Those trials underscore the messages that personalizing therapy is essential, as are addressing specific triggers and helping patients develop defenses against suicidal thoughts.

Dr. Goldstein described a recently published, National Institutes of Health–funded study that focused on suicide reduction. The study was conducted in adolescents who were being discharged from a brief hospitalization for acute suicidal ideation or a suicide attempt (J Adolesc Health. 2018 Nov. 8. doi: 10.1016/j.jadohealth.2018.09.015). “We know that there is this really high-risk period after discharge from the hospital for which we could potentially do things better,” said Dr. Goldstein, whose center was involved in the study.

The tested intervention, called As Safe As Possible (ASAP), involved “front-loading some coping skills and giving [the patients] a good safety plan even before they are discharged,” Dr. Goldstein said. For risk management after discharge, the adolescents were provided with a smartphone app called BRITE that contained the safety plan as well as a summary of personalized coping skills, including reminders that the patients themselves had provided for reasons for living. The app was augmented as appropriate with favorite songs, photos of the patients’ pet, or other customized aids to provide support during the typical delay between the time of discharge and the next step in care.

In 6 months of follow-up, the rate of suicide attempts was 8.7% of those enrolled in the intensive outpatient program, compared with 27.3% (P = .08) for those who received treatment as usual. Dr. Goldstein called this trend promising, particularly in the context of other favorable results, including a significantly longer (P = .03) time to a suicide attempt in the ASAP group.

In patients at imminent risk of a suicide attempt, it is logical to assume that treatment must be personalized to the issues behind increased suicidal ideation. However, a study published by Dr. Goldstein and her associates several years ago suggested that evidence of deteriorating mental health can signal a need for intensification of suicide risk management (Arch Gen Psychiatry. 2012;69:1113-22). In one part of that study, risk factors for suicide were evaluated in the 8 weeks before a suicide attempt in 413 children with bipolar disorder. During that time, depression scores increased as did substance use, but, surprisingly, so did use of mental health services.

“The way we have come to think of these data is that the kids, their parents, and their providers were recognizing that things were getting worse and they needed more services,” Dr. Goldstein said. “The bad news is that the services we were giving them were not particularly effective.”

Those data underscore some of the challenges facing clinicians who treat pediatric patients with mental illness. “Our field has not yet developed ... gold standard treatments for preventing suicidal behavior in kids with mood disorder,” Dr. Goldstein said. However, she thinks that some progress has been made and that some of the personalized approaches are demonstrating efficacy – particularly in children and adolescents who exhibit signs of imminent risk.

Positive well-being might function as a “resilient factor against depression” in autism spectrum disorder, results of a 12-month study of newly employed adults with ASD suggest.

“The potential for positive well-being to functioning as a buffer against depression in this study, as well as the broader benefits of positive well-being in the general population, suggests that positive well-being should be cultivated within the employment context,” wrote Darren Hedley, PhD, of La Trobe University, Melbourne, and his associates (Autism Res. 2019 Jan 24. doi: 10.1002/aur/2064).

To conduct the study, Dr. Hedley and his associates tested 36 (32 male) adults aged 18-57 with ASD who worked in an employment program supported by the Australian government. Among the measures used to assess mental health, social support, and job satisfaction were the Patient Health Questionnaire-9, the DSM-5 Dimensional Anxiety Scale, the Warwick-Edinburgh Mental Wellbeing Scale, the Interpersonal Support Evaluation List-12, and the Minnesota Satisfaction Questionnaire-Short Form.

Over the course of 12 months, Dr. Hedley and his associates found that the participants experienced a small increase in their daily living skills and a small drop in job satisfaction, but all other measures – except for depression – remained stable. In the case of depressive symptoms, a negative correlation was found between baseline positive well-being and depression at follow-up. “These results are consistent with research in the general population that shows well-being functions as a buffer or protective factor against depression,” they wrote.

Dr. Hedley and his associates cited several limitations, including the small sample size and the absence of a comparative sample of adults with ASD engaged in open employment.

The full study can be found at Autism Research.

cpalmer@mdedge.com

Positive well-being might function as a “resilient factor against depression” in autism spectrum disorder, results of a 12-month study of newly employed adults with ASD suggest.

“The potential for positive well-being to functioning as a buffer against depression in this study, as well as the broader benefits of positive well-being in the general population, suggests that positive well-being should be cultivated within the employment context,” wrote Darren Hedley, PhD, of La Trobe University, Melbourne, and his associates (Autism Res. 2019 Jan 24. doi: 10.1002/aur/2064).

To conduct the study, Dr. Hedley and his associates tested 36 (32 male) adults aged 18-57 with ASD who worked in an employment program supported by the Australian government. Among the measures used to assess mental health, social support, and job satisfaction were the Patient Health Questionnaire-9, the DSM-5 Dimensional Anxiety Scale, the Warwick-Edinburgh Mental Wellbeing Scale, the Interpersonal Support Evaluation List-12, and the Minnesota Satisfaction Questionnaire-Short Form.

Over the course of 12 months, Dr. Hedley and his associates found that the participants experienced a small increase in their daily living skills and a small drop in job satisfaction, but all other measures – except for depression – remained stable. In the case of depressive symptoms, a negative correlation was found between baseline positive well-being and depression at follow-up. “These results are consistent with research in the general population that shows well-being functions as a buffer or protective factor against depression,” they wrote.

Dr. Hedley and his associates cited several limitations, including the small sample size and the absence of a comparative sample of adults with ASD engaged in open employment.

The full study can be found at Autism Research.

cpalmer@mdedge.com

Positive well-being might function as a “resilient factor against depression” in autism spectrum disorder, results of a 12-month study of newly employed adults with ASD suggest.

“The potential for positive well-being to functioning as a buffer against depression in this study, as well as the broader benefits of positive well-being in the general population, suggests that positive well-being should be cultivated within the employment context,” wrote Darren Hedley, PhD, of La Trobe University, Melbourne, and his associates (Autism Res. 2019 Jan 24. doi: 10.1002/aur/2064).

To conduct the study, Dr. Hedley and his associates tested 36 (32 male) adults aged 18-57 with ASD who worked in an employment program supported by the Australian government. Among the measures used to assess mental health, social support, and job satisfaction were the Patient Health Questionnaire-9, the DSM-5 Dimensional Anxiety Scale, the Warwick-Edinburgh Mental Wellbeing Scale, the Interpersonal Support Evaluation List-12, and the Minnesota Satisfaction Questionnaire-Short Form.

Over the course of 12 months, Dr. Hedley and his associates found that the participants experienced a small increase in their daily living skills and a small drop in job satisfaction, but all other measures – except for depression – remained stable. In the case of depressive symptoms, a negative correlation was found between baseline positive well-being and depression at follow-up. “These results are consistent with research in the general population that shows well-being functions as a buffer or protective factor against depression,” they wrote.

Dr. Hedley and his associates cited several limitations, including the small sample size and the absence of a comparative sample of adults with ASD engaged in open employment.

The full study can be found at Autism Research.

cpalmer@mdedge.com

A sign on the wall of the Sip of Hope Coffee Bar in the Logan Square area of Chicago reads: “It’s OK not to be OK.” The slogan is more than a way to distinguish the coffee shop from competitors. According to a report published recently in the Chicago Sun-Times, all money spent on beverages and pastries is donated to suicide prevention and mental health programs in the Windy City.

Lynda Banzi/IMNG Medical Media

“Sip of Hope is the brick-and-mortar version of what we do every day,” Jonny Boucher, who started a nonprofit called Hope for the Day in 2011 in an effort to make mental health issues part of the everyday conversation, said in the article. “I’ve lost 16 people to suicide, and I thought if I can just take this pain and I can do something with it, then I can allow others to do something with their pain.”

Mr. Boucher organizes a monthly get-together at the coffee shop where people can talk about their mental health struggles and find help and friendship.

“If I got paid $10 for every time someone said I saved their life, this organization would be bankrolled for eternity,” said Mr. Boucher. “There is no magic wand with mental health but I try to tell people – we’re all in this together – it’s not about me, it’s about we.”
 

Housing First program launched

A housing program being offered in some parts of Kansas, including Wichita, is making housing available to people with mental illness without the traditional requirements of a nightly curfew or adherence to sobriety.

“What we’re doing with a program like this is essentially leveling the playing field so that people who have for some reason become homeless have the same opportunity to have and keep housing as the rest of us,” Sam J. Tsemberis, PhD, a psychologist who founded Pathways to Housing in New York City and is spearheading the program in Kansas, said in an interview with the Topeka Capital-Journal. “Most people in Kansas don’t have sobriety and treatment requirements in order to stay housed. And if they did, we’d be in a lot more trouble on the homelessness front.”

Dr. Tsemberis said his philosophy about providing housing for people with mental illness stems from his work years ago at Bellevue Hospital in New York. During his commute, Dr. Tsemberis said, he “passed people on the sidewalk he had just treated as patients, still wearing the hospital pajamas they were dispatched in.”

“A community’s social structure is impaired when people can walk by somebody who is homeless on the street,” Dr. Tsemberis, a psychiatry professor at Columbia University in New York, said in the interview. “It’s not just the person who is homeless, who is isolated and disconnected. It’s everybody else who walks past them that also has to cut off a part of their humanity in order to tolerate being able to walk past another human being who is sitting there.”

More than 2,000 homeless people live in Kansas, and Wichita is the hub. So far, more than 320 Kansas residents have entered the Housing First program, and more than 240 have found permanent housing.
 

Some residents shortchanged on services

Policymakers in Chicago are discussing the possibility of reopening some of the city’s mental health clinics.

A city council committee recently unanimously voted to approve a Public Mental Health Clinic Service Expansion Task Force to look into the possibility.

“We are all aware of the anecdotal issues related to the gaps in mental health care that face our wards,” Alderman Sophia King, who sponsored the measure, said in an article published in the Chicago Sun-Times.

According to the article, six of the city’s mental health clinics were shut down in 2012. Mental health clinics said funding for mental health care in the city has continued to decline. A report issued last year by the Collaborative for Community Wellness focusing on mental health services on the city’s southwest side said there were 0.17 licensed mental health clinicians for every 1,000 residents. Meanwhile, on the city’s near north side, also known as the Gold Coast, there were 4.45 clinicians for every 1,000 residents, the report said.
 

Increase in suicides raising concerns

A recent report from the Tennessee Suicide Prevention Network reveals a dark picture. As reported by the Tennessean, the suicide rate continued to climb last year, continuing an increase that began in 2014. The suicide rate of 17.3 of every 100,000 people is markedly higher than the national rate of 14.5, according to an article in the Tennessean.

For children and adolescents aged 10-17 years, the situation is worse. In that cohort, rate of suicide climbed by more than 24% from 2016 to 2017, and a huge 55% between 2015 and 2017. In 2017, 142 people between 10 and 24 years of age ended their own lives. Overall, there were 1,163 suicides in 2017, an average of 3 every day.

Among the states’ demographics, suicide is three times higher among white non-Hispanics. Whites comprise 79% of the population of Tennessee and account for 91% of the suicides.

A national study in 2015 estimated the total national cost of suicides and suicide attempts at $93.5 billion. A single suicide can cost $1,329,553 in medical treatment and the lost productivity.

But those losses cannot be quantified. “For every number and rate that is provided in the 2019 ‘Status of Suicide in Tennessee’ report, a family member, loved one, neighbor, coworker, and friend suffers an unimaginable loss,” said Scott Ridgway, executive director of the Tennessee Suicide Prevention Network.
 

Anticonversion therapy bill introduced

A state senator in Arizona has reintroduced legislation aimed at preventing mental health professionals from practicing conversion therapy on minors.

Under the bill reintroduced by state Sen. Sean Bowie, a Democrat, psychotherapists who engage in practices aimed at changing the sexual orientation of a person under age 18 years would be “subject to disciplinary action.”

“This (practice) is completely discredited and actually hurtful for young people,” said state Sen. Bowie, according to azcentral.com, which is part of the USA Today network. “There’s really no medical proof that it’s helpful or effective at all.”

Late last year, the American Psychiatric Association reiterated its strong opposition to the practice. “Conversion therapy is banned in 14 states as well as the District of Columbia,” the group said. “The APA calls upon other lawmakers to ban the harmful and discriminatory practice.”

A sign on the wall of the Sip of Hope Coffee Bar in the Logan Square area of Chicago reads: “It’s OK not to be OK.” The slogan is more than a way to distinguish the coffee shop from competitors. According to a report published recently in the Chicago Sun-Times, all money spent on beverages and pastries is donated to suicide prevention and mental health programs in the Windy City.

Lynda Banzi/IMNG Medical Media

“Sip of Hope is the brick-and-mortar version of what we do every day,” Jonny Boucher, who started a nonprofit called Hope for the Day in 2011 in an effort to make mental health issues part of the everyday conversation, said in the article. “I’ve lost 16 people to suicide, and I thought if I can just take this pain and I can do something with it, then I can allow others to do something with their pain.”

Mr. Boucher organizes a monthly get-together at the coffee shop where people can talk about their mental health struggles and find help and friendship.

“If I got paid $10 for every time someone said I saved their life, this organization would be bankrolled for eternity,” said Mr. Boucher. “There is no magic wand with mental health but I try to tell people – we’re all in this together – it’s not about me, it’s about we.”
 

Housing First program launched

A housing program being offered in some parts of Kansas, including Wichita, is making housing available to people with mental illness without the traditional requirements of a nightly curfew or adherence to sobriety.

“What we’re doing with a program like this is essentially leveling the playing field so that people who have for some reason become homeless have the same opportunity to have and keep housing as the rest of us,” Sam J. Tsemberis, PhD, a psychologist who founded Pathways to Housing in New York City and is spearheading the program in Kansas, said in an interview with the Topeka Capital-Journal. “Most people in Kansas don’t have sobriety and treatment requirements in order to stay housed. And if they did, we’d be in a lot more trouble on the homelessness front.”

Dr. Tsemberis said his philosophy about providing housing for people with mental illness stems from his work years ago at Bellevue Hospital in New York. During his commute, Dr. Tsemberis said, he “passed people on the sidewalk he had just treated as patients, still wearing the hospital pajamas they were dispatched in.”

“A community’s social structure is impaired when people can walk by somebody who is homeless on the street,” Dr. Tsemberis, a psychiatry professor at Columbia University in New York, said in the interview. “It’s not just the person who is homeless, who is isolated and disconnected. It’s everybody else who walks past them that also has to cut off a part of their humanity in order to tolerate being able to walk past another human being who is sitting there.”

More than 2,000 homeless people live in Kansas, and Wichita is the hub. So far, more than 320 Kansas residents have entered the Housing First program, and more than 240 have found permanent housing.
 

Some residents shortchanged on services

Policymakers in Chicago are discussing the possibility of reopening some of the city’s mental health clinics.

A city council committee recently unanimously voted to approve a Public Mental Health Clinic Service Expansion Task Force to look into the possibility.

“We are all aware of the anecdotal issues related to the gaps in mental health care that face our wards,” Alderman Sophia King, who sponsored the measure, said in an article published in the Chicago Sun-Times.

According to the article, six of the city’s mental health clinics were shut down in 2012. Mental health clinics said funding for mental health care in the city has continued to decline. A report issued last year by the Collaborative for Community Wellness focusing on mental health services on the city’s southwest side said there were 0.17 licensed mental health clinicians for every 1,000 residents. Meanwhile, on the city’s near north side, also known as the Gold Coast, there were 4.45 clinicians for every 1,000 residents, the report said.
 

Increase in suicides raising concerns

A recent report from the Tennessee Suicide Prevention Network reveals a dark picture. As reported by the Tennessean, the suicide rate continued to climb last year, continuing an increase that began in 2014. The suicide rate of 17.3 of every 100,000 people is markedly higher than the national rate of 14.5, according to an article in the Tennessean.

For children and adolescents aged 10-17 years, the situation is worse. In that cohort, rate of suicide climbed by more than 24% from 2016 to 2017, and a huge 55% between 2015 and 2017. In 2017, 142 people between 10 and 24 years of age ended their own lives. Overall, there were 1,163 suicides in 2017, an average of 3 every day.

Among the states’ demographics, suicide is three times higher among white non-Hispanics. Whites comprise 79% of the population of Tennessee and account for 91% of the suicides.

A national study in 2015 estimated the total national cost of suicides and suicide attempts at $93.5 billion. A single suicide can cost $1,329,553 in medical treatment and the lost productivity.

But those losses cannot be quantified. “For every number and rate that is provided in the 2019 ‘Status of Suicide in Tennessee’ report, a family member, loved one, neighbor, coworker, and friend suffers an unimaginable loss,” said Scott Ridgway, executive director of the Tennessee Suicide Prevention Network.
 

Anticonversion therapy bill introduced

A state senator in Arizona has reintroduced legislation aimed at preventing mental health professionals from practicing conversion therapy on minors.

Under the bill reintroduced by state Sen. Sean Bowie, a Democrat, psychotherapists who engage in practices aimed at changing the sexual orientation of a person under age 18 years would be “subject to disciplinary action.”

“This (practice) is completely discredited and actually hurtful for young people,” said state Sen. Bowie, according to azcentral.com, which is part of the USA Today network. “There’s really no medical proof that it’s helpful or effective at all.”

Late last year, the American Psychiatric Association reiterated its strong opposition to the practice. “Conversion therapy is banned in 14 states as well as the District of Columbia,” the group said. “The APA calls upon other lawmakers to ban the harmful and discriminatory practice.”

A sign on the wall of the Sip of Hope Coffee Bar in the Logan Square area of Chicago reads: “It’s OK not to be OK.” The slogan is more than a way to distinguish the coffee shop from competitors. According to a report published recently in the Chicago Sun-Times, all money spent on beverages and pastries is donated to suicide prevention and mental health programs in the Windy City.

Lynda Banzi/IMNG Medical Media

“Sip of Hope is the brick-and-mortar version of what we do every day,” Jonny Boucher, who started a nonprofit called Hope for the Day in 2011 in an effort to make mental health issues part of the everyday conversation, said in the article. “I’ve lost 16 people to suicide, and I thought if I can just take this pain and I can do something with it, then I can allow others to do something with their pain.”

Mr. Boucher organizes a monthly get-together at the coffee shop where people can talk about their mental health struggles and find help and friendship.

“If I got paid $10 for every time someone said I saved their life, this organization would be bankrolled for eternity,” said Mr. Boucher. “There is no magic wand with mental health but I try to tell people – we’re all in this together – it’s not about me, it’s about we.”
 

Housing First program launched

A housing program being offered in some parts of Kansas, including Wichita, is making housing available to people with mental illness without the traditional requirements of a nightly curfew or adherence to sobriety.

“What we’re doing with a program like this is essentially leveling the playing field so that people who have for some reason become homeless have the same opportunity to have and keep housing as the rest of us,” Sam J. Tsemberis, PhD, a psychologist who founded Pathways to Housing in New York City and is spearheading the program in Kansas, said in an interview with the Topeka Capital-Journal. “Most people in Kansas don’t have sobriety and treatment requirements in order to stay housed. And if they did, we’d be in a lot more trouble on the homelessness front.”

Dr. Tsemberis said his philosophy about providing housing for people with mental illness stems from his work years ago at Bellevue Hospital in New York. During his commute, Dr. Tsemberis said, he “passed people on the sidewalk he had just treated as patients, still wearing the hospital pajamas they were dispatched in.”

“A community’s social structure is impaired when people can walk by somebody who is homeless on the street,” Dr. Tsemberis, a psychiatry professor at Columbia University in New York, said in the interview. “It’s not just the person who is homeless, who is isolated and disconnected. It’s everybody else who walks past them that also has to cut off a part of their humanity in order to tolerate being able to walk past another human being who is sitting there.”

More than 2,000 homeless people live in Kansas, and Wichita is the hub. So far, more than 320 Kansas residents have entered the Housing First program, and more than 240 have found permanent housing.
 

Some residents shortchanged on services

Policymakers in Chicago are discussing the possibility of reopening some of the city’s mental health clinics.

A city council committee recently unanimously voted to approve a Public Mental Health Clinic Service Expansion Task Force to look into the possibility.

“We are all aware of the anecdotal issues related to the gaps in mental health care that face our wards,” Alderman Sophia King, who sponsored the measure, said in an article published in the Chicago Sun-Times.

According to the article, six of the city’s mental health clinics were shut down in 2012. Mental health clinics said funding for mental health care in the city has continued to decline. A report issued last year by the Collaborative for Community Wellness focusing on mental health services on the city’s southwest side said there were 0.17 licensed mental health clinicians for every 1,000 residents. Meanwhile, on the city’s near north side, also known as the Gold Coast, there were 4.45 clinicians for every 1,000 residents, the report said.
 

Increase in suicides raising concerns

A recent report from the Tennessee Suicide Prevention Network reveals a dark picture. As reported by the Tennessean, the suicide rate continued to climb last year, continuing an increase that began in 2014. The suicide rate of 17.3 of every 100,000 people is markedly higher than the national rate of 14.5, according to an article in the Tennessean.

For children and adolescents aged 10-17 years, the situation is worse. In that cohort, rate of suicide climbed by more than 24% from 2016 to 2017, and a huge 55% between 2015 and 2017. In 2017, 142 people between 10 and 24 years of age ended their own lives. Overall, there were 1,163 suicides in 2017, an average of 3 every day.

Among the states’ demographics, suicide is three times higher among white non-Hispanics. Whites comprise 79% of the population of Tennessee and account for 91% of the suicides.

A national study in 2015 estimated the total national cost of suicides and suicide attempts at $93.5 billion. A single suicide can cost $1,329,553 in medical treatment and the lost productivity.

But those losses cannot be quantified. “For every number and rate that is provided in the 2019 ‘Status of Suicide in Tennessee’ report, a family member, loved one, neighbor, coworker, and friend suffers an unimaginable loss,” said Scott Ridgway, executive director of the Tennessee Suicide Prevention Network.
 

Anticonversion therapy bill introduced

A state senator in Arizona has reintroduced legislation aimed at preventing mental health professionals from practicing conversion therapy on minors.

Under the bill reintroduced by state Sen. Sean Bowie, a Democrat, psychotherapists who engage in practices aimed at changing the sexual orientation of a person under age 18 years would be “subject to disciplinary action.”

“This (practice) is completely discredited and actually hurtful for young people,” said state Sen. Bowie, according to azcentral.com, which is part of the USA Today network. “There’s really no medical proof that it’s helpful or effective at all.”

Late last year, the American Psychiatric Association reiterated its strong opposition to the practice. “Conversion therapy is banned in 14 states as well as the District of Columbia,” the group said. “The APA calls upon other lawmakers to ban the harmful and discriminatory practice.”

Most parents are unaware their teenager has been having suicidal thoughts or thinking about death, according to a study published in Pediatrics.

asiseeit/E+/Getty Images

Jason D. Jones, PhD, from the Children’s Hospital of Philadelphia, and his coauthors wrote that more than two-thirds of adolescents who experience suicidal thoughts do not get medical help, and this may be because their parents – the gatekeepers for mental health services – are unaware of what their teen is going through.

In this study, researchers recruited 5,137 adolescents aged 11-17 years and either a parent or step-parent, and interviewed both about the adolescent’s lifetime suicidal thoughts.

While 413 (8%) of the adolescents surveyed said they had had thoughts about killing themselves, 50% of those adolescents’ parents said their teen hadn’t experienced suicidal thoughts. Similarly, 786 (15%) of adolescents surveyed said they had had thoughts about death and dying, but three-quarters of their parents were unaware.

A significant number of parents – 8% – said their teenager had had suicidal thoughts, but in 48% of these cases, the teenager said they had not thought about killing themselves.

Researchers saw more agreement between parents and adolescents when the adolescents were older: The parents were less likely to be unaware that their older teen had had suicidal thoughts, and older adolescents were less likely to deny it.

“This indicates that younger adolescents may be more likely to go unnoticed and not receive services either because their parents are unaware of their suicidal thoughts or because they deny suicidal thoughts that their parents think they are having,” Dr. Jones and his associates wrote. They also suggested younger adolescents may have “interpretive difficulties” around questions of suicidal ideation.

“These age findings are particularly noteworthy in light of recent evidence that deaths by suicide have increased among younger adolescents,” they noted.

There also was an interaction between age and gender. For girls, parents were less likely to be aware of suicidal thoughts in their younger daughters but more likely to be aware of them in their older daughters. However the opposite was true for boys: Parental unawareness increased slightly in older boys.

Parents of Hispanic or Latino ethnicity were less likely to be aware that their offspring had had thoughts about death and dying.

Generally fathers were less likely than mothers to be aware of suicidal thoughts in their adolescents.

However, if adolescents had previously received psychiatric treatment, or there was a family history of suicide, parents were more likely to be aware of suicidal thoughts, and adolescents who had a history of psychiatric hospitalization were less likely to deny suicidal thoughts, the researchers reported.

The study was supported by grants from the National Institutes of Health, the Dowshen Program for Neuroscience, and the Lifespan Brain Institute of the Children’s Hospital of Philadelphia and University of Pennsylvania. The study was funded by NIH. One author declared a board position and stock options in Taliaz Health unrelated to the study subject; the other authors said they had no relevant financial disclosures.

SOURCE: Jones JD et al. Pediatrics. 2019 Jan 14. doi: 10.1542/peds.2018-1771.
 

Most parents are unaware their teenager has been having suicidal thoughts or thinking about death, according to a study published in Pediatrics.

asiseeit/E+/Getty Images

Jason D. Jones, PhD, from the Children’s Hospital of Philadelphia, and his coauthors wrote that more than two-thirds of adolescents who experience suicidal thoughts do not get medical help, and this may be because their parents – the gatekeepers for mental health services – are unaware of what their teen is going through.

In this study, researchers recruited 5,137 adolescents aged 11-17 years and either a parent or step-parent, and interviewed both about the adolescent’s lifetime suicidal thoughts.

While 413 (8%) of the adolescents surveyed said they had had thoughts about killing themselves, 50% of those adolescents’ parents said their teen hadn’t experienced suicidal thoughts. Similarly, 786 (15%) of adolescents surveyed said they had had thoughts about death and dying, but three-quarters of their parents were unaware.

A significant number of parents – 8% – said their teenager had had suicidal thoughts, but in 48% of these cases, the teenager said they had not thought about killing themselves.

Researchers saw more agreement between parents and adolescents when the adolescents were older: The parents were less likely to be unaware that their older teen had had suicidal thoughts, and older adolescents were less likely to deny it.

“This indicates that younger adolescents may be more likely to go unnoticed and not receive services either because their parents are unaware of their suicidal thoughts or because they deny suicidal thoughts that their parents think they are having,” Dr. Jones and his associates wrote. They also suggested younger adolescents may have “interpretive difficulties” around questions of suicidal ideation.

“These age findings are particularly noteworthy in light of recent evidence that deaths by suicide have increased among younger adolescents,” they noted.

There also was an interaction between age and gender. For girls, parents were less likely to be aware of suicidal thoughts in their younger daughters but more likely to be aware of them in their older daughters. However the opposite was true for boys: Parental unawareness increased slightly in older boys.

Parents of Hispanic or Latino ethnicity were less likely to be aware that their offspring had had thoughts about death and dying.

Generally fathers were less likely than mothers to be aware of suicidal thoughts in their adolescents.

However, if adolescents had previously received psychiatric treatment, or there was a family history of suicide, parents were more likely to be aware of suicidal thoughts, and adolescents who had a history of psychiatric hospitalization were less likely to deny suicidal thoughts, the researchers reported.

The study was supported by grants from the National Institutes of Health, the Dowshen Program for Neuroscience, and the Lifespan Brain Institute of the Children’s Hospital of Philadelphia and University of Pennsylvania. The study was funded by NIH. One author declared a board position and stock options in Taliaz Health unrelated to the study subject; the other authors said they had no relevant financial disclosures.

SOURCE: Jones JD et al. Pediatrics. 2019 Jan 14. doi: 10.1542/peds.2018-1771.
 

Most parents are unaware their teenager has been having suicidal thoughts or thinking about death, according to a study published in Pediatrics.

asiseeit/E+/Getty Images

Jason D. Jones, PhD, from the Children’s Hospital of Philadelphia, and his coauthors wrote that more than two-thirds of adolescents who experience suicidal thoughts do not get medical help, and this may be because their parents – the gatekeepers for mental health services – are unaware of what their teen is going through.

In this study, researchers recruited 5,137 adolescents aged 11-17 years and either a parent or step-parent, and interviewed both about the adolescent’s lifetime suicidal thoughts.

While 413 (8%) of the adolescents surveyed said they had had thoughts about killing themselves, 50% of those adolescents’ parents said their teen hadn’t experienced suicidal thoughts. Similarly, 786 (15%) of adolescents surveyed said they had had thoughts about death and dying, but three-quarters of their parents were unaware.

A significant number of parents – 8% – said their teenager had had suicidal thoughts, but in 48% of these cases, the teenager said they had not thought about killing themselves.

Researchers saw more agreement between parents and adolescents when the adolescents were older: The parents were less likely to be unaware that their older teen had had suicidal thoughts, and older adolescents were less likely to deny it.

“This indicates that younger adolescents may be more likely to go unnoticed and not receive services either because their parents are unaware of their suicidal thoughts or because they deny suicidal thoughts that their parents think they are having,” Dr. Jones and his associates wrote. They also suggested younger adolescents may have “interpretive difficulties” around questions of suicidal ideation.

“These age findings are particularly noteworthy in light of recent evidence that deaths by suicide have increased among younger adolescents,” they noted.

There also was an interaction between age and gender. For girls, parents were less likely to be aware of suicidal thoughts in their younger daughters but more likely to be aware of them in their older daughters. However the opposite was true for boys: Parental unawareness increased slightly in older boys.

Parents of Hispanic or Latino ethnicity were less likely to be aware that their offspring had had thoughts about death and dying.

Generally fathers were less likely than mothers to be aware of suicidal thoughts in their adolescents.

However, if adolescents had previously received psychiatric treatment, or there was a family history of suicide, parents were more likely to be aware of suicidal thoughts, and adolescents who had a history of psychiatric hospitalization were less likely to deny suicidal thoughts, the researchers reported.

The study was supported by grants from the National Institutes of Health, the Dowshen Program for Neuroscience, and the Lifespan Brain Institute of the Children’s Hospital of Philadelphia and University of Pennsylvania. The study was funded by NIH. One author declared a board position and stock options in Taliaz Health unrelated to the study subject; the other authors said they had no relevant financial disclosures.

SOURCE: Jones JD et al. Pediatrics. 2019 Jan 14. doi: 10.1542/peds.2018-1771.
 

Almost a quarter of an elderly U.S. population who were prescribed an antidepressant potentially received an overprescription, according to William V. Bobo, MD, MPH, of the Mayo Clinic in Jacksonville, Fla., and his associates.

In a study published in Pharmacology Research & Perspectives, the authors drew data from the Rochester Epidemiology Project and included 3,199 incident antidepressant prescriptions from adults aged at least 65 years who lived in Olmsted County, Minn., from 2005 to 2012. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed medication (40%), followed by trazodone/nefazodone (20%), tricyclic antidepressants (16%), and mirtazapine (12%). About 57% of prescriptions were for specific psychiatric indications, 22% were for nonspecific symptoms, and 21% were for general medical diagnoses, Dr. Bobo and his associates reported.

Potential antidepressant overprescribing occurred in 24% of all prescriptions; SSRIs were most commonly overprescribed, accounting for 74% of all overprescriptions, followed by mirtazapine (19%). Overprescription was most common when antidepressants were prescribed for nonspecific psychiatric symptoms (18%), compared with specific psychiatric indications (3.5%) and general medical diagnoses (2.5%).

Other factors associated with antidepressant overprescription included living in a nursing home, having a higher number of comorbid medical conditions and outpatient prescribers, taking more concomitant medications, more commonly using urgent or acute care in the year prior to index prescription, and being prescribed antidepressants via telephone, email, or patient portal.

“Potential antidepressant overprescribing in a large cohort of elderly patients mainly involved the use of newer antidepressants for nonspecific psychiatric symptoms and indications,” the investigators wrote. “However, the majority of incident antidepressant starts did not represent potential overprescribing. When overprescribing occurred, it was associated with factors representing higher multimorbidity, clinical complexity, and severity – and with antidepressant prescribing that did not involve face-to-face interaction of patients with prescribers.”

The authors reported no conflicts of interest.

lfranki@mdedge.com

SOURCE: Bobo WV et al. Pharmacol Res Perspect. 2019 Jan 24. doi: 10.1002/prp2.461.

Almost a quarter of an elderly U.S. population who were prescribed an antidepressant potentially received an overprescription, according to William V. Bobo, MD, MPH, of the Mayo Clinic in Jacksonville, Fla., and his associates.

In a study published in Pharmacology Research & Perspectives, the authors drew data from the Rochester Epidemiology Project and included 3,199 incident antidepressant prescriptions from adults aged at least 65 years who lived in Olmsted County, Minn., from 2005 to 2012. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed medication (40%), followed by trazodone/nefazodone (20%), tricyclic antidepressants (16%), and mirtazapine (12%). About 57% of prescriptions were for specific psychiatric indications, 22% were for nonspecific symptoms, and 21% were for general medical diagnoses, Dr. Bobo and his associates reported.

Potential antidepressant overprescribing occurred in 24% of all prescriptions; SSRIs were most commonly overprescribed, accounting for 74% of all overprescriptions, followed by mirtazapine (19%). Overprescription was most common when antidepressants were prescribed for nonspecific psychiatric symptoms (18%), compared with specific psychiatric indications (3.5%) and general medical diagnoses (2.5%).

Other factors associated with antidepressant overprescription included living in a nursing home, having a higher number of comorbid medical conditions and outpatient prescribers, taking more concomitant medications, more commonly using urgent or acute care in the year prior to index prescription, and being prescribed antidepressants via telephone, email, or patient portal.

“Potential antidepressant overprescribing in a large cohort of elderly patients mainly involved the use of newer antidepressants for nonspecific psychiatric symptoms and indications,” the investigators wrote. “However, the majority of incident antidepressant starts did not represent potential overprescribing. When overprescribing occurred, it was associated with factors representing higher multimorbidity, clinical complexity, and severity – and with antidepressant prescribing that did not involve face-to-face interaction of patients with prescribers.”

The authors reported no conflicts of interest.

lfranki@mdedge.com

SOURCE: Bobo WV et al. Pharmacol Res Perspect. 2019 Jan 24. doi: 10.1002/prp2.461.

Almost a quarter of an elderly U.S. population who were prescribed an antidepressant potentially received an overprescription, according to William V. Bobo, MD, MPH, of the Mayo Clinic in Jacksonville, Fla., and his associates.

In a study published in Pharmacology Research & Perspectives, the authors drew data from the Rochester Epidemiology Project and included 3,199 incident antidepressant prescriptions from adults aged at least 65 years who lived in Olmsted County, Minn., from 2005 to 2012. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed medication (40%), followed by trazodone/nefazodone (20%), tricyclic antidepressants (16%), and mirtazapine (12%). About 57% of prescriptions were for specific psychiatric indications, 22% were for nonspecific symptoms, and 21% were for general medical diagnoses, Dr. Bobo and his associates reported.

Potential antidepressant overprescribing occurred in 24% of all prescriptions; SSRIs were most commonly overprescribed, accounting for 74% of all overprescriptions, followed by mirtazapine (19%). Overprescription was most common when antidepressants were prescribed for nonspecific psychiatric symptoms (18%), compared with specific psychiatric indications (3.5%) and general medical diagnoses (2.5%).

Other factors associated with antidepressant overprescription included living in a nursing home, having a higher number of comorbid medical conditions and outpatient prescribers, taking more concomitant medications, more commonly using urgent or acute care in the year prior to index prescription, and being prescribed antidepressants via telephone, email, or patient portal.

“Potential antidepressant overprescribing in a large cohort of elderly patients mainly involved the use of newer antidepressants for nonspecific psychiatric symptoms and indications,” the investigators wrote. “However, the majority of incident antidepressant starts did not represent potential overprescribing. When overprescribing occurred, it was associated with factors representing higher multimorbidity, clinical complexity, and severity – and with antidepressant prescribing that did not involve face-to-face interaction of patients with prescribers.”

The authors reported no conflicts of interest.

lfranki@mdedge.com

SOURCE: Bobo WV et al. Pharmacol Res Perspect. 2019 Jan 24. doi: 10.1002/prp2.461.

Lead exposure during childhood appears tied to a significant increase in the risk of psychopathology in adulthood, results of a multidecade, prospective cohort study show.

“These results suggest that early life lead exposure in the era of leaded gasoline experienced by individuals who are currently adults may have contributed to subtle, lifelong differences in emotion and behavior that are detectable at least up to 38 years of age,” Aaron Reuben and his coauthors wrote in JAMA Psychiatry.

The ongoing Dunedin longitudinal cohort study in New Zealand has followed 1,037 individuals born during 1972-1973. Of these individuals, 579 were tested for lead exposure at 11 years of age. The study assessed their mental health at 18, 21, 26, 32, and 38 years of age.

“Although follow-up studies of lead-tested children have reported the persistence of lead-related cognitive deficits well into adulthood, apart from antisocial outcomes, the long-term mental and behavioral health consequences of early life lead exposure have not been fully characterized,” wrote Mr. Reuben, a PhD student in the department of psychology and neuroscience at Duke University in Durham, N.C., and his coauthors.

Researchers saw that, for each 5-mcg/dL increase in childhood blood lead level, there was a significant 1.34-point increase in general psychopathology (P = 0.03), which was largely driven by a 1.41-point increase in internalizing (P = 0.02) and 1.30-point increase in thought-disorder symptoms (P = 0.04). Those associations were seen after adjustment for covariates, such as family socioeconomic status, maternal IQ, and family history of mental illness.

Adults who had higher lead exposure during childhood also were described by their informants – close friends or family members – as being significantly more neurotic, less agreeable, and less conscientious. However, they showed no significant differences in extroversion or in openness to experience, compared with those with less lead exposure.

“These results suggest that early-life lead exposure in the era of leaded gasoline experienced by individuals who are currently adults may have contributed to subtle, lifelong differences in emotion and behavior that are detectable at least up to 38 years of age,” the authors wrote.

They noted that the size of the effect was around one-third the size of the associations seen between psychopathology and other risk factors, such as family history of mental illness and childhood maltreatment. However, the effects of lead exposure on adult psychopathology were similar to its effects on IQ and stronger than the associations seen between lead exposure and criminal offending.

The researchers also examined how early these psychopathology symptoms could be detected with use of parent- and teacher-reported measures of antisocial behavior, hyperactivity, and internalizing from 11 years of age. This showed that individuals with higher lead exposure scored higher on these measures even at 11 years of age, “suggesting that the association between lead exposure and psychopathology may begin to manifest broadly well before adulthood.”

Mr. Reuben and his associates cited several limitations. One is that the study used a cohort that was predominantly white and born in the 1970s. Also, as an observational study, it does not establish causality between lead exposure and psychopathology.

Nevertheless, they wrote, the study results suggest that adult patients who were exposed to high levels of lead as children might benefit from increased screening and access to mental health services.

The Dunedin study is supported by the New Zealand Health Research Council and the New Zealand Ministry of Business, Innovation, and Employment. This study was supported by several entities, including the National Institute on Aging, the U.K. Medical Research Council, the National Institute of Child Health and Human Development, and the National Institute of Environmental Health Sciences. The authors reported no conflicts of interest.

SOURCE: Reuben A et al. JAMA Psychiatry. 2019 Jan 23. doi: 10.1001/jamapsychiatry.2018.4192.
 

Lead exposure during childhood appears tied to a significant increase in the risk of psychopathology in adulthood, results of a multidecade, prospective cohort study show.

“These results suggest that early life lead exposure in the era of leaded gasoline experienced by individuals who are currently adults may have contributed to subtle, lifelong differences in emotion and behavior that are detectable at least up to 38 years of age,” Aaron Reuben and his coauthors wrote in JAMA Psychiatry.

The ongoing Dunedin longitudinal cohort study in New Zealand has followed 1,037 individuals born during 1972-1973. Of these individuals, 579 were tested for lead exposure at 11 years of age. The study assessed their mental health at 18, 21, 26, 32, and 38 years of age.

“Although follow-up studies of lead-tested children have reported the persistence of lead-related cognitive deficits well into adulthood, apart from antisocial outcomes, the long-term mental and behavioral health consequences of early life lead exposure have not been fully characterized,” wrote Mr. Reuben, a PhD student in the department of psychology and neuroscience at Duke University in Durham, N.C., and his coauthors.

Researchers saw that, for each 5-mcg/dL increase in childhood blood lead level, there was a significant 1.34-point increase in general psychopathology (P = 0.03), which was largely driven by a 1.41-point increase in internalizing (P = 0.02) and 1.30-point increase in thought-disorder symptoms (P = 0.04). Those associations were seen after adjustment for covariates, such as family socioeconomic status, maternal IQ, and family history of mental illness.

Adults who had higher lead exposure during childhood also were described by their informants – close friends or family members – as being significantly more neurotic, less agreeable, and less conscientious. However, they showed no significant differences in extroversion or in openness to experience, compared with those with less lead exposure.

“These results suggest that early-life lead exposure in the era of leaded gasoline experienced by individuals who are currently adults may have contributed to subtle, lifelong differences in emotion and behavior that are detectable at least up to 38 years of age,” the authors wrote.

They noted that the size of the effect was around one-third the size of the associations seen between psychopathology and other risk factors, such as family history of mental illness and childhood maltreatment. However, the effects of lead exposure on adult psychopathology were similar to its effects on IQ and stronger than the associations seen between lead exposure and criminal offending.

The researchers also examined how early these psychopathology symptoms could be detected with use of parent- and teacher-reported measures of antisocial behavior, hyperactivity, and internalizing from 11 years of age. This showed that individuals with higher lead exposure scored higher on these measures even at 11 years of age, “suggesting that the association between lead exposure and psychopathology may begin to manifest broadly well before adulthood.”

Mr. Reuben and his associates cited several limitations. One is that the study used a cohort that was predominantly white and born in the 1970s. Also, as an observational study, it does not establish causality between lead exposure and psychopathology.

Nevertheless, they wrote, the study results suggest that adult patients who were exposed to high levels of lead as children might benefit from increased screening and access to mental health services.

The Dunedin study is supported by the New Zealand Health Research Council and the New Zealand Ministry of Business, Innovation, and Employment. This study was supported by several entities, including the National Institute on Aging, the U.K. Medical Research Council, the National Institute of Child Health and Human Development, and the National Institute of Environmental Health Sciences. The authors reported no conflicts of interest.

SOURCE: Reuben A et al. JAMA Psychiatry. 2019 Jan 23. doi: 10.1001/jamapsychiatry.2018.4192.
 

Lead exposure during childhood appears tied to a significant increase in the risk of psychopathology in adulthood, results of a multidecade, prospective cohort study show.

“These results suggest that early life lead exposure in the era of leaded gasoline experienced by individuals who are currently adults may have contributed to subtle, lifelong differences in emotion and behavior that are detectable at least up to 38 years of age,” Aaron Reuben and his coauthors wrote in JAMA Psychiatry.

The ongoing Dunedin longitudinal cohort study in New Zealand has followed 1,037 individuals born during 1972-1973. Of these individuals, 579 were tested for lead exposure at 11 years of age. The study assessed their mental health at 18, 21, 26, 32, and 38 years of age.

“Although follow-up studies of lead-tested children have reported the persistence of lead-related cognitive deficits well into adulthood, apart from antisocial outcomes, the long-term mental and behavioral health consequences of early life lead exposure have not been fully characterized,” wrote Mr. Reuben, a PhD student in the department of psychology and neuroscience at Duke University in Durham, N.C., and his coauthors.

Researchers saw that, for each 5-mcg/dL increase in childhood blood lead level, there was a significant 1.34-point increase in general psychopathology (P = 0.03), which was largely driven by a 1.41-point increase in internalizing (P = 0.02) and 1.30-point increase in thought-disorder symptoms (P = 0.04). Those associations were seen after adjustment for covariates, such as family socioeconomic status, maternal IQ, and family history of mental illness.

Adults who had higher lead exposure during childhood also were described by their informants – close friends or family members – as being significantly more neurotic, less agreeable, and less conscientious. However, they showed no significant differences in extroversion or in openness to experience, compared with those with less lead exposure.

“These results suggest that early-life lead exposure in the era of leaded gasoline experienced by individuals who are currently adults may have contributed to subtle, lifelong differences in emotion and behavior that are detectable at least up to 38 years of age,” the authors wrote.

They noted that the size of the effect was around one-third the size of the associations seen between psychopathology and other risk factors, such as family history of mental illness and childhood maltreatment. However, the effects of lead exposure on adult psychopathology were similar to its effects on IQ and stronger than the associations seen between lead exposure and criminal offending.

The researchers also examined how early these psychopathology symptoms could be detected with use of parent- and teacher-reported measures of antisocial behavior, hyperactivity, and internalizing from 11 years of age. This showed that individuals with higher lead exposure scored higher on these measures even at 11 years of age, “suggesting that the association between lead exposure and psychopathology may begin to manifest broadly well before adulthood.”

Mr. Reuben and his associates cited several limitations. One is that the study used a cohort that was predominantly white and born in the 1970s. Also, as an observational study, it does not establish causality between lead exposure and psychopathology.

Nevertheless, they wrote, the study results suggest that adult patients who were exposed to high levels of lead as children might benefit from increased screening and access to mental health services.

The Dunedin study is supported by the New Zealand Health Research Council and the New Zealand Ministry of Business, Innovation, and Employment. This study was supported by several entities, including the National Institute on Aging, the U.K. Medical Research Council, the National Institute of Child Health and Human Development, and the National Institute of Environmental Health Sciences. The authors reported no conflicts of interest.

SOURCE: Reuben A et al. JAMA Psychiatry. 2019 Jan 23. doi: 10.1001/jamapsychiatry.2018.4192.
 

Gail Erlick Robinson, MD, joins Lorenzo Norris, MD, at the 2018 meeting of the Group for the Advancement of Psychiatry in White Plains, N.Y., to talk about violence against women.Dr. Robinson is professor of psychiatry and obstetrics/gynecology and professor of equality, gender, and population at the University of Toronto. She’s also chair of GAP’s Committee on Gender & Mental Health. In this episode, Dr. Robinson delves into strategies for interacting with survivors of violence, the roots of the “Me Too” movement, as well as rising rates of maternal mortality in the United States.
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Gail Erlick Robinson, MD, joins Lorenzo Norris, MD, at the 2018 meeting of the Group for the Advancement of Psychiatry in White Plains, N.Y., to talk about violence against women.Dr. Robinson is professor of psychiatry and obstetrics/gynecology and professor of equality, gender, and population at the University of Toronto. She’s also chair of GAP’s Committee on Gender & Mental Health. In this episode, Dr. Robinson delves into strategies for interacting with survivors of violence, the roots of the “Me Too” movement, as well as rising rates of maternal mortality in the United States.
​​​​​​​Amazon
Apple Podcasts
Google Podcasts
Spotify


 

Gail Erlick Robinson, MD, joins Lorenzo Norris, MD, at the 2018 meeting of the Group for the Advancement of Psychiatry in White Plains, N.Y., to talk about violence against women.Dr. Robinson is professor of psychiatry and obstetrics/gynecology and professor of equality, gender, and population at the University of Toronto. She’s also chair of GAP’s Committee on Gender & Mental Health. In this episode, Dr. Robinson delves into strategies for interacting with survivors of violence, the roots of the “Me Too” movement, as well as rising rates of maternal mortality in the United States.
​​​​​​​Amazon
Apple Podcasts
Google Podcasts
Spotify


 

Vitiligo and major depressive disorder have a bidirectional relationship, according to a new study that examined data from a cohort of more than 6 million people.

“Ultimately, this suggests that mental health appears to play a large role in the pathogenesis of autoimmune diseases like vitiligo, which in turn can increase the risk of MDD, especially in younger patients,” wrote Isabelle Vallerand, PhD, and her colleagues. The report is in the Journal of the American Academy of Dermatology.

Dr. Vallerand and her colleagues found that patients with major depressive disorder (MDD, n = 405,397) had a 64% increased risk of vitiligo, compared with a referent cohort (n = 5,739,048; 95% confidence interval, 1.43-1.87; P less than .0001). Conversely, patients who had vitiligo also were at an increased risk of MDD. Patients who were younger than 30 years old at diagnosis (n = 7,104) had a hazard ratio of 1.31 for MDD (P less than .0001), compared with 1.22 for patients aged 30 years and older (P = .001).

Individuals who took antidepressants, whether or not they also had an MDD diagnosis, had a decreased risk for vitiligo.

Though it’s known that vitiligo increases the risk of MDD, less clarity has been in the literature about whether the converse also might be true. “The question of whether vitiligo onset can be precipitated by MDD has received less attention, despite the notion that patients often ask their dermatologists if stress or depression may have contributed to their disease,” wrote Dr. Vallerand, an epidemiologist and medical student at the University of Calgary, Alberta, and her colleagues.

There is a biologic plausibility for a bidirectional relationship, said Dr. Vallerand and her colleagues, since depression can boost systemic inflammation, and the risk for autoimmune disease such as vitiligo can be increased by proinflammatory states.

Access to a large dataset gave Dr. Vallerand and her collaborators the numbers to look at the relationship between vitiligo and MDD in the context of potential confounders, and to correct for those in their statistical analysis. Using medical records from The Health Improvement Network (THIN) database in the United Kingdom, the investigators conducted two independent population-based cohort studies. Each looked at risk in one direction of the MDD-vitiligo association.

The first analysis looked at MDD as a risk factor for vitiligo, following all patients with an incident diagnostic code for MDD. Patients without the MDD diagnosis code were the referent cohort. Patients in each cohort were followed until they reached the outcome of interest – a diagnosis of vitiligo – or were censored. Patients who had a vitiligo diagnosis before receiving an MDD diagnosis were not included.

The second analysis examined whether vitiligo was a risk factor for MDD, with a similar design that used nonvitiligo patients as the referent cohort. This analysis followed all patients until a diagnosis of MDD was recorded, or patients were censored. Again, patients with MDD diagnoses that came before the vitiligo diagnosis were excluded.

For the analysis of risk of vitiligo, the investigators looked at the effects of multiple covariates, including age, sex, alcohol use and smoking status, socioeconomic status, medical comorbidities, and whether patients were taking antidepressants. The covariates included in the analysis of risk of MDD were age, sex, medical comorbidities, and type of vitiligo treatment.

After the researchers determined unadjusted hazard ratios, each covariate was removed one at a time to see where there were substantial changes to the HR. Two additional models, one unadjusted and one that fully adjusted for all covariates, also were built.

The sensitivity analyses showed “an overall protective effect of antidepressants among both cohorts,” wrote Dr. Vallerand and her colleagues. The incidence rate of vitiligo among patients with MDD using antidepressants was 19.7 per 100,000 person-years, compared with 27.5 among MDD patients not using antidepressants (P = .0053).

“Similarly, those in the referent cohort who used antidepressants had about half the risk of vitiligo,” compared with the nonusers in the referent group, the investigators said. Serotonin also is present in the skin, and neurons and melanocytes share embryonic ectodermal origins, Dr. Vallerand and her colleagues said. Though the exact mechanisms are not known, patients with vitiligo may have lower skin serotonin, so there’s a potential role for serotonergic medication in the incidence of vitiligo in the THIN cohorts, they noted.

Though younger patients with vitiligo were at higher risk for MDD than were those aged 30 years and older, the overall cohort of individuals with vitiligo still had an unadjusted elevated risk for MDD, compared with the referent cohort (HR 1.27; 95% confidence interval, 1.16-1.40; P less than .0001).

“Unexpectedly, the magnitude of the reciprocal association was highest with MDD being a risk factor for vitiligo,” wrote Dr. Vallerand and her colleagues. “This highlights the notion that mental health may have a greater impact on the body, specifically with dermatologic manifestations, than previously thought.”

Some misclassification of both conditions is likely in such a large dataset, the investigators acknowledged. Also, subclinical depression was not evaluated, and there was no way to track the severity of either depression or vitiligo, they noted. Still, the big data approach “renders this one of the largest studies on psychodermatology to date,” said Dr. Vallerand and her colleagues, and the independent bidirectional analyses support causality.

Dr. Vallerand is a partner in a pharmaceutical consulting firm, GlacierRX, and was funded by Alberta Innovates. The authors reported having no conflicts of interest.

koakes@mdedge.com

SOURCE: Vallerand IA et al. J Am Acad Dermatol. 2019. doi: 10.1016/j.jaad.2018.11.047.

Vitiligo and major depressive disorder have a bidirectional relationship, according to a new study that examined data from a cohort of more than 6 million people.

“Ultimately, this suggests that mental health appears to play a large role in the pathogenesis of autoimmune diseases like vitiligo, which in turn can increase the risk of MDD, especially in younger patients,” wrote Isabelle Vallerand, PhD, and her colleagues. The report is in the Journal of the American Academy of Dermatology.

Dr. Vallerand and her colleagues found that patients with major depressive disorder (MDD, n = 405,397) had a 64% increased risk of vitiligo, compared with a referent cohort (n = 5,739,048; 95% confidence interval, 1.43-1.87; P less than .0001). Conversely, patients who had vitiligo also were at an increased risk of MDD. Patients who were younger than 30 years old at diagnosis (n = 7,104) had a hazard ratio of 1.31 for MDD (P less than .0001), compared with 1.22 for patients aged 30 years and older (P = .001).

Individuals who took antidepressants, whether or not they also had an MDD diagnosis, had a decreased risk for vitiligo.

Though it’s known that vitiligo increases the risk of MDD, less clarity has been in the literature about whether the converse also might be true. “The question of whether vitiligo onset can be precipitated by MDD has received less attention, despite the notion that patients often ask their dermatologists if stress or depression may have contributed to their disease,” wrote Dr. Vallerand, an epidemiologist and medical student at the University of Calgary, Alberta, and her colleagues.

There is a biologic plausibility for a bidirectional relationship, said Dr. Vallerand and her colleagues, since depression can boost systemic inflammation, and the risk for autoimmune disease such as vitiligo can be increased by proinflammatory states.

Access to a large dataset gave Dr. Vallerand and her collaborators the numbers to look at the relationship between vitiligo and MDD in the context of potential confounders, and to correct for those in their statistical analysis. Using medical records from The Health Improvement Network (THIN) database in the United Kingdom, the investigators conducted two independent population-based cohort studies. Each looked at risk in one direction of the MDD-vitiligo association.

The first analysis looked at MDD as a risk factor for vitiligo, following all patients with an incident diagnostic code for MDD. Patients without the MDD diagnosis code were the referent cohort. Patients in each cohort were followed until they reached the outcome of interest – a diagnosis of vitiligo – or were censored. Patients who had a vitiligo diagnosis before receiving an MDD diagnosis were not included.

The second analysis examined whether vitiligo was a risk factor for MDD, with a similar design that used nonvitiligo patients as the referent cohort. This analysis followed all patients until a diagnosis of MDD was recorded, or patients were censored. Again, patients with MDD diagnoses that came before the vitiligo diagnosis were excluded.

For the analysis of risk of vitiligo, the investigators looked at the effects of multiple covariates, including age, sex, alcohol use and smoking status, socioeconomic status, medical comorbidities, and whether patients were taking antidepressants. The covariates included in the analysis of risk of MDD were age, sex, medical comorbidities, and type of vitiligo treatment.

After the researchers determined unadjusted hazard ratios, each covariate was removed one at a time to see where there were substantial changes to the HR. Two additional models, one unadjusted and one that fully adjusted for all covariates, also were built.

The sensitivity analyses showed “an overall protective effect of antidepressants among both cohorts,” wrote Dr. Vallerand and her colleagues. The incidence rate of vitiligo among patients with MDD using antidepressants was 19.7 per 100,000 person-years, compared with 27.5 among MDD patients not using antidepressants (P = .0053).

“Similarly, those in the referent cohort who used antidepressants had about half the risk of vitiligo,” compared with the nonusers in the referent group, the investigators said. Serotonin also is present in the skin, and neurons and melanocytes share embryonic ectodermal origins, Dr. Vallerand and her colleagues said. Though the exact mechanisms are not known, patients with vitiligo may have lower skin serotonin, so there’s a potential role for serotonergic medication in the incidence of vitiligo in the THIN cohorts, they noted.

Though younger patients with vitiligo were at higher risk for MDD than were those aged 30 years and older, the overall cohort of individuals with vitiligo still had an unadjusted elevated risk for MDD, compared with the referent cohort (HR 1.27; 95% confidence interval, 1.16-1.40; P less than .0001).

“Unexpectedly, the magnitude of the reciprocal association was highest with MDD being a risk factor for vitiligo,” wrote Dr. Vallerand and her colleagues. “This highlights the notion that mental health may have a greater impact on the body, specifically with dermatologic manifestations, than previously thought.”

Some misclassification of both conditions is likely in such a large dataset, the investigators acknowledged. Also, subclinical depression was not evaluated, and there was no way to track the severity of either depression or vitiligo, they noted. Still, the big data approach “renders this one of the largest studies on psychodermatology to date,” said Dr. Vallerand and her colleagues, and the independent bidirectional analyses support causality.

Dr. Vallerand is a partner in a pharmaceutical consulting firm, GlacierRX, and was funded by Alberta Innovates. The authors reported having no conflicts of interest.

koakes@mdedge.com

SOURCE: Vallerand IA et al. J Am Acad Dermatol. 2019. doi: 10.1016/j.jaad.2018.11.047.

Vitiligo and major depressive disorder have a bidirectional relationship, according to a new study that examined data from a cohort of more than 6 million people.

“Ultimately, this suggests that mental health appears to play a large role in the pathogenesis of autoimmune diseases like vitiligo, which in turn can increase the risk of MDD, especially in younger patients,” wrote Isabelle Vallerand, PhD, and her colleagues. The report is in the Journal of the American Academy of Dermatology.

Dr. Vallerand and her colleagues found that patients with major depressive disorder (MDD, n = 405,397) had a 64% increased risk of vitiligo, compared with a referent cohort (n = 5,739,048; 95% confidence interval, 1.43-1.87; P less than .0001). Conversely, patients who had vitiligo also were at an increased risk of MDD. Patients who were younger than 30 years old at diagnosis (n = 7,104) had a hazard ratio of 1.31 for MDD (P less than .0001), compared with 1.22 for patients aged 30 years and older (P = .001).

Individuals who took antidepressants, whether or not they also had an MDD diagnosis, had a decreased risk for vitiligo.

Though it’s known that vitiligo increases the risk of MDD, less clarity has been in the literature about whether the converse also might be true. “The question of whether vitiligo onset can be precipitated by MDD has received less attention, despite the notion that patients often ask their dermatologists if stress or depression may have contributed to their disease,” wrote Dr. Vallerand, an epidemiologist and medical student at the University of Calgary, Alberta, and her colleagues.

There is a biologic plausibility for a bidirectional relationship, said Dr. Vallerand and her colleagues, since depression can boost systemic inflammation, and the risk for autoimmune disease such as vitiligo can be increased by proinflammatory states.

Access to a large dataset gave Dr. Vallerand and her collaborators the numbers to look at the relationship between vitiligo and MDD in the context of potential confounders, and to correct for those in their statistical analysis. Using medical records from The Health Improvement Network (THIN) database in the United Kingdom, the investigators conducted two independent population-based cohort studies. Each looked at risk in one direction of the MDD-vitiligo association.

The first analysis looked at MDD as a risk factor for vitiligo, following all patients with an incident diagnostic code for MDD. Patients without the MDD diagnosis code were the referent cohort. Patients in each cohort were followed until they reached the outcome of interest – a diagnosis of vitiligo – or were censored. Patients who had a vitiligo diagnosis before receiving an MDD diagnosis were not included.

The second analysis examined whether vitiligo was a risk factor for MDD, with a similar design that used nonvitiligo patients as the referent cohort. This analysis followed all patients until a diagnosis of MDD was recorded, or patients were censored. Again, patients with MDD diagnoses that came before the vitiligo diagnosis were excluded.

For the analysis of risk of vitiligo, the investigators looked at the effects of multiple covariates, including age, sex, alcohol use and smoking status, socioeconomic status, medical comorbidities, and whether patients were taking antidepressants. The covariates included in the analysis of risk of MDD were age, sex, medical comorbidities, and type of vitiligo treatment.

After the researchers determined unadjusted hazard ratios, each covariate was removed one at a time to see where there were substantial changes to the HR. Two additional models, one unadjusted and one that fully adjusted for all covariates, also were built.

The sensitivity analyses showed “an overall protective effect of antidepressants among both cohorts,” wrote Dr. Vallerand and her colleagues. The incidence rate of vitiligo among patients with MDD using antidepressants was 19.7 per 100,000 person-years, compared with 27.5 among MDD patients not using antidepressants (P = .0053).

“Similarly, those in the referent cohort who used antidepressants had about half the risk of vitiligo,” compared with the nonusers in the referent group, the investigators said. Serotonin also is present in the skin, and neurons and melanocytes share embryonic ectodermal origins, Dr. Vallerand and her colleagues said. Though the exact mechanisms are not known, patients with vitiligo may have lower skin serotonin, so there’s a potential role for serotonergic medication in the incidence of vitiligo in the THIN cohorts, they noted.

Though younger patients with vitiligo were at higher risk for MDD than were those aged 30 years and older, the overall cohort of individuals with vitiligo still had an unadjusted elevated risk for MDD, compared with the referent cohort (HR 1.27; 95% confidence interval, 1.16-1.40; P less than .0001).

“Unexpectedly, the magnitude of the reciprocal association was highest with MDD being a risk factor for vitiligo,” wrote Dr. Vallerand and her colleagues. “This highlights the notion that mental health may have a greater impact on the body, specifically with dermatologic manifestations, than previously thought.”

Some misclassification of both conditions is likely in such a large dataset, the investigators acknowledged. Also, subclinical depression was not evaluated, and there was no way to track the severity of either depression or vitiligo, they noted. Still, the big data approach “renders this one of the largest studies on psychodermatology to date,” said Dr. Vallerand and her colleagues, and the independent bidirectional analyses support causality.

Dr. Vallerand is a partner in a pharmaceutical consulting firm, GlacierRX, and was funded by Alberta Innovates. The authors reported having no conflicts of interest.

koakes@mdedge.com

SOURCE: Vallerand IA et al. J Am Acad Dermatol. 2019. doi: 10.1016/j.jaad.2018.11.047.

Diagnosis of any mental disorder significantly increased the risk for all other mental disorders, based on data from a population-based cohort study of almost 6 million individuals followed for nearly 84 million person-years.

Comorbidity among mental disorders has been acknowledged, but comprehensive data on comorbidities across all subsets of disease and a comprehensive risk assessment has been lacking, wrote Oleguer Plana-Ripoll, PhD, of Aarhus University in Denmark, and his colleagues.

In a study published in JAMA Psychiatry, the researchers included all individuals born in Denmark between Jan. 1, 1900, and Dec. 31, 2015, who were living in Denmark between Jan. 1, 2000, and Dec. 31, 2016. They used national health registries to identify mental disorders, and diagnoses were based on the International Statistical Classification of Diseases and Related Health Problems. The study population included 2,958,293 men and 2,982,485 women with an average age of 32 years at the start of the follow-up period; participants were followed for a total of 83.9 million person-years. Mental disorders were categorized in groups, and groups were paired for risk assessment.

Overall, the risk of developing all other mental disorders increased with the diagnosis of one mental disorder, most prominently in the first year after diagnosis, but the risk persisted for at least 15 years. In one model controlling for age, calendar time, and sex, hazard ratios ranged from 2.0 for prior intellectual disabilities paired with later eating disorders to 48.6 for prior developmental disorders paired with later intellectual disabilities.

The large sample size allowed for focus on absolute risk and the study was accompanied by an interactive website (http://www.nbepi.com) that allows clinicians (and potentially patients) to monitor possible emerging mental health comorbidities.

As one example of absolute risk assessment, the researchers determined that 40% of men and 50% of women diagnosed with a mood disorder before age 20 years would develop an incident neurotic disorder as defined by the 10th revision of the International Statistical Classification of Diseases and Related Health Problems within the next 15 years. “The provision of absolute risk estimates may facilitate the clinical translation of our findings, and lay the groundwork for future studies related to personalized medicine and the primary prevention of comorbidity,” Dr. Plana-Ripoll and his colleagues wrote.

The researchers acknowledged the study’s limitation of comorbidities to pairs of disorders versus three or more, the use of groups of disorders rather than specific disorders, and the limitation to mental disorders treated in secondary care settings. However, the data support findings from previous studies and “provide new insights into the complex nature of comorbidity and the comprehensive nature of the analysis will provide an important foundation for future research,” they said.

The research was supported by the Danish National Research Foundation. Dr. Plana-Ripoll had no financial conflicts to disclose. Some coauthors disclosed grants from the National Institutes of Health, Novo Nordisk Foundation, and the European Research Council, and some coauthors disclosed financial relationships with Sanofi Aventis, Johnson & Johnson, Sage Pharmaceuticals, Shire, and Takeda.

SOURCE: Plana-Ripoll O et al. JAMA Psychiatry. 2019 Jan 16. doi: 10.1001/jamapsychiatry.2018.3658.

Diagnosis of any mental disorder significantly increased the risk for all other mental disorders, based on data from a population-based cohort study of almost 6 million individuals followed for nearly 84 million person-years.

Comorbidity among mental disorders has been acknowledged, but comprehensive data on comorbidities across all subsets of disease and a comprehensive risk assessment has been lacking, wrote Oleguer Plana-Ripoll, PhD, of Aarhus University in Denmark, and his colleagues.

In a study published in JAMA Psychiatry, the researchers included all individuals born in Denmark between Jan. 1, 1900, and Dec. 31, 2015, who were living in Denmark between Jan. 1, 2000, and Dec. 31, 2016. They used national health registries to identify mental disorders, and diagnoses were based on the International Statistical Classification of Diseases and Related Health Problems. The study population included 2,958,293 men and 2,982,485 women with an average age of 32 years at the start of the follow-up period; participants were followed for a total of 83.9 million person-years. Mental disorders were categorized in groups, and groups were paired for risk assessment.

Overall, the risk of developing all other mental disorders increased with the diagnosis of one mental disorder, most prominently in the first year after diagnosis, but the risk persisted for at least 15 years. In one model controlling for age, calendar time, and sex, hazard ratios ranged from 2.0 for prior intellectual disabilities paired with later eating disorders to 48.6 for prior developmental disorders paired with later intellectual disabilities.

The large sample size allowed for focus on absolute risk and the study was accompanied by an interactive website (http://www.nbepi.com) that allows clinicians (and potentially patients) to monitor possible emerging mental health comorbidities.

As one example of absolute risk assessment, the researchers determined that 40% of men and 50% of women diagnosed with a mood disorder before age 20 years would develop an incident neurotic disorder as defined by the 10th revision of the International Statistical Classification of Diseases and Related Health Problems within the next 15 years. “The provision of absolute risk estimates may facilitate the clinical translation of our findings, and lay the groundwork for future studies related to personalized medicine and the primary prevention of comorbidity,” Dr. Plana-Ripoll and his colleagues wrote.

The researchers acknowledged the study’s limitation of comorbidities to pairs of disorders versus three or more, the use of groups of disorders rather than specific disorders, and the limitation to mental disorders treated in secondary care settings. However, the data support findings from previous studies and “provide new insights into the complex nature of comorbidity and the comprehensive nature of the analysis will provide an important foundation for future research,” they said.

The research was supported by the Danish National Research Foundation. Dr. Plana-Ripoll had no financial conflicts to disclose. Some coauthors disclosed grants from the National Institutes of Health, Novo Nordisk Foundation, and the European Research Council, and some coauthors disclosed financial relationships with Sanofi Aventis, Johnson & Johnson, Sage Pharmaceuticals, Shire, and Takeda.

SOURCE: Plana-Ripoll O et al. JAMA Psychiatry. 2019 Jan 16. doi: 10.1001/jamapsychiatry.2018.3658.

Diagnosis of any mental disorder significantly increased the risk for all other mental disorders, based on data from a population-based cohort study of almost 6 million individuals followed for nearly 84 million person-years.

Comorbidity among mental disorders has been acknowledged, but comprehensive data on comorbidities across all subsets of disease and a comprehensive risk assessment has been lacking, wrote Oleguer Plana-Ripoll, PhD, of Aarhus University in Denmark, and his colleagues.

In a study published in JAMA Psychiatry, the researchers included all individuals born in Denmark between Jan. 1, 1900, and Dec. 31, 2015, who were living in Denmark between Jan. 1, 2000, and Dec. 31, 2016. They used national health registries to identify mental disorders, and diagnoses were based on the International Statistical Classification of Diseases and Related Health Problems. The study population included 2,958,293 men and 2,982,485 women with an average age of 32 years at the start of the follow-up period; participants were followed for a total of 83.9 million person-years. Mental disorders were categorized in groups, and groups were paired for risk assessment.

Overall, the risk of developing all other mental disorders increased with the diagnosis of one mental disorder, most prominently in the first year after diagnosis, but the risk persisted for at least 15 years. In one model controlling for age, calendar time, and sex, hazard ratios ranged from 2.0 for prior intellectual disabilities paired with later eating disorders to 48.6 for prior developmental disorders paired with later intellectual disabilities.

The large sample size allowed for focus on absolute risk and the study was accompanied by an interactive website (http://www.nbepi.com) that allows clinicians (and potentially patients) to monitor possible emerging mental health comorbidities.

As one example of absolute risk assessment, the researchers determined that 40% of men and 50% of women diagnosed with a mood disorder before age 20 years would develop an incident neurotic disorder as defined by the 10th revision of the International Statistical Classification of Diseases and Related Health Problems within the next 15 years. “The provision of absolute risk estimates may facilitate the clinical translation of our findings, and lay the groundwork for future studies related to personalized medicine and the primary prevention of comorbidity,” Dr. Plana-Ripoll and his colleagues wrote.

The researchers acknowledged the study’s limitation of comorbidities to pairs of disorders versus three or more, the use of groups of disorders rather than specific disorders, and the limitation to mental disorders treated in secondary care settings. However, the data support findings from previous studies and “provide new insights into the complex nature of comorbidity and the comprehensive nature of the analysis will provide an important foundation for future research,” they said.

The research was supported by the Danish National Research Foundation. Dr. Plana-Ripoll had no financial conflicts to disclose. Some coauthors disclosed grants from the National Institutes of Health, Novo Nordisk Foundation, and the European Research Council, and some coauthors disclosed financial relationships with Sanofi Aventis, Johnson & Johnson, Sage Pharmaceuticals, Shire, and Takeda.

SOURCE: Plana-Ripoll O et al. JAMA Psychiatry. 2019 Jan 16. doi: 10.1001/jamapsychiatry.2018.3658.

Young people enrolled in Medicaid who commit suicide are disproportionately female, younger, and more likely to die by hanging, compared with non-Medicaid youth, results of a large, observational, population-based study suggest.

Nearly 40% of young people in the study who died by suicide were covered by Medicaid, according to study lead author Cynthia A. Fontanella, PhD, of the department of psychiatry and behavioral health at the Ohio State University, Columbus. Those findings, in addition to those of other studies indicating that youth enrolled in Medicaid endure more maltreatment and poverty-related adversity, suggest a need for health care delivery systems to develop “trauma-informed approaches” and implement them, Dr. Fontanella and her coauthors reported in the American Journal of Preventive Medicine.

“Effective suicide screening of enrollees could substantially decrease suicide mortality in the United States,” they wrote.

Dr. Fontanella and her coauthors reviewed death certificate data from the 16 most populous states to identify all youth aged 10-18 who committed suicide during 2009-2013. They identified 4,045 deaths from suicide based on state death certificate data in California, Florida, Georgia, Illinois, Indiana, Massachusetts, Michigan, Minnesota, New York, North Carolina, Ohio, Oregon, Texas, Virginia, Washington, and Wisconsin. To identify the subset of youth who were enrolled in Medicaid, they used Social Security numbers to link the death certificate data to data from a Medicaid database.

Out of 4,045 youth suicide deaths that occurred during that time period, 39% were among youth enrolled in Medicaid, the investigators found.

Although the overall suicide rate did not differ significantly between the Medicaid and non-Medicaid groups, investigators said they did identify significant differences in age and sex subgroups. Specifically, those in the Medicaid group had a 28% increased risk of suicide among the 10- to 14-year age subgroup, and a 14% increased risk of suicide among females, the findings showed. Moreover, the risk of death by hanging was 26% greater among the Medicare youth.

Dr. Fontanella and her coauthors reported several limitations. One is that the findings might not be generalizable to all 50 states. Also, they said, because suicide is underreported as a cause of death, the prevalence of suicide found in the study might have been underreported.

Nevertheless, the findings confirm the importance of Medicaid as a “boundaried” setting for efforts targeting youth suicide prevention, Dr. Fontanella and her associates wrote. Boundaried populations are those defined by a service setting or organizational function. In other words, they wrote, findings based on an analysis of service use patterns captured in Medicaid claims “could prove helpful in identifying periods known to be associated with heightened suicide risk, such as that immediately following discharge from inpatient psychiatric care.”

The National Action Alliance for Suicide Prevention’s Research Prioritization Task Force has recommended that those populations be targeted for research on interventions designed to reduce suicide deaths, Dr. Fontanella and her coauthors wrote.

This is the first-ever study to evaluate suicide-related mortality among Medicaid-covered youth, the investigators said. Previous studies of suicide in Medicaid have focused on adults – specifically those in the Veterans Health Administration, specific state Medicaid programs, or health maintenance organization networks.

The American Foundation for Suicide Prevention and the National Institutes of Health funded the study. Dr. Fontanella and her coauthors reported no other financial conflicts of interest.

SOURCE: Fontanella CA et al. Am J Prev Med. 2019 Jan 17. doi: 10.1016/j.amepre.2018.10.008.

Young people enrolled in Medicaid who commit suicide are disproportionately female, younger, and more likely to die by hanging, compared with non-Medicaid youth, results of a large, observational, population-based study suggest.

Nearly 40% of young people in the study who died by suicide were covered by Medicaid, according to study lead author Cynthia A. Fontanella, PhD, of the department of psychiatry and behavioral health at the Ohio State University, Columbus. Those findings, in addition to those of other studies indicating that youth enrolled in Medicaid endure more maltreatment and poverty-related adversity, suggest a need for health care delivery systems to develop “trauma-informed approaches” and implement them, Dr. Fontanella and her coauthors reported in the American Journal of Preventive Medicine.

“Effective suicide screening of enrollees could substantially decrease suicide mortality in the United States,” they wrote.

Dr. Fontanella and her coauthors reviewed death certificate data from the 16 most populous states to identify all youth aged 10-18 who committed suicide during 2009-2013. They identified 4,045 deaths from suicide based on state death certificate data in California, Florida, Georgia, Illinois, Indiana, Massachusetts, Michigan, Minnesota, New York, North Carolina, Ohio, Oregon, Texas, Virginia, Washington, and Wisconsin. To identify the subset of youth who were enrolled in Medicaid, they used Social Security numbers to link the death certificate data to data from a Medicaid database.

Out of 4,045 youth suicide deaths that occurred during that time period, 39% were among youth enrolled in Medicaid, the investigators found.

Although the overall suicide rate did not differ significantly between the Medicaid and non-Medicaid groups, investigators said they did identify significant differences in age and sex subgroups. Specifically, those in the Medicaid group had a 28% increased risk of suicide among the 10- to 14-year age subgroup, and a 14% increased risk of suicide among females, the findings showed. Moreover, the risk of death by hanging was 26% greater among the Medicare youth.

Dr. Fontanella and her coauthors reported several limitations. One is that the findings might not be generalizable to all 50 states. Also, they said, because suicide is underreported as a cause of death, the prevalence of suicide found in the study might have been underreported.

Nevertheless, the findings confirm the importance of Medicaid as a “boundaried” setting for efforts targeting youth suicide prevention, Dr. Fontanella and her associates wrote. Boundaried populations are those defined by a service setting or organizational function. In other words, they wrote, findings based on an analysis of service use patterns captured in Medicaid claims “could prove helpful in identifying periods known to be associated with heightened suicide risk, such as that immediately following discharge from inpatient psychiatric care.”

The National Action Alliance for Suicide Prevention’s Research Prioritization Task Force has recommended that those populations be targeted for research on interventions designed to reduce suicide deaths, Dr. Fontanella and her coauthors wrote.

This is the first-ever study to evaluate suicide-related mortality among Medicaid-covered youth, the investigators said. Previous studies of suicide in Medicaid have focused on adults – specifically those in the Veterans Health Administration, specific state Medicaid programs, or health maintenance organization networks.

The American Foundation for Suicide Prevention and the National Institutes of Health funded the study. Dr. Fontanella and her coauthors reported no other financial conflicts of interest.

SOURCE: Fontanella CA et al. Am J Prev Med. 2019 Jan 17. doi: 10.1016/j.amepre.2018.10.008.

Young people enrolled in Medicaid who commit suicide are disproportionately female, younger, and more likely to die by hanging, compared with non-Medicaid youth, results of a large, observational, population-based study suggest.

Nearly 40% of young people in the study who died by suicide were covered by Medicaid, according to study lead author Cynthia A. Fontanella, PhD, of the department of psychiatry and behavioral health at the Ohio State University, Columbus. Those findings, in addition to those of other studies indicating that youth enrolled in Medicaid endure more maltreatment and poverty-related adversity, suggest a need for health care delivery systems to develop “trauma-informed approaches” and implement them, Dr. Fontanella and her coauthors reported in the American Journal of Preventive Medicine.

“Effective suicide screening of enrollees could substantially decrease suicide mortality in the United States,” they wrote.

Dr. Fontanella and her coauthors reviewed death certificate data from the 16 most populous states to identify all youth aged 10-18 who committed suicide during 2009-2013. They identified 4,045 deaths from suicide based on state death certificate data in California, Florida, Georgia, Illinois, Indiana, Massachusetts, Michigan, Minnesota, New York, North Carolina, Ohio, Oregon, Texas, Virginia, Washington, and Wisconsin. To identify the subset of youth who were enrolled in Medicaid, they used Social Security numbers to link the death certificate data to data from a Medicaid database.

Out of 4,045 youth suicide deaths that occurred during that time period, 39% were among youth enrolled in Medicaid, the investigators found.

Although the overall suicide rate did not differ significantly between the Medicaid and non-Medicaid groups, investigators said they did identify significant differences in age and sex subgroups. Specifically, those in the Medicaid group had a 28% increased risk of suicide among the 10- to 14-year age subgroup, and a 14% increased risk of suicide among females, the findings showed. Moreover, the risk of death by hanging was 26% greater among the Medicare youth.

Dr. Fontanella and her coauthors reported several limitations. One is that the findings might not be generalizable to all 50 states. Also, they said, because suicide is underreported as a cause of death, the prevalence of suicide found in the study might have been underreported.

Nevertheless, the findings confirm the importance of Medicaid as a “boundaried” setting for efforts targeting youth suicide prevention, Dr. Fontanella and her associates wrote. Boundaried populations are those defined by a service setting or organizational function. In other words, they wrote, findings based on an analysis of service use patterns captured in Medicaid claims “could prove helpful in identifying periods known to be associated with heightened suicide risk, such as that immediately following discharge from inpatient psychiatric care.”

The National Action Alliance for Suicide Prevention’s Research Prioritization Task Force has recommended that those populations be targeted for research on interventions designed to reduce suicide deaths, Dr. Fontanella and her coauthors wrote.

This is the first-ever study to evaluate suicide-related mortality among Medicaid-covered youth, the investigators said. Previous studies of suicide in Medicaid have focused on adults – specifically those in the Veterans Health Administration, specific state Medicaid programs, or health maintenance organization networks.

The American Foundation for Suicide Prevention and the National Institutes of Health funded the study. Dr. Fontanella and her coauthors reported no other financial conflicts of interest.

SOURCE: Fontanella CA et al. Am J Prev Med. 2019 Jan 17. doi: 10.1016/j.amepre.2018.10.008.