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Bengoechea-Fortes SDLP, Ramírez-Expósito MJ, Martínez-Martos JM. Suicide, neuroinflammation and other physiological alterations. Eur Arch Psychiatry Clin Neurosci 2024; 274:1037-1049. [PMID: 36913003 PMCID: PMC10009854 DOI: 10.1007/s00406-023-01584-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/26/2023] [Indexed: 03/14/2023]
Abstract
Suicide is considered one of the major public health problems worldwide, being the second leading cause of death in the 15-29 age group. It is estimated that every 40s someone in the world commits suicide. The social taboo surrounding this phenomenon as well as the fact that suicide prevention measures currently fail to avoid deaths from this cause, means that more research is needed to understand its mechanisms. The present narrative review on suicide tries to point out several important aspects, such as risk factors or the dynamics of suicide, as well as the current findings in the field of physiology that could offer advances in the understanding of suicide. Subjective measures of risk such as scales and questionnaires are not effective alone, whereas the objective measures can be addressed from physiology. Thus, an increased neuroinflammation in people who take their own lives has been found, with an increase in inflammatory markers such as interleukin-6 and other cytokines in plasma or cerebrospinal fluid. Also, the hyperactivity of the hypothalamic-pituitary-adrenal axis and a decrease in serotonin or in vitamin D levels seems to also be involved. In conclusion, this review could help to understand which factors can trigger an increased risk of dying by suicide, as well as pointing out those alterations that occur in the body when someone attempt to commit suicide or succeeds in taking their own life. There is a need for more multidisciplinary approaches that address suicide to help to raise awareness of the relevance of this problem that causes the death of thousands of people every year.
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Affiliation(s)
- Sabina de la Paz Bengoechea-Fortes
- Experimental and Clinical Physiopathology Research Group CTS-1039, Department of Health Sciences, School of Health Sciences, University of Jaén, Campus Universitario Las Lagunillas, 23071, Jaén, Spain
| | - María Jesús Ramírez-Expósito
- Experimental and Clinical Physiopathology Research Group CTS-1039, Department of Health Sciences, School of Health Sciences, University of Jaén, Campus Universitario Las Lagunillas, 23071, Jaén, Spain
| | - José Manuel Martínez-Martos
- Experimental and Clinical Physiopathology Research Group CTS-1039, Department of Health Sciences, School of Health Sciences, University of Jaén, Campus Universitario Las Lagunillas, 23071, Jaén, Spain.
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LeardMann CA, Sharifian N, Warner S, Boyko EJ, Boparai SK, Powell TM, Rull RP, Reger MA, Hoge CW. Prospective comparison of risk factors for firearm suicide and non-firearm suicide in a large population-based cohort of current and former US service members: findings from the Millennium Cohort Study. LANCET REGIONAL HEALTH. AMERICAS 2024; 36:100802. [PMID: 38974380 PMCID: PMC11225814 DOI: 10.1016/j.lana.2024.100802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 07/09/2024]
Abstract
Background Suicide is a leading cause of death among service members and veterans. Among suicide methods, firearms are the most lethal and commonly used method among military populations. Limited research has compared risk factors for the various suicide methods. This study evaluated and compared risk factors for firearm versus non-firearm suicides using data from the Millennium Cohort Study, a large longitudinal military cohort. Methods Using a competing risk approach, we identified factors associated with each suicide method. Risk factors included demographics, mental health diagnoses, mental health symptoms, military-specific characteristics, health behaviors, and psychosocial factors. Cause of death was assessed from July 1, 2001, through December 31, 2018. Findings Among 201,565 eligible participants with a mean [SD] age of 29.0 [58.1] years, there were 139,789 (69.3%) male, 61,776 (30.7%) female, 15,927 (7.9%) Hispanic, 24,667 (12.3%) non-Hispanic Black, 14,138 (7.0%) Asian, Pacific Islander, American Indian or Multiracial, and 146,736 (72.8%) non-Hispanic White participants. During the study period, 330 died by firearm suicide and 168 died by non-firearm suicide. Overall, effect estimates for risk factors were similar across both methods of suicide. After adjustment, men (HR: 3.69, 95% CI: 2.59, 5.24) and those who screened positive for depression (HR: 1.97, 95% CI: 1.36, 2.87) had an elevated risk for firearm suicide. In contrast, those who self-reported a history of bipolar diagnosis (HR: 3.40, 95% CI: 1.76, 6.55) had significantly increased risk for non-firearm suicide. Interpretation Findings suggest that prevention and intervention strategies overall may not need to be differentiated by specific demographic, military, or health factors. Targeted interventions that consider sex and mental health screens might have relative utility in preventing firearm related suicide risk compared with non-firearm suicide. Funding Military Operational Medicine Research Program, Defense Health Program, and Department of Veterans Affairs.
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Affiliation(s)
- Cynthia A. LeardMann
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc., San Diego, CA, USA
| | - Neika Sharifian
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc., San Diego, CA, USA
| | - Steven Warner
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc., San Diego, CA, USA
| | - Edward J. Boyko
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Satbir K. Boparai
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc., San Diego, CA, USA
| | | | - Rudolph P. Rull
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Mark A. Reger
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Charles W. Hoge
- Center for Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Office of the Army Surgeon General, Falls Church, VA, USA
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Tian X, Dong YQ, Yuan JY, Gao Y, Zhang CH, Li MJ, Li J. Association between peripheral plasma cytokine levels and suicidal ideation in first-episode, drug-naïve major depressive disorder. Psychoneuroendocrinology 2024; 165:107042. [PMID: 38613945 DOI: 10.1016/j.psyneuen.2024.107042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/30/2024] [Accepted: 03/31/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Inflammatory processes could potentially impact both mood and suicide risk, however, the relationship between cytokines and suicidal ideation remains unclear. This study aimed to investigate the association between plasma levels of cytokines and suicidal ideation in population with major depressive disorders (MDD). METHODS A cross-sectional study was performed to assess the peripheral plasma levels of interleukin-1β (IL-1β), IL-2, IL-6, IL-8, IL-10 and tumor necrosis factor-α (TNF-α) in 88 Chinese Han first-episode drug-naïve MDD patients. Suicidal ideation in the past week were identified using the Beck Scale for Suicide Ideation-Chinese Version (BSI-CV). The Hamilton Depression Rating Scale-17 (HAMD-17), the Hamilton Anxiety Rating Scale-14 (HAMA-14) and the Childhood Trauma Questionnaire (CTQ) was used to assess depression, anxiety and childhood trauma. Multivariable logistic regression models were used to estimate the association between cytokines and suicidal ideation. Interaction and stratified analyses were conducted according to age, sex, marital status, education, smoking status, BMI and physical activity. RESULTS Among the 88 participants, 42 individuals (47.7%) reported suicidal ideation within the past week. In the fully adjusted model, a statistically significant trend was observed in the association between IL-2 level and suicidal ideation (OR: 1.40, 95% CI: 1.00-1.97). The stratified analysis showed a statistically significant association between IL-6 level and suicidal ideation among younger people (OR: 1.17, 95% CI: 1.01-1.36) and a significant positive association between IL-8 (OR: 1.59, 95% CI: 1.03-2.44) and IL-10 (OR: 2.51, 95% CI: 1.27-4.96) levels and suicide ideation among higher educated populations. LIMITATIONS The cross-sectional design, residual confounding effects and small sample size CONCLUSION: Our findings indicate a significant positive association between plasma IL-2 level and suicidal ideation in MDD patients. IL-2 has the potential to be a biomarker of suicidal ideation in patients with depression.
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Affiliation(s)
- Xue Tian
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Ye-Qing Dong
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Jia-Yu Yuan
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Ying Gao
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Chu-Hao Zhang
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Mei-Juan Li
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Jie Li
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China.
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Bond AE, Houtsma C, Shapiro ME, Bandel SL, Moceri-Brooks J, Anestis MD. Female military service members and veterans: Understanding treatment seeking behavior and previous suicide risk among suicide decedents. DEATH STUDIES 2024:1-8. [PMID: 38912977 DOI: 10.1080/07481187.2024.2370468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
To examine the differences in treatment seeking behaviors, previous suicidal thoughts, previous suicide attempts, and disclosure of suicidal thoughts among female service members (SM)/Veteran suicide decedents who used a firearm and those who used another method. Data was acquired from the National Violent Death Reporting System which is maintained and monitored by the Center for Disease Control and Prevention. Data included in the present study were from suicide deaths that occurred between 2003-2018. Female SM/Veterans who died by firearm suicide had lower proportions of current mental health or substance use treatment, lifetime mental health or substance use treatment, and previous suicide attempts compared to those who used another method. Female SM/Veterans who die by firearm suicide are less likely to encounter mental health services than those who use another method. Conversations on secure firearm storage need to occur outside of the health care setting.
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Affiliation(s)
- Allison E Bond
- The New Jersey Gun Violence Research Center, Rutgers The State University of New Jersey, New Brunswick, USA
- Department of Psychology, Rutgers University, USA
| | - Claire Houtsma
- Southeast Louisiana Veterans Health Care System, USA
- South Central Mental Illness Research, Education and Clinical Center, USA
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mary E Shapiro
- Southeast Louisiana Veterans Health Care System, USA
- South Central Mental Illness Research, Education and Clinical Center, USA
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Shelby L Bandel
- The New Jersey Gun Violence Research Center, Rutgers The State University of New Jersey, New Brunswick, USA
- Department of Psychology, Rutgers University, USA
| | - Jayna Moceri-Brooks
- The New Jersey Gun Violence Research Center, Rutgers The State University of New Jersey, New Brunswick, USA
| | - Michael D Anestis
- The New Jersey Gun Violence Research Center, Rutgers The State University of New Jersey, New Brunswick, USA
- School of Public Health, Rutgers University, New Brunswick, USA
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5
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Xiao Y, Bi K, Yip PSF, Cerel J, Brown TT, Peng Y, Pathak J, Mann JJ. Decoding Suicide Decedent Profiles and Signs of Suicidal Intent Using Latent Class Analysis. JAMA Psychiatry 2024; 81:595-605. [PMID: 38506817 PMCID: PMC10955339 DOI: 10.1001/jamapsychiatry.2024.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/07/2024] [Indexed: 03/21/2024]
Abstract
Importance Suicide rates in the US increased by 35.6% from 2001 to 2021. Given that most individuals die on their first attempt, earlier detection and intervention are crucial. Understanding modifiable risk factors is key to effective prevention strategies. Objective To identify distinct suicide profiles or classes, associated signs of suicidal intent, and patterns of modifiable risks for targeted prevention efforts. Design, Setting, and Participants This cross-sectional study used data from the 2003-2020 National Violent Death Reporting System Restricted Access Database for 306 800 suicide decedents. Statistical analysis was performed from July 2022 to June 2023. Exposures Suicide decedent profiles were determined using latent class analyses of available data on suicide circumstances, toxicology, and methods. Main Outcomes and Measures Disclosure of recent intent, suicide note presence, and known psychotropic usage. Results Among 306 800 suicide decedents (mean [SD] age, 46.3 [18.4] years; 239 627 males [78.1%] and 67 108 females [21.9%]), 5 profiles or classes were identified. The largest class, class 4 (97 175 [31.7%]), predominantly faced physical health challenges, followed by polysubstance problems in class 5 (58 803 [19.2%]), and crisis, alcohol-related, and intimate partner problems in class 3 (55 367 [18.0%]), mental health problems (class 2, 53 928 [17.6%]), and comorbid mental health and substance use disorders (class 1, 41 527 [13.5%]). Class 4 had the lowest rates of disclosing suicidal intent (13 952 [14.4%]) and leaving a suicide note (24 351 [25.1%]). Adjusting for covariates, compared with class 1, class 4 had the highest odds of not disclosing suicide intent (odds ratio [OR], 2.58; 95% CI, 2.51-2.66) and not leaving a suicide note (OR, 1.45; 95% CI, 1.41-1.49). Class 4 also had the lowest rates of all known psychiatric illnesses and psychotropic medications among all suicide profiles. Class 4 had more older adults (23 794 were aged 55-70 years [24.5%]; 20 100 aged ≥71 years [20.7%]), veterans (22 220 [22.9%]), widows (8633 [8.9%]), individuals with less than high school education (15 690 [16.1%]), and rural residents (23 966 [24.7%]). Conclusions and Relevance This study identified 5 distinct suicide profiles, highlighting a need for tailored prevention strategies. Improving the detection and treatment of coexisting mental health conditions, substance and alcohol use disorders, and physical illnesses is paramount. The implementation of means restriction strategies plays a vital role in reducing suicide risks across most of the profiles, reinforcing the need for a multifaceted approach to suicide prevention.
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Affiliation(s)
- Yunyu Xiao
- Department of Population Health Sciences, Weill Cornell Medicine/NewYork-Presbyterian, New York
| | - Kaiwen Bi
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Paul Siu-Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong
| | - Julie Cerel
- College of Social Work, University of Kentucky, Lexington
| | | | - Yifan Peng
- Department of Population Health Sciences, Weill Cornell Medicine/NewYork-Presbyterian, New York
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medicine/NewYork-Presbyterian, New York
| | - J. John Mann
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, New York
- Department of Radiology, Columbia University Irving Medical Center, Columbia University, New York, New York
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York
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Anestis MD. Firearm Access and Suicide Rates: An Unambiguously Robust Association. Arch Suicide Res 2024; 28:701-705. [PMID: 36987987 DOI: 10.1080/13811118.2023.2192753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Firearms account for approximately half of all suicide deaths within the United States each year. Recently, Lane and Kleck published pieces reporting conflicting results regarding the relationship between firearm access and suicide rates. In this commentary, I aim to contextualize the findings within the broader literature and to provide clarity for readers aiming to navigate the findings of the two studies. Ultimately, I conclude that the results of Lane more accurately represent the nature of the relationship and align with the extant literature on the topic.
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Docherty M, Kubik J, Drawve G. Examining predictors of suicide by firearm in young, middle, and late adulthood. Suicide Life Threat Behav 2024; 54:221-232. [PMID: 38124679 DOI: 10.1111/sltb.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/18/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Suicide remains a leading cause of death in the U.S., and firearms are one of the most lethal methods of suicide. This study examines personal and contextual factors that predict suicide with a firearm compared to other methods across stages of adulthood. METHODS Data on adult suicide decedents from 2009 to 2019 were obtained from Colorado's National Violent Death Reporting System (NVDRS) data (N = 11,512). The dataset includes incident and person characteristics collected by law enforcement and coroners. Zip code level data were integrated from the American Community Survey. RESULTS Age, sex, race, marital status, military service, substance use, suicide attempt history, mental health, and location characteristics (population density, as well as age, education, veteran status, and household status of population) predicted suicide by firearm. Risk was particularly high for males in older adulthood. We further explored age-specific models (young, middle-aged, and older adults) to determine salient risk factors for each group. CONCLUSION This study highlights the need for comprehensive suicide prevention approaches that consider both individual and contextual risk factors, as well as unique risks in each stage of adulthood.
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Affiliation(s)
- Meagan Docherty
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Joanna Kubik
- Department of Sociology, Rider University, Lawrenceville, New Jersey, USA
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Bond AE, Houtsma C, Bryan CJ, Anestis MD. Self-Reported Likelihood of a Future Suicide Attempt: The Role of Plans for Suicide. Arch Suicide Res 2024:1-11. [PMID: 38526309 DOI: 10.1080/13811118.2024.2332249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
OBJECTIVE The present study seeks to add to the existing literature by determining if having a plan for suicide, is associated with an individual's self-reported likelihood of attempting suicide in the future. METHOD Data came from a sample of 97 United States Army personnel with past week ideation or lifetime attempt history. Assessments were collected at baseline, 1-month, 3-month, and 6-months. RESULTS Self-reported likelihood of attempting suicide in the future was not associated with the presence of a plan for suicide overall or a plan with a specific method (i.e., firearm, cutting/scratching, and medication). DISCUSSION Although a plan for suicide is commonly thought to indicate elevated risk our findings suggest that presence or absence of suicide plans is not associated with more self-reported likelihood of a future suicide attempt.
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Bond AE, Stanley I, Bandel SL, Anestis M. Law enforcement and firearms: understanding firearm ownership and storage habits. Inj Prev 2024; 30:132-137. [PMID: 37875335 DOI: 10.1136/ip-2023-044919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE This study seeks to better understand firearm ownership among law enforcement officers (LEO), with the goal of informing future firearm injury and suicide prevention efforts. We describe the frequency and sociodemographic correlates of firearm ownership and storage practices among, and examine the association between suicidal ideation and current firearm storage practices. METHODS The present study used data from a large online study (n=6410) and included data from individuals who were currently or previously being employed as an LEO (n=369; M (SD) age=39.2 y (15.8 y), 75.2% male, 66.7% white). Self-report measures were used to assess for firearm ownership, storage habits and suicidal ideation. Descriptive statistics were used to describe the frequency of firearm ownership and logistic regressions were used to examine the extent to which demographic characteristics and suicidal ideation were associated with firearm ownership. RESULTS Overall, 70.5% (n=261) of the sample reported firearm ownership. LEO who were older had significantly lower odds of reporting firearm ownership. Those who were married and those who reported lifetime suicidal ideation had significantly greater odds of reporting firearm ownership. Whereas firearm-owning LEO who reporting storing a firearm locked had significantly lower odds of reporting lifetime suicidal ideation, those who reported storing a firearm unloaded had significantly greater odds of reporting lifetime suicidal ideation. CONCLUSION Findings have important public health implications and can be used to increase adherence with secure storage recommendations. Increasing secure storage may help reduce suicide risk among LEO, a sample at heightened risk for suicide.
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Affiliation(s)
- Allison E Bond
- Psychology, Rutgers University, Piscataway, New Jersey, USA
- New Jersey Gun Violence Research Center, Rutgers University, New Brunswick, New Jersey, USA
| | - Ian Stanley
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shelby L Bandel
- New Jersey Gun Violence Research Center, Rutgers University, New Brunswick, New Jersey, USA
- Department of Psychology, The State University of NJ, Piscataway, New Jersey, USA
| | - Michael Anestis
- New Jersey Gun Violence Research Center, Rutgers University, New Brunswick, New Jersey, USA
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Miller AB, Oppenheimer CW, Chew RF, Weitzel KJ, D'Arcangelo B, Barnes A, Lowe A, Yaros AC. Exploring whether mental health crisis text conversations that include discussion of firearms differ from those without firearms. Prev Med 2023; 177:107783. [PMID: 37980956 PMCID: PMC10783174 DOI: 10.1016/j.ypmed.2023.107783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 10/10/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Firearm violence represents a public health crisis in the United States. Yet, there is limited knowledge about how firearms are discussed in the context of mental health emergencies representing a major gap in the current research literature. This study addresses this gap by examining whether the content of mental health crisis text conversations that mention firearms differ from those that do not mention firearms in a large, unique dataset from a national crisis text line. METHODS We examined data from over 3.2 million conversations between texters to Crisis Text Line and volunteer crisis counselors between September 2018 and July 2022. We used a study developed text classification machine learning algorithm that builds on natural language processing to identify and label whether crisis conversations mentioned firearms. We compared the frequency of psychosocial factors between conversations that mention firearms with those that did not. RESULTS Results from a generalized linear mixed-effects model demonstrated that. conversations mentioning firearms more frequently were associated with suicide, racism, physical, sexual, emotional, and unspecified abuse, grief, concerns about a third party, substance use, bullying, gender and sexual identity, relationships, depression, and loneliness. Further, conversations mentioning firearms were less likely to be related to self-harm and eating/body image. CONCLUSIONS These results offer an initial glimpse of how firearms are mentioned in the context of acute mental health emergencies, which has been completely absent in prior literature. Our results are preliminary and help sharpen our understanding of contextual factors surrounding mental health emergencies where a firearm is mentioned.
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Affiliation(s)
| | | | | | | | | | | | - Ashley Lowe
- RTI International, Research Triangle Park, NC, USA
| | - Anna C Yaros
- RTI International, Research Triangle Park, NC, USA
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Clark KA, Blosnich JR. Sexual Orientation and Disclosure of Suicidal Thoughts Before Suicide Mortality. Am J Prev Med 2023; 65:953-963. [PMID: 37429387 PMCID: PMC10772205 DOI: 10.1016/j.amepre.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Disclosure of suicidal thoughts and behaviors represents an opportunity to intervene before suicide mortality, representing a cornerstone for suicide prevention. Sexual minority (e.g., lesbian/gay, bisexual) people experience sharply elevated suicide risk, yet there is scant research on patterns of disclosure of suicidal thoughts and behaviors before suicide that might uncover missed opportunities for suicide prevention. Thus, authors leveraged postmortem suicide data to evaluate associations among sexual orientation, sex, and disclosure of suicidal thoughts and behaviors in the month preceding death. METHODS Data on suicides from the 2013-2019 National Violent Death Reporting System (N=155,516) were classified for sexual orientation and denoted disclosure of suicidal thoughts and behaviors and to whom suicidal thoughts and behaviors were disclosed in the month preceding death. Logistic regression models stratified by sex and adjusted for sociodemographic covariates assessed the associations between sexual orientation and suicidal thoughts and behaviors disclosure. Analyses were conducted from October 2022 to February 2023. RESULTS Among females, sexual minority decedents were 65% more likely to disclose suicidal thoughts and behaviors than heterosexual decedents (95% CI=37%, 99%, p<0.001). No difference in suicidal thoughts and behaviors disclosure was observed between sexual minority and heterosexual men. Of decedents who disclosed suicidal thoughts and behaviors, one in five sexual minority decedents disclosed to a friend/colleague, whereas fewer than 5% disclosed to a healthcare professional. Among sexual minority females, younger age, intimate partner problems, and physical health problems were positively associated with disclosing suicidal thoughts and behaviors. CONCLUSIONS These findings suggest that reducing suicide mortality in sexual minority populations will require considering contexts beyond the healthcare system, including engaging peer networks. Gatekeeper training for suicide prevention may be an especially promising approach for reducing suicide among sexual minority women.
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Affiliation(s)
- Kirsty A Clark
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee.
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
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12
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Bond AE, Brooks JR, Rodriguez TR, Bandel SL, Anestis MD. Examining characteristics and experiences of Black firearm owners. J Clin Psychol 2023. [PMID: 37190950 DOI: 10.1002/jclp.23532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/05/2023] [Accepted: 05/03/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE The present study sought to better understand the characteristics of those who own firearms in the Black community; and to understand how Black firearm owners differ from nonfirearm owning Black individuals on a variety of variables related to safety, threat concerns, and suicide risk. METHODS Two samples were utilized in this study. The first was a subsample of those who identified as Black from a nationally representative sample (N = 502) seeking to understand firearm ownership within the United States. The second used a subsample of those who identified as Black (N = 1086) from a representative sample from New Jersey, Minnesota, and Mississippi. Variables related to safety and threat concerns were included in the second sample. RESULTS In both samples, multiple demographic variables, such as being a woman and having higher education, predicted firearm ownership. In the second sample, experiences of everyday discrimination and crime experiences were associated with firearm ownership. Additionally, Black firearm owners reported significantly more suicidal ideation than Black nonfirearm owners. CONCLUSION The findings demonstrate the unique characteristics and experiences of Black firearm owners and show that firearm ownership is associated with increased suicide risk factors for Black adults. Findings should be used to advocate for the creation of more culturally relevant suicide prevention and firearm means safety strategies.
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Affiliation(s)
- Allison E Bond
- The New Jersey Gun Violence Research Center, Rutgers University, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Jasmin R Brooks
- Department of Psychology, The University of Houston, Houston, Texas, USA
| | - Taylor R Rodriguez
- The New Jersey Gun Violence Research Center, Rutgers University, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Shelby L Bandel
- The New Jersey Gun Violence Research Center, Rutgers University, Piscataway, New Jersey, USA
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Michael D Anestis
- The New Jersey Gun Violence Research Center, Rutgers University, Piscataway, New Jersey, USA
- School of Public Health, Rutgers University, Piscataway, New Jersey, USA
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Bond AE, Moceri-Brooks J, Rodriguez TR, Semenza D, Anestis MD. Determining who healthcare providers screen for firearm access in the United States. Prev Med 2023; 169:107476. [PMID: 36870571 DOI: 10.1016/j.ypmed.2023.107476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
Healthcare providers are well positioned to screen for firearm access to reduce risk of suicides, yet there is a limited understanding of how often and for whom firearm access screening occurs. The present study examined the extent to which providers screen for firearm access and sought to identify who has been screened in the past. The representative sample included 3510 residents from five US states who reported whether they have been asked about their access to firearms by a healthcare provider. The findings demonstrate that most participants have never been asked by a provider about firearm access. People who have been asked were more likely to be White, male, and firearm owners. Those with children under 17 years old in the home, that have been in mental health treatment, and report a history of suicidal ideation were more likely to be screened for firearm access. Although there are interventions for mitigating firearm related risks in healthcare settings, many providers may be missing the opportunity to implement these because they do not ask about firearm access.
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Affiliation(s)
- Allison E Bond
- The New Jersey Gun Violence Research Center, Rutgers University, United States of America; Department of Psychology, Rutgers University, United States of America; Department of Sociology, Anthropology, and Criminal Justice, Rutgers University - Camden, United States of America.
| | - Jayna Moceri-Brooks
- The New Jersey Gun Violence Research Center, Rutgers University, United States of America; School of Public Health, Rutgers University, United States of America
| | - Taylor R Rodriguez
- The New Jersey Gun Violence Research Center, Rutgers University, United States of America; Department of Psychology, Rutgers University, United States of America
| | - Daniel Semenza
- The New Jersey Gun Violence Research Center, Rutgers University, United States of America; Department of Sociology, Anthropology, and Criminal Justice, Rutgers University - Camden, United States of America
| | - Michael D Anestis
- The New Jersey Gun Violence Research Center, Rutgers University, United States of America; School of Public Health, Rutgers University, United States of America
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Hallford D, Rusanov D, Winestone B, Kaplan R, Fuller-Tyszkiewicz M, Melvin G. Disclosure of suicidal ideation and behaviours: A systematic review and meta-analysis of prevalence. Clin Psychol Rev 2023; 101:102272. [PMID: 37001469 DOI: 10.1016/j.cpr.2023.102272] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/30/2023] [Accepted: 03/24/2023] [Indexed: 03/28/2023]
Abstract
Disclosure of suicidal ideation and behaviours, defined as thoughts, plans, or attempts, to other people provides opportunity for intervention and prevention. This study is the first to meta-analyze all available studies to estimate the prevalence of disclosure, to whom people disclose, and examine factors that influence disclosure. Databases were searched for studies reporting samples of people who had experienced suicidal ideation or behaviours (including those who had died by suicide) and whether they had disclosed this. Almost 100 studies (k = 94, N participants = 1,044,629) were included in the overall prevalance analysis. The results showed less than half of people disclosed suicidal ideation or behaviour: 45.9% (95%CI 41.9-49.9%, PI 12.3-81.8%; k = 94). High heterogeneity, common to prevalence studies, was found (Q[93] = 130,584, p < .001; I2 = 99.9%). No publication bias was detected. Removing outliers did not change the prevalence estimate, but provided tighter prediction intervals: 45.6% (95%CI 43.4-47.9%, PI 35.8-55.7%; k = 33). Disclosure was related to higher prevalence of psychiatric disorders, female gender, and a longer timeframe of suicidal ideation or behaviour. Prevalence of disclosure was lower among people who died by suicide, relative to community samples, and lower when reported verbally rather than written online. Disclosure, and proportions of disclosures, to family members, was numerically higher than to friends or professionals, but could not be directly compared. In conclusion, between 50 and 60% of people do not disclose their suicidal ideation and behaviours to other people, and therefore remain unidentified and potentially untreated.
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Anestis MD, Bond AE, Capron DW, Bryan AO, Bryan CJ. Differences in firearm storage practices among United States military servicemembers who have and have not disclosed suicidal thoughts or attended behavioral health sessions. Suicide Life Threat Behav 2023; 53:262-269. [PMID: 36622136 DOI: 10.1111/sltb.12940] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/24/2022] [Accepted: 12/09/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Two-thirds of military suicides are by firearm, and unsafe storage increases the risk of suicide. Understanding who is at risk for suicide, their interactions with behavioral healthcare, and their firearm storage habits have implications for suicide prevention. METHOD Probability-based sampling was used. Inclusion criteria were current military service and firearm ownership. Analyses focused on those who endorsed past year (n = 180) or past month suicidal ideation (n = 85). RESULTS Servicemembers with undisclosed past year ideation stored firearms at home more often and with a locking device less often. Servicemembers with past year ideation who did not attend recent behavioral health sessions stored firearms with a locking device and loaded less often. Servicemembers with undisclosed suicidal ideation in the past month stored firearms with a locking device less often. Servicemembers with past month ideation who have not attended recent behavioral health sessions stored firearms with a locking device and loaded less often. CONCLUSIONS Servicemembers experiencing undisclosed suicidal ideation and who are not receiving treatment generally have more ready access to firearms. Safe firearm storage messaging needs to be disseminated in a manner that shifts social norms around firearm storage, whether or not suicide risk is known.
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Affiliation(s)
- Michael D Anestis
- New Jersey Gun Violence Research Center, Piscataway, USA.,Rutgers, The State University of New Jersey, Piscataway, USA
| | - Allison E Bond
- New Jersey Gun Violence Research Center, Piscataway, USA.,Rutgers, The State University of New Jersey, Piscataway, USA
| | | | | | - Craig J Bryan
- The Ohio State University College of Medicine, Columbus, USA
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Anestis MD, Bryan CJ, Capron DW, Bryan AO. Evaluation of Safe Firearm Storage Messaging in a Sample of Firearm-Owning US Military Service Members. JAMA Netw Open 2022; 5:e2235984. [PMID: 36219445 PMCID: PMC9554700 DOI: 10.1001/jamanetworkopen.2022.35984] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Nearly two-thirds of military suicides involve firearms, and safe firearm storage is rare. OBJECTIVE To examine whether US military service members endorse greater openness to safe firearm storage depending on the content of the visual message they are randomly assigned to view. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness study used a 3 × 2 × 2 factorial design to randomize US military service members to view 1 of 12 visual messages on safe firearm storage. Willingness to use safe firearm storage practices was assessed immediately before and after exposure to the message. Participants were recruited using the KnowledgePanel Calibration approach. Inclusion criteria included current membership in the US military and current firearm ownership. The KnowledgePanel sample was fielded from December 3 to 27, 2021, with a 76% completion rate and 45 individuals determined to be qualified (28% qualification rate). The opt-in sample was fielded December 7, 2021, through January 4, 2022, with 699 individuals (3%) qualified and 674 included in the final data set. EXPOSURES Messages shared the same image and text on safe firearm storage but varied in messenger occupation (eg, primary care physician, security forces, or combat controller), the presence of text validating the perspective of firearm owners, and the presence of text validating the drive for home protection. MAIN OUTCOMES AND MEASURES Outcomes included changes in willingness to use 4 at-home (unloaded, separate from ammunition, in a locked location, and with a locking device) and 3 away-from-home (with family or friend, at a firearm retailer, or at a law enforcement agency) firearm storage practices. All analyses, including sample descriptives, are based on weighted data. RESULTS Of the 719 individuals in the data set, 367 (median [range] age, 33.64 [18-86] years; 80.4% male; 71.4% White) who endorsed not currently storing firearms using the methods assessed were included in analyses. In a multivariate analysis of variance, a significant interaction was found among time, messenger profession, gun-friendly text, and home protection text across all outcomes (Wilks' λ F = 2.09; P = .01; pη2 = 0.040); however, in a post hoc repeated-measures analysis of variance, the interaction was statistically significant only for storing firearms away from home with a trusted family member or friend (F = 5.42; P = .005; pη2 = 0.030). The profession of the messenger was more consistently associated with shifts in willingness than was the message content, although this varied across storage options. CONCLUSIONS AND RELEVANCE The findings of this comparative effectiveness study suggest that several combinations of messenger and content may be associated with willingness to endorse safe firearm storing practices, with particularly consistent positive findings for messages featuring security forces. The scalability and dosage potential of this intervention may render visual messaging valuable for promoting safe firearm storage at the population level.
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Affiliation(s)
- Michael D. Anestis
- New Jersey Gun Violence Research Center, Piscataway
- Rutgers, the State University of New Jersey, Piscataway
| | - Craig J. Bryan
- The Ohio State University Wexner Medical Center, Columbus
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Abstract
This Viewpoint discusses lethal means safety (LMS), an approach to reducing suicide risk by reducing access to firearms by at-risk individuals; highlights challenges in implementing LMS interventions in clinical settings; and provides examples of programs and resources for preventing firearm suicide at the individual, patient group, and population level.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, University of Colorado Anschutz School of Medicine, Aurora
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora
| | | | - Joseph A Simonetti
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Veterans Health Administration, Aurora, Colorado
- Division of Hospital Medicine, University of Colorado Anschutz School of Medicine, Aurora
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Bryan CJ, Bryan AO, Wastler HM, Khazem LR, Ammendola E, Baker JC, Szeto E, Tabares J, Bauder CR. Assessment of Latent Subgroups With Suicidal Ideation and Suicidal Behavior Among Gun Owners and Non-Gun Owners in the US. JAMA Netw Open 2022; 5:e2211510. [PMID: 35544138 PMCID: PMC9096594 DOI: 10.1001/jamanetworkopen.2022.11510] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Firearm ownership is associated with increased risk for suicide. OBJECTIVE To examine patterns of associations among suicidal thoughts and behaviors among gun owners and non-gun owners in the US. DESIGN, SETTING, AND PARTICIPANTS In this survey study, cross-sectional online survey data were collected from March to April 2020 from US adults recruited via Qualtrics Panels. Quota sampling was used to approximate US census demographics. MAIN OUTCOMES AND MEASURES The primary outcomes were past-year passive suicidal ideation, active suicidal ideation, suicidal planning, suicidal behaviors, and nonsuicidal self-injury as measured by items from the Self-Injurious Thoughts and Behaviors Interview-Revised (SITBI-R). Simple latent class analysis (LCA) was used to assign participants to separate classes based on posterior probabilities, and multigroup LCA was used to assess whether the same construct was measured in specified groups. RESULTS Of 65 079 adults invited to participate, 10 625 (16.3%) completed the survey; 9153 responded "yes" or "no" to the firearm ownership item and were included in the analysis. Of these 9153 respondents (4695 [51.3%] male; mean [SD] age, 46.7 [16.8] years), 2773 (30.3%) reported owning a gun and 6380 (69.7%) reported not owning a gun. Compared with non-gun owners, gun owners were more likely to be male (1779 [64.2%] vs 2916 [45.7%]; χ21, 263.3; P < .001) and White (2090 [75.4%] vs 3945 [61.8%]; χ25, 232.9; P < .001) and to have served in the military (772 [27.8%] vs 609 [9.5%]; χ21, 571.4; P < .001). Five distinct patterns of SITBI-R item endorsement were extracted using simple LCA. Multigroup LCA indicated that the probability of SITBI-R item endorsement differed between gun owners and non-gun owners across subgroups. Among gun owners, the probability of past-month nonfatal suicide attempts was highest in class 4 (ranging from 16.8% for reaching out for help to 27.2% for starting, then changing one's mind). Gun owners in class 4 were characterized by high probabilities of endorsing thoughts about specific ways or methods to attempt suicide (100%) and preparatory behavior (100%). Among non-gun owners, the probability of nonfatal suicide attempts was highest in class 5 (ranging from 14.9% for reaching out for help to 29.7% for starting, then changing one's mind). Non-gun owners in class 5 were characterized by high probabilities of endorsing passive suicidal ideation (84.0%-100%), active suicidal ideation (86.7%-95.0%), and thoughts about specific ways or methods to attempt suicide (97.4%) and a specific place (92.1%) to attempt suicide. CONCLUSIONS AND RELEVANCE In this study, in subgroups with lower probabilities of suicide attempt, gun owners and non-gun owners showed similar patterns of suicide risk item endorsement, but when the probability of a suicide attempt increased, gun owners were less likely than non-gun owners to endorse passive and active suicidal ideation. These findings suggest that assessing a broader range of suicide risk indicators may improve risk detection.
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Affiliation(s)
- Craig J. Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - AnnaBelle O. Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - Heather M. Wastler
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - Lauren R. Khazem
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - Ennio Ammendola
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - Justin C. Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - Edwin Szeto
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - Jeffrey Tabares
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - Christina R. Bauder
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
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