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O'Brien B, Lee J, Kim S, Nandra GS, Pannu P, Tamman A, Amarneh D, Swann AC, Murphy N, Averill L, Jha M, Mathew SJ. Anti-suicidal effects of IV ketamine in a real-world setting. Psychiatry Res 2024; 331:115604. [PMID: 38064911 DOI: 10.1016/j.psychres.2023.115604] [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: 07/07/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 01/02/2024]
Abstract
The current study evaluated the effectiveness of intravenous ketamine treatment for suicidality in a community-based clinical sample of 295 outpatients (mean age= 40.37; 58.6 % male). We conducted growth mixture modeling to estimate latent classes of changes in symptoms of suicidality measured by the Concise Health Risk Tracking - Self-Report (CHRT-SR) across five infusions in a two-week course of treatment. Best-fit indices indicated three trajectory groups demonstrating non-linear, quadratic changes in CHRT-SR scores during ketamine treatment. The largest group of patients (n= 170, 57.6 %) had moderate CHRT-SR scores at baseline and showed gradual improvement during treatment. The other two groups of patients had severe CHRT-SR scores at baseline and diverged into one group with no improvement throughout treatment (n = 63, 21 %) and one group with rapid improvement (n = 62, 21 %). Of the clinical and demographic variables available and tested, only higher scores pertaining to active thoughts of death and/or plan were found to predict which of the patients with severe CHRT-SR scores at baseline would not benefit from treatment. The present study provides an important contribution to the knowledge of ketamine's effects on symptoms related to suicide over time. providing support for the possible effectiveness of ketamine in a proportion of patients.
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Affiliation(s)
- Brittany O'Brien
- Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA; Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA. Brittany.O'
| | - Jaehoon Lee
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA; Texas Tech University, Department of Educational Psychology and Leadership, 2500 Broadway, Lubbock, TX 79409, USA; The Menninger Clinic, 12301 S Main Street, Houston, TX 77035, USA
| | - Seungman Kim
- Texas Tech University, Department of Educational Psychology and Leadership, 2500 Broadway, Lubbock, TX 79409, USA
| | - Guriqbal S Nandra
- IV Solution and Ketamine Centers of Chicago and Kansas City, 712 North Dearborn Street, Chicago, IL 60654, USA
| | - Prabhneet Pannu
- IV Solution and Ketamine Centers of Chicago and Kansas City, 712 North Dearborn Street, Chicago, IL 60654, USA
| | - Amanda Tamman
- Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA; Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA
| | - Dania Amarneh
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA
| | - Alan C Swann
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA
| | - Nicholas Murphy
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA
| | - Lynnette Averill
- Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA; Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA
| | - Manish Jha
- UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Sanjay J Mathew
- Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA; Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA; The Menninger Clinic, 12301 S Main Street, Houston, TX 77035, USA
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Vo HT, Kulikova A, Mayes TL, Carmody T, Shoptaw S, Ling W, Trombello JM, Trivedi MH. Psychometric properties of the Treatment Effectiveness Assessment in methamphetamine use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 151:209085. [PMID: 37245855 PMCID: PMC10977640 DOI: 10.1016/j.josat.2023.209085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 05/01/2023] [Accepted: 05/23/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The ability for people living with stimulant use disorder to live meaningful lives requires not only abstinence from addictive substances, but also healthy engagement with their community, lifestyle practices, and overall health. The Treatment Effectiveness Assessment (TEA) assesses components of recovery consisting of four functional domains: substance use, health, lifestyle, and community. This secondary data analysis of 403 participants with severe methamphetamine use disorder tested the reliability and validity of the TEA. METHODS Participants were enrolled in the Accelerated Development of Additive Pharmacotherapy Treatment (ADAPT-2) for methamphetamine use disorder. The study used total TEA and domain scores at baseline to assess factor structure and internal consistency, as well as construct validity related to substance cravings (visual analog scale [VAS]), quality of life (quality-of-life assessment [QoL]), mental health (Patient Health Questionnaire-9 [PHQ-9], Concise Health Risk Tracking Scale Self-Report [CHRT-SR16]), and social support (CHRT-SR16). RESULTS Individual TEA items showed moderate to large correlations with each other (r = 0.27-0.51; p < .001), and strong correlations to the total score (r = 0.69-0.78; p < .001). Internal consistency was strong (coefficient α = 0.73 [0.68-0.77]; coefficient ω = 0.73 [0.69-0.78]). Construct validity was acceptable, with the strongest correlation between the TEA Health item and the general health status item on the QoL (r = 0.53, p < .001). CONCLUSIONS TEA has acceptable levels of reliability and validity supporting prior similar findings in a sample of participants with moderate to severe methamphetamine use disorder. Results from this study provide support for its use in assessing clinically meaningful changes beyond simply reduced substance use.
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Affiliation(s)
- Hoa T Vo
- Center for Depression Research and Clinical Care, Department of Psychiatry and Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA
| | - Alexandra Kulikova
- Center for Depression Research and Clinical Care, Department of Psychiatry and Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Department of Psychiatry and Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Carmody
- Center for Depression Research and Clinical Care, Department of Psychiatry and Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| | - Steve Shoptaw
- University of California Los Angeles, Los Angeles, CA, USA
| | - Walter Ling
- University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph M Trombello
- Center for Depression Research and Clinical Care, Department of Psychiatry and Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Department of Psychiatry and Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA.
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Mayes TL, Carmody T, Rush AJ, Nandy K, Emslie GJ, Kennard BD, Forbes K, Jha MK, Hughes JL, Heerschap JK, Trivedi MH. Predicting suicidal events: A comparison of the Concise Health Risk Tracking Self-Report (CHRT-SR) and the Columbia Suicide Severity Rating Scale (C-SSRS). Psychiatry Res 2023; 326:115306. [PMID: 37364504 DOI: 10.1016/j.psychres.2023.115306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 06/28/2023]
Abstract
This report examines the predictive capabilities of two scales of suicidality in high-risk adolescents. Charts of adolescents with severe suicidality participating in an intensive outpatient program were reviewed. Self-report data from the 9-item Concise Health Risk Tracking Self-Report (CHRT-SR9) and clinician-completed data from the Columbia Suicide Severity Risk Scale (C-SSRS) were obtained at entry. Scales' performances in predicting suicide attempts and suicidal events were evaluated using logistic regression models and ROC analyses. Of 539 adolescents, 53 had events of which 19 were attempts. The CHRT-SR9 total score predicted events (OR=1.05) and attempts (OR=1.09), as did the C-SSRS Suicide Ideation (SI) Intensity Composite for events (OR=1.10) and attempts (OR=1.16). The CHRT-SR9 AUC was 0.70 (84.2% sensitivity; 41.7% specificity; PPV=5.0%; NPV=98.6%) for attempts. The C-SSRS Intensity Composite AUC was 0.62 (89.5% sensitivity; 24.1% specificity; PPV=4.2%; NPV=98.4%) for attempts. Both the CHRT-SR9 and C-SSRS capture important parameters related to suicidal events or attempts that can help assess suicidal risk in adolescents.
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Affiliation(s)
- Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donell Jr. School of Public Health and Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Thomas Carmody
- Center for Depression Research and Clinical Care, Peter O'Donell Jr. School of Public Health and Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA; Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - A John Rush
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA; Duke-National University of Singapore, Singapore
| | - Karabi Nandy
- Center for Depression Research and Clinical Care, Peter O'Donell Jr. School of Public Health and Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA; Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Graham J Emslie
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA; Children's Health, Children's Medical Center, Dallas, Texas, USA
| | - Beth D Kennard
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA; Children's Health, Children's Medical Center, Dallas, Texas, USA
| | - Kathryn Forbes
- Center for Depression Research and Clinical Care, Peter O'Donell Jr. School of Public Health and Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Manish K Jha
- Center for Depression Research and Clinical Care, Peter O'Donell Jr. School of Public Health and Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jennifer L Hughes
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | | | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donell Jr. School of Public Health and Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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Trombello JM, Kulikova A, Mayes TL, Nandy K, Carmody T, Bart G, Nunes EV, Schmitz J, Kalmin M, Shoptaw S, Trivedi MH. Psychometrics of the Concise Health Risk Tracking Self-Report (CHRT-SR 16) Assessment of Suicidality in a Sample of Adults with Moderate to Severe Methamphetamine Use Disorder: Findings from the ADAPT-2 Randomized Trial. Neuropsychiatr Dis Treat 2023; 19:1443-1454. [PMID: 37377462 PMCID: PMC10292610 DOI: 10.2147/ndt.s406909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/28/2023] [Indexed: 06/29/2023] Open
Abstract
Background The co-occurrence of suicidality and substance use disorders has been well established, but rating scales to examine suicidal behavior and risk are sparse among participants with substance use disorders. We examined the psychometric properties of the 16-item Concise Health Risk Tracking Scale - Self Report (CHRT-SR16) to measure suicidality among adults with moderate-to-severe methamphetamine use disorder. Methods Participants (n = 403) with moderate-to-severe methamphetamine use disorder completed the CHRT-SR16 as part of a randomized, double-blind, placebo-controlled pharmacotherapy trial. The CHRT-SR16 factor structure was assessed using confirmatory factor analysis (CFA). Internal consistency was estimated with coefficients alpha (α) and omega (ω), test-retest reliability with intraclass correlation coefficient (ICC) and standard error of measurement, and convergent validity using Spearman's ρ rank order correlation coefficient test between CHRT-SR16 factors and the Patient Health Questionnaire (PHQ-9). The analyses utilized baseline and week 1 data (for test-retest reliability only). Results CFA revealed a seven-factor model of Pessimism, Helplessness, Social Support, Despair, Impulsivity, Irritability, and Suicidal Thoughts as the best-fitting model. The CHRT-SR16 also exhibited strong internal consistency (α = 0.89; ω = 0.89), test-retest reliability (ICC = 0.78) and convergent validity with the PHQ-9 total score (ρ = 0.62). Conclusion The CHRT-SR16 showed strong psychometric properties in a sample of participants with primary methamphetamine use disorder. Clinicaltrialsgov Identifier NCT03078075.
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Affiliation(s)
- Joseph M Trombello
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alexandra Kulikova
- Department of Educational Psychology, University of North Texas, Denton, TX, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karabi Nandy
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Carmody
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gavin Bart
- Department of Medicine, University of Minnesota, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Edward V Nunes
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Joy Schmitz
- Faillace Department of Psychiatry and Behavioral Sciences, University of Texas (UT Health) at Houston, Houston, TX, USA
| | - Mariah Kalmin
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Steven Shoptaw
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Jha MK, Chin Fatt C, Minhajuddin A, Mayes TL, Trivedi MH. Accelerated Brain Aging in Adults With Major Depressive Disorder Predicts Poorer Outcome With Sertraline: Findings From the EMBARC Study. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:462-470. [PMID: 36179972 PMCID: PMC10177666 DOI: 10.1016/j.bpsc.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/09/2022] [Accepted: 09/20/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) may be associated with accelerated brain aging (higher brain age than chronological age). This report evaluated whether brain age is a clinically useful biomarker by checking its test-retest reliability using magnetic resonance imaging scans acquired 1 week apart and by evaluating the association of accelerated brain aging with symptom severity and antidepressant treatment outcomes. METHODS Brain age was estimated in participants of the EMBARC (Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care) study using T1-weighted structural magnetic resonance imaging (MDD n = 290; female n = 192; healthy control participants n = 39; female n = 24). Intraclass correlation coefficient was used for baseline-to-week-1 test-retest reliability. Association of baseline Δ brain age (brain age minus chronological age) with Hamilton Depression Rating Scale-17 and Concise Health Risk Tracking Self-Report domains (impulsivity, suicide propensity [measures: pessimism, helplessness, perceived lack of social support, and despair], and suicidal thoughts) were assessed at baseline (linear regression) and during 8-week-long treatment with either sertraline or placebo (repeated-measures mixed models). RESULTS Mean ± SD baseline chronological age, brain age, and Δ brain age were 37.1 ± 13.3, 40.6 ± 13.1, and 3.1 ± 6.1 years in MDD and 37.1 ± 14.7, 38.4 ± 12.9, and 0.6 ± 5.5 years in healthy control groups, respectively. Test-retest reliability was high (intraclass correlation coefficient = 0.98-1.00). Higher baseline Δ brain age in the MDD group was associated with higher baseline impulsivity and suicide propensity and predicted smaller baseline-to-week-8 reductions in Hamilton Depression Rating Scale-17, impulsivity, and suicide propensity with sertraline but not with placebo. CONCLUSIONS Brain age is a reliable and potentially clinically useful biomarker that can prognosticate antidepressant treatment outcomes.
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Affiliation(s)
- Manish K Jha
- Center for Depression Research and Clinical Care, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Psychiatry, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Cherise Chin Fatt
- Center for Depression Research and Clinical Care, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Psychiatry, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Abu Minhajuddin
- Center for Depression Research and Clinical Care, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Psychiatry, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Psychiatry, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Psychiatry, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas.
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O'Brien B, Lee J, Kim S, Nandra GS, Pannu P, Swann AC, Murphy N, Tamman AJF, Amarneh D, Lijffijt M, Averill LA, Mathew SJ. Replication of distinct trajectories of antidepressant response to intravenous ketamine. J Affect Disord 2023; 321:140-146. [PMID: 36302492 DOI: 10.1016/j.jad.2022.10.031] [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: 08/30/2022] [Revised: 10/08/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The goal of this study was to replicate previous findings of three distinct treatment response pathways associated with repeated intravenous (IV) ketamine infusions among patients with major depressive disorder (MDD). METHODS We conducted growth mixture modeling to estimate latent classes of change in depression (Quick Inventory of Depressive Symptomatology-Self Report, QIDS-SR) across six treatment visits in 298 patients with MDD treated with IV ketamine in an outpatient community clinic. Mean age was 40.36 and patients were primarily male (58.4 %). The sample had relatively severe depression (QIDS-SR = 16.61) at pre-treatment and the majority had not responded to at least two prior medications. RESULTS Best-fit indices indicated three trajectory groups to optimally demonstrate non-linear, quadratic changes in depressive symptoms during ketamine treatment. Two groups had severe depression at baseline but diverged into a group of modest improvement over the treatment course (n = 78) and a group of patients with rapid improvement (n = 103). A third group had moderate depression at baseline with moderate improvement during the treatment course (n = 117). Additional planned trajectory comparisons showed that suicidality at entry was higher in the high depression groups and that change in suicidality severity followed that of depression. LIMITATIONS This was a retrospective analysis of a naturalistic sample. Patients were unblinded and more heterogenous than those included in most controlled clinical trial samples. CONCLUSIONS This replication study in an independent community-based ketamine clinic sample revealed similar response trajectories, with only about a third of depressed patients benefitting substantially from an acute induction course of ketamine infusions.
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Affiliation(s)
- Brittany O'Brien
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA; Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA. Brittany.o'
| | - Jaehoon Lee
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA; Texas Tech University, Department of Educational Psychology, Leadership, and Counseling, 2500 Broadway, Lubbock, TX, 79409, USA; The Menninger Clinic, 12301 S Main Street, Houston, TX, 77035, USA
| | - Seungman Kim
- Texas Tech University, Department of Educational Psychology, Leadership, and Counseling, 2500 Broadway, Lubbock, TX, 79409, USA
| | - Guriqbal S Nandra
- IV Solution and Ketamine Centers of Chicago and Kansas City, 712 North Dearborn Street, Chicago, IL 60654, USA
| | - Prabhneet Pannu
- IV Solution and Ketamine Centers of Chicago and Kansas City, 712 North Dearborn Street, Chicago, IL 60654, USA
| | - Alan C Swann
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA; Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Nicholas Murphy
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA; The Menninger Clinic, 12301 S Main Street, Houston, TX, 77035, USA
| | - Amanda J F Tamman
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA; Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Dania Amarneh
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA; Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Marijn Lijffijt
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA; Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Lynnette A Averill
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA; Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Sanjay J Mathew
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA; Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA; The Menninger Clinic, 12301 S Main Street, Houston, TX, 77035, USA
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Nandy K, Rush AJ, Carmody TJ, Mayes TL, Trivedi MH. The 9-item Concise Health Risk Tracking - Self-Report (CHRT-SR 9) measure of suicidal risk: Performance in adult primary care patients. Front Psychiatry 2023; 14:1014766. [PMID: 36865066 PMCID: PMC9971953 DOI: 10.3389/fpsyt.2023.1014766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE To evaluate the psychometric properties of a 9-item Concise Health Risk Tracking Self-Report (or CHRT-SR9) to assess suicidal risk in adult primary care outpatients. METHODS Overall, 369 adults completed the original 14-item version of CHRT-SR at baseline and within 4 months thereafter, from which the CHRT-SR9 was extracted using multigroup confirmatory factor analysis. Measurement invariance (across age and sex) and classical test theory characteristics of the CHRT-SR9 were evaluated. Concurrent validity was assessed by comparing CHRT-SR9 responses to those of the suicide item in the Patient Health Questionnaire (PHQ-9), both cross-sectionally and as a change measure over time. RESULTS Confirmatory factor analysis identified the CHRT-SR9 as the optimal solution. Factors included pessimism, helplessness, despair (2 items each) and suicidal thoughts (3 items). Measurement invariance held across sex and age groups, indicating that mean differences among sub-groups were real and not attributable to measurement bias. Classical test theory revealed acceptable item-total correlations overall (0.57-0.79) and internal consistency (Spearman-Brown from 0.76 to 0.90). Concurrent validity analyses revealed that the CHRT-SR9 can measure both improvement and worsening of suicidality over time. A PHQ-9 response of 0, 1, 2, and 3 on the suicide item corresponded to 7.82 (5.53), 16.80 (4.99), 20.71 (5.36), and 25.95 (7.30) (mean and SD) on CHRT-SR9 total score, respectively. CONCLUSION The CHRT-SR9 is a brief self-report evaluating suicidality with excellent psychometric properties that is sensitive to change over time.
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Affiliation(s)
- Karabi Nandy
- Peter O'Donnell School of Public Health, The University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - A John Rush
- Curbstone Consultant LLC., Santa Fe, NM, United States.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,Department of Psychiatry, Duke-National University of Singapore, Singapore, Singapore
| | - Thomas J Carmody
- Peter O'Donnell School of Public Health, The University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Taryn L Mayes
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Madhukar H Trivedi
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, United States
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Goldstein TR, Merranko J, Hafeman D, Gill MK, Liao F, Sewall C, Hower H, Weinstock L, Yen S, Goldstein B, Keller M, Strober M, Ryan N, Birmaher B. A risk calculator to predict suicide attempts among individuals with early-onset bipolar disorder. Bipolar Disord 2022; 24:749-757. [PMID: 36002150 DOI: 10.1111/bdi.13250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To build a one-year risk calculator (RC) to predict individualized risk for suicide attempt in early-onset bipolar disorder. METHODS Youth numbering 394 with bipolar disorder who completed ≥2 follow-up assessments (median follow-up length = 13.1 years) in the longitudinal Course and Outcome of Bipolar Youth (COBY) study were included. Suicide attempt over follow-up was assessed via the A-LIFE Self-Injurious/Suicidal Behavior scale. Predictors from the literature on suicidal behavior in bipolar disorder that are readily assessed in clinical practice were selected and trichotomized as appropriate (presence past 6 months/lifetime history only/no lifetime history). The RC was trained via boosted multinomial classification trees; predictions were calibrated via Platt scaling. Half of the sample was used to train, and the other half to independently test the RC. RESULTS There were 249 suicide attempts among 106 individuals. Ten predictors accounted for >90% of the cross-validated relative influence in the model (AUC = 0.82; in order of relative influence): (1) age of mood disorder onset; (2) non-suicidal self-injurious behavior (trichotomized); (3) current age; (4) psychosis (trichotomized); (5) socioeconomic status; (6) most severe depressive symptoms in past 6 months (trichotomized none/subthreshold/threshold); (7) history of suicide attempt (trichotomized); (8) family history of suicidal behavior; (9) substance use disorder (trichotomized); (10) lifetime history of physical/sexual abuse. For all trichotomized variables, presence in the past 6 months reliably predicted higher risk than lifetime history. CONCLUSIONS This RC holds promise as a clinical and research tool for prospective identification of individualized high-risk periods for suicide attempt in early-onset bipolar disorder.
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Affiliation(s)
- Tina R Goldstein
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - John Merranko
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Danella Hafeman
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Fangzi Liao
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Craig Sewall
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Lauren Weinstock
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Martin Keller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michael Strober
- Department of Psychiatry, University of California, Los Angeles, California, USA
| | - Neal Ryan
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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9
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Nandy K, Rush AJ, Carmody TJ, Kulikova A, Mayes TL, Emslie G, Trivedi MH. The Concise Health Risk Tracking - Self-Report (CHRT-SR)-A measure of suicidal risk: Performance in adolescent outpatients. Int J Methods Psychiatr Res 2022:e1944. [PMID: 36217566 DOI: 10.1002/mpr.1944] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 08/12/2022] [Accepted: 08/20/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The Concise Health Risk Tracking Self-Report (CHRT-SR) assesses the risk of suicidal behavior. We report its psychometric properties in a representative sample of adolescent outpatients. METHODS A sample (n = 657) of adolescents (<18 years of age) in primary or psychiatric care completed the 14-item version of CHRT-SR at both baseline and within 3 months. To identify an optimal brief solution for the scale, we evaluated the factor structure of CHRT-SR using multigroup confirmatory factor analysis, and testing measurement invariance across age and gender. The item response theory and classical test theory characteristics of the optimal solution were evaluated. Concurrent validity (both cross-sectional and as a change measure over time) of the optimal solution was assessed by comparing it to another suicide measure. RESULTS Confirmatory factor analysis identified the 9-item CHRT-SR (CHRT-SR9 ) as the optimal solution. Classical test theory and item response theory indicated excellent fit. Concurrent validity analyses revealed that it can measure both improvement/worsening of suicidality over time. CONCLUSION The CHRT-SR9 is a brief self-report with excellent psychometric properties in a sample of adolescents that is sensitive to changes in suicidality over time. Its performance in other populations and ability to predict future suicidal events deserves study.
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Affiliation(s)
- Karabi Nandy
- Division of Biostatistics, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - A John Rush
- Curbstone Consultant LLC, Santa Fe, New Mexico, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Duke-National University of Singapore, Singapore, Singapore
| | - Thomas J Carmody
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alexandra Kulikova
- Department of Educational Psychology, University of North Texas, Denton, Texas, USA
| | - Taryn L Mayes
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Graham Emslie
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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10
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Saab MM, Murphy M, Meehan E, Dillon CB, O'Connell S, Hegarty J, Heffernan S, Greaney S, Kilty C, Goodwin J, Hartigan I, O'Brien M, Chambers D, Twomey U, O'Donovan A. Suicide and Self-Harm Risk Assessment: A Systematic Review of Prospective Research. Arch Suicide Res 2022; 26:1645-1665. [PMID: 34193026 DOI: 10.1080/13811118.2021.1938321] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Suicide and self-harm are widespread yet underreported. Risk assessment is key to effective self-harm and suicide prevention and management. There is contradicting evidence regarding the effectiveness of risk assessment tools in predicting self-harm and suicide risk. This systematic review examines the effect of risk assessment strategies on predicting suicide and self-harm outcomes among adult healthcare service users. METHOD Electronic and gray literature databases were searched for prospective research. Studies were screened and selected by independent reviewers. Quality and level of evidence assessments were conducted. Due to study heterogeneity, we present a narrative synthesis under three categories: (1) suicide- and self-harm-related outcomes; (2) clinician assessment of suicide and self-harm risk; and (3) healthcare utilization due to self-harm or suicide. RESULTS Twenty-one studies were included in this review. The SAD PERSONS Scale was the most used tool. It outperformed the Beck Scale for Suicide Ideation in predicting hospital admissions and stay following suicide and self-harm, yet it failed to predict repeat suicide and self-harm and was not recommended for routine use. There were mixed findings relating to clinician risk assessment, with some studies recommending clinician assessment over structured tools, whilst others found that clinician assessment failed to predict future attempts and deaths. CONCLUSIONS There is insufficient evidence to support the use of any one tool, inclusive of clinician assessment of risk, for self-harm and suicidality. The discourse around risk assessment needs to move toward a broader discussion on the safety of patients who are at risk for self-harm and/or suicide.HIGHLIGHTSThere is insufficient evidence to support using standalone risk assessment tools.There are mixed findings relating to clinician assessment of risk.Structured professional judgment is widely accepted for risk assessment.
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11
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Weissman RS, Scott BG, Schure MB, McCrory B, Greist J, Kuntz M, Wilcox HC. Psychometric properties of the 7-item version of the Concise Health Risk Tracking Self-Report Scale for rural adults enrolled in an Internet-delivered self-help program for depression. J Rural Health 2021; 38:574-582. [PMID: 34643960 DOI: 10.1111/jrh.12629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Monitoring suicide risk in clinical practice requires valid and reliable assessment instruments. This study evaluated the psychometric properties of the 7-item version of the Concise Health Risk Tracking Self-Report, CHRT-SR7 in a primarily rural population. METHODS The sample comprised 788 participants (81.7% female) of an effectiveness trial of an internet-based self-help intervention for depression. Participants completed self-report questionnaires, including the CHRT-SR7 , Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Work and Social Adjustment Scale, Connor-Davidson Resilience Scale-10, and Barriers to Seeking Mental Health Care. Four-week test-retest reliability was calculated for a subsample of 147 participants randomized to a waitlist control group. FINDINGS The CHRT-SR7 internal consistency was α = 0.80 (total sample), α = 0.80 (women), and α = 0.83 (men). The 4-week test-retest reliability was strong for women (r = 0.78) and moderate for men (r = 0.66). Confirmatory factor analysis supported the original 3-factor solution: Hopelessness (2 items), Perceived Lack of Social Support (2 items), and Current Suicidal Thoughts and Plans (3 items), which was invariant across gender and rural status. Convergent and divergent validity was supported as reflected in significant correlations of the CHRT-SR7 and its subscales with measures of depression, anxiety, adjustment, and resilience. Limitations include the limited demographic diversity (mostly non-Hispanic White women) and reliance on self-report data. CONCLUSIONS Our findings complement those reported in prior studies of patients with severe depression and support the use of the CHRT-SR7 for measuring suicide risk in rural adults; future studies should further test the instrument's psychometric properties in racial or ethnic minority rural residents.
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Affiliation(s)
| | - Brandon G Scott
- Department of Psychology, Montana State University, Bozeman, Montana, USA
| | - Mark B Schure
- Department of Health and Human Development, Montana State University, Bozeman, Montana, USA
| | - Bernadette McCrory
- Department of Mechanical and Industrial Engineering, Montana State University, Bozeman, Montana, USA
| | - John Greist
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Holly C Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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12
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Mayes TL, Killian M, Rush AJ, Emslie GJ, Carmody T, Kennard BD, Jha MK, King J, Hughes JL, Trivedi MH. Predicting future suicidal events in adolescents using the Concise Health Risk Tracking Self-Report (CHRT-SR). J Psychiatr Res 2020; 126:19-25. [PMID: 32413596 DOI: 10.1016/j.jpsychires.2020.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several self-report rating scales have been developed to assess suicidal ideation, yet most have limited utility in predicting future suicide attempts. This is particularly critical in adolescence, where suicide is the second leading cause of death. This study evaluated the Concise Health Risk Tracking Self-Report (CHRT-SR) as a prospective predictor of suicide attempts and events in high-risk adolescents enrolled in a suicide-prevention intensive outpatient program (IOP). METHODS Data were collected by retrospective chart review of adolescents treated in IOP for youth with severe suicidality. At baseline, youth completed the 14-item CHRT-SR (CHRT-SR14), which assesses suicide risk based on 3 subscales: Propensity, Impulsivity, and Suicidal Thoughts. Two outcomes were assessed: actual suicide attempts and suicidal events (suicide attempt, inpatient hospitalization, or emergency department visit) during the IOP. RESULTS Of the 251 adolescents who completed the baseline CHRT-SR14, 26 had a suicidal event during IOP (mean time in IOP: 5.4 ± 2.3 weeks), of whom 14 had an actual suicide attempt. Youth with any suicidal event had higher scores than those without an event on the CHRT-SR14 Total (p = .005), Propensity (p = .008), and Suicidal Thoughts (p = .001) scales at baseline. Youth who made a suicide attempt had significantly higher scores than those without an event for the Total Score, Propensity, and Suicidal Thoughts subscales. CHRT-SR14 Total Score of 28 had a sensitivity of 85.7% and specificity of 56.5% in predicting suicide attempts. A score of 22 predicted suicidal events, with a sensitivity of 80.8% and specificity of 40.9%. CHRT-SR7 Total Score of 12 predicted suicide attempts, with a sensitivity of 85.7% and specificity of 53.4%. CONCLUSIONS The CHRT-SR14 self-report predicts suicide attempts and events with at least 80% sensitivity and acceptable specificity in adolescents at high-risk for suicide.
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Affiliation(s)
- Taryn L Mayes
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
| | - Michael Killian
- College of Social Work, Florida State University 296 Champions Way, Tallahassee, FL, 32304, Children's Medical Center of Dallas, USA.
| | - A John Rush
- Department of Psychiatry, Duke Medical School, Texas Tech University-Health Sciences Center, Permian Basin, Professor Emeritus at Duke National University of Singapore, Singapore.
| | - Graham J Emslie
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA; Department of Psychiatry, Children's Health Systems of Texas, Children's Medical Center, USA.
| | - Thomas Carmody
- Department of Population and Data Sciences, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
| | - Betsy D Kennard
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA; Department of Psychiatry, Children's Health Systems of Texas, Children's Medical Center, USA.
| | - Manish K Jha
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Jessica King
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA; Department of Psychiatry, Children's Health Systems of Texas, Children's Medical Center, USA
| | - Jennifer L Hughes
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
| | - Madhukar H Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
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13
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De La Garza N, Rush AJ, Killian MO, Grannemann BD, Carmody TJ, Trivedi MH. The Concise Health Risk Tracking Self-Report (CHRT-SR) assessment of suicidality in depressed outpatients: A psychometric evaluation. Depress Anxiety 2019; 36:313-320. [PMID: 30370613 DOI: 10.1002/da.22855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/22/2018] [Accepted: 09/22/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The 12-item Concise Health Risk Tracking Self-Report (CHRT-SR12 ) is a brief, self-report measure that systematically assesses both suicidal thinking and associated thoughts that may indicate the propensity for suicidal acts. It can be used as a tool to both assess risk and guide treatment interventions targeting associated cognitions. METHODS This report used acute treatment data from a clinically representative sample of outpatients with nonpsychotic major depressive disorder (N = 665) participating in the Combining Medications to Enhance Depression Outcomes trial, who received up to 12 weeks of escitalopram, escitalopram plus bupropion SR, or venlafaxine XR plus mirtazapine. Outcome assessors and patients were masked to treatment. RESULTS Factor analysis of CHRT-SR12 confirmed that the 12 items have higher order structure with two subscales (Propensity, Suicidal Thoughts) and a total score. Internal consistencies were acceptable for both subscales and total score. All three scales were modestly correlated with overall depression severity (r = 0.54 to r = 0.21) and highly discriminating among patients grouped by suicide item ratings on three different depressive symptom ratings. The three scales also distinguished change over the acute phase treatment for those with different levels of baseline suicidal ideation (measured by 30-item Inventory of Depressive Symptomatology (item 18) and for those with change in suicidal ideation (baseline to last visit). CONCLUSIONS The CHRT-SR12 has good to excellent psychometric properties and is sensitive to change in suicidal thinking and propensity toward suicidal behavior in outpatients with major depressive disorder. It allows for the monitoring of thoughts and feelings associated with increased suicidal risk as well as levels of thoughts about suicide.
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Affiliation(s)
- Nancy De La Garza
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - A John Rush
- Department of Psychiatry, Duke Medical School, Durham, North Carolina.,Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbbock, Texas.,Department of Psychiatry, Duke National University of Singapore, Singapore
| | - Michael O Killian
- Department of Social Work, Florida State University, Tallahassee, Florida
| | - Bruce D Grannemann
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Thomas J Carmody
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
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14
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Trombello JM, Killian MO, Grannemann BD, Rush AJ, Mayes TL, Parsey RV, McInnis M, Jha MK, Ali A, McGrath PJ, Adams P, Oquendo MA, Weissman MM, Carmody TJ, Trivedi MH. The Concise Health Risk Tracking-Self Report: Psychometrics within a placebo-controlled antidepressant trial among depressed outpatients. J Psychopharmacol 2019; 33:185-193. [PMID: 30652941 PMCID: PMC6379122 DOI: 10.1177/0269881118817156] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS While substantial prior research has evaluated the psychometric properties of the 12-item Concise Health Risk Tracking-Self Report (CHRT-SR12), a measure of suicide propensity and suicidal thoughts, no prior research has investigated its factor structure, sensitivity to change over time, and other psychometric properties in a placebo-controlled trial of antidepressant medication, nor determined whether symptoms change throughout treatment. METHODS Participants in the multi-site Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) study ( n=278) provided data to evaluate the factor structure and sensitivity to change over time of the CHRT-SR12 through eight weeks of a clinical trial in which participants received either placebo or antidepressant medication (sertraline). RESULTS/OUTCOMES Factor analysis confirmed two factors: propensity (comprised of first-order factors including pessimism, helplessness, social support, and despair) and suicidal thoughts. Internal consistency (α's ranged from 0.69-0.92) and external validity were both acceptable, with the total score and propensity factor scores significantly correlated with total scores and single-item suicidal-thoughts scores on the self-report Quick Inventory of Depressive Symptoms and the clinician-rated 17-item Hamilton Rating Scale for Depression. Through analyzing CHRT-SR12 changes over eight treatment weeks, the total score and both the factors decreased regardless of baseline suicidal thoughts. Change in clinician-rated suicidal thoughts was reflected by change in both the total score and propensity factor score. CONCLUSIONS/INTERPRETATION These results confirm the reliability, validity, and applicability of the CHRT-SR12 to a placebo-controlled clinical trial of depressed outpatients receiving antidepressant medication.
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Affiliation(s)
- Joseph M Trombello
- 1 Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael O Killian
- 2 College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Bruce D Grannemann
- 1 Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Augustus John Rush
- 3 Department of Psychiatry, Duke Medical School, Durham, NC, USA.,5 Duke-National University of Singapore, Singapore
| | - Taryn L Mayes
- 1 Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ramin V Parsey
- 6 Department of Psychiatry, Stony Brook University, Stony Brook, NY USA
| | - Melvin McInnis
- 7 Department of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Manish K Jha
- 1 Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aasia Ali
- 1 Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Patrick J McGrath
- 8 Department of Psychiatry, Columbia University, New York, NY USA.,9 New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY USA
| | - Phil Adams
- 9 New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY USA
| | - Maria A Oquendo
- 10 Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Myrna M Weissman
- 8 Department of Psychiatry, Columbia University, New York, NY USA.,9 New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY USA
| | - Thomas J Carmody
- 1 Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Madhukar H Trivedi
- 1 Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
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15
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Mayes TL, Kennard BD, Killian M, Carmody T, Grannemann BD, Rush AJ, Jha MK, Hughes J, Emslie GJ, Trivedi MH. Psychometric properties of the concise health risk tracking (CHRT) in adolescents with suicidality. J Affect Disord 2018; 235:45-51. [PMID: 29649710 DOI: 10.1016/j.jad.2018.03.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/01/2018] [Accepted: 03/10/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Several self-report rating scales have been developed to assess suicidal ideation, yet few examine other factors related to increased suicidal risk, and even fewer have been validated in both adolescents and adults. We evaluate the 14-item Concise Health Risk Tracking - Self Report (CHRT-SR), a measure previously validated in adults, in a sample of adolescents at risk for suicide. METHOD Data are from a retrospective chart review of adolescents treated in an intensive outpatient program for youth with severe suicidality. Teens completed the CHRT-SR and Quick Inventory of Depressive Symptomatology - Adolescents (QIDS-A) at baseline and discharge. The CHRT-SR was evaluated to determine the factor validity, internal consistency, construct validity, and sensitivity to change. RESULTS Adolescents (n = 271) completed the CHRT-SR prior to treatment, and 231 completed the CHRT-SR at discharge. Three factors were identified with excellent model fit: Propensity, Impulsivity, and Suicidal Thoughts. Internal consistency reliability coefficients were good-to-excellent for the total score and all three factors at baseline (a = 0.774-0.915) and exit (a = 0.849-0.941). The total score and all three factors significantly correlated with overall depression severity and suicidal ideation as rated by teens and parent (p = .704-0.756, all p < .001). The CHRT-SR was sensitive to change, with moderate to large effect sizes (Cohen's d = 0.599-1.062). LIMITATIONS Study limitations include generalizability, lack of a control group, and retrospective data from a sample of opportunity. CONCLUSIONS The CHRT-SR is a reliable and valid measure for examining severity of suicidal thoughts and associated risk factors, and is sensitive to change following an intervention in adolescents.
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Affiliation(s)
- Taryn L Mayes
- Department of Psychiatry at UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, United States. taryn.mayes.@utsouthwestern.edu
| | - Betsy D Kennard
- UT Southwestern Medical Center and the Department of Psychiatry at Children's Health Systems of Texas, Children's Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, United States.
| | - Michael Killian
- School of Social Work at UT Arlington, 211 S. Cooper St., #201b, Arlington, TX, 76019, United States.
| | - Thomas Carmody
- Department of Clinical Sciences at UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, United States.
| | - Bruce D Grannemann
- Department of Psychiatry at UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, United States.
| | - A John Rush
- Professor emeritus, Duke-NUS, 7 Avenida Vista Grande, #112, Santa Fe, NM, 87508, United States.
| | - Manish K Jha
- Department of Psychiatry at UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, United States.
| | - Jennifer Hughes
- Department of Psychiatry at UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, United States.
| | - Graham J Emslie
- Department of Psychiatry at UT Southwestern Medical Center, 6300 Harry Hines Blvd. Suite 1200, Dallas, TX 75235, United States.
| | - Madhukar H Trivedi
- Department of Psychiatry at UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, United States.
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16
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Sanchez K, Killian MO, Mayes TL, Greer TL, Trombello JM, Lindblad R, Grannemann BD, Carmody TJ, Rush AJ, Walker R, Trivedi MH. A psychometric evaluation of the Concise Health Risk Tracking Self-Report (CHRT-SR)- a measure of suicidality-in patients with stimulant use disorder. J Psychiatr Res 2018; 102:65-71. [PMID: 29626753 PMCID: PMC7505104 DOI: 10.1016/j.jpsychires.2018.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/25/2018] [Indexed: 12/14/2022]
Abstract
Stimulant use disorders are both common and associated with suicidal ideation and attempts. The psychometric properties of the 12-item Concise Health Risk Tracking Scale Self-Report (CHRT-SR), a measure that was created to assess suicidal thinking and several factors associated with a propensity to act, has been established in persons with mood disorders. This is a secondary analysis to assess the CHRT-SR in 302 stimulant abusing patients that had participated in a clinical trial. A confirmatory factor analysis (CFA) was conducted to assess the factor validity of the 12-item CHRT-SR model with a second-order Propensity factor. The CHRT-SR total score and 2 factor scores (Propensity and Suicidal Thoughts) demonstrated acceptable internal consistency and test-retest reliabilities. These two subscales and the total score were modestly but significantly associated with measures of depression and life satisfaction, demonstrating construct validity. Two additional items assessing Impulsivity were also analyzed, and demonstrated acceptable internal consistency, test-retest reliability, and construct validity. The CHRT-SR appears to be a reliable and valid tool to assess suicidality in persons with stimulant use disorder.
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Affiliation(s)
- Katherine Sanchez
- Center for Applied Health Research, Baylor Scott and White Research Institute, Dallas, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael O Killian
- Center for Applied Health Research, Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Taryn L Mayes
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tracy L Greer
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joseph M Trombello
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Bruce D Grannemann
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas J Carmody
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - A John Rush
- Dept Psychiatry, Duke Medical School, Durham, NC, USA; Texas Tech University-Health Sciences Center, Permian Basin, TX, USA; Duke-National University of Singapore, Singapore
| | - Robrina Walker
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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17
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Villegas AC, DuBois CM, Celano CM, Beale EE, Mastromauro CA, Stewart JG, Auerbach RP, Huffman JC, Hoeppner BB. A longitudinal investigation of the Concise Health Risk Tracking Self-Report (CHRT-SR) in suicidal patients during and after hospitalization. Psychiatry Res 2018; 262:558-565. [PMID: 28954699 DOI: 10.1016/j.psychres.2017.09.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 07/31/2017] [Accepted: 09/17/2017] [Indexed: 01/25/2023]
Abstract
The Concise Health Risk Tracking Self-Report (CHRT-SR) scale is a brief self-report instrument to assess suicide risk. Initial investigations have indicated good psychometric properties in psychiatric outpatients. The aims of this paper were to examine the construct validity and factor structure of the twelve- (CHRT-SR12) and seven-item (CHRT-SR7) versions and to test if clinically expected within-person changes in suicide risk over time were measurable using the CHRT-SR in two study cohorts hospitalized for suicidal ideation or behavior: (1) patients with major depressive disorder (MDD) who participated in a psychological intervention trial, n = 65, and (2) participants with bipolar disorder or MDD in an observational study, n = 44. The CHRT-SR12 and self-report measures of hopelessness, depression, and positive psychological states were administered during admission and several times post-discharge. Both versions showed good internal consistency in inpatients and confirmed the three-factor structure (i.e., hopelessness, perceived lack of social support and active suicidal ideation and plans) found in outpatients. CHRT-SR scores had strong correlations with negative and positive affective constructs in the expected directions, and indicated decreases in suicide risk following discharge, in line with clinical expectations. The CHRT-SR12 and CHRT-SR7 are promising self-report measures for assessing suicide risk in very high-risk patient populations.
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Affiliation(s)
- Ana C Villegas
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Christina M DuBois
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher M Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Eleanor E Beale
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Jeremy G Stewart
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Randy P Auerbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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18
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Köhler-Forsberg O, Madsen T, Behrendt-Møller I, Sylvia L, Bowden CL, Gao K, Bobo WV, Trivedi MH, Calabrese JR, Thase M, Shelton RC, McInnis M, Tohen M, Ketter TA, Friedman ES, Deckersbach T, McElroy SL, Reilly-Harrington NA, Nierenberg AA. Trajectories of suicidal ideation over 6 months among 482 outpatients with bipolar disorder. J Affect Disord 2017; 223:146-152. [PMID: 28755622 DOI: 10.1016/j.jad.2017.07.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/14/2017] [Accepted: 07/19/2017] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Suicidal ideation occurs frequently among individuals with bipolar disorder; however, its course and persistence over time remains unclear. We aimed to investigate 6-months trajectories of suicidal ideation among adults with bipolar disorder. METHODS The Bipolar CHOICE study randomized 482 outpatients with bipolar disorder to 6 months of lithium- or quetiapine-based treatment including other psychotropic medications as clinically indicated. Participants were asked at 9 visits about suicidal ideation using the Concise Health Risk Tracking scale. We performed latent Growth Mixture Modelling analysis to empirically identify trajectories of suicidal ideation. Multinomial logistic regression analyses were applied to estimate associations between trajectories and potential predictors. RESULTS We identified four distinct trajectories. The Moderate-Stable group represented 11.1% and was characterized by constant suicidal ideation. The Moderate-Unstable group included 2.9% with persistent thoughts about suicide with a more fluctuating course. The third (Persistent-low, 20.8%) and fourth group (Persistent-very-low, 65.1%) were characterized by low levels of suicidal ideation. Higher depression scores and previous suicide attempts (non-significant trend) predicted membership of the Moderate-Stable group, whereas randomized treatment did not. LIMITATIONS No specific treatments against suicidal ideation were included and suicidal thoughts may persist for several years. CONCLUSION More than one in ten adult outpatients with bipolar disorder had moderately increased suicidal ideation throughout 6 months of pharmacotherapy. The identified predictors may help clinicians to identify those with additional need for treatment against suicidal thoughts and future studies need to investigate whether targeted treatment (pharmacological and non-pharmacological) may improve the course of persistent suicidal ideation.
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Affiliation(s)
- Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark; Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Trine Madsen
- Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ida Behrendt-Møller
- Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Louisa Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Charles L Bowden
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | - Keming Gao
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
| | - William V Bobo
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Joseph R Calabrese
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
| | - Michael Thase
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard C Shelton
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Melvin McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Mauricio Tohen
- Department of Psychiatry, University of New Mexico Health Science Center, Albuquerque, NM, USA
| | - Terence A Ketter
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Edward S Friedman
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Susan L McElroy
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH and Lindner Center of HOPE, Mason, OH, USA
| | - Noreen A Reilly-Harrington
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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19
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Cui X, Niu W, Kong L, He M, Jiang K, Chen S, Zhong A, Li W, Lu J, Zhang L. Long noncoding RNA expression in peripheral blood mononuclear cells and suicide risk in Chinese patients with major depressive disorder. Brain Behav 2017; 7:e00711. [PMID: 28638716 PMCID: PMC5474714 DOI: 10.1002/brb3.711] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND WHO stated that nearly one million people commit suicide every year worldly, and 40% of the suicide completer suffered from depression. The primary aim of this study was to explore the association between long noncoding RNAs (lncRNAs) expression in peripheral blood mononuclear cells (PBMCs) and suicide risk of patients with major depressive disorder (MDD). METHODS Using Human LncRNA 3.0 microarray profiling which includes 30,586 human lncRNAs and RT-PCR, six down-regulated lncRNAs were identified differentially expressed in MDD patients. According to suicidal ideation and suicidal attempt, the suicide risk of MDD patients was classified into suicidal ideation versus no suicidal ideation groups, and past attempt versus no past attempt groups, respectively. The expression of six lncRNAs in MDD patients and controls were examined by RT-PCR. RESULTS The expression of six lncRNAs had significant differences between no suicidal ideation, suicidal ideation, and controls; corresponding lncRNAs associated with suicidal attempt had remarkable differences between no past attempt, past attempt, and controls. Additionally, only the expression of lncRNAs in suicidal ideation group and past attempt group markedly declined compared with controls. CONCLUSIONS This study indicated that the expression of six down-regulated lncRNAs had a negative association with suicide risk in MDD patients, and the expression of lncRNAs in PBMCs could have the potential to help clinician judge the suicide risk of MDD patients to provide timely treatment and prevent suicide.
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Affiliation(s)
- Xuelian Cui
- Health Care Department Changzhou Maternity and Child Health Care Hospital Affiliated with Nanjing Medical University Changzhou China
| | - Wei Niu
- Department of Rehabilitation No. 102 Hospital of Chinese People's Liberation Army Changzhou China
| | - Lingming Kong
- Prevention and Treatment Center for Psychological Diseases No.102 Hospital of Chinese People's Liberation Army Changzhou China
| | - Mingjun He
- Prevention and Treatment Center for Psychological Diseases No.102 Hospital of Chinese People's Liberation Army Changzhou China
| | - Kunhong Jiang
- Prevention and Treatment Center for Psychological Diseases No.102 Hospital of Chinese People's Liberation Army Changzhou China
| | - Shengdong Chen
- Department of Neurology No.102 Hospital of Chinese People's Liberation Army Changzhou China
| | - Aifang Zhong
- Department of Laboratory No.102 Hospital of Chinese People's Liberation Army Changzhou China
| | - Wanshuai Li
- Gopath Diagnostic Laboratory Co. Ltd Changzhou China
| | - Jim Lu
- Gopath Diagnostic Laboratory Co. Ltd Changzhou China.,Gopath Laboratories LLC Buffalo Grove IL USA
| | - Liyi Zhang
- Prevention and Treatment Center for Psychological Diseases No.102 Hospital of Chinese People's Liberation Army Changzhou China
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20
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Celano CM, Beale EE, Mastromauro CA, Stewart JG, Millstein RA, Auerbach RP, Bedoya CA, Huffman JC. Psychological interventions to reduce suicidality in high-risk patients with major depression: a randomized controlled trial. Psychol Med 2017; 47:810-821. [PMID: 27876105 PMCID: PMC5340604 DOI: 10.1017/s0033291716002798] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Positive psychological constructs have been associated with reduced suicidal ideation, and interventions to cultivate positive feelings have the potential to reduce suicide risk. This study compares the efficacy of a 6-week, telephone-based positive psychology (PP) intervention against a cognition-focused (CF) control intervention among patients recently hospitalized for depression and suicidal ideation or behavior. METHOD A total of 65 adults with a current major depressive episode reporting suicidal ideation or a recent suicide attempt were enrolled from participating in-patient psychiatric units. Prior to discharge, participants were randomized to the PP (n = 32) or CF (n = 33) intervention. In both interventions, participants received a treatment manual, performed weekly PP (e.g. gratitude letter) or CF (e.g. recalling daily events) exercises, and completed weekly one-on-one telephone sessions over 6 weeks. Between-group differences in hopelessness (primary outcome), depression, suicidality and positive psychological constructs at 6 and 12 weeks were tested using mixed-effects models accounting for intensity of post-hospitalization psychiatric treatment. RESULTS Compared with PP, the CF intervention was associated with significantly greater improvements in hopelessness at 6 weeks (β = -3.15, 95% confidence interval -6.18 to -0.12, effect size = -0.84, p = 0.04), but not 12 weeks. Similarly, the CF intervention led to greater improvements in depression, suicidal ideation, optimism and gratitude at 6 and 12 weeks. CONCLUSIONS Contrary to our hypothesis, the CF intervention was superior to PP in improving hopelessness, other suicide risk factors and positive psychological constructs during a key post-discharge period among suicidal patients with depression. Further study of this CF intervention is warranted in populations at high suicide risk.
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Affiliation(s)
- C. M. Celano
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - E. E. Beale
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - C. A. Mastromauro
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - J. G. Stewart
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - R. A. Millstein
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - R. P. Auerbach
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - C. A. Bedoya
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - J. C. Huffman
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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