External Minority Stress, Gender Dysphoria, and Capability for Suicide Among Transgender Adults: A Daily Diary Study

This study analyzed whether external gender-related minority stress (i.e., discrimination, rejection, and violence) and gender dysphoria contribute to same-day and next-day acquired capability for suicide (ACS) in a sample of transgender adults residing in the southeastern United States. A sample of transgender participants (n = 38, 84.2% White, average age = 28.6 years) residing in the southeastern United States completed daily surveys on discrimination, rejection, violence, gender dysphoria, and ACS over 30 days (n = 836 of the 1,140 surveys sent out were completed). External minority stress (i.e., rejection, discrimination, and violence) was very common in this sample. External minority stress experiences were reported on 16% of the completed daily surveys, and 68% of the sample reported experiencing such stress at least once over the 30-day study period. Similarly, gender dysphoria occurred on 37.2% of the completed days and was experienced on at least 1 day by 78.9% of the participants over the 30-day survey period. Multilevel modeling showed daily experiences of discrimination and rejection, but not gender dysphoria, were positively associated with same-day ACS. Violence trended toward significance in correlating with same-day capability for suicide. Neither external minority stress nor gender dysphoria were associated with next-day ACS while controlling for acquired capability reported on the previous day. These preliminary data support proximal associations of external gender minority stress with same-day, but not next-day, ACS. Findings from this study advance understanding of how anti-transgender discrimination and violence contribute to increased capability for suicide in a population at increased risk for suicide.

Refusal to participate in research among hard-to-reach populations: The case of detained persons

Providing insights on refusal to participate in research is critical to achieve a better understanding of the non-response bias. Little is known on people who refused to participate, especially in hard-to-reach populations such as detained persons. This study investigated the potential non-response bias among detained persons, comparing participants who accepted or refused to sign a one-time general informed consent. We used data collected in a cross-sectional study primary designed to evaluate a one-time general informed consent for research. A total of 190 participants were included in the study (response rate = 84.7%). The main outcome was the acceptance to sign the informed consent, used as a proxy to evaluate non-response. We collected sociodemographic variables, health literacy, and self-reported clinical information. A total of 83.2% of the participants signed the informed consent. In the multivariable model after lasso selection and according to the relative bias, the most important predictors were the level of education (OR = 2.13, bias = 20.7%), health insurance status (OR = 2.04, bias = 7.8%), need of another study language (OR = 0.21, bias = 39.4%), health literacy (OR = 2.20, bias = 10.0%), and region of origin (not included in the lasso regression model, bias = 9.2%). Clinical characteristics were not significantly associated with the main outcome and had low relative biases (≤ 2.7%). Refusers were more likely to have social vulnerabilities than consenters, but clinical vulnerabilities were similar in both groups. The non-response bias probably occurred in this prison population. Therefore, efforts should be made to reach this vulnerable population, improve participation in research, and ensure a fair and equitable distribution of research benefits.

Prediction Models for Suicide Attempts among Adolescents Using Machine Learning Techniques

OBJECTIVE

Suicide attempts (SAs) in adolescents are difficult to predict although it is a leading cause of death among adolescents. This study aimed to develop and evaluate SA prediction models based on six different machine learning (ML) algorithms for Korean adolescents using data from online surveys.

METHODS

Data were extracted from the 2011-2018 Korea Youth Risk Behavior Survey (KYRBS), an ongoing annual national survey. The participants comprised 468,482 nationally representative adolescents from 400 middle and 400 high schools, aged 12 to 18. The models were trained using several classic ML methods and then tested on internal and external independent datasets; performance metrics were calculated. Data analysis was performed from March 2020 to June 2020.

RESULTS

Among the 468,482 adolescents included in the analysis, 15,012 cases (3.2%) were identified as having made an SA. Three features (suicidal ideation, suicide planning, and grade) were identified as the most important predictors. The performance of the six ML models on the internal testing dataset was good, with both the area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC) ranging from 0.92 to 0.94. Although the AUROC of all models on the external testing dataset (2018 KYRBS) ranged from 0.93 to 0.95, the AUPRC of the models was approximately 0.5.

CONCLUSION

The developed and validated SA prediction models can be applied to detect high risks of SA. This approach could facilitate early intervention in the suicide crisis and may ultimately contribute to suicide prevention for adolescents.

Non-suicidal self-injury and its co-occurrence with suicidal behavior: An epidemiological-study among adolescents and young adults

OBJECTIVE

Non-suicidal self-injury (NSSI) comprising thoughts and behaviors is common and often co-occurring with suicidal behavior like ideation, plan, and attempt. As limited data are available for adolescents and young adults, this study aims to present prevalence estimates for lifetime NSSI, its co-occurrence with suicidal behavior, conditional probabilities and their association with socio-demographic characteristics, severity characteristics of suicidal behavior, and health service utilization.

METHOD

The epidemiological Behavior and Mind Health (BeMIND) study assessed in 2015/16 a random-community sample of N = 1180 aged 14-21 years from Dresden, Germany, regarding lifetime NSSI via self-administered questionnaire and suicidal behaviors via standardized interview.

RESULTS

Any lifetime NSSI was reported by 19.3% (thoughts: 18.0%, behaviors: 13.6%) of the sample with higher prevalence in females (OR = 2.7, 95% CI 1.9-3.8, P < 0.001). Lifetime prevalence of co-occurring NSSI and suicidal behavior was 7.7%. Females had a 3.3- to 8.8-fold odds of co-occurrence than males. Among those with any NSSI, 39.6% endorsed suicidal behavior, and 66.3% of those with any suicidal behavior reported NSSI. 42.3% of those with any NSSI reported to have used mental healthcare services at any time during their life with higher rates in those with co-occurring suicidal behavior (62.3%).

CONCLUSION

Non-suicidal self-injury and co-occurring suicidal behavior is common in adolescents and young adults-especially females. The limited utilization of mental healthcare services underpins the need for improving recognition of NSSI and suicidal behavior as well as the accessibility of mental healthcare services during adolescence and emerging adulthood.

Family Support for Medical Nutritional Therapy and Dietary Intake among Japanese with Type 2 Diabetes (JDDM 56)

The aim of this study was to investigate the association between habitual dietary intake for patients with diabetes and the content of family support for medical nutritional therapy (MNT). Analyzed were 289 Japanese with type 2 diabetes (men, 58.5%; mean age, 62.0 years; mean HbA1c, 53.4 mmol/mol) who completed the Food Frequency Questionnaire and Diabetes Family Behavior Checklist (DFBC). Relationships of mean values for food group intake to DFBC responses regarding MNT were examined using multivariate analysis of covariance. Positive response to "Praise for following diet" was associated with lower sweets intake (none: 60.1 g/day; ≥once monthly: 50.9 g/day, p = 0.038) and higher seasoning intake (none: 21.6 g/day, ≥once monthly: 24.1 g/day, p = 0.046). Energy intake was higher with positive responses to "Eat at the same time that you do" (none: 1636 kcal/day, ≥once monthly: 1818 kcal/day, p = 0.038). "Nags about not following diet" was associated with higher fish (none: 68.7 g/day, ≥once monthly: 78.7 g/day, p = 0.042) and salt intake (none: 8.3 g/day, ≥once monthly: 9.0 g/day, p = 0.014). Eating foods not part of the diabetic diet (none: 218.4 g/day, ≥once monthly: 246.9 g/day, p = 0.014) resulted in a higher vegetable intake. In females, significant differences in relationships in the overall analysis were reversed. Our results clarified relationships between types of family support of patients with type 2 diabetes and their dietary intake and the importance of sex differences for more effective MNT.

Approach-oriented coping strategy level may be related to volume of the whole hippocampus in the elderly

AIM

Stress-related disorders and severe stress exposure can cause atrophy of the whole hippocampus and its subfields. However, the impact of stress coping strategies on the hippocampus remains unclear. Therefore, we aimed to examine the relation between approach- and avoidance-oriented coping strategies and hippocampal volume in elderly persons.

METHODS

A total of 1045 elderly persons living in Arakawa-ward, Tokyo (mean ± SD age: 72.8 ± 5.2 years; 569 females [54.4%]) were included in the study and completed several questionnaires and face-to-face interviews and underwent magnetic resonance imaging. Approach- or avoidance-oriented coping strategies were assessed with the Stress and Coping Inventory, while cognitive function and depressive symptoms were assessed with the Mini-Mental State Examination and Geriatric Depression Scale, respectively. The volume of the whole hippocampus on T1-weighted images was delineated and calculated using FreeSurfer 6.0. Multiple regression analyses were performed to examine the relation between Stress and Coping Inventory scores and whole hippocampal volume.

RESULTS

Approach-oriented coping strategy scores were positively correlated with whole hippocampal volume. Furthermore, these relations remained significant after controlling for the influence of cognitive function and depressive symptoms on these volumetric variables. In contrast, avoidance-oriented coping strategy scores were not correlated with whole hippocampal volume.

CONCLUSION

This study demonstrated that hippocampal volume may be associated with the approach-oriented coping strategy; therefore, this strategy may preserve hippocampal volume in the elderly.

Prevalence, Onset, and Course of Suicidal Behavior Among Adolescents and Young Adults in Germany

Importance

Suicidal behavior is a leading cause of death among adolescents and young adults. In light of the ideation-to-action framework, the delineation of frequency and temporal characteristics of such behavior during this developmental period is crucial.

Objectives

To provide lifetime and 12-month prevalence estimates of suicidal behavior, including ideation, plan, and attempt, in adolescents and young adults of the general population, and to provide information about age at onset, temporal characteristics of suicidal behavior, including duration (number of years between onset and last occurrence) and frequency (number of episodes), and transition patterns across suicidal behaviors.

Design, Setting, and Participants

A cross-sectional epidemiological study was conducted in a random community sample of 1180 adolescents and young adults aged 14 to 21 years assessed in 2015 to 2016 in Dresden, Germany. Data analysis was performed from October 2018 to March 2019.

Main Outcomes and Measures

Lifetime and 12-month suicidal behavior (ideation, plan, and attempt) were assessed with a standardized diagnostic interview (Munich-Composite International Diagnostic Interview) by trained clinical interviewers. The onset, frequency, and duration of suicidal behavior were assessed by questionnaire.

Results

Of the 1180 participants (495 male [weighted percentage, 51.7%]; mean [SD] age, 17.9 [2.3] years), 130 participants (10.7%; 95% CI, 9.0%-12.8%), 65 participants (5.0%; 95% CI, 3.9%-6.5%), and 41 participants (3.4%; 95% CI, 2.4%-4.7%) reported lifetime suicidal ideation, plan, and attempt, respectively. Any lifetime suicidal behavior was reported by 138 participants (11.5%; 95% CI, 9.7%-13.7%). Age-specific cumulative incidence estimates indicated an increase in suicidal behavior during adolescence, starting at age 10 years (<1%), increasing slightly until the age of 12 years (2.2%), and then increasing sharply thereafter until age 20 years (13.5%). There were different patterns among female and male participants for ideation, plan, and attempt, with an overall higher incidence among female participants for ideation (hazard ratio, 1.51; 95% CI, 1.02-2.22; P = .04), for plan (hazard ratio, 3.31; 95% CI, 1.72-6.36; P < .001), and, among those older than 14 years, for attempt (hazard ratio, 3.07; 95% CI, 1.11-8.49; P = .03). Of those with suicidal ideation, 66.0% reported persistent or recurrent ideation over more than 1 year with 75.0% reporting more than 1 episode. Of the participants with lifetime suicidal ideation, 47.0% reported a suicide plan and 23.9% reported a suicide attempt. The transition to suicide plan or attempt occurred mainly in the year of onset of suicidal ideation or plan; of those who transitioned, 74.9% transitioned from ideation to plan, 71.2% transitioned from ideation to attempt, and 85.4% transitioned from plan to attempt in the same year.

Conclusions and Relevance

There is an urgent public health need for timely identification of suicidal behavior in adolescents and young adults to terminate persistent or recurrent suicidal tendencies and to interrupt the ideation-to-action transition.

Association between parents' work hours and nutrient inadequacy in Japanese schoolchildren on weekdays and weekends

OBJECTIVES

Evidence is sparse concerning whether the nutrient intake in schoolchildren differs according to parents' work hours. The aim of this study was to investigate the relationship between parents' work hours and nutrient inadequacy among Japanese primary schoolchildren using dietary reference intakes on days with and without a school lunch.

METHODS

Participants included 10- to 11-y-old children in grade 5 from 19 public primary schools in four prefectures of east Japan. Data for 699 children were analyzed. Participants completed 24-h dietary records with photographs of their meals for 4 d consecutively, which included of 2 d of weekdays and 2 d of weekends. Their mothers' and fathers' work hours were obtained from questionnaires that were completed by the participants' guardians. Logistic regression analyses were used to estimate the odds ratios for whether participants had poor nutrient intake, with adjustment for confounders.

RESULTS

Children whose mothers worked ≥40 h/wk had significantly higher rates of nutrient shortages for vitamins A, E, K, and B₆, pantothenic acid, potassium, magnesium, and iron (P = 0.007, 0.003, 0.007, 0.023, 0.021, 0.045, 0.004, and 0.009, respectively) than those in the 0 h/wk group. These differences were not significant based on fathers' working hours, with the exception of vitamin A (≥40 versus 0-39 h/wk, P = 0.032). Additionally, nutrient shortages for children were more pronounced on weekdays than on weekends.

CONCLUSIONS

This evidence revealed the necessity to improve nutrition intake in children whose mothers work more than statutory working hours, which would enable children to have adequate nutrient intake, especially on weekdays.

Suicidal ideation while incarcerated: Prevalence and correlates in a large sample of male prisoners in Flanders, Belgium

Prisoners constitute a high-risk group for suicide. As an early stage in the pathway leading to suicide, suicidal ideation represents an important target for prevention, yet research on this topic is scarce in general prison populations. Using a cross-sectional survey design, correlates of suicidal ideation while incarcerated were examined in a sample of 1203 male prisoners, randomly selected from 15 Flemish prisons. Overall, a lifetime history of suicidal ideation and attempts was endorsed by 43.1% and 20.3% of respondents, respectively. Approximately a quarter of all prisoners (23.7%) reported past-year suicidal ideation during their current incarceration, which was significantly associated with both imported vulnerabilities (psychiatric diagnoses and a history of attempted suicide) and variables unique to the prison experience (lack of working activity, exposure to suicidal behaviour by peers, and low levels of perceived autonomy, safety and social support) in the multivariate regression analysis. A first-ever period of imprisonment and a shorter length of incarceration (≤12months) were also associated with increased odds of recent suicidal ideation. Collectively, the current findings underscore the importance of both vulnerability factors and prison-specific stressors for suicidal ideation in prisoners, and hence the need for a multi-faceted approach to suicide prevention in custodial settings. In addition to the provision of appropriate mental health care, environmental interventions that target modifiable aspects of the prison regime could provide a substantial buffer for the onset and persistence of suicidal ideation in this at-risk population.