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Yıldız M, Orak U, Aydoğdu R. Enduring Effects of Early Life Traumas on Adult Suicidal Ideation. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:297-307. [PMID: 37234841 PMCID: PMC10205958 DOI: 10.1007/s40653-022-00482-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 05/28/2023]
Abstract
Exposure to traumas early in life has been found to have a range of negative health effects later in adulthood, including a higher risk for suicidal behavior. Using data from the Waves I (1994/95) and IV (2008) of the National Longitudinal Study of Adolescent to Adult Health (N = 14,385; 49.35% female; Mage in Wave IV = 29), this study examines the effects of exposure to three different types of early life traumas-emotional abuse, physical abuse, and sexual abuse before the age of 18-on adult suicidal ideation. Guided by the stress process model incorporated with a life-course perspective, potential mediating roles of psychological distress, subjective powerlessness, and perceived social rejection were also investigated. A series of regression and Karlson-Holm-Breen (KHB) mediation analyses were performed using Stata 14 to assess the total, direct, and indirect effects. All three early life trauma measures were found to be significantly and independently associated with a higher risk of suicidal ideation in adulthood. A substantive portion (between 30 and 50%) of the effects was mediated by psychological distress (i.e., depression and anxiety), subjective powerlessness, and perceived social rejection. The general policy implications of this study include evaluating suicidal individuals for prior childhood abuse experiences and assessing abuse survivors for suicidality.
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Affiliation(s)
- Muhammed Yıldız
- Applied Sociology and Criminal Justice Department, Utah Tech University, 232 McDonald Center, 84770 St. George, UT USA
| | - Uğur Orak
- Department of Sociology and Anthropology, Middle Tennessee State University, Murfreesboro, TN USA
| | - Ramazan Aydoğdu
- General Education & Health Sciences Department, Baptist Health Sciences University, Memphis, TN USA
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Balbuena LD, Baetz M, Sexton JA, Harder D, Feng CX, Boctor K, LaPointe C, Letwiniuk E, Shamloo A, Ishwaran H, John A, Brantsæter AL. Identifying long-term and imminent suicide predictors in a general population and a clinical sample with machine learning. BMC Psychiatry 2022; 22:120. [PMID: 35168594 PMCID: PMC8848909 DOI: 10.1186/s12888-022-03702-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 01/12/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Machine learning (ML) is increasingly used to predict suicide deaths but their value for suicide prevention has not been established. Our first objective was to identify risk and protective factors in a general population. Our second objective was to identify factors indicating imminent suicide risk. METHODS We used survival and ML models to identify lifetime predictors using the Cohort of Norway (n=173,275) and hospital diagnoses in a Saskatoon clinical sample (n=12,614). The mean follow-up times were 17 years and 3 years for the Cohort of Norway and Saskatoon respectively. People in the clinical sample had a longitudinal record of hospital visits grouped in six-month intervals. We developed models in a training set and these models predicted survival probabilities in held-out test data. RESULTS In the general population, we found that a higher proportion of low-income residents in a county, mood symptoms, and daily smoking increased the risk of dying from suicide in both genders. In the clinical sample, the only predictors identified were male gender and older age. CONCLUSION Suicide prevention probably requires individual actions with governmental incentives. The prediction of imminent suicide remains highly challenging, but machine learning can identify early prevention targets.
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Affiliation(s)
- Lloyd D Balbuena
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada.
| | - Marilyn Baetz
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | | | - Douglas Harder
- Mental Health & Addictions Services, Saskatchewan Health Authority, Saskatoon, Canada
| | - Cindy Xin Feng
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Kerstina Boctor
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada
| | - Candace LaPointe
- Mental Health & Addictions Services, Saskatchewan Health Authority, Saskatoon, Canada
| | - Elizabeth Letwiniuk
- Mental Health & Addictions Services, Saskatchewan Health Authority, Saskatoon, Canada
| | - Arash Shamloo
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada
| | | | - Ann John
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Anne Lise Brantsæter
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
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Murray EG, Isbister GK, McCrabb S, Halpin SA, Bonevski B. An examination of factors associated with tobacco smoking amongst patients presenting with deliberate self-poisoning. J Affect Disord 2020; 260:544-549. [PMID: 31539691 DOI: 10.1016/j.jad.2019.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Understand factors related to related to tobacco smoking amongst individuals who present with deliberate self-harm is important. This article explores the relationship between tobacco use with mental health diagnoses and substance use in a cohort of overdose admissions. METHODS Secondary analysis of an existing health service database with 7133 patients admitted for deliberate self-poisonings from 1997 to 2013 was conducted. A data collection form was used on admission to capture information on patient demographics, drugs ingested, use of drugs of misuse, regular medications and management and complications of poisoning. The data was analysed using a multiple logistic regression model. RESULTS Within a deliberate self-poisoning population, those diagnosed with: an amphetamine substance use disorder (OR = 1.84, p < .001), alcohol use disorder (OR = 1.68, p < .001), other substance use disorder (OR = 1.77, p < .001), psychotic diagnoses (OR = 1.17, p = .032), or had a history of self-harm (OR = 1.15, p = .011) were more likely to be a current tobacco smoker. Those who were older (OR = 0.99, p < .001) or diagnosed with a mood disorder (OR = 0.87, p = .018) were less likely to smoke tobacco. LIMITATIONS The study was unable to differentiate between suicide attempts and self-harm self-poisonings. CONCLUSIONS Among a deliberate self-poisoning population those who were younger, diagnosed with a variety of substance use disorders, or had a history of previous self-poisoning were more likely to use tobacco. Those with a mood disorder were less likely to smoke tobacco.
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Affiliation(s)
- Edward G Murray
- School of Psychology, Faculty of Science, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Geoffrey K Isbister
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, 1 University Drive, Callaghan, NSW 2308, Australia; Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Waratah NSW 2294, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, 1 University Drive, Callaghan, NSW 2308, Australia
| | - Sean A Halpin
- School of Psychology, Faculty of Science, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, 1 University Drive, Callaghan, NSW 2308, Australia.
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Holma KM, Holma I, Ketokivi M, Oquendo MA, Isometsä E. The Relationship Between Smoking and Suicidal Behavior in Psychiatric Patients with Major Depressive Disorder. Arch Suicide Res 2019; 23:590-604. [PMID: 29883280 DOI: 10.1080/13811118.2018.1480986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Smoking is frequently associated with suicidal behavior, but also with confounding other risk factors. We investigated whether smoking independently predicts suicidal ideation, attempts (SAs), or modifies risk of SAs during major depressive episodes (MDEs). In the Vantaa Depression Study (VDS), a 5-year prospective study of psychiatric patients (N = 269) with major depressive disorder (MDD), we investigated the association of suicidal ideation and smoking, and smoking as an independent risk factor for SAs in 2-level analyses of risk during MDEs. Smoking was not significantly associated with suicidal ideation, nor SAs after controlling for confounding factors, and no evidence of a significant effect during MDEs was found. Smoking was neither significantly associated with suicidal ideation, nor predicted suicide attempts.
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Affiliation(s)
- K Mikael Holma
- Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland.,Department of Mental Health and Substance Abuse, City of Helsinki, Social Services and Health Care , Helsinki , Finland
| | - Irina Holma
- Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland.,Department of Psychiatry, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Mikko Ketokivi
- Operations and Technology Department, IE Business School , Madrid , Spain
| | - Maria A Oquendo
- Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Erkki Isometsä
- Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland.,Department of Psychiatry, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
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Kious BM, Kondo DG, Renshaw PF. Creatine for the Treatment of Depression. Biomolecules 2019; 9:E406. [PMID: 31450809 PMCID: PMC6769464 DOI: 10.3390/biom9090406] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 12/28/2022] Open
Abstract
Depressed mood, which can occur in the context of major depressive disorder, bipolar disorder, and other conditions, represents a serious threat to public health and wellness. Conventional treatments are not effective for a significant proportion of patients and interventions that are often beneficial for treatment-refractory depression are not widely available. There is, therefore, an immense need to identify novel antidepressant strategies, particularly strategies that target physiological pathways that are distinct from those addressed by conventional treatments. There is growing evidence from human neuroimaging, genetics, epidemiology, and animal studies that disruptions in brain energy production, storage, and utilization are implicated in the development and maintenance of depression. Creatine, a widely available nutritional supplement, has the potential to improve these disruptions in some patients, and early clinical trials indicate that it may have efficacy as an antidepressant agent.
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Affiliation(s)
- Brent M Kious
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA.
| | - Douglas G Kondo
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA
- George E. Wahlen Veterans Affairs Medical Center, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | - Perry F Renshaw
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA
- George E. Wahlen Veterans Affairs Medical Center, 500 Foothill Drive, Salt Lake City, UT 84148, USA
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Anthenelli RM, Gaffney M, Benowitz NL, West R, McRae T, Russ C, Lawrence D, St Aubin L, Krishen A, Evins AE. Predictors of Neuropsychiatric Adverse Events with Smoking Cessation Medications in the Randomized Controlled EAGLES Trial. J Gen Intern Med 2019; 34:862-870. [PMID: 30847828 PMCID: PMC6544691 DOI: 10.1007/s11606-019-04858-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 09/05/2018] [Accepted: 01/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pre-treatment factors that increase smokers' risk of experiencing neuropsychiatric adverse events (NPSAEs) when quitting smoking are unknown. OBJECTIVE To identify baseline smoker characteristics beyond the history of mental illness that predict which participants were more likely to experience moderate to severe NPSAEs in EAGLES. DESIGN A prospective correlational cohort study in the context of a multinational, multicenter, double-blind, randomized trial. PARTICIPANTS Smokers without (N = 3984; NPC)/with (N = 4050; PC) histories of, or current clinically stable, psychiatric disorders including mood (N = 2882; 71%), anxiety (N = 782; 19%), and psychotic (N = 386; 10%) disorders. INTERVENTIONS Bupropion, 150 mg twice daily, or varenicline, 1 mg twice daily, versus active control (nicotine patch, 21 mg/day with taper) and placebo for 12 weeks with 12-week non-treatment follow-up. MAIN MEASURES Primary safety outcome was the incidence of a composite measure of moderate/severe NPSAEs. Associations among baseline demographic/clinical characteristics and the primary safety endpoint were analyzed post hoc via generalized linear regression. KEY RESULTS The incidence of moderate to severe NPSAEs was higher among smokers in the PC (238/4050; 5.9%) than in the NPC (84/3984; 2.1%). Three baseline characteristics predicted increased risk for experiencing clinically significant NPSAEs when quitting regardless of carrying a psychiatric diagnosis: current symptoms of anxiety (for every ~ 4-unit increase in HADS anxiety score, the absolute risk of occurrence of the NPSAE endpoint increased by 1% in both PC and NPC); prior history of suicidal ideation and/or behavior (PC, 4.4% increase; P = 0.001; NPC, 4.1% increase; P = 0.02), and being of White race (versus Black: PC, 2.9% ± 0.9 [SE] increase; P = 0.002; and NPC, 3.4% ± 0.8 [SE] increase; P = 0.001). Among smokers with psychiatric disorders, younger age, female sex, history of substance use disorders, and proxy measures of nicotine dependence or psychiatric illness severity also predicted greater risk. There were no significant interactions between these characteristics and treatment. Smokers with unstable psychiatric disorders or with current, active substance abuse were excluded from the study. CONCLUSIONS Irrespective of cessation pharmacotherapy use, smokers attempting to quit were more likely to experience moderate to severe NPSAEs if they reported current anxiety or prior suicidal ideation at baseline and were White. In smokers with a psychiatric history, female sex, younger age, and greater severity of nicotine dependence were also predictive. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01456936.
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Affiliation(s)
- Robert M Anthenelli
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
| | | | - Neal L Benowitz
- Department of Medicine, University of California, San Francisco, CA, USA
| | | | | | | | | | | | - Alok Krishen
- PAREXEL International on behalf of GlaxoSmithKline, Research Triangle Park, NC, USA
| | - A Eden Evins
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Jung M. The relationship between alcohol abuse and suicide risk according to smoking status: A cross-sectional study. J Affect Disord 2019; 244:164-170. [PMID: 30342376 DOI: 10.1016/j.jad.2018.09.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/30/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Considering the rising suicide risk rate, we investigated the associations between alcohol abuse, smoking, and suicide risk. METHODS Participants were 21,654 (male: 9,729, female: 11,925) responders of the National Nutrition Survey from 2013 to 2015 in Korea. Associations between alcohol, smoking, and suicide risk were analyzed using logistic regression and path analysis. The Alcohol Use Disorder Identification Test (AUDIT) measured alcohol consumption levels. RESULTS Among participants, 1,718 (male: 602, female: 1,116) presented a suicide risk related to alcohol and smoking. Men's odds ratio of suicide ideation was the highest among those reporting current smoking and AUDIT scores ≥ 20, at 83.75 (95% confidence interval [CI] = 48.07-145.94); that of suicide ideation was the highest for men reporting current smoking and AUDIT scores ≥ 20, at 121.49 (CI = 48.92-301.67); and that of suicide attempts was the highest for men reporting current smoking and AUDIT scores of 16-19, at 256.341 (CI = 77.12-852.05). Women's odds ratio of suicide ideation was the highest for those reporting current smoking and AUDIT scores ≥ 20, at 21.92 (CI = 7.19-66.80); that of suicide ideation was the highest for women reporting current smoking and AUDIT scores ≥ 20, at 19.26 (CI = 4.52-82.17); and that for suicide attempts was the highest for those reporting past smoking and AUDIT scores 8-15, at 104.64 (CI = 10.32- < 999.99). As a result of the path analysis, six paths were fully adopted. Smoking status had a statistically significant positive effect on attempted suicide (t = 146.50, p < .001). AUDIT scores were found to have a significant positive effect on attempted suicide (t = 2503.74, p < .001). LIMITATIONS Results must be interpreted within the study design context. Suicidality does not assess any depressive episode. the sample did not include persons who had committed suicide. As suicidal ideation, plans, and attempts are on a spectrum it is difficult to find valid and appropriate, as well as culturally-sensitive, screening questions for suicidal risk that are comparable across international studies. The data used in this study were based on self-reports of smoking, drinking, and suicide risk. CONCLUSIONS The combination of alcohol use and smoking was associated with greater suicide risk than were alcohol and smoking separately.
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Affiliation(s)
- Myoungjee Jung
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwon-do 26426, Republic of Korea.
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Early-onset tobacco use and suicide-related behavior - A prospective study from adolescence to young adulthood. Addict Behav 2018; 79:32-38. [PMID: 29245024 DOI: 10.1016/j.addbeh.2017.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Developmental relationships between tobacco use and suicide-related behaviors (SRB) remain unclear. Our objective was to investigate the longitudinal associations of tobacco use in adolescence and SRB in adulthood. METHODS Using a prospective design, we examined whether tobacco use in adolescence is associated with SRB (intentional self-injury, suicide ideation) in young adulthood in a population-based sample of 1330 twins (626 males, 704 females). The baseline and follow-up data were collected by professionally administered semi-structured poly-diagnostic interviews at ages 14 and 22, respectively. RESULTS After adjusting for multiple potential confounders, those who reported early-onset of regular tobacco use had a significantly increased risk for intentional self-injury, such as cutting or burning, at age 22 (adjusted odds ratio [AOR] 4.57, 95% CI 1.93-10.8) in comparison to those who had not at all initiated tobacco use. Also, daily cigarette smoking at baseline was associated with future intentional self-injury (AOR 4.45, 95% CI 2.04-9.70). Early-onset tobacco use was associated with suicidal ideation in females (AOR 3.69, 95% CI 1.56-8.72) but not in males. Considering any SRB, baseline daily smokers (AOR 2.13, 95% CI 1.12-4.07) and females with early onset of regular tobacco use (AOR 3.97, 95% CI 1.73-9.13) had an increased likelihood. Within-family analyses among twin pairs discordant for exposure and outcome controlling for familial confounds showed similar, albeit statistically non-significant, associations. CONCLUSION Early-onset tobacco use in adolescence is longitudinally associated with SRB (intentional self-injury and/or suicide ideation) in young adulthood, particularly among females. Further investigation may reveal whether this association has implications for prevention of SRB in adolescence and young adulthood.
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Oliveira RMD, Santos JLF, Furegato ARF. Tobacco addiction in the psychiatric population and in the general population. Rev Lat Am Enfermagem 2017; 25:e2945. [PMID: 29211192 PMCID: PMC5738870 DOI: 10.1590/1518-8345.2202.2945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/02/2017] [Indexed: 11/21/2022] Open
Abstract
Objective: To estimate the degree of tobacco addiction and identify independently associated
factors by comparing the psychiatric population of secondary and tertiary care
with the general population of the primary healthcare network. Method: This is a cross-sectional epidemiological study, conducted in a municipality of
São Paulo, with 134 smokers of a Mental Health Outpatient Unit (MHOU), a
Psychiatric Hospital (PH), and a Primary Healthcare Unit (PHU). Data were
collected by means of individual interviews, recorded on a mobile device. Data
were statistically processed using Stata/12 Results: Of the 134 participants, 54.5% were women. While 49.1% of the psychiatric
population (MHOU/PH) had medium/high nicotine addiction, 58.3% of smokers of the
general population had very low/low dependency. The Poisson regression model
indicated a higher prevalence of smokers with high dependence among men (PR =
1.41), people aged 49 years or less (15 - 29 years, PR = 4.06, 30 - 39 PR = 2.96
years, 40 - 49 years PR = 1.84), with severe mental disorders (PR = 3.05), with
anxiety disorders/other (PR = 3.98), and with high suicide risk (PR = 1.55). Conclusion: Nicotine dependence was greater in the psychiatric population than in the general
population. The independent factors associated with severe dependence were sex,
age group, diagnosis, and current risk of suicide. These results trigger
reflection among nurses on the need to focus more attention on a neglected subject
in mental health services.
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Affiliation(s)
| | - Jair Lício Ferreira Santos
- PhD, Full Professor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Antonia Regina Ferreira Furegato
- PhD, Full Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Icick R, Karsinti E, Lépine JP, Bloch V, Brousse G, Bellivier F, Vorspan F. Serious suicide attempts in outpatients with multiple substance use disorders. Drug Alcohol Depend 2017; 181:63-70. [PMID: 29035706 DOI: 10.1016/j.drugalcdep.2017.08.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Suicide is a major public health concern and suicide attempts (SA) are frequent and burdensome in people suffering from substance use disorders (SUDs). In particular, serious SAs are a preoccupying form of attempt, which remain largely overlooked in these populations, especially regarding basic risk factors such as gender, addictive comorbidity and substance use patterns. Thus, we undertook a gender-specific approach to identify the risk factors for serious SAs in outpatients with multiple SUDs. MATERIAL AND METHODS 433 Treatment-seeking outpatients were consecutively recruited in specialized care centers and reliably classified as serious, non-serious and non-suicide attempters. We also characterized lifetime exposure to SUDs, including tobacco smoking, with standardized instruments. Current medication, including psychotropic treatments were collected, which informed psychiatric diagnoses. Multinomial regression identified independent factors specifically associated with serious SAs in each gender, separately. RESULTS 32% Participants (N=139, 47% Women and 27% Men) reported lifetime SA. There were 82 serious attempters (59% of attempters), without significant gender difference. Sedative dependence was an independent risk factor for serious SA compared to non-SA in Women and compared to non-serious SA in Men, respectively. Other risk factors included later onset of daily tobacco smoking in Men and history of psychiatric hospitalizations in Women, whose serious SA risk was conversely lower when reporting opiate use disorder or mood disorder, probably because of treatment issues. CONCLUSIONS Despite several study limitations, we identified subgroups for a better-tailored prevention of serious SAs among individuals with SUDs, notably highlighting the need to better prevent and treat sedative dependence.
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Affiliation(s)
- R Icick
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris, F-75006, France; Paris Descartes University, Inserm UMR-S1144, Paris, F-75006, France; Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-S1144, Paris, F-75013, France; FondaMental Foundation, Créteil, F-94000, France.
| | - E Karsinti
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris, F-75006, France; Paris Descartes University, Inserm UMR-S1144, Paris, F-75006, France; Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-S1144, Paris, F-75013, France
| | - J-P Lépine
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris, F-75006, France; Paris Descartes University, Inserm UMR-S1144, Paris, F-75006, France; Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-S1144, Paris, F-75013, France
| | - V Bloch
- INSERM U1144, Paris, F-75006, France; Paris Descartes University, Inserm UMR-S1144, Paris, F-75006, France; Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-S1144, Paris, F-75013, France; Hospital Pharmacy, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France
| | - G Brousse
- Psychiatry B-Department of Addiction Psychiatry, Université Clermont 1, UFR Médecine, EA7280, Clermont-Ferrand, France; CHU Clermont-Ferrand, Clermont-Ferrand, F-63003, France
| | - F Bellivier
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris, F-75006, France; Paris Descartes University, Inserm UMR-S1144, Paris, F-75006, France; Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-S1144, Paris, F-75013, France; FondaMental Foundation, Créteil, F-94000, France
| | - F Vorspan
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris, F-75006, France; Paris Descartes University, Inserm UMR-S1144, Paris, F-75006, France; Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-S1144, Paris, F-75013, France
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Evins AE, Korhonen T, Kinnunen TH, Kaprio J. Prospective association between tobacco smoking and death by suicide: a competing risks hazard analysis in a large twin cohort with 35-year follow-up. Psychol Med 2017; 47:2143-2154. [PMID: 28399944 PMCID: PMC5551385 DOI: 10.1017/s0033291717000587] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 01/02/2017] [Accepted: 02/14/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The relationship between smoking and suicide remains controversial. METHOD A total of 16 282 twin pairs born before 1958 in Finland and alive in 1974 were queried with detailed health and smoking questionnaires in 1975 and 1981, with response rates of 89% and 84%. Smoking status and dose, marital, employment, and socio-economic status, and indicators of psychiatric and somatic illness were assessed at both time points. Emergent psychiatric and medical illness and vital status, including suicide determined by forensic autopsy, were evaluated over 35-year follow-up through government registries. The association between smoking and suicide was determined in competing risks hazard models. In twin pairs discordant for smoking and suicide, the prospective association between smoking and suicide was determined using a matched case-control design. RESULTS Smokers had a higher cumulative suicide incidence than former or never smokers. Heavy smokers had significantly higher suicide risk [hazard ratio (HR) 3.47, 95% confidence interval (CI) 2.31-5.22] than light smokers (HR 2.30, 95% CI 1.61-3.23) (p = 0.017). Compared with never smokers, smokers, but not former smokers, had increased suicide risk (HR 2.56, 95% CI 1.43-4.59), adjusting for depressive symptoms, alcohol and sedative-hypnotic use, and excluding those who developed serious somatic or psychiatric illness. In twin pairs discordant for smoking and suicide, suicide was more likely in smokers [odds ratio (OR) 6.0, 95% CI 2.06-23.8]. CONCLUSIONS Adults who smoked tobacco were more likely to die by suicide, with a large, dose-dependent effect. This effect remained after consideration of many known predictors of suicide and shared familial effects, consistent with the hypothesis that exposure to tobacco smoke increases the risk of suicide.
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Affiliation(s)
- A. E. Evins
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - T. Korhonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- National Institute for Health and Welfare, Helsinki, Finland
| | - T. H. Kinnunen
- Behavioral Science Consulting, Hopkinton, MA, USA
- Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland
| | - J. Kaprio
- Department of Public Health, University of Helsinki, Helsinki, Finland
- National Institute for Health and Welfare, Helsinki, Finland
- Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland
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12
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Agrawal A, Tillman R, Grucza RA, Nelson EC, McCutcheon VV, Few L, Conner KR, Lynskey MT, Dick DM, Edenberg HJ, Hesselbrock VM, Kramer JR, Kuperman S, Nurnberger JI, Schuckit MA, Porjesz B, Bucholz KK. Reciprocal relationships between substance use and disorders and suicidal ideation and suicide attempts in the Collaborative Study of the Genetics of Alcoholism. J Affect Disord 2017; 213:96-104. [PMID: 28213124 PMCID: PMC5434702 DOI: 10.1016/j.jad.2016.12.060] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/22/2016] [Accepted: 12/21/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Substance use and misuse and suicidal thoughts and behaviors tend to co-occur. The purpose of this study was to examine whether (a) suicidal ideation and attempt are related to onset of alcohol, nicotine and cannabis use and dependence; (b) early use of alcohol, nicotine and cannabis is associated with onset of suicidal ideation and attempt; and (c) whether these associations persist while controlling for covariates, such as family history of alcohol problems, major depression and other internalizing and externalizing disorders. METHODS The prospective cohort of the Collaborative Study of the Genetics of Alcoholism (COGA; N=3277) was used. Cross-sectional and discrete time logistic regression (i.e. survival) analyses examined associations between suicidal ideation and attempt and onset of alcohol, nicotine and cannabis use and dependence. Survival models also examined whether individual early substance use was related to onset of ideation and attempt. RESULTS Ideation was related to 0.71-0.77 odds of onset of subsequent alcohol, nicotine and cannabis use. Attempt was associated with 1.44-1.61 odds of later alcohol, nicotine and cannabis dependence, even after accounting for covariates. Evidence for early substance use being related to subsequent onset of ideation or attempt was limited. Several sex and race differences emerged. LIMITATIONS The sample was ascertained for family history of alcoholism; not all participants had been followed up allowing for censored observations; reporting bias. CONCLUSION Suicide attempts are associated with increased likelihood of onset of substance dependence.
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Affiliation(s)
- Arpana Agrawal
- Washington University School of Medicine, Dept. of Psychiatry, St. Louis, MO, USA.
| | - Rebecca Tillman
- Washington University School of Medicine, Dept. of Psychiatry, St. Louis, MO, USA
| | - Richard A Grucza
- Washington University School of Medicine, Dept. of Psychiatry, St. Louis, MO, USA
| | - Elliot C Nelson
- Washington University School of Medicine, Dept. of Psychiatry, St. Louis, MO, USA
| | - Vivia V McCutcheon
- Washington University School of Medicine, Dept. of Psychiatry, St. Louis, MO, USA
| | - Lauren Few
- Washington University School of Medicine, Dept. of Psychiatry, St. Louis, MO, USA
| | - Kenneth R Conner
- University of Rochester Medical Center, Dept. of Emergency Medicine, Rochester, NY, USA
| | - Michael T Lynskey
- Kings College, Institute of Psychiatry, Dept. of Addiction, London, UK
| | - Danielle M Dick
- Virginia Commonwealth University, Dept. of African-American Studies, Richmond, VA, USA
| | - Howard J Edenberg
- Indiana University, Dept. of Biochemistry and Molecular Biology, Indianapolis, IN, USA
| | | | - John R Kramer
- University of Iowa Carver College of Medicine, Dept. of Psychiatry - Div. of Psychology, Iowa City, IA, USA
| | - Samuel Kuperman
- University of Iowa Carver College of Medicine, Depts. of Psychiatry and Pediatrics, Iowa City, IA, USA
| | - John I Nurnberger
- Indiana University School of Medicine, Dept. of Psychiatry, Indianapolis, IN, USA
| | - Marc A Schuckit
- University of California San Diego, Dept. of Psychiatry, San Diego, CA, USA
| | - Bernice Porjesz
- SUNY Downstate Medical Center, Dept. of Psychiatry, Brooklyn, NY, USA
| | - Kathleen K Bucholz
- Washington University School of Medicine, Dept. of Psychiatry, St. Louis, MO, USA
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Keyser-Marcus L, Vassileva J, Stewart K, Johns S. Impulsivity and cue reactivity in smokers with comorbid depression and anxiety: Possible implications for smoking cessation treatment strategies. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 43:432-441. [DOI: 10.1080/00952990.2017.1287190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Lori Keyser-Marcus
- Institute for Drug and Alcohol Studies, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Jasmin Vassileva
- Institute for Drug and Alcohol Studies, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Karen Stewart
- Department of Psychiatry and Behavior Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sade Johns
- Institute for Drug and Alcohol Studies, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
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14
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Han B, Compton WM, Blanco C. Tobacco Use and 12-Month Suicidality Among Adults in the United States. Nicotine Tob Res 2016; 19:39-48. [PMID: 27190402 DOI: 10.1093/ntr/ntw136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 04/29/2016] [Indexed: 12/29/2022]
Abstract
INTRODUCTION To examine how 12-month prevalences of suicidality vary by tobacco use. METHODS Data were from 325 800 adults who participated in the 2008-2014 National Survey on Drug Use and Health. Descriptive analyses and multivariable multinomial logistic regression models were applied. RESULTS Among adults aged 18 or older in the United States during 2008-2014, 27.4% (annual average, standard error [SE] = 0.14%) were never tobacco users, 38.8% (SE = 0.17%) were former tobacco users, 5.9% (SE = 0.07%) were past-year users of other types of tobacco (non-cigarette), 20.2% (SE = 0.13%) were past-year cigarette-only users, and 7.7% (SE = 0.07%) were past-year users of cigarettes plus other types of tobacco; 2.6% (SE = 0.04%) had suicidal ideation only, 0.7% (SE = 0.02%) had suicidal ideation and suicide plan only, and 0.5% (SE = 0.02%) attempted suicide. After controlling for covariates, compared with never tobacco users, past-year users of cigarettes plus other types of tobacco were at elevated risk of all examined suicidality outcomes (adjusted relative risks [ARRs] = 1.2-1.7), and past-year cigarette-only users were at higher risk of suicide attempt (ARR = 1.4). Early age of first tobacco use was associated with higher risk of suicidal ideation and suicide plan among former tobacco users, past-year tobacco users, and past-year cigarette users (ARRs = 1.2-1.6). Among past-year tobacco users, frequencies of cigarette and cigar use were associated with suicide attempt (ARRs = 1.4-1.7). Nicotine dependence was associated with suicide attempt among past-year cigarette users (ARR = 1.2). CONCLUSIONS Tobacco use is associated with 12-month suicidality among adults. Patients who use tobacco should be assessed further for mental health status and suicide risk. IMPLICATIONS Our results revealed that tobacco use is independently associated with the 12-month suicidality outcomes among adults and identified how the prevalences of 12-month suicidality outcomes vary by tobacco use status and use characteristics among adults. These results have important clinical implications. Future research should assess the effectiveness of tobacco use questions as simple screeners for more extensive assessment of mental health status and suicide risk.
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Affiliation(s)
- Beth Han
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD;
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD
| | - Carlos Blanco
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD
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15
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Gim W, Yoo JH, Shin JY, Goo AJ. Relationship between Secondhand Smoking with Depressive Symptom and Suicidal Ideation in Korean Non-Smoker Adults: The Korean National Health and Nutrition Examination Survey 2010-2012. Korean J Fam Med 2016; 37:97-104. [PMID: 27073608 PMCID: PMC4826998 DOI: 10.4082/kjfm.2016.37.2.97] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/04/2015] [Accepted: 09/27/2015] [Indexed: 12/31/2022] Open
Abstract
Background Research suggests that mental health is affected not only by smoking, but also by secondhand smoking. But the most researches have been conducted in North America and/or Europe. We examined whether this relationship remains evident within the South Korean population. Specifically, we investigated the effect of secondhand smoking on depressive symptoms and suicidal ideation. Methods We analyzed data from 6,043 non-smoking adults who participated in the 2010–2012 Korea National Health and Nutrition Examination Survey. We compared the presence of depressive symptoms and suicidal ideation in 3,006 participants who were exposed to secondhand smoking in the office or at home with 3,037 non-exposed participants. Results In unadjusted logistic regression analysis, secondhand smoking exposure group had more suicidal ideations than no secondhand smoking exposure (16.1% vs. 12.2%; odds ratio [OR], 1.50; 95% confidence interval [CI], 1.241–1.804), but risk of depressive symptoms was not significantly different between two groups (15.2% vs. 12.2%; OR, 1.21; 95% CI, 0.997–1.460). In multivariate logistic regression analysis, Among those exposed to secondhand smoking, the OR for depressive symptoms was 1.02 (95% CI, 0.866–1.299) and 1.43 (95% CI, 1.139–1.802) for suicidal ideation. Overall, secondhand smoking at home was significantly related to depressive symptoms and suicidal ideation. Among females, secondhand smoking exposure at home only (not in the office) was related to depressive symptoms and suicidal ideation. Conclusion Exposure to secondhand smoking, especially at home, may be associated with an increase in especially in female depressive symptoms and suicidal ideation among adults in South Korea.
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Affiliation(s)
- Wook Gim
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Hyun Yoo
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Young Shin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ae-Jin Goo
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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16
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Kim SM, Jung JW, Park IW, Ahn CM, Kim YI, Yoo KH, Chun EM, Jung JY, Park YS, Park JH, Kim JY. Gender Differences in Relations of Smoking Status, Depression, and Suicidality in Korea: Findings from the Korea National Health and Nutrition Examination Survey 2008-2012. Psychiatry Investig 2016; 13:239-46. [PMID: 27081387 PMCID: PMC4823202 DOI: 10.4306/pi.2016.13.2.239] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/20/2015] [Accepted: 07/24/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE As mental health problems may play an important role in initiating and maintaining cigarette smoking in females and there are an increasing number of female smokers, we evaluated the relationship between smoking status and mental health problems including depression and suicide ideation in women in Korea. METHODS We analyzed the 5-year cumulative data (19 years of age or older, n=32,184) from the Korean National Health and Nutrition Examination Survey (KNHANES) conducted from 2008 to 2012. Logistic regression analyses were used to evaluate associations between cigarette smoking status and mental health parameters while controlling for potentially confounding variables. RESULTS Among current smokers, females showed higher lifetime prevalence in having a depressive episode, a doctor-diagnosed major depression, a current diagnosis of depression, or receiving treatment for depression in comparison with males. In addition, females were more likely to report on having a depressive episode, suicidal ideation and attempts, and psychiatric counselling within the previous year, as compared to males. Female former smokers showed intermediate characteristics in parameters of mental health status within the previous year, ranking between lifetime non-smokers and the current smokers. CONCLUSION Identifying the factors related to mental health status among current smokers can increase opportunities for an early intervention and help reduce the prevalence of smoking and increase smoking cessation rates particularly in females. Developing adaptive coping strategies other than smoking in female youth is potentially important in reducing the initiation of smoking.
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Affiliation(s)
- Sun Mi Kim
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jae-Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - In-Won Park
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Chul Min Ahn
- Division of Pulmonology, Department of Internal Medicine, Kangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yu-Il Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kwang-Ha Yoo
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Eun Mi Chun
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Ji Ye Jung
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Sik Park
- Division of Pulmonology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ju-Heon Park
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jae Yeol Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Berlin I, Luquiens A, Aubin HJ. Smoking as a confounder of the association of suicidality with serum lipid levels. J Psychiatry Neurosci 2016; 41:E24. [PMID: 26898729 PMCID: PMC4764488 DOI: 10.1503/jpn.150361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ivan Berlin
- From the Département de pharmacologie, Hôpital Pitié-Salpêtrière - Université P. & M. Curie, Paris, France; and the Département de psychiatrie et d'addictologie, Villejuif, France
| | - Amandine Luquiens
- From the Département de pharmacologie, Hôpital Pitié-Salpêtrière - Université P. & M. Curie, Paris, France; and the Département de psychiatrie et d'addictologie, Villejuif, France
| | - Henri-Jean Aubin
- From the Département de pharmacologie, Hôpital Pitié-Salpêtrière - Université P. & M. Curie, Paris, France; and the Département de psychiatrie et d'addictologie, Villejuif, France
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18
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Tempier R, Guérin E. Tobacco smoking and suicidal thoughts and attempts: Relationships from a general population survey. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2015. [DOI: 10.1016/j.cegh.2014.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Hasin DS, Grant BF. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1609-40. [PMID: 26210739 PMCID: PMC4618096 DOI: 10.1007/s00127-015-1088-0] [Citation(s) in RCA: 274] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/28/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking. METHOD NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized. RESULT The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers. CONCLUSIONS Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, New York, NY, 10032, USA
- Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Bridget F Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Room 3077, Rockville, MD, 20852, USA.
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Michel L, Lions C, Maradan G, Mora M, Marcellin F, Morel A, Spire B, Roux P, Carrieri PM. Suicidal risk among patients enrolled in methadone maintenance treatment: HCV status and implications for suicide prevention (ANRS Methaville). Compr Psychiatry 2015; 62:123-31. [PMID: 26343476 DOI: 10.1016/j.comppsych.2015.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 06/26/2015] [Accepted: 07/07/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Suicide is a critical issue among opioid users. The aim of this study was to assess the relationship between HCV status and suicidal risk in patients receiving methadone treatment. METHODS We used data from Methaville, a multicenter, pragmatic randomized trial designed to evaluate the feasibility of methadone induction in primary care compared with induction in specialized centers. Suicidal risk was assessed at enrollment and after one year of methadone treatment using the suicidality module in the MINI International Neuropsychiatric Interview. Socio-demographic characteristics, drug and alcohol consumption, behavioral and personality factors, history of drug use and health indicators were also assessed. RESULTS A total of 195 individuals were enrolled from January 2009 to December 2010. Suicidal risk assessment was available at month 0 (M0) and M12 for 159 (72%) and 118 (73%) individuals, respectively. Forty-four (28%) were at risk of suicide at M0 and 17 (14%) at M12 (p=0.004). One patient attempted suicide by overdose during the one-year follow-up. The following three factors were associated with suicidal risk: hepatitis C virus (HCV) positive status (OR [95%CI]=17.25 [1.14-161.07]; p=0.04), receiving food assistance (OR [95%CI]=0.05 [0.00-1.05]; p=0.05) and a higher number of health problems (OR [95%CI]=1.24 [1.08-1.44]; p=0.003). CONCLUSIONS Special attention should be given to HCV-positive patients through suicidal risk prevention strategies and routine suicide assessment as part of a comprehensive approach to prevention and care for opioid users. Our results represent a new and powerful argument for the expansion of access to HCV treatment to drug users with chronic infection.
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Affiliation(s)
- Laurent Michel
- Health and Medical Research National Institute, Research Unit 669, Paris, France; University Paris-Sud and University Paris Descartes, UMRS0669, Paris, France; Centre Pierre Nicole, French Red Cross, 27 rue Pierre Nicole, Paris, France.
| | - Caroline Lions
- INSERM, UMR912 "Economics and Social Sciences Applied to Health and Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; Aix Marseille University, UMRS912, IRD, 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
| | - Gwenaelle Maradan
- INSERM, UMR912 "Economics and Social Sciences Applied to Health and Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; Aix Marseille University, UMRS912, IRD, 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
| | - Marion Mora
- INSERM, UMR912 "Economics and Social Sciences Applied to Health and Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; Aix Marseille University, UMRS912, IRD, 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
| | - Fabienne Marcellin
- INSERM, UMR912 "Economics and Social Sciences Applied to Health and Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; Aix Marseille University, UMRS912, IRD, 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
| | - Alain Morel
- Oppelia, 20 Avenue Daumesnil, 7512 Paris, France
| | - Bruno Spire
- INSERM, UMR912 "Economics and Social Sciences Applied to Health and Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; Aix Marseille University, UMRS912, IRD, 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
| | - Perrine Roux
- INSERM, UMR912 "Economics and Social Sciences Applied to Health and Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; Aix Marseille University, UMRS912, IRD, 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
| | - Patrizia M Carrieri
- INSERM, UMR912 "Economics and Social Sciences Applied to Health and Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; Aix Marseille University, UMRS912, IRD, 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
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Berlin I, Hakes JK, Hu MC, Covey LS. Tobacco use and suicide attempt: longitudinal analysis with retrospective reports. PLoS One 2015; 10:e0122607. [PMID: 25849514 PMCID: PMC4388646 DOI: 10.1371/journal.pone.0122607] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/11/2015] [Indexed: 11/18/2022] Open
Abstract
Background Suicide has been associated with smoking/tobacco use but its association of and change in smoking/tobacco use status with suicide attempt (SA) is not well established. Methods We investigated whether persistent, former tobacco use, initiation, quitting tobacco use, relapse to tobacco use, and DSM-IV nicotine dependence predict independently SA using Wave 1 and 2 data of the National Epidemiologic Survey of Alcohol and Related Conditions. Data from 34,653 US adults interviewed at Wave 1 (2001-02) and Wave 2 (2004-05) were analyzed. The main outcome measure was SA between Wave 1 and Wave 2 as reported at Wave 2. Results Among the 1,673 respondents reporting lifetime SA at Wave 2, 328 individuals reported SA between Wave 1 and Wave 2. Current and former tobacco use at Wave 1 predicted Wave 2 SA independently of socio-demographic characteristics, psychiatric history, and prior SA (Adjusted Odds Ratio (AOR): 1.49; 95% CI: 1.13-1.95, AOR: 1.31; 95% CI:1.01-1.69, respectively versus never tobacco users). The strongest association with SA was observed among former tobacco users who relapsed after Wave 1 (AOR: 4.66; 95% CI: 3.49-6.24) and among tobacco use initiators after Wave 1 (AOR: 3.16; 95% CI: 2.23-4.49). Persistent tobacco use (current tobacco use at both Wave 1 and Wave 2) also had an increased risk of SA (AOR: 1.89; 95% CI: 1.47-2.42). However, former tobacco users in both Waves 1 and 2 did not show a significantly elevated risk for SA in Wave 2 (AOR:1.09, 95% CI: 0.78-1.52) suggesting that the risk resided mainly in Wave 1 former tobacco users who relapsed to tobacco use by Wave 2. DSM-IV nicotine dependence did not predict SA at Wave 2. Conclusion In a representative sample of US adults, relapse, tobacco use initiation, and persistent tobacco use, which are amenable to intervention, were associated with risk of SA.
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Affiliation(s)
- Ivan Berlin
- Département de Pharmacologie, Hôpital Pitié-Salpêtrière-Assistance publique-Hôpitaux de Paris-Faculté de médicine, Université P.& M. Curie—INSERM U1178, Paris, France
- * E-mail:
| | - Jahn K. Hakes
- Center for Administrative Records Research and Applications, U.S. Census Bureau, Suitland, MD, United States of America
| | - Mei-Chen Hu
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY, United States of America
| | - Lirio S. Covey
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY, United States of America
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22
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Oliveira RM, Siqueira Júnior AC, Furegato ARF. The meaning of smoking for patients with mental disorder. Issues Ment Health Nurs 2015; 36:127-34. [PMID: 25625713 DOI: 10.3109/01612840.2014.953277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
When patients smoke cigarettes in psychiatric services, it brings to the forefront current ethical and political dilemmas. This study aims to explore the meaning attributed to smoking by mental health patients who smoke and who are hospitalized in a psychiatric ward of a general hospital. This qualitative descriptive study was conducted with 96 smokers who were hospitalized in a psychiatric ward in Brazil. Semi-structured interviews, test of nicotine dependence, and content thematic analysis were carried out. The results show that tobacco has an important role in the lives of psychiatric patients. The meanings they attribute to tobacco use are related to overcoming difficulties that are consequential of mental disorders and of side effects caused by their treatments.
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23
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Krawczyk N, Meyer A, Fonseca M, Lima J. Suicide mortality among agricultural workers in a region with intensive tobacco farming and use of pesticides in Brazil. J Occup Environ Med 2014; 56:993-1000. [PMID: 25046321 PMCID: PMC5240450 DOI: 10.1097/jom.0000000000000214] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate whether suicide risk among agricultural workers is higher in regions with heavier pesticide use and/or presence of tobacco farming. METHODS Suicide mortality data were gathered from residents of the Brazilian state of Alagoas. Agricultural census data were used to arrange and classify Alagoas cities into distribution groups on the basis of variables concerning pesticide use and/or tobacco farming. Mortality odds ratio calculations were then used to compare suicide risk among agricultural and nonagricultural workers in different groups. RESULTS Suicide risk was higher among agricultural workers than among nonagricultural workers, elevated in regions that used more pesticides, and greatest in regions that produced more tobacco. CONCLUSIONS This is one of the first studies of its kind to suggest that combined effects of pesticide and tobacco exposure may be linked to higher suicide risk among agricultural workers.
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Affiliation(s)
- Noa Krawczyk
- From the Department of Preventative Medicine (Ms Krawczyk and Ms Fonseca), Icahn School of Medicine at Mount Sinai, New York, NY; Institute for Studies in Collective Health (Dr Meyer), Universidade Federal do Rio de Janeiro; and Department of Biochemistry (Dr Lima), Universidade Federal do Estado do Rio de Janeiro, RJ, Brazil
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24
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Kosidou K, Dalman C, Fredlund P, Lee BK, Galanti R, Isacsson G, Magnusson C. School performance and the risk of suicide attempts in young adults: a longitudinal population-based study. Psychol Med 2014; 44:1235-1243. [PMID: 23883735 DOI: 10.1017/s0033291713001852] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Poor school performance is strongly associated with attempted suicide, but the mechanisms underlying this association are uncertain. We examined this relationship and the extent to which it is explained by (i) adult health behaviours and (ii) social conditions. Furthermore, we examined the potential modifying role of previous suicidal thoughts in the relationship. METHOD We conducted a longitudinal cohort study of 6146 individuals aged 18-33 years, recruited in 2002 and 2006 in Stockholm and resurveyed in 2007 and 2010 respectively. We estimated the risk of reported lifetime suicide attempts at follow-up among individuals without a history of suicide attempts at baseline and in relation to compulsory school-leaving grades, controlling for possible confounders and mediators. RESULTS There were 91 cases of self-reported suicide attempts during the follow-up (5-year incidence of 1.5%). ORs ranged from 3.35 [95% confidence interval (CI) 1.88-5.96] for those in the lowest grade quartile to 2.60 (95% CI 1.48-4.57) and 1.76 (95% CI 0.99-3.13) for those in the second and third quartiles respectively. The relationship between school performance and risk of suicide attempts did not differ by sex. Adult health behaviours and social conditions marginally attenuated, but did not explain, the relationship. The gradient varied with baseline history of suicidal thoughts, and was found only among individuals without such a history. CONCLUSIONS Poor school performance was found to predict suicide attempts among young adults without a history of suicidal thoughts. Adult health behaviours and social conditions did not explain this relationship. Instead, other factors linked with poor school performance, such as poor coping ability, may increase the risk of suicide attempts.
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Affiliation(s)
- K Kosidou
- Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - C Dalman
- Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - P Fredlund
- Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - B K Lee
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA, USA
| | - R Galanti
- Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - G Isacsson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - C Magnusson
- Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
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25
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Aubin HJ, Luquiens A, Berlin I. Pharmacotherapy for smoking cessation: pharmacological principles and clinical practice. Br J Clin Pharmacol 2014; 77:324-36. [PMID: 23488726 PMCID: PMC4014023 DOI: 10.1111/bcp.12116] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 02/11/2013] [Indexed: 11/30/2022] Open
Abstract
Strategies for assisting smoking cessation include behavioural counselling to enhance motivation and to support attempts to quit and pharmacological intervention to reduce nicotine reinforcement and withdrawal from nicotine. Three drugs are currently used as first line pharmacotherapy for smoking cessation, nicotine replacement therapy, bupropion and varenicline. Compared with placebo, the drug effect varies from 2.27 (95% CI 2.02, 2.55) for varenicline, 1.69 (95% CI 1.53, 1.85) for bupropion and 1.60 (95% CI 1.53, 1.68) for any form of nicotine replacement therapy. Despite some controversy regarding the safety of bupropion and varenicline, regulatory agencies consider these drugs as having a favourable benefit/risk profile. However, given the high rate of psychiatric comorbidity in dependent smokers, practitioners should closely monitor patients for neuropsychiatric symptoms. Second-line pharmacotherapies include nortriptyline and clonidine. This review also offers an overview of pipeline developments and issues related to smoking cessation in special populations such as persons with psychiatric comorbidity and pregnant and adolescent smokers.
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Affiliation(s)
- Henri-Jean Aubin
- Centre d'enseignement, de recherche, et de traitement des addictions, Hôpital Paul Brousse, Pars-Sud 11 UniversityINSERM U669, 94800, Villejuif, France
| | - Amandine Luquiens
- Centre d'enseignement, de recherche, et de traitement des addictions, Hôpital Paul Brousse, Pars-Sud 11 UniversityINSERM U669, 94800, Villejuif, France
| | - Ivan Berlin
- Département de Pharmacologie, Université P.&M. Curie, Faculté de médecine, Hôpital Pitié-Salpêtrière75013, Paris, France
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26
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Young SN. Elevated incidence of suicide in people living at altitude, smokers and patients with chronic obstructive pulmonary disease and asthma: possible role of hypoxia causing decreased serotonin synthesis. J Psychiatry Neurosci 2013; 38:423-6. [PMID: 24148847 PMCID: PMC3819157 DOI: 10.1503/jpn.130002] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Recent research indicates that suicide rates are elevated in those living at higher altitudes in both the United States and South Korea. A possible mechanism that was proposed is metabolic stress associated with hypoxia. This commentary discusses these results, and also the association between elevated suicide rates and other conditions associated with hypoxia (smoking, chronic obstructive pulmonary disease and asthma). Tryptophan hydroxylase may not normally be saturated with oxygen, so mild hypoxia would decrease serotonin synthesis. Low brain serotonin is known to be associated with suicide. Thus, the commentary proposes and discusses the hypothesis that decreased brain serotonin synthesis associated with hypoxia is a mechanism that may contribute to suicide in conditions causing hypoxia. Finally the commentary proposes various studies that could test aspects of this hypothesis.
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Affiliation(s)
- Simon N. Young
- Correspondence to: S.N. Young, Department of Psychiatry, McGill University, 1033 Pine Ave. W, Montréal QC H3A 1A1;
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27
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Baek JH, Eisner LR, Nierenberg AA. Smoking and suicidality in subjects with bipolar disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Depress Anxiety 2013; 30:982-90. [PMID: 23658140 DOI: 10.1002/da.22107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 03/01/2013] [Accepted: 03/01/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Smoking in patients with bipolar disorder is known to be related to suicidality. This link has not been investigated, however, in community-based samples. The aim of this study is to delineate the sociodemographic and clinical characteristics of bipolar smokers and examine the relationship between these characteristics and suicidal ideation or attempts in an epidemiologic database, the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). METHODS Subjects (n = 1,643) with bipolar disorder I and II, defined by the DSM-IV criteria, who had a history of low moods lasting more than 2 weeks were included in our analysis. Current smokers, former smokers, and lifetime nonsmokers were compared in terms of demographic, clinical characteristics, and functional level. Suicidality, evaluated by a history of suicide ideation and attempts while in low mood were compared. RESULTS Current smokers with bipolar disorder showed a greater number of DSM-IV symptoms while in acute episodes, higher rate of alcohol, and drug use disorders, as well as poorer functional levels than nonsmokers. Previous smokers displayed intermediate characteristics between current smokers and nonsmokers. The logistic regression analysis revealed that current smoking status predicted the risk of having a history of attempted suicide (Odds ratio 1.35, 95% CI: 1.05-1.76) after adjusting for age, sex, race, bipolar subtype, lifetime axis II/anxiety/alcohol use/substance use disorder; however, lifetime smoking status did not. CONCLUSIONS The present study confirms that current cigarette smoking can predict attempted suicide in a community representative sample of people with bipolar disorder.
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Affiliation(s)
- Ji Hyun Baek
- Bipolar Clinic and Research Program at Massachusetts General Hospital, Boston, Massachusetts
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28
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Komiyama M, Wada H, Ura S, Yamakage H, Satoh-Asahara N, Shimatsu A, Koyama H, Kono K, Takahashi Y, Hasegawa K. Analysis of factors that determine weight gain during smoking cessation therapy. PLoS One 2013; 8:e72010. [PMID: 23991026 PMCID: PMC3749100 DOI: 10.1371/journal.pone.0072010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 07/05/2013] [Indexed: 12/29/2022] Open
Abstract
Cigarette smokers are generally known to gain weight after quitting smoking, and such weight gain is thought to contribute to the worsening of glucose tolerance. While smoking cessation therapy such as nicotine replacement is useful to minimize post-cessation weight gain, substantial gain occurs even during the therapy. The purpose of the present study was to identify factors associated with weight gain during smoking cessation therapy. We evaluated 186 patients(132 males and 54 females)who visited our outpatient clinic for smoking cessation, and successfully achieved smoking abstinence. We performed gender-adjusted regression analysis for the rate of BMI increase from the beginning of cessation to 3 months after initiation. Furthermore, we performed multivariate analysis to investigate factors that determine the BMI increase after smoking cessation. The mean BMI significantly (p<0.0001) increased from 23.5 ± 3.6 kg/m(2) at the initial consultation to 23.9 ± 3.8 kg/m(2) at 3 months after the start of therapy. There was no significant difference in the extent of BMI increase between nicotine patch and varenicline therapy groups. Factors significantly correlated with the %BMI increase at 3 months after the start of therapy were triglyceride (p = 0.0006, βa = 0.260), high-density lipoprotein cholesterol (p = 0.0386, βa = -0.168), daily cigarette consumption (p = 0.0385, βa = 0.154), and the Fagerström Test for Nicotine Dependence (FTND) score (p = 0.0060, βa = 0.203). Stepwise multivariate analysis demonstrated that triglyceride and the FTND score were the factors determining the post-cessation BMI increase and that the FTND score was the strongest one. The present study demonstrated that smokers with a high FTND score are more likely to gain weight during smoking cessation therapy. Thus, smokers with a high nicotine dependency may require intervention against weight gain in the cessation clinic.
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Affiliation(s)
- Maki Komiyama
- Department of General Internal Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- Department of Hygiene and Public Health, Osaka Medical College, Osaka, Japan
| | - Hiromichi Wada
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shuichi Ura
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hajime Yamakage
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Noriko Satoh-Asahara
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Akira Shimatsu
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hiroshi Koyama
- Department of General Internal Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Koichi Kono
- Department of Hygiene and Public Health, Osaka Medical College, Osaka, Japan
| | - Yuko Takahashi
- Health Care Center, Nara Women’s University, Nara, Japan
| | - Koji Hasegawa
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- * E-mail:
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