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Assari S. Racial Differences in Biopsychosocial Pathways to Tobacco and Marijuana Use Among Youth. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02035-8. [PMID: 38807026 DOI: 10.1007/s40615-024-02035-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND The influence of socioeconomic disparities and multidimensional stressors on youth tobacco and marijuana use is recognized; however, the extent of these effects varies among different racial groups. Understanding the racial differences in the factors influencing substance use is crucial for developing tailored interventions aimed at reducing disparities in tobacco and marijuana use among adolescents. AIMS This study aims to explore the differential effects of socioeconomic disparities and multidimensional stressors on tobacco and marijuana use between Black and White adolescents. METHODS Utilizing longitudinal data from the Adolescent Brain Cognitive Development (ABCD) study, this research includes a cohort of pre-youth, monitored from the age of 9-10 years for a period of up to 36 months. We examined the impact of various socioeconomic status (SES) indicators and multidimensional stressors, including trauma, financial stress, racial discrimination, and family stress, alongside baseline average cortical thickness and the subsequent initiation of tobacco and marijuana use over the 36-month follow-up. RESULTS Overall, 10,777 participants entered our analysis. This included 8263 White and 2514 Black youth. Our findings indicate significant differences in the pathways from SES indicators through stress types to cortical thickness between Black and White youths. Notably, cortical thickness's impact on the future initiation of tobacco and marijuana use was present in both groups. CONCLUSION The study suggests that compared to White adolescents, Black adolescents' substance use and associated cortical thickness are less influenced by stress and SES indicators. This discrepancy may be attributed to the compounded effects of racism, where psychosocial mechanisms might be more diminished for Black youth than White youth. These findings support the theory of Minorities' Diminished Returns rather than the cumulative disadvantage or double jeopardy hypothesis, highlighting the need for interventions that address the unique challenges faced by Black adolescents.
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Affiliation(s)
- Shervin Assari
- Department of Internal Medicine, Charles R Drew University of Medicine and Science, 1731 E. 120th St., Los Angeles, CA, 90059, USA.
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
- Marginalization-Related Diminished Returns, Los Angeles, CA, USA.
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2
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Miller TR, Weinstock LM, Ahmedani BK, Carlson NN, Sperber K, Cook BL, Taxman FS, Arias SA, Kubiak S, Dearing JW, Waehrer GM, Barrett JG, Hulsey J, Johnson JE. Share of Adult Suicides After Recent Jail Release. JAMA Netw Open 2024; 7:e249965. [PMID: 38728036 PMCID: PMC11087834 DOI: 10.1001/jamanetworkopen.2024.9965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/04/2024] [Indexed: 05/13/2024] Open
Abstract
Importance Although people released from jail have an elevated suicide risk, the potentially large proportion of this population in all adult suicides is unknown. Objective To estimate what percentage of adults who died by suicide within 1 year or 2 years after jail release could be reached if the jail release triggered community suicide risk screening and prevention efforts. Design, Setting, and Participants This cohort modeling study used estimates from meta-analyses and jail census counts instead of unit record data. The cohort included all adults who were released from US jails in 2019. Data analysis and calculations were performed between June 2021 and February 2024. Main Outcomes and Measures The outcomes were percentage of total adult suicides within years 1 and 2 after jail release and associated crude mortality rates (CMRs), standardized mortality ratios (SMRs), and relative risks (RRs) of suicide in incarcerated vs not recently incarcerated adults. Taylor expansion formulas were used to calculate the variances of CMRs, SMRs, and other ratios. Random-effects restricted maximum likelihood meta-analyses were used to estimate suicide SMRs in postrelease years 1 and 2 from 10 jurisdictions. Alternate estimate was computed using the ratio of suicides after release to suicides while incarcerated. Results Included in the analysis were 2019 estimates for 7 091 897 adults (2.8% of US adult population; 76.7% males and 23.3% females) who were released from incarceration at least once, typically after brief pretrial stays. The RR of suicide was 8.95 (95% CI, 7.21-10.69) within 1 year after jail release and 6.98 (95% CI, 4.21-9.76) across 2 years after release. A total of 27.2% (95% CI, 18.0%-41.7%) of all adult suicide deaths occurred in formerly incarcerated individuals within 2 years of jail release, and 19.9% (95% CI, 16.2%-24.1%) of all adult suicides occurred within 1 year of release (males: 23.3% [95% CI, 20.8%-25.6%]; females: 24.0% [95% CI, 19.7%-36.8%]). The alternate method yielded slightly larger estimates. Another 0.8% of adult suicide deaths occurred during jail stays. Conclusions and Relevance This cohort modeling study found that adults who were released from incarceration at least once make up a large, concentrated population at greatly elevated risk for death by suicide; therefore, suicide prevention efforts focused on return to the community after jail release could reach many adults within 1 to 2 years of jail release, when suicide is likely to occur. Health systems could develop infrastructure to identify these high-risk adults and provide community-based suicide screening and prevention.
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Affiliation(s)
- Ted R. Miller
- National Capital Region Center, Pacific Institute for Research and Evaluation (PIRE), Beltsville, Maryland
- Curtin University School of Public Health, Beltsville, Maryland
| | - Lauren M. Weinstock
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Brian K. Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Nancy N. Carlson
- School of Counseling, Walden University, Silver Spring, Maryland
| | - Kimberly Sperber
- Complex Health Solutions, Behavioral Health and Wellness, CareSource, Dayton, Ohio
| | - Benjamin Lê Cook
- Harvard Medical School, Cambridge, Massachusetts
- Cambridge Health Alliance, Cambridge, Massachusetts
| | - Faye S. Taxman
- Schar School of Policy and Government, Center for Advancing Correctional Excellence, George Mason University, Fairfax, Virginia
| | - Sarah A. Arias
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
- Butler Hospital, Providence, Rhode Island
| | - Sheryl Kubiak
- Center for Behavioral Health and Justice, Wayne State University School of Social Work, Detroit, Michigan
| | - James W. Dearing
- Department of Communication, Michigan State University, East Lansing
| | - Geetha M. Waehrer
- National Capital Region Center, Pacific Institute for Research and Evaluation (PIRE), Beltsville, Maryland
| | - James G. Barrett
- Harvard Medical School, Cambridge, Massachusetts
- Cambridge Health Alliance, Cambridge, Massachusetts
- Cambridge Police Department, Cambridge, Massachusetts
| | | | - Jennifer E. Johnson
- Charles Stewart Mott Department of Public Health, Michigan State University, East Lansing
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Conrick KM, Mills B, Fuentes M, Graves JM, St. Vil C, Vavilala MS, Bulger EM, Arbabi S, Rowhani-Rahbar A, Moore M. Identifying Common Data Elements to Achieve Injury-related Health Equity Across the Lifespan: A Consensus-Driven Approach. Health Equity 2024; 8:249-253. [PMID: 38595933 PMCID: PMC11002320 DOI: 10.1089/heq.2023.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background Limited availability and poor quality of data in medical records and trauma registries impede progress to achieve injury-related health equity across the lifespan. Methods We used a Nominal Group Technique (NGT) in-person workgroup and a national web-based Delphi process to identify common data elements (CDE) that should be collected. Results The 12 participants in the NGT workgroup and 23 participants in the national Delphi process identified 10 equity-related CDE and guiding lessons for research on collection of these data. Conclusions These high-priority CDE define a detailed, equity-oriented approach to guide research to achieve injury-related health equity across the lifespan.
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Affiliation(s)
- Kelsey M. Conrick
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Brianna Mills
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Molly Fuentes
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Rehabilitation, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Janessa M. Graves
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- College of Nursing, Washington State University, Spokane, Washington, USA
| | | | - Monica S. Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Eileen M. Bulger
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Trauma Surgery, Harborview Medical Center, Seattle, Washington, USA
| | - Saman Arbabi
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Trauma Surgery, Harborview Medical Center, Seattle, Washington, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Megan Moore
- School of Social Work, University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
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4
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Lee CS, Sirin SR, Choi E, Sin EJ. Meta-Analysis of Acculturation and Suicide-Related Outcomes: A Test of the Immigrant Paradox. J Racial Ethn Health Disparities 2024; 11:913-927. [PMID: 36943654 DOI: 10.1007/s40615-023-01572-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE This meta-analysis aimed to systematically test the relation between acculturation and suicide-related outcomes among immigrants, with attention to key methodological (i.e., measure of suicide-related outcome, measure of acculturation) and demographic (i.e., race, gender, age, geographic region, publication year) moderators. METHOD We conducted a meta-analysis of 72 independent samples from 50 studies (38 peer-reviewed articles, 12 dissertations) representing more than 1.4 million immigrants. Participants' age ranged from 11.20 to 74.70 years (M = 29.96, SD = 15.07). Random effects models were used for both main and moderation analyses. RESULTS We found significant positive associations between acculturation and suicidal ideation, but not suicide attempts and deaths. We also found a significant and positive effect of acculturation on suicide-related outcomes when acculturation was measured by psychological scales, but not by generation status, length of residence in the host country, and proficiency in the host country's language. More acculturated Latinx immigrants were at higher risk for suicide-related outcomes, whereas a reverse pattern was found among Asian immigrants. Meta-regressions revealed that the moderating effects of participants' age and publication year were also significant. CONCLUSION Our results show partial support for the immigrant paradox but suggest that the relation between acculturation and suicide-related outcomes is complex and multifaceted. We discuss the implications of our findings and recommendations for research and prevention.
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Affiliation(s)
- Christina Seowoo Lee
- Department of Applied Psychology, New York University, 246 Greene St, New York, NY, 10004, USA.
| | - Selcuk R Sirin
- Department of Applied Psychology, New York University, 246 Greene St, New York, NY, 10004, USA
| | - Elysia Choi
- Department of Applied Psychology, New York University, 246 Greene St, New York, NY, 10004, USA
| | - Esther J Sin
- Department of Applied Psychology, New York University, 246 Greene St, New York, NY, 10004, USA
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5
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Clapham R, Brausch A. Internalizing and Externalizing Symptoms Moderate the Relationship Between Emotion Dysregulation and Suicide Ideation in Adolescents. Child Psychiatry Hum Dev 2024; 55:467-478. [PMID: 36066655 PMCID: PMC9986343 DOI: 10.1007/s10578-022-01413-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/14/2022] [Accepted: 08/02/2022] [Indexed: 01/09/2023]
Abstract
The relationship between emotion dysregulation and suicide ideation may depend on the level of internalizing and externalizing symptoms. It was expected that both internalizing and externalizing symptoms would moderate the relationship between emotion dysregulation and suicide ideation, such that greater symptoms would strengthen the relationship between emotion dysregulation and suicide ideation. Adolescent participants (n = 559, Mage = 15.40, 85.0% white, 57.2% female) completed self-report measures that assessed emotion dysregulation, internalizing and externalizing symptoms, and recent suicide ideation. Both internalizing and externalizing symptoms moderated the relationship between emotion dysregulation and suicide ideation; this relationship strengthened as internalizing and externalizing symptoms increased. The results of this study indicate that internalizing and externalizing symptoms may both affect the connection between emotion dysregulation and suicide ideation. Future research should focus on targeting both internalizing and externalizing symptoms in treatment to help reduce emotion dysregulation and suicide ideation in adolescents.
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Affiliation(s)
- Rebekah Clapham
- Department of Psychological Sciences, Western Kentucky University, 1906 College Heights Blvd., 42101, Bowling Green, KY, USA
| | - Amy Brausch
- Department of Psychological Sciences, Western Kentucky University, 1906 College Heights Blvd., 42101, Bowling Green, KY, USA.
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6
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Adams RS, Forster JE, Gradus JL, Hoffmire CA, Hostetter TA, Larson MJ, Smith AA, Walsh CG, Brenner LA. Divergent trends in accidental deaths since return from an Afghanistan/Iraq deployment among army soldiers. Ann Epidemiol 2024; 91:23-29. [PMID: 38185289 DOI: 10.1016/j.annepidem.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024]
Abstract
PURPOSE Accidental death is a leading cause of mortality among military members and Veterans; however, knowledge is limited regarding time-dependent risk following deployment and if there are differences by type of accidental death. METHODS Longitudinal cohort study (N = 860,930) of soldiers returning from Afghanistan/Iraq deployments in fiscal years 2008-2014. Accidental deaths (i.e., motor vehicle accidents [MVA], accidental overdose, other accidental deaths), were identified through 2018. Crude and age-adjusted mortality rates, rate ratios, time-dependent hazard rates and trends postdeployment were compared across demographic and military characteristics. RESULTS During the postdeployment observation period, over one-third of deaths were accidental; most were MVA (46.0 %) or overdoses (37.9 %). Across accidental mortality categories (all, MVA, overdose), younger soldiers (18-24, 25-29) were at higher risk compared to older soldiers (40+), and females at lower risk than males. MVA death rates were highest immediately postdeployment, with a significant decreasing hazard rate over time (annual percent change [APC]: -6.5 %). Conversely, accidental overdose death rates were lowest immediately following deployment, with a significant increasing hazard rate over time (APC: 9.9 %). CONCLUSIONS Observed divergent trends in risk for the most common types of accidental deaths provide essential information to inform prevention and intervention planning for the immediate postdeployment transition and long-term.
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Affiliation(s)
- Rachel Sayko Adams
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, MA, USA; Brandeis University, The Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA, USA; Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA.
| | - Jeri E Forster
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA; University of Colorado, Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, Aurora, CO, USA
| | - Jaimie L Gradus
- Boston University School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - Claire A Hoffmire
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA; University of Colorado, Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, Aurora, CO, USA
| | - Trisha A Hostetter
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA
| | - Mary Jo Larson
- Brandeis University, The Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA, USA
| | - Alexandra A Smith
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA
| | - Colin G Walsh
- Vanderbilt University Medical Center, Departments of Biomedical Informatics, Medicine, and Psychiatry, Nashville, TN, USA
| | - Lisa A Brenner
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA; University of Colorado, Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, Aurora, CO, USA; University of Colorado, Departments of Psychiatry and Neurology, Anschutz Medical Campus, Aurora, CO, USA
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7
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Arseniev-Koehler A, Mays VM, Foster JG, Chang KW, Cochran SD. Gendered Patterns in Manifest and Latent Mental Health Indicators Among Suicide Decedents: 2003-2020 National Violent Death Reporting System (NVDRS). Am J Public Health 2024; 114:S268-S277. [PMID: 37948056 PMCID: PMC10976443 DOI: 10.2105/ajph.2023.307427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 11/12/2023]
Abstract
Objectives. To investigate differences in the documentation of mental health symptomology between male and female suicide decedents in the 2003-2020 US National Violent Death Reporting System (NVDRS). Methods. Using information on 271 998 suicides in the 2003-2020 NVDRS, we evaluated precoded mental health-related variables and topic model-derived latent mental health themes in the law enforcement and coroner or medical examiner death narratives compiled by trained public health workers. Results. Public health records of male compared with female suicides were less likely to include notations of mental health conditions or treatment interventions. However, topic modeling of death summaries revealed that male suicide decedents were more likely to evidence several subclinical cognitive and emotional indicators of distress. Conclusions. Suicide death records vary by gender, both in recorded evidence for mental health conditions at time of death and in accompanying narratives describing proximal circumstances surrounding these deaths. Our findings hint that patterns of subclinical mental health changes among men might be less well captured in commonly used mental health indicators, suggesting that prevention efforts may benefit from measures that also target assessment of subclinical distress. (Am J Public Health. 2024;114(S3):S268-S277. https://doi.org/10.2105/AJPH.2023.307427).
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Affiliation(s)
- Alina Arseniev-Koehler
- Alina Arseniev-Koehler is with the Division of Biomedical Informatics, University of California, San Diego, La Jolla, and the Department of Sociology, Purdue University, West Lafayette, IN. Vickie M. Mays is with the Department of Psychology, University of California, Los Angeles (UCLA), and the Department of Health Policy and Management, UCLA Fielding School of Public Health. Jacob G. Foster is with the Department of Sociology, UCLA. Kai-Wei Chang is with the Department of Computer Science, UCLA Samueli School of Engineering. Susan D. Cochran is with the Department of Epidemiology, UCLA Fielding School of Public Health, and the Department of Statistics, UCLA. Vickie M. Mays and Susan D. Cochran served as guest editors for this supplemental issue
| | - Vickie M Mays
- Alina Arseniev-Koehler is with the Division of Biomedical Informatics, University of California, San Diego, La Jolla, and the Department of Sociology, Purdue University, West Lafayette, IN. Vickie M. Mays is with the Department of Psychology, University of California, Los Angeles (UCLA), and the Department of Health Policy and Management, UCLA Fielding School of Public Health. Jacob G. Foster is with the Department of Sociology, UCLA. Kai-Wei Chang is with the Department of Computer Science, UCLA Samueli School of Engineering. Susan D. Cochran is with the Department of Epidemiology, UCLA Fielding School of Public Health, and the Department of Statistics, UCLA. Vickie M. Mays and Susan D. Cochran served as guest editors for this supplemental issue
| | - Jacob G Foster
- Alina Arseniev-Koehler is with the Division of Biomedical Informatics, University of California, San Diego, La Jolla, and the Department of Sociology, Purdue University, West Lafayette, IN. Vickie M. Mays is with the Department of Psychology, University of California, Los Angeles (UCLA), and the Department of Health Policy and Management, UCLA Fielding School of Public Health. Jacob G. Foster is with the Department of Sociology, UCLA. Kai-Wei Chang is with the Department of Computer Science, UCLA Samueli School of Engineering. Susan D. Cochran is with the Department of Epidemiology, UCLA Fielding School of Public Health, and the Department of Statistics, UCLA. Vickie M. Mays and Susan D. Cochran served as guest editors for this supplemental issue
| | - Kai-Wei Chang
- Alina Arseniev-Koehler is with the Division of Biomedical Informatics, University of California, San Diego, La Jolla, and the Department of Sociology, Purdue University, West Lafayette, IN. Vickie M. Mays is with the Department of Psychology, University of California, Los Angeles (UCLA), and the Department of Health Policy and Management, UCLA Fielding School of Public Health. Jacob G. Foster is with the Department of Sociology, UCLA. Kai-Wei Chang is with the Department of Computer Science, UCLA Samueli School of Engineering. Susan D. Cochran is with the Department of Epidemiology, UCLA Fielding School of Public Health, and the Department of Statistics, UCLA. Vickie M. Mays and Susan D. Cochran served as guest editors for this supplemental issue
| | - Susan D Cochran
- Alina Arseniev-Koehler is with the Division of Biomedical Informatics, University of California, San Diego, La Jolla, and the Department of Sociology, Purdue University, West Lafayette, IN. Vickie M. Mays is with the Department of Psychology, University of California, Los Angeles (UCLA), and the Department of Health Policy and Management, UCLA Fielding School of Public Health. Jacob G. Foster is with the Department of Sociology, UCLA. Kai-Wei Chang is with the Department of Computer Science, UCLA Samueli School of Engineering. Susan D. Cochran is with the Department of Epidemiology, UCLA Fielding School of Public Health, and the Department of Statistics, UCLA. Vickie M. Mays and Susan D. Cochran served as guest editors for this supplemental issue
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8
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Fitch KV, Pence BW, Rosen DL, Miller VE, Gaynes BN, Swilley-Martinez ME, Kavee AL, Carey TS, Proescholdbell SK, Ranapurwala SI. Suicide Mortality Among Formerly Incarcerated People Compared With the General Population in North Carolina, 2000-2020. Am J Epidemiol 2024; 193:489-499. [PMID: 37939151 DOI: 10.1093/aje/kwad214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/11/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
We aimed to compare rates and characteristics of suicide mortality in formerly incarcerated people with those of the general population in North Carolina. We conducted a retrospective cohort study of 266,400 people released from North Carolina state prisons between January 1, 2000, and March 1, 2020. Using direct and indirect standardization by age, sex, and calendar year, we calculated standardized suicide mortality rates and standardized mortality ratios comparing formerly incarcerated people with the North Carolina general population. We evaluated effect modification by race/ethnicity, sex, age, and firearm involvement. Formerly incarcerated people had approximately twice the overall suicide mortality of the general population for 3 years after release, with the highest rate of suicide mortality being observed in the 2-week period after release. In contrast to patterns in the general population, formerly incarcerated people had higher rates of non-firearm-involved suicide mortality than firearm-involved suicide mortality. Formerly incarcerated female, White and Hispanic/Latino, and emerging adult people had a greater elevation of suicide mortality than their general-population peers compared with other groups. These findings suggest a need for long-term support for formerly incarcerated people as they return to community living and a need to identify opportunities for interventions that reduce the harms of incarceration for especially vulnerable groups. This article is part of a Special Collection on Mental Health.
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Simon DH, Masters RK. Institutional Failures as Structural Determinants of Suicide: The Opioid Epidemic and the Great Recession in the United States. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465231223723. [PMID: 38235534 DOI: 10.1177/00221465231223723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
We investigate recent trends in U.S. suicide mortality using a "structural determinants of health" framework. We access restricted-use multiple cause of death files to track suicide rates among U.S. Black, White, American Indian/Alaska Native, and Latino/a men and women between 1990 and 2017. We examine suicide deaths separately by poisonings and nonpoisonings to illustrate that (1) women's suicide rates from poisonings track strongly with increases in prescription drug availability and (2) nonpoisoning suicide rates among all adult Americans track strongly with worsening economic conditions coinciding with the financial crash and Great Recession. These findings suggest that institutional failures elevated U.S. suicide risk between 1990 and 2017 by increasing access to more lethal means of self-harm and by increasing both exposure and vulnerability to economic downturns. Together, these results support calls to scale up to focus on the structural determinants of U.S. suicide.
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10
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Lewis C, Fedock G, Garthe R, Lee C. Racial Differences in Suicidal Behaviors and Post-Suicide Attempt Treatment: a Latent Class Analysis of Incarcerated Men's Experiences. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01826-9. [PMID: 37938433 DOI: 10.1007/s40615-023-01826-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 09/06/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023]
Abstract
Community-based research has found racial differences in suicide attempts for Black and White men and in how men are treated after a suicide attempt; however, prison-based research has largely not explored such differences. This study examined racial differences in the circumstances of incarcerated men's suicide attempts and investigated health care disparities in staff responses to these suicide attempts. With administrative data from three state prisons over a 5-year period, we conducted a latent class analysis to explore patterns of suicide attempts for 207 incarcerated men. We examined race as a predictor of class membership. Black men were more likely than White men to use a method of hanging/suffocation for attempting suicide, and they were also commonly subjected to segregation when they attempted suicide. Black men were less likely to receive health care post-attempt than White men. Given the findings of this study, several key researches, practices, and policy directions are needed to prevent suicide and promote the health and well-being of incarcerated men, particularly incarcerated Black men.
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Affiliation(s)
- Cashell Lewis
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E. 60th Street, Chicago, IL, 60637, USA.
| | - Gina Fedock
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E. 60th Street, Chicago, IL, 60637, USA
| | - Rachel Garthe
- School of Social Work, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Carol Lee
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
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11
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Syed O, Jancic P, Fink AB, Knezevic NN. Drug Safety and Suicidality Risk of Chronic Pain Medications. Pharmaceuticals (Basel) 2023; 16:1497. [PMID: 37895968 PMCID: PMC10609967 DOI: 10.3390/ph16101497] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
Chronic pain is one of the main leading causes of disability in the world at present. A variety in the symptomatology, intensity and duration of this phenomenon has led to an ever-increasing demand of pharmacological treatment and relief. This demand for medication, ranging from well-known groups, such as antidepressants and benzodiazepines, to more novel drugs, was followed by a rise in safety concerns of such treatment options. The validity, frequency, and diversity of such concerns are discussed in this paper, as well as their possible effect on future prescription practices. A specific caution is provided towards the psychological safety and toll of these medications, regarding suicidality and suicidal ideation. Most significantly, this paper highlights the importance of pharmacovigilance and underscores the necessity of surveillance programs when considering chronic pain medication.
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Affiliation(s)
- Osman Syed
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA; (O.S.); (P.J.); (A.B.F.)
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL 60515, USA
| | - Predrag Jancic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA; (O.S.); (P.J.); (A.B.F.)
| | - Adam B. Fink
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA; (O.S.); (P.J.); (A.B.F.)
- Harborview Medical Center, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA 98104, USA
| | - Nebojsa Nick Knezevic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA; (O.S.); (P.J.); (A.B.F.)
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
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12
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Grobman B, Mansur A, Babalola D, Srinivasan AP, Antonio JM, Lu CY. Suicide among Cancer Patients: Current Knowledge and Directions for Observational Research. J Clin Med 2023; 12:6563. [PMID: 37892700 PMCID: PMC10607431 DOI: 10.3390/jcm12206563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/03/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Cancer is a major public health concern associated with an increased risk of psychosocial distress and suicide. The reasons for this increased risk are still being characterized. The purpose of this study is to highlight existing observational studies on cancer-related suicides in the United States and identify gaps for future research. This work helps inform clinical and policy decision-making on suicide prevention interventions and ongoing research on the detection and quantification of suicide risk among cancer patients. We identified 73 peer-reviewed studies (2010-2022) that examined the intersection of cancer and suicide using searches of PubMed and Embase. Overall, the reviewed studies showed that cancer patients have an elevated risk of suicide when compared to the general population. In general, the risk was higher among White, male, and older cancer patients, as well as among patients living in rural areas and with lower socioeconomic status. Future studies should further investigate the psychosocial aspects of receiving a diagnosis of cancer on patients' mental health as well as the impact of new treatments and their availability on suicide risk and disparities among cancer patients to better inform policies.
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Affiliation(s)
- Ben Grobman
- Harvard Medical School, Boston, MA 02115, USA; (B.G.); (A.M.)
| | - Arian Mansur
- Harvard Medical School, Boston, MA 02115, USA; (B.G.); (A.M.)
| | - Dolapo Babalola
- College of Medicine, University of Ibadan, Ibadan 200285, Nigeria;
| | | | | | - Christine Y. Lu
- Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA 02215, USA
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW 2050, Australia
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, The Northern Sydney Local Health District, Sydney, NSW 2064, Australia
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13
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Akinyemi O, Ogundare T, Oladunjoye AF, Nasef KE, Lipscombe C, Akinbote JA, Bezold M. Factors associated with suicide/self-inflicted injuries among women aged 18-65 years in the United States: A 13-year retrospective analysis of the National Inpatient Sample database. PLoS One 2023; 18:e0287141. [PMID: 37788271 PMCID: PMC10547191 DOI: 10.1371/journal.pone.0287141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/30/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Suicide is a significant cause of mortality in the United States, accounting for 14.5 deaths/100,000. Although there are data on gender disparity in suicide/self-inflicted injury rates in the United States, few studies have examined the factors associated with suicide/self-inflicted injury in females. OBJECTIVE To determine factors associated with suicide/self-inflicted injuries among women aged 18-65 years in the United States. METHODS Hospitalizations for suicide or self-inflicted injuries were identified using the National Inpatient Sample database from 2003-2015 using sample weights to generate national estimates. Independent predictors of suicide/self-inflicted injuries were identified using multivariable regression models. Interaction term analysis to identify the interaction between race/ethnicity and income were conducted. RESULTS There were 1,031,693 adult women hospitalizations in the U.S. with a primary diagnosis of suicide/self-inflicted injury in the study period. The highest suicide/self-inflicted injury risk was among women aged 31-45years (OR = 1.23, CI = 1.19-1.27, p < 0.05). Blacks in the highest income strata had a 20% increase in the odds of suicide/self-inflicted injury compared to Whites in the lowest socioeconomic strata (OR = 1.20, CI = 1.05-1.37, p <0.05). Intimate partner violence increased suicide/self-inflicted injury risk 6-fold (OR = 5.77, CI = 5.01-6.65, p < 0.05). CONCLUSION Suicide risk is among women aged 31-45 years, higher earning Black women, intimate partner violence victims, uninsured, and current smokers. Interventions and policies that reduce smoking, prevents intimate partner violence, addresses racial discrimination and bias, and provides universal health coverage are needed to prevent excess mortality from suicide deaths.
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Affiliation(s)
- Oluwasegun Akinyemi
- Clive O Callender Department of Surgery, Howard University, Washington, D.C., United States of America
| | - Temitope Ogundare
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America
| | - Adeolu Funsho Oladunjoye
- Department of Obstetrics and Gynecology, Howard University, Washington, D.C., United States of America
| | - Kindha Elleissy Nasef
- Department of Obstetrics and Gynecology, Howard University, Washington, D.C., United States of America
| | - Christina Lipscombe
- Department of Obstetrics and Gynecology, Howard University, Washington, D.C., United States of America
| | - John Akinshola Akinbote
- Department of Obstetrics and Gynecology, Howard University, Washington, D.C., United States of America
| | - Maureen Bezold
- Department of Health Sciences and Social Work, Western Illinois University, Macomb, Illinois, United States of America
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14
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Phillips JA, Davidson TR, Baffoe-Bonnie MS. Identifying latent themes in suicide among black and white adolescents and young adults using the National Violent Death Reporting System, 2013-2019. Soc Sci Med 2023; 334:116144. [PMID: 37678110 DOI: 10.1016/j.socscimed.2023.116144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 09/09/2023]
Abstract
Suicide rates for adolescents and young adults (AYA) have risen dramatically in recent years - by almost 60% for Americans aged 10-24 years between 2007 and 2018. This increase has occurred for both whites and Blacks, with the rise in suicide among Black youth of particular note. Blacks historically exhibit lower rates of suicide relative to whites and thus, less is known about the etiology of Black suicide. To gain insight into the underlying causes of suicide among AYA, we examine medical examiner reports from the National Violent Death Reporting System (NVDRS) from 2013 to 2019 for over 26,000 Black and white suicide decedents ages 10-29. We apply structural topic modeling (STM) approaches to describe the broad contours of AYA suicide in the United States today. Our findings reveal distinct patterns by race. Guns, violence and the criminal justice system are prominent features of Black suicide, whether through the mechanism used in the suicide, either by firearm or other violent means such as fire or electrocution, the existence of criminal or legal problems/disputes, the location of death in a jail, or the presence of police. In contrast, the narratives of white AYA are more likely to reference mental health or substance abuse problems. Access to resources, as measured by county median household income, overlay these patterns. Themes more prevalent among Blacks are more common in poorer counties; those more prevalent among whites tend to be more common in wealthier counties. Our findings are consistent with other studies that suggest Black people experience greater exposure to violence and other traumas, systemic racism and interpersonal discrimination that may elevate the risk for suicidal behavior.
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Affiliation(s)
- Julie A Phillips
- Department of Sociology, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ, 08901, USA.
| | - Thomas R Davidson
- Department of Sociology, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ, 08901, USA
| | - Marilyn S Baffoe-Bonnie
- Department of Sociology, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ, 08901, USA
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15
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Livingston WS, Tannahill HS, Meter DJ, Fargo JD, Blais RK. The Association of Military Sexual Harassment/Assault With Suicide Ideation, Plans, Attempts, and Mortality Among US Service Members/Veterans: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:2616-2629. [PMID: 35763372 DOI: 10.1177/15248380221109790] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Suicide rates continue to increase among service members/veterans. Military sexual harassment/assault (MSH/A) may increase risk of suicide, but little is known about the collective magnitude of associations between MSH/A and suicide outcomes, including ideation, plan, attempt, and mortality. The current meta-analysis addressed this literature gap while testing potential moderators of gender, marital status, discharge status, and military branch. PsycINFO, PubMed, Dissertations/Theses, relevant citation lists, and conference brochures were reviewed for papers that included quantitative analyses in English, U.S. military samples, and measures of MSH/A and suicide ideation/plan/attempt/mortality. The search resulted in 22 studies (N = 10,898,875) measuring the association of MSH/A with suicide ideation (k = 15), plans (k = 1), attempts (k = 14), and mortality (k = 2), with papers published from 2007-2021. MSH/A was associated with suicide ideation (r ¯ = .14) and attempts (r ¯ = .11, ps < .05). The association of MSH/A and suicide ideation and attempts was higher among women relative to men, those identifying as married versus not married, those actively serving compared to discharged, and those reporting service in the Air Force relative to all other branches. The association of MSH/A with suicide plans and mortality was not calculated due to the small number of studies reporting those effect sizes (ks = 1-2). The effect sizes observed suggest MSH/A is part of a larger network of risk factors for suicide. Moderators indicate that suicide risk is higher among specific groups, and prevention strategies would be most effective if they targeted these individuals. This research area would be strengthened by additional studies of plans and mortality.
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Affiliation(s)
| | | | - Diana J Meter
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Jamison D Fargo
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Rebecca K Blais
- Department of Psychology, Utah State University, Logan, UT, USA
- Psychology Department, Arizona State University,Tempe, AZ, USA
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16
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Kandula S, Higgins J, Goldstein A, Gould MS, Olfson M, Keyes KM, Shaman J. Trends in Crisis Hotline Call Rates and Suicide Mortality in the United States. Psychiatr Serv 2023; 74:978-981. [PMID: 36872897 PMCID: PMC10480335 DOI: 10.1176/appi.ps.20220199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Utilization of the 988 Suicide and Crisis Lifeline (Lifeline; formerly called the National Suicide Prevention Lifeline) was analyzed in relation to suicide deaths in U.S. states between 2007 and 2020 to identify states with potential unmet need for mental health crisis hotline services. METHODS Annual state call rates were calculated from calls routed to the Lifeline during the 2007-2020 period (N=13.6 million). Annual state suicide mortality rates (standardized) were calculated from suicide deaths reported to the National Vital Statistics System (2007-2020 cumulative deaths=588,122). Call rate ratio (CRR) and mortality rate ratio (MRR) were estimated by state and year. RESULTS Sixteen U.S. states demonstrated a consistently high MRR and a low CRR, suggesting high suicide burden and relatively low Lifeline use. Heterogeneity in state CRRs decreased over time. CONCLUSIONS Prioritizing states with a high MRR and a low CRR for messaging and outreach regarding the availability of the Lifeline can ensure more equitable, need-based access to this critical resource.
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Affiliation(s)
- Sasikiran Kandula
- Department of Environmental Health Sciences (Kandula, Shaman), Department of Epidemiology (Gould, Olfson, Keyes), and Department of Psychiatry (Gould, Olfson), Columbia University, New York City; 988 Suicide and Crisis Lifeline, Vibrant Emotional Health, New York City (Higgins, Goldstein)
| | - Johnathan Higgins
- Department of Environmental Health Sciences (Kandula, Shaman), Department of Epidemiology (Gould, Olfson, Keyes), and Department of Psychiatry (Gould, Olfson), Columbia University, New York City; 988 Suicide and Crisis Lifeline, Vibrant Emotional Health, New York City (Higgins, Goldstein)
| | - Alena Goldstein
- Department of Environmental Health Sciences (Kandula, Shaman), Department of Epidemiology (Gould, Olfson, Keyes), and Department of Psychiatry (Gould, Olfson), Columbia University, New York City; 988 Suicide and Crisis Lifeline, Vibrant Emotional Health, New York City (Higgins, Goldstein)
| | - Madelyn S Gould
- Department of Environmental Health Sciences (Kandula, Shaman), Department of Epidemiology (Gould, Olfson, Keyes), and Department of Psychiatry (Gould, Olfson), Columbia University, New York City; 988 Suicide and Crisis Lifeline, Vibrant Emotional Health, New York City (Higgins, Goldstein)
| | - Mark Olfson
- Department of Environmental Health Sciences (Kandula, Shaman), Department of Epidemiology (Gould, Olfson, Keyes), and Department of Psychiatry (Gould, Olfson), Columbia University, New York City; 988 Suicide and Crisis Lifeline, Vibrant Emotional Health, New York City (Higgins, Goldstein)
| | - Katherine M Keyes
- Department of Environmental Health Sciences (Kandula, Shaman), Department of Epidemiology (Gould, Olfson, Keyes), and Department of Psychiatry (Gould, Olfson), Columbia University, New York City; 988 Suicide and Crisis Lifeline, Vibrant Emotional Health, New York City (Higgins, Goldstein)
| | - Jeffrey Shaman
- Department of Environmental Health Sciences (Kandula, Shaman), Department of Epidemiology (Gould, Olfson, Keyes), and Department of Psychiatry (Gould, Olfson), Columbia University, New York City; 988 Suicide and Crisis Lifeline, Vibrant Emotional Health, New York City (Higgins, Goldstein)
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17
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Clapham R, Laves E, Fergerson A, Nichols P, Brausch A. Interoceptive deficits moderate the relationship between bulimia symptoms and suicide risk. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1612-1621. [PMID: 34242545 PMCID: PMC8742842 DOI: 10.1080/07448481.2021.1944165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 04/14/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
Objective: Interoceptive deficits have been linked to suicidality and eating disorders. The relationship between disordered eating symptoms and suicidality may depend on the level of interoceptive deficits. It was expected that interoceptive deficits would moderate the relationship between disordered eating symptoms (oral control, dieting, and bulimia) and suicidality (suicide attempts, ideation, and communication) when interoceptive deficits were high. Methods: University students (N = 417, Mage = 19.75, 78.2% white, 72.4% female) completed self-report measures that assessed disordered eating, interoceptive deficits, and suicide history. Results: Interoceptive deficits emerged as a significant moderator only in the association between bulimia symptoms and suicidality, when interoceptive deficits were high. Conclusions: The results of this study indicate that bulimia symptoms may have a unique interaction with interoceptive deficits and suicidality. Future research should focus on targeting interoceptive deficits in treatment to help reduce disordered eating symptoms and suicide risk, particularly for students with bulimia symptoms.
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Affiliation(s)
- Rebekah Clapham
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY
| | - Eliza Laves
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY
| | - Ava Fergerson
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY
- Ava Fergerson is now in the School of Psychology, University of Southern Mississippi, Hattiesburg, MS
| | - Paige Nichols
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY
| | - Amy Brausch
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY
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18
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Cureton JL, Spates K, James T, Lloyd C. Readiness of a U.S. Black community to address suicide. DEATH STUDIES 2023; 48:197-206. [PMID: 37226926 DOI: 10.1080/07481187.2023.2214888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Communities need to be ready to address increased suicide among Black Americans. The Community Readiness Model (CRM) provides an established assessment for marginalized communities facing suicide. CRM assessment of the Northeast Ohio Black community involved interviews with 25 representatives, analysis using rating scales, co-scoring, and calculation. Results include a marginal overall score and low to average scores for five dimensions: knowledge of efforts to address suicide, leadership, community climate, knowledge of suicide, and resources. The vague awareness readiness stage indicates the community is unclear about what can be done to address suicide and has not taken ownership of the issue. We highlight implications for mental health practice, prevention and funding campaigns, and consultation with community leadership for culturally informed prevention strategies targeting areas of lowest readiness. Future research should use expanded designs to examine readiness changes from intervention in this and other Black communities.
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Affiliation(s)
- Jenny L Cureton
- Counselor Education and Supervision, Kent State University, Kent, Ohio, USA
| | - Kamesha Spates
- Africana Studies, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tierra James
- Sociology, Anthropology & Social Work, College of Liberal Arts, Auburn University, Auburn, Alabama, USA
| | - Christina Lloyd
- Counselor Education and Supervision, Kent State University, Kent, Ohio, USA
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19
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Chakoma T, Moon PK, Osazuwa-Peters OL, Megwalu UC, Osazuwa-Peters N. Association of Human Papillomavirus Status With Suicide Risk Among Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:291-299. [PMID: 36795392 PMCID: PMC9936382 DOI: 10.1001/jamaoto.2022.4839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/06/2022] [Indexed: 02/17/2023]
Abstract
Importance Human papillomavirus (HPV) is strongly associated with head and neck cancer, and HPV status is considered a prognostic factor. Being a sexually transmitted infection, HPV-related cancers may have greater risk of stigma and psychological distress; however, the potential association of HPV-positive status with psychosocial outcomes, such as suicide, is understudied in head and neck cancer. Objective To investigate the association between HPV tumor status and suicide risk among patients with head and neck cancer. Design, Setting, and Participants This population-based retrospective cohort study included adult patients with clinically confirmed cases of head and neck cancer based on HPV tumor status from the Surveillance, Epidemiology, and End Results database from January 1, 2000, to December 31, 2018. Data analysis was conducted from February 1 to July 22, 2022. Main Outcomes and Measures The outcome of interest was death by suicide. Primary measure was HPV status of tumor site, dichotomized as positive or negative. Covariates included age, race, ethnicity, marital status, cancer stage at presentation, treatment modality, and type of residence. Cumulative risk of suicide among patients with HPV-positive and HPV-negative head and neck cancer was assessed using Fine and Gray competing risk models. Results Of 60 361 participants, the mean (SD) age was 61.2 (13.65) years, and 17 036 (28.2%) were women; there were 347 (0.6%) American Indian, 4369 (7.2%) Asian, 5226 (8.7%) Black, 414 (0.7%) Native Hawaiian or Other Pacific Islander, and 49 187 (81.5%) White individuals. A competing risk analysis showed a significant difference in the cumulative incidence of suicide between HPV-positive cancers (5-year suicide-specific mortality, 0.43%; 95% CI, 0.33%-0.55%) and HPV-negative cancers (5-year suicide-specific mortality, 0.24%; 95% CI, 0.19%-0.29%). Tumor status that was HPV positive was associated with increased suicide risk in the unadjusted model (hazard ratio [HR], 1.76; 95% CI, 1.28-2.40), but not the fully adjusted model (adjusted HR, 1.18; 95% CI, 0.79-1.79). Among people with oropharyngeal cancer only, HPV status was associated with increased suicide risk, but the width of the confidence interval prevented definitive conclusion (adjusted HR, 1.61; 95% CI 0.88-2.94). Conclusions and Relevance The results of this cohort study suggest that patients with HPV-positive head and neck cancer have similar risk of suicide as patients with HPV-negative cancer, despite differences in overall prognosis. Early mental health interventions may be associated with reduced suicide risk in all patients with head and neck cancer and should be assessed in future work.
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Affiliation(s)
- Tatenda Chakoma
- Stanford University School of Medicine, Stanford, California
| | - Peter K Moon
- Stanford University School of Medicine, Stanford, California
| | - Oyomoare L Osazuwa-Peters
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Uchechukwu C Megwalu
- Stanford University School of Medicine, Stanford, California
- Stanford Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Nosayaba Osazuwa-Peters
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Duke University, Durham, North Carolina
- Duke Center for the Study of Suicide Prevention and Intervention, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
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20
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Kandula S, Martinez-Alés G, Rutherford C, Gimbrone C, Olfson M, Gould MS, Keyes KM, Shaman J. County-level estimates of suicide mortality in the USA: a modelling study. Lancet Public Health 2023; 8:e184-e193. [PMID: 36702142 PMCID: PMC9990589 DOI: 10.1016/s2468-2667(22)00290-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/11/2022] [Accepted: 10/31/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Suicide is one of the leading causes of death in the USA and population risk prediction models can inform decisions on the type, location, and timing of public health interventions. We aimed to develop a prediction model to estimate county-level suicide risk in the USA using population characteristics. METHODS We obtained data on all deaths by suicide reported to the National Vital Statistics System between Jan 1, 2005, and Dec 31, 2019, and age, sex, race, and county of residence of the decedents were extracted to calculate baseline risk. We also obtained county-level annual measures of socioeconomic predictors of suicide risk (unemployment, weekly wage, poverty prevalence, median household income, and population density) and state-level prevalence of major depressive disorder and firearm ownership from US public sources. We applied conditional autoregressive models, which account for spatiotemporal autocorrelation in response and predictors, to estimate county-level suicide risk. FINDINGS Estimates derived from conditional autoregressive models were more accurate than from models not adjusted for spatiotemporal autocorrelation. Inclusion of suicide risk and protective covariates further reduced errors. Suicide risk was estimated to increase with each SD increase in firearm ownership (2·8% [95% credible interval (CrI) 1·8 to 3·9]), prevalence of major depressive episode (1·0% [0·4 to 1·5]), and unemployment rate (2·8% [1·9 to 3·8]). Conversely, risk was estimated to decrease by 4·3% (-5·1 to -3·2) for each SD increase in median household income and by 4·3% (-5·8 to -2·5) for each SD increase in population density. An increase in the heterogeneity in county-specific suicide risk was also observed during the study period. INTERPRETATION Area-level characteristics and the conditional autoregressive models can estimate population-level suicide risk. Availability of near real-time situational data are necessary for the translation of these models into a surveillance setting. Monitoring changes in population-level risk of suicide could help public health agencies select and deploy targeted interventions quickly. FUNDING US National Institute of Mental Health.
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Affiliation(s)
- Sasikiran Kandula
- Department of Environmental Health Sciences, Columbia University, New York, NY, USA.
| | - Gonzalo Martinez-Alés
- Department of Epidemiology, Columbia University, New York, NY, USA; CAUSALab, Harvard T H Chan School of Public Health, Boston, MA, USA; Mental Health Network Biomedical Research Center, Madrid, Spain; Mental Health Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain
| | | | | | - Mark Olfson
- Department of Epidemiology, Columbia University, New York, NY, USA; Department of Psychiatry, Columbia University, New York, NY, USA
| | - Madelyn S Gould
- Department of Epidemiology, Columbia University, New York, NY, USA; Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Jeffrey Shaman
- Department of Environmental Health Sciences, Columbia University, New York, NY, USA
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21
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Kandula S, Olfson M, Gould MS, Keyes KM, Shaman J. Hindcasts and forecasts of suicide mortality in US: A modeling study. PLoS Comput Biol 2023; 19:e1010945. [PMID: 36913441 PMCID: PMC10047563 DOI: 10.1371/journal.pcbi.1010945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 03/28/2023] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
Deaths by suicide, as well as suicidal ideations, plans and attempts, have been increasing in the US for the past two decades. Deployment of effective interventions would require timely, geographically well-resolved estimates of suicide activity. In this study, we evaluated the feasibility of a two-step process for predicting suicide mortality: a) generation of hindcasts, mortality estimates for past months for which observational data would not have been available if forecasts were generated in real-time; and b) generation of forecasts with observational data augmented with hindcasts. Calls to crisis hotline services and online queries to the Google search engine for suicide-related terms were used as proxy data sources to generate hindcasts. The primary hindcast model (auto) is an Autoregressive Integrated Moving average model (ARIMA), trained on suicide mortality rates alone. Three regression models augment hindcast estimates from auto with call rates (calls), GHT search rates (ght) and both datasets together (calls_ght). The 4 forecast models used are ARIMA models trained with corresponding hindcast estimates. All models were evaluated against a baseline random walk with drift model. Rolling monthly 6-month ahead forecasts for all 50 states between 2012 and 2020 were generated. Quantile score (QS) was used to assess the quality of the forecast distributions. Median QS for auto was better than baseline (0.114 vs. 0.21. Median QS of augmented models were lower than auto, but not significantly different from each other (Wilcoxon signed-rank test, p > .05). Forecasts from augmented models were also better calibrated. Together, these results provide evidence that proxy data can address delays in release of suicide mortality data and improve forecast quality. An operational forecast system of state-level suicide risk may be feasible with sustained engagement between modelers and public health departments to appraise data sources and methods as well as to continuously evaluate forecast accuracy.
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Affiliation(s)
- Sasikiran Kandula
- Department of Environmental Health Sciences, Columbia University, New York, New York, United States of America
| | - Mark Olfson
- Department of Epidemiology, Columbia University, New York, New York, United States of America
- Department of Psychiatry, Columbia University, New York, New York, United States of America
| | - Madelyn S. Gould
- Department of Epidemiology, Columbia University, New York, New York, United States of America
- Department of Psychiatry, Columbia University, New York, New York, United States of America
| | - Katherine M. Keyes
- Department of Epidemiology, Columbia University, New York, New York, United States of America
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Columbia University, New York, New York, United States of America
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Rockett IR, Ali B, Caine ED, Shepard DS, Banerjee A, Nolte KB, Connery HS, Larkin GL, Stack S, White FM, Jia H, Cossman JS, Feinberg J, Stover AN, Miller TR. Escalating costs of self-injury mortality in the 21st century United States: an interstate observational study. BMC Public Health 2023; 23:285. [PMID: 36755229 PMCID: PMC9906586 DOI: 10.1186/s12889-023-15188-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Estimating the economic costs of self-injury mortality (SIM) can inform health planning and clinical and public health interventions, serve as a basis for their evaluation, and provide the foundation for broadly disseminating evidence-based policies and practices. SIM is operationalized as a composite of all registered suicides at any age, and 80% of drug overdose (intoxication) deaths medicolegally classified as 'accidents,' and 90% of corresponding undetermined (intent) deaths in the age group 15 years and older. It is the long-term practice of the United States (US) Centers for Disease Control and Prevention (CDC) to subsume poisoning (drug and nondrug) deaths under the injury rubric. This study aimed to estimate magnitude and change in SIM and suicide costs in 2019 dollars for the United States (US), including the 50 states and the District of Columbia. METHODS Cost estimates were generated from underlying cause-of-death data for 1999/2000 and 2018/2019 from the US Centers for Disease Control and Prevention's (CDC's) Wide-ranging ONline Data for Epidemiologic Research (WONDER). Estimation utilized the updated version of Medical and Work Loss Cost Estimation Methods for CDC's Web-based Injury Statistics Query and Reporting System (WISQARS). Exposures were medical expenditures, lost work productivity, and future quality of life loss. Main outcome measures were disaggregated, annual-averaged total and per capita costs of SIM and suicide for the nation and states in 1999/2000 and 2018/2019. RESULTS 40,834 annual-averaged self-injury deaths in 1999/2000 and 101,325 in 2018/2019 were identified. Estimated national costs of SIM rose by 143% from $0.46 trillion to $1.12 trillion. Ratios of quality of life and work losses to medical spending in 2019 US dollars in 2018/2019 were 1,476 and 526, respectively, versus 1,419 and 526 in 1999/2000. Total national suicide costs increased 58%-from $318.6 billion to $502.7 billion. National per capita costs of SIM doubled from $1,638 to $3,413 over the observation period; costs of the suicide component rose from $1,137 to $1,534. States in the top quintile for per capita SIM, those whose cost increases exceeded 152%, concentrated in the Great Lakes, Southeast, Mideast and New England. States in the bottom quintile, those with per capita cost increases below 70%, were located in the Far West, Southwest, Plains, and Rocky Mountain regions. West Virginia exhibited the largest increase at 263% and Nevada the smallest at 22%. Percentage per capita cost increases for suicide were smaller than for SIM. Only the Far West, Southwest and Mideast were not represented in the top quintile, which comprised states with increases of 50% or greater. The bottom quintile comprised states with per capita suicide cost increases below 24%. Regions represented were the Far West, Southeast, Mideast and New England. North Dakota and Nevada occupied the extremes on the cost change continuum at 75% and - 1%, respectively. CONCLUSION The scale and surge in the economic costs of SIM to society are large. Federal and state prevention and intervention programs should be financed with a clear understanding of the total costs-fiscal, social, and personal-incurred by deaths due to self-injurious behaviors.
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Affiliation(s)
- Ian R.H. Rockett
- grid.268154.c0000 0001 2156 6140Department of Epidemiology and Biostatistics, West Virginia University School of Public Health, One Medical Center Drive, Morgantown, WV 26506-9190 USA ,grid.412750.50000 0004 1936 9166Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642 USA
| | - Bina Ali
- grid.280247.b0000 0000 9994 4271Pacific Institute for Research and Evaluation, 4061 Powder Mill Rd, Beltsville, MD 20705 USA
| | - Eric D. Caine
- grid.412750.50000 0004 1936 9166Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642 USA
| | - Donald S. Shepard
- grid.253264.40000 0004 1936 9473Cost and Value Group, Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA 02453 USA
| | - Aniruddha Banerjee
- grid.257413.60000 0001 2287 3919Department of Geography, Indiana University-Purdue University at Indianapolis, Cavanaugh Hall 441, 425 University Blvd., Indianapolis, IN 46202 USA
| | - Kurt B. Nolte
- grid.266832.b0000 0001 2188 8502Department of Pathology, University of New Mexico School of Medicine, MSC08-4640, Albuquerque, NM 87131 USA
| | - Hilary S. Connery
- grid.240206.20000 0000 8795 072XMcLean Hospital, 115 Mill Street, Mail Stop 222, Belmont, MA 02478-1064 USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, 2 West, Room 305, 401 Park Drive, Boston, MA 02215 USA
| | - G. Luke Larkin
- grid.261103.70000 0004 0459 7529Northeast Ohio Medical University, 4209 St. Rt. 44, PO Box 95, Rootstown, OH 44272 USA
| | - Steven Stack
- grid.254444.70000 0001 1456 7807Department of Criminology and Criminal Justice, Wayne State University, 3293 Faculty/Administration Building (FAB) 656 W. Kirby St, Detroit, MI 48202 USA ,grid.254444.70000 0001 1456 7807Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Tolan Park Medical Building, 3901 Chrysler Service Drive, Detroit, MI 48201-2167 USA
| | - Franklin M.M. White
- grid.55602.340000 0004 1936 8200Department of Community Health and Epidemiology, Dalhousie University, 5790 University Ave, Halifax, NS B3H 1V7 Canada
| | - Haomiao Jia
- grid.21729.3f0000000419368729Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032 USA ,grid.21729.3f0000000419368729School of Nursing, Columbia University, 560 W 168th St, New York, NY 10032 USA
| | - Jeralynn S. Cossman
- grid.215352.20000000121845633College for Health, Community and Policy, University of Texas-San Antonio, One UTSA Circle, San Antonio, TX 78249-3209 USA
| | - Judith Feinberg
- grid.268154.c0000 0001 2156 6140Departments of Behavioral Medicine and Psychiatry and Medicine, Infectious Diseases, West Virginia University School of Medicine, 30 Chestnut Ridge Rd, Morgantown, WV 26506 USA
| | - Amanda N. Stover
- grid.266856.90000 0001 0291 7689Eshelman School of Pharmacy, University of North Carolina at Asheville, One University Heights, 2214 Kerr Hall, Asheville, NC 28804 USA
| | - Ted R. Miller
- grid.280247.b0000 0000 9994 4271Pacific Institute for Research and Evaluation, 4061 Powder Mill Rd, Beltsville, MD 20705 USA ,grid.1032.00000 0004 0375 4078Centre for Population Health Research, Curtin University, 208 Kent St, Bentley, WA 6102 Australia
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23
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Williams SZ, Lewis CF, Muennig P, Martino D, Pahl K. Self-reported anxiety and depression problems and suicide ideation among black and latinx adults and the moderating role of social support. J Community Health 2022; 47:914-923. [PMID: 35921053 DOI: 10.1007/s10900-022-01127-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 01/09/2023]
Abstract
Suicide is a critical public health problem. Over the past decade, suicide rates have increased among Black and Latinx adults in the U.S. Though depression is the most prevalent psychiatric contributor to suicide risk, Black and Latinx Americans uniquely experience distress and stress (e.g., structural adversity) that can independently operate to worsen suicide risk. This makes it important to investigate non-clinical, subjective assessment of mental health as a predictor of suicide ideation. We also investigate whether social support can buffer the deleterious impact of poor mental health on suicide ideation.We analyzed data from 1,503 Black and Latinx participants of the Washington Heights Community Survey, a 2015 survey of residents of a NYC neighborhood. Multivariable logistic regression was conducted to examine the effect of subjectively experienced problems with anxiety and depression on suicide ideation independent of depression diagnosis, and the role of social support as a moderator.Estimated prevalence of past two-week suicide ideation was 5.8%. Regression estimates showed significantly increased odds of suicide ideation among participants reporting moderate (OR = 8.54,95% CI = 2.44-29.93) and severe (OR = 16.84,95% CI = 2.88-98.46) versus no problems with anxiety and depression, after adjustment for depression diagnosis. Informational support, i.e., having someone to provide good advice in a crisis, reduced the negative impact of moderate levels of anxiety and depression problems on suicide ideation.Findings suggest that among Black and Latinx Americans, subjective feelings of anxiety and depression account for a significant portion of the suicide ideation risk related to poor mental health. Further, social support, particularly informational support, may provide protection against suicide ideation.
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Affiliation(s)
- Sharifa Z Williams
- Center for Research on Cultural and Structural Equity in Behavioral Health, Division of Social Solutions & Services Research, Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Bldg. 35, 10962-1159, Orangeburg, NY, USA. .,Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA.
| | - Crystal Fuller Lewis
- Center for Research on Cultural and Structural Equity in Behavioral Health, Division of Social Solutions & Services Research, Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Bldg. 35, 10962-1159, Orangeburg, NY, USA.,Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Peter Muennig
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniele Martino
- Center for Research on Cultural and Structural Equity in Behavioral Health, Division of Social Solutions & Services Research, Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Bldg. 35, 10962-1159, Orangeburg, NY, USA
| | - Kerstin Pahl
- Center for Research on Cultural and Structural Equity in Behavioral Health, Division of Social Solutions & Services Research, Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Bldg. 35, 10962-1159, Orangeburg, NY, USA.,Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
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24
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Tilstra AM, Gutin I, Dollar NT, Rogers RG, Hummer RA. "Outside the Skin": The Persistence of Black-White Disparities in U.S. Early-Life Mortality. Demography 2022; 59:2247-2269. [PMID: 36367341 PMCID: PMC10155466 DOI: 10.1215/00703370-10346963] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Research on Black-White disparities in mortality emphasizes the cumulative pathways through which racism gets "under the skin" to affect health. Yet this framing is less applicable in early life, when death is primarily attributable to external causes rather than cumulative, biological processes. We use mortality data from the National Vital Statistics System Multiple Cause of Death files and population counts from the Surveillance, Epidemiology, and End Result Program to analyze 705,801 deaths among Black and White males and females, ages 15-24. We estimate age-standardized death rates and single-decrement life tables to show how all-cause and cause-specific mortality changed from 1990 to 2016 by race and sex. Despite overall declines in early-life mortality, Black-White disparities remain unchanged across several causes-especially homicide, for which mortality is nearly 20 times as high among Black as among White males. Suicide and drug-related deaths are higher among White youth during this period, yet their impact on life expectancy at birth is less than half that of homicide among Black youth. Critically, early-life disparities are driven by preventable causes of death whose impact occurs "outside the skin," reflecting racial differences in social exposures and experiences that prove harmful for both Black and White adolescents and young adults.
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25
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Pregnancy-Associated Homicide and Suicide: An Analysis of the National Violent Death Reporting System, 2008-2019. Obstet Gynecol 2022; 140:565-573. [PMID: 36075083 DOI: 10.1097/aog.0000000000004932] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/07/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To analyze differences in the demographic and social factors associated with pregnancy-associated violent deaths due to homicide compared with suicide by pregnancy timing. METHODS This was a retrospective cohort study using the Centers for Disease Control and Prevention's National Violent Death Reporting System from 2008 to 2019. We included females aged 15-44 years who died by suicide , defined as intentional self-harm, or homicide. Pregnancy-associated deaths were defined as those that occurred during or within 1 year of pregnancy. RESULTS Of 38,417 female victims aged 15-44 years identified in the data set, 10,411 had known pregnancy status; 1,300 of those deaths were pregnancy associated. Of all deaths with known pregnancy status, 3,203 were by homicide (30.8%) and 7,208 (69.2%) were by suicide. Pregnancy-associated homicide deaths made up 20.6% of all homicide deaths, and pregnancy-associated suicide deaths made up 8.8% of all suicide deaths. Individuals who died by homicide were younger (29.4±8.2 years vs 31.5±8.6 years), more likely to be single or never married (61.0% vs 50.0%), and had a higher proportion of associate's degree-level education or less as compared with individuals who died by suicide (28.1% vs 43.9%). Of individuals who died by homicide, 37.7% were Black or African American, 13.4% were Hispanic, and 56.0%% were White. In comparison, 6.9% of individuals who died by suicide were Black or African American, 8.0% were Hispanic, and 85.0% were White. Having a mental health problem and any substance use were significantly more often associated with suicide deaths compared with homicide deaths (77.4% vs 7.2%, P <.001 for mental health, 33.3% vs 12.8%, P <.001 for substance use, respectively). Intimate partner violence was prevalent in both groups, although significantly higher in homicide deaths (57.3% vs 37.1%, P <.001). This pattern persisted when stratified by pregnancy status. CONCLUSION Mental health problems, substance use disorder, and intimate partner violence are preceding circumstances to pregnancy-associated suicide and homicide.
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26
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Rahman N, Mozer R, McHugh RK, Rockett IRH, Chow CM, Vaughan G. Using natural language processing to improve suicide classification requires consideration of race. Suicide Life Threat Behav 2022; 52:782-791. [PMID: 35384040 DOI: 10.1111/sltb.12862] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/25/2022] [Accepted: 03/22/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To improve the accuracy of classification of deaths of undetermined intent and to examine racial differences in misclassification. METHODS We used natural language processing and statistical text analysis on restricted-access case narratives of suicides, homicides, and undetermined deaths in 37 states collected from the National Violent Death Reporting System (NVDRS) (2017). We fit separate race-specific classification models to predict suicide among undetermined cases using data from known homicide cases (true negatives) and known suicide cases (true positives). RESULTS A classifier trained on an all-race dataset predicts less than half of these cases as suicide. Importantly, our analysis yields an estimated suicide rate for the Black population comparable with the typical detection rate for the White population, indicating that misclassification excess is endemic for Black suicide. This problem may be mitigated by using race-specific data. Our findings, based on the statistical text analysis, also reveal systematic differences in the phrases identified as most predictive of suicide. CONCLUSIONS This study highlights the need to understand the reasons underlying suicide rate differences and for further testing of strategies to reduce misclassification, particularly among people of color.
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Affiliation(s)
- Nusrat Rahman
- Department of Natural and Applied Sciences, Bentley University, Waltham, Massachusetts, USA.,Health Thought Leadership Network, Bentley University, Waltham, Massachusetts, USA
| | - Reagan Mozer
- Department of Mathematical Sciences, Bentley University, Waltham, Massachusetts, USA
| | - R Kathryn McHugh
- Division of Alcohol, Drugs and Addiction, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Ian R H Rockett
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, West Virginia, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Clifton M Chow
- Department of Mathematical Sciences, Bentley University, Waltham, Massachusetts, USA.,Academic Technology Center, Bentley University, Waltham, Massachusetts, USA
| | - Gregory Vaughan
- Department of Mathematical Sciences, Bentley University, Waltham, Massachusetts, USA
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27
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Larson PS, Bergmans RS. Impact of the COVID-19 pandemic on temporal patterns of mental health and substance abuse related mortality in Michigan: An interrupted time series analysis. LANCET REGIONAL HEALTH. AMERICAS 2022; 10:100218. [PMID: 35284903 PMCID: PMC8898171 DOI: 10.1016/j.lana.2022.100218] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background The emergence of SARS-CoV2 (COVID-19) had wide impacts to health and mortality and prompted unprecedented containment efforts. The full impact of the COVID-19 pandemic and resulting responses on mental health and substance abuse related mortality are unknown. Methods We obtained records for deaths from suicide, alcohol related liver failure, and overdose from the Michigan Department of Health and Human Services (MDHHS) for 2006 to 2020. We compared mortality within sex, age, marital, racial and urban/rural groups using basic statistical methods. We compared standardized mean daily mortality incidence before and after the onset of the pandemic using t-tests. We used an interrupted time series approach, using generalized additive Poisson regression models with smoothed components for time to assess differences in mortality trends before and after the onset of the pandemic within demographic groups. Findings There were 19,365 suicides, 8,790 deaths from alcohol related liver failure, and 21,778 fatal drug overdoses. Compared with 2019, suicides in 2020 declined by 17.6%, overdose mortality declined by 22.5%—while alcohol deaths increased by 12.4%. Crude comparisons suggested that there were significant declines in suicides for white people, people 18 to 65 and increases for rural decedents, overdoses increased for Black people, females and married/widowed people, and alcohol mortality increased for nearly all groups. ITS models, however, suggested increased suicide mortality for rural residents, significantly increased alcohol related mortality for people ≥65 and increased overdose mortality in men. Interpretation The onset of the pandemic was associated with mixed patterns of mortality between suicide, alcohol and overdose deaths. Patterns varied within demographic groups, suggesting that impacts varied among different groups, particularly racial and marital groups. Funding This work was supported by the United States National Institute of Environmental Health Sciences [K99/R00ES026198] and their Michigan Center on Lifestage Environmental Exposures and Disease [grant number P30ES017885]; and the Institute for Global Biological Change at the University of Michigan.
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Affiliation(s)
- Peter S Larson
- Survey Research Center, Social Environment and Health Program, University of Michigan Institute for Social Research, 426 Thompson, Ann Arbor, MI 48104, USA.,Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Rachel S Bergmans
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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28
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Troya M, Spittal MJ, Pendrous R, Crowley G, Gorton HC, Russell K, Byrne S, Musgrove R, Hannah-Swain S, Kapur N, Knipe D. Suicide rates amongst individuals from ethnic minority backgrounds: A systematic review and meta-analysis. EClinicalMedicine 2022; 47:101399. [PMID: 35518122 PMCID: PMC9065636 DOI: 10.1016/j.eclinm.2022.101399] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Existing evidence suggests that some individuals from ethnic minority backgrounds are at increased risk of suicide compared to their majority ethnic counterparts, whereas others are at decreased risk. We aimed to estimate the absolute and relative risk of suicide in individuals from ethnic minority backgrounds globally. METHODS Databases (Medline, Embase, and PsycInfo) were searched for epidemiological studies between 01/01/2000 and 3/07/2020, which provided data on absolute and relative rates of suicide amongst ethnic minority groups. Studies reporting on clinical or specific populations were excluded. Pairs of reviewers independently screened titles, abstracts, and full texts. We used random effects meta-analysis to estimate overall, sex, location, migrant status, and ancestral origin, stratified pooled estimates for absolute and rate ratios. PROSPERO registration: CRD42020197940. FINDINGS A total of 128 studies were included with 6,026,103 suicide deaths in individuals from an ethnic minority background across 31 countries. Using data from 42 moderate-high quality studies, we estimated a pooled suicide rate of 12·1 per 100,000 (95% CIs 8·4-17·6) in people from ethnic minority backgrounds with a broad range of estimates (1·2-139·7 per 100,000). There was weak statistical evidence from 51 moderate-high quality studies that individuals from ethnic minority groups were more likely to die by suicide (RR 1·3 95% CIs 0·9-1·7) with again a broad range amongst studies (RR 0·2-18·5). In our sub-group analysis we only found evidence of elevated risk for indigenous populations (RR: 2·8 95% CIs 1·9-4·0; pooled rate: 23·2 per 100,000 95% CIs 14·7-36·6). There was very substantial heterogeneity (I2 > 98%) between studies for all pooled estimates. INTERPRETATION The homogeneous grouping of individuals from ethnic minority backgrounds is inappropriate. To support suicide prevention in marginalised groups, further exploration of important contextual differences in risk is required. It is possible that some ethnic minority groups (for example those from indigenous backgrounds) have higher rates of suicide than majority populations. FUNDING No specific funding was provided to conduct this research. DK is funded by Wellcome Trust and Elizabeth Blackwell Institute Bristol. Matthew Spittal is a recipient of an Australian Research Council Future Fellowship (project number FT180100075) funded by the Australian Government. Rebecca Musgrove is funded by the NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC-2016-003).
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Affiliation(s)
- M.Isabela Troya
- School of Public Health, College of Medicine and Health, University College Cork, 4.07 Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Grace Crowley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hayley C Gorton
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Kirsten Russell
- School of Psychological Sciences and Health, Graham Hills Building, 40 George Street, Glasgow, UK
| | - Sadhbh Byrne
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Rebecca Musgrove
- Centre for Mental Health and Safety, National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Navneet Kapur
- Division of Psychology and Mental Health, Centre for Mental Health and Safety, The University of Manchester, Manchester, UK
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Corresponding author.
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29
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Reeves M, Bhat HS, Goldman-Mellor S. Resampling to address inequities in predictive modeling of suicide deaths. BMJ Health Care Inform 2022; 29:bmjhci-2021-100456. [PMID: 35396246 PMCID: PMC8996002 DOI: 10.1136/bmjhci-2021-100456] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 03/03/2022] [Indexed: 01/09/2023] Open
Abstract
ObjectiveImprove methodology for equitable suicide death prediction when using sensitive predictors, such as race/ethnicity, for machine learning and statistical methods.MethodsTrain predictive models, logistic regression, naive Bayes, gradient boosting (XGBoost) and random forests, using three resampling techniques (Blind, Separate, Equity) on emergency department (ED) administrative patient records. The Blind method resamples without considering racial/ethnic group. Comparatively, the Separate method trains disjoint models for each group and the Equity method builds a training set that is balanced both by racial/ethnic group and by class.ResultsUsing the Blind method, performance range of the models’ sensitivity for predicting suicide death between racial/ethnic groups (a measure of prediction inequity) was 0.47 for logistic regression, 0.37 for naive Bayes, 0.56 for XGBoost and 0.58 for random forest. By building separate models for different racial/ethnic groups or using the equity method on the training set, we decreased the range in performance to 0.16, 0.13, 0.19, 0.20 with Separate method, and 0.14, 0.12, 0.24, 0.13 for Equity method, respectively. XGBoost had the highest overall area under the curve (AUC), ranging from 0.69 to 0.79.DiscussionWe increased performance equity between different racial/ethnic groups and show that imbalanced training sets lead to models with poor predictive equity. These methods have comparable AUC scores to other work in the field, using only single ED administrative record data.ConclusionWe propose two methods to improve equity of suicide death prediction among different racial/ethnic groups. These methods may be applied to other sensitive characteristics to improve equity in machine learning with healthcare applications.
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Affiliation(s)
- Majerle Reeves
- Department of Applied Mathematics, University of California Merced, Merced, California, USA
| | - Harish S Bhat
- Department of Applied Mathematics, University of California Merced, Merced, California, USA
| | - Sidra Goldman-Mellor
- Department of Public Health, University of California Merced, Merced, California, USA
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Townsend T, Kline D, Rivera-Aguirre A, Bunting AM, Mauro PM, Marshall BDL, Martins SS, Cerdá M. Racial/Ethnic and Geographic Trends in Combined Stimulant/Opioid Overdoses, 2007-2019. Am J Epidemiol 2022; 191:599-612. [PMID: 35142341 PMCID: PMC9077116 DOI: 10.1093/aje/kwab290] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/02/2021] [Accepted: 12/21/2021] [Indexed: 01/26/2023] Open
Abstract
In the United States, combined stimulant/opioid overdose mortality has risen dramatically over the last decade. These increases may particularly affect non-Hispanic Black and Hispanic populations. We used death certificate data from the US National Center for Health Statistics (2007-2019) to compare state-level trends in overdose mortality due to opioids in combination with 1) cocaine and 2) methamphetamine and other stimulants (MOS) across racial/ethnic groups (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian American/Pacific Islander). To avoid unstable estimates from small samples, we employed principles of small area estimation and a Bayesian hierarchical model, enabling information-sharing across groups. Black Americans experienced severe and worsening mortality due to opioids in combination with both cocaine and MOS, particularly in eastern states. Cocaine/opioid mortality increased 575% among Black people versus 184% in White people (Black, 0.60 to 4.05 per 100,000; White, 0.49 to 1.39 per 100,000). MOS/opioid mortality rose 16,200% in Black people versus 3,200% in White people (Black, 0.01 to 1.63 per 100,000; White, 0.09 to 2.97 per 100,000). Cocaine/opioid overdose mortality rose sharply among Hispanic and Asian Americans. State-group heterogeneity highlighted the importance of data disaggregation and methods to address small sample sizes. Research to understand the drivers of these trends and expanded efforts to address them are needed, particularly in minoritized groups.
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Affiliation(s)
- Tarlise Townsend
- Correspondence to Dr. Tarlise Townsend, Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016 (e-mail: )
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31
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Lawson SG, Lowder EM, Ray B. Correlates of suicide risk among Black and White adults with behavioral health disorders in criminal-legal systems. BMC Psychiatry 2022; 22:163. [PMID: 35246077 PMCID: PMC8895515 DOI: 10.1186/s12888-022-03803-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/19/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Adults with behavioral health disorders in criminal-legal systems are at heightened risk of suicide relative to the general population. Despite documented racial disparities in criminal processing and behavioral health treatment, few studies have examined racial differences in suicide risk in this already high-risk population. This study examined 1) the correlates of suicide risk in this population overall and by race and 2) the moderating role of race in these associations. METHODS We investigated correlates of clinician-rated suicide risk at baseline in a statewide sample of 2,827 Black and 14,022 White adults with criminal-legal involvement who engaged in community-based behavioral health treatment. Regression-based approaches were used to model suicide risk and test for evidence of interaction effects. RESULTS Findings showed the strongest correlates of suicide risk were greater behavioral health needs, evidence of self-harm, and a primary mental health diagnosis or co-occurring diagnosis. In race-specific analyses, correlates of suicide risk were mostly similar for both Black and White clients, with a couple exceptions. Interaction terms testing between-group effects on correlates of suicide risk were non-significant. CONCLUSIONS Adults with behavioral health disorders in criminal-legal systems experience similar risk factors for suicide as the general population. Similar to prior research, we found that Black adults, in particular, are at lower risk for suicide overall. Contrary to expectations, we found similarities in correlates of suicide risk across race in our sample of felony-level adults with behavioral health disorders in the criminal-legal system. Prior research shows that behavioral health professionals should be cognizant of cultural factors when developing a comprehensive approach to suicide care and treatment. Our findings show correlates of suicide risk are largely stable in Black and White adults involved in criminal-legal systems, suggesting culturally responsive treatment for suicide risk should target shared risk factors.
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Affiliation(s)
- Spencer G. Lawson
- grid.17088.360000 0001 2150 1785School of Criminal Justice, Michigan State University, East Lansing, MI USA
| | - Evan M. Lowder
- grid.22448.380000 0004 1936 8032Department of Criminology, Law and Society, George Mason University, Fairfax, VA USA
| | - Bradley Ray
- grid.62562.350000000100301493Division for Applied Justice Research, RTI International, Research Triangle Park, NC USA
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Abstract
Most research on suicides focuses on youth or the elderly and dominant groups of a population. The purpose of this study was to assess suicide trends for non-elderly adult Hispanics (age 20-64 years) over the past decade (2010-2020). Data from the Web-Based Injury Statistics Query and Reporting System (WISQARS) were analyzed for the study period. Suicides for Hispanics in 2010 were the 7th leading cause of death and became the 5th leading cause of death by 2020. During the decade of analyses, suicide rates increased 35.7% for males and 40.6% for females. Non-elderly Hispanic males were most likely to die by hanging/suffocation (2010 = 42%, 2020 = 41%), or firearms (2010 = 39%, 2020 = 42%). Whereas, Hispanic adult females were most likely to use hanging/suffocation (2010 = 36%, 2020 = 43%) or poisoning (2010 = 27%, 2020 = 19%) for completed suicides. In 2020, the top three states for non-elderly Hispanic adult suicides (per 100,000 population) were Colorado (25.52), New Mexico (23.99), and Utah (21.73). The Hispanic population continues to grow, but also faces chronicity of prejudice, underemployment, lack of healthcare access, multiple stressors, and rising levels of suicide. The reduction of adult Hispanic suicides would require additional resources, interventions, and research to understand prevention and risk factors.
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Marraccini ME, Griffin D, O’Neill JC, Martinez RR, Chin AJ, Toole EN, Grapin SL, Naser SC. School Risk and Protective Factors of Suicide: A Cultural Model of Suicide Risk and Protective Factors in Schools. SCHOOL PSYCHOLOGY REVIEW 2022; 51:266-289. [PMID: 35935591 PMCID: PMC9354860 DOI: 10.1080/2372966x.2020.1871305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
There are known cultural variations in correlates of and symptoms related to suicide-related thoughts and behaviors; however, the majority of research that informs suicide prevention in school systems has focused on research based on Euro-American/White students. By exploring school-related risk and protective factors in ethnic-racial minoritized students, we expand existing multicultural models of suicide prevention for school settings. Specifically, this systematic literature review identified 33 studies conducted with American Indian and Alaskan Native, Hispanic and Latinx, Black and African American, and Asian American and Pacific Islander students. Findings underscore the importance of building relationships with the school community and fostering a sense of safety for students, the need to approach school-based suicide prevention and intervention with cultural considerations, and the importance of connecting students and families with providers in culturally sensitive and informed ways. Taken together, schools need to build school-family-community partnerships that promote culturally sensitive approaches to suicide prevention.
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Affiliation(s)
| | - Dana Griffin
- School of Education, University of North Carolina at Chapel
Hill
| | - J. Conor O’Neill
- Department of Psychiatry and Behavioral Sciences, Duke
University School of Medicine
| | | | - Andrew J. Chin
- School of Education, University of North Carolina at Chapel
Hill
| | - Emily N. Toole
- School of Education, University of North Carolina at Chapel
Hill
| | | | - Shereen C. Naser
- College of Sciences and Health Professions, Cleveland State
University
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Scarth B, Pavlova A, Hetrick SE, Witt KG, Hawton K, Fortune S. Service users’ experiences of emergency care following an episode of self-harm: a mixed evidence synthesis. Hippokratia 2021. [DOI: 10.1002/14651858.cd014940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Bonnie Scarth
- WellSouth, Primary Care Organisation; Dunedin New Zealand
| | - Alina Pavlova
- Psychological Medicine; University of Otago; Dunedin New Zealand
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
- Children and Young People Satellite, Cochrane Common Mental Disorders; The University of Auckland; Auckland New Zealand
| | - Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry; University of Oxford; Oxford UK
| | - Sarah Fortune
- Department of Social and Community Health, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
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35
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First responder, clinician, and non‐clinical support staff knowledge, attitudes, and behaviours towards people presenting for emergency care following self‐harm: a mixed evidence synthesis. Cochrane Database Syst Rev 2021; 2021:CD014939. [PMCID: PMC8668017 DOI: 10.1002/14651858.cd014939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: The objectives of this review are threefold, as follows. Firstly, to assess the content of knowledge, attitudes, and behaviours of first responders, clinicians, and non‐clinical support staff towards service users with SH presentations. Secondly, to understand how service user and staff characteristics (e.g. age, gender, sociodemographic background), type of SH presentation (e.g. method, repetition), and contextual factors (e.g. hospital environment, presence of bystanders) affect the knowledge, attitudes, and behaviours of first responders, clinicians, and non‐clinical support staff in providing acute care. Thirdly, to assess whether clinicians' knowledge, attitudes, and behaviours have evolved over time.
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Eiffert S, Li CX, Anthony K, Poole C. RE: "TRENDS IN 'DEATHS OF DESPAIR' AMONG WORKING-AGED WHITE AND BLACK AMERICANS, 1990-2017". Am J Epidemiol 2021; 191:363-365. [PMID: 34664613 PMCID: PMC8897988 DOI: 10.1093/aje/kwab256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Abstract
Suicide and non-suicidal self-injury (NSSI) are prevalent in emerging adulthood and one possible commonality is emotion regulation deficits. Participants (N = 708) completed multiple self-report measures that assessed emotion regulation deficits, depression, past-year NSSI frequency, past-year suicide attempts, and recent suicide ideation severity. Controlling for depression, linear regression analyses found that the only significant association was between greater deficits in emotion regulation strategies and greater recent NSSI frequency and suicide ideation intensity. These results suggest some commonality in emotion regulation deficits across NSSI and suicide ideation. Prevention and intervention efforts should teach emotion regulation strategies to lower self-harm risk.
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Affiliation(s)
- Rebekah Clapham
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, USA
| | - Amy Brausch
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, USA
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38
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Tilstra AM, Simon DH, Masters RK. Trends in "Deaths of Despair" Among Working-Aged White and Black Americans, 1990-2017. Am J Epidemiol 2021; 190:1751-1759. [PMID: 33778856 DOI: 10.1093/aje/kwab088] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 01/09/2023] Open
Abstract
Life expectancy for US White men and women declined between 2013 and 2017. Initial explanations for the decline focused on increases in "deaths of despair" (i.e., deaths from suicide, drug use, and alcohol use), which have been interpreted as a cohort-based phenomenon afflicting middle-aged White Americans. There has been less attention on Black mortality trends from these same causes, and whether the trends are similar or different by cohort and period. We complement existing research and contend that recent mortality trends in both the US Black and White populations most likely reflect period-based exposures to 1) the US opioid epidemic and 2) the Great Recession. We analyzed cause-specific mortality trends in the United States for deaths from suicide, drug use, and alcohol use among non-Hispanic Black and non-Hispanic White Americans, aged 20-64 years, over 1990-2017. We employed sex-, race-, and cause-of-death-stratified Poisson rate models and age-period-cohort models to compare mortality trends. Results indicate that rising "deaths of despair" for both Black and White Americans are overwhelmingly driven by period-based increases in drug-related deaths since the late 1990s. Further, deaths related to alcohol use and suicide among both White and Black Americans changed during the Great Recession, despite some racial differences across cohorts.
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Milam AJ, Furr-Holden D, Wang L, Simon KM. Health Data Disparities in Opioid-Involved Overdose Deaths From 1999 to 2018 in the United States. Am J Public Health 2021; 111:1627-1635. [PMID: 34185576 PMCID: PMC8589046 DOI: 10.2105/ajph.2021.306322] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 01/09/2023]
Abstract
Objectives. To examine temporal trends in the classification of opioid-involved overdose deaths (OODs) and racial variation in the classification of specific types of opioids used. Methods. We analyzed OODs coded as other or unspecified narcotics from 1999 to 2018 in the United States using data from the National Vital Statistics System and the Centers for Disease Control and Prevention. Results. The total proportion of OODs from unspecified narcotics decreased from 32.4% in 1999 to 1.9% in 2018. The proportion of OODs from unspecified narcotics among African American persons was approximately 2-fold greater than that of non-Hispanic White persons until 2012. Similarly, the proportion of OODs from unspecified narcotics among Hispanic persons was greater than that of White persons until 2015. After we controlled for death investigation system, African American persons had a higher incidence rate of OODs from unspecified narcotics compared with White persons. Conclusions. There have been significant improvements in the specification OODs over the past 20 years, and there has been significant racial disparity in the classification of OODs until about 2015. The findings suggest a health data disparity; the excessive misclassification of OODs is likely attributable to the race/ethnicity of the decedent.
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Affiliation(s)
- Adam J Milam
- Adam J. Milam is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH. Debra Furr-Holden is with the Division of Public Health, College of Human Medicine, Michigan State University, Flint, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health. Ling Wang is with Department of Medicine, College of Human Medicine, Michigan State University, East Lansing. Kevin M. Simon is with Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, and Adolescent Substance Use and Addiction Program, Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Debra Furr-Holden
- Adam J. Milam is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH. Debra Furr-Holden is with the Division of Public Health, College of Human Medicine, Michigan State University, Flint, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health. Ling Wang is with Department of Medicine, College of Human Medicine, Michigan State University, East Lansing. Kevin M. Simon is with Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, and Adolescent Substance Use and Addiction Program, Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Ling Wang
- Adam J. Milam is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH. Debra Furr-Holden is with the Division of Public Health, College of Human Medicine, Michigan State University, Flint, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health. Ling Wang is with Department of Medicine, College of Human Medicine, Michigan State University, East Lansing. Kevin M. Simon is with Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, and Adolescent Substance Use and Addiction Program, Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Kevin M Simon
- Adam J. Milam is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH. Debra Furr-Holden is with the Division of Public Health, College of Human Medicine, Michigan State University, Flint, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health. Ling Wang is with Department of Medicine, College of Human Medicine, Michigan State University, East Lansing. Kevin M. Simon is with Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, and Adolescent Substance Use and Addiction Program, Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA
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40
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Palframan KM, Szymanski BR, McCarthy JF. Ascertainment of Patient Suicides by Veterans Affairs Facilities and Associations With Veteran, Clinical, and Suicide Characteristics. Am J Public Health 2021; 111:S116-S125. [PMID: 34314199 DOI: 10.2105/ajph.2021.306262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objectives. To evaluate the sensitivity of health care facility documentation of suicide deaths among US veterans with recent Veterans Health Administration (VHA) care and assess variation in identification by veteran, clinical, and suicide death characteristics. Methods. Cross-sectional analyses included 11 148 veterans who died by suicide in 2013 to 2017, per National Death Index death certificate information, with VHA encounters in the year of death or the previous year. Facility suicide ascertainment was assessed per site reports in the VHA Suicide Prevention Applications Network. Bivariate and multivariable analyses assessed ascertainment by decedent demographic, clinical, utilization, and method of suicide characteristics. Results. Site reports identified 3667 suicide decedents (32.9%). Veteran suicide decedents identified by facilities were more likely to be younger and with clinical risk factors and more recent VHA encounters. Suicide deaths involving poisoning were less likely to be identified than deaths involving other methods. Conclusions. VHA facility ascertainment of suicide deaths among recent patients was neither comprehensive nor representative. Findings will inform efforts to enhance facility suicide surveillance and veteran suicide prevention.
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Affiliation(s)
- Kristen M Palframan
- Kristen M. Palframan, Benjamin R. Szymanski, and John F. McCarthy are with the Office of Mental Health and Suicide Prevention, US Department of Veterans Affairs, Ann Arbor, MI. J. F. McCarthy is also with the Department of Psychiatry, University of Michigan, Ann Arbor
| | - Benjamin R Szymanski
- Kristen M. Palframan, Benjamin R. Szymanski, and John F. McCarthy are with the Office of Mental Health and Suicide Prevention, US Department of Veterans Affairs, Ann Arbor, MI. J. F. McCarthy is also with the Department of Psychiatry, University of Michigan, Ann Arbor
| | - John F McCarthy
- Kristen M. Palframan, Benjamin R. Szymanski, and John F. McCarthy are with the Office of Mental Health and Suicide Prevention, US Department of Veterans Affairs, Ann Arbor, MI. J. F. McCarthy is also with the Department of Psychiatry, University of Michigan, Ann Arbor
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41
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Coley RY, Johnson E, Simon GE, Cruz M, Shortreed SM. Racial/Ethnic Disparities in the Performance of Prediction Models for Death by Suicide After Mental Health Visits. JAMA Psychiatry 2021; 78:726-734. [PMID: 33909019 PMCID: PMC8082428 DOI: 10.1001/jamapsychiatry.2021.0493] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Clinical prediction models estimated with health records data may perpetuate inequities. OBJECTIVE To evaluate racial/ethnic differences in the performance of statistical models that predict suicide. DESIGN, SETTING, AND PARTICIPANTS In this diagnostic/prognostic study, performed from January 1, 2009, to September 30, 2017, with follow-up through December 31, 2017, all outpatient mental health visits to 7 large integrated health care systems by patients 13 years or older were evaluated. Prediction models were estimated using logistic regression with LASSO variable selection and random forest in a training set that contained all visits from a 50% random sample of patients (6 984 184 visits). Performance was evaluated in the remaining 6 996 386 visits, including visits from White (4 031 135 visits), Hispanic (1 664 166 visits), Black (578 508 visits), Asian (313 011 visits), and American Indian/Alaskan Native (48 025 visits) patients and patients without race/ethnicity recorded (274 702 visits). Data analysis was performed from January 1, 2019, to February 1, 2021. EXPOSURES Demographic, diagnosis, prescription, and utilization variables and Patient Health Questionnaire 9 responses. MAIN OUTCOMES AND MEASURES Suicide death in the 90 days after a visit. RESULTS This study included 13 980 570 visits by 1 433 543 patients (64% female; mean [SD] age, 42 [18] years. A total of 768 suicide deaths were observed within 90 days after 3143 visits. Suicide rates were highest for visits by patients with no race/ethnicity recorded (n = 313 visits followed by suicide within 90 days, rate = 5.71 per 10 000 visits), followed by visits by Asian (n = 187 visits followed by suicide within 90 days, rate = 2.99 per 10 000 visits), White (n = 2134 visits followed by suicide within 90 days, rate = 2.65 per 10 000 visits), American Indian/Alaskan Native (n = 21 visits followed by suicide within 90 days, rate = 2.18 per 10 000 visits), Hispanic (n = 392 visits followed by suicide within 90 days, rate = 1.18 per 10 000 visits), and Black (n = 65 visits followed by suicide within 90 days, rate = 0.56 per 10 000 visits) patients. The area under the curve (AUC) and sensitivity of both models were high for White, Hispanic, and Asian patients and poor for Black and American Indian/Alaskan Native patients and patients without race/ethnicity recorded. For example, the AUC for the logistic regression model was 0.828 (95% CI, 0.815-0.840) for White patients compared with 0.640 (95% CI, 0.598-0.681) for patients with unrecorded race/ethnicity and 0.599 (95% CI, 0.513-0.686) for American Indian/Alaskan Native patients. Sensitivity at the 90th percentile was 62.2% (95% CI, 59.2%-65.0%) for White patients compared with 27.5% (95% CI, 21.0%-34.7%) for patients with unrecorded race/ethnicity and 10.0% (95% CI, 0%-23.0%) for Black patients. Results were similar for random forest models, with an AUC of 0.812 (95% CI, 0.800-0.826) for White patients compared with 0.676 (95% CI, 0.638-0.714) for patients with unrecorded race/ethnicity and 0.642 (95% CI, 0.579-0.710) for American Indian/Alaskan Native patients and sensitivities at the 90th percentile of 52.8% (95% CI, 50.0%-55.8%) for White patients, 29.3% (95% CI, 22.8%-36.5%) for patients with unrecorded race/ethnicity, and 6.7% (95% CI, 0%-16.7%) for Black patients. CONCLUSIONS AND RELEVANCE These suicide prediction models may provide fewer benefits and more potential harms to American Indian/Alaskan Native or Black patients or those with undrecorded race/ethnicity compared with White, Hispanic, and Asian patients. Improving predictive performance in disadvantaged populations should be prioritized to improve, rather than exacerbate, health disparities.
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Affiliation(s)
- R. Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle,Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Eric Johnson
- Kaiser Permanente Washington Health Research Institute, Seattle
| | | | - Maricela Cruz
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Susan M. Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle,Department of Biostatistics, University of Washington School of Public Health, Seattle
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42
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Assari S, Boyce S, Bazargan M. Feasibility of Race by Sex Intersectionality Research on Suicidality in the Adolescent Brain Cognitive Development (ABCD) Study. CHILDREN-BASEL 2021; 8:children8060437. [PMID: 34071105 PMCID: PMC8224640 DOI: 10.3390/children8060437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 01/09/2023]
Abstract
Intersectional research on childhood suicidality requires studies with a reliable and valid measure of suicidality, as well as a large sample size that shows some variability of suicidality across sex by race intersectional groups. Objectives: We aimed to investigate the feasibility of intersectionality research on childhood suicidality in the Adolescent Brain Cognitive Development (ABCD) study. We specifically explored the reliability and validity of the measure, sample size, and variability of suicidality across sex by race intersectional groups. Methods: We used cross-sectional data (wave 1) from the ABCD study, which sampled 9013 non-Hispanic white (NHW) or non-Hispanic black (NHB) children between the ages of 9 and 10 between years 2016 and 2018. Four intersectional groups were built based on race and sex: NHW males (n = 3554), NHW females (n = 3158), NHB males (n = 1164), and NHB females (n = 1137). Outcome measure was the count of suicidality symptoms, reflecting all positive history and symptoms of suicidal ideas, plans, and attempts. To validate our measure, we tested the correlation between our suicidality measure and depression and Child Behavior Checklist (CBCL) sub-scores. Cronbach alpha was calculated for reliability across each intersectional group. We also compared groups for suicidality. Results: We observed some suicidality history in observed 3.2% (n = 101) of NHW females, 4.9% (n = 175) of NHW males, 5.4% (n = 61) of NHB females, and 5.8% (n = 68) of NHB males. Our measure’s reliability was acceptable in all race by sex groups (Cronbach alpha higher than 0.70+ in all intersectional groups). Our measure was valid in all intersectional groups, documented by a positive correlation with depression and CBCL sub-scores. We could successfully model suicidality across sex by race groups, using multivariable models. Conclusion: Given the high sample size, reliability, and validity of the suicidality measure, variability of suicidality, it is feasible to investigate correlates of suicidality across race by sex intersections in the ABCD study. We also found evidence of higher suicidality in NHB than NHW children in the ABCD study. The ABCD rich data in domains of social context, self-report, schools, parenting, psychopathology, personality, and brain imaging provides a unique opportunity to study intersectional differences in neural circuits associated with youth suicidality.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles Drew University, Los Angeles, CA 90059, USA;
- Department of Urban Public Health, Charles Drew University, Los Angeles, CA 90059, USA
- Correspondence: ; Tel.: +1-734-858-8333
| | - Shanika Boyce
- Department of Pediatrics, Charles Drew University, Los Angeles, CA 90059, USA;
| | - Mohsen Bazargan
- Department of Family Medicine, Charles Drew University, Los Angeles, CA 90059, USA;
- Department of Urban Public Health, Charles Drew University, Los Angeles, CA 90059, USA
- Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
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43
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Race, Family Conflict and Suicidal Thoughts and Behaviors among 9-10-Year-Old American Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105399. [PMID: 34070158 PMCID: PMC8158501 DOI: 10.3390/ijerph18105399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 01/09/2023]
Abstract
Family conflict is known to operate as a major risk factor for children’s suicidal thoughts and behaviors (STBs). However, it is unknown whether this effect is similar or different in Black and White children. Objectives: We compared Black and White children for the association between family conflict and STBs in a national sample of 9–10-year-old American children. Methods: This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) study. This study included 9918 White or Black children between the ages of 9 and 10 living in married households. The predictor variable was family conflict. Race was the moderator. The outcome variable was STBs, treated as a count variable, reflecting positive STB items that were endorsed. Covariates included ethnicity, sex, age, immigration status, family structure, parental education, and parental employment, and household income. Poisson regression was used for data analysis. Results: Of all participants, 7751 were Whites, and 2167 were Blacks. In the pooled sample and in the absence of interaction terms, high family conflict was associated with higher STBs. A statistically significant association was found between Black race and family conflict, suggesting that the association between family conflict and STBs is stronger in Black than White children. Conclusion: The association between family conflict and STBs is stronger in Black than White children. Black children with family conflict may be at a higher risk of STBs than White children with the same family conflict level. These findings align with the literature on the more significant salience of social relations as determinants of mental health of Black than White people. Reducing family conflict should be regarded a significant element of suicide prevention for Black children in the US.
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Ali B, Rockett IRH, Miller TR, Leonardo JB. Racial/Ethnic Differences in Preceding Circumstances of Suicide and Potential Suicide Misclassification Among US Adolescents. J Racial Ethn Health Disparities 2021; 9:296-304. [PMID: 33415703 DOI: 10.1007/s40615-020-00957-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/23/2020] [Accepted: 12/27/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE There is a paucity of research on racial/ethnic differences in preceding circumstances of suicide among adolescents aged 10-19 years and consequential potential misclassification of suicide deaths (i.e., manner of death classified as injury of undetermined intent). This study (1) examined preceding circumstances of suicide among non-Hispanic White, non-Hispanic Black, non-Hispanic Asian/Pacific Islander (A/PI), non-Hispanic American Indian/Alaskan Native (AI/AN), and Hispanic adolescent decedents; and (2) investigated potential suicide misclassification of racial/ethnic minority decedents. METHODS We used data from the 2006-2015 National Violent Death Reporting System Restricted Access Database. Multivariable logistic regression analyses examined differences in depressed mood, mental health problem and treatment, crisis in the past 2 weeks, problems with school, intimate partner, family relationship, and other relationships (e.g., friend) among racial/ethnic minority decedents compared to White decedents. A separate logistic regression analysis assessed potential suicide misclassification of racial/ethnic minority decedents relative to White counterparts. RESULTS Adjusting for sex and suicide history and circumstances, all racial/ethnic minority decedents had significantly lower odds of documented mental health problem and treatment compared to White decedents. Racial/ethnic differences in relationship problems were also identified. Black decedents had significantly higher odds of manner-of-death classification as undetermined intent than did White decedents, suggesting greater likelihood of suicide misclassification. CONCLUSIONS Circumstances contributing to suicide among adolescents differ by race/ethnicity, indicating the need for culturally tailored suicide prevention efforts.
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Affiliation(s)
- Bina Ali
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD, 20705, USA.
| | - Ian R H Rockett
- Department of Epidemiology, West Virginia University, Morgantown, WV, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Ted R Miller
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD, 20705, USA.,School of Public Health, Curtin University, Perth, Australia
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Ali B, Rockett I, Miller T. Variable Circumstances of Suicide Among Racial/Ethnic Groups by Sex and Age: A National Violent-Death Reporting System Analysis. Arch Suicide Res 2021; 25:94-106. [PMID: 31538548 DOI: 10.1080/13811118.2019.1661894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Suicide rates vary by race/ethnicity, but little is known about how the circumstances that contribute to suicide differ across racial/ethnic groups. This study investigated suicide circumstances among non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic Asian/Pacific Islanders, non-Hispanic Native American/Alaskan Natives, and Hispanics by sex and age. Using de-identified National Violent Death Reporting System (NVDRS) Restricted Access Database files from 2006-2015, we examined proximal circumstances of suicide among decedents aged 10 years and older. Hierarchical logistic regression analysis revealed racial/ethnic differentials in non-alcohol substance abuse problem, intimate partner problem, and physical health problem across sex and age, controlling for potential confounders. Study findings highlight priority areas for suicide interventions.
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Variation in rates of self-harm hospital admission and re-admission by ethnicity in London: a population cohort study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1967-1977. [PMID: 33877371 PMCID: PMC8519852 DOI: 10.1007/s00127-021-02087-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/07/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE To compare sex-specific rates of hospital admission and repeat admission following self-harm between ethnic groups in London and test whether differences persist after adjustment for socio-economic deprivation. METHODS A population-based cohort of all individuals aged over 11 admitted to a general hospital for physical health treatment following self-harm between 2008 and 2018, using administrative Hospital Episode Statistics for all people living in Greater London. RESULTS There were 59,510 individuals admitted to the hospital following self-harm in the 10 year study period, ethnicity data were available for 94% of individuals. The highest rates of self-harm admission and readmission were found in the White Irish group. Rates of admission and readmission were lower in Black and Asian people compared to White people for both sexes at all ages and in all more specific Black and Asian ethnic groups compared to White British. These differences increased with adjustment for socio-economic deprivation. People of Mixed ethnicity had higher rates of readmission. Rates were highest in the 25-49 age group for Black and Mixed ethnicity men, but in under-25 s for all other groups. There were substantial differences in rates within the broader ethnic categories, especially for the Black and White groups. CONCLUSION In contrast to earlier UK studies, self-harm rates were not higher in Black or South Asian women, with lower self-harm admission rates seen in almost all ethnic minority groups. Differences in rates by ethnicity were not explained by socio-economic deprivation. Aggregating ethnicity into broad categories masks important differences in self-harm rates between groups.
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47
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Choi NG, Marti CN, DiNitto DM, Choi BY. Suicides and Deaths of Undetermined Intent by Poisoning: Reexamination of Classification Differences by Race/Ethnicity and State. Arch Suicide Res 2020; 24:S264-S281. [PMID: 30955464 DOI: 10.1080/13811118.2019.1592042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study examined differences by race/ethnicity and state in poisoning deaths of undetermined intent (UnD) versus suicide classification and the potential impact of state variations on UnD rates for Blacks and Hispanics. We used data from the 2005-2015 U.S. National Violent Death Reporting System (N = 29,567 aged 15+) and weighted coarsened exact matching. The odds of UnD classification were 7-10 times higher in the 5 highest UnD states (Kentucky, Maryland, Michigan, Utah, and Rhode Island) than in other states. Blacks in these 5 states had twice the odds of Whites of being classified as UnDs than suicides, but had lower odds in other states. Other significant UnD classification factors were opioid and cocaine positive toxicologies.
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48
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Peng S, Yang XY, Rockett IR. A typology of social capital and its mixed blessing for suicidal ideation: A multilevel study of college students. Soc Sci Med 2019; 243:112640. [DOI: 10.1016/j.socscimed.2019.112640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/09/2019] [Accepted: 10/19/2019] [Indexed: 01/09/2023]
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49
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Adams NJ, Vincent B. Suicidal Thoughts and Behaviors Among Transgender Adults in Relation to Education, Ethnicity, and Income: A Systematic Review. Transgend Health 2019; 4:226-246. [PMID: 31637302 PMCID: PMC6798808 DOI: 10.1089/trgh.2019.0009] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction: This systematic review assessed the impact of race/ethnicity, education, and income on transgender individual's lifetime experience of suicidal thoughts and behaviors (SITB) in gray and published literature (1997-2017). Methods: Sixty four research projects (108 articles) were identified in WorldCat, PubMed, and Google Scholar. Articles were included if they were published in Canada or the United States, included original quantifiable data on transgender SITBs, and had ≥5 participants, at least 51% of whom were ≥18 years. Results: Across all projects suicide ideation averaged 46.55% and attempts averaged 27.19%. The majority of participants were Caucasian, whereas the highest rate of suicide attempts (55.31%) was among First Nations, who accounted for <1.5% of participants. Caucasians, by contrast, had the lowest attempt rate (36.80%). More participants obtained a bachelor's degree and fewer an associate or technical degree than any other level of education. Suicide attempts were highest among those with ≤some high school (50.70%) and lowest among those with an advanced degree (30.25%). More participants made an income of $20-$50,000/year and less $10-$20,000 than any other income bracket. Conclusion: SITBs, among the transgender population, are both universally high and impacted by race/ethnicity, educational attainment, and income. These findings may be useful in creating culturally and factually informed interventions for transgender individuals experiencing SITBs and in informing future research on this topic.
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Affiliation(s)
- Noah J. Adams
- Department of Leadership, Higher and Adult Education, Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada
| | - Ben Vincent
- Department of Sociology, University of York, York, United Kingdom
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50
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Rockett IRH, Caine ED, Connery HS, Nolte KB, Nestadt PS, Nelson LS, Jia H. Unrecognised self-injury mortality (SIM) trends among racial/ethnic minorities and women in the USA. Inj Prev 2019; 26:439-447. [PMID: 31551367 PMCID: PMC7513258 DOI: 10.1136/injuryprev-2019-043371] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/22/2019] [Accepted: 08/24/2019] [Indexed: 01/09/2023]
Abstract
AIM To assess whether an enhanced category combining suicides with nonsuicide drug self-intoxication fatalities more effectively captures the burden of self-injury mortality (SIM) in the USA among US non-Hispanic black and Hispanic populations and women irrespective of race/ethnicity. METHODS This observational study used deidentified national mortality data for 2008-2017 from the CDC's Web-based Injury Statistics Query and Reporting System. SIM comprised suicides by any method and age at death plus estimated nonsuicide drug self-intoxication deaths at age ≥15 years. Measures were crude SIM and suicide rates; SIM-to-suicide rate ratios; and indices of premature mortality. RESULTS While the suicide rate increased by 29% for blacks, 36% for Hispanics and 25% for non-Hispanic whites between 2008 and 2017, corresponding SIM rate increases were larger at 109%, 69% and 55% (p<0.0001). SIM:suicide rate ratio gaps were widest among blacks but similar for the other two groups. Gaps were wider for females than males, especially black females whose ratios measured ≥3.71 across the observation period versus <3.00 for white and Hispanic counterparts. Total lost years of life for Hispanic, white and black SIM decedents in 2017 were projected to be 42.6, 37.1 and 32.4, respectively. CONCLUSION Application of SIM exposed substantial excess burdens from substance poisoning relative to suicide for minorities, particularly non-Hispanic blacks and for women generally. Results underscored the need to define, develop, implement and evaluate comprehensive strategies to address common antecedents of self-injurious behaviours.
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Affiliation(s)
- Ian R H Rockett
- Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA .,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.,Injury Control Research Center for Suicide Prevention, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric D Caine
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Hilary S Connery
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kurt B Nolte
- Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Paul S Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
| | - Lewis S Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Haomiao Jia
- Department of Biostatistics, Columbia University, New York, New York, USA.,School of Nursing, Columbia University, New York, New York, USA
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