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Olsson P, Wiktorsson S, Strömsten LMJ, Salander Renberg E, Runeson B, Waern M. Clinical characteristics and 6-month follow-up of adults with and without alcohol use disorder who self-harm. Front Psychiatry 2024; 15:1396855. [PMID: 39156607 PMCID: PMC11327149 DOI: 10.3389/fpsyt.2024.1396855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/22/2024] [Indexed: 08/20/2024] Open
Abstract
Background Alcohol use disorder (AUD) is associated with suicidal behavior, but prospective clinical studies are lacking. Aim To compare clinical characteristics and 6-month outcomes in persons with and without AUD who self-harm. Methods 804 adults (mean age 33, age range 18-95, 541 women and 263 men, 666 with suicide attempts and 138 with non-suicidal self-injuries at index) at three Swedish university hospitals took part in a research interview that included the Mini International Neuropsychiatric Interview (MINI). Subsequent non-fatal suicidal behavior within six months was identified by record review; suicides were identified by national register. Results At index, 39% of the men and 29% of the women had AUD. Over two thirds of these cases (69%) were identified by the MINI, but not by clinical AUD diagnosis. While trait impulsivity was more common among persons with AUD than those without (56% vs 36%, P adj = <.001), impulsivity in connection with the index attempt was noted in half of the participants in each group (48% vs 52%, P adj = 1). Subsequent suicidal behavior (fatal/non-fatal) occurred in 67 persons with AUD (26%) and in 98 without AUD (18%), a 60% higher risk among persons with AUD (OR = 1.60, 95% [CI 1.13-2.28], P = .009). Four persons with AUD (2%) and six without (1%) died by suicide within 6 months. Conclusion Almost a third of patients presenting at psychiatric emergency settings after self-harm fulfilled criteria for AUD, but clinicians often missed this diagnosis. Risk for subsequent suicidal behavior was elevated in patients with AUD. Educational interventions to improve recognition of alcohol use disorder may aid clinicians in the assessment and management of patients who present with self-harm.
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Affiliation(s)
- Petter Olsson
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Wiktorsson
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Mölndal, Sweden
| | | | | | - Bo Runeson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institute and Stockholm Health Care Services, Stockholm, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Mölndal, Sweden
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2
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Littlefield AK, Himes KP, Conner KR, Bagge CL. Warning signs in a period of acute risk for suicide attempt: The utility of count- and combination-based classification. Gen Hosp Psychiatry 2024; 89:55-59. [PMID: 38795612 DOI: 10.1016/j.genhosppsych.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/10/2024] [Accepted: 05/10/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE This study sought to establish if models involving the specific combinations of identifiable behavioral warning signs (WS; i.e., alcohol use, suicidal communications, preparation of personal affairs, experiencing negative interpersonal life events) for a suicide attempt outperformed a simpler count model of WS to distinguish an acute risk period (the six hours prior to a suicide attempt) from a control period (a matched six-hour period the day prior). METHOD Generalized linear mixed models tested all logical combinations of four behavioral WS in addition to a count variable of the number of behavioral warning signs. For the count variable, receiver operating characteristic curve analysis was utilized to determine the optimal cut point for the number of endorsed WS. RESULTS Area under the curve (AUC) compared classification across all models, with the count model demonstrating similar classification performance to the best multivariate model (AUCs of 0.72 and 0.73, respectively), with an optimal cut point of endorsing one or more WS. CONCLUSION Although determinations of acute risk should be informed by multiple sources of information, this study suggests a relatively simple count-based approach that considers the presence of one (or more) behavioral WS may be used as a potential indication of increased acute risk for suicide attempt.
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Affiliation(s)
| | - Katie P Himes
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Kenneth R Conner
- Department of Emergency Medicine and Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Courtney L Bagge
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI, USA; VA Center for Clinical Management Research, Department of Veteran Affairs, Ann Arbor, MI, USA
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3
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Jafari A, Rahnejat AM, Hooshyari Z, Taghva A, Ghasemzadeh MR, Donyavi V. Psychometric Properties of a Persian Version of the Columbia Suicide Severity Rating Scale (C-SSRS) in Iranian Soldiers. IRANIAN JOURNAL OF PSYCHIATRY 2024; 19:295-305. [PMID: 39055517 PMCID: PMC11267123 DOI: 10.18502/ijps.v19i3.15831] [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: 08/02/2023] [Revised: 02/28/2024] [Accepted: 04/20/2024] [Indexed: 07/27/2024]
Abstract
Objective: Suicide is an important health issue nearly all over the world. The Columbia Suicide Severity Rating Scale (C-SSRS) is a well-known instrument for suicide risk assessment. Our purpose in this study is to provide a Persian version of the C-SSRS and evaluate its psychometric properties in the Iranian military population, particularly suicide risk leveling characteristic of the C-SSRS. Method : For linguistic adaptation, we gathered opinions of an expert panel consisting of 23 professionals in mental health sciences. Furthermore, this version was administered to two groups of soldiers, one representing a sample of normal population (N = 338), while the other group comprised a sample of clinical population from a referral psychiatric hospital (N = 348) in Tehran, capital of Iran, from July 2021 until one year later. Besides the C-SSRS, the Beck Scale for Suicidal Ideation (BSSI), Beck Hopelessness Scale (BSS), and General Health Questionnaire 28 (GHQ28) were obtained from the participants. Correlation coefficients, internal consistency, and factor analysis were evaluated using the Statistical Package for the Social Sciences (version 23) software. Results: All items of the Persian version of the C-SSRS had acceptable content validity and face validity. This tool demonstrated high correlation coefficients with the BSSI (r = 0.73, P < 0.001) and BHS (r = 0.64, P < 0.001), but a low correlation coefficient with the GHQ28 (r = 0.22, P < 0.001). Specifically, the suicide risk level based on the C-SSRS had a high correlation with both the BSSI and BHS. Also, its internal consistency was satisfactory (Cronbach's alpha = 0.89). Furthermore, factor analysis revealed two factors that is consistent with suicidal ideation and suicidal behavior factors. Conclusion: Our results indicated acceptable validity and reliability for the Persian version of the C-SSRS, demonstrating its capability to classify suicide risk. It can be concluded that the ordinal suicide risk level (as red, orange, yellow and green) is a valid index for the application of the C-SSRS.
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Affiliation(s)
- Amirhossein Jafari
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Mohsen Rahnejat
- Department of Clinical Psychology, Behavioral and Cognitive Science Research Center, Aja University of Medical Sciences, Tehran, Iran
| | - Zahra Hooshyari
- Faculty of Psychology and Education, University of Tehran (UT), Tehran, Iran
| | - Arsia Taghva
- Behavioral and Cognitive Science Research Center, Aja University of Medical Sciences, Tehran, Iran
| | | | - Vahid Donyavi
- Department of Psychiatry, Aja University of Medical Science, Tehran, Iran
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4
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Carson NJ, Yang X, Mullin B, Stettenbauer E, Waddington M, Zhang A, Williams P, Rios Perez GE, Cook BL. Predicting adolescent suicidal behavior following inpatient discharge using structured and unstructured data. J Affect Disord 2024; 350:382-387. [PMID: 38158050 PMCID: PMC10923087 DOI: 10.1016/j.jad.2023.12.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/30/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The objective was to develop and assess performance of an algorithm predicting suicide-related ICD codes within three months of psychiatric discharge. METHODS This prognostic study used a retrospective cohort of EHR data from 2789 youth (12 to 20 years old) hospitalized in a safety net institution in the Northeastern United States. The dataset combined structured data with unstructured data obtained through natural language processing of clinical notes. Machine learning approaches compared gradient boosting to random forest analyses. RESULTS Area under the ROC and precision-recall curve were 0.88 and 0.17, respectively, for the final Gradient Boosting model. The cutoff point of the model-generated predicted probabilities of suicide that optimally classified the individual as high risk or not was 0.009. When applying the chosen cutoff (0.009) to the hold-out testing set, the model correctly identified 8 positive cases out of 10, and 418 negative cases out 548. The corresponding performance metrics showed 80 % sensitivity, 76 % specificity, 6 % PPV, 99 % NPV, F-1 score of 0.11, and an accuracy of 76 %. LIMITATIONS The data in this study comes from a single health system, possibly introducing bias in the model's algorithm. Thus, the model may have underestimated the incidence of suicidal behavior in the study population. Further research should include multiple system EHRs. CONCLUSIONS These performance metrics suggest a benefit to including both unstructured and structured data in design of predictive algorithms for suicidal behavior, which can be integrated into psychiatric services to help assess risk.
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Affiliation(s)
- Nicholas J Carson
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02139, USA.
| | - Xinyu Yang
- Parexel, 275 Grove St., Suite 101C, Newton, MA 02466, USA
| | - Brian Mullin
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02139, USA
| | | | - Marin Waddington
- Division of Gastroenterology at Brigham and Women's Hospital, Resnek Family Center for PSC Research, 75 Francis Street, Boston, MA 02115, USA
| | - Alice Zhang
- Department of Psychology, New York University, 6 Washington Place, New York, NY 10003, USA
| | - Peyton Williams
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02139, USA
| | - Gabriel E Rios Perez
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02139, USA
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02139, USA
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Cheng X, Chen J, Zhang X, Wang T, Sun J, Zhou Y, Yang R, Xiao Y, Chen A, Song Z, Chen P, Yang C, QiuxiaWu, Lin T, Chen Y, Cao L, Wei X. Characterizing the temporal dynamics of intrinsic brain activities in depressed adolescents with prior suicide attempts. Eur Child Adolesc Psychiatry 2024; 33:1179-1191. [PMID: 37284850 PMCID: PMC11032277 DOI: 10.1007/s00787-023-02242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
Converging evidence has revealed disturbances in the corticostriatolimic system are associated with suicidal behaviors in adults with major depressive disorder. However, the neurobiological mechanism that confers suicidal vulnerability in depressed adolescents is largely unknown. A total of 86 depressed adolescents with and without prior suicide attempts (SA) and 47 healthy controls underwent resting-state functional imaging (R-fMRI) scans. The dynamic amplitude of low-frequency fluctuations (dALFF) was measured using sliding window approach. We identified SA-related alterations in dALFF variability primarily in the left middle temporal gyrus, inferior frontal gyrus, middle frontal gyrus (MFG), superior frontal gyrus (SFG), right SFG, supplementary motor area (SMA) and insula in depressed adolescents. Notably, dALFF variability in the left MFG and SMA was higher in depressed adolescents with recurrent suicide attempts than in those with a single suicide attempt. Moreover, dALFF variability was capable of generating better diagnostic and prediction models for suicidality than static ALFF. Our findings suggest that alterations in brain dynamics in regions involved in emotional processing, decision-making and response inhibition are associated with an increased risk of suicidal behaviors in depressed adolescents. Furthermore, dALFF variability could serve as a sensitive biomarker for revealing the neurobiological mechanisms underlying suicidal vulnerability.
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Affiliation(s)
- Xiaofang Cheng
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Jianshan Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Xiaofei Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Ting Wang
- The Second Affiliated Hospital, School of Medicine, South China University of Technology, 1 Panfu Road, Yuexiu district, Guangzhou, 510180, Guangdong, People's Republic of China
| | - Jiaqi Sun
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Ruilan Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Yeyu Xiao
- Guangzhou Integrated Traditional Chinese and Western Medicine, Guangzhou, 510800, Guangdong, People's Republic of China
| | - Amei Chen
- The Second Affiliated Hospital, School of Medicine, South China University of Technology, 1 Panfu Road, Yuexiu district, Guangzhou, 510180, Guangdong, People's Republic of China
| | - Ziyi Song
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Pinrui Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Chanjuan Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - QiuxiaWu
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Taifeng Lin
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Yingmei Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China
| | - Liping Cao
- The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, liwan district, Guangzhou, 510370, Guangdong, People's Republic of China.
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, 510370, Guangdong, People's Republic of China.
| | - Xinhua Wei
- The Second Affiliated Hospital, School of Medicine, South China University of Technology, 1 Panfu Road, Yuexiu district, Guangzhou, 510180, Guangdong, People's Republic of China.
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Brown KA, Donise KR, Cancilliere MK, Aluthge DP, Chen ES. Characterizing Autism Spectrum Disorder and Predicting Suicide Risk for Pediatric Psychiatric Emergency Services Encounters. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:864-873. [PMID: 38222397 PMCID: PMC10785882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Individuals diagnosed with autism spectrum disorder (ASD) are at a higher risk for mental health concerns including suicidal thoughts and behaviors (STB). Limited studies have focused on suicidal risk factors that are more prevalent or unique to the population with ASD. This study sought to characterize and classify youth presenting to the psychiatric emergency department (ED) for a chief complaint of STB. The results of this study validated that a high number of patients with ASD present to the ED with STB. There were important differences in clinical characteristics to those with ASD versus those without. Clinical features that showed important impact in predicting high suicide risk in the ASD cases include elements of the mental status exam such as affect, trauma symptoms, abuse history, and auditory hallucinations. Focused attention is needed on these unique differences in ASD cases so that suicide risk level can be appropriately and promptly addressed.
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Affiliation(s)
| | - Kathleen R Donise
- Department of Psychiatry and Human Behavior at Alpert Medical School, Brown University, Providence RI
- Department of Child and Adolescent Psychiatry, Hasbro Children's Hospital, Providence RI
| | - Mary Kathryn Cancilliere
- Department of Psychiatry and Human Behavior at Alpert Medical School, Brown University, Providence RI
- Department of Child and Adolescent Psychiatry, Hasbro Children's Hospital, Providence RI
| | - Dilum P Aluthge
- Center for Biomedical Informatics, Brown University, Providence RI
| | - Elizabeth S Chen
- Center for Biomedical Informatics, Brown University, Providence RI
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7
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Langford VM. Risk Factors for Suicide in Men. Nurs Clin North Am 2023; 58:513-524. [PMID: 37832996 DOI: 10.1016/j.cnur.2023.06.010] [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] [Indexed: 10/15/2023]
Abstract
Suicide and the risk factors associated with it have been researched with increasing interest over the last 5 decades with respect to socioeconomic status, age, geographic location, and ethnic background. There has been less focus related to the risk factors specific to gender and how to incorporate clinical screening and interventions to reduce the mortality of suicide in males. With men accounting for a disproportionate number of deaths from suicide in the United States and worldwide, how gender could impact suicidal behavior and ideations remains a topic understudied and with great potential for significant improvement in clinical recognition and treatment.
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8
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Ji Y, Liu X, Zheng S, Zhong Q, Zheng R, Huang J, Yin H. Validation and application of the Chinese version of the Columbia-Suicide Severity Rating Scale: Suicidality and cognitive deficits in patients with major depressive disorder. J Affect Disord 2023; 342:139-147. [PMID: 37714386 DOI: 10.1016/j.jad.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/25/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Depression is a significant risk factor for death by suicide. Additionally, patients with depression who have neurocognitive dysfunction are at a higher risk of exhibiting suicidal behaviors. We aimed to validate the Chinese version of the Columbia Suicide Severity Rating Scale (C-SSRS) and then employ it to examine the association between suicidality and cognitive deficits in patients with Major Depressive Disorder (MDD). METHODS Data from 456 patients with MDD who underwent baseline assessment and 3-month follow-up were used for psychometric validation of the C-SSRS. 430 patients were divided into a mild cognitive impairment group (N = 390) and a severe cognitive impairment group (N = 40) using cluster analysis and compared with healthy controls. The relationship between C-SSRS scores and the degree of cognitive impairment was analyzed. RESULTS 1) The Chinese version of C-SSRS demonstrated good internal consistency (Cronbach's alpha = 0.884/0.842), convergent and divergent validity. 2) The severity of suicidal ideation (SI), the intensity of SI, and the lifetime history of suicide attempts were significant independent predictors of short-term suicide attempts. 3) Higher worst-point lifetime SI severity and intensity scores in patients with MDD were significantly associated with severe cognitive impairment. LIMITATIONS The analysis of cognition and suicide was based on cross-sectional studies. Hence, changes in SI and cognitive function over time could not be analyzed. CONCLUSIONS The Chinese C-SSRS is a reliable and valid assessment tool for suicidal ideation and behavior in patients with depression. Suicidal ideation in patients with MDD is associated with cognitive dysfunction. These findings provide a reference for suicide prevention in patients with depression.
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Affiliation(s)
- Yujia Ji
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Institute of Brain Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Xingchang Liu
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shuqiong Zheng
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Institute of Brain Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Quan Zhong
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Institute of Brain Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Rongxin Zheng
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Institute of Brain Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Jin Huang
- Institute of Brain Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Honglei Yin
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Institute of Brain Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China.
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9
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Kayan Ocakoğlu B, Kafalı HY, Ocakoğlu FT, Kardaş B, Kardaş Ö, Işık A, Müjdecioğlu G, Akpınar S, Karakaya SEK, Balca Y, Yektaş Ç. Relations of Childhood Trauma and Emotional Dysregulation with Suicide Ideation and Suicidal Behaviour Severity in a Clinical Sample of Depressive Female Adolescents. IRANIAN JOURNAL OF PSYCHIATRY 2023; 18:443-454. [PMID: 37881414 PMCID: PMC10593995 DOI: 10.18502/ijps.v18i4.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/26/2022] [Accepted: 12/19/2022] [Indexed: 10/27/2023]
Abstract
Objective: This study aimed to explore the aspects of emotional dysregulation (ED) and childhood trauma (CT) which are associated with suicide ideation (SI) and suicidal behaviour (SB) severity in depressive female adolescents who previously attempted suicide. Method : In this cross-sectional study, we evaluated SI and SB severity. The Columbia-Suicide Severity Rating Scale (C-SSRS) was administered to 80 depressive female patients who had suicide attempts within the last month. Current suicide ideation (C-SI) and total score (C-TS), lifetime- suicide ideation (L-SI), and total score (L-TS) were obtained with the C-SSRS. Patients were recruited from five different provinces in Turkey. Additionally, the patients completed the Difficulties in Emotion Regulation Scale (DERS), Childhood Trauma Questionnaire (CTQ), and Beck Depression Inventory (BDI). The Pearson correlation test and a multiple linear regression analysis were used to determine variables predictive of suicide scores. Results: The results of multiple linear regression analysis indicated that the BDI and DERS - total scores explained 35% (adjusted R) of the variance in C-SI ((F (2;67) = 19.61, P < 0.001). C-TS was explained by 'BDI,' 'emotional neglect' and 'DERS impulse' (38% (adjusted R) (F (3;66) = 15.15, P < 0.001). L-SI was only associated with DERS strategies (explains 13% (adjusted R) of the variance in L-SI (F (1;68) = 10.411, P = 0.02). Concerning the C-SSRS L-TS, the DERS impulse and CTQ total accounted for 24% (adjusted R) of the variance (F (2;67) = 10.620, P < 0.001). Conclusion: The results of our study suggest that adolescents who have experienced emotional neglect and depressive symptoms are more at risk for suicidal ideation and behaviour. In addition, depressed adolescents who show impulsive behaviours and restricted emotional strategies are also at risk. Identifying neglected depressed adolescents and teaching impulse control and effective emotional strategies is important for the prevention of suicidal behaviours and thoughts.
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Affiliation(s)
- Binay Kayan Ocakoğlu
- Clinic of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| | - Helin Yılmaz Kafalı
- Ministry of Health Ankara City Hospital Child and Adolescent Psychiatry Department, Ankara, Turkey
| | - Fevzi Tuna Ocakoğlu
- İstanbul Private French Lape Hospital Child and Adolescent Psychiatry Clinic, Istanbul, Turkey
| | - Burcu Kardaş
- Kocaeli University Faculty of Medicine Child and Adolescent Psychiatry Department, Kocaeli, Turkey
| | - Ömer Kardaş
- Kocaeli University Faculty of Medicine Child and Adolescent Psychiatry Department, Kocaeli, Turkey
| | - Adem Işık
- Van Regional Training and Research Hospital, Van, Turkey
| | | | - Serap Akpınar
- Ministry of Health Ankara City Hospital Child and Adolescent Psychiatry Department, Ankara, Turkey
| | | | - Yeliz Balca
- Diyarbakır Child Diseases Hospital Child and Adolescent Psychiatry Clinic, Diyarbakır, Turkey
| | - Çiğdem Yektaş
- Uskudar University Child and Adolescent Psychiatry Department, Istanbul, Turkey
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McCall WV, Ribbens LT, Looney SW. Relationships among insomnia, executive function, and suicidal ideation in depressed outpatients: A mediation analysis. Scand J Psychol 2023; 64:105-112. [PMID: 36214265 DOI: 10.1111/sjop.12872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 12/01/2022]
Abstract
Insomnia is a risk factor for suicide, and both are associated with cognitive problems. However, prior research has not examined insomnia, cognition, and suicidal ideation within one sample. We describe cross-sectional associations among insomnia, psychomotor speed, set shifting, and suicidal ideation in 85 depressed adults. Greater insomnia was associated with slower psychomotor speed, while slower psychomotor speed was associated with a greater level (i.e., elaboration of suicide planning) and intensity of suicidal ideation in the past week. Slower set shifting was associated with a greater level and intensity of suicidal ideation in the past week. Mediation analysis indicated that psychomotor speed and set shifting both had a significant total effect on the intensity of suicidal ideation in the past week; set shifting also had a significant total effect on the sum of intensity and suicidal ideation level in the past week. The level of insomnia explained only small percentages of the total effect of either psychomotor speed or set shifting on the intensity of suicidal ideation and the sum of intensity and suicidal ideation level. The findings in this sample demonstrate significant associations of slower psychomotor speed and set shifting with suicidal ideation, with negligible contribution from insomnia.
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Affiliation(s)
- William V McCall
- Department of Psychiatry and Health Behavior; Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Lucas T Ribbens
- Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Stephen W Looney
- Department of Population Health Sciences; Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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11
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Caldieraro MA, Tung TC, Agudelo Baena LM, Vilapriño Duprat M, Corral RM, Alviso de la Serna LD, Saucedo E, Kanevsky G, Cabrera P. Depression and suicidality severity among TRD patients after 1-year under standard of care: Findings from the TRAL study, a multicenter, multinational, observational study in Latin America. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:85-94. [PMID: 38591721 DOI: 10.1016/j.rpsm.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Treatment resistant depression (TRD) is one of the most pressing issues in mental healthcare in LatAm. However, clinical data and outcomes of standard of care (SOC) are scarce. The present study reported on the Treatment-Resistant Depression in America Latina (TRAL) project 1-year follow-up of patients under SOC assessing clinical presentation and outcomes. MATERIALS AND METHODS 420 patients with clinical diagnoses of TRD from Argentina, Brazil, Colombia and Mexico were included in a 1-year follow-up to assess clinical outcomes of depression (MADRS) and suicidality (C-SSRS), as well as evolution of clinical symptoms of depression. Patients were assessed every 3 months and longitudinal comparison was performed based on change from baseline to each visit and end of study (12 months). Socio demographic characterization was also performed. RESULTS Most patients were female (80.9%), married (42.5%) or single (34.4%), with at least 10 years of formal education (71%). MDD diagnosis was set at 37.29 (SD=14.00) years, and MDD duration was 11.11 years (SD=10.34). After 1-year of SOC, 79.1% of the patients were still symptomatic, and 40% of the patients displayed moderate/severe depression. Only 44.1% of the patients achieved a response (≥50% improvement in MADRS), and 60% of the sample failed to achieve remission. Suicidal ideation was reported by more than half of the patients at the end of study. CONCLUSIONS Depression and suicidality symptoms after a 1-year of SOC is of great concern. Better therapeutic options are needed to tackle this debilitating and burdensome disease.
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Affiliation(s)
- Marco Antonio Caldieraro
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Serviço de Psiquiatria, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Teng Chei Tung
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Manuel Vilapriño Duprat
- Médico Psiquiatra, Centro de Estudios Asistencia e Investigación en Neurociencias (CESASIN), Mendoza, Argentina
| | - Ricardo Marcelo Corral
- Médico especialista en Psiquiatría; Presidente Fundación Estudio y Tratamiento de las Enfermedades Mentales, Buenos Aires, Argentina
| | | | - Erasmo Saucedo
- Departamento de Psiquiatría del Hospital Universitario de la Universidad Autónoma de Nuevo León/CIT-Neuropsique S.C (Centro de Investigación y Terapia), Argentina
| | - Gabriela Kanevsky
- Janssen-Cilag Farmacéutica (Argentina), Mendoza, Buenos Aires, Argentina.
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12
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Zheng S, Guo J, Xin Q, Galfalvy H, Ye Y, Yan N, Qian R, Mann JJ, Li E, Xue X, Yin H. Association of adenosine triphosphate-related genes to major depression and suicidal behavior: Cognition as a potential mediator. J Affect Disord 2023; 323:131-139. [PMID: 36442653 DOI: 10.1016/j.jad.2022.11.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/31/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Soluble epoxide hydrolase (sEH, encoded by EPHX2) and P2X2 (a subtype of ATP receptors) may mediate the antidepressant-like effects of ATP. We sought to determine whether polymorphisms and mRNA expression of EPHX2 and P2X2 are associated with depression and suicidal behavior and how cognition may mediate such associations. METHOD We examined 83 single nucleotide polymorphisms (SNPs) of EPHX2 and P2X2. Subjects were MDD suicide attempters (N = 143), MDD non-suicide attempters (N = 248), and healthy volunteers (HV, N = 110). Data on demographics, depression severity, and suicide attempts were collected. Participants completed a set of cognitive tasks. Polymorphisms were genotyped using MALDI-TOF MS within the MassARRAY system. The expression of mRNA was measured using real-time polymerase chain reaction (RT-PCR). RESULTS Cognitive function was a significant mediator (p = 0.006) of the genetic effect on depression. Allele C of rs202059124 was associated with depression risk (OR = 11.57, 95%CI: 2.33-209.87, p = 0.0181). A significant relationship was found between P2X2 mRNA expression and depression (OR = 0.68, 95%CI: 0.49-0.94, p = 0.0199). One haploblock (rs9331942 and rs2279590) was associated with suicide attempts: subjects with haplotype GC (frequency = 19.8 %, p = 0.017) and AT (frequency = 35.2 %, p < 0.001) had a lower rate of suicide attempts. CONCLUSIONS Our results confirmed that cognitive impairment plays a role in the effect of rs9331949 on depression. Moreover, we confirmed a relationship between P2X2, EPHX2, and MDD in humans and presented preliminary haplotype-based evidence that implicates EPHX2 in suicide. LIMITATIONS The main limitation of this study is the limited sample size. More comprehensive and multi-domain cognition tasks and different assessment measures are required in further study.
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Affiliation(s)
- Shuqiong Zheng
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Jia Guo
- Department of Biostatistics, Columbia University, New York, NY, United States
| | - Qianqian Xin
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Hanga Galfalvy
- Department of Biostatistics, Columbia University, New York, NY, United States
| | - Youran Ye
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Na Yan
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Rongrong Qian
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - J John Mann
- Department of Psychiatry, Columbia University, New York, NY, United States; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, United States
| | - Enze Li
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Xiang Xue
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Honglei Yin
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China.
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13
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Dillon EC, Huang Q, Deng S, Li M, de Vera E, Pesa J, Nguyen T, Kiger A, Becker DF, Azar K. Implementing universal suicide screening in a large healthcare system's hospitals: rates of screening, suicide risk, and documentation of subsequent psychiatric care. Transl Behav Med 2023; 13:193-205. [PMID: 36694929 DOI: 10.1093/tbm/ibac117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Implementation of suicide risk screening may improve prevention and facilitate mental health treatment. This study analyzed implementation of universal general population screening using the Columbia-Suicide Severity Rating Scale (C-SSRS) within hospitals. The study included adults seen at 23 hospitals from 7/1/2019-12/31/2020. We describe rates of screening, suicide risk, and documented subsequent psychiatric care (i.e., transfer/discharge to psychiatric acute care, or referral/consultation with system-affiliated behavioral health providers). Patients with suicide risk (including those with Major Depressive Disorder [MDD]) were compared to those without using Wilcoxon rank-sum -tests for continuous variables and χ2 tests for categorical variables. Results reported are statistically significant at p < 0.05 level. Among 595,915 patients, 84.5% were screened by C-SSRS with 2.2% of them screening positive (37.6% low risk [i.e., ideation only], and 62.4% moderate or high risk [i.e., with a plan, intent, or suicidal behaviors]). Of individuals with suicide risk, 52.5% had documentation of psychiatric care within 90 days. Individuals with suicide risk (vs. without) were male (48.1% vs 43.0%), Non-Hispanic White (55.0% vs 47.8%), younger (mean age 41.0 [SD: 17.7] vs. 49.8 [SD: 20.4]), housing insecure (12.5% vs 2.6%), with mental health diagnoses (80.3% vs 25.1%), including MDD (41.3% vs 6.7%). Universal screening identified 2.2% of screened adults with suicide risk; 62.4% expressed a plan, intent or suicidal behaviors, and 80.3% had mental health diagnoses. Documented subsequent psychiatric care likely underestimates true rates due to care fragmentation. These findings reinforce the need for screening, and research on whether screening leads to improved care and fewer suicides.
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Affiliation(s)
- Ellis C Dillon
- Center on Aging, University of Connecticut, Farmington, CT
| | - Qiwen Huang
- Sutter Health Center for Health Systems Research and Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA
| | - Sien Deng
- Sutter Health Center for Health Systems Research and Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA
| | - Martina Li
- Sutter Health Center for Health Systems Research and Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA
| | - Ernell de Vera
- Mental Health & Addiction Care, Sutter Health, Sacramento, CA
| | - Jacqueline Pesa
- Real World Value & Evidence, Janssen Scientific Affairs, Titusville, NJ
| | - Tam Nguyen
- Mental Health & Addiction Care, Sutter Health, Sacramento, CA
| | - Anna Kiger
- Office of the System Chief Nurse Officer, Sutter Health, Sacramento, CA
| | - Daniel F Becker
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA
| | - Kristen Azar
- Institute for Advancing Health Equity, Sutter Health, Walnut Creek, CA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
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Riblet NB, Matsunaga S, Lee Y, Young-Xu Y, Shiner B, Schnurr PP, Levis M, Watts BV. Tools to Detect Risk of Death by Suicide: A Systematic Review and Meta-Analysis. J Clin Psychiatry 2022; 84:21r14385. [PMID: 36383739 PMCID: PMC9890591 DOI: 10.4088/jcp.21r14385] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: There is limited knowledge about the ability of instruments to detect risk of suicide in a range of settings. Prior reviews have not considered whether the utility of instruments depends on prior probability of risk. We performed a systematic review to determine the diagnostic accuracy of instruments to detect risk of suicide in adults using likelihood ratio analysis. This method aids evaluation of prior probabilities of risk. Data Sources: We searched MEDLINE, Cochrane Database of Systematic Reviews, PsycINFO, EMBASE, and Scopus from inception through January 19, 2021. Study Selection: We included clinical trials, observational studies, and quasi-experimental studies assessing the diagnostic accuracy of instruments to detect risk of suicide in adults. There were no language restrictions. Data Extraction: Three reviewers in duplicate assessed full texts to determine eligibility and extracted data from included studies. Positive (LR+) and negative likelihood ratio (LR-) and 95% CIs were calculated for each instrument. Results: Thirty studies met inclusion criteria. Most instruments showed minimal utility to detect or rule out risk of suicide, with LR+ ≤ 2.0 and LR- ≥ 0.5. A few instruments had a high utility for improving risk detection in emergency department, inpatient mental health, and prison settings when patients scored above the cutoff (LR+ > 10). For example, among patients discharged from an emergency department, the Columbia Suicide Severity Rating Scale-Clinical Practice Screener had a LR+ of 10.3 (95% CI, 6.3-16.8) at 3-month follow-up. The clinical utility of the instruments depends on the pretest probability of suicide in the setting. Because studies spanned over 6 decades, the findings are at risk for secular trends. Discussion: We identified several instruments that may hold promise for detecting risk of suicide in emergency department, inpatient mental health, or prison settings. The utility of the instrument hinges, in part, on baseline suicide risk. Registration: PROSPERO: CRD42021285528.
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Affiliation(s)
- Natalie B Riblet
- Mental Health Service, Veterans Affairs Medical Center, White River Junction, Vermont
- Department of Psychiatry and Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Corresponding author: Natalie B. Riblet, MD, MPH, Veterans Affairs Medical Center, Bldg 9, 215 North Main St, White River Junction, VT 05009
| | - Sarah Matsunaga
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Younji Lee
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Yinong Young-Xu
- Mental Health Service, Veterans Affairs Medical Center, White River Junction, Vermont
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Brian Shiner
- Mental Health Service, Veterans Affairs Medical Center, White River Junction, Vermont
- Department of Psychiatry and Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- National Center for PTSD, White River Junction, Vermont
| | - Paula P Schnurr
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- National Center for PTSD, White River Junction, Vermont
| | - Maxwell Levis
- Mental Health Service, Veterans Affairs Medical Center, White River Junction, Vermont
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Bradley V Watts
- Mental Health Service, Veterans Affairs Medical Center, White River Junction, Vermont
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Veterans Rural Health Resource Center, White River Junction VA Medical Center, White River Junction, Vermont
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15
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Robison M, Rogers ML, Robertson L, Duffy ME, Manwaring J, Riddle M, Rienecke RD, Le Grange D, Duffy A, Plotkin M, Blalock DV, Mehler PS, Joiner TE. Avoidant restrictive food intake disorder and suicidal ideation. Psychiatry Res 2022; 317:114925. [PMID: 37732866 DOI: 10.1016/j.psychres.2022.114925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/14/2022] [Accepted: 10/22/2022] [Indexed: 11/28/2022]
Abstract
Most DSM-5 eating disorder diagnoses are associated with elevated suicide risk; however, little is known about the relationship between Avoidant/Restrictive Food Intake Disorder (ARFID) and suicidal ideation. The aim of the current study was to examine suicidal ideation within an adult ARFID sample. Patients with eating disorders (N = 936), some of whom met criteria for a current DSM-5 diagnosis of ARFID (n = 79), completed the Beck Depression Inventory II Item 9, regarding suicidal ideation. The study was conducted within an eating disorder treatment facility that offers inpatient, residential, partial hospitalization program, and intensive outpatient levels of care. Findings suggest no significant pairwise differences in suicidal ideation prevalence between participants with ARFID and those with any other ED diagnosis. Thorough screening for suicidal thoughts and risk among those with ARFID is warranted at all levels of care. We suggest that future research expand upon this work in a larger adult ARFID sample.
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Affiliation(s)
- Morgan Robison
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA.
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Lee Robertson
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA
| | - Mary E Duffy
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA
| | - Jamie Manwaring
- ACUTE at Denver Health, Denver, CO, USA; Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA
| | - Megan Riddle
- ACUTE at Denver Health, Denver, CO, USA; University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, WA
| | - Renee D Rienecke
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL (Emeritus), USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA
| | - Millie Plotkin
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Philip S Mehler
- ACUTE at Denver Health, Denver, CO, USA; Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA; Department of Internal Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA
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Lee HJ, Lee DH, Jeon HJ, Lee DH, Yook V, Jeon JY. Development and Validation of the Self-Rating Suicide Risk Screening Questionnaire. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221119029. [PMID: 35968773 DOI: 10.1177/00302228221119029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Since suicide is one of the major health problems worldwide, the goal of the present study is to develop a psychometrically sound suicide risk screening tool named Suicide Screening Questionnaire- Self-Rating (SSQ-SR) to quantify the risk of suicidal behavior. The development process includes item generation, item revision and refinement, and validation. A total sample of 2,238 adults in South Korea was used for analysis. The results of factor analysis showed that the SSQ-SR, containing 25 items, supported a three-factor model: "Situational factors," "Negative self-perceptions and mental health factors," and "Suicidal thoughts and behaviors." Also, SSQ-SR showed satisfying internal consistency, concurrent validity and discriminant validity. Lastly, the results of ROC analysis showed a cut-off point of 33.5 for the low-risk group and 36.5 for the high-risk group. Considering these results, the current results demonstrate the SSQ-SR is a valid scale and therefore can contribute to future suicide-related studies and prevention.
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Affiliation(s)
- Hwa Jung Lee
- Department of Education, Traumatic Stress Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Dong Hun Lee
- Department of Education, Traumatic Stress Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Deok Hee Lee
- Department of Education, Traumatic Stress Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Vidal Yook
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Yeol Jeon
- Department of Education, Traumatic Stress Center, Sungkyunkwan University, Seoul, Republic of Korea
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17
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Liu BP, Jia CX, Qin P, Zhang YY, Yu YK, Luo X, Li SX. Associating factors of suicide and repetition following self-harm: A systematic review and meta-analysis of longitudinal studies. EClinicalMedicine 2022; 49:101461. [PMID: 35747199 PMCID: PMC9126760 DOI: 10.1016/j.eclinm.2022.101461] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Longitudinal evidence for sociodemographic and clinic factors deviating risk for suicide and repetition following SH (self-harm) varied greatly. METHODS A comprehensive search of PubMed, Web of Science, EMBASE, and PsycINFO was conducted from January 1st, 2010 to April 5th, 2022. Longitudinal studies focusing on examining associating factors for suicide and repetition following SH were included. PROSPERO registration CRD42021248695. FINDINGS The present meta-analysis synthesized data from 62 studies published from Jan. 1st, 2010. The associating factors of SH repetition included female gender (RR, 95%CI: 1.11, 1.04-1.18, I2=82.8%), the elderly (compared with adolescents and young adults, RR, 95%CI: 0.67, 0.52-0.87, I2=86.3%), multiple episodes of SH (RR, 95%CI: 1.97, 1.51-2.57, I2=94.3%), diagnosis (RR, 95%CI: 1.60, 1.27-2.02, I2=92.7%) and treatment (RR, 95%CI: 1.59, 1.40-1.80, I2=93.3%) of psychiatric disorder. Male gender (RR, 95%CI: 2.03, 1.80-2.28, I2=83.8%), middle-aged adults (compared with adolescents and young adults, RR, 95%CI: 2.40, 1.87-3.08, I2=74.4%), the elderly (compared with adolescents and young adults, RR, 95%CI: 4.38, 2.98-6.44, I2=76.8%), physical illness (RR, 95%CI: 1.95, 1.56-2.43, I2=0), multiple episodes of SH (RR, 95%CI: 2.02, 1.58-2.58, I2=87.4%), diagnosis (RR, 95%CI: 2.13, 1.67-2.71, I2=90.9%) and treatment (RR, 95%CI: 1.36, 1.16-1.58, I2=58.6%) of psychiatric disorder were associated with increased risk of suicide following SH. INTERPRETATION Due to the substantial heterogeneity for clinic factors of suicide and repetition following SH, these results need to be interpreted with caution. Clinics should pay more attention to the cases with SH repetition, especially with poor physical and psychiatric conditions. FUNDING This work was supported by National Natural Science Foundation of China (NSFC) [No: 82103954; 30972527; 81573233].
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Affiliation(s)
- Bao-Peng Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
- Corresponding author at: Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine of University of Oslo, Oslo, Norway
| | - Ying-Ying Zhang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Yao-Kun Yu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Xiao Luo
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Shi-Xue Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Corresponding author at: Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Olsson P, Wiktorsson S, Strömsten LMJ, Salander Renberg E, Runeson B, Waern M. Attention deficit hyperactivity disorder in adults who present with self-harm: a comparative 6-month follow-up study. BMC Psychiatry 2022; 22:428. [PMID: 35751076 PMCID: PMC9233312 DOI: 10.1186/s12888-022-04057-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND ADHD is common in psychiatric populations. This study aimed to compare clinical characteristics in adults with and without ADHD who presented with self-harm, and to compare later risk of suicidal behaviour within 6 months. METHODS Eight hundred four adults presented with self-harm (with and without suicidal intent) at psychiatric emergency services at three Swedish hospitals. Persons with a discharge ICD-10 diagnosis F90.0-F90.9 or a prescription for ADHD medication were considered to have ADHD (n = 93). Medical records were reviewed for evidence of subsequent suicide attempts (SA) within 6 months; suicides were identified by national register. RESULTS Recent relationship problems were more prevalent in the ADHD group. While the index episodes of those with ADHD were more often non-suicidal, and actual SAs more often rated as impulsive, medical lethality at presentation did not differ in attempters with and without ADHD. Subsequent SAs (fatal or non-fatal) were observed in 29% of the ADHD group and 20% in all others (P = .005). A logistic regression model showed elevated risk of suicidal behaviour during follow-up in the ADHD group (OR = 1.70, CI 1.05-2.76), although a final regression model suggested that this association was partly explained by age and comorbid emotionally unstable personality disorder. CONCLUSIONS Findings highlight the need for clinicians to take self-harm seriously in adults with ADHD.
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Affiliation(s)
- Petter Olsson
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Blå stråket 15, vån 3, SU/S, 413 45, Göteborg, Sweden.
| | - Stefan Wiktorsson
- grid.8761.80000 0000 9919 9582Department of Psychiatry and Neurochemistry, University of Gothenburg, Blå stråket 15, vån 3, SU/S, 413 45 Göteborg, Sweden ,grid.1649.a000000009445082XRegion Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Mölndal, Sweden
| | - Lotta M. J. Strömsten
- grid.12650.300000 0001 1034 3451Department of Psychology, Umeå University, Umeå, Sweden
| | - Ellinor Salander Renberg
- grid.12650.300000 0001 1034 3451Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
| | - Bo Runeson
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institute and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Margda Waern
- grid.8761.80000 0000 9919 9582Department of Psychiatry and Neurochemistry, University of Gothenburg, Blå stråket 15, vån 3, SU/S, 413 45 Göteborg, Sweden ,grid.1649.a000000009445082XRegion Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Mölndal, Sweden
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Ferreira ACZ, Capistrano FC, Kaled M, Maftum MA, Kalinke LP, Palm RDCM, Miasso AI. Tentativa de suicídio por pessoas com transtornos relacionados ao uso de substâncias em tratamento. REME: REVISTA MINEIRA DE ENFERMAGEM 2022. [DOI: 10.35699/2316-9389.2022.38798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objetivo: identificar os fatores associados à tentativa de suicídio por pessoas com transtornos relacionados ao uso de substâncias em tratamento nos Centros de Atenção Psicossocial de Álcool e outras Drogas. Método: estudo observacional e transversal realizado com 137 pessoas com transtornos relacionados ao uso de substâncias em tratamento em Centros de Atenção Psicossocial de Álcool e outras Drogas de uma capital da região Sul do Brasil. Os dados foram coletados entre abril e novembro de 2018 por entrevista estruturada e submetidos à análise quantitativa descritiva, univariada e múltipla. Resultados: 51,8% dos participantes apresentaram ao menos uma tentativa de suicídio alguma vez na vida. Pensamentos suicidas ativos com intenção e com planejamento permaneceram associadas de modo independente ao histórico de tentativa de suicídio (RP: 2,87; IC: 1,04-7,91; p: 0,041). Na análise univariada houve associação entre tentativa de suicídio e dias de problema físico, intensidade dos pensamentos suicidas, comportamento preparatório, sentimentos depressivos, histórico familiar de transtorno mental, internamento em hospital psiquiátrico, importância de tratamento em saúde mental e prescrição de medicamentos. Conclusão: mais gravidade de pensamentos suicidas foi identificada como fator associado ao histórico de tentativa de suicídio. Enfatiza-se a importância da escuta ativa na prática profissional em saúde, do vínculo terapêutico e do acolhimento nos serviços de atenção à saúde.
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Wiktorsson S, Strömsten L, Renberg ES, Runeson B, Waern M. Clinical Characteristics in Older, Middle-Aged and Young Adults Who Present With Suicide Attempts at Psychiatric Emergency Departments: A Multisite Study. Am J Geriatr Psychiatry 2022; 30:342-351. [PMID: 34470715 DOI: 10.1016/j.jagp.2021.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/08/2021] [Accepted: 08/01/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To study age group differences in clinical characteristics in older, middle-aged and younger adults with actual suicide attempts (SA). DESIGN Cross-sectional cohort study. SETTING 3 Swedish university hospitals. PARTICIPANTS 821 persons who presented with self-harm at psychiatric emergency departments participated. Those with non-suicidal self-injury according to the Columbia Suicide Severity Rating Scale (C-SSRS) were excluded, leaving a total of 683 with an actual SA (18-44 years, n = 423; 45-64 years, n = 164; 65+, n = 96). MEASUREMENTS Suicidal behavior was characterized with the C-SSRS and the Suicide Intent Scale (SIS); symptoms associated with suicide were rated with the Suicide Assessment Scale (SUAS). Diagnoses were set using the Mini-International Neuropsychiatric Interview. Patients self-rated their symptoms with the Karolinska Affective and Borderline Symptoms Scale (KABOSS). RESULTS Older adults scored higher than the younger group on SIS total score and on the subjective subscale, but no age group differences were detected for the objective subscale. Half of the 65+ group fulfilled criteria for major depression, compared to 3-quarters in both the middle-aged and young groups. Anxiety disorders, as well as alcohol and substance use disorders were also less prevalent in the 65+ group, while serious physical illness was more common. Older adults scored lower on all symptom scales; effect sizes were large. CONCLUSIONS While older adults with an SA showed higher suicide intent than young adults, they had lower scores on all ratings of psychiatric symptomatology. Low ratings might interfere with clinicians' assessments of the needs of older adults with intentional self-harm.
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Affiliation(s)
- Stefan Wiktorsson
- Institute of Neuroscience (SW, MW), Department of Psychiatry, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland (SW, MW), Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden.
| | - Lotta Strömsten
- Department of Clinical Sciences (LS, ESR), Umeå University, Sweden
| | | | - Bo Runeson
- Department of Clinical Neuroscience (BR), Centre for Psychiatry Research, Karolinska Institute, and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Margda Waern
- Institute of Neuroscience (SW, MW), Department of Psychiatry, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland (SW, MW), Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
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Bjureberg J, Dahlin M, Carlborg A, Edberg H, Haglund A, Runeson B. Columbia-Suicide Severity Rating Scale Screen Version: initial screening for suicide risk in a psychiatric emergency department. Psychol Med 2021; 52:1-9. [PMID: 33766155 PMCID: PMC9811343 DOI: 10.1017/s0033291721000751] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Suicide screening is routine practice in psychiatric emergency (PE) departments, but evidence for screening instruments is sparse. Improved identification of nascent suicide risk is important for suicide prevention. The aim of the current study was to evaluate the association between the novel Colombia Suicide Severity Rating Scale Screen Version (C-SSRS Screen) and subsequent clinical management and suicide within 1 week, 1 month and 1 year from screening. METHODS Consecutive patients (N = 18 684) attending a PE department in Stockholm, Sweden between 1 May 2016 and 31 December 2017 were assessed with the C-SSRS Screen. All patients (52.1% women; mean age = 39.7, s.d. = 16.9) were followed-up in the National Cause of Death Register. Logistic regression and receiver operating characteristic curves analyses were conducted. Optimal cut-offs and accuracy statistics were calculated. RESULTS Both suicidal ideation and behaviour were prevalent at screening. In total, 107 patients died by suicide during follow-up. Both C-SSRS Screen Ideation Severity and Behaviour Scales were associated with death by suicide within 1-week, 1-month and 1-year follow-up. The optimal cut-off for the ideation severity scale was associated with at least four times the odds of dying by suicide within 1 week (adjusted OR 4.7, 95% confidence interval 1.5-14.8). Both scales were also associated with short-term clinical management. CONCLUSIONS The C-SSRS Screen may be feasible to use in the actual management setting as an initial step before the clinical assessment of suicide risk. Future research may investigate the utility of combining the C-SSRS Screen with a more thorough assessment.
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Affiliation(s)
- Johan Bjureberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Psychology, Stanford University, Stanford, California, USA
| | - Marie Dahlin
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stockholms Psykiatri, Stockholm, Sweden
| | - Andreas Carlborg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stockholms Psykiatri, Stockholm, Sweden
| | - Hanna Edberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stockholms Psykiatri, Stockholm, Sweden
| | - Axel Haglund
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & The National Board of Forensic Medicine, Stockholm, Sweden
| | - Bo Runeson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stockholms Psykiatri, Stockholm, Sweden
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Park CHK, Lee JW, Moon J, Jeon DW, Lee SY, Shim SH, Kim SG, Lee J, Paik JW, Cho SJ, Kim MH, You S, Jeon HJ, Rhee SJ, Kim MJ, Kim J, Ahn YM. Early Trauma and Relationships among Recent Stress, Depressive Symptoms, Anxiety Symptoms, and Suicidal Ideation in Korean Women. J Korean Med Sci 2021; 36:e72. [PMID: 33724739 PMCID: PMC7961867 DOI: 10.3346/jkms.2021.36.e72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Evidence continues to accumulate that the presence or absence of early trauma (ET) implies unique characteristics in the relationships between suicidal ideation and its risk factors. We examined the relationships among recent stress, depressive symptoms, anxiety symptoms, and suicidal ideation in Korean suicidal women with or without such a history. METHODS Using data on suicidal adult females, 217 victims and 134 non-victims of ET, from the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior, we performed structural equation modeling to investigate the contribution of recent stress, depressive symptoms, and anxiety symptoms on suicidal ideation within each group according to the presence or absence of a history of ET. RESULTS Structural equation modeling with anxiety and depressive symptoms as potential mediators showed a good fit. Recent stress had a direct effect on both depressive symptoms and anxiety symptoms in both groups. Only anxiety symptoms for victims of ET (standardized regression weight, 0.281; P = 0.005) and depressive symptoms for non-victims of ET (standardized regression weight, 0.326; P = 0.003) were full mediators that increased suicidal ideation. Thus, stress contributed to suicidal ideation by increasing the level of anxiety and depressive symptoms for victims and non-victims, respectively. CONCLUSION Tailored strategies to reduce suicidal ideation should be implemented according to group type, victims or non-victims of ET. Beyond educating suicidal women in stress-management techniques, it would be effective to decrease anxiety symptoms for those with a history of ET and decrease depressive symptoms for those without such a history.
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Affiliation(s)
| | - Jae Won Lee
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Korea
| | - Jungjoon Moon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong Wook Jeon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Yeol Lee
- Department of Psychiatry, Wonkwang University Hospital, Iksan, Korea
| | - Se Hoon Shim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jeewon Lee
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jong Woo Paik
- Department of Psychiatry, Kyung Hee University Medical Center, Seoul, Korea
| | - Seong Jin Cho
- Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Korea
| | - Min Hyuk Kim
- Department of Psychiatry, Wonju Severance Christian Hospital, Wonju, Korea
| | - Sungeun You
- Department of Psychology, College of Social Sciences, Chungbuk National University, Cheongju, Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Min Ji Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea
| | - Junghyun Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea.
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Rigucci S, Sarubbi S, Erbuto D, Rogante E, Hantouche EG, Innamorati M, Lester D, Pompili M. Negative emotion dysregulation is linked to the intensity of suicidal ideation in a mixed inpatient sample. J Affect Disord 2021; 281:605-608. [PMID: 33257041 DOI: 10.1016/j.jad.2020.11.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/14/2020] [Accepted: 11/18/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Suicide has been associated with dysfunctional strategies for emotion regulation but, so far, research findings have been inconclusive. METHODS To investigate how difficulties in emotion regulation impact suicidal ideation (SI) and behavior, 111 psychiatric inpatients were enrolled. Affective instability (AI), emotional impulsivity (EI), and negative and positive emotionality (NE and PE) were measured by the RIPoSt-40 questionnaire; the first three subscales have been summed to form a total negative emotion dysregulation (NED) score. RESULTS In the sample, 55 subjects reported at least one-lifetime suicide attempt; 50 patients were diagnosed with mood-disorder (MD), 30 with the schizophrenia-spectrum disorder (SSD), and 15 with personality-disorder (PD). Diagnostic groups differed for NED scores (p=.008) but not for PE (p>0.05), with patients suffering from PD having higher scores (p=0.03). Compared to non-attempters, lifetime-suicide attempters were 6.5 times more likely to have a personality disorder (95% CI=1.34/31.83). Partial correlation analyses, controlling for the presence of suicide attempts, showed that lifetime SI-intensity score was significantly and positively associated with NED (r=.39, p<.001), AI (r=.40, p<.001), and NE (r=.42, p<.001). NED scores (p=.001) and the presence of lifetime suicide attempts (p<.001) were independently associated with lifetime SI-intensity scores. LIMITATIONS The lack of a non-clinical control group and the cross sectional nature of the study limits the generalizability of the results. CONCLUSION Our findings support the hypothesis that negative emotion dysregulation is independently associated with SI and behavior. Negative emotion dysregulation should be targeted in suicide prevention.
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Affiliation(s)
| | - Salvatore Sarubbi
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Elena Rogante
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Elie G Hantouche
- Centre des Troubles Anxieux et de l'Humeur, Anxiety & Mood Center, 89 Boulevard de Courcelles 75008, Paris, France
| | | | | | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
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Mitchell SM, Cero I, Littlefield AK, Brown SL. Using categorical data analyses in suicide research: Considering clinical utility and practicality. Suicide Life Threat Behav 2021; 51:76-87. [PMID: 33624878 PMCID: PMC7995491 DOI: 10.1111/sltb.12670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/10/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Categorical data analysis is relevant to suicide risk and prevention research that focuses on discrete outcomes (e.g., suicide attempt status). Unfortunately, results from these analyses are often misinterpreted and not presented in a clinically tangible manner. We aimed to address these issues and highlight the relevance and utility of categorical methods in suicide research and clinical assessment. Additionally, we introduce relevant basic machine learning methods concepts and address the distinct utility of the current methods. METHOD We review relevant background concepts and pertinent issues with references to helpful resources. We also provide non-technical descriptions and tutorials of how to convey categorical statistical results (logistic regression, receiver operating characteristic [ROC] curves, area under the curve [AUC] statistics, clinical cutoff scores) for clinical context and more intuitive use. RESULTS We provide comprehensive examples, using simulated data, and interpret results. We also note important considerations for conducting and interpreting these analyses. We provide a walk-through demonstrating how to convert logistic regression estimates into predicted probability values, which is accompanied by Appendices demonstrating how to produce publication-ready figures in R and Microsoft Excel. CONCLUSION Improving the translation of statistical estimates to practical, clinically tangible information may narrow the divide between research and clinical practice.
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Affiliation(s)
- Sean M. Mitchell
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Ian Cero
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Sarah L. Brown
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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25
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Moreno M, Porras-Segovia A, Lopez-Castroman J, Peñuelas-Calvo I, Díaz-Oliván I, Barrigón ML, Baca-García E. Validation of the Spanish version of the Death/Suicide Implicit Association Test for the assessment of suicidal behavior. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2020. [DOI: 10.1016/j.jadr.2020.100012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Predicting suicide: A comparison between clinical suicide risk assessment and the Suicide Intent Scale. J Affect Disord 2020; 263:445-449. [PMID: 31969276 DOI: 10.1016/j.jad.2019.11.131] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/27/2019] [Accepted: 11/29/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND How suicide risk should be assessed is under discussion with arguments for both actuarial and clinical approaches. The aim of the present study was to compare the predictive accuracy of a clinical suicide risk assessment to that of the Suicide Intent Scale (SIS) in predicting suicide within one year of an episode of self-harm with or without suicidal intent. METHODS Prospective clinical study of 479 persons assessed in a psychiatric emergency department after an episode of self-harm. The clinical risk assessment and the SIS rating were made independently of each other. Suicides within one year were identified in the National Cause of Death Register. Receiver operating characteristic (ROC) curves were constructed, optimal cut-offs were identified and accuracy statistics were calculated. RESULTS Of 479 participants, 329 (68.7%) were women. The age range was 18-95 years. During one-year follow up, 14 participants died by suicide. The area under the curve (AUC) for the clinical risk assessment and the SIS score were very similar, as were the accuracy statistic measures at the optimal cut-offs of the respective methods. The positive predictive value (PPV) of each assessment method was 6%. LIMITATIONS The clinical suicide risk assessment is not standardized. The number of suicides is small, not allowing for stratification by e.g. gender or diagnosis. CONCLUSION Predictive accuracy was similar for a clinical risk assessment and the SIS, and insufficient to guide treatment allocation.
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27
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Suicide prevention in community mental health: changing systems. JOURNAL OF PUBLIC MENTAL HEALTH 2020. [DOI: 10.1108/jpmh-06-2019-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to describe a performance improvement process related to suicide assessment in a community mental health center. As suicide rates rise in the USA, it is crucial that community mental health providers are capable and comfortable to assess for suicide risk among individuals with mental illness. Support for healthcare providers is emphasized in the quadruple aim model of enhancing healthcare delivery and patient experience. The quadruple aim model is applied in the present performance improvement project in a community mental health center.
Design/methodology/approach
An interprofessional team used provider survey responses, critical incident data and other stakeholder input to implement a new assessment mechanism and education plan to support direct care staff to address suicide risk.
Findings
Although the rate of patient death by suicide at the community mental health center is low, managing risk is a frequent provider concern. Providers’ comfort assessing and managing suicide risk varied widely based on survey responses. A structured suicide assessment process was implemented to offer clarity and direction for providers. Education to address assessment and management was designed and implemented.
Research limitations/implications
Suicide data were retrospective and limited to known deaths, thus there may have been higher numbers of deaths by suicide historically. Providers’ comfort with suicide risk management was based on self-report and future work should also integrate skills-based assessment.
Originality/value
Improving the provider experience in mental health care must be explored. Focusing on provider input and voice in suicide-related efforts in community settings is a step toward integrating the quadruple aim ideals into mental health care.
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Abstract
Throughout the world, approximately 800,000 people die by suicide every year, accounting for 1.5% of all deaths. Suicide is the 10th leading cause of death in North America and the foremost cause of death worldwide among persons 15 to 24 years of age.
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Affiliation(s)
- Seena Fazel
- From the Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (S.F.); and the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm (B.R.)
| | - Bo Runeson
- From the Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (S.F.); and the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm (B.R.)
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29
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Rodante DE, Grendas LN, Puppo S, Vidjen P, Portela A, Rojas SM, Chiapella LC, Daray FM. Predictors of short- and long-term recurrence of suicidal behavior in borderline personality disorder. Acta Psychiatr Scand 2019; 140:158-168. [PMID: 31155713 DOI: 10.1111/acps.13058] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the incidence of suicidal outcomes and risk factors for short- and long-term recurrence of suicidal behavior (SB) among high-risk borderline personality disorder (BPD) patients during a 24-month prospective follow-up period. METHODS A multicenter prospective cohort study was designed to compare data obtained from 136 patients admitted to the emergency department for current suicidal ideation (SI) or a recent suicide attempt (SA). Subjects were clinically evaluated and monitored for a new SA or suicide. RESULTS The incidence of a new SA was 25.63 events/100 persons-year, and one patient died by suicide. Child sexual abuse (CSA) was the only significant predictor throughout the complete follow-up period. The absence of prior psychiatric treatment predicts the recurrence of SB in the first 6 months of follow-up. Patient age, poor psychosocial functioning before hospitalization, age at first SA, and having multiple suicide attempts increased risk of SB recurrence at the long-term period (24th months). In addition, there was an interaction between CSA and poor psychosocial functioning that increased risk of SB. CONCLUSION The risk of recurrence was higher during the first 6 months. Risk factors at 6 and 24 months vary. These findings are important for implementing suicide strategies.
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Affiliation(s)
- D E Rodante
- School of Medicine, Institute of Pharmacology, University of Buenos Aires, Buenos Aires, Argentina.,Braulio A. Moyano Neuropsychiatric Hospital, Buenos Aires, Argentina
| | - L N Grendas
- School of Medicine, Institute of Pharmacology, University of Buenos Aires, Buenos Aires, Argentina.,Teodoro Alvarez Hospital, Buenos Aires, Argentina
| | - S Puppo
- School of Medicine, Institute of Pharmacology, University of Buenos Aires, Buenos Aires, Argentina.,Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - P Vidjen
- José Tiburcio Borda Hospital, Buenos Aires, Argentina
| | - A Portela
- José Tiburcio Borda Hospital, Buenos Aires, Argentina
| | - S M Rojas
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - L C Chiapella
- Pharmacology Area, Faculty of Biochemical and Pharmaceutical Sciences, National University of Rosario, Rosario, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - F M Daray
- School of Medicine, Institute of Pharmacology, University of Buenos Aires, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
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Wang M, Swaraj S, Chung D, Stanton C, Kapur N, Large M. Meta-analysis of suicide rates among people discharged from non-psychiatric settings after presentation with suicidal thoughts or behaviours. Acta Psychiatr Scand 2019; 139:472-483. [PMID: 30864183 DOI: 10.1111/acps.13023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To quantify the suicide rate among people discharged from non-psychiatric settings after presentations with suicidal thoughts or behaviours. METHOD Meta-analysis of studies reporting suicide deaths among people with suicidal thoughts or behaviours after discharge from emergency departments or the medical or surgical wards of general hospitals. RESULTS A total of 115 studies reported 167 cohorts and 3747 suicide deaths among 248 005 patients during 1 263 727 person-years. The pooled suicide rate postdischarge was 483 suicide deaths per 100 000 person-years (95% confidence interval (CI) 445-520, prediction interval (PI) 200-770) with high between-sample heterogeneity (I2 = 92). The suicide rate was highest in the first year postdischarge (851 per 100 000 person-years) but remained elevated in the long term. Suicide rates were elevated among samples of men (716 per 100 000 person-years) and older people (799 per 100 000 person-years) but were lower in samples of younger people (107 per 100 000 person-years) and among studies published between 2010 and 2018 (329 per 100 000 person-years). CONCLUSIONS People with suicidal thoughts or behaviours who are discharged from non-psychiatric settings have highly elevated rates of suicide despite a clinically meaningful decline in these suicide rates in recent decades.
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Affiliation(s)
- M Wang
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - S Swaraj
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - D Chung
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - C Stanton
- School of Psychiatry, University of NSW, Kensington, Sydney, NSW, Australia
| | - N Kapur
- Centre for Suicide Prevention, Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester and Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, UK
| | - M Large
- School of Psychiatry, University of NSW, Kensington, Sydney, NSW, Australia
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