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Khan ZA, Lilly CL, DeFazio C, Claydon EA. "It is more isolating to patients if you aren't familiar with the resources": a pilot test of a clinician sensitivity training on eating disorders in pregnancy. BMC MEDICAL EDUCATION 2023; 23:924. [PMID: 38057767 PMCID: PMC10699011 DOI: 10.1186/s12909-023-04894-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 11/22/2023] [Indexed: 12/08/2023]
Abstract
It is more isolating to patients if you aren't familiar with the resources: A pilot test of a clinician sensitivity training on eating disorders in pregnancy.(IRB Number: 1909705198).Background Pregnant women with a history of eating disorders (EDs) or active EDs have greater maternal and child health complications. They are also unlikely to disclose their history with an ED to their clinician, few of which are confident in their knowledge to provide appropriate care for patients who present with EDs. This study's goal was to evaluate changes to knowledge, behavior, and attitudes for health professionals who were part of a sensitivity training (to provide information of and awareness, address potential clinician biases, and offer strategies for more patient-centered care with de-stigmatizing language) about eating disorders and pregnancy compared with those who received a reference document.Methods Our pilot study compared responses of health professionals before and after this sensitivity training (N = 54) with a group who were provided a clinician reference document about the same topic (N = 61).Results Mann-Whitney Wilcoxon tests showed significant differences between the sensitivity training and reference document groups, with the sensitivity training resulting in increases to participants' perception of ED's relevance to overall treatment (p = 0.018), comfort in providing resources (p < 0.0001), frequency of ability to introduce strategies (p = 0.001), and interest in additional strategies/recommendations in treating patients with eating disorders (p = 0.009). Thematic analysis of the open-ended responses indicated four major themes: Resources and support, Treatment, Additional training, and Clinician Strategies. Discussion Results indicated that the sensitivity training improved training outcomes compared to the reference document group. Qualitative responses from both groups indicated four themes that can help inform ED-centered care. This study provides context for future directions for continuing education courses as well as clinical training recommendations for treating pregnant patients with EDs.
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Affiliation(s)
- Zoya A Khan
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Christa L Lilly
- Department of Biostatistics, West Virginia University School of Public Health, Morgantown, WV, USA
| | - Caterina DeFazio
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, Morgantown, WV, USA
| | - Elizabeth A Claydon
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, Morgantown, WV, USA.
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MacDonald C, Caimino C, Burns-O’Connell G, Hartley D, Lockwood J, Sereda M, Whitmer W, Cima R, Turton L, Hoare DJ. Tinnitus, Suicide, and Suicidal Ideation: A Scoping Review of Primary Research. Brain Sci 2023; 13:1496. [PMID: 37891863 PMCID: PMC10605905 DOI: 10.3390/brainsci13101496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Tinnitus (the perception of sound in the absence of any corresponding external source) is highly prevalent and can be distressing. There are unanswered questions about how tinnitus, suicidal thoughts, and suicidal behaviours co-occur and interact. To establish the extent of scientific literature, this scoping review catalogued primary reports addressing the associations between tinnitus, suicidal ideation, attempted suicide, and death by suicide. We searched OvidSP, Medline, EMBASE, PsycINFO, CINAHL, Google Scholar, EThoS, and ProQuest for all studies and case reports on ideation and/or attempted and/or completed suicide in the context of tinnitus. Twenty-three studies were included, and data were charted according to study type. Several epidemiological and other observational studies gave evidence of risk factors and an association between suicidal ideation, suicidal behaviour, and tinnitus. However, there was no evidence of the direction of causality. Qualitative studies are indicated to explore the patient's experience and understand the dynamics of any interaction between tinnitus and suicidal thoughts and behaviours. A theory-informed model of tinnitus and suicide needs to be developed to inform the development of interventions and how tinnitus patients are supported clinically.
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Affiliation(s)
- Carol MacDonald
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK (D.J.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Department of Psychology, University of Stirling, Stirling FK9 4LA, UK
| | | | | | - Douglas Hartley
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK (D.J.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - Joanna Lockwood
- NIHR MindTech MedTech Co-Operative, Institute of Mental Health, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK;
| | - Magdalena Sereda
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK (D.J.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - William Whitmer
- Hearing Sciences: Scottish Section, Glasgow, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK;
| | - Rilana Cima
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven University, 3000 Leuven, Belgium;
- Tinnitus Center of Expertise, Centre of Expertise in Rehabilitation and Audiology, Adelante, 6432 CC Hoensbroek, The Netherlands
- Experimental Health Psychology, Faculty of Psychology and Neurosciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | | | - Derek J. Hoare
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK (D.J.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
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Quality of Media Reporting of Suicide in Nepal. PSYCHIATRY JOURNAL 2022; 2022:5708092. [PMID: 35845252 PMCID: PMC9282984 DOI: 10.1155/2022/5708092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022]
Abstract
Objectives. Suicide is a major public health concern. Sensible media reporting of suicide is one of the important prevention strategies. There has been no report assessing the quality of media reporting of suicide in Nepal. We aimed to assess the quality of newspaper reporting of suicide in Nepal against the World Health Organization (WHO) reporting guidelines. Methods. We undertook a content analysis study of articles from the online archives on reporting of suicide deaths in six English language (daily or weekly) newspapers published in Nepal over the two-year duration from a period between January 1, 2019, and December 31, 2020. Also, we compared them with the World Health Organization (WHO) guidelines. Results. A total of 165 English newspaper articles reporting on suicide were analyzed. 163 (98.8%) of news were published in the main section of the newspaper, and the mean length was 17.6 sentences. The name and age of the person who died of suicide were mentioned in about 69.1% (
) and 53.3% (
) articles, respectively. The most common method of suicide reported in the news articles was hanging (45.5%,
), followed by poisoning (11.5%,
). About 97.6% (
) of news articles violated the recommendation provided in the WHO guidelines. Conclusions. The adherence to the WHO guidelines for media reporting of suicide in Nepal was found to be poor, with a large majority of news reports having at least one potentially harmful media characteristic. Only a small minority of news reports included potentially helpful information to prevent suicide.
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Usual presence and intensity of pain are differentially associated with suicidality across chronic pain conditions: A population-based study. J Psychosom Res 2021; 148:110557. [PMID: 34225001 DOI: 10.1016/j.jpsychores.2021.110557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/06/2021] [Accepted: 06/25/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study examined the prevalence of suicidality and associations with pain characteristics (i.e., presence of usual pain/discomfort, pain intensity) among those with chronic pain conditions (i.e., arthritis, migraine, back pain). METHODS We analyzed data from the 2012 Canadian Community Health Survey-Mental Health supplement (N = 25,113), including self-reported pain characteristics and suicidality. Weighted cross-tabulations described suicidality prevalence estimates according to pain characteristics among each chronic pain condition. Multiple logistic regressions evaluated associations between the presence of usual pain/discomfort and suicidality across pain conditions. Post-hoc analyses examined pain intensity in significant associations. RESULTS Across pain conditions, rates of suicidality were greater in those usually in pain and with more severe pain, compared to mild or moderate pain. After adjustment, usual pain/discomfort was associated with increased odds of suicide ideation (AOR = 1.79, 95% CI [1.19-2.68], p < .05) and attempts (AOR = 2.49, 95% CI [1.25-4.98], p < .05) among those with migraines, and plans (AOR = 1.55, 95% CI [1.04-2.31], p < .05) in those with back pain (reference = absence of usual pain). Usual pain/discomfort was not associated with suicidality in those with arthritis after adjusting for sociodemographics and psychiatric comorbidity. Post-hoc analyses showed that severe pain was associated with elevated odds of suicide ideation (AOR = 2.19, 95% CI [1.07-4.48], p < .05) in migraines and plans (AOR = 3.11, 95% CI [1.42-6.80], p < .01) in back pain (reference = mild pain). CONCLUSION Our findings may facilitate a more targeted approach to screening for suicidality among chronic pain populations.
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Mafura C, Charura D. ‘I then had 50 stitches in my arms…such damage to my own body’: An Interpretative Phenomenological Analysis of Izzat trauma and self‐harm experiences among UK women of South Asian heritage. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Calvin Mafura
- School of Education, Language and Psychology York St John University YorkUK
| | - Divine Charura
- School of Education, Language and Psychology York St John University YorkUK
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Quarshie ENB, Andoh-Arthur J, Asante KO, Asare-Doku W. Online media reporting of suicidal behaviour in Ghana: Analysis of adherence to the WHO guidelines. Int J Soc Psychiatry 2021; 67:251-259. [PMID: 32418459 PMCID: PMC8107450 DOI: 10.1177/0020764020919787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Irresponsible media reporting of suicide is a potential risk for copycat suicide. There is a paucity of studies from sub-Saharan Africa on the quality of media reporting of suicide. OBJECTIVES We assessed the compliance of Ghanaian online media outlets with the World Health Organization (WHO) guidelines for media reporting of suicide. METHODS We searched 10 local media outlets with strong online presence in Ghana, to identify suicide-related news reports from 2000 through 2019. We applied summative content analysis and chi-square (χ2) test to the data. RESULTS We included 288 news reports, of which 261 (90.6%) were completed suicides, 7 (2.4%) were attempted suicides and 20 (6.9%) were homicide suicides. Most of the news reports failed to comply with the WHO guidelines: 92.7% mentioned the specific method of the suicide act, 82.6% included 'suicide' in the headline and 55.6% included photos of the victims. The χ2 tests indicated that privately owned media outlets were more likely than publicly owned to post a photo of the victim, χ2(1) = 17.37, p < .001, and report the incident location in the headline, χ2(1) = 15.00, p < .001. However, generally, there were no statistically significant relationships between the quality of reporting and media outlet ownership. Each of the 288 reports failed to mention any of the potentially helpful features recommended by the WHO guidelines. CONCLUSION Regardless of the ownership of the media outlet (whether private or publicly owned), mostly, the online reportage of suicidal behaviour in Ghana deviates sharply from the international recommended best practice by the WHO.
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Affiliation(s)
- Emmanuel Nii-Boye Quarshie
- School of Psychology, University of Leeds, Leeds, UK.,Centre for Suicide and Violence Research (CSVR), Accra, Ghana
| | - Johnny Andoh-Arthur
- Centre for Suicide and Violence Research (CSVR), Accra, Ghana.,Department of Psychology, University of Ghana, Accra, Ghana
| | - Kwaku Oppong Asante
- Centre for Suicide and Violence Research (CSVR), Accra, Ghana.,Department of Psychology, University of Ghana, Accra, Ghana.,Department of Psychology, University of the Free State, Bloemfontein, South Africa
| | - Winifred Asare-Doku
- Centre for Suicide and Violence Research (CSVR), Accra, Ghana.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
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Howell AJ, Cowan-Nelson ERH, Cobuz VD. Depicted Immorality Influences the Perceived Applicability of the Phrase "Committed Suicide". CRISIS 2021; 43:135-141. [PMID: 33620254 DOI: 10.1027/0227-5910/a000767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: "Committed suicide" is often deemed less acceptable than alternative phrases, but such judgments vary widely across individuals. Aim: We tested whether the endorsement of statements containing "committed suicide" is greater when a suicide death is depicted as immoral. We also assessed the degree of immorality suggested by the free-standing phrases "committed suicide" and "died by suicide." Method: Undergraduate participants (N = 154) read scenarios of a suicide depicted as immoral and one depicted more neutrally and judged the applicability of statements employing either "committed suicide" or "died by suicide" to each scenario. Participants next chose between the free-standing phrases "committed suicide" or "died by suicide" in terms of which connoted immorality and provided written justifications for their choices. Results: Participants judged "committed suicide" statements to be most applicable to the immoral-suicide scenario. A large majority of participants chose "committed suicide" over "died by suicide" as connoting immorality and participants' justifications for this choice revealed several meaningful themes. Limitations: Our manipulation of immorality employed religious overtones and our participants were undergraduate students. Conclusions: Findings contribute to the empirical basis for concerns regarding the phrase "committed suicide," with implications for stigma reduction and help-seeking.
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Affiliation(s)
- Andrew J Howell
- Department of Psychology, MacEwan University, Edmonton, AB, Canada
| | | | - Victoria D Cobuz
- Department of Psychology, MacEwan University, Edmonton, AB, Canada
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Ahuja M, Records K, Haeny AM, Gavares EM, Mamudu HM. The association between experiencing police arrest and suicide ideation among emerging young adults: Does race matter? Health Psychol Open 2021; 8:20551029211026027. [PMID: 34221440 PMCID: PMC8221685 DOI: 10.1177/20551029211026027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of the study was to examine the association between lifetime arrest and marijuana-related first arrest with past-year suicide ideation among Black and White people. We used data from Wave-IV (2008-2009; N = 5114) of the publicly available National Adolescent Health Study (Add Health) data. A total of 4313 Non-Hispanic Black and White participants were selected for this study. Logistic regression was used to assess whether lifetime arrest and marijuana-related arrests were associated with past year suicide. Overall, 28.8% of the sample reported lifetime arrest, 6.3% reported lifetime suicide ideation, and 3.7% reported marijuana-related arrest. A significantly higher percentage of Black people (32.3%) in comparison to White people (27.4%) reported lifetime arrest (χ2 = 9.91; p < 0.001; df = 1). Among Black people, lifetime arrest (AOR = 2.98; 95% CI, 1.66-5.35; p < 0.001) and marijuana-related arrest (AOR = 4.09; 95% CI, 1.47-11.35; p < 0.001) were both associated with lifetime suicide ideation. Given the rate of death by suicide among Black people has been rising for two decades, further efforts are needed to educate and inform key stakeholders including law enforcement and policymakers regarding racial disparities in arrests, which may contribute to reducing risk for death by suicide among Black people.
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Padmanathan P, Biddle L, Hall K, Scowcroft E, Nielsen E, Knipe D. Language use and suicide: An online cross-sectional survey. PLoS One 2019; 14:e0217473. [PMID: 31194768 PMCID: PMC6563960 DOI: 10.1371/journal.pone.0217473] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/12/2019] [Indexed: 12/03/2022] Open
Abstract
Background There has been a recent focus on language use in relation to suicide, with concerns raised about the potential to cause distress, perpetuate stigma and discourage help-seeking. While some terms are promoted as more sensitive than others, empirical research exploring the views of people affected by suicide to inform academic and media guidelines is lacking. Methods An anonymous, cross-sectional online survey was promoted opportunistically via online channels. Participation was requested from adults affected by suicide. Participants were asked to rate descriptors pertaining to suicidal behaviour according to perceived acceptability. A descriptive analysis of quantitative data was conducted alongside thematic content analysis of free-text data. Outcomes There were 2,719 responses, of which 1,679 (61·8%) were complete. Of phrases describing non-fatal suicidal behaviour, “attempted suicide” had the highest median acceptability score. Of phrases describing fatal suicidal behaviour, “took their own life” and “died by suicide” had the highest median acceptability scores. The scores for “commit suicide” were most variable and spanned the range of acceptability scores. Free text data illustrated the nuances in decision-making. Interpretation Variation in opinion exists amongst people affected by suicide regarding most phrases, often depending on contextual factors. “Attempted suicide”, “took their own life”, “died by suicide” and “ended their life” were however considered most acceptable. We argue that academic and media guidelines should promote use of these phrases.
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Affiliation(s)
- Prianka Padmanathan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Lucy Biddle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Katherine Hall
- Avon & Wiltshire Mental Health Partnership NHS Trust, Bristol, United Kingdom
| | | | - Emma Nielsen
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Daly C, Mörch CM, Kirtley OJ. Preventing Suicide - What Precedes Us Will Propel Us. CRISIS 2018; 39:409-415. [PMID: 30465618 DOI: 10.1027/0227-5910/a000575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Caroline Daly
- 1 National Suicide Research Foundation, Cork, Ireland.,2 School of Public Health, University College Cork, Ireland
| | - Carl-Maria Mörch
- 3 Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices (CRISE), Université du Québec à Montréal, Canada
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de Ávila Berni G, Rabelo-da-Ponte FD, Librenza-Garcia D, V. Boeira M, Kauer-Sant’Anna M, Cavalcante Passos I, Kapczinski F. Potential use of text classification tools as signatures of suicidal behavior: A proof-of-concept study using Virginia Woolf's personal writings. PLoS One 2018; 13:e0204820. [PMID: 30356303 PMCID: PMC6200194 DOI: 10.1371/journal.pone.0204820] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 09/15/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The present study analyzes the feasibility of text classification to predict individual suicidal behavior. Entries from Virginia Woolf's diaries and letters were used to assess whether a text classification algorithm could identify written patterns associated with suicide. METHODS This is a text classification study. We compared 46 text entries from the two months before Virginia Woolf's suicide with 54 texts randomly selected from Virginia Woolf's work during other periods of her life. Letters and diaries were included, while books, novels, short stories, and article fragments were excluded. The data was analyzed using a Naïve-Bayes machine-learning algorithm. RESULTS The model showed a balanced accuracy of 80.45%, sensitivity of 69%, and specificity of 91%. The Kappa statistic was 0.6, which means a good agreement, and the p-value of the model was 0.003. The area under the ROC curve (AUC) was 0.80. In other words, the model exhibited good performance when used for classifying Virginia Woolf's diaries and letters. DISCUSSION The present study showed the feasibility of a machine-learning model coupled with text to identify individual written patterns associated with suicidal behavior. Our text signature was able to identify the period of two months preceding suicide with a high accuracy. This technique may be applied to subjects with psychiatric disorders by means of data captured from social media, e-mail, among others. The algorithm may then predict a specific outcome and enable early intervention by clinicians.
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Affiliation(s)
- Gabriela de Ávila Berni
- Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- Graduation Program in Psychiatry and Department of Psychiatry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Francisco Diego Rabelo-da-Ponte
- Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- Graduation Program in Psychiatry and Department of Psychiatry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Diego Librenza-Garcia
- Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- Graduation Program in Psychiatry and Department of Psychiatry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Manuela V. Boeira
- Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- Graduation Program in Psychiatry and Department of Psychiatry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Márcia Kauer-Sant’Anna
- Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- Graduation Program in Psychiatry and Department of Psychiatry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ives Cavalcante Passos
- Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- Graduation Program in Psychiatry and Department of Psychiatry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Flávio Kapczinski
- Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Department of Psychiatry and Behavioral Neurosciences, St. Joseph Health Hamilton, Hamilton, ON, Canada
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