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Jin T, Seo J, Ye S, Lee S, Park EY, Oh JK, Han C, Kim B. Suicide mortality following the implementation of tobacco packaging and pricing policies in Korea: an interrupted time-series analysis. BMC Med 2024; 22:180. [PMID: 38679738 PMCID: PMC11057188 DOI: 10.1186/s12916-024-03372-5] [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] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND To prevent tobacco use in Korea, the national quitline number was added to tobacco packages in December 2012, tobacco prices were raised by 80% in January 2015, and graphic health warning labels were placed on tobacco packages in December 2016. This study evaluated the association of these tobacco packaging and pricing policies with suicide mortality in Korea. METHODS Monthly mortality from suicide was obtained from Cause-of-Death Statistics in Korea from December 2007 to December 2019. Interrupted time-series analysis was performed using segmented Poisson regression models. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated adjusted for suicide prevention strategies. RESULTS Suicide mortality was 20 per 1,000,000 in December 2007 and showed a downward trend over the study period. After the implementation of tobacco packaging and pricing policies, suicide mortality immediately declined by - 0.09 percent points (95% CI = - 0.19 to 0.01; P > 0.05) for the national quitline number, - 0.22 percent points (95% CI = - 0.35 to - 0.09; P < 0.01) for tobacco prices, and - 0.30 percent points (95% CI = - 0.49 to - 0.11; P < 0.01) for graphic health warning labels. The corresponding RRs for these post-implementation changes compared with the pre-implementation level were 0.91 (95% CI = 0.83 to 1.00), 0.80 (95% CI = 0.70 to 0.91), and 0.74 (95% CI = 0.61 to 0.90), respectively. Significant associations between tobacco control policies and suicide mortality were observed even when stratified by sex and region. CONCLUSIONS The findings of this study provide new evidence for an association between tobacco control policies and deaths by suicide. An array of effective tobacco control policies should be considered for prevention programs targeting suicide.
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Affiliation(s)
- Taiyue Jin
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang, Gyeonggi, 10408, South Korea
| | - Juhee Seo
- Vital Statistics Division, Statistics Korea, Daejeon, South Korea
| | - Shinhee Ye
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Incheon, South Korea
| | - Seulbi Lee
- Department of Big Data Strategy, National Health Insurance Service, Wonju, South Korea
| | - Eun Young Park
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Jin-Kyoung Oh
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang, Gyeonggi, 10408, South Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Changwoo Han
- Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Byungmi Kim
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang, Gyeonggi, 10408, South Korea.
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea.
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Ajayi T, Thomas A, Nikolic M, Henderson L, Zaheri A, Dwyer DS. Evolutionary conservation of putative suicidality-related risk genes that produce diminished motivation corrected by clozapine, lithium and antidepressants. Front Psychiatry 2024; 15:1341735. [PMID: 38362034 PMCID: PMC10867104 DOI: 10.3389/fpsyt.2024.1341735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024] Open
Abstract
Background Genome wide association studies (GWAS) and candidate gene analyses have identified genetic variants and genes that may increase the risk for suicidal thoughts and behaviors (STBs). Important unresolved issues surround these tentative risk variants such as the characteristics of the associated genes and how they might elicit STBs. Methods Putative suicidality-related risk genes (PSRGs) were identified by comprehensive literature search and were characterized with respect to evolutionary conservation, participation in gene interaction networks and associated phenotypes. Evolutionary conservation was established with database searches and BLASTP queries, whereas gene-gene interactions were ascertained with GeneMANIA. We then examined whether mutations in risk-gene counterparts in C. elegans produced a diminished motivation phenotype previously connected to suicide risk factors. Results and conclusions From the analysis, 105 risk-gene candidates were identified and found to be: 1) highly conserved during evolution, 2) enriched for essential genes, 3) involved in significant gene-gene interactions, and 4) associated with psychiatric disorders, metabolic disturbances and asthma/allergy. Evaluation of 17 mutant strains with loss-of-function/deletion mutations in PSRG orthologs revealed that 11 mutants showed significant evidence of diminished motivation that manifested as immobility in a foraging assay. Immobility was corrected in some or all of the mutants with clozapine, lithium and tricyclic antidepressant drugs. In addition, 5-HT2 receptor and muscarinic receptor antagonists restored goal-directed behavior in most or all of the mutants. These studies increase confidence in the validity of the PSRGs and provide initial clues about possible mechanisms that mediate STBs.
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Affiliation(s)
- Titilade Ajayi
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Shreveport, Shreveport, LA, United States
| | - Alicia Thomas
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Shreveport, Shreveport, LA, United States
| | - Marko Nikolic
- Department of Psychiatry and Behavioral Medicine, LSU Health Shreveport, Shreveport, LA, United States
| | - Lauryn Henderson
- Department of Psychiatry and Behavioral Medicine, LSU Health Shreveport, Shreveport, LA, United States
| | - Alexa Zaheri
- Department of Psychiatry and Behavioral Medicine, LSU Health Shreveport, Shreveport, LA, United States
| | - Donard S. Dwyer
- Department of Pharmacology, Toxicology and Neuroscience, LSU Health Shreveport, Shreveport, LA, United States
- Department of Psychiatry and Behavioral Medicine, LSU Health Shreveport, Shreveport, LA, United States
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Cestelli L, Gulsvik A, Johannessen A, Stavem K, Nielsen R. Reduced lung function and cause-specific mortality: A population-based study of Norwegian men followed for 26 years. Respir Med 2023; 219:107421. [PMID: 37776914 DOI: 10.1016/j.rmed.2023.107421] [Citation(s) in RCA: 1] [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: 06/30/2023] [Revised: 09/06/2023] [Accepted: 09/28/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND AND AIM Reduced lung function is associated with increased mortality, but it is unclear how different spirometric patterns are related to specific deaths. Aim of this study was to investigate these associations in a large general population cohort. METHODS The study population consisted of 26,091 men aged 30-46 years from the Pneumoconiosis Survey of Western Norway conducted in 1988-1990 with follow-up on date and cause of death for 26 years. Cox proportional hazard models were used to estimate the association between baseline FEV1, FVC, obstructive (OSP) and restrictive spirometric pattern (RSP) (z-scores calculated according to GLI-2012 equations) and mortality (European 2012 shortlist classification (E-2012)), after adjustment for age, body mass index, smoking habits, and education. RESULTS In total, 2462 (9%) subjects died. A predominant reduction of FEV1 (and OSP) were associated with respiratory non-cancer (E-8) (HR for one unit FEV1 z-score decrease 2.29 (95% CI 1.90, 2.77) and lung cancer mortality (E-2.1.8) (1.27(1.12, 1.44)). A similar reduction of FEV1 and FVC (and RSP) were associated with diabetes (E-4.1) (FEV1 2.21(1.67, 2.92), FVC 2.41(1.75, 3.32)), cerebrovascular (E-7.3) (1.52(1.21, 1.91), 1.54(1.19, 1.98)), ischemic heart disease (E-7.1) (1.22(1.10, 1.35), 1.21(1.08, 1.36)), neurological (E-6.3) (1.56(1.21, 2.01), 1.61(1.22, 2.13)), suicide (E-17.2) (1.37(1.13, 1.65), 1.29(1.04, 1.59)) and hematological cancer mortality (E-2.1.19-21) (1.29(1.05, 1.58), (1.26(1.00, 1.58)). No association was found between reduced lung function and mortality due to accidents, alcohol abuse, digestive and genitourinary cancer. CONCLUSIONS Spirometric obstruction was mainly related to pulmonary mortality. Spirometric restriction was mainly related to extra-pulmonary mortality.
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Affiliation(s)
- Lucia Cestelli
- Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Amund Gulsvik
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Knut Stavem
- Pulmonary Department, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Rune Nielsen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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Gonda X, Serafini G, Dome P. Fight the Fire: Association of Cytokine Genomic Markers and Suicidal Behavior May Pave the Way for Future Therapies. J Pers Med 2023; 13:1078. [PMID: 37511694 PMCID: PMC10381806 DOI: 10.3390/jpm13071078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
The fight against suicide is highly challenging as it may be one of the most complex and, at the same time, most threatening among all psychiatric phenomena. In spite of its huge impact, and despite advances in neurobiology research, understanding and predicting suicide remains a major challenge for both researchers and clinicians. To be able to identify those patients who are likely to engage in suicidal behaviors and identify suicide risk in a reliable and timely manner, we need more specific, novel biological and genetic markers/indicators to develop better screening and diagnostic methods, and in the next step to utilize these molecules as intervention targets. One such potential novel approach is offered by our increasing understanding of the involvement of neuroinflammation based on multiple observations of increased proinflammatory states underlying various psychiatric disorders, including suicidal behavior. The present paper overviews our existing understanding of the association between suicide and inflammation, including peripheral and central biomarkers, genetic and genomic markers, and our current knowledge of intervention in suicide risk using treatments influencing inflammation; also overviewing the next steps to be taken and obstacles to be overcome before we can utilize cytokines in the treatment of suicidal behavior.
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Affiliation(s)
- Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, 1085 Budapest, Hungary
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, 1085 Budapest, Hungary
- International Centre for Education and Research in Neuropsychiatry (ICERN), Samara State Medical University, 443079 Samara, Russia
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16126 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, 1085 Budapest, Hungary
- National Institute of Mental Health, Neurology and Neurosurgery, 1135 Budapest, Hungary
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Association between Asthma and Suicidality in 9-12-Year-Old Youths. Brain Sci 2022; 12:brainsci12121602. [PMID: 36552062 PMCID: PMC9775696 DOI: 10.3390/brainsci12121602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Suicidal ideation and attempts in youth are a growing health concern, and more data are needed regarding their biological underpinnings. Asthma is a common chronic inflammatory disorder in youth and has been associated with suicidal ideation and attempts in adolescent and adult populations, but data in younger children and early adolescents are lacking. We wished to study associations of asthma with childhood suicidality considering asthma's potential as a clinically relevant model for childhood chronic immune dysregulation. METHODS Using data from the Adolescent Brain Cognitive Development (ABCD) Study (n = 11,876, 47.8% female, mean age 9.9 years at baseline assessment and 12.0 years at two-year follow-up), we assessed associations between asthma and suicidal ideation and attempts through baseline to two-year follow-up. RESULTS Asthma history as defined by parent report (n = 2282, 19.2% of study population) was associated with suicide attempts (SA) (odds ratio (OR) = 1.44, p = 0.01), and this association remained significant even when controlling for demographics, socioeconomic factors, and environmental factors (OR = 1.46, p = 0.028). History of asthma attacks was associated with both suicidal ideation (SI) and SA when controlling for demographics, socioeconomic factors, and environmental factors (OR = 1.27, p = 0.042; OR = 1.83, p = 0.004, respectively). The association of asthma attack with SA remained significant when controlling for self-reported psychopathology (OR = 1.92, p = 0.004). The total number of asthma attacks was associated with both SI and SA (OR = 1.03, p = 0.043; OR = 1.06, p = 0.05, respectively). CONCLUSIONS Findings suggest an association between asthma and suicidality in early adolescence. Further research is needed to investigate mechanisms underlying this relationship.
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Protocol for READY2Exit: a patient-oriented, mixed methods study examining transition readiness in adolescents with co-occurring physical and mental health conditions. JOURNAL OF TRANSITION MEDICINE 2022. [DOI: 10.1515/jtm-2022-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Abstract
Background
Up to 57% of adolescents and young adults (AYA) with chronic physical health conditions experience mental health conditions, the presence of which contributes to increased morbidity and poor quality of life. AYA with co-occurring physical and mental health conditions, therefore, may experience additional challenges as they transition from pediatric to adult services. While transition readiness – the acquisition of self-management and advocacy skills – contributes to successful transitions to adult care, this concept has not been adequately explored for AYA with co-occurring physical and mental health conditions. Research is needed to identify whether the presence of a mental health comorbidity is associated with transition readiness, and what the experiences of AYA with co-occurring conditions are as they exit pediatric services. This paper outlines the protocol for the Readiness and Experiences of ADolescents and Young Adults with Co-occurring Physical and Mental Health Conditions Exiting Pediatric Services (READY2Exit) study; the first study to address this gap using a patient-oriented, mixed methods design.
Methods
A sequential explanatory mixed methods design will be used to understand the transition readiness of 16–21 year olds with physical and mental health conditions using quantitative and qualitative data. First, Transition Readiness Assessment Questionnaire (TRAQ) scores will be compared among AYA with chronic health conditions, with and without mental health comorbidity. Interviews will then be conducted with approximately 15 AYA with co-occurring health and mental health conditions and analyzed using qualitative description. The READY2Exit study will be conducted in collaboration with five Young Adult Research Partners (YARP) aged 18–30 with lived experience in the health/mental health systems across Canada. The YARP will partner in key tasks such as interview guide co-design, data interpretation, and knowledge translation tool development.
Discussion
AYA with co-occurring physical and mental health conditions may have unique needs as they prepare for health care transitions. The results of this study will inform the refinement of transition readiness practices to improve care for this group. The active involvement of the YARP across study phases will bring the critical perspectives of young adults to READY2Exit, ensuring the methods, research approaches and outputs align with their needs.
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[Asthma and suicidal behavior in adolescents: a literature review]. Rev Mal Respir 2022; 39:344-366. [PMID: 35459587 DOI: 10.1016/j.rmr.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Adolescence is a difficult time in life and asthma has major psychological consequences for adolescents. OBJECTIVES This systematic literature review focused on the association between asthma and suicidal behaviors (suicidal ideations [SI], suicide plans [SP] and suicide attempts [SA]) among adolescents in the general population. METHOD Research on Medline for the 1980-2021 period. Objectives This systematic literature review focused on the association between asthma and suicidal behaviors (suicidal ideations [SI], suicide plans [SP] and suicide attempts [SA]) among adolescents in the general population. RESULTS An overwhelming majority of the studies taken into consideration demonstrated a significant positive association between asthma and suicidal behaviors. Among the 10 studies assessing SI (with or without SP), 9 of them found a significant positive association between asthma and SI. Eight studies assessed SA; five cross-sectional studies and one prospective study demonstrated a significant positive association between asthma and SA. Only one case-control study did not find a significant positive association between asthma and SA after hospitalization for asthma. The two cross-sectional studies assessing suicidal risk taken as a whole (SI, SP and SA) demonstrated a significant positive association between asthma and at least one suicidal behavior. (OR=1.71; P<0.001). However, several studies did not include depression as an adjustment factor. CONCLUSION It is important that healthcare professionals assess suicide risk in adolescent suffering from asthma, the objective being to avoid SA or death from SA.
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Abstract
BACKGROUND The use of older data and references is becoming increasingly disfavored for publication. A myopic focus on newer research risks losing sight of important research questions already addressed by now-invisible older studies. This creates a 'Groundhog Day' effect as illustrated by the 1993 movie of this name in which the protagonist has to relive the same day (Groundhog Day) over and over and over within a world with no memory of it. This article examines the consequences of the recent preference for newer data and references in current publication practices and is intended to stimulate new consideration of the utility of selected older data and references for the advancement of scientific knowledge. METHODS Examples from the literature are used to exemplify the value of older data and older references. To illustrate the recency of references published in original medical research articles in a selected sample of recent academic medical journals, original research articles were examined in recent issues in selected psychiatry, medicine, and surgery journals. RESULTS The literature examined reflected this article's initial assertion that journals are emphasizing the publication of research with newer data and more recent references. CONCLUSIONS The current valuation of newer data above older data fails to appreciate the fact that new data eventually become old, and that old data were once new. The bias demonstrated in arbitrary policies pertaining to older data and older references can be addressed by instituting comparable treatment of older and newer data and references.
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Affiliation(s)
- Barry A Hong
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- The Altshuler Center for Education & Research at Metrocare Services, Dallas, TX, USA
| | - David E Pollio
- The Altshuler Center for Education & Research at Metrocare Services, Dallas, TX, USA
- Center for Scientific Review, National Institutes of Health, Washington, DC, USA
| | - Dana L Downs
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel W Coyne
- John T. Milliken Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Carol S North
- The Altshuler Center for Education & Research at Metrocare Services, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Miola A, Dal Porto V, Tadmor T, Croatto G, Scocco P, Manchia M, Carvalho AF, Maes M, Vieta E, Sambataro F, Solmi M. Increased C-reactive protein concentration and suicidal behavior in people with psychiatric disorders: A systematic review and meta-analysis. Acta Psychiatr Scand 2021; 144:537-552. [PMID: 34292580 PMCID: PMC9290832 DOI: 10.1111/acps.13351] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/29/2021] [Accepted: 07/17/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Suicide is a leading cause of death worldwide. Identifying factors associated with suicidality (suicidal ideation [SI]/suicidal behavior) could increase our understanding of the pathophysiological underpinnings of suicide and improve its prevention. METHODS We conducted a systematic review (PubMed/PsycInfo/Cochrane databases, up to September 2020) and random-effect meta-analysis including observational studies comparing peripheral C-reactive protein (CRP) levels in suicidal versus non-suicidal patients affected by any psychiatric disorder and healthy controls (HC). Primary outcome was the CRP standardized mean difference (SMD) between patients with high suicidality versus those with absent or low suicidality. Secondary outcomes were SMD of CRP levels between those with suicide attempt versus no suicide attempt, as well as between those with (high) versus low or absent SI. Quality of included studies was measured with Newcastle-Ottawa scale. RESULTS Out of initial 550 references, 21 observational studies involving 7682 subjects (7445 with mood disorders or first-episode psychosis, 237 HC) were included. A significant association of CRP levels with suicidality (SMD 0.688, 95% CI 0.476-0.9, p < 0.001) emerged. CRP levels were higher in individuals with high SI (SMD 1.145, 95% CI 0.273-2.018, p = 0.010) and in those with suicide attempt (SMD 0.549, 95%CI 0.363-0.735, p < 0.001) than non-suicidal individuals (either patients or HC). Main analyses were confirmed in sensitivity analysis (removing HC), and after adjusting for publication bias. The cross-sectional design of included studies, and the high heterogeneity of diagnosis and treatment limit the generalizability of these results. Median quality of included studies was high. CONCLUSION CRP is associated with higher suicidality in patients with mental disorders. Large cohort studies longitudinally monitoring CRP levels are needed to explore its longitudinal association with suicidality.
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Affiliation(s)
| | | | - Tal Tadmor
- Neurosciences DepartmentUniversity of PaduaPaduaItaly
| | | | | | - Mirko Manchia
- Unit of PsychiatryDepartment of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly,Unit of Clinical PsychiatryUniversity Hospital Agency of CagliariCagliariItaly,Department of PharmacologyDalhousie UniversityHalifaxNova ScotiaCanada
| | - Andre F. Carvalho
- IMPACT ‐ the Institute for Mental and Physical Health and Clinical TranslationSchool of MedicineBarwon HealthDeakin UniversityGeelongAustralia
| | - Michael Maes
- Department of PsychiatryFaculty of MedicineKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkokThailand,School of MedicineIMPACT Strategic Research CentreDeakin UniversityGeelongVictoriaAustralia
| | - Eduard Vieta
- Bipolar and Depressive Disorders UnitHospital ClinicInstitute of NeuroscienceUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaSpain
| | | | - Marco Solmi
- Department of PsychiatryUniversity of OttawaOttawaOntarioCanada,Department of Mental HealthThe Ottawa HospitalOttawaOntarioCanada
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Vázquez VS, de Lima VB, de Mello LM, Duarte DCB, Saback de Oliveira TD, Cruz ÁA. Depression, suicidal motivation and suicidal ideation among individuals with asthma: a cross-sectional study. J Thorac Dis 2021; 13:6082-6094. [PMID: 34795954 PMCID: PMC8575806 DOI: 10.21037/jtd-20-3197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 09/16/2021] [Indexed: 12/17/2022]
Abstract
Background Asthma is a chronic disease associated with risk of depression and suicidal events. The present study estimated the frequency of depression, suicidal motivation (SM) and suicidal ideation (SI) and identified clinical and psychosocial factors associated with these outcomes among individuals with asthma. Methods Cross-sectional study of a non-probabilistic sample of 1,358 adults with asthma and controls without asthma. Asthma severity and asthma control were assessed by a physician according to WHO (2009) and GINA (2012) criteria. Depression, SM and SI were screened by Beck Depression Inventory (BDI). Psychosocial factors were evaluated by a Community Violence Questionnaire, a Social Support Scale, a Stress Perceived Scale and a Resilience Scale. Chi-Square Test, and logistic regression models were performed to evaluate association between variables and outcomes. Results Among all participants, 222 (16.30%) had depression, 331 (24.40%) SM and 73 (5.40%) SI. There were 138 (12.10%) individuals with mild depression and SM, and 14 (1.20%) with mild depression and SI. After adjustment, severe asthma (SA) increased the chance of depression by 53.00% whereas mild to moderate asthma (MMA) increased by eleven-fold the likelihood of SI. Perception of low social support increased the chance of depression (OR 3.59; 95% CI, 2.44-5.28) and low resilience by (OR 2.96; 95% CI, 2.00-4.38); distress increased the odds of SM by 37.00%, and low affective support perception raised the likelihood of SI by (OR 6.82; 95% CI, 1.94-2.90). Conclusions Asthma, whether mild to moderate or severe, increased the chance of depression and SI. It is noteworthy that individuals with mild depression and MMA are at greater risk for SM and SI. Among the psychosocial variables, perception of low social support and low resilience were the variables associated with depression; distress impacted on SM, and the perception of low affective support raised the chance of SI.
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Ana-Isabel DSD, Marina PH, Raquel MB, Irene DDS, Enrique LG, Jesús AS. Suicidal behaviour: emergency department attendance for suicidal recurrence and other psychiatric or medical reasons in the 6 months following the index episode. ACTAS ESPANOLAS DE PSIQUIATRIA 2021; 49:244-252. [PMID: 34734640 PMCID: PMC9330303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 12/01/2022]
Abstract
The prevention of a complex phenomenon, such as suicide, requires an interdisciplinary approach that provides a comprehensive response to the care needs of people with suicidal behavior (SB). The aim of this study is to investigate the clinical and healthcare features of people presenting thoughts and/or attempts of suicide to define risk factors for recurrence.
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Affiliation(s)
- De Santiago-Díaz Ana-Isabel
- Hospital Universitario Marqués de Valdecilla (HUMV), Santander, Spain
Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | | | | | | | | | - Artal-Simón Jesús
- Hospital Universitario Marqués de Valdecilla (HUMV), Santander, Spain
Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
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12
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Kyung Y, Han YJ, Lee JS, Lee JH, Jo SH, Kim SH. Evaluation of changing trend in depression, suicidal ideation, and suicide attempts among adolescents with asthma and identification of associated factors: 11-year national data analysis in 788,411 participants. J Asthma 2020; 58:921-931. [PMID: 33158389 DOI: 10.1080/02770903.2020.1847930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We identified associated factors for depression and suicidality in adolescents with asthma. METHODS We obtained data from the annual Korea Youth Risk Behavior Web-based Surveys, completed from 2007 to 2017, as a stratified, multistage, clustered sample. Using self-reported questionnaires, students provided yes-or-no answers to questions addressing doctor-diagnosed asthma and self-experienced depression and suicidality. Associated factors for depression and suicidality were tested by logistic regression models after controlling for potential confounding factors. A total of 788,411 adolescents completed the survey. RESULTS The prevalence of asthma was similar every year during the survey with 8.9% overall rate. Among them, the prevalence of depression (45.8-29.9%), suicidal ideation (28.6-15.5%), and suicide attempts (9.3-3.9%) decreased. Participants with asthma perceived themselves as unhealthier and unhappier, had more stress, sleep dissatisfaction, depression, suicidal ideation and suicide attempts than did subjects without asthma. In the multivariate model, perception of stress was most strongly associated with depression (adjusted Odds ratio: 4.78, 95% confidence intervals; 4.17-5.06) and suicide attempts (2.51; 1.67-2.93), whereas, perceived unhappiness was most strongly associated with suicidal ideation (4.81; 3.87-5.46) among adolescents with asthma. Asthma itself was also associated with depression, suicidal ideation and suicide attempts (1.12; 1.09-1.22, 1.18; 1.07-1.24, and 1.15; 1.04-1.19, respectively). CONCLUSION Although the prevalence of asthma was similar every year, the prevalence of depression and suicidality among adolescents with asthma decreased. Nevertheless, clinical physicians should pay more attention to screen for depression and suicidality among adolescents with asthma, especially having associated factors.
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Affiliation(s)
- Yechan Kyung
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Young Joo Han
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Ju Suk Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jun Hwa Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Seon Hui Jo
- Department of Biostatistics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Sung Hoon Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
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Tel BC, Telli G, Onder S, Nemutlu E, Bozkurt TE. Investigation of the relationship between chronic montelukast treatment, asthma and depression-like behavior in mice. Exp Ther Med 2020; 21:27. [PMID: 33262813 PMCID: PMC7690246 DOI: 10.3892/etm.2020.9459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/26/2020] [Indexed: 12/13/2022] Open
Abstract
In 2008, the Food and Drug Administration of the US issued a warning about the neuropsychiatric side effects of montelukast. Previous clinical studies on montelukast have reported conflicting results and, to the best of our knowledge, no experimental studies concerning these side effects had been conducted. In the current study, the effect of montelukast on depression-like behavior in an ovalbumin (OVA)-induced mouse model was investigated. A total of 3 OVA challenges were applied at 2 week intervals for the persistence of asthma. Depression-like behavior was assessed using forced swim tests following each challenge and locomotor activities were evaluated using open field tests. At the end of the current study, plasma montelukast concentrations were measured and the development of asthma and effect of montelukast treatment were histopathologically examined. Inflammation scores that were increased in the OVA mice following all challenges were indicated to be reduced by montelukast treatment. The immobility time of mice increased beginning with the first challenge and this was also reduced by montelukast treatment. Montelukast administration to the control mice did not alter immobility times. Moreover, motor activity of the OVA and montelukast-treated mice were not altered. The results indicated there was no association between chronic montelukast treatment and depression. Furthermore, the chronic administration of montelukast to non-asthmatic mice did not increase immobility. However, depressive behavior increased at all time points in the OVA mice. These results indicated that chronic montelukast treatment is not associated with depression-like behavior and confirmed the association between asthma and depression. Further studies are required to provide an improved understanding of the neuropsychiatric side effects of montelukast.
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Affiliation(s)
- Banu Cahide Tel
- Department of Pharmacology, Hacettepe University Faculty of Pharmacy, Ankara, Sihhiye 06100, Turkey
| | - Gokcen Telli
- Department of Pharmacology, Hacettepe University Faculty of Pharmacy, Ankara, Sihhiye 06100, Turkey
| | - Sevgen Onder
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Sihhiye 06100, Turkey
| | - Emirhan Nemutlu
- Department of Analytical Chemistry, Hacettepe University Faculty of Pharmacy, Ankara, Sihhiye 06100, Turkey
| | - Turgut Emrah Bozkurt
- Department of Pharmacology, Hacettepe University Faculty of Pharmacy, Ankara, Sihhiye 06100, Turkey
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Babcock A, Moussa RK, Diaby V. Prevalence and effects of suicidal ideation diagnosis code position in claims on readmission rate estimates. Res Social Adm Pharm 2020; 17:1174-1180. [PMID: 32928656 DOI: 10.1016/j.sapharm.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/19/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Suicidal ideation (SI) is a major health concern in children, adolescents, and young adults (CAYA) population. Inaccurate estimates of SI-related hospital readmission rates may contribute to inappropriate allocation of resources for the prevention of future readmissions. The estimation of these readmission rates using claims data may be sensitive to the diagnosis code position used to establish analytic cohorts. OBJECTIVE To examine the prevalence and effects of SI diagnosis code position in claims on 30-day readmission rates using the Nationwide Readmissions Database (NRD). METHODS This was a cross-sectional study using the NRD (2010-2015). We established six cohorts of hospitalized CAYA (5-24 years old) with a diagnosis of SI based on different combinations of SI diagnosis code (ICD-9 code V62.84) positions in claims. Thirty-day hospital readmission rates following an index SI discharge were estimated for each cohort. We tested the null hypothesis that hospital readmission rates following an index SI discharge are not sensitive to diagnosis code positions using a test for equality of proportions between the predefined SI cohorts. RESULTS The prevalence of SI diagnosis codes increased yearly from 2.9% in 2010 to 5.8% in 2015. SI hospital readmission rates ranged from 0 to 41.1 per 1000 index events based on cohort definitions (i.e. diagnosis code positions). We rejected the null hypothesis that SI-related readmission rates are not sensitive to diagnosis code positions. CONCLUSION SI-related readmission rate estimates are sensitive to SI diagnosis code positions. Determining appropriate diagnostic positions can further improve readmission analyses for SI and its applications in healthcare policies.
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Affiliation(s)
- Aram Babcock
- Department of Pharmaceutical Outcomes and Policy College of Pharmacy, HPNP 2309, University of Florida 1225 Center Drive Gainesville, FL, 32610, USA.
| | - Richard K Moussa
- Ecole Nationale Supérieure de Statistiques et d'Economie Appliquée (ENSEA), 08 BP 03 Abidjan 08, Abidjan, Cote d'Ivoire.
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes and Policy College of Pharmacy, HPNP 3317, University of Florida 1225 Center Drive Gainesville, FL, 32610, USA.
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Biological Targets Underlying the Antisuicidal Effects of Lithium. Curr Behav Neurosci Rep 2020. [DOI: 10.1007/s40473-020-00208-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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16
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Integrating Suicide Risk Screening into Pediatric Ambulatory Subspecialty Care. Pediatr Qual Saf 2020; 5:e310. [PMID: 32656472 PMCID: PMC7297392 DOI: 10.1097/pq9.0000000000000310] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 05/13/2020] [Indexed: 12/29/2022] Open
Abstract
Background Suicide risk screening is recommended in pediatric care. To date, no previous studies illustrate the implementation of suicide risk screening in pediatric subspecialty care, even though chronic medical conditions are associated with a higher risk of suicide. Methods A large multidivision pediatric ambulatory clinic implemented annual suicide risk screening. Patients ages 9-21 years participated in suicide risk screening using the Ask Suicide-Screening Questions during the project. A multidisciplinary team employed quality improvement methods and survey-research design methods to evaluate the feasibility and acceptability of the screening process for patients, families, and medical providers. Results During the quality improvement project period, 1,934 patients were offered screening; 1,301 (67.3%) patients completed screening; 82 patients (6.3% of 1,301 patients) screened positive. The monthly compliance rate held steady at 86% following several Plan-Do-Study-Act cycles of improvement. The survey results demonstrate that providers rated the suicide risk screening process positively; however, a subset of providers indicated that the screening process was out of their scope of practice or impeded their workflow. Conclusions Suicide risk screening is feasible in pediatric specialty care and can identify at-risk patients. Continued efforts are needed to standardize suicide risk screening practices. Future directions include identifying factors associated with suicide risk in patients in pediatric subspecialty care settings.
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Suicidality among patients with asthma: A systematic review and meta-analysis. J Affect Disord 2019; 256:594-603. [PMID: 31299440 DOI: 10.1016/j.jad.2019.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/06/2019] [Accepted: 06/29/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Asthma is associated with multiple psychiatric comorbidities. However, the relationship between asthma and suicidality has not be well established. METHODS According to the PRISMA guidelines, protocol of the study was registered in the PROSPERO database (CRD42019123150). A systematic search of the PubMed, Embase and PsycINFO databases was performed for relevant studies published from its inception to January 25, 2019. Studies that reported the risk of suicidal ideation, attempts and mortality in asthmatics compared with non-asthmatics were included. A random-effects model was used to synthesize the estimates and the quality of the included studies was assessed under the Newcastle-Ottawa Scale. RESULTS Twenty-eight studies including 2,759,841 asthmatic patients and 16,290,362 non-asthmatic controls were pooled and analyzed in the current study. The pooled data showed that asthmatic patients had increased risk of exhibiting suicidal ideation (OR, 1.52; 95%CI, 1.37-1.70), suicide attempts (OR, 1.60; 95%CI, 1.33-1.92) and suicide mortality (OR, 1.31; 95%CI, 1.11-1.55) compared to non-asthmatic controls. Noticeably, adolescent asthmatic patients had a more than 2-fold risk of suicide mortality compared to non-asthmatic controls (OR, 2.14; 95%CI, 1.61-2.83). LIMITATIONS The limitations of the present study were variability in study designs and various measures of asthma and suicidality, which possibly contribute to notable heterogeneity. CONCLUSIONS Patients with asthma have a significantly increased risk of suicidal ideation, suicide attempts and suicide mortality. Clinical physicians should pay more attention to the increased risk of suicidality in asthmatics, screen for these suicidal thoughts and behaviors, and make appropriate mental health referrals when necessary.
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Khazem LR, Anestis MD. Do physical disabilities differentiate between suicidal ideation and attempts? An examination within the lens of the ideation to action framework of suicide. J Clin Psychol 2018; 75:681-695. [DOI: 10.1002/jclp.22735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/07/2018] [Accepted: 11/15/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Lauren R. Khazem
- Department of Psychology, The University of Southern Mississippi; Hattiesburg Mississippi
| | - Michael D. Anestis
- Department of Psychology, The University of Southern Mississippi; Hattiesburg Mississippi
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Akula M, Kulikova A, Khan DA, Brown ES. The relationship between asthma and depression in a community-based sample. J Asthma 2018; 55:1271-1277. [PMID: 29336633 PMCID: PMC6212321 DOI: 10.1080/02770903.2017.1418885] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/07/2017] [Accepted: 12/14/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Asthma is an increasingly prevalent disease that is associated with substantial physical and financial burdens. Additionally, asthma is linked to psychiatric disorders. This study examines the relationship between asthma diagnosis, current depressive symptoms, and lifetime psychiatric disorder history in a large, community-based sample. METHODS We analyzed data from 2168 participants in the Dallas Heart Study, a large, diverse, community-based sample of people designed to be representative of the Dallas County population. Logistic regressions analyzing the relationship between asthma diagnosis and history of a psychiatric disorder, as well as between asthma diagnosis and the Quick Inventory of Depressive Symptomatology (QIDS) scores were performed, controlling for demographic data. RESULTS 13.4% of the sample had an asthma diagnosis. Asthma diagnosis was significantly associated with a history of nervous, emotional, or mental health disorder diagnosis [OR 1.810 (95% CI 1.280-2.559) p = 0.001], and with QIDS scores consistent with moderate or greater current depressive symptom severity [OR 1.586 (95%CI 1.106-2.274) p = 0.012]. The relationships were not moderated by age, gender, race, smoking status, or Body Mass Index. CONCLUSIONS A diagnosis of asthma may be associated with current clinically significant levels of depressive symptoms and a lifetime psychiatric disorder. The current report adds to the existing literature in this area by assessing both current and lifetime symptoms and by using a large and diverse population. The findings highlight the clinical importance of considering the possibility of psychiatric illness in asthma patients and suggest further research in this area is needed.
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Affiliation(s)
- Mahima Akula
- Departments of Psychiatry, The University of Texas Southwestern Medical Center; Dallas, Texas, USA
| | - Alexandra Kulikova
- Departments of Psychiatry, The University of Texas Southwestern Medical Center; Dallas, Texas, USA
| | - David A. Khan
- Internal Medicine, The University of Texas Southwestern Medical Center; Dallas, Texas, USA
| | - E. Sherwood Brown
- Departments of Psychiatry, The University of Texas Southwestern Medical Center; Dallas, Texas, USA
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Muhammad LN, Korte JE, Bowman CM, De Santis ML, Nietert PJ. The Effects of Asthma and Bullying on Suicidal Behaviors Among US Adolescents. THE JOURNAL OF SCHOOL HEALTH 2018; 88:762-767. [PMID: 30203476 PMCID: PMC6134875 DOI: 10.1111/josh.12680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 11/29/2017] [Accepted: 12/14/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Positive associations between suicidal behaviors and asthma have been established in previous adolescent studies. Few studies consider social risk factors, such as bullying. This study involved an analysis of suicidal behaviors and asthma, but also includes an assessment of whether these relationships were modified by the co-occurrence of bullying. METHODS Data included 13,154 participants from the 2013 Youth Risk Behavior Survey (YRBS), collected by the US Centers for Disease Control and Prevention. Logistic regression models were constructed and summarized using odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS When comparing adolescents with asthma who were bullied at school to those who were not bullied at school, the odds of contemplating suicide were increased by nearly 2-fold (OR = 1.8, 95% CI = 1.5-2.3), and the odds of creating a suicide plan were 2.3 times higher (OR = 2.3, 95% CI = 1.7-3.1). The odds of a suicide attempt and incurring an injury from a suicide attempt were also substantially increased. Similarly, increased odds of suicidal behaviors were observed for adolescents with asthma who were bullied electronically. CONCLUSION Having asthma and being bullied are both associated with increased odds of suicidal behaviors.
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Affiliation(s)
- Lutfiyya N Muhammad
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite 303, Charleston, SC 29425-8350
| | - Jeffrey E Korte
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Charleston, SC 29425-8350
| | - Charles M Bowman
- Pediatrics-Pulmonology, Allergy and Immunology, Medical University of South Carolina, P.O. Box 250561, Charleston, SC 29425
| | - Mark L De Santis
- Department of Psychiatry and Behavioral Sciences, Ralph H. Johnson VA Medical Center, Medical University of South Carolina, 109 Bee Street, Charleston, SC 29401
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Charleston, SC 29425-8350
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Han YY, Forno E, Canino G, Celedón JC. Psychosocial risk factors and asthma among adults in Puerto Rico. J Asthma 2018; 56:653-661. [PMID: 29738276 DOI: 10.1080/02770903.2018.1474366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Asthma and psychosocial stressors are common among Puerto Rican adults living in the United States. We estimated the prevalence of current asthma, and examined potential psychosocial risk factors and current asthma, among adults in Puerto Rico. METHODS Cross-sectional study of 3,049 Puerto Ricans aged 18-64 years living in Puerto Rico between May 2014 and June 2016. A structured interview was conducted to obtain information on demographics, lifestyle, mental disorders, and respiratory health. Current asthma was defined as self-reported physician-diagnosed asthma and still having asthma. Multivariable logistic regression was used to examine psychosocial risk factors and current asthma. RESULTS The estimated prevalence of current asthma was 10.2%. In a multivariable analysis, exposure to violence (odds ratio [OR] for each 1-point increment in a validated scale = 1.14, 95% confidence interval [CI] = 1.07 to 1.21) and a lifetime history of at least one suicide attempt (OR = 3.01, 95% CI = 1.80 to 5.01) were significantly associated with current asthma, independently of major depressive disorder. Moreover, a lifetime history of at least one suicide attempt was associated with co-existing asthma and chronic obstructive pulmonary disease (i.e., asthma-COPD overlap syndrome or ACOS (OR = 9.05, 95% CI = 3.32-24.67). CONCLUSIONS Our findings suggest that asthma is a major health problem among adults in Puerto Rico, with psychosocial risk factors playing a significant role in asthma and ACOS. Addressing chronic stressors and mental illness should be part of comprehensive strategies to reduce asthma burden in this population.
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Affiliation(s)
- Yueh-Ying Han
- a Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh , Pittsburgh , Pennsylvania
| | - Erick Forno
- a Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh , Pittsburgh , Pennsylvania
| | - Glorisa Canino
- b Behavioral Sciences Research Institute, University of Puerto Rico , San Juan , Puerto Rico
| | - Juan C Celedón
- a Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh , Pittsburgh , Pennsylvania
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Junker A, Bjørngaard JH, Bjerkeset O. Adolescent health and subsequent risk of self-harm hospitalisation: a 15-year follow-up of the Young-HUNT cohort. Child Adolesc Psychiatry Ment Health 2017; 11:25. [PMID: 28469702 PMCID: PMC5410696 DOI: 10.1186/s13034-017-0161-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 04/13/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Self-harm is associated with increased suicide risk, and constitutes a major challenge in adolescent mental healthcare. In the current study, we examined the association between different aspects of adolescent health and risk of later self-harm requiring hospital admission. METHODS We linked baseline information from 13 to 19 year old participants (n = 8965) in the Norwegian Young-HUNT 1 study to patient records of self-harm hospitalisation during 15 years of follow-up. We used Cox regression to estimate risk factor hazard ratios (HR). RESULTS Eighty-nine persons (71% female) were admitted to hospital because of self-harm. Intoxication/self-poisoning was the most frequent method (81%). Both mental (anxiety/depression, loneliness, being bullied) and somatic (epilepsy, migraine) health issues were associated with up to fourfold increased risk of self-harm-related hospital admission. CONCLUSIONS Several health issues during adolescence markedly increased the risk of later self-harm hospitalisation. Current findings should be incorporated in the strive to reduce self-harming and attempted suicides among young people.
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Affiliation(s)
- Asbjørn Junker
- 0000 0001 1516 2393grid.5947.fDepartment of Neuroscience, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Johan Håkon Bjørngaard
- 0000 0001 1516 2393grid.5947.fDepartment of Public Health and General Practice, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway ,0000 0004 0627 3560grid.52522.32Forensic Department and Research Centre Brøset, St. Olavs University Hospital, Trondheim, Norway
| | - Ottar Bjerkeset
- 0000 0001 1516 2393grid.5947.fDepartment of Neuroscience, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway ,grid.465487.cFaculty of Health Sciences, Nord University, Levanger, Norway
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Aberle D, Wu SE, Oklu R, Erinjeri J, Deipolyi AR. Association Between Allergies and Psychiatric Disorders in Patients Undergoing Invasive Procedures. PSYCHOSOMATICS 2017; 58:490-495. [PMID: 28527521 DOI: 10.1016/j.psym.2017.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/25/2017] [Accepted: 03/26/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Associations between allergies and psychiatric disorders have been reported in the context of depression and suicide; psychiatric disorders may affect pain perception. OBJECTIVE To investigate the relationship of allergies with psychiatric disorders and pain perception in the context of invasive procedures, specifically during tunneled hemodialysis catheter placement. METHODS We identified 89 patients (51 men, 38 women), mean age 66 years (range: 23-96), who underwent tunneled hemodialysis catheter placement (1/2014-2/2015), recording numeric rating scale pain scores, medications, psychiatric history, allergies, and smoking status. RESULTS Of 89 patients, 47 patients had no allergies, and 42 had ≥1 allergy. Patients with allergies were more likely to have a pre-existing psychiatric disorder compared to those without allergies, odds ratio 2.6 (95% CI: 1.0-6.8). Having allergies did not affect procedural sedation or postprocedural pain scores. Multiple logistic regression with age, sex, smoking, presence of allergies, psychiatric history, inpatient/outpatient status, procedure time, and procedural sedation administration as inputs and postprocedural pain as the outcome showed that the only independent predictor was receiving procedural sedation (P = 0.005). CONCLUSIONS Findings corroborate anecdotal reports of allergies as a marker for psychiatric history. However, having allergies was not associated with increased pain or need for more sedation. Further studies could prospectively assess whether allergies and psychiatric disorders affect patient/doctor perceptions beyond pain during invasive procedures.
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Affiliation(s)
| | - Stephanie E Wu
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Rahmi Oklu
- Division of Vascular and Interventional Radiology, Mayo Clinic, Scottsdale, AZ
| | - Joseph Erinjeri
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amy R Deipolyi
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
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Churruca K, Draper B, Mitchell R. Varying impact of co-morbid conditions on self-harm resulting in mortality in Australia. HEALTH INF MANAG J 2016; 47:28-37. [DOI: 10.1177/1833358316686799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Research has associated some chronic conditions with self-harm and suicide. Quantifying such a relationship in mortality data relies on accurate death records and adequate techniques for identifying these conditions. Objective: This study aimed to quantify the impact of identification methods for co-morbid conditions on suicides in individuals aged 30 years and older in Australia and examined differences by gender. Method: A retrospective examination of mortality records in the National Coronial Information System (NCIS) was conducted. Two different methods for identifying co-morbidities were compared: International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) coded data, which are provided to the NCIS by the Australian Bureau of Statistics, and free-text searches of Medical Cause of Death fields. Descriptive statistics and χ2 tests were used to compare the methods for identifying co-morbidities and look at differences by gender. Results: Results showed inconsistencies between ICD-10 coded and coronial reports in the identification of suicide and chronic conditions, particularly by type (physical or mental). There were also significant differences in the proportion of co-morbid conditions by gender. Conclusion: While ICD-10 coded mortality data more comprehensively identified co-morbidities, discrepancies in the identification of suicide and co-morbid conditions in both systems require further investigation to determine their nature (linkage errors, human subjectivity) and address them. Furthermore, due to the prescriptive coding procedures, the extent to which medico-legal databases may be used to explore potential and previously unrecognised associations between chronic conditions and self-harm deaths remains limited.
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Affiliation(s)
- Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Australia
| | - Brian Draper
- School of Psychiatry, University of New South Wales, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Australia
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Courtet P, Giner L, Seneque M, Guillaume S, Olie E, Ducasse D. Neuroinflammation in suicide: Toward a comprehensive model. World J Biol Psychiatry 2016. [PMID: 26223957 DOI: 10.3109/15622975.2015.1054879] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Suicidal behaviour (SB) entered the DSM-5, underlying a specific biological vulnerability. Then, recent findings suggested a possible role of the immune system in SB pathogenesis. The objective of this review is to present these main immune factors involved in SB pathogenesis. METHODS We conducted a review using Preferred Reporting Items for Systematic reviews and Meta-Analysis criteria, and combined ("Inflammation") AND ("Suicidal ideation" OR "Suicidal attempt" OR "suicide"). RESULTS Post mortem studies demonstrated associations between suicide and inflammatory cytokines in the orbitofrontal cortex, a brain region involved in suicidal vulnerability. Also, microgliosis and monocyte-macrophage system activation may be a useful marker of suicide neurobiology. Kynurenine may influence inflammatory processes, and related molecular pathways may be involved in SB pathophysiology. Few recent studies associated inflammatory markers with suicidal vulnerability: serotonin dysfunction, impulsivity and childhood trauma. Interestingly, the perception of threat that leads suicidal individuals to contemplate suicide may activate biological stress responses, including inflammatory responses. CONCLUSIONS Translational projects would be crucial to identify a specific marker in SB disorders, to investigate its clinical correlations, and the interaction between inflammatory cytokines and monoamine systems in SB. These researches might lead to new biomarkers and novel directions for therapeutic strategies.
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Affiliation(s)
- Philippe Courtet
- a Department of Emergency Psychiatry , Hôpital Lapeyronie, CHU Montpellier and Post Acute Care , CHU Montpellier , France.,b Inserm, University of Montpellier , Montpellier , France.,c FondaMental Foundation , France
| | | | - Maude Seneque
- a Department of Emergency Psychiatry , Hôpital Lapeyronie, CHU Montpellier and Post Acute Care , CHU Montpellier , France.,b Inserm, University of Montpellier , Montpellier , France.,c FondaMental Foundation , France
| | - Sebastien Guillaume
- a Department of Emergency Psychiatry , Hôpital Lapeyronie, CHU Montpellier and Post Acute Care , CHU Montpellier , France.,b Inserm, University of Montpellier , Montpellier , France.,c FondaMental Foundation , France
| | - Emilie Olie
- a Department of Emergency Psychiatry , Hôpital Lapeyronie, CHU Montpellier and Post Acute Care , CHU Montpellier , France.,b Inserm, University of Montpellier , Montpellier , France.,c FondaMental Foundation , France
| | - Deborah Ducasse
- a Department of Emergency Psychiatry , Hôpital Lapeyronie, CHU Montpellier and Post Acute Care , CHU Montpellier , France.,b Inserm, University of Montpellier , Montpellier , France.,c FondaMental Foundation , France
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Chung JH, Kim SH, Lee YW. Suicidal ideation and suicide attempts among asthma. Ann Gen Psychiatry 2016; 15:35. [PMID: 27956934 PMCID: PMC5129230 DOI: 10.1186/s12991-016-0122-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/19/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The present study aimed to investigate the mental health status in patients with asthma and assess the effects of asthma on suicidal ideation and attempts using a representative sample from Korea. METHODS Individual-level data were obtained from 228,744 participants (6372 with asthma and 222,372 without asthma) of the 2013 Korean Community Health Survey. Demographic characteristics, socioeconomic status, physical health status, and mental health status were compared between patients with asthma and population without asthma. Multivariable logistic regression was performed to investigate the independent effects of the asthma on suicidal ideation and attempts. RESULTS A depressed mood for 2 or more continuous weeks was reported by 12.0% of subjects with asthma and 5.7% of controls (p < 0.001). Suicidal thoughts were reported by 21.4% of patients with asthma and 9.8% of controls (p < 0.001). Suicidal attempts were reported by 1.0% of the patients with asthma and 0.4% of controls (p < 0.001). Following adjustment for age, sex, income, education, job, marital status, smoking, alcohol, exercise, and presence of diabetes mellitus, hypertension, stroke, arthritis, and depression, the ORs for suicidal ideation with asthma were 1.53 (95% CI 1.42-1.65) and that for suicidal attempts was 1.32 (95% CI 1.01-1.73). CONCLUSIONS We found that asthma increased the risk for suicidal ideation and attempts, even controlling for the effects of socioeconomic status, physical health status, comorbid chronic medical diseases, and depressive mood. Our finding suggests that asthma per se may be an independent risk factor for suicidality.
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Affiliation(s)
- Jae Ho Chung
- Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Sun-Hyun Kim
- Department of Family Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Simgokro 100 Gil 25 Seo-gu, Incheon, 22711 Republic of Korea
| | - Yong Won Lee
- Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
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Abstract
We assessed the association between asthma and suicidality in a nationally representative sample of US high school students. Data came from the 2007, 2009, and 2011 Youth Risk Behavioral Surveys. Weighted prevalence estimates and adjusted odds ratios were calculated. Subjects with asthma are more likely to report 2-week sadness (35.2%) compared to those without asthma (26.7%). Teens with asthma are also more likely to report suicide ideation (20.1% vs. 15%), planning (15.7% vs. 12.1%), attempt (10.1% vs. 6.9%), and treatment for attempt (3.5% vs. 2%). Although the unadjusted association between lifetime asthma and suicide attempts is statistically significant (crude odds ratio 1.5 (95% CI 1.3-1.8)), after controlling for confounders, that association is no longer statistically significant (AOR 1.2 (1-1.6)). Thus, this increase in suicidality seems to be due to the increased prevalence of sadness among teens with asthma. Similar patterns were seen in the 2007 and 2009 surveys.
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Ducasse D, Olié E, Guillaume S, Artéro S, Courtet P. A meta-analysis of cytokines in suicidal behavior. Brain Behav Immun 2015; 46:203-11. [PMID: 25678163 DOI: 10.1016/j.bbi.2015.02.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/27/2015] [Accepted: 02/01/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND We conducted the first meta-analysis of studies comparing the plasma and CSF concentrations of cytokines in suicidal patients vs. non-suicidal patients or healthy controls. METHODS We searched Medline, Web of Science, and PsycINFO from 1965 to November 2014 for relevant studies. Manual searches of references and unpublished data were also included. Suicidal patients included severe suicide ideators and suicide attempters. RESULTS Eleven articles were available for the meta-analysis, for a total sample size of 494 suicidal patients, 497 non-suicidal patients and 398 healthy controls. Levels of 6 independent plasma cytokines (IL2, IL6, TNFalpha, IFNgamma, IL4, TGFbeta) were meta-analyzed for plasma studies comparing suicidal vs. both controls. IL8 level was meta-analyzed for cerebrospinal fluid studies comparing suicidal patients with healthy controls. We reported with medium effect size, that suicidal patients had: (1) lower IL2 plasma levels than both non-suicidal patients and healthy controls (medium effect size); (2) lower IL4 and higher TGFbeta plasma levels than healthy controls. CONCLUSION Our results promote the hypothesis of altered inflammatory markers in suicidal patients, for both pro-inflammatory (IL2) and anti-inflammatory (IL4 and TGFbeta) cytokines.
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Affiliation(s)
- Déborah Ducasse
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; University of Montpellier UM1, Montpellier, France; INSERM U1061, Montpellier, France; Fondamental Foundation, France.
| | - Emilie Olié
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; University of Montpellier UM1, Montpellier, France; INSERM U1061, Montpellier, France; Fondamental Foundation, France
| | - Sébastien Guillaume
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; University of Montpellier UM1, Montpellier, France; INSERM U1061, Montpellier, France; Fondamental Foundation, France
| | | | - Philippe Courtet
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; University of Montpellier UM1, Montpellier, France; INSERM U1061, Montpellier, France; Fondamental Foundation, France
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Barker E, Kõlves K, De Leo D. The relationship between asthma and suicidal behaviours: a systematic literature review. Eur Respir J 2015; 46:96-106. [PMID: 25837034 DOI: 10.1183/09031936.00011415] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/03/2015] [Indexed: 01/28/2023]
Abstract
Asthma is a highly prevalent chronic condition worldwide, and is particularly common in younger people compared to other chronic conditions. Asthma can result in a number of symptoms that are detrimental to the quality of life of sufferers. The aim of the present systematic literature review was to analyse the existing literature on the relationship between asthma and fatal and nonfatal suicidal behaviours. Articles were retrieved from Scopus, PubMed, ProQuest and Web of Knowledge. We searched for the terms (suicid* OR self-harm) AND (asthma* OR "bronchial hyperreactivity") published in English-language peer-reviewed journals between 1990 and December 2014. Original research papers providing empirical evidence about the potential link between asthma and suicidal behaviours were included. The initial search identified 746 articles. Specific limiting criteria reduced the number of articles to the 19 articles that were finally included in the systematic review. The review found a potential link between asthma and suicide mortality, ideation and attempts across the age groups. Limitations of the review include the restriction to English-language papers published within the chosen time period, the limited number of papers involving suicide mortality, and the fact that the majority of papers originated from the USA.
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Affiliation(s)
- Emma Barker
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Australia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Australia
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Crawford AA, Galobardes B, Jeffreys M, Davey Smith G, Gunnell D. Risk of suicide for individuals reporting asthma and atopy in young adulthood: findings from the Glasgow Alumni study. Psychiatry Res 2015; 225:364-7. [PMID: 25596956 PMCID: PMC4326175 DOI: 10.1016/j.psychres.2014.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 11/26/2014] [Accepted: 12/03/2014] [Indexed: 11/23/2022]
Abstract
There is emerging evidence that asthma and atopy may be associated with a higher risk of suicide. We investigated the association of asthma and atopy with mortality from suicide (n=32) in the Glasgow Alumni cohort, adjusting for the key confounders of socioeconomic position and smoking. We found no evidence of an association in our a priori atopy phenotypes with suicide, and there were insufficient suicides in the asthma phenotypes to draw any conclusions. In additional analyses, individuals reporting both eczema-urticaria and hay fever and those with family history of atopy were at higher risk of suicide. As these were secondary analyses and based on small numbers of events we cannot rule out chance findings. The lack of evidence in our main hypothesis may be due to the small number of suicides or reported associations between asthma and atopy may be confounded.
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Affiliation(s)
- Andrew A. Crawford
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK,Corresponding author. Tel.: +44 11733 10177; fax: +44 11733 14026.
| | - Bruna Galobardes
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
| | - Mona Jeffreys
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, UK
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
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Bolton JM, Walld R, Chateau D, Finlayson G, Sareen J. Risk of suicide and suicide attempts associated with physical disorders: a population-based, balancing score-matched analysis. Psychol Med 2015; 45:495-504. [PMID: 25032807 DOI: 10.1017/s0033291714001639] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The association between physical disorders and suicide remains unclear. The aim of this study was to examine the relationship between physical disorders and suicide after accounting for the effects of mental disorders. METHOD Individuals who died by suicide (n = 2100) between 1996 and 2009 were matched 3:1 by balancing score to general population controls (n = 6300). Multivariate conditional logistic regression compared the two groups across physician-diagnosed physical disorders [asthma, chronic obstructive pulmonary disease (COPD), ischemic heart disease, hypertension, diabetes, cancer, multiple sclerosis and inflammatory bowel disease], adjusting for mental disorders and co-morbidity. Secondary analyses examined the risk of suicide according to time since first diagnosis of each physical disorder (1-90, 91-364, ⩾ 365 days). Similar analyses also compared individuals with suicide attempts (n = 8641) to matched controls (n = 25 923). RESULTS Cancer was associated with increased risk of suicide [adjusted odds ratio (AOR) 1.40, 95% confidence interval (CI) 1.03-1.91, p < 0.05] even after adjusting for all mental disorders. The risk of suicide with cancer was particularly high in the first 90 days after initial diagnosis (AOR 4.10, 95% CI 1.71-9.82, p < 0.01) and decreased to non-significance after 1 year. Women with respiratory diseases had elevated risk of suicide whereas men did not. COPD, hypertension and diabetes were each associated with increased odds of suicide attempts in adjusted models (AORs ranged from 1.20 to 1.73). CONCLUSIONS People diagnosed with cancer are at increased risk of suicide, especially in the 3 months following initial diagnosis. Increased support and psychiatric involvement should be considered for the first year after cancer diagnosis.
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Affiliation(s)
- J M Bolton
- Department of Psychiatry,University of Manitoba,Winnipeg, Manitoba,Canada
| | - R Walld
- Manitoba Centre for Health Policy,Winnipeg, Manitoba,Canada
| | - D Chateau
- Manitoba Centre for Health Policy,Winnipeg, Manitoba,Canada
| | - G Finlayson
- Manitoba Centre for Health Policy,Winnipeg, Manitoba,Canada
| | - J Sareen
- Department of Psychiatry,University of Manitoba,Winnipeg, Manitoba,Canada
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Asthma and self-harm: a population-based cohort study in Taiwan. J Psychosom Res 2014; 77:462-7. [PMID: 25224126 DOI: 10.1016/j.jpsychores.2014.08.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/26/2014] [Accepted: 08/28/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Few studies have investigated the relationship between asthma and suicidality-related outcomes in the world. We sought to investigate the association between asthma and risk of non-fatal self-harm in a large national sample. METHODS Cases aged 10years and over were identified from Taiwan's National Health Insurance Research Database with a new primary diagnosis of asthma (ICD-9:493) between 2000 and 2008. Case status required the presence of any inpatient diagnosis of asthma and/or at least two recorded diagnoses and 1year duration of asthma in outpatient services. These 27,781 cases were compared to 138,905 sex- and age-matched controls and both groups were followed until end of 2008 for instances of self-harm, defined as ICD-9 codes E950-E959 (self-harm causes) and E980-E989 (undetermined causes). Competing risk adjusted Cox regression analyses were applied, adjusting for sex, age, residence (urban/rural), insurance premium, episode of psychiatric disease, montelukast, Charlson comorbidity index and mortality. RESULTS Of the 166,686 subjects, 445 carried out self-harm during a mean (SD) follow-up period of 5.84 (2.35) years. Asthma (hazard ratio=1.70, 95% CI: 1.35-2.14), age, residence, episode of psychiatric disease and Charlson comorbidity index were independent risks on self-harm in the fully adjusted model. CONCLUSIONS Asthma was associated with increased risk of self-harm in this population, independent of a number of potential confounding factors including montelukast use. This reinforces the need to consider mental health in routine asthma care, and to consider asthma as a potentially important stressor in people with comorbid mental disorder.
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Alonso J, de Jonge P, Lim CCW, Aguilar-Gaxiola S, Bruffaerts R, Caldas-de-Almeida JM, Liu Z, O'Neill S, Stein DJ, Viana MC, Al-Hamzawi AO, Angermeyer MC, Borges G, Ciutan M, de Girolamo G, Fiestas F, Haro JM, Hu C, Kessler RC, Lépine JP, Levinson D, Nakamura Y, Posada-Villa J, Wojtyniak BJ, Scott KM. Association between mental disorders and subsequent adult onset asthma. J Psychiatr Res 2014; 59:179-88. [PMID: 25263276 PMCID: PMC5120389 DOI: 10.1016/j.jpsychires.2014.09.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 07/18/2014] [Accepted: 09/05/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Associations between asthma and anxiety and mood disorders are well established, but little is known about their temporal sequence. We examined associations between a wide range of DSM-IV mental disorders with adult onset of asthma and whether observed associations remain after mental comorbidity adjustments. METHODS During face-to-face household surveys in community-dwelling adults (n = 52,095) of 19 countries, the WHO Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Asthma was assessed by self-report of physician's diagnosis together with age of onset. Survival analyses estimated associations between first onset of mental disorders and subsequent adult onset asthma, without and with comorbidity adjustment. RESULTS 1860 adult onset (21 years+) asthma cases were identified, representing a total of 2,096,486 person-years of follow up. After adjustment for comorbid mental disorders several mental disorders were associated with subsequent adult asthma onset: bipolar (OR = 1.8; 95%CI 1.3-2.5), panic (OR = 1.4; 95%CI 1.0-2.0), generalized anxiety (OR = 1.3; 95%CI 1.1-1.7), specific phobia (OR = 1.3; 95%CI 1.1-1.6); post-traumatic stress (OR = 1.5; 95%CI 1.1-1.9); binge eating (OR = 1.8; 95%CI 1.2-2.9) and alcohol abuse (OR = 1.5; 95%CI 1.1-2.0). Mental comorbidity linearly increased the association with adult asthma. The association with subsequent asthma was stronger for mental disorders with an early onset (before age 21). CONCLUSIONS A wide range of temporally prior mental disorders are significantly associated with subsequent onset of asthma in adulthood. The extent to which asthma can be avoided or improved among those with early mental disorders deserves study.
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Affiliation(s)
- Jordi Alonso
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Pompeu Fabra University (UPF), Barcelona, Spain.
| | - Peter de Jonge
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Carmen C W Lim
- Department of Psychological Medicine, Otago University, Dunedin, New Zealand
| | - Sergio Aguilar-Gaxiola
- University of California, Davis, Center for Reducing Health Disparities, School of Medicine, Sacramento, CA, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC - KUL), Leuven, Belgium
| | - Jose Miguel Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Zhaorui Liu
- Institute of Mental Health, Peking University, Beijing, PR China
| | - Siobhan O'Neill
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Derry, Northern Ireland, UK
| | - Dan J Stein
- University of Cape Town, Department of Psychiatry & Mental Health, Groote Schuur Hospital, Cape Town, South Africa
| | - Maria Carmen Viana
- Department of Social Medicine, Federal University of Espírito Santo (UFES), Vitória, Brazil
| | | | | | - Guilherme Borges
- Division of Epidemiological and Psychosocial Research, National Institute of Psychiatry (Mexico) and Metropolitan Autonomous University, Mexico City, Mexico
| | - Marius Ciutan
- National School of Public Health and Professional Development, Bucharest, Romania
| | | | - Fabian Fiestas
- Evidence Generation for Public Health Research Unit, National Institute of Health, Lima, Peru
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; CIBER de Salud Mental (CIBERSAM), Spain; University of Barcelona, Barcelona, Spain
| | - Chiyi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Guangdong Province, PR China
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Jean Pierre Lépine
- Hôpital Saint-Louis Lariboisière Fernand Widal, INSERM U 705, CNRS UMR 8206, Paris, France
| | - Daphna Levinson
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - Yosikazu Nakamura
- Department of Public Health, Jichi Medical University, Yakushiji, Shimotsuke-shi, Tochigi-ken, Japan
| | - Jose Posada-Villa
- Colegio Mayor de Cundinamarca University, CALLE 28 No. 5B-02, Bogota, DC, Colombia
| | - Bogdan J Wojtyniak
- Department-Centre of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Kate M Scott
- Department of Psychological Medicine, Otago University, Dunedin, New Zealand
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Identifying rare variants for genetic risk through a combined pedigree and phenotype approach: application to suicide and asthma. Transl Psychiatry 2014; 4:e471. [PMID: 25335167 PMCID: PMC4350517 DOI: 10.1038/tp.2014.111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 08/28/2014] [Indexed: 12/13/2022] Open
Abstract
Suicidal behavior is a complex disorder, with evidence for genetic risk independent of other genetic risk factors including psychiatric disorders. Since 1996, over 3000 DNA samples from Utah suicide decedents have been collected and banked for research use through the Utah Medical Examiner. In addition, over 12,000 Utah suicides were identified through examination of death certificates back to 1904. By linking this data with the Utah Population Database, we have identified multiple extended pedigrees with increased risk for suicide completion. A number of medical conditions co-occur with suicide, including asthma, and this study was undertaken to identify genetic risk common to asthma and suicide. This study tests the hypothesis that a particular comorbid condition may identify a more homogeneous genetic subgroup, facilitating the identification of specific genetic risk factors in that group. From pedigrees at increased risk for suicide, we identified three pedigrees also at significantly increased familial risk for asthma. Five suicide decedents from each of these pedigrees, plus an additional three decedents not from these pedigrees with diagnosed asthma, and 10 decedents with close relatives with asthma were genotyped. Results were compared with 183 publicly available unaffected control exomes from 1000 Genomes and CEPH (Centre d'etude du polymorphisme humain) samples genotyped on the same platform. A further 432 suicide decedents were also genotyped as non-asthma suicide controls. Genotyping was done using the Infinium HumanExome BeadChip. For analysis, we used the pedigree extension of Variant Annotation, Analysis and Search Tool (pVAAST) to calculate the disease burden of each gene. The Phenotype Driven Variant Ontological Re-ranking tool (Phevor) then re-ranked our pVAAST results in context of the phenotype. Using asthma as a seed phenotype, Phevor traversed biomedical ontologies and identified genes with similar biological properties to those known to result in asthma. Our top associated genes included those related to neurodevelopment or neural signaling (brain-derived neurotrophic factor (BDNF), neutral sphingomyelinase 2 (SMPD2), homeobox b2 (HOXB2), neural cell adhesion molecule (NCAM2), heterogeneous nuclear ribonucleoprotein A0 (HNRNPA0)), inflammation (free fatty acid receptor 2 (FFAR2)) and inflammation with additional evidence of neuronal involvement (oxidized low density lipoprotein receptor 1 (OLR1), toll-like receptor 3 (TLR3)). Of particular interest, BDNF has been previously implicated in both psychiatric disorders and asthma. Our results demonstrate the utility of combining pedigree and co-occurring phenotypes to identify rare variants associated with suicide risk in conjunction with specific co-occurring conditions.
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Abstract
Montelukast (a leukotriene receptor antagonist) is a commonly prescribed medication used in the management of asthma in both children and adults. It has been associated with a possible increased risk of various neuropsychiatric events in post-marketing analyses of clinical trial data and surveillance studies. When establishing a link between a medication and side effects, it is usual to establish and enquire whether there is a chronological relationship between the commencement of the medication and the onset of the symptoms. We report a case where a number of unusual neuropsychiatric events were reported several years after commencement of montelukast in a young boy who may have a genetic predisposition and a likely psychological trigger. There was complete resolution of these symptoms upon the withdrawal of montelukast.
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Abstract
OBJECTIVE Suicide is a major public health concern as each year 30000 people die by suicide in the USA alone. In the teenage population, it is the second leading cause of death. There have been extensive studies of psychosocial factors associated with suicide and suicidal behavior. However, very little is known about the neurobiology of suicide. Recent research has provided some understanding of the neurobiology of suicide, which is the topic of this review. METHODS Neurobiology of suicide has been studied using peripheral tissues such as platelets, lymphocytes, and cerebrospinal fluid obtained from suicidal patients or from the postmortem brains of suicide victims. RESULTS These studies have provided encouraging information with regard to the neurobiology of suicide. They show an abnormality of the serotonergic mechanism, such as increased serotonin receptor subtypes and decreased serotonin metabolites (e.g. 5-hydroxyindoleacetic acid). These studies also suggest abnormalities of receptor-linked signaling mechanisms such as phosphoinositide and adenylyl cyclase. Other biological systems that appear to be dysregulated in suicide involve the hypothalamic-pituitary-adrenal axis, and neurotrophins and neurotrophin receptors. More recently, several studies have also indicated abnormalities of neuroimmune functions in suicide. CONCLUSIONS Some encouraging information emerged from the present review, primarily related to some of the neurobiological mechanisms mentioned above. It is hoped that neurobiological studies may eventually result in the identification of appropriate biomarkers for suicidal behavior as well as appropriate therapeutic targets for its treatment.
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Affiliation(s)
- Ghanshyam N Pandey
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Yonas MA, Marsland AL, Emeremni CA, Moore CG, Holguin F, Wenzel S. Depressive symptomatology, quality of life and disease control among individuals with well-characterized severe asthma. J Asthma 2013; 50:884-90. [PMID: 23725317 DOI: 10.3109/02770903.2013.810750] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES A thorough examination of the relationship of asthma severity and control with symptoms of depression is needed to identify groups of asthmatics at high risk for poor disease control outcomes. This study examines the relationship of symptoms of depression with severity and control in a well-characterized cohort of asthmatics and healthy controls. METHODS Depressive symptoms and quality of life were assessed using the Beck Depression Inventory. Disease control was measured by a composite index incorporating symptoms, activity limitation and rescue medication use. RESULTS Individuals with asthma (n = 91) reported more symptoms of depression than controls (n = 36; p < 0.001). Those with severe asthma (n = 49) reported more symptoms of depression (p = 0.002) and poorer asthma control (p < 0.0001) than those with not severe asthma. Worse asthma control was associated with more depressive symptoms in severe (r = 0.46, p = 0.002) but not in not severe (r = 0.13, p = 0.40) asthmatics. The relationship of symptoms of depression among severe asthmatics was attenuated by disease control. Exploratory analyses identified specific disease symptom characteristics, as opposed to exacerbations, as associated with symptoms of depression. CONCLUSIONS Among individuals with severe asthma, increased symptom burden is positively associated with risk for co-morbid depression. These findings point to a need for regular mood disorder screenings and treatment referrals among this group. Further research is warranted to examine whether treatment of comorbid depression improves treatment adherence and asthma-related quality of life.
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Bandiera FC, Ramirez R, Arheart KL, Canino G, Goodwin RD. Asthma and suicidal ideation and behavior among Puerto Rican older children and adolescents. J Nerv Ment Dis 2013; 201:587-91. [PMID: 23817156 PMCID: PMC3868493 DOI: 10.1097/nmd.0b013e3182982ba4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is growing evidence of a positive association between asthma and suicidal ideation and behavior in the general community, although information on this potential association is scarce among older children and adolescents and Puerto Ricans, groups at risk for both conditions. Data came from wave 3 of the Boricua Youth Study, a longitudinal study of youth in the Bronx and San Juan conducted from 2000 to 2004. Logistic regressions for correlated data (Generalized Estimating Equation) were conducted, with asthma predicting suicidal ideation and behavior among participants 11 years or older. After adjustment for survey design; age; sex; poverty; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, mental disorders; cigarette smoking; and stressful life events, asthma was positively associated with suicidal ideation and behavior among the Puerto Rican older children and adolescents. Public health interventions targeting Puerto Rican older children and adolescents with asthma and future studies investigating potential biological and psychological mechanisms of association are warranted.
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Affiliation(s)
- Frank C. Bandiera
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami,Behavioral Sciences Research Institute, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Rafael Ramirez
- Behavioral Sciences Research Institute, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Kristopher L. Arheart
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami
| | - Glorisa Canino
- Behavioral Sciences Research Institute, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Renee D. Goodwin
- Department of Psychology, Queens College, City University of New York (CUNY),Department of Epidemiology, Mailman School of Public Health, Columbia University
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Blake K, Raissy H. Considerations for Care: Management of Asthma in the Child with Sickle Cell Disease. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2013; 26:43-47. [PMID: 35927847 DOI: 10.1089/ped.2013.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Asthma is difficult to diagnose in the child with sickle cell disease because symptoms and pulmonary function abnormalities are similar to the spectrum of pulmonary manifestations in sickle cell disease. There are no published reports of controlled trials of asthma medications in children with sickle cell disease. Thus, treatment decisions should be guided by the Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf). However, issues specific to children with sickle cell disease should be considered. Initial strategies should focus on control of environmental triggers, as effectiveness on asthma outcomes is proven and the cost for implementation can be low. Use of short- and long-acting β2-agonists may prolong QTc, particularly in this population of children who already have a higher prevalence of prolonged QTc than the general population. Long-acting β2-agonist use has been associated with life-threatening asthma exacerbations with potentially higher risks in African Americans. Montelukast has been reported to increase suicidal thinking and behavior, and persons with asthma and sickle cell disease are already at risk for these events. Oral corticosteroids in the treatment of acute chest syndrome may increase risk of readmission even in children with asthma. The lack of prospective controlled trials of asthma drug treatment in children with asthma and sickle cell disease compels us to move this issue forward.
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Affiliation(s)
- Kathryn Blake
- Center for Clinical Pharmacogenomics and Translational Research, Nemours Children's Clinic, Jacksonville, Florida
| | - Hengameh Raissy
- Health Sciences Center, School of Medicine, Department of Pediatrics, University of New Mexico
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Goodwin RD, Seeley JR, Lewinsohn PM. Childhood respiratory symptoms and mental health problems: the role of intergenerational smoking. Pediatr Pulmonol 2013; 48:195-201. [PMID: 22588945 PMCID: PMC3422397 DOI: 10.1002/ppul.22579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 03/13/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the potential role of youth smoking, parental cigarette smoking and parental anxiety/depressive disorders in the relationship between respiratory symptoms and mental health problems among youth. WORKING HYPOTHESIS Adjusting for both parental smoking and parental anxiety/depressive disorders in the association between respiratory symptoms and mental health problems among young persons will significantly reduce the strength of the observed relationship. STUDY DESIGN Prospective cohort study. PATIENT-SUBJECT SELECTION: Data were drawn from a school-based sample of 1709 young persons in Oregon. METHODOLOGY Physical and mental health data were collected on youth. RESULTS Respiratory symptoms were associated with significantly increased odds of mental health problems among youth. After adjusting for youth smoking, the relationship between respiratory symptoms and depressive disorders was no longer statistically significant. The relationships between respiratory symptoms and anxiety and depressive disorders were no longer significant after adjusting for parental smoking. Parental anxiety/depressive disorders did not appear to influence these relationships. CONCLUSIONS These results provide initial evidence that exposure to parental smoking may play a role in the observed co-occurrence of respiratory and mental health problems in youth, and youths' own smoking appears to influence the link with depressive disorders, but not anxiety disorders.
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Affiliation(s)
- Renee D Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA.
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Goodwin RD, Demmer RT, Galea S, Lemeshow AR, Ortega AN, Beautrais A. Asthma and suicide behaviors: results from the Third National Health and Nutrition Examination Survey (NHANES III). J Psychiatr Res 2012; 46:1002-7. [PMID: 22682509 DOI: 10.1016/j.jpsychires.2012.04.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 04/24/2012] [Accepted: 04/26/2012] [Indexed: 11/20/2022]
Abstract
Asthma and suicide attempts are leading causes of morbidity and mortality among adults in the United States. The objective of this study was to investigate the relationship between asthma and suicidal ideation and suicide attempt among adults in the United States, and to examine whether timing of asthma, mood disorders, poverty, allergies, cigarette smoking and sex differences confound these relationships. Data were drawn from the Third National Health and Nutrition Examination Survey (NHANES III), a representative sample of adults (N = 6584) in the United States. Logistic regression analyses were used to examine the relationships between current and former asthma and suicidal ideation and suicide attempt, adjusting for demographics, poverty, smoking, allergies and mood disorders. Current asthma is significantly associated with an increased likelihood of suicidal ideation (OR: 1.77, CI: 1.11, 2.84) and suicide attempt (OR: 3.26, CI: 1.97, 5.39), after adjusting for mood disorders, smoking, poverty and demographics. There does not appear to be a significant relationship between former asthma and suicidal ideation or suicide attempt. These findings confirm and extend previous evidence by showing that the link between asthma and suicide-related outcomes is evident among adults in a representative sample and that this relationship persists after adjusting for a range of variables. This study may provide an empiric foundation for including asthma in the clinical assessment of suicide risk.
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Affiliation(s)
- Renee D Goodwin
- Department of Epidemiology, Columbia University, 722 West 168th Street, New York, NY 10032, USA.
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Schumock GT, Stayner LT, Valuck RJ, Joo MJ, Gibbons RD, Lee TA. Risk of suicide attempt in asthmatic children and young adults prescribed leukotriene-modifying agents: A nested case-control study. J Allergy Clin Immunol 2012; 130:368-75. [DOI: 10.1016/j.jaci.2012.04.035] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 04/24/2012] [Accepted: 04/25/2012] [Indexed: 11/15/2022]
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Association between asthma medications and suicidal ideation in adult asthmatics. Respir Med 2012; 106:933-41. [PMID: 22495109 DOI: 10.1016/j.rmed.2011.10.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/17/2011] [Accepted: 10/31/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Asthma has been associated with suicidal ideation (SI), though the mechanisms remain poorly understood. Some asthma medications (e.g., theophylline and beta-2 adrenergic agonists) have been shown to provoke feelings of anxiety, fear, and irritability, but their link to SI among asthmatics has not been examined, which was the purpose of the present study. METHODS 664 adult asthma outpatient (39% male, M age = 49 ± 14.3) underwent a sociodemographic, psychiatric, and medical history interview. Patients reported asthma medication use, which was verified by chart review. All patients underwent spirometry and completed questionnaires including the beck depression inventory-II (BDI-II) which includes an item that assesses SI in the past two weeks. RESULTS 11.5% of patients reported having SI in the past two weeks. After adjusting for age, sex, smoking, asthma severity, and depressive disorders, analyses indicated that theophylline use was associated with an increased likelihood of SI (OR = 2.67, 95% CI = 1.07-6.65). Sensitivity analyses including asthma control levels and benzodiazepine use as additional covariates did not alter this association (respectively: OR = 2.54, 95% CI = 1.04-6.37; OR = 2.71, 95% CI = 1.09-6.78), though adding cohabitation rendered it no longer statistically significant (OR = 2.34, 95% CI = 0.90-6.09). There were no associations between SI and LABA use. CONCLUSIONS Findings suggest that theophylline but not LABA use may be associated with an increased risk of SI among adult asthmatics independent of depressive disorders, asthma control levels, and asthma severity, but not cohabitation, suggesting that cohabitation may be important for SI in this population. Physicians should be cautious when prescribing theophylline or similar agents to asthmatics, and ensure adequate follow-up.
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Abstract
The prevalence of asthma has risen dramatically, especially among youth, in recent years, and asthma is now among the most common chronic conditions. Recent studies suggest a relationship between asthma and suicidal ideation, suicide attempt, and death by suicide. This paper reviews the literature, summarizes the weight of evidence, and discusses the clinical implications and future directions for research.
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Affiliation(s)
- Renee D Goodwin
- Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 1505, New York, NY 10032, USA.
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Pandey GN, Rizavi HS, Ren X, Fareed J, Hoppensteadt DA, Roberts RC, Conley RR, Dwivedi Y. Proinflammatory cytokines in the prefrontal cortex of teenage suicide victims. J Psychiatr Res 2012; 46:57-63. [PMID: 21906753 PMCID: PMC3224201 DOI: 10.1016/j.jpsychires.2011.08.006] [Citation(s) in RCA: 251] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 08/15/2011] [Accepted: 08/18/2011] [Indexed: 01/12/2023]
Abstract
Teenage suicide is a major public health concern, but its neurobiology is not well understood. Proinflammatory cytokines play an important role in stress and in the pathophysiology of depression-two major risk factors for suicide. Cytokines are increased in the serum of patients with depression and suicidal behavior; however, it is not clear if similar abnormality in cytokines occurs in brains of suicide victims. We therefore measured the gene and protein expression levels of proinflammatory cytokines interleukin (IL)-1β, IL-6, and tissue necrosis factor (TNF)-α in the prefrontal cortex (PFC) of 24 teenage suicide victims and 24 matched normal control subjects. Our results show that the mRNA and protein expression levels of IL-1β, IL-6, and TNF-α were significantly increased in Brodmann area 10 (BA-10) of suicide victims compared with normal control subjects. These results suggest an important role for IL-1β, IL-6, and TNF-α in the pathophysiology of suicidal behavior and that proinflammatory cytokines may be an appropriate target for developing therapeutic agents.
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Affiliation(s)
- Ghanshyam N. Pandey
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Hooriyah S. Rizavi
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Xinguo Ren
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Jawed Fareed
- Loyola University Medical Center, Maywood, Illinois
| | | | | | | | - Yogesh Dwivedi
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
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Schumock GT, Lee TA, Joo MJ, Valuck RJ, Stayner LT, Gibbons RD. Association between leukotriene-modifying agents and suicide: what is the evidence? Drug Saf 2011; 34:533-44. [PMID: 21663330 DOI: 10.2165/11587260-000000000-00000] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The US FDA has issued safety alerts and required manufacturers of leukotriene-modifying agents (LTMAs), including montelukast, zafirlukast and zileuton, to include suicide and neuropsychiatric events as a precaution in the drug label. This paper reviews the existing evidence on the potential association between the LTMAs and suicidal behaviour. We conducted a literature search of MEDLINE, EMBASE and International Pharmaceutical Abstracts from 1995 to 2010 (inclusive) to identify pertinent studies and reports. We also examined data obtained from the FDA adverse event reporting system. To date, there are no well conducted, comparative, observational studies of this association, and the safety alerts are based primarily on case reports. While the FDA safety alerts apply to all three LTMAs, montelukast (known by its trade name Singulair®) is by far the most widely used of these drugs and most of the reports to date regarding suicide pertain to montelukast. From 1998 to 2009 there were 838 suicide-related adverse events associated with leukotrienes reported to the FDA, of which all but five involved montelukast. Nearly all cases were reported in 2008 and 2009 (96.1%) after the FDA warnings. LTMAs are approved for use in asthma and allergic rhinitis, and are effective drugs. Both of these diseases are also associated with suicide, making confirmation of the association more difficult. Given the lack of good evidence, we recommend that a large observational cohort or case-control study be conducted to quantify the association between LTMAs and suicide. Until then, when prescribing LTMAs, clinicians should consider the potential for suicide and monitor patients who may be at elevated risk carefully for suicidal ideation or psychiatric symptoms associated with suicidal behaviour.
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Affiliation(s)
- Glen T Schumock
- Center for Pharmacoeconomic Research, University of Illinois at Chicago, USA.
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Bae J, Park EY, Park SW. Modifying effect of suicidal ideation on the relationship between asthma and cigarette use behaviors among Korean adolescents. J Prev Med Public Health 2011; 44:118-24. [PMID: 21617337 PMCID: PMC3249247 DOI: 10.3961/jpmph.2011.44.3.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Although cigarette smoking is known to be related to the exacerbation of asthma symptoms, several studies have indicated that the prevalence of cigarette smoking among asthmatic adolescents is similar to or even higher than that among non-asthmatic adolescents. The aim of this study was to evaluate the relationship between asthma and cigarette use behaviors and whether or not the presence of suicidal ideation modifies this relationship among Korean adolescents. Methods We analyzed data from the 2008 Korea Youth Risk Behavior Web-based Survey, which included a nationally representative sample of middle and high school students. Multiple logistic regression models were used to calculate odd ratios and 95% confidence intervals of cigarette use behaviors among current asthmatics, former asthmatics, and non-asthmatics, after adjusting for gender, grade, school records, socioeconomic status, current alcohol use, and suicidal ideation. Results Of 75 238 study participants, 3.5% were current asthmatics and 4.5% were former asthmatics. Compared with non-asthmatics, asthmatics were more likely to report current cigarette use, frequent and heavy cigarette use, and cigarette use before 13 years of age. There were statistically significant interactions between asthma and suicidal ideation in cigarette use behaviors. Conclusions This study demonstrated that asthmatic adolescents are more likely than non-asthmatic adolescents to engage in cigarette use behaviors and the presence of suicidal ideation is an effect modifier of the relationship between asthma and cigarette use behaviors. Particular attention should be paid to the awareness of health risks of cigarette smoking and mental health problems among asthmatic adolescents.
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Affiliation(s)
- Jisuk Bae
- Department of Preventive Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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Schumock GT, Gibbons RD, Lee TA, Joo MJ, Valuck RJ, Stayner LT. Relationship between leukotriene-modifying agent prescriptions dispensed and rate of suicide deaths by county in the US. Drug Healthc Patient Saf 2011; 3:47-52. [PMID: 22046105 PMCID: PMC3202760 DOI: 10.2147/dhps.s23665] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The US Food and Drug Administration has issued warnings about a potential link between leukotriene receptor-modifying agents (LTMA) and suicide. These warnings are based on case reports and there is controversy about the association. While spontaneous reporting of suicide-related events attributed to LTMA has risen dramatically, these data may be biased by the warnings. The objective of this study was to explore the relationship between LTMA and suicide deaths using event data preceding the Food and Drug Administration warnings. METHODS We conducted a mixed-effects Poisson regression analysis of the association between LTMA prescriptions dispensed and suicide deaths at the county level. Counts of suicide deaths in each US county, stratified by race, age group, gender, and year were obtained from the National Center for Health Statistics for the period January 1, 1999 to December 31, 2006. Counts of LTMA prescriptions dispensed in each US county were obtained from IMS Health Incorporated. The model estimated the overall suicide rate conditional on LTMA use, adjusted for age, gender, race, year, and antidepressant utilization. We also assessed the intracounty and intercounty associations. RESULTS There were 249,872 suicides in the US between 1999 and 2006, and the annual suicide rate ranged from 11.17 to 11.92 per 100,000 population. There were 118.63, 11.68, and 0.12 million prescriptions dispensed for montelukast, zafirlukast, and zileuton, respectively, between 1999 and 2006. The mean rate of LTMA prescriptions dispensed by county was 42.91 (95% confidence interval [CI] 42.78-43.04), 4.82 (95% CI 4.81-4.84), and 0.05 (95% CI 0.05-0.05) per 1000 for montelukast, zafirlukast, and zileuton, respectively. We found a negative within-county association between the rate of total LTMA prescriptions dispensed and the suicide rate by county (P = 0.0296). This association was primarily driven by montelukast. CONCLUSION Our results, while subject to certain limitations, provide preliminary evidence that the association between LTMA and suicide could be different (ie, reduced risk) than that which might be anticipated based on previous warnings. Patient-level research is needed to understand more clearly the association between LTMA and suicide.
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Affiliation(s)
- Glen T Schumock
- Center for Pharmacoeconomic Research, and Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert D Gibbons
- Center for Health Statistics, and Departments of Medicine and Health Studies, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Todd A Lee
- Center for Pharmacoeconomic Research, and Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
- Center for Management of Complex Chronic Care, Hines VA Hospital, Hines, IL, USA
- Section of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Min J Joo
- Section of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert J Valuck
- Department of Clinical Pharmacy, School of Pharmacy, University of Colorado, Aurora, CO, USA
| | - Leslie T Stayner
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
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Gibbons RD, Mann JJ. Strategies for quantifying the relationship between medications and suicidal behaviour: what has been learned? Drug Saf 2011; 34:375-95. [PMID: 21513361 DOI: 10.2165/11589350-000000000-00000] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In recent years there has been considerable concern that certain classes of drugs, for example antidepressants, may increase the risk of suicide. In this current opinion article, we examine the literature on methodological and statistical approaches to the design and analysis of suicidal event studies. Experimental, ecological and observational studies of the relationship between drugs and suicidal events (thoughts, attempts and completion) are discussed. Areas considered include analysis of spontaneous reporting system data, ecological trends in national and/or small area (e.g. county) suicide rates, meta-analyses of randomized clinical trials, and large-scale medical claims data. New statistical and experimental strategies for investigating possible associations between drugs and suicide are highlighted, and we suggest directions for future statistical/methodological research. To put this into context, we then review the most recent literature on the relationship between drugs (antidepressants, antiepileptics, varenicline, montelukast and antipsychotics) and suicidal events. Overall, there appears to be little evidence that drugs increase the risk of suicide and related behaviour. Numerous lines of evidence in adults clearly demonstrate that inadequate treatment of depression (pharmacotherapy and/or psychotherapy) is associated with increased risk of suicidal behaviour. In children, the results are less clear and further study is required to better delineate which children benefit from treatment and who may be at increased risk as a consequence of treatment. From a statistical and methodological perspective, the field of pharmacoepidemiology is a fertile area for statistical research, both in theory and in application. In general, methods have been adopted from other areas such as general epidemiology, despite the singular nature of many of the problems that are unique to drug safety in general, in particular the study of rare events. Finally, there is considerable debate concerning the communication of risk. For suicide, regulatory action has been taken largely on the basis of evidence suggesting increased risk of suicidal thoughts. However, suicidal thoughts are quite common, particularly among patients with depression, and may have little relationship to suicidal behaviour and/or completion.
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Affiliation(s)
- Robert D Gibbons
- Department of Medicine, and the Center for Health Statistics, University of Chicago, Chicago, Illinois 60637, USA.
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Gangwisch JE, Jacobson CM. New perspectives on assessment of suicide risk. Curr Treat Options Neurol 2011; 11:371-6. [PMID: 19744403 DOI: 10.1007/s11940-009-0041-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Concerns have arisen during recent years over a possible link between suicide and medications used to treat several medical conditions, including depression, asthma, epilepsy, and smoking. The concern over the safety of these medications was sparked by data from postmarketing and retrospective analyses of clinical trials. However, clinical trials were not initially designed to measure suicidality, and this methodologic limitation weakens the ability to make causal conclusions. Postmarketing results also have methodologic limitations (such as the absence of control groups) that limit the ability to make causal conclusions. Postmarketing results are also misleading because each of the medical conditions involved is highly comorbid with depression. The risk of not treating these conditions with an active and effective medication may clearly outweigh the possible slight elevation of the risk of suicidal thoughts and behaviors. The decision to take a medication should be made in consultation with a physician and based upon considerations of the risks and benefits of the medication. Physicians and the public need accurate information on the suicide risks associated with medications to make informed treatment decisions. The most effective way to ascertain the true risk (or lack of risk) associated with a medication is to systematically and prospectively assess suicidal thoughts and behaviors in randomized, placebo-controlled clinical trials. If a medication is scientifically determined to increase the risk for suicidal thoughts and behaviors, then the risk needs to be accurately translated and communicated to physicians and patients. Physicians prescribing these medications will need to closely monitor and assess their patients for changes in mood and suicide risk throughout treatment and must be able to recognize when a patient needs specialized mental health care. Mental status changes can be appropriately monitored and managed. Some medical conditions, such as asthma and epilepsy, and some treatment goals, such as smoking cessation, have inherent increased risks for depression-and by extension, suicide-that necessitate accurate, ongoing assessment.
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Affiliation(s)
- James E Gangwisch
- James E. Gangwisch, PhD Department of Psychiatry, Division of Cognitive Neuroscience, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, Unit 74, New York, NY 10032, USA.
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