Psychiatric Comorbidity Among Sexual and Gender Minority Youth and Young Adults at Risk for Suicide

Background

Compared with peers, young sexual and gender minorities (SGM) are at a four to seven-fold increased risk of attempting suicide. Prior epidemiological studies, mainly focusing on monomorbid inequalities and without conducting diagnostic clinical interviews, have been unable to report robust data on psychiatric comorbidities among those who attempted suicide. The purpose of this presentation is to describe the presence of current psychiatric comorbidities among SGM youth and young adults at elevated risk for repeat suicide attempts.

Methods

A diverse convenience sample of SGM youth and young adults with a lifetime history of suicide attempts and current suicidal ideation was recruited for an open-phase suicide prevention trial in San Diego, CA. At baseline, participants underwent a 15-module DIAMOND interview for adults or computerized K-SADS for minors, and a battery of self-report questionnaires.

Results

Among the 31 participants (Mage = 22 years [Range: 16, 29]; 100% sexual, 52% gender, and 61% racial/ethnic minority), 27 (87%) participants met criteria for any mood disorder, 24 (77%) for any anxiety disorder, 16 (52%) for any trauma or stress disorder, and 2 (6%) for any psychotic disorder. One (3%) participant did not meet criteria for any psychiatric diagnoses, while five (16%) met criteria for a single and 25 (81%) for multiple diagnoses. The average number of diagnoses was 3.2 (Range: 0, 7). Additionally, 20 (65%) participants met the cut-off for likely ADHD, 20 (65%) for possible borderline personality disorder, and 21 (68%) for likely body dysmorphic disorder, with 11 (35%) within the 90th percentile for reference eating disorder severity.

Conclusions

The degree of psychiatric comorbidities in the sample of SGM youth and young adults at elevated risk for suicide was high. Beside direct suicide risk mitigation efforts, suicide prevention programs that target young SGM with a history of attempts should screen for untreated psychiatric disorders.

Key messages

• LGBTQ+ youth and young adults at elevated risk for repeat suicide attempts experience a high degree of psychiatric comorbity.

• Beyond suicide risk mitigation, LGBTQ+ youth suicide prevention programs should focus on untreated psychiatric comorbidities.

Feasibility and Acceptability of a Patient Navigation Intervention to Prevent Suicide in LGBTQ Youth and Young Adults

Background

Across Western countries, young LGBTQ+ individuals are at a four to seven-fold increased risk of attempting suicide, compared to the general public. Despite these substantial health disparities, no known empirically supported suicide prevention programs exist for this highly vulnerable population. Patient navigation (PN), as an intervention to assist people in overcoming barriers to care, paired with the Safety Planning Intervention (SPI), may be a promising intervention to target mechanisms (e.g., thwarted belongingness and suicide-related coping skills) that theoretically underlie suicide. The purpose of this presentation is to describe the developed intervention and present initial data on its feasibility and acceptability.

Methods

In collaboration with a Participatory Planning Group (PPG), an iterative process was used to develop a PN+SPI intervention to prevent suicide among at-risk LGBTQ+ youth and young adults. A mixed-methods case series was used to examine feasibility and acceptability of implementing the PN+SPI intervention over a three-month period of time.

Results

Theoretical models regarding suicidality and LGBTQ+ mental health along with PPG feedback have informed the development of the PN+SPI intervention, with 7 modules included in feasibility evaluation: 1) Introduction + SPI; 2) Minority Stress Psychoeducation; 3) Barriers to Mental Health Services; 4) Barriers to Community Resources; 5) Decision Making; 6) Crisis Intervention; and 7) Wrap Up.

Conclusions

This project has the potential for reducing mortality and morbidity due to suicide attempts among LGBTQ+ youth/emerging adults, who are one of the most vulnerable groups for attempting suicide globally. Given the brevity of the PN+SPI intervention and its emphasis on safety planning and accessing community resources, the PN+SPI intervention has high potential for wide dissemination and public health impact, should it demonstrate feasibility, acceptability, and preliminary efficacy.

CpG motif-based adjuvant as a replacement for Freund's complete adjuvant in a recombinant LHRH vaccine

This study compared: (1) Freund's complete adjuvant and CpG oligodeoxynucleotide (ODN) 2006 in water-in-oil emulsion as adjuvants; and (2) increasing doses of a recombinant ovalbumin-LHRH (ova-LHRH) fusion protein as an antigen for a contraceptive vaccine. Treatment groups (n=8 heifers/group) were: one untreated control group; five groups receiving CpG ODN with different doses of ova-LHRH (1.5; 2.3; 3.4; 5.1; and 7.6 mg); and one group receiving 3.4 mg ova-LHRH in Freund's. Heifers were immunized at weeks 0 and 14. All vaccine treatments caused gonadal regression and estrus suppression. CpG ODN is a suitable replacement for Freund's for LHRH immunization.

The effectiveness of a CpG motif-based adjuvant (CpG ODN 2006) for LHRH immunization

A recombinant ovalbumin-luteinizing hormone-releasing hormone (ova-LHRH) antigen has been developed for immunocontraception. In this study, a novel immunostimulant for ova-LHRH immunization, CpG oligodeoxynucleotide (ODN) 2006, was compared against Mycobacterium butyricum. Also, the immunogenicity of ova-LHRH after lyophilization and exposure to organic solvents was assessed. Rats received either ova-LHRH solubilized in urea; lyophilized ova-LHRH; lyophilized ova-LHRH exposed to methylene chloride; or lyophilized ova-LHRH exposed to ethyl acetate. Immunogenicity of lyophilized ova-LHRH was reduced compared with solubilized ova-LHRH. Exposure to ethyl acetate further decreased immunogenicity of ova-LHRH. CpG ODN 2006 was a more effective immunostimulant than M. butyricum for LHRH immunization.

Qualitative study of clinic staff members' experiences using an immunization registry

OBJECTIVES

To examine individual clinic staff members' experiences with using an immunization registry and to compare staff members' perceptions of immunization registries across different provider sites.

DESIGN

Cross-sectional survey using in-depth interviews and direct observation.

SETTINGS

The pediatric department of an urban community health center and 2 urban hospital-based pediatric primary care clinics.

PARTICIPANTS

Twenty-five subjects were recruited using maximum variation sampling at each site. The subjects included clerks, clinic assistants, licensed practical nurses, a nurse practitioner, and registered nurses.

MAIN OUTCOME MEASURES

Clinic staff members' perceptions of an immunization registry and frequency of registry use.

RESULTS

Differences were observed in subjects' perceptions of an immunization registry across provider sites. Although most subjects had positive attitudes toward the registry, they did not necessarily believe that the registry decreased their workload. The ability to access immunization registry data and actual use of the registry seem to be related to training of clinic personnel, location of the registry terminal, and helpfulness and availability of registry staff.

CONCLUSION

Obtaining the opinions of immunization registry users is an important strategy to evaluate the usefulness of a registry in a site and target possible areas for improvement.

The cost to providers of participating in an immunization registry

INTRODUCTION

The medical and public health communities advocate immunization registries as one tool to achieve national immunization goals. Although substantial resources have been expended to establish registries across the nation, minimal research has been conducted to evaluate provider participation costs.

METHODS

The objective of this study was to identify the direct costs to participate in an immunization registry. To estimate labor and equipment costs, we conducted interviews and direct observation at four sites that were participating in one of two immunization registries. We calculated mean data-entry times from direct observation of clinic personnel.

RESULTS

The annual cost of participating in a registry varied extremely, ranging from $6083 to $24,246, with the annual cost per patient ranging from $0.65 to $7. 74. Annual per-patient costs were lowest in the site that used an automated data-entry interface. Of the sites requiring a separate data-entry step, costs were lowest for the site participating in the registry that provided more intensive training and had a higher proportion of the target population entered into the registry.

CONCLUSIONS

Ease of registry interface, data-entry times, and target population coverage affect provider participation costs. Designing the registry to accept electronic transfers of records and to avoid duplicative data-entry tasks may decrease provider costs.

Measuring immunization registry costs: promises and pitfalls

INTRODUCTION

The medical and public health communities advocate the use of immunization registries as one tool to achieve national goals for immunization. Despite the considerable investment of resources into registry development, little information is available about the costs of developing or maintaining a registry.

METHODS

The objective of this study was to measure the direct costs of maintaining one immunization registry. Cost and resource-use data were collected by interviewing registry personnel and staff at participating pediatric practices, collecting available financial records, and direct observation.

RESULTS

The estimated direct cost for maintaining the registry during the 3 calendar years 1995 through 1997 was $439,232. In 1997, this represented an annual cost of $5.26 per child immunized whose record was entered into the registry. In all years, personnel expenses represented at least three fourths of the total costs, with the majority of administrative effort donated. Yearly costs increased over time largely because of growing administrative personnel requirements as the registry became fully operational.

CONCLUSION

Considerable resources are required to establish and maintain immunization registries. Because personnel costs, particularly nontechnical personnel, represent a large portion of total registry costs, it is important to accurately account for donated effort. Recommendations for future registry cost studies include prospective data collection and focusing upon the costs of providing specific outreach or surveillance functions rather than overall registry costs. In addition, registry effectiveness evaluations are needed to translate registry costs into cost-effectiveness ratios.