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Aalsma M, Keys J, Ferrin S, Shan M, Garbuz T, Scott T, Adams Z, Hulvershorn L, Downs S. Adolescent suicide assessment and management in primary care. BMC Pediatr 2022; 22:389. [PMID: 35780090 PMCID: PMC9250265 DOI: 10.1186/s12887-022-03454-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background To understand how suicide management occurs within the primary care setting in terms of follow-up assessments and referral practices. Methods At an initial primary care visit, adolescents (aged 12–20 years old) completed electronic screening. Data were focused on youth who endorsed a suicidal risk item while completing screening at two Midwestern primary care clinics. Data were collected through retrospective chart reviews to analyze actions taken by the primary care physician at the youth’s initial visit and follow-up visit within the next 12 months. Results At initial visits 200 adolescents endorsed a suicidal risk item and 39 (19.5%) were considered to be concerning by their primary care physician. The average age was 14.7 years old (SD ± 2.0). Seventy-two percent (n = 144) were female, and 65% (n = 129) identified as Black. At initial visits, significant differences between suicidal concern groups were found in reporting active suicidal ideation, past suicide attempts, those who were referred to behavioral health counseling, and those who had a diagnosis of depression. Interestingly, only 13% (n = 25) of all patients who endorsed the suicide item were asked whether or not there were weapons in their home and primary care providers asked only 7% (n = 13) of all patients whether they had a safety plan. Conclusions There was inconsistent follow-up for adolescents with a history of suicide concerns. At this time, national guidelines do not exist regarding primary care follow-up of youth with suicide concerns. Guidelines are a necessary precursor for practice improvement. Trial Registration Clinical Trials Registry: NCT02244138. Registration date, September 1, 2014. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03454-4.
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Affiliation(s)
- M Aalsma
- Division of Adolescent Medicine, Adolescent Behavioral Health Research Program, Department of Pediatrics, Indiana University School of Medicine, 410 W. 10th St. Rm 2025, Indianapolis, IN, USA. .,General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North, Carolina School of Medicine, Chapel Hill, NC, USA.
| | - J Keys
- Division of Adolescent Medicine, Adolescent Behavioral Health Research Program, Department of Pediatrics, Indiana University School of Medicine, 410 W. 10th St. Rm 2025, Indianapolis, IN, USA
| | - S Ferrin
- General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North, Carolina School of Medicine, Chapel Hill, NC, USA
| | - M Shan
- Department of Biostatistics, School of Public Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - T Garbuz
- Division of Adolescent Medicine, Adolescent Behavioral Health Research Program, Department of Pediatrics, Indiana University School of Medicine, 410 W. 10th St. Rm 2025, Indianapolis, IN, USA
| | - T Scott
- Division of Adolescent Medicine, Adolescent Behavioral Health Research Program, Department of Pediatrics, Indiana University School of Medicine, 410 W. 10th St. Rm 2025, Indianapolis, IN, USA
| | - Z Adams
- Department of Psychiatry, Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, USA
| | - L Hulvershorn
- Department of Psychiatry, Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, USA
| | - S Downs
- Department of Pediatrics and Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Le-Niculescu H, Case NJ, Hulvershorn L, Patel SD, Bowker D, Gupta J, Bell R, Edenberg HJ, Tsuang MT, Kuczenski R, Geyer MA, Rodd ZA, Niculescu AB. Convergent functional genomic studies of ω-3 fatty acids in stress reactivity, bipolar disorder and alcoholism. Transl Psychiatry 2011; 1:e4. [PMID: 22832392 PMCID: PMC3309466 DOI: 10.1038/tp.2011.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 02/24/2011] [Indexed: 12/28/2022] Open
Abstract
Omega-3 fatty acids have been proposed as an adjuvant treatment option in psychiatric disorders. Given their other health benefits and their relative lack of toxicity, teratogenicity and side effects, they may be particularly useful in children and in females of child-bearing age, especially during pregnancy and postpartum. A comprehensive mechanistic understanding of their effects is needed. Here we report translational studies demonstrating the phenotypic normalization and gene expression effects of dietary omega-3 fatty acids, specifically docosahexaenoic acid (DHA), in a stress-reactive knockout mouse model of bipolar disorder and co-morbid alcoholism, using a bioinformatic convergent functional genomics approach integrating animal model and human data to prioritize disease-relevant genes. Additionally, to validate at a behavioral level the novel observed effects on decreasing alcohol consumption, we also tested the effects of DHA in an independent animal model, alcohol-preferring (P) rats, a well-established animal model of alcoholism. Our studies uncover sex differences, brain region-specific effects and blood biomarkers that may underpin the effects of DHA. Of note, DHA modulates some of the same genes targeted by current psychotropic medications, as well as increases myelin-related gene expression. Myelin-related gene expression decrease is a common, if nonspecific, denominator of neuropsychiatric disorders. In conclusion, our work supports the potential utility of omega-3 fatty acids, specifically DHA, for a spectrum of psychiatric disorders such as stress disorders, bipolar disorder, alcoholism and beyond.
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Affiliation(s)
- H Le-Niculescu
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N J Case
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - L Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - S D Patel
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indianapolis VA Medical Center, Indianapolis, IN, USA
| | - D Bowker
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - J Gupta
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - R Bell
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - H J Edenberg
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M T Tsuang
- Department of Psychiatry, UC San Diego, La Jolla, CA, USA
| | - R Kuczenski
- Department of Psychiatry, UC San Diego, La Jolla, CA, USA
| | - M A Geyer
- Department of Psychiatry, UC San Diego, La Jolla, CA, USA
| | - Z A Rodd
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A B Niculescu
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indianapolis VA Medical Center, Indianapolis, IN, USA
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