suicide

Importance: Increasing child and adolescent use of social media, video games, and mobile phones has raised concerns about potential links to youth mental health problems. Prior research has largely focused on total screen time rather than longitudinal addictive use trajectories.

Objectives: To identify trajectories of addictive use of social media, mobile phones, and video games and to examine their associations with suicidal behaviors and ideation and mental health outcomes among youths.

Design, setting, and participants: Cohort study analyzing data from baseline through year 4 follow-up in the Adolescent Brain Cognitive Development Study (2016-2022), with population-based samples from 21 US sites.

Exposures: Addictive use of social media, mobile phones, and video games using validated child-reported measures from year 2, year 3, and year 4 follow-up surveys.

Main outcomes and measures: Suicidal behaviors and ideation assessed using child- and parent-reported information via the Kiddie Schedule for Affective Disorders and Schizophrenia. Internalizing and externalizing symptoms were assessed using the parent-reported Child Behavior Checklist.

Results: The analytic sample (n = 4285) had a mean age of 10.0 (SD, 0.6) years; 47.9% were female; and 9.9% were Black, 19.4% Hispanic, and 58.7% White. Latent class linear mixed models identified 3 addictive use trajectories for social media and mobile phones and 2 for video games. Nearly one-third of participants had an increasing addictive use trajectory for social media or mobile phones beginning at age 11 years. In adjusted models, increasing addictive use trajectories were associated with higher risks of suicide-related outcomes than low addictive use trajectories (eg, increasing addictive use of social media had a risk ratio of 2.14 [95% CI, 1.61-2.85] for suicidal behaviors). High addictive use trajectories for all screen types were associated with suicide-related outcomes (eg, high-peaking addictive use of social media had a risk ratio of 2.39 [95% CI, 1.66-3.43] for suicidal behaviors). The high video game addictive use trajectory showed the largest relative difference in internalizing symptoms (T score difference, 2.03 [95% CI, 1.45-2.61]), and the increasing social media addictive use trajectory for externalizing symptoms (T score difference, 1.05 [95% CI, 0.54-1.56]), compared with low addictive use trajectories. Total screen time at baseline was not associated with outcomes.

Conclusions and relevance: High or increasing trajectories of addictive use of social media, mobile phones, or video games were common in early adolescents. Both high and increasing addictive screen use trajectories were associated with suicidal behaviors and ideation and worse mental health.

Author/s:

Yunyu Xiao, PhD, Yuan Meng, PhD, Timothy T. Brown, PhD

Clinical Approaches to the Prevention of Firearm-Related Injury

Erin Blanchette — Mon, 16 Sep 2024 13:17:52 +0000

Date Added:

September 16, 2024

Journal/Publication:

The New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

September 12, 2024

Issue:

Volume:

391

Pages:

926-940

URL:

Clinical Approaches to the Prevention of Firearm-Related Injury

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/NEJMra2306867

Keywords

PMID (1):

39259896

MeSH

Firearm-related injuries are the second leading cause of death in children. If one our goals as PCPs is to prevent premature deaths, we need to make this issue a focus of attention during WCCs. James W. Mold, MD, MPH

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Firearm-related injuries are an urgent health crisis in the United States, with firearm-related deaths surpassing deaths from motor vehicle crashes in 2017.1 In contrast to other conditions for which clinicians have evidence-based solutions to reduce harm, the 25-year gap in federal research funding2,3 halted substantial advances in the science of firearm-related injury prevention. Yet renewed funding and emerging science continue to highlight the critical role clinicians have in prevention efforts.2,3 Similar to other complex health issues, firearm-related injury is heterogeneous, with multiple causes (Figure 1). Each of these causes has entry points within clinical encounters that represent opportunities to interact, interrupt, and prevent negative outcomes.

The lack of research has resulted in a generation of clinicians currently lacking the training necessary to implement the solutions generated by recent science. As a result, despite clinicians recognizing the need for prevention and agreeing that prevention of firearm-related injury is within their scope of practice,13 few deliver evidence-based interventions even though their patients find such measures acceptable within the context of clinical care.14 This lack of training is compounded by a shortage of adequate health care infrastructure necessary to support the integration of useful approaches into practice. Clinicians note multiple barriers, including a lack of knowledge, guidelines, time, clinical support, and reimbursement, as well as a fear of offending patients or encountering legal trouble.15-17

Clinicians routinely provide harm-reduction measures and anticipatory guidance for a range of complex health issues (e.g., substance use and vaccination), capitalizing on available evidence, their relationships with patients, and their community standing to promote health and safety. Although gaps exist, there remain opportunities to improve the current standard of care for the prevention of firearm-related injury. In this article, we review clinical approaches to prevention, ranging from ones implemented within individual clinical encounters to ones advanced by health care leaders within the systems and communities they serve.

Author/s:

Patrick M Carter, Rebecca M Cunningham

Screening for Depression and Suicide Risk in Adults US Preventive Services Task Force Recommendation Statement

Aubrey Delammermore — Sat, 24 Jun 2023 05:00:00 +0000

Date Added:

June 24, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

June 20, 2023

Issue:

Volume:

329

Pages:

2057-2067

URL:

Screening for Depression and Suicide Risk in Adults US Preventive Services Task Force Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2023.9297

Keywords

PMID (1):

37338872

MeSH

Depression / diagnosis

Depressive Disorder, Major* / diagnosis

Mass Screening / adverse effects

Suicide*

pregnancy

Final recommendations from the USPSTF regarding screening adults for depression (just do it). However, there is still insufficient evidence to screen for suicide risk apparently. James W. Mold, MD, MPH

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IMPORTANCE Major depressive disorder (MDD), a common mental disorder in the US, may
have substantial impact on the lives of affected individuals. If left untreated, MDD can
interfere with daily functioning and can also be associated with an increased risk of
cardiovascular events, exacerbation of comorbid conditions, or increased mortality.

OBJECTIVE The US Preventive Services Task Force (USPSTF) commissioned a systematic
review to evaluate benefits and harms of screening, accuracy of screening, and benefits and
harms of treatment of MDD and suicide risk in asymptomatic adults that would be applicable
to primary care settings.

POPULATION Asymptomatic adults 19 years or older, including pregnant and postpartum
persons. Older adults are defined as those 65 years or older.

EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that screening for
MDD in adults, including pregnant and postpartum persons and older adults, has a moderate
net benefit. The USPSTF concludes that the evidence is insufficient on the benefit and harms
of screening for suicide risk in adults, including pregnant and postpartum persons and older
adults.

RECOMMENDATION The USPSTF recommends screening for depression in the adult
population, including pregnant and postpartum persons and older adults. (B
recommendation) The USPSTF concludes that the current evidence is insufficient to assess
the balance of benefits and harms of screening for suicide risk in the adult population,
including pregnant and postpartum persons and older adults. (I statement)

Author/s:

US Preventive Services Task Force, Barry, M. J., Nicholson, W. K., Silverstein, M., Chelmow, D., Coker, T. R., Davidson, K. W., Davis, E. M., Donahue, K. E., Jaén, C. R., Li, L., Ogedegbe, G., Pbert, L., Rao, G., Ruiz, J. M., Stevermer, J. J., Tsevat, J., Underwood, S. M., Wong, J. B.

Understanding Suicide Risk And Prevention

Devin Evans — Fri, 19 Mar 2021 05:00:00 +0000

Date Added:

March 19, 2021

Journal/Publication:

Health Affairs

Publication Date:

January 29, 2021

URL:

Understanding Suicide Risk And Prevention

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

DOI (1):

10.1377/hpb20201228.198475

Keywords

MeSH

Self-Injurious Behavior

A review of suicide risk and prevention by a psychologist who works with primary care practices. James W. Mold, MD, MPH

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KEY POINTS:

Suicide rates have been rising during the past several years, but suicide is preventable.
There are many known risk factors for suicide, but the predictive utility of any single risk factor is low, requiring a focus on population-level rather than individual-level prevention.
There are proven processes for identifying suicide risk and intervening in health care, criminal justice, and education settings.
There is also a need for an enhanced data infrastructure to support suicide and self-harm surveillance systems.
Additional policy intervention is needed to scale and spread successful prevention approaches and to identify others. For example, policies should support removal of lethal means, increased funding for help lines and school-based programs, and integration of mental health care into routine health care.

Author/s:

Miller, Benjamin F., Coffey, M. J.

Health Policy Brief: Understanding Suicide Risk and Prevention

Devin Evans — Wed, 03 Feb 2021 06:00:00 +0000

Date Added:

February 3, 2021

Publisher:

Health Affairs

Publication Date:

January 29, 2021

URL:

Health Policy Brief: Understanding Suicide Risk and Prevention

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

DOI (1):

10.1377/hpb20201228.198475

Keywords

MeSH

A summary of what we know about prevention of suicide written by someone who has been working hard to integrate primary and mental health care for years. James WE. Mold, MD, MPH

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Suicide rates have been rising during the past several years, but suicide is preventable.
There are many known risk factors for suicide, but the predictive utility of any single risk factor is low, requiring a focus on population-level rather than individual-level prevention.
There are proven processes for identifying suicide risk and intervening in health care, criminal justice, and education settings.
There is also a need for an enhanced data infrastructure to support suicide and self-harm surveillance systems.
Additional policy intervention is needed to scale and spread successful prevention approaches and to identify others. For example, policies should support removal of lethal means, increased funding for help lines and school-based programs, and integration of mental health care into routine health care.

Author/s:

Miller, Benjamin F., Coffery, M. J.

SBIRT: Improving behavioral health outcomes in primary care

John Bayhi — Mon, 03 Feb 2020 19:46:50 +0000

Date Added:

February 3, 2020

Publication Date:

October 31, 2019

Type:

Clinical Decision Aids

Format:

Poster

Keywords

SBIRT

screening and brief intervention

This clinical decision aid was produced for use in the OPHIC (Screening and Brief Intervention, Referral, and Treatment (SBIRT) for depression, alcohol, and substance abuse implementation project. James W. Mold, MD, MPH

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Author/s:

Oklahoma Department of Mental & Substance Abuse Services, Oklahoma Primary Healthcare Improvement Cooperative, University of Oklahoma Health Sciences Center, Alosa Health

Assessment and Management of Patients at Risk for Suicide: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines.

Brian Desmarais — Wed, 28 Aug 2019 19:36:58 +0000

Date Added:

August 28, 2019

Journal/Publication:

Annals of Internal Medicine

Publication Date:

August 27, 2019

URL:

Assessment and Management of Patients at Risk for Suicide: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines.

Format:

Article

DOI (1):

10.7326/M19-0687

Keywords

MeSH

evidence-based practice

DESCRIPTION:

In May 2019, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved an update to the 2013 joint clinical practice guideline for assessing and managing patients who are at risk for suicide. This guideline provides health care providers with a framework by which to screen for, evaluate, treat, and manage the individual needs and preferences of VA and DoD patientswho may be at risk for suicide.

METHODS:

In January 2018, the VA/DoD Evidence-Based Practice Work Group convened to develop a joint VA/DoD guideline including clinical stakeholders and conforming to the National Academy of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel drafted key questions, systematically searched and evaluated the literature through April 2018, created algorithms, and advanced 22 recommendations in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.

RECOMMENDATIONS:

This synopsis, which includes 3 clinical practice algorithms, summarizes the key recommendations of the guideline related to screening and evaluation, risk management and treatment, and other management methods. Risk management and treatment recommendations address both pharmacologic and nonpharmacologic approaches for patients with suicidal ideation and behavior. Other management methods address lethal means safety (such as restricting access to firearms, poisons, and medications and installing barriers to prevent jumping from lethal heights) and population health strategies.

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These guidelines produced by the VA apply equally well to all adults. James W. Mold, MD, MPH

Author/s:

Sall, J., Brenner, J., Bell, A.M.M., Colston, M.J.

Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and violent crime: population based cohort study in Sweden

Brian Desmarais — Wed, 26 Jun 2019 01:00:12 +0000

Date Added:

June 26, 2019

Journal/Publication:

British Medical Journal

Publication Date:

June 12, 2019

URL:

Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and violent crime: population based cohort study in Sweden

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1136/bmj.l2147

Keywords

Lyrica

suicide

motor vehicle accidents

MeSH

Accidents

Traffic/statistics & numerical data

Wounds and Injuries/epidemiology

Violence/statistics & numerical data

Sweden/epidemiology

Suicide/statistics & numerical data

risk factors

Prescription Drugs/adverse effects

Pregabalin/adverse effects

Middle Aged

Gabapentin/adverse effects

Drug Prescriptions/statistics & numerical data

Drug Overdose/epidemiology

Pregabalin (Lyrica) appears to be associated with an increased risk of suicidal behaviors, unintentional overdoses, and motor vehicle accidents, particularly in adolescents and young adults. James W. Mold, MD, MPH

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Abstract

OBJECTIVE:

To examine associations between gabapentinoids and adverse outcomes related to coordination disturbances (head or body injuries, or both and road traffic incidents or offences), mental health (suicidal behaviour, unintentional overdoses), and criminality.

DESIGN:

Population based cohort study.

SETTING:

High quality prescription, patient, death, and crime registers, Sweden.

PARTICIPANTS:

191 973 people from the Swedish Prescribed Drug Register who collected prescriptions for gabapentinoids (pregabalin or gabapentin) during 2006 to 2013.

MAIN OUTCOME MEASURES:

Primary outcomes were suicidal behaviour, unintentional overdoses, head/body injuries, road traffic incidentsand offences, and arrests for violent crime. Stratified Cox proportional hazards regression was conducted comparing treatment periods with non-treatment periods within an individual. Participants served as their own control, thus accounting for time invariant factors (eg, genetic and historical factors), and reducing confounding by indication. Additional adjustments were made by age, sex, comorbidities, substance use, and use of other antiepileptics.

RESULTS:

During the study period, 10 026 (5.2%) participants were treated for suicidal behaviour or died from suicide, 17 144 (8.9%) experienced an unintentional overdose, 12 070 (6.3%) had a road traffic incident or offence, 70 522 (36.7%) presented with head/body injuries, and 7984 (4.1%) were arrested for a violent crime. In within-individual analyses, gabapentinoid treatment was associated with increased hazards of suicidal behaviour and deaths from suicide (age adjusted hazard ratio 1.26, 95% confidence interval 1.20 to 1.32), unintentional overdoses (1.24, 1.19 to 1.28), head/body injuries (1.22, 1.19 to 1.25), and road traffic incidents and offences (1.13, 1.06 to 1.20). Associations with arrests for violent crime were less clear (1.04, 0.98 to 1.11). When the drugs were examined separately, pregabalin was associated with increased hazards of all outcomes, whereas gabapentin was associated with decreased or no statistically significant hazards. When stratifying on age, increased hazards of all outcomes were associated with participants aged 15 to 24 years.

CONCLUSIONS:

This study suggests that gabapentinoids are associated with an increased risk of suicidal behaviour, unintentionaloverdoses, head/body injuries, and road traffic incidents and offences. Pregabalin was associated with higher hazards of these outcomes than gabapentin.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Author/s:

Molero, Y., Larsson H., D'Onofrio B.M., Sharp D.J., Fazel S.