Browsing by Subject "Suicidal ideation"
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Item Correction: Neural correlates of automatic emotion regulation and their association with suicidal ideation in adolescents during the first 90-days of residential care(Springer Nature, 2024-02-19) Dobbertin, Matthew; Blair, Karina S.; Aloi, Joseph; Bajaj, Sahil; Bashford-Largo, Johannah; Mathur, Avantika; Zhang, Ru; Carollo, Erin; Schwartz, Amanda; Elowsky, Jaimie; Ringle, J. L.; Tyler, Patrick; Blair, R. James; Psychiatry, School of MedicineCorrection to: Translational Psychiatry 10.1038/s41398-023-02723-9, published online 23 January 2024 In this article, the affiliation details for Author Sahil Bajaj were incorrectly given as “Department of Cancer Systems Imaging, MD Anderson Center, South Campus Research Bldg, Houston, TX, USA” but should have been “Department of Cancer Systems Imaging, MD Anderson Cancer Center, Houston, TX, USA” The original article has been corrected.Item Defining Suicidal Thought and Behavior Phenotypes for Genetic Studies(medRxiv, 2024-07-29) Monson, Eric T.; Colbert, Sarah M. C.; Andreassen, Ole A.; Ayinde, Olatunde O.; Bejan, Cosmin A.; Ceja, Zuriel; Coon, Hilary; DiBlasi, Emily; Izotova, Anastasia; Kaufman, Erin A.; Koromina, Maria; Myung, Woojae; Nurnberger, John I., Jr.; Serretti, Alessandro; Smoller, Jordan W.; Stein, Murray B.; Zai, Clement C.; Suicide Working Group of the Psychiatric Genomics Consortium; Aslan, Mihaela; Barr, Peter B.; Bigdeli, Tim B.; Harvey, Philip D.; Kimbrel, Nathan A.; Patel, Pujan R.; Cooperative Studies Program (CSP) #572; Ruderfer, Douglas; Docherty, Anna R.; Mullins, Niamh; Mann, J. John; Psychiatry, School of MedicineBackground: Standardized definitions of suicidality phenotypes, including suicidal ideation (SI), attempt (SA), and death (SD) are a critical step towards improving understanding and comparison of results in suicide research. The complexity of suicidality contributes to heterogeneity in phenotype definitions, impeding evaluation of clinical and genetic risk factors across studies and efforts to combine samples within consortia. Here, we present expert and data-supported recommendations for defining suicidality and control phenotypes to facilitate merging current/legacy samples with definition variability and aid future sample creation. Methods: A subgroup of clinician researchers and experts from the Suicide Workgroup of the Psychiatric Genomics Consortium (PGC) reviewed existing PGC definitions for SI, SA, SD, and control groups and generated preliminary consensus guidelines for instrument-derived and international classification of disease (ICD) data. ICD lists were validated in two independent datasets (N = 9,151 and 12,394). Results: Recommendations are provided for evaluated instruments for SA and SI, emphasizing selection of lifetime measures phenotype-specific wording. Recommendations are also provided for defining SI and SD from ICD data. As the SA ICD definition is complex, SA code list recommendations were validated against instrument results with sensitivity (range = 15.4% to 80.6%), specificity (range = 67.6% to 97.4%), and positive predictive values (range = 0.59-0.93) reported. Conclusions: Best-practice guidelines are presented for the use of existing information to define SI/SA/SD in consortia research. These proposed definitions are expected to facilitate more homogeneous data aggregation for genetic and multisite studies. Future research should involve refinement, improved generalizability, and validation in diverse populations.Item Experiences of LGBTQ+ Residents in US General Surgery Training Programs(American Medical Association, 2022) Heiderscheit, Evan A.; Schlick, Cary Jo R.; Ellis, Ryan J.; Cheung, Elaine O.; Irizarry, Dre; Amortegui, Daniela; Eng, Joshua; Sosa, Julie Ann; Hoyt, David B.; Buyske, Jo; Nasca, Thomas J.; Bilimoria, Karl Y.; Hu, Yue-Yung; Surgery, School of MedicineImportance: Previous studies have shown high rates of mistreatment among US general surgery residents, leading to poor well-being. Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) residents represent a high-risk group for mistreatment; however, their experience in general surgery programs is largely unexplored. Objective: To determine the national prevalence of mistreatment and poor well-being for LGBTQ+ surgery residents compared with their non-LGBTQ+ peers. Design, setting, and participants: A voluntary, anonymous survey adapting validated survey instruments was administered to all clinically active general surgery residents training in Accreditation Council for Graduate Medical Education-accredited general surgery programs following the 2019 American Board of Surgery In-Training Examination. Main outcomes and measures: Self-reported mistreatment, sources of mistreatment, perceptions of learning environment, career satisfaction, burnout, thoughts of attrition, and suicidality. The associations between LGBTQ+ status and (1) mistreatment, (2) burnout, (3) thoughts of attrition, and (4) suicidality were examined using multivariable regression models, accounting for interactions between gender and LGBTQ+ identity. Results: A total of 6956 clinically active residents completed the survey (85.6% response rate). Of 6381 respondents included in this analysis, 305 respondents (4.8%) identified as LGBTQ+ and 6076 (95.2%) as non-LGBTQ+. Discrimination was reported among 161 LGBTQ+ respondents (59.2%) vs 2187 non-LGBTQ+ respondents (42.3%; P < .001); sexual harassment, 131 (47.5%) vs 1551 (29.3%; P < .001); and bullying, 220 (74.8%) vs 3730 (66.9%; P = .005); attending surgeons were the most common overall source. Compared with non-LGBTQ+ men, LGBTQ+ residents were more likely to report discrimination (men: odds ratio [OR], 2.57; 95% CI, 1.78-3.72; women: OR, 25.30; 95% CI, 16.51-38.79), sexual harassment (men: OR, 2.04; 95% CI, 1.39-2.99; women: OR, 5.72; 95% CI, 4.09-8.01), and bullying (men: OR, 1.51; 95% CI, 1.07-2.12; women: OR, 2.00; 95% CI, 1.37-2.91). LGBTQ+ residents reported similar perceptions of the learning environment, career satisfaction, and burnout (OR, 1.22; 95% CI, 0.97-1.52) but had more frequent considerations of leaving their program (OR, 2.04; 95% CI, 1.52-2.74) and suicide (OR, 1.95; 95% CI, 1.26-3.04). This increased risk of suicidality was eliminated after adjusting for mistreatment (OR, 1.47; 95% CI, 0.90-2.39). Conclusions and relevance: Mistreatment is a common experience for LGBTQ+ surgery residents, with attending surgeons being the most common overall source. Increased suicidality among LGBTQ+ surgery residents is associated with this mistreatment. Multifaceted interventions are necessary to develop safer and more inclusive learning environments.Item Hope, optimism, and hopelessness : conceptual distinctions and empirical associations with suicidal ideation(2018-12) Shanahan, Mackenzie Lynmarie; Rand, Kevin L.; Hirsh, Adam T.; Stewart, Jesse C.Trait expectancies are related to several aspects of psychological well-being. Specifically, hope, optimism, and hopelessness have been associated with positive and negative indicators of mental health, including suicidality. In addition to empirical similarities, these constructs also have substantial conceptual and measurement overlap. Moreover, while current literature suggests hope and optimism are unique constructs, the distinctions between hopelessness, hope, and optimism remain unclear. The main goals of the present study were: 1) to identify the best structural conceptualization of hope, optimism, and hopelessness; and 2) to apply this conceptualization to examine how different trait expectancies uniquely predict suicidal ideation. Undergraduate students (N= 456) completed a battery of questionnaires at two time points, two months apart. To achieve the first goal, a series of a priori factor models of hope, optimism, and hopelessness was tested using confirmatory factor analysis (CFA). CFA was also performed to confirm the best factor structure of suicidal ideation. Finally, using results from these CFAs, the differential relationships between trait expectancies and suicidal ideation were examined using latent variable path analysis. Results showed that hope, optimism, and hopelessness are best conceptualized as distinct but related constructs. Results also found that both hope and hopelessness predicted increased suicidal ideation over time; whereas, optimism was not predictive of suicidal ideation. Surprisingly, these results suggest that higher hope may be a risk factor for increased suicidal ideation among undergraduates.Item Lithium Treatment in the Prevention of Repeat Suicide-Related Outcomes in Veterans With Major Depression or Bipolar Disorder(American Medical Association, 2022) Katz, Ira R.; Rogers, Malcolm P.; Lew, Robert; Thwin, Soe Soe; Doros, Gheorghe; Ahearn, Eileen; Ostacher, Michael J.; DeLisi, Lynn E.; Smith, Eric G.; Ringer, Robert J.; Ferguson, Ryan; Hoffman, Brian; Kaufman, James S.; Paik, Julie M.; Conrad, Chester H.; Holmberg, Erika F.; Boney, Tamara Y.; Huang, Grant D.; Liang, Matthew H.; Li+ plus Investigators; Psychiatry, School of MedicineImportance: Suicide and suicide attempts are persistent and increasing public health problems. Observational studies and meta-analyses of randomized clinical trials have suggested that lithium may prevent suicide in patients with bipolar disorder or depression. Objective: To assess whether lithium augmentation of usual care reduces the rate of repeated episodes of suicide-related events (repeated suicide attempts, interrupted attempts, hospitalizations to prevent suicide, and deaths from suicide) in participants with bipolar disorder or depression who have survived a recent event. Design, setting, and participants: This double-blind, placebo-controlled randomized clinical trial assessed lithium vs placebo augmentation of usual care in veterans with bipolar disorder or depression who had survived a recent suicide-related event. Veterans at 29 VA medical centers who had an episode of suicidal behavior or an inpatient admission to prevent suicide within 6 months were screened between July 1, 2015, and March 31, 2019. Interventions: Participants were randomized to receive extended-release lithium carbonate beginning at 600 mg/d or placebo. Main outcomes and measures: Time to the first repeated suicide-related event, including suicide attempts, interrupted attempts, hospitalizations specifically to prevent suicide, and deaths from suicide. Results: The trial was stopped for futility after 519 veterans (mean [SD] age, 42.8 [12.4] years; 437 [84.2%] male) were randomized: 255 to lithium and 264 to placebo. Mean lithium concentrations at 3 months were 0.54 mEq/L for patients with bipolar disorder and 0.46 mEq/L for patients with major depressive disorder. No overall difference in repeated suicide-related events between treatments was found (hazard ratio, 1.10; 95% CI, 0.77-1.55). No unanticipated safety concerns were observed. A total of 127 participants (24.5%) had suicide-related outcomes: 65 in the lithium group and 62 in the placebo group. One death occurred in the lithium group and 3 in the placebo group. Conclusions and relevance: In this randomized clinical trial, the addition of lithium to usual Veterans Affairs mental health care did not reduce the incidence of suicide-related events in veterans with major depression or bipolar disorders who experienced a recent suicide event. Therefore, simply adding lithium to existing medication regimens is unlikely to be effective for preventing a broad range of suicide-related events in patients who are actively being treated for mood disorders and substantial comorbidities.Item Moderators of the association between depressive, manic, and mixed mood symptoms and suicidal ideation and behavior: An analysis of the National Network of Depression Centers Mood Outcomes Program(Elsevier, 2021) Fiedorowicz, Jess G.; Persons, Jane E.; Assari, Shervin; Ostacher, Michael J.; Goes, Fernando S.; Nurnberger, John I.; Coryell, William H.; Psychiatry, School of MedicineBackground: It has not been established that suicide risk with mixed symptoms is any greater than the depressive component or if there is synergy between depressive and manic symptoms in conveying suicide risk. Methods: The National Network of Depression Centers Mood Outcomes Program collected data from measurement-based care for 17,179 visits from 6,105 unique individuals with clinically diagnosed mood disorders (998 bipolar disorder, 5,117 major depression). The Patient Health Questionaire-8 (PHQ-8) captured depressive symptoms and the Altman Self-Rating Mania scale (ASRM) measured hypomanic/manic symptoms. Generalized linear mixed models assessed associations between depressive symptoms, manic symptoms, and their interaction (to test for synergistic effects of mixed symptoms) on the primary outcome of suicidal ideation or behavior (secondarily suicidal behavior only) from the Columbia-Suicide Severity Rating Scale (C-SSRS). Moderation was assessed. Results: PHQ-8 scores were strongly associated with suicide-related outcomes across diagnoses. ASRM scores showed no association with suicidal ideation/behavior in bipolar disorder and an inverse association in major depression. There was no evidence of synergy between depressive and manic symptoms. There was no moderation by sex, race, or mood disorder polarity. Those over 55 years of age showed a protective effect of manic symptoms, which was lost when depressive symptoms were also present (mixed symptoms). Discussion: Mixed depressive and manic symptoms convey no excess risk of suicidal ideation or behavior beyond the risk conveyed by the depressive symptoms alone. Depressive symptoms are strongly linked to suicidal ideation and suicidal behavior and represent an important and potentially modifiable risk factor for suicide.Item National Evaluation of Surgical Resident Grit and the Association With Wellness Outcomes(American Medical Association, 2021) Hewitt, D. Brock; Chung, Jeanette W.; Ellis, Ryan J.; Cheung, Elaine O.; Moskowitz, Judith T.; Hu, Yue-Yung; Etkin, Caryn D.; Nussbaum, Michael S.; Choi, Jennifer N.; Greenberg, Caprice C.; Bilimoria, Karl Y.; Surgery, School of MedicineImportance: Grit, defined as perseverance and passion for long-term goals, is predictive of success and performance even among high-achieving individuals. Previous studies examining the effect of grit on attrition and wellness during surgical residency are limited by low response rates or single-institution analyses. Objectives: To characterize grit among US general surgery residents and examine the association between resident grit and wellness outcomes. Design, setting, and participants: A cross-sectional national survey study of 7464 clinically active general surgery residents in the US was administered in conjunction with the 2018 American Board of Surgery In-Training Examination and assessed grit, burnout, thoughts of attrition, and suicidal thoughts during the previous year. Multivariable logistic regression models were constructed to assess the association of grit with resident burnout, thoughts of attrition, and suicidal thoughts. Statistical analyses were performed from June 1 to August 15, 2019. Exposures: Grit was measured using the 8-item Short Grit Scale (scores range from 1 [not at all gritty] to 5 [extremely gritty]). Main outcomes and measures: The primary outcome was burnout. Secondary outcomes were thoughts of attrition and suicidal thoughts within the past year. Results: Among 7464 residents (7413 [99.3%] responded; 4469 men [60.2%]) from 262 general surgery residency programs, individual grit scores ranged from 1.13 to 5.00 points (mean [SD], 3.69 [0.58] points). Mean (SD) grit scores were significantly higher in women (3.72 [0.56] points), in residents in postgraduate training year 4 or 5 (3.72 [0.58] points), and in residents who were married (3.72 [0.57] points; all P ≤ .001), although the absolute magnitude of the differences was small. In adjusted analyses, residents with higher grit scores were significantly less likely to report duty hour violations (odds ratio [OR], 0.85; 95% CI, 0.77-0.93), dissatisfaction with becoming a surgeon (OR, 0.53; 95% CI, 0.48-0.59), burnout (OR, 0.53; 95% CI, 0.49-0.58), thoughts of attrition (OR, 0.61; 95% CI, 0.55-0.67), and suicidal thoughts (OR, 0.58; 95% CI, 0.47-0.71). Grit scores were not associated with American Board of Surgery In-Training Examination performance. For individual residency programs, mean program-level grit scores ranged from 3.18 to 4.09 points (mean [SD], 3.69 [0.13] points). Conclusions and relevance: In this national survey evaluation, higher grit scores were associated with a lower likelihood of burnout, thoughts of attrition, and suicidal thoughts among general surgery residents. Given that surgical resident grit scores are generally high and much remains unknown about how to employ grit measurement, grit is likely not an effective screening instrument to select residents; instead, institutions should ensure an organizational culture that promotes and supports trainees across this elevated range of grit scores.Item Neural correlates of automatic emotion regulation and their association with suicidal ideation in adolescents during the first 90-days of residential care(Springer Nature, 2024-01-23) Dobbertin, Matthew; Blair, Karina S.; Aloi, Joseph; Bajaj, Sahil; Bashford-Largo, Johannah; Mathur, Avantika; Zhang, Ru; Carollo, Erin; Schwartz, Amanda; Elowsky, Jaimie; Ringle, J. L.; Tyler, Patrick; Blair, R. James; Psychiatry, School of MedicineBackground: Suicide is the second leading cause of death for adolescents in the United States. However, relatively little is known about the forms of atypical neuro-cognitive function that are correlates of suicidal ideation (SI). One form of cognitive/affective function that, when dysfunctional, is associated with SI is emotion regulation. However, very little work has investigated the neural correlates of emotion dysregulation in adolescents with SI. Methods: Participants (N = 111 aged 12-18, 32 females, 31 [27.9%] reporting SI) were recruited shortly after their arrival at a residential care facility where they had been referred for behavioral and mental health problems. Daily reports of SI were collected during the participants' first 90-days in residential care. Participants were presented with a task-fMRI measure of emotion regulation - the Affective Number Stroop task shortly after recruitment. Participants were divided into two groups matched for age, sex and IQ based on whether they demonstrated SI. Results: Participants who demonstrated SI showed increased recruitment of regions including dorsomedial prefrontal cortex/supplemental motor area and parietal cortex during task (congruent and incongruent) relative to view trials in the context of emotional relative to neutral distracters. Conclusions: Participants with SI showed increased recruitment of regions implicated in executive control during the performance of a task indexing automatic emotion regulation. Such data might suggest a relative inefficiency in the recruitment of these regions in individuals with SI.Item Next-generation precision medicine for suicidality prevention(Springer Nature, 2024-09-06) Bhagar, R.; Gill, S. S.; Le-Niculescu, H.; Yin, C.; Roseberry, K.; Mullen, J.; Schmitz, M.; Paul, E.; Cooke, J.; Tracy, C.; Tracy, Z.; Gettelfinger, A. S.; Battles, D.; Yard, M.; Sandusky, G.; Shekhar, A.; Kurian, S. M.; Bogdan, P.; Niculescu, A. B.; Psychiatry, School of MedicineSuicidality remains a clear and present danger in society in general, and for mental health patients in particular. Lack of widespread use of objective and/or quantitative information has hampered treatment and prevention efforts. Suicidality is a spectrum of severity from vague thoughts that life is not worth living, to ideation, plans, attempts, and completion. Blood biomarkers that track suicidality risk provide a window into the biology of suicidality, as well as could help with assessment and treatment. Previous studies by us were positive. Here we describe new studies we conducted transdiagnostically in psychiatric patients, starting with the whole genome, to expand the identification, prioritization, validation and testing of blood gene expression biomarkers for suicidality, using a multiple independent cohorts design. We found new as well as previously known biomarkers that were predictive of high suicidality states, and of future psychiatric hospitalizations related to them, using cross-sectional and longitudinal approaches. The overall top increased in expression biomarker was SLC6A4, the serotonin transporter. The top decreased biomarker was TINF2, a gene whose mutations result in very short telomeres. The top biological pathways were related to apoptosis. The top upstream regulator was prednisolone. Taken together, our data supports the possibility that biologically, suicidality is an extreme stress-driven form of active aging/death. Consistent with that, the top subtypes of suicidality identified by us just based on clinical measures had high stress and high anxiety. Top therapeutic matches overall were lithium, clozapine and ketamine, with lithium stronger in females and clozapine stronger in males. Drug repurposing bioinformatic analyses identified the potential of renin-angiotensin system modulators and of cyclooxygenase inhibitors. Additionally, we show how patient reports for doctors would look based on blood biomarkers testing, personalized by gender. We also integrated with the blood biomarker testing social determinants and psychological measures (CFI-S, suicidal ideation), showing synergy. Lastly, we compared that to machine learning approaches, to optimize predictive ability and identify key features. We propose that our findings and comprehensive approach can have transformative clinical utility.Item Non-suicidal Self-Injury, Suicidal Behaviors, and Mental Health Symptoms among Sexual Minority Youth with Juvenile Justice System Involvement(Elsevier, 2023) Vieira, Alyssa; Sheerin, Kaitlin M.; Williamson-Butler, Shannon; Pederson, Casey A.; Thompson, Elizabeth C.; Soriano, Sheiry; Wolff, Jennifer C.; Spirito, Anthony; Kemp, Kathleen; Pediatrics, School of MedicineSexual minority youth have long remained an understudied population within the juvenile justice system, despite emerging evidence suggesting that sexual minority youth are overrepresented. Recent literature indicates that system-involved sexual minority youth may have more behavioral health concerns than their heterosexual counterparts. Even so, more work is needed to elucidate the unique needs of sexual minority youth who become involved in the system, especially as it pertains to suicidal behaviors and non-suicidal self-injury (NSSI). The present study provided a descriptive evaluation of the prevalence of sexual minority youth making early system contact and their mental health concerns. Of the 218 justice-involved youth from a Northeastern family court in the sample, over a quarter identified as a sexual minority (n = 58). Our findings indicated that these youth evidenced significantly higher scores on a mental health screener compared to their heterosexual counterparts, evidencing greater symptomology on scales indicative of depression/anxiety, thought disturbance, etc. Further, sexual minority youth reported higher rates of lifetime, past year, and past month NSSI as well as lifetime and past year suicide attempts. These findings highlight the need to support the well-being of sexual minority youth in the juvenile justice system by screening for and addressing their mental health needs in this unique setting.