Browsing by Subject "Suicide"
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Item Adolescent suicide assessment and management in primary care(BMC, 2022-07-02) Aalsma, M.; Keys, J.; Ferrin, S.; Shan, M.; Garbuz, T.; Scott, T.; Adams, Z.; Hulvershorn, L.; Downs, S.; Pediatrics, School of MedicineBackground: 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.Item Adverse Childhood Experiences (ACEs) and Their Impact on Substance Misuse & Overall Health(The Center for Health Policy, 2018-03-01) Balio, Casey; Greene, Marion S.Adverse childhood experiences (ACEs) encompass a wide variety of distressing events, including emotional, physical, or sexual abuse; witnessing maternal domestic violence; or living with a household member who has a substance use disorder, is mentally ill or suicidal, or is currently or was ever incarcerated during the first 18 years of a child’s life. According to most recent estimates, nearly half of Indiana’s youth have experienced at least one ACE in their life. ACEs are linked to many risk behaviors, including substance use, which can adversely affect health outcomes.Item Art Therapy with the LGBTQ Community(2018) Wiggins, Meaghan; Misluk, EileenThe Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) community is a population that has faced discrimination for many years. There has been a shift in attitudes towards this community following the rise of the 45thpresidential administration. Noteworthy events that have impacted this community are briefly explored, to provide context for what these individuals have and continue to face in this society. This ranges from when homosexuality was defined as a mental disorder, to the present military travel ban on transgender individuals. As this discussion continues, the issue of increased mortality rates of individuals that identify as LGBTQ is explored, connecting to the impact of historical and current events. The importance of identity to this community is briefly discussed, specifically sexuality and gender, stressing the impact these events have. Additionally, there is a brief overview of important terminology that is explained and defined for the reader, to provide a comprehensive understanding of LGBTQ identities and the community. Art therapy is one treatment approach that can serve this community.The intention of this scoping review is to identify what is in best practice in art therapy to service this community. The results of the study compiles art therapy and psychotherapeutic approaches and reports on what is found to best serve this population.Item Assessing Risk of Future Suicidality in Emergency Department Patients(Wiley, 2020-04-02) Brucker, Krista; Duggan, Carter; Niezer, Joseph; Roseberry, Kyle; Le-Niculescu, Helen; Niculescu, Alexander B.; Kline, Jeffrey A.; Emergency Medicine, School of MedicineBackground. Emergency Departments (ED) are the first line of evaluation for patients at risk and in crisis, with or without overt suicidality (ideation, attempts). Currently employed triage and assessments methods miss some of the individuals who subsequently become suicidal. The Convergent Functional Information for Suicidality (CFI-S) 22 item checklist of risk factors, that does not ask directly about suicidal ideation, has demonstrated good predictive ability for suicidality in previous studies in psychiatric outpatients, but has not been tested in the real world-setting of emergency departments (EDs). Methods. We administered CFI-S prospectively to a convenience sample of consecutive ED patients. Median administration time was 3 minutes. Patients were also asked at triage about suicidal thoughts or intentions per standard ED suicide clinical screening (SCS), and the treating ED physician was asked to fill a physician gestalt visual analog scale (VAS) for likelihood of future suicidality spectrum events (SSE) (ideation, preparatory acts, attempts, completed suicide). We performed structured chart review and telephone follow-up at 6 months post index visit. Results. The median time to complete the CFI-S was three minutes (1st to 3rd quartile 3–6 minutes). Of the 338 patients enrolled, 45 (13.3%) were positive on the initial SCS, and 32 (9.5%) experienced a SSE in the 6 months follow-up. Overall, across genders, SCS had a modest diagnostic discrimination for future SSE (ROC AUC 0.63,). The physician VAS was better (AUC 0.76 CI 0.66–0.85), and the CFI-S was slightly higher (AUC 0.81, CI 0.76–0.87). The top CFI-S differentiating items were psychiatric illness, perceived uselessness, and social isolation. The top CFI-S items were family history of suicide, age, and past history of suicidal acts. Conclusions. Using CFI-S, or some of its items, in busy EDs may help improve the detection of patients at high risk for future suicidality.Item Associations between Suicidal Thoughts and Behaviors and Genetic Liability for Cognitive Performance, Depression, and Risk-Taking in a High-Risk Sample(Karger, 2021) Johnson, Emma C.; Aliev, Fazil; Meyers, Jacquelyn L.; Salvatore, Jessica E.; Tillman, Rebecca; Chang, Yoonhoo; Docherty, Anna R.; Bogdan, Ryan; Acion, Laura; Chan, Grace; Chorlian, David B.; Kamarajan, Chella; Kuperman, Samuel; Pandey, Ashwini; Plawecki, Martin H.; Schuckit, Marc; Tischfield, Jay; Edenberg, Howard J.; Bucholz, Kathleen K.; Nurnberger, John I.; Porjesz, Bernice; Hesselbrock, Victor; Dick, Danielle M.; Kramer, John R.; Agrawal, Arpana; Psychiatry, School of MedicineBackground: Suicidal thoughts and behaviors (STBs) and nonsuicidal self-injury (NSSI) behaviors are moderately heritable and may reflect an underlying predisposition to depression, impulsivity, and cognitive vulnerabilities to varying degrees. Objectives: We aimed to estimate the degrees of association between genetic liability to depression, impulsivity, and cognitive performance and STBs and NSSI in a high-risk sample. Methods: We used data on 7,482 individuals of European ancestry and 3,359 individuals of African ancestry from the Collaborative Study on the Genetics of Alcoholism to examine the links between polygenic scores (PGSs) for depression, impulsivity/risk-taking, and cognitive performance with 3 self-reported indices of STBs (suicidal ideation, persistent suicidal ideation defined as ideation occurring on at least 7 consecutive days, and suicide attempt) and with NSSI. Results: The PGS for depression was significantly associated with all 4 primary self-harm measures, explaining 0.6-2.5% of the variance. The PGS for risk-taking behaviors was also associated with all 4 self-harm behaviors in baseline models, but was no longer associated after controlling for a lifetime measure of DSM-IV alcohol dependence and abuse symptom counts. Polygenic predisposition for cognitive performance was negatively associated with suicide attempts (q = 3.8e-4) but was not significantly associated with suicidal ideation nor NSSI. We did not find any significant associations in the African ancestry subset, likely due to smaller sample sizes. Conclusions: Our results encourage the study of STB as transdiagnostic outcomes that show genetic overlap with a range of risk factors.Item Burnout, Drop Out, Suicide: Physician Loss in Emergency Medicine, Part I.(University of California, 2019-05) Stehman, Christine R.; Testo, Zachary; Gershaw, Rachel S.; Kellogg, Adam R.; Emergency Medicine, School of MedicineEach year more than 400 physicians take their lives, likely related to increasing depression and burnout. Burnout-a psychological syndrome featuring emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment-is a disturbingly and increasingly prevalent phenomenon in healthcare, and emergency medicine (EM) in particular. As self-care based solutions have proven unsuccessful, more system-based causes, beyond the control of the individual physicians, have been identified. Such system-based causes include limitations of the electronic health record, long work hours and substantial educational debt, all in a culture of "no mistakes allowed." Blame and isolation in the face of medical errors and poor outcomes may lead to physician emotional injury, the so-called "second victim" syndrome, which is both a contributor to and consequence of burnout. In addition, emergency physicians (EP) are also particularly affected by the intensity of clinical practice, the higher risk of litigation, and the chronic fatigue of circadian rhythm disruption. Burnout has widespread consequences, including poor quality of care, increased medical errors, patient and provider dissatisfaction, and attrition from medical practice, exacerbating the shortage and maldistribution of EPs. Burned-out physicians are unlikely to seek professional treatment and may attempt to deal with substance abuse, depression and suicidal thoughts alone. This paper reviews the scope of burnout, contributors, and consequences both for medicine in general and for EM in particular.Item Computer adaptive testing to assess impairing behavioral health problems in emergency department patients with somatic complaints(Wiley, 2022-09-22) O’Reilly, Lauren M.; Dalal, Azhar I.; Maag, Serena; Perry, Matthew T.; Card, Alex; Bohrer, Max B.; Hamersly, Jackson; Nader, Setarah Mohammad; Peterson, Kelli; Beiser, David G.; Gibbons, Robert D.; D’Onofrio, Brian M.; Musey, Paul I.; Emergency Medicine, School of MedicineObjectives: To assess: (1) the prevalence of mental health and substance use in patients presenting to the emergency department (ED) through use of a computer adaptive test (CAT-MH), (2) the correlation among CAT-MH scores and self- and clinician-reported assessments, and (3) the association between CAT-MH scores and ED utilization in the year prior and 30 days after enrollment. Methods: This was a single-center observational study of adult patients presenting to the ED for somatic complaints (97%) from May 2019 to March 2020. The main outcomes were computer-adaptive-assessed domains of suicidality, depression, anxiety, post-traumatic stress disorder (PTSD), and substance use. We conducted Pearson correlations and logistic regression for objectives 2 and 3, respectively. Results: From a sample of 794 patients, the proportion of those at moderate/severe risk was: 24.1% (suicidality), 8.3% (depression), 16.5% (anxiety), 12.3% (PTSD), and 20.4% (substance use). CAT-MH domains were highly correlated with self-report assessments (r = 0.49-0.79). Individuals who had 2 or more ED visits in the prior year had 62% increased odds of being in the intermediate-high suicide risk category (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.07-2.44) compared to those with zero prior ED visits. Individuals who scored in the intermediate-high-suicide risk group had 63% greater odds of an ED visit within 30 days after enrollment compared to those who scored as low risk (OR, 1.63; 95% CI, 1.09, 2.44). Conclusion: The CAT-MH documented that a considerable proportion of ED patients presenting for somatic problems had mental health conditions, even if mild. Mental health problems were also associated with ED utilization.Item Construction of a Database for Socio-Demographic, Medico-Legal, Anatomic, and Genomic Research into Suicide(Office of the Vice Chancellor for Research, 2015-04-17) Engle, Kaitlyn; Cook, Shannon; Levey, Daniel; Ballew, Alfarena; Yard, MichaelSuicide is a potentially preventable tragedy. Over 180 cases of suicide a year occur in Marion County. We have created a database that permits integration of socio-demographic data, medico-legal information, anatomic images, and genomic results. We have collected over 50 cases to date. We will show results of analyses looking at method of suicide, toxicology results, and genomic biomarker correlates. It is hoped that this resource would permit the study of risk factors and the creation of predictive algorithms that may better identify people at risk, and lead to early intervention and prevention efforts.Item Correlates of suicide risk among Black and White adults with behavioral health disorders in criminal-legal systems(Springer Nature, 2022-03-04) Lawson, Spencer G.; Lowder, Evan M.; Ray, Bradley; School of Public and Environmental AffairsBackground: Adults with behavioral health disorders in criminal-legal systems are at heightened risk of suicide relative to the general population. Despite documented racial disparities in criminal processing and behavioral health treatment, few studies have examined racial differences in suicide risk in this already high-risk population. This study examined 1) the correlates of suicide risk in this population overall and by race and 2) the moderating role of race in these associations. Methods: We investigated correlates of clinician-rated suicide risk at baseline in a statewide sample of 2,827 Black and 14,022 White adults with criminal-legal involvement who engaged in community-based behavioral health treatment. Regression-based approaches were used to model suicide risk and test for evidence of interaction effects. Results: Findings showed the strongest correlates of suicide risk were greater behavioral health needs, evidence of self-harm, and a primary mental health diagnosis or co-occurring diagnosis. In race-specific analyses, correlates of suicide risk were mostly similar for both Black and White clients, with a couple exceptions. Interaction terms testing between-group effects on correlates of suicide risk were non-significant. Conclusions: Adults with behavioral health disorders in criminal-legal systems experience similar risk factors for suicide as the general population. Similar to prior research, we found that Black adults, in particular, are at lower risk for suicide overall. Contrary to expectations, we found similarities in correlates of suicide risk across race in our sample of felony-level adults with behavioral health disorders in the criminal-legal system. Prior research shows that behavioral health professionals should be cognizant of cultural factors when developing a comprehensive approach to suicide care and treatment. Our findings show correlates of suicide risk are largely stable in Black and White adults involved in criminal-legal systems, suggesting culturally responsive treatment for suicide risk should target shared risk factors.Item Discovery and validation of blood biomarkers for suicidality(Springer Nature, 2013) Le-Niculescu, H.; Levey, D. F.; Ayalew, M.; Palmer, L.; Gavrin, L. M.; Jain, N.; Winiger, E.; Bhosrekar, S.; Shankar, G.; Radel, M.; Bellanger, E.; Duckworth, H.; Olesek, K.; Vergo, J.; Schweitzer, R.; Yard, M.; Ballew, A.; Shekhar, A.; Sandusky, G. E.; Schork, N. J.; Kurian, S. M.; Salomon, D. R.; Niculescu, A. B., III; Psychiatry, School of MedicineSuicides are a leading cause of death in psychiatric patients, and in society at large. Developing more quantitative and objective ways (biomarkers) for predicting and tracking suicidal states would have immediate practical applications and positive societal implications. We undertook such an endeavor. First, building on our previous blood biomarker work in mood disorders and psychosis, we decided to identify blood gene expression biomarkers for suicidality, looking at differential expression of genes in the blood of subjects with a major mood disorder (bipolar disorder), a high-risk population prone to suicidality. We compared no suicidal ideation (SI) states and high SI states using a powerful intrasubject design, as well as an intersubject case-case design, to generate a list of differentially expressed genes. Second, we used a comprehensive Convergent Functional Genomics (CFG) approach to identify and prioritize from the list of differentially expressed gene biomarkers of relevance to suicidality. CFG integrates multiple independent lines of evidence-genetic and functional genomic data-as a Bayesian strategy for identifying and prioritizing findings, reducing the false-positives and false-negatives inherent in each individual approach. Third, we examined whether expression levels of the blood biomarkers identified by us in the live bipolar subject cohort are actually altered in the blood in an age-matched cohort of suicide completers collected from the coroner's office, and report that 13 out of the 41 top CFG scoring biomarkers (32%) show step-wise significant change from no SI to high SI states, and then to the suicide completers group. Six out of them (15%) remained significant after strict Bonferroni correction for multiple comparisons. Fourth, we show that the blood levels of SAT1 (spermidine/spermine N1-acetyltransferase 1), the top biomarker identified by us, at the time of testing for this study, differentiated future as well as past hospitalizations with suicidality, in a live cohort of bipolar disorder subjects, and exhibited a similar but weaker pattern in a live cohort of psychosis (schizophrenia/schizoaffective disorder) subjects. Three other (phosphatase and tensin homolog (PTEN), myristoylated alanine-rich protein kinase C substrate (MARCKS), and mitogen-activated protein kinase kinase kinase 3 (MAP3K3)) of the six biomarkers that survived Bonferroni correction showed similar but weaker effects. Taken together, the prospective and retrospective hospitalization data suggests SAT1, PTEN, MARCKS and MAP3K3 might be not only state biomarkers but trait biomarkers as well. Fifth, we show how a multi-dimensional approach using SAT1 blood expression levels and two simple visual-analog scales for anxiety and mood enhances predictions of future hospitalizations for suicidality in the bipolar cohort (receiver-operating characteristic curve with area under the curve of 0.813). Of note, this simple approach does not directly ask about SI, which some individuals may deny or choose not to share with clinicians. Lastly, we conducted bioinformatic analyses to identify biological pathways, mechanisms and medication targets. Overall, suicidality may be underlined, at least in part, by biological mechanisms related to stress, inflammation and apoptosis.