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Developmental timing of suicide attempts and cardiovascular risk during young adulthood.

ABSTRACT: OBJECTIVE:Self-control/self-regulation has received increased attention in health research. Suicide attempts index severe dysregulation in emotional, behavioral, and/or physiological domains. The current study tested whether own and/or others' suicide attempts during the early life course predicted cardiovascular risk by young adulthood and whether developmental timing of suicide attempts, sex of the person, and source of suicide attempts exposure modified these associations. METHOD:Data came from the National Longitudinal Study of Adolescent to Adult Health (Add Health). At each assessment during Waves I-IV (covering approximately ages 12-32 years), participants reported whether they and/or a friend/family member had attempted suicide. At Wave IV, trained interviewers assessed participants' obesity and hypertension and collected bloodspots from which high-sensitivity C-reactive protein (hs-CRP) was assayed. Sample sizes in the present analyses ranged from n = 7,884 to n = 8,474. RESULTS:Exposure to own and others' suicide attempts during adolescence was relatively common. In males, suicide attempts during adolescence (?age 15 years) were associated with hypertension and elevated inflammation more than 1 decade later. Associations among suicide attempts by others and cardiovascular risk also emerged. CONCLUSIONS:Exposure to one's own or others' severe dysregulation in the form of suicide attempts during the early life course signals risk for cardiovascular health problems by the late twenties. Adolescent males who attempted suicide and individuals exposed to suicide attempts in their social network may benefit from a dual focus on mental and physical health in care. (PsycINFO Database Record

SUBMITTER: Shanahan L

PROVIDER: S-EPMC5033671 | biostudies-literature | 2016 Oct

REPOSITORIES: biostudies-literature

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Developmental timing of suicide attempts and cardiovascular risk during young adulthood.

Shanahan Lilly L Schorpp Kristen M KM Volpe Vanessa V VV Linthicum Kathryn K Freeman Jason A JA

Health psychology : official journal of the Division of Health Psychology, American Psychological Association 20160606 10

<h4>Objective</h4>Self-control/self-regulation has received increased attention in health research. Suicide attempts index severe dysregulation in emotional, behavioral, and/or physiological domains. The current study tested whether own and/or others' suicide attempts during the early life course predicted cardiovascular risk by young adulthood and whether developmental timing of suicide attempts, sex of the person, and source of suicide attempts exposure modified these associations.<h4>Method</ ...[more]

PMID: 27266578

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Project description:IMPORTANCE:Suicide attempts in the US Army have risen in the past decade. Understanding the association between suicide attempts and deployment, as well as method and timing of suicide attempts, can assist in developing interventions. OBJECTIVE:To examine suicide attempt risk factors, methods, and timing among soldiers currently deployed, previously deployed, and never deployed at the time this study was conducted. DESIGN, SETTING, AND PARTICIPANTS:This longitudinal, retrospective cohort study of Regular Army-enlisted soldiers on active duty from 2004 through 2009 used individual-level person-month records to examine risk factors (sociodemographic, service related, and mental health), method, and time of suicide attempt by deployment status (never, currently, and previously deployed). Administrative data for the month before each of 9650 incident suicide attempts and an equal-probability sample of 153?528 control person-months for other soldiers were analyzed using a discrete-time survival framework. MAIN OUTCOMES AND MEASURES:Suicide attempts and career, mental health, and demographic predictors were obtained from administrative and medical records. RESULTS:Of the 9650 enlisted soldiers who attempted suicide, 86.3% were male, 68.4% were younger than 30 years, 59.8% were non-Hispanic white, 76.5% were high school educated, and 54.7% were currently married. The 40.4% of enlisted soldiers who had never been deployed (n?=?12?421?294 person-months) accounted for 61.1% of enlisted soldiers who attempted suicide (n?=?5894 cases). Risk among those never deployed was highest in the second month of service (103 per 100?000 person-months). Risk among soldiers on their first deployment was highest in the sixth month of deployment (25 per 100?000 person-months). For those previously deployed, risk was highest at 5 months after return (40 per 100?000 person-months). Currently and previously deployed soldiers were more likely to attempt suicide with a firearm than those never deployed (currently deployed: OR, 4.0; 95% CI, 2.9-5.6; previously deployed: OR, 2.7; 95% CI, 1.8-3.9). Across deployment status, suicide attempts were more likely among soldiers who were women (currently deployed: OR, 3.4; 95% CI, 3.0-4.0; previously deployed: OR, 1.5; 95% CI, 1.4-1.7; and never deployed: OR, 2.4; 95% CI, 2.3-2.6), in their first 2 years of service (currently deployed: OR, 1.9; 95% CI, 1.5-2.3; previously deployed: OR, 2.2; 95% CI, 1.9-2.7; and never deployed: OR, 3.1; 95% CI, 2.7-3.6), and had a recently received a mental health diagnosis in the previous month (currently deployed: OR, 29.8; 95% CI, 25.0-35.5; previously deployed: OR, 22.2; 95% CI, 20.1-24.4; and never deployed: OR, 15.0; 95% CI, 14.2-16.0). Among soldiers with 1 previous deployment, odds of a suicide attempt were higher for those who screened positive for depression or posttraumatic stress disorder after return from deployment and particularly at follow-up screening, about 4 to 6 months after deployment (depression: OR, 1.4; 95% CI, 1.1-1.9; posttraumatic stress disorder: OR, 2.4; 95% CI, 2.1-2.8). CONCLUSIONS AND RELEVANCE:Identifying the timing and risk factors for suicide attempt in soldiers requires consideration of environmental context, individual characteristics, and mental health. These factors can inform prevention efforts.

Project description:ImportancePatients with attention-deficit/hyperactivity disorder (ADHD) are at an increased risk of attempting suicide. Stimulants, such as methylphenidate hydrochloride, are the most common treatment for ADHD, but the association between their therapeutic use and suicide is unclear.ObjectiveTo investigate the association between methylphenidate and the risk of suicide attempts.Design, setting, and participantsA population-based, electronic medical records database from the Hong Kong Clinical Data Analysis & Reporting System was used to identify 25 629 individuals aged 6 to 25 years who were treated with methylphenidate between January 1, 2001, and December 31, 2015. Those who had attempted suicide were included in the analysis. A self-controlled case series design was used to control for time-invariant characteristics of the patients.Main outcomes and measuresRelative incidence of suicide attempt during periods when patients were exposed to methylphenidate compared with nonexposed periods.ResultsAmong 25 629 patients with methylphenidate prescriptions, 154 had their first recorded suicide attempt within the study period; of these individuals, 111 (72.1%) were male; mean (SD) age at baseline was 7.15 (2.19) years. The overall incidence of suicide attempts during methylphenidate treatment was 9.27 per 10 000 patient-years. An increased risk of suicide attempts was detected during the 90-day period before methylphenidate was initiated, with an incidence rate ratio (IRR) of 6.55 (95% CI, 3.37-12.72). The IRR remained elevated during the first 90 days of treatment (IRR, 3.91; 95% CI, 1.62-9.42) before returning to baseline levels during ongoing treatment (IRR, 1.35; 95% CI, 0.77-2.38). When the risk during the first 90 days of treatment was compared with the 90 days preceding first treatment, the incidence of suicide attempts was not elevated (IRR, 0.78; 95% CI, 0.26-2.35).Conclusions and relevanceThe incidence of suicide attempts was higher in the period immediately before the start of methylphenidate treatment. The risk remained elevated immediately after the start of methylphenidate treatment and returned to baseline levels during continuation of methylphenidate treatment. The observed higher risk of suicide attempts before treatment may reflect emerging psychiatric symptoms that trigger medical consultations that result in a decision to begin ADHD treatment. Therefore, this study's results do not support a causal association between methylphenidate treatment and suicide attempts.

Project description:ObjectivePatients with fibromyalgia (FM) are 10 times more likely to die by suicide than the general population. The purpose of this study was to externally validate published models predicting suicidal ideation and suicide attempts in patients with FM and to identify interpretable risk and protective factors for suicidality unique to FM.MethodsThis was a case-control study of large-scale electronic health record data collected from 1998 to 2017, identifying FM cases with validated Phenotype KnowledgeBase criteria. Model performance was measured through discrimination, including the receiver operating area under the curve (AUC), sensitivity, and specificity, and through calibration, including calibration plots. Risk factors were selected by L1 penalized regression with bootstrapping for both outcomes. Secondary utilization analyses converted time-based billing codes to equivalent minutes to estimate face-to-face provider contact.ResultsWe identified 8,879 patients with FM, with 34 known suicide attempts and 96 documented cases of suicidal ideation. External validity was good for both suicidal ideation (AUC 0.80) and attempts (AUC 0.82) with excellent calibration. Risk factors specific to suicidal ideation included polysomatic symptoms such as fatigue (odds ratio [OR] 1.29 [95% confidence interval (95% CI) 1.25-1.32]), dizziness (OR 1.25 [95% CI 1.22-1.28]), and weakness (OR 1.17 [95% CI 1.15-1.19]). Risk factors specific to suicide attempt included obesity (OR 1.18 [95% CI 1.10-1.27]) and drug dependence (OR 1.15 [95% CI 1.12-1.18]). Per utilization analyses, those patients with FM and no suicidal ideation spent 3.5 times more time in follow-up annually, and those without documented suicide attempts spent more than 40 times more time face-to-face with providers annually.ConclusionThis is the first study to successfully apply machine learning to reliably detect suicidality in patients with FM, identifying novel risk factors for suicidality and highlighting outpatient engagement as a protective factor against suicide.

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Developmental timing of suicide attempts and cardiovascular risk during young adulthood.

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Developmental timing of suicide attempts and cardiovascular risk during young adulthood.

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