Depression is often accompanied by thoughts of self-harm, which are a strong predictor of subsequent suicide attempt and suicide death. Few empirical data are available regarding the temporal ...correlation between depression symptoms and suicidal ideation. We investigated the anecdotal concern that suicidal ideation may increase during a period of depression improvement.
Longitudinal Patient Health Questionnaire (PHQ)-9 is a questionnaire of 9 multiple-choice questions to assess the frequency of depressive symptoms within the previous two weeks. We analyzed a chronic depression treatment population's electronic health record (EHR) data, containing 610 patients' longitudinal PHQ-9 scores (62% age 45 and older; 68% female) within 40 weeks.
The irregular and sparse EHR data were transformed into continuous trajectories using Gaussian process regression. We first estimated the correlations between the symptoms (total score of the first 8 questions; PHQ-8) and suicide ideation (9th question score; Item 9) using the cross-correlation function. We then used an artificial neural network (ANN) to discover subtypes of depression patterns from the fitted depression trajectories. In addition, we conducted a separate analysis using the unfitted raw PHQ scores to examine PHQ-8's and Item 9's pattern changes.
Results showed that the majority of patients' PHQ-8 and Item 9 scores displayed strong temporal correlations. We found five patterns in the PHQ-8 and the Item 9 trajectories. We also found 8% - 13% of the patients have experienced an increase in suicidal ideation during the improvement of their PHQ-8. Using a trajectory-based method for subtype pattern detection in depression progression, we provided a better understanding of temporal correlations between depression symptoms over time.
•Disingenuous natures are artifactual and generative of post truth politics.•Five knowledge modalities of concern show how power shapes knowledge and ignorance.•These knowledges support post-truth ...politics and create disingenuous natures.•These knowledges pose challenges for social-environmental decision-making.•How we know and manage nature connects to how it is made knowable and manageable.
In this paper I examine our current post-truth politics and use the concept ‘disingenuous natures’ to describe the intersecting knowledge constructs, management practices and material conditions that enable authoritative knowledge of human-environment interactions to take hold and persist. These conditions are disingenuous because they are both artifactual and generative of social-ecological reifications, knowledge distortions and information deficiencies, yet retain a position of authority and legitimacy in decision-making contexts. I argue that researchers seeking to confront our current post-truth wave lack a clear framework for describing the process through which post-truthism unfolds and disingenuous natures are produced. I describe five interrelated ‘knowledge modalities of concern’ that illuminate key elements of this process. I argue for continued engagement with these knowledge types by critical scholars of the environment because they pose serious challenges for progressive environmental governance.
Major Physical Health Conditions and Risk of Suicide Ahmedani, Brian K., PhD, LMSW; Peterson, Edward L., PhD; Hu, Yong, MA ...
American journal of preventive medicine,
09/2017, Letnik:
53, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Introduction Most individuals make healthcare visits before suicide, but many do not have a diagnosed mental health condition. This study seeks to investigate suicide risk among patients with a range ...of physical health conditions in a U.S. general population sample and whether risk persists after adjustment for mental health and substance use diagnoses. Methods This study included 2,674 individuals who died by suicide between 2000 and 2013 along with 267,400 controls matched on year and location in a case–control study conducted in 2016 across eight Mental Health Research Network healthcare systems. A total of 19 physical health conditions were identified using diagnostic codes within the healthcare systems’ Virtual Data Warehouse, including electronic health record and insurance claims data, during the year before index date. Results Seventeen physical health conditions were associated with increased suicide risk after adjustment for age and sex ( p< 0.001); nine associations persisted after additional adjustment for mental health and substance use diagnoses. Three conditions had a more than twofold increased suicide risk: traumatic brain injury (AOR=8.80, p <0.001); sleep disorders; and HIV/AIDS. Multimorbidity was present in 38% of cases versus 15.5% of controls, and represented nearly a twofold increased risk for suicide. Conclusions Although several individual conditions, for example, traumatic brain injury, were associated with high risk of suicide, nearly all physical health conditions increased suicide risk, even after adjustment for potential confounders. In addition, having multiple physical health conditions increased suicide risk substantially. These data support suicide prevention based on the overall burden of physical health.
Response to specific depression treatments varies widely among individuals. Understanding and predicting that variation could have great benefits for people living with depression.
The authors ...describe a conceptual model for identifying and evaluating evidence relevant to personalizing treatment for depression. They review evidence related to three specific treatment decisions: choice between antidepressant medication and psychotherapy, selection of a specific antidepressant medication, and selection of a specific psychotherapy. They then discuss potential explanations for negative findings as well as implications for research and clinical practice.
Many previous studies have examined general predictors of outcome, but few have examined true moderators (predictors of differential response to alternative treatments). The limited evidence indicates that some specific clinical characteristics may inform the choice between antidepressant medication and psychotherapy and the choice of specific antidepressant medication. Research to date does not identify any biologic or genetic predictors of sufficient clinical utility to inform the choice between medication and psychotherapy, the selection of specific medication, or the selection of a specific psychotherapy.
While individuals vary widely in response to specific depression treatments, the variability remains largely unpredictable. Future research should focus on identifying true moderator effects and should consider how response to treatments varies across episodes. At this time, our inability to match patients with treatments implies that systematic follow-up assessment and adjustment of treatment are more important than initial treatment selection.
OBJECTIVE As use of standard depression questionnaires in clinical practice increases, clinicians will frequently encounter patients reporting thoughts of death or suicide. This study examined ...whether responses to the Patient Health Questionnaire for depression (PHQ-9) predict subsequent suicide attempt or suicide death. METHODS Electronic records from a large integrated health system were used to link PHQ-9 responses from outpatient visits to subsequent suicide attempts and suicide deaths. A total of 84,418 outpatients age ≥13 completed 207,265 questionnaires between 2007 and 2011. Electronic medical records, insurance claims, and death certificate data documented 709 subsequent suicide attempts and 46 suicide deaths in this sample. RESULTS Cumulative risk of suicide attempt over one year increased from .4% among outpatients reporting thoughts of death or self-harm "not at all" to 4% among those reporting thoughts of death or self-harm "nearly every day." After adjustment for age, sex, treatment history, and overall depression severity, responses to item 9 of the PHQ-9 remained a strong predictor of suicide attempt. Cumulative risk of suicide death over one year increased from .03% among those reporting thoughts of death or self-harm ideation "not at all" to .3% among those reporting such thoughts "nearly every day." Response to item 9 remained a moderate predictor of subsequent suicide death after the same factor adjustments. CONCLUSIONS Response to item 9 of the PHQ-9 for depression identified outpatients at increased risk of suicide attempt or death. This excess risk emerged over several days and continued to grow for several months, indicating that suicidal ideation was an enduring vulnerability rather than a short-term crisis.
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