Holly C. Wilcox

Acute alcohol use and suicidal behavior: a review of the literature.

BACKGROUNDnBoth acute and chronic use of alcohol are associated with suicidal behavior. However, the differing relationship of each component of alcohol use and possible causal mechanisms remain unclear.nnnMETHODSnThis article reviews and summarizes associations between acute alcohol consumption (with and without intoxication) and suicidal behavior (both completed suicide and suicide attempts) among adults 19 years and older, as presented in literature published between 1991 and 2001. Possible mechanisms and methodologic challenges for evaluating the association are also discussed. An application of a research design (the case-crossover study) that has the potential for addressing the effects of acute alcohol use over and above usual or chronic use is presented.nnnRESULTSnThe majority of articles reviewed were restricted to descriptive studies that documented the prevalence of suicide completers or attempters who tested positive for alcohol use. A wide range of alcohol-positive cases were found for both completed suicide (10-69%) and suicide attempts (10-73%). Common methodologic limitations included the lack of control groups (for evaluating risk conferred by alcohol use), selection and ascertainment bias, and small sample sizes. The results of the case-crossover pilot study indicated substantially higher risk of suicide during or shortly after use of alcohol compared with alcohol-free periods.nnnCONCLUSIONSnAlthough there is a substantial literature of published studies on acute alcohol use and suicidal behavior, the majority of studies focus on completed suicide and report prevalence estimates. Findings from such studies are subject to several possible sources of bias and have not advanced our knowledge of mechanisms in the association between acute alcohol use and suicidal behavior. The case-crossover design may help to overcome some limitations of these studies and facilitate evaluation of associations and possible causal mechanisms by which acute alcohol use is linked to suicidal behavior.

Mid-life suicide: an increasing problem in U.S. Whites, 1999-2005.

BACKGROUNDnThe overall suicide rate in the U.S. increased by 6% between 1981 and 1986 and declined by 18% between 1986 and 1999. Detailed descriptions of recent trends in suicide are lacking, especially with regard to the method of suicide. Information is needed on the major changes in rates of suicide in specific population groups in recent years (1999-2005).nnnMETHODSnMortality data came from the Web-based Injury Statistics Query and Reporting System. Suicide trends during 1981-2005 were analyzed by age, race, gender, and method, with an emphasis on increases between 1999 and 2005. Linear regression was used to examine the significance of trends in suicide mortality. The annual percentage change in rates was employed to measure the linear trend in suicide mortality.nnnRESULTSnThe suicide rate increased after 1999, due primarily to an increase in suicide among whites aged 40-64 years, whose rate of completed suicide between 1999 and 2005 rose by 2.7% annually for men and by 3.9% annually for women,with increases of 6.3% and 2.3% for poisoning, 2.8% and 19.3% for hanging/suffocation, and 1.5% and 1.9% for firearms for men and women, respectively. Rates did not increase for other age or racial groups [corrected].nnnCONCLUSIONSnThe differential increases by age, race, gender, and method underscore a change in the epidemiology of suicide.Whites aged 40-64 years have recently emerged as a new high-risk group for suicide. Although firearms remain the most common method of suicide, the notable increases in suicide by poisoning in men and hanging/suffocation in women deserve prevention attention [corrected].

The association between parental bonding and obsessive compulsive disorder in offspring at high familial risk

BACKGROUNDnThe aim of the current study is to estimate the association between parenting factors derived from the Parental Bonding Instrument (PBI) and a lifetime DSM-IV diagnosis of OCD.nnnMETHODnData were from approximately 1200 adults from 465 families assessed as part of a large family and genetic study of OCD. The association of three parenting factors, for fathers and mothers, with offspring OCD status were examined; analyses were stratified by parental OCD status and family loading for OCD (multiplex versus sporadic).nnnRESULTSnThree factors were derived by principal components factor analysis of the PBI (maternal and paternal care, overprotection and control). Maternal overprotection was associated with OCD in offspring with familial OCD (familial cases) but only if neither parent was affected with OCD, which suggests independent but additive environmental and genetic risk (OR = 5.9, 95% CI 1.2, 29.9, p = 0.031). Paternal care was a protective factor in those not at high genetic risk (sporadic cases) (OR = 0.2, 95% CI 0.0, 0.8, p = 0.027). Maternal overprotection was also associated with offspring OCD in sporadic families (OR = 2.9, 95% CI 1.3, 6.6, p = 0.012). The finding that parental overprotection and care were not associated with offspring OCD when at least one parent had OCD addressed directly the hypothesis of maternal or paternal OCD adversely impacting parenting.nnnCONCLUSIONSnThis study provides evidence that aspects of parenting may contribute to the development of OCD among offspring. Prospective studies of children at risk for OCD are needed to explore the direction of causality.

Genetics of obsessive-compulsive disorder: a research update

The genetic study of obsessive–compulsive disorder (OCD) has made significant gains in the past decade. However, etiological gene findings are still elusive. Epidemiological studies, including family and twin studies, strongly support a genetic component for OCD. In addition, complex segregation analyses suggest the presence of at least one major gene. The neurobiology of OCD also lends support to the notion that programmed CNS-based biological processes underlie OCD symptom expression, with mapping of brain circuits to fronto–subcortical circuits in a consistent manner. Genetic linkage studies of OCD, using families with multiple affected relatives, have generated several suggestive linkage peaks, regions that may harbor a gene or genes for OCD. However, the presence of multiple linkage peaks has added to the complexity of OCD genetics, suggesting that the exploration of gene–gene interactions and gene–environment interactions, in addition to the exploration of alternate phenotypes based on symptom expression, age at onset or comorbid conditions, may be key in locating etiologic genes. Finally, candidate gene studies, while promising, are not yet associated with linkage regions, except in the case of the glutamate transporter gene SLC1A1 in 9p24. While OCD appears to have a genetic component, additional innovative research is needed to unravel the genetic influences in the disorder.

Association between binge eating and attention‐deficit/hyperactivity disorder in two pediatric community mental health clinics

OBJECTIVEnAttention-Deficit/ Hyperactivity Disorder (ADHD) has been linked with obesity; however its relationship with binge eating (BE) is less clear. We aimed to explore the associations among ADHD, weight, and BE in pediatric mental health clinics.nnnMETHODnWe retrospectively reviewed consecutive intakes in two pediatric mental health clinics (Nu2009=u2009252). BE was assessed using the C-BEDS scale. Associations between ADHD, BE, and BMI-z score were assessed via regression.nnnRESULTSnMean age was 10.8 (3.7 SD) years. Twelve percent (nu2009=u200931) had BE. The association between ADHD and BE was statistically significant (OR 16.1, pu2009<u2009.001), and persisted after adjusting for comorbid diagnoses, medications, demographic variables, and clinic. There was a statistically significant association between ADHD and BMI z-scores (βu2009=u20090.54, pu2009<u2009.001). After adjusting for BE, the relationship between ADHD and BMI z-scores was attenuated (βu2009=u20090.35, pu2009=u2009.025), and the coefficient for BE was decreased (βu2009=u20090.75, pu2009=u2009.001). Although stimulant use was associated with a three-fold increase in odds of BE (OR 3.16, pu2009=u2009.006), stimulants were not associated with greater BMI-z scores (βu2009=u20090.18, pu2009=u2009.32).nnnDISCUSSIONnThere was a significant association between ADHD and BE in two pediatric mental health clinics. Although these data are cross-sectional, and cannot be used to make causal inferences, these findings are compatible with the hypothesis that BE partially mediates the association between ADHD and BMI z-scores. In mental health clinics, children with ADHD may present as overweight or obese. Further, children with ADHD may exhibit BE. Future prospective studies should elucidate the complex relationships among ADHD, weight, stimulants, and BE.

Posttraumatic stress disorder increases risk for suicide attempt in adults with recurrent major depression

Genetics of Recurrent Early‐Onset Depression study (GenRED II) data were used to examine the relationship between posttraumatic stress disorder (PTSD) and attempted suicide in a population of 1,433 individuals with recurrent early‐onset major depressive disorder (MDD). We tested the hypothesis that PTSD resulting from assaultive trauma increases risk for attempted suicide among individuals with recurrent MDD.

Depressed mood and antisocial behavior problems as correlates for suicide-related behaviors in Mexico

Suicide rates in Mexico have been rising steadily for several decades. This study examined the relationship of depressed mood and antisocial behavior problems with thoughts of death, suicide plans and attempts. Data from 22,966 individuals who participated in a population-based nationally-representative survey in Mexico were analyzed. After adjusting for covariates, all odds ratios for thoughts of death and suicidal behaviors were statistically significant in relation to antisocial behavior problems and depressed mood, both moderate and severe. Multiplicative effects of depressed mood and antisocial problems were found, with comorbid individuals showing increased risk of thoughts of death and suicidal plans and attempts, compared to individuals displaying none. Possible explanations, particularly for the multiplicative effect of both mood and problem behaviors on suicide-related behaviors, are discussed in the context of prior findings and directions for future research.

Functional impairment due to bereavement after the death of adolescent or young adult offspring in a national population study of 1,051,515 parents

PurposeThis study addresses the burden of grief after the death of an adolescent or young adult offspring. Parental bereavement following the death of an adolescent or young adult offspring is associated with considerable psychiatric and somatic impairment. Our aim is to fill a research gap by examining offspring death due to suicide, accidents, or natural causes in relation to risk of parental sickness absence with psychiatric or somatic disorders.MethodsThis whole population-based prospective study included mothers and fathers of all offspring aged 16–24xa0years in Sweden on December 31, 2004 (nxa0=xa01,051,515). This study had no loss to follow-up and exposure, confounders, and the outcome were recorded independently of each other. Cox survival analysis was used to model time to sickness absence exceeding 30xa0days, adjusting for parental demographic characteristics, previous parental sickness absence and disability pension, and inpatient and outpatient psychiatric and somatic healthcare prior to offspring death in 2001–2004. This large study population provided satisfactory statistical power for stratification by parents’ sex and adolescent and young adults’ cause of death.ResultsMothers and fathers of offspring suicide and accident decedents both had over tenfold higher risk for psychiatric sickness absence exceeding 30xa0days as compared to parents of live offspring. Fathers of suicide decedents were at 40xa0% higher risk for somatic sickness absence.ConclusionsThis is the largest study to date of parents who survived their offspring’s death and the first study of work-related outcomes in bereaved parents. This study uses a broad metric of work-related functional impairment, sickness absence, for capturing the burden of sudden offspring death.

The Association of School Climate, Depression Literacy, and Mental Health Stigma among High School Students.

BACKGROUNDnAlthough school climate is linked with youth educational, socioemotional, behavioral, and health outcomes, there has been limited research on the association between school climate and mental health education efforts. We explored whether school climate was associated with students depression literacy and mental health stigma beliefs.nnnMETHODSnData were combined from 2 studies: the Maryland Safe Supportive Schools Project and a randomized controlled trial of the Adolescent Depression Awareness Program. Five high schools participated in both studies, allowing examination of depression literacy and stigma measures from 500 9th and 10th graders. Multilevel models examined the relationship between school-level school climate characteristics and student-level depression literacy and mental health stigma scores.nnnRESULTSnOverall school climate was positively associated with depression literacy (odds ratio [OR]u2009=u20092.78, pu2009<u2009.001) and negatively associated with stigma (Est.u2009=u2009-3.822, pu2009=u2009.001). Subscales of engagement (ORu2009=u20095.30, pu2009<u2009.001) and environment were positively associated with depression literacy (ORu2009=u20092.01, pu2009<u2009.001) and negatively associated with stigma (Est.u2009=u2009-6.610, pu2009<u2009.001), (Est.u2009=u2009-2.742, pu2009<u2009.001).nnnCONCLUSIONSnPositive school climate was associated with greater odds of depression literacy and endorsement of fewer stigmatizing beliefs among students. Our findings raise awareness regarding aspects of the school environment that may facilitate or inhibit students recognition of depression and subsequent treatment-seeking.

Violent offending and suicidal behavior have common familial risk factors a rejoinder to tolstoy

Tolstoy’s novel Anna Karenina begins, “All happy families are alike; each unhappy family is unhappy in its own way.”1(p3) Mok et al,2 in this issue of JAMA Psychiatry, provide evidence to the contrary: in fact, many unhappy families share common risk factors. These authors report on a Danish record linkage study to elucidate the relationships between parental disorders and offspring suicide attempt and violent offending.2 The study encompassed 1 743 525 individuals born in Denmark between 1967 and 1997, followed up from their 15th birthday to the occurrence of adverse outcomes (suicide attempt or violent offending) or through 2012, whichever came first. Survival analyses were used to link parental mental disorders to the outcomes of suicide attempt and violent offending in offspring. Even controlling for the occurrence of other mental disorders and socioeconomic status (SES), parental history of cannabis misuse was related to offspring violent offending, and parental history of suicide attempt and antisocial personality disorder were associated with both offspring violent offending and offspring suicide attempt. Parental disorder conveyed a greater risk for both adverse outcomes in those of lower SES, and a greater risk of violent offending in females than in males. There is much to commend in this study, including the assessment and control for a broad range of parental psychiatric disorders, as well as the sheer size and representativeness of this sample. As in every study, there are limitations, some of which are noted by the authors. Although the authors controlled for SES, the impact of parental psychiatric disorder on suicide attempt and violent offending may still be overestimated, as there are likely to be other shared environmental factors correlated with parental disorder that could contribute to suicidal behavior and violent offending, such as maltreatment, separation from parents, and intrauterine drug and alcohol exposure... Language: en