Intentional Self-inflicted Injuries Research Articles

Suicide mortality in Paraíba (Brazil) between 2010 and 2021 and the impact of the Covid-19 pandemic: an ecological study

This study aims to analyze the rates of suicide mortality in the State of Paraíba (Brazil) between 2010 and 2021, describing the impact of the COVID-19 pandemic on the suicide rates in 2020 and 2021. We here proposed a mixed longitudinal - ecological study that employed secondary data provided by the Mortality Information System regarding deaths from self-harm in 2010 - 2021 in the state of Paraíba. It also included cases of death from intentional self-inflicted injuries, coded X60-X84 according to the 10th International Classification of Diseases (ICD-10). A linear regression was used to evaluate the relationship between the mortality rates and the years analyzed and also to calculate the predicted values for 2020 and 2021 based on findings from previous years. Although the suicide rates observed in 2020 and 2021 were higher than expected (6.387 and 6.789, respectively), they were still within the confidence interval. The present study found a constant increase in the suicide mortality during the period studied, even if without a significant difference between the expected trends according to previous years and those observed during the COVID-19 pandemic.

Receptivity of providing firearm safety storage devices to parents along with firearms safety education.

In the United States, 33% of households with children contain firearms, however only one-third reportedly store firearms securely. It's estimated that 31% of unintentional firearm injury deaths can be prevented with safety devices. Our objective was to distribute safe storage devices, provide safe storage education, evaluate receptivity, and assess impact of intervention at follow-up. At five independent, community safety events, parents received a safe storage device after completing a survey that assessed firearms storage methods and parental comfort with discussions regarding firearm safety. Follow-up surveys collected 4 weeks later. Data were evaluated using descriptive analysis. 320 participants completed the surveys, and 288 participants were gunowners living with children. Most participants were comfortable discussing safe storage with healthcare providers and were willing to talk with friends about firearm safety. 54% reported inquiring about firearm storage in homes their children visit, 39% stored all their firearms locked-up and unloaded, 32% stored firearms/ammunition separately. 121 (37%0.8) of participants completed the follow-up survey, 84% reported using the distributed safety device and 23% had purchased additional locks for other firearms. Participants were receptive to firearm safe storage education by a healthcare provider and distribution of a safe storage device. Our follow up survey results showed that pairing firearm safety education with device distribution increased overall use of safe storage devices which in turn has the potential to reduce the incidence of unintentional and intentional self-inflicted firearm injuries. Providing messaging to promote utilization of safe storage will impact a firearm safety culture change.

Analysis of the panorama of mortality by suicide in the elderly population of the Southeast region from 2011 to 2015

The proportion of elderly people has been increasing in recent years, and with it the related public health problems. Intentional self-inflicted injuries are an important public health problem, even among this section of the population. The aim of this study was to describe the panorama of self-inflicted injuries in the elderly population of the southeast region between 2011 and 2015. It was concluded that self-inflicted injuries in the elderly ranked 6th among external causes of morbidity and mortality between 2011 and 2015 in the southeast region, demonstrating the relevance of the issue in this part of the population. Suicide among the over-60s occurs more frequently in men. It is necessary to identify these patients and what leads them to idealize the suicidal act so that we can address factors that improve their mental health in order to prevent this event

Suicides among adults in Paraguay: An 18-year national exploratory study (2004-2022).

The number of suicides has been increasing worldwide, year after year, becoming the fourth leading cause of death among young people between 15 and 29 years of age. In this study, we explored the frequency and characteristics of suicides among the adult general population in Paraguay between 2004 and 2022, considering that suicide attempts and suicidal risk/ideation are frequent and relevant issues in the consultation activity, even if epidemiological evidence on the national rates of suicide is scarce. In this observational, descriptive, and exploratory study, official records of all deaths by suicide were reviewed and information analyzed. In addition, an attempt was made to predict the number of suicides in the next 5 years according to a mathematical modeling. In the 18-year period, 5,527 suicides of adults were recorded. Patients' mean age was 36.8 ± 17 years old. A 76.77% of them were males, 77.44% were from an urban area and 25.98% from the Greater Asunción and Central Department of Paraguay. The most frequently used method of suicide was intentional self-inflicted injury by hanging, strangulation, or suffocation (all 67.6%). The expected number of national suicides in the following years from 2023 to 2027 will range between 462 and 530. Limitations include the lack of information regarding diagnoses and personal history in the suicide reports as well as the possibility of underreporting of national suicide cases. Our results represent the first large national epidemiological report of suicides in Paraguay and may be of interest for mental health professionals and health authorities in order to reduce the suicide mortality rate within the country.

Integrating Environmental Data with Medical Data in a Records-Linkage System to Explore Groundwater Nitrogen Levels and Child Health Outcomes.

Background: The Rochester Epidemiology Project (REP) medical records-linkage system offers a unique opportunity to integrate medical and residency data with existing environmental data, to estimate individual-level exposures. Our primary aim was to provide an archetype of this integration. Our secondary aim was to explore the association between groundwater inorganic nitrogen concentration and adverse child and adolescent health outcomes. Methods: We conducted a nested case-control study in children, aged seven to eighteen, from six counties of southeastern Minnesota. Groundwater inorganic nitrogen concentration data were interpolated, to estimate exposure across our study region. Residency data were then overlaid, to estimate individual-level exposure for our entire study population (n = 29,270). Clinical classification software sets of diagnostic codes were used to determine the presence of 21 clinical conditions. Regression models were adjusted for age, sex, race, and rurality. Results: The analyses support further investigation of associations between nitrogen concentration and chronic obstructive pulmonary disease and bronchiectasis (OR: 2.38, CI: 1.64-3.46) among boys and girls, thyroid disorders (OR: 1.44, CI: 1.05-1.99) and suicide and intentional self-inflicted injury (OR: 1.37, CI: >1.00-1.87) among girls, and attention deficit conduct and disruptive behavior disorders (OR: 1.34, CI: 1.24-1.46) among boys. Conclusions: Investigators with environmental health research questions should leverage the well-enumerated population and residency data in the REP.

Patterns and Characteristics of Intentional Self-inflicted Hand Injuries among Military Personnel: A Retrospective Study and Proposal of Treatment Algorithm.

This retrospective chart review study was conducted at a tertiary hospital in Riyadh, Saudi Arabia. Our inclusion criteria included military personnel patients who presented to the emergency department with intentional self-inflicted hand-related injuries between 2016 and 2018. A total of 274 cases were included; 241 (88%) were men. Injuries to the left hand (52.2%) were more common than injuries to the right hand. The most common injury site involved the little finger (45.6%). The majority were followed up (97.8%), and 28.8% of cases had a complication. The majority of fractures were managed with open reduction and internal fixation (63.9%). Moreover, the mean sick leave duration was 23 days. Self-inflicted injuries can be challenging to diagnose when patients are manipulative about the cause and mechanism. Most self-inflicted injuries involved the left little finger, and most were treated with open reduction and internal fixation. A self-inflicted injury is possible in the context of an unusual injury with a vague medical history.

Comparison of Mental Health Visits at a Military Treatment Facility Emergency Department Pre- and Post-COVID-19 Pandemic.

There is a paucity of quantitative research regarding the effect of coronavirus 2019 (COVID-19) on Emergency Department (ED) visits in the United States, and specifically mental health-related ED visits. The small existing body of research describes an overall decline in ED visits worldwide; however, there are anecdotal reports that psychiatric complaints to the ED have increased during the pandemic. The primary objective of this study was to describe the volume of mental health ED visits at a single ED during the COVID-19 pandemic compared to previous years. This was a single-center, retrospective chart review of adult patients evaluated in the ED at an academic military medical facility from March to December of 2017-2020 for mental health. The electronic medical record was queried for mental health International Classification of Diseases, 10th Revision diagnosis codes. Demographic data including age, gender, disposition, diagnosis, and beneficiary status were collected, and Pearson Chi-Square was used to assess for statistical significance between years. There was a total of 1,486 mental health ED visits from March to December 2020, compared to an average of 1,668 visits from March to December 2017-2019. Statistically significant (P < 0.05) differences, between 2020 and the prior 3 years combined, were identified in the categories of age, disposition, beneficiary status, and diagnosis. In 2020, there was a lower proportion of visits for patients aged ≥60 (1.2%) than in 2017-2019 (2.5%). Active-duty patients comprised a higher proportion of mental health visits in 2020 (82.4%) versus 2017-2019 (77%). Proportionately fewer patients were admitted in 2020 (25.2%) versus 2017-2019 (29.2%). Adjustment disorders made up 19.0% of visits in 2020 versus 23.2% in 2017-2019, and suicidal ideation and intentional self-inflicted injury comprised 43.3% in 2020 compared with 40.4% in 2017-2019. There was a significant decline in ED visits for patients over the age of 60 but a significant increase in visits for active-duty patients. Fewer patients were admitted compared to previous years. There was a significant increase in patients diagnosed with suicidal ideation and intentional self-inflicted injury in 2020 compared to previous years. Alarmingly, this study shows increased rates of self-harm and suicidal ideation. Further study is needed to determine why these effects were seen and if there is a higher risk for suicide attempt or completion in these populations. These results indicate that military leadership and the military health system is failing to adequately support and protect service members and their families during these uniquely stressful times. High-level attention to this issue by military leadership is required; the readiness and safety of the nation's fighting force is at stake.

Hospitalizations at United States Children's Hospitals and Severity of Illness by Neighborhood Child Opportunity Index

To describe the association between neighborhood opportunity measured by the Child Opportunity Index 2.0 (COI) and patterns of hospital admissions and disease severity among children admitted to US pediatric hospitals. Retrospective, cross-sectional study of 773 743 encounters for children <18years of age admitted to US children's hospitals participating in the Pediatric Health Information System database 7/2020-12/2021. The proportion of children from each COI quintile was inversely related to the degree of neighborhood opportunity. The difference between the proportion of patients from Very Low COI and Very High COI ranged from +32.0% (type 2 diabetes mellitus with complications) to -14.1% (mood disorders). The most common principal diagnoses were acute bronchiolitis, respiratory failure/insufficiency, chemotherapy, and asthma. Of the 45 diagnoses which occurred in ≥0.5% of the cohort, 22, including type 2 diabetes mellitus, asthma, and sleep apnea had higher odds of occurring in lower COI tiers in multivariable analysis. Ten diagnoses, including mood disorders, neutropenia, and suicide and intentional self-inflicted injury had lower odds of occurring in the lower COI tiers. The proportion of patients needing critical care and who died increased, as neighborhood opportunity decreased. Pediatric hospital admission diagnoses and severity of illness are disproportionately distributed across the range of neighborhood opportunity, and these differences persist after adjustment for factors including race/ethnicity and payor status, suggesting that these patterns in admissions reflect disparities in neighborhood resources and differential access to care.

Prevalence of Substance use disorder among young adults hospitalized in the US hospital: A decade of change

IntroductionMental health disorders (MHD) and substance use disorders (SUD) lead to outstanding socioeconomic costs and increased hospital visits. However, very few studies have quantified this trend over time and across specific conditions. ​​Our study aims to investigate and compare the prevalence of MHDs and SUDs in hospitalizations between 2007 and 2017. MethodsWe used hospital records for 2007 and 2017 from the National Inpatient Sample (NIS) datasets to identify young adults (18–44 years) hospitalized with MHD and SUD. The prevalence of MHD in hospitalized patients in 2017 vs. 2007 was measured and compared. We generated a multivariable logistic regression analysis controlled for confounders, including age, sex, race, and payer status. We evaluated these outcomes using Odds Ratio (OR) and 95% Confidence Interval (CI). ResultsA total 10,353,890 patients were included in 2007, and 8,569,789 patients were included in 2017. The prevalence of drug abuse among hospitalized patients was 8.4% in 2017 vs. 6.2% in 2007. Prevalence increased in both genders (15.7% vs. 13.0% among male, 5.7% vs. 3.9% among females) in 2017 vs. 2007. All psychiatric disorders showed a higher prevalence in 2017 compared to 2007.When stratified by race, the prevalence of substance use disorder increased among all races except Black race between 2017 vs. 2007. On multivariable analysis, widespread drug abuse was significantly associated with hospital admissions in 2017 vs. 2007 (OR: 1.27, 95% CI: 1.20–1.34, p<0.001). These associations held across many substance abuse cases and mental health disorders except cocaine abuse (OR: 0.84, 95%CI: 0.76–0.93, p<0.001). ConclusionThere was a significant rise in substance use disorder and psychiatric disorder a decade later, from 2007, in hospitalized patients in the age group 18–44 years. The most increase was observed in amphetamine use disorder and anxiety disorder. Suicide and intentional self-inflicted injury increased in all races, with a maximum increase observed in Native Americans. Further studies evaluating the factors responsible for this upward trend would be beneficial.

Role of Gender in Phemenon of Non-Suicidal Self-Injuries and Suicide Attempt Among Clinical Population of Adolescents

Abstract Non suicidal self-injury is defined as intentional self-inflicted injury without the intent to die. Suicide attempt is defined as a nonfatal, self-directed, potentially injurious behavior with the intent to die. Although distinct behaviors, they are frequently associated and possibly clinically related. The aims of this study are to explore demographic data, social-demographic differences between genders, co-occurrence of non-suicidal self-injuries with suicide attempt, their association with gender and clinical variables. Retrospective cohort study on 143 patient admitted in Clinic for mental disorders „Dr Laza Lazarevic“, aged 14 to 18 years, between January 2015 and January 2016. Information were obtained from database and included two categories of variables: socio-demographic (age, gender, education level, current living situation) and clinical variables (abuse, neglect, peer violence, aggressive behavior, non-suicidal self-injuries, suicide attempt and others). The mean age of adolescents was 15.8 years, with female being more frequent in the sample (51.4%). The incidence of Mood disorders was significantly higher (p&lt;0.05) in female compared to male (χ²꞊3,96, df꞊1, rC꞊0.16, p꞊0.04). A significantly higher incidence (p&lt;0.05) of non-suicidal self-injury (χ²꞊11.15, df꞊1, rC꞊0.27, p꞊0.001) and suicide attempt was found in female compared to male (χ²꞊5.38, df꞊1, rC꞊0.19, p꞊0.02). No statistically significant difference was found in their simultaneous occurrence compared to total population of hospitalized adolescents. The findings of the present study demonstrated that non-suicidal selfinjury and suicide attempt occur in clinical population of adolescent more often among female then in male adolescents.

Mental health disorders are more common in patients with Hodgkin lymphoma and may negatively impact overall survival.

Long-term mental health outcomes werecharacterized in patients who were diagnosed with Hodgkin lymphoma (HL), and risk factors for the development of mental health disorders were identified. Patients who were diagnosed with HL between 1997 and 2014 were identified in the Utah Cancer Registry. Each patient was matched with up to five individuals from a general population cohort identified within the Utah Population Database, a unique source of linked records that includes patient and demographic data. In total, 795 patients who had HL were matched with 3575 individuals from the general population. Compared with the general population, patients who had HL had a higher risk of any mental health diagnosis (hazard ratio, 1.77; 95% confidence interval, 1.57-2.00). Patients with HL had higher risks of anxiety, depression, substance-related disorders, and suicide and intentional self-inflicted injuries compared with the general population. The main risk factor associated with an increased risk of being diagnosed with mental health disorders was undergoing hematopoietic stem cell transplantation, with a hazard ratio of 2.06 (95% confidence interval, 1.53-2.76). The diagnosis of any mental health disorder among patients with HL was associated with a detrimental impact on overall survival; the 10-year overall survival rate was 70% in patients who had a mental health diagnosis compared with 86% in those patients without a mental health diagnosis (p < .0001). Patients who had HL had an increased risk of various mental health disorders compared with a matched general population. The current data illustrate the importance of attention to mental healthin HL survivorship, particularly for patients who undergo therapy with hematopoietic stem cell transplantation.

Suicidal ideation and intentional self-inflicted injury in autism spectrum disorder and intellectual disability: An examination of trends in youth emergency department visits in the United States from 2006 to 2014.

Youth suicide is a major problem in the United States and globally, but little is known about suicide risk in autistic youth and youth with intellectual disability specifically. Using data from the National Emergency Department Sample, which is the largest database of emergency department visits in the United States, we found that emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis were more common in autistic youth and youth with intellectual disability than in youth without these diagnoses (i.e. the comparison group). This was true when examining both suicidal ideation diagnoses and intentional self-inflicted injury diagnoses at emergency department visits. In addition, the number of emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis increased more from 2006 to 2014 in autistic youth and youth with intellectual disability compared with the comparison group. We also found both similarities and differences when examining factors, such as age, sex, and co-occurring mental health conditions, related to emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis across groups that may be helpful for understanding suicide risk. It is urgent that we improve our understanding, assessment, and treatment of suicidality and self-harm in these groups through more research and clinical efforts.

THE PRINCIPLE OF COMPLICITY IN INTENTIONAL SELF-INFLICTED INJURY AS A NEGATIVE PREMISE FOR THE OBJECTIVE ATTRIBUTION OF AN EFFECT FROM THE PERSPECTIVE OF CRIMES AGAINST LIFE AND HEALTH IN POLISH AND GERMAN CRIMINAL LAW

The subject of the present article is the principle of complicity in intentional self-inflicted injury as a negative premise for objective attribution of an effect from the perspective of crimes against life and health in Polish and German criminal law. First, the problem of negative prerequisites for objective attribution of an effect is briefly discussed, which is an extremely interesting issue both from the perspective of dogmatics and the practice of criminal law. Then the article brings closer the criterion of the principle of victim autonomy by means of examples taken from the German doctrine and jurisprudence in the area of crimes against life and health and analyses them from the perspective of the Polish Penal Code. The whole allows to get acquainted with the discussed premise and to understand both its theoretical essence and a somewhat illustrative exemplification

36 Comparison of Mental Health Visits at a Military Treatment Facility Emergency Department Pre- And Post-COVID-19 Pandemic

There is a paucity of quantitative research regarding the effect of COVID-19 on emergency department (ED) visits in the United States, and specifically mental health-related ED visits. The small existing body of research describes an overall decline in ED visits worldwide; however, there are anecdotal reports that psychiatric complaints to the ED have increased during the pandemic. The primary objective of this study was to describe the volume of mental health ED visits at a single ED during the COVID-19 pandemic compared to previous years. This was a single-center, retrospective chart review of adult patients evaluated in the ED at an academic military medical facility from March-December of 2017-2020 for mental health. The electronic medical record was queried for 1,542 mental health ICD-10 diagnosis codes. Demographic data including age, sex, disposition, diagnosis, and beneficiary status were collected. Tests of association included Pearson Chi-square with Bonferroni correction for post-hoc tests and one-way ANOVA. There were a total of 1,486 mental health ED visits from March-December 2020, compared to an average of 1,668 visits from March-December 2017-2019. Statistically significant (p<0.05) differences, between 2020 and the prior three years combined, were identified in the categories of age, disposition, beneficiary status, and diagnosis. In 2020, there was a lower proportion of visits for patients aged ≥ 60 (1.2%) than in 2017-2019 (2.5%). Active duty patients comprised a lower proportion in 2020 (17.6%) versus 2017-2019 (23.0%). Proportionately fewer patients were admitted in 2020 (25.2%) versus 2017-2019 (29.2%). Adjustment disorders made up 19.0% of visits in 2020 versus 23.2% in 2017-2019 and suicidal ideation and intentional self-inflicted injury comprised 43.3% in 2020 compared with 40.4% in 2017-2019. There was a significant decline in ED visits for patients over the age of 60 and for active duty military patients. Overall, fewer patients were admitted compared to previous years. There was a significant increase in patients diagnosed with suicidal ideation and intentional self-inflicted injury in 2020 compared to previous years. The COVID-19 pandemic and associated quarantines have negatively affected mental health worldwide. Active duty military and elderly patients were uniquely impacted. Both groups have been subject to highly restrictive limitations during the pandemic. Alarmingly, this study shows increased rates of self-harm and suicidal ideation, yet a lower likelihood of these populations to present to the ED for mental health care. Further study is needed to determine why these effects were seen, and if there is a higher risk for suicide attempt or completion in these populations.

Disease Prevalence, Comorbid Conditions, and Medication Utilization Among Patients with Schizophrenia in the United States

Disease prevalence, comorbid conditions, and pharmacological treatments were examined in a large population of US commercial- or Medicaid-insured individuals with schizophrenia. This retrospective, cross-sectional claims analysis sourced data from the IBM MarketScan Commercial and Medicare Supplemental Databases and the Multi-state Medicaid Database (01Jan2009 to 30Jun2016). Cases were defined by =1 diagnostic claim (ICD-9-CM/ICD-10-CM) for schizophrenia during the study period. Comorbidities (=1 ICD-9-CM/ICD-10-CM diagnosis code) were grouped according to Clinical Classifications Software (CCS) level 2 categories. For the per-database analysis of comorbidities, schizophrenia cases were matched with controls by demographic characteristics. Case-control comorbidity comparisons were performed using prevalence rate ratios (PRRs) and 95% CIs. Per-database medication exposure (=1 National Drug Code in outpatients grouped by Redbook classification) was also assessed. Schizophrenia prevalence was 0.11% and 0.99% in commercially and Medicaid-insured patients, respectively. In both databases, comorbidity prevalence was higher among schizophrenia cases versus controls in approximately =80% of the CCS level 2 categories assessed. Common top categories of comorbidities for schizophrenia cases were mood disorders, anxiety disorders, other connective tissue disease, and diseases of the heart. Comorbidities with the highest case-control PRRs included personality disorders, suicide and intentional self-inflicted injury, and impulse control disorders. Across databases, the most commonly prescribed medications in cases were antipsychotics, antidepressants, and analgesics/antipyretics opiate agonists; the most highly prescribed antipsychotics were risperidone, quetiapine, aripiprazole, and olanzapine. This large-scale analysis quantifies the high prevalence of medical and psychiatric comorbidity burden in patients with schizophrenia, highlighting the importance of integrated medical and psychiatric care. Alkermes, Inc.

Craniocerebral nail gun injuries: a definitive review of the literature

ABSTRACT Aim Nail guns are important time saving devices but are associated with morbidity and mortality. Specifically, craniocerebral injuries have been reported in the literature since 1963 and have increased in frequency as the use of these tools has become commonplace. There remains a paucity of literature comprehensively assessing nail gun injuries, as compared with other penetrating craniocerebral injuries like those from firearms. Method A literature review of PubMed, Medline (Ovid), Cochrane library, and Google Scholar for articles published between 1960 and 2018 reporting craniocerebral nail gun injuries. Results In total, 96 individual cases were identified, with 80 meeting inclusion criteria. These were categorized as accidental and intentional injuries. The demographic was overwhelmingly young males (97.5%), and intentional self-inflicted injuries (54%) was the most frequent mechanism of injury. Overall mortality was 10%. Mortality was more common in patients with intentional injuries, but morbidity rates were similar between the accidental and intentional injury cohorts. Post-operative complications rate was 23.8%. Conclusion Craniocerebral nail gun injuries are associated with lower rates of both mortality and residual neurological deficits than craniocerebral firearms injuries. There is limited data to inform clinical prognostication about long-term neurological impairments and the time to recovery which should be addressed in future studies.

Comorbid PTSD and Depression Diagnoses Mediate the Association of Military Sexual Trauma and Suicide and Intentional Self-Inflicted Injury in VHA-Enrolled Iraq/Afghanistan Veterans, 2004-2014

BackgroundExposure to military sexual trauma (MST) in veterans is associated with suicidal ideation. Previous research suggests there are mechanisms of this association, including posttraumatic stress disorder (PTSD) and depression. Research has yet to examine whether comorbid PTSD and depression mediate the association of MST and suicide and intentional self-inflicted injury, and whether this comorbidity confers a greater risk for suicide relative to PTSD-only and depression-only. The current study addressed this gap in our knowledge. MethodsScreening results identifying MST exposure, PTSD and depression diagnoses, suicide and intentional self-inflicted injury, and demographic covariates in 435,690 Iraq/Afghanistan veterans were extracted from Veterans Health Administration (VHA) medical records. Veterans were included if they attended VHA from 2004-2014. Mediation was tested with path analyses. ResultsSuicide and intentional self-inflicted injury was observed in 16,149 (3.71%) veterans. The indirect effect of suicide and intentional self-inflicted injury, given a positive screen for MST, was highest among veterans with comorbid PTSD and depression diagnoses (indirect effect=3.18%, 95% confidence interval [CI] [3.01%, 3.32%]), with smaller probabilities observed for both PTSD-only (indirect effect=-0.18%, 95% CI [-0.20%, -0.14%]) and depression-only (indirect effect=0.56%, 95% CI [0.51%, 0.62%]; ps<.05). LimitationsData were limited to VHA-enrolled Iraq/Afghanistan veterans. ConclusionsTo reduce suicide risk among veterans with a history of MST, treatments may be most effective if they target comorbid PTSD and depression. Future research should examine the mechanisms through which comorbid PTSD and depression result in heightened risk for suicide and intentional self-inflicted injury.

Poor psychological health and 5-year suicide mortality: A population-based prospective cohort study.

The objective was to investigate associations between the General Health Questionnaire with twelve sub-items (GHQ-12) and prospective five-year suicide mortality. The two commonly used GHQ-12 cut-offs (2/3 and 3/4) were analyzed. The 2008 public health survey, which was conducted in the autumn of 2008 in Scania, southern Sweden, is based on a postal questionnaire answered by 28,198 participants, aged 18 to 80. GHQ-12 was assessed from the baseline questionnaire, and five-year prospective register data on causes of death were connected to the baseline survey. In total, 21 persons died from intentional self-inflicted injuries, and twenty of them had complete answers regarding GHQ-12. Hazard rate ratios (HRR) were analyzed in survival (Cox-) regression analyses, adjusted for age, sex, marital status and socioeconomic status (SES). The prevalence of poor psychological health according to GHQ-12 with the 2/3 cut-off was 14% among men and 18% among women, and with the 3/4 cut-off it was 11% among men and 15% among women. The 2/3 cut-off yielded a HRR of 3.02 (1.14-7.98, 95% CI) which decreased to 2.44 (0.92-6.49) when adjusted for marital status and SES, and a 3/4 cut-off HRR of 3.97 (1.51-10.47) which decreased to 3.23 (1.22-1.22-8.56) when adjusted for marital status and SES. The results indicate high effect measures (HRRs) between GHQ12 with both cut offs and five-year suicide mortality.

M125. DISEASE PREVALENCE, COMORBID CONDITIONS, AND MEDICATION UTILIZATION AMONG PATIENTS WITH SCHIZOPHRENIA IN THE UNITED STATES

BackgroundThe comorbid medical and psychiatric burden for individuals with schizophrenia in the United States is substantial compared with the general population. This study sourced the IBM® MarketScan® Research Databases to examine disease prevalence, comorbid conditions, and drug treatments in a large population of commercial- or Medicaid-insured individuals with schizophrenia in the United States to characterize this patient population.MethodsA retrospective cross-sectional claims analysis from the IBM® MarketScan® Commercial and Medicare Supplemental Databases and the Multi-state Medicaid Database from January 1, 2009 to June 30, 2016 was conducted. Individuals with dual coverage for commercial and Medicare Supplemental were included within the commercial analysis. Schizophrenia cases were defined by ≥1 diagnostic claim (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]/ICD-10-CM) for schizophrenia anytime during the study period. Comorbidities were assessed by ≥1 ICD-9-CM/ICD-10-CM diagnosis code, grouped into clinically meaningful categories according to the Clinical Classifications Software (CCS) level 2 categories. For the comorbidity analysis, within each database, schizophrenia cases were matched with controls along several demographic characteristics. Case-control comorbidity comparisons were performed using prevalence rate ratios (PRRs) and 95% confidence intervals. Medication exposure was assessed for cases only within each database and was based on ≥1 National Drug Code (NDC) occurring in the outpatient setting grouped by Redbook classification.ResultsSchizophrenia prevalence was 0.99% in Medicaid-insured patients and 0.11% in those with commercial insurance. In both commercial and Medicaid databases, the prevalence of comorbidities was higher among schizophrenia cases as compared with controls in approximately ≥80% of the CCS level 2 categories assessed. Of the top 5 categories of comorbidities across databases for schizophrenia cases, those in common were mood disorders, anxiety disorders, other connective tissue disease, and cardiovascular disease. The comorbidities with the highest case-control PRR point estimates across databases included personality disorders, suicide and intentional self-inflicted injury, and impulse control disorders. Antipsychotics, antidepressants, and analgesics/antipyretics–opiate agonists were the most commonly prescribed medications for schizophrenia cases across databases. Risperidone, quetiapine, aripiprazole, and olanzapine were the top 4 antipsychotics prescribed across both databases. The fifth most commonly prescribed antipsychotics were ziprasidone and haloperidol in the commercial and Medicaid databases, respectively.DiscussionThis large-scale database analysis confirmed the burden of medical and psychiatric comorbidities in patients with schizophrenia compared with controls and provided additional insight on treatment approaches in these patients. Understanding the comorbidities affecting this patient population in comparison with the general population highlights the importance of integrated medical and psychiatric care.

Dermatology clinical case

A previously healthy 15-year-old girl was sent to the Pediatric Emergency Department by the general practitioner due to suspicion of a hematological condition. The girl presented with ecchymotic lesions on the anterior region of the thorax and antero-proximal region of the upper limbs, which had apparently worsened in the last 24 hours. She denied trauma or impact sports, fever or recent infections, and blood loss or other symptoms. Laboratory evaluation showed no alterations and urine toxicology screening was negative. When confronted with normal laboratory evaluation, the girl confessed intentional self-inflicted injuries following a discussion with her mother. Parents were made aware of the situation, and a pediatric psychiatry consultation was recommended. After discharge, follow-up in the girl’s home country was assured.With this report, the author intend to raise awareness of the importance of maintaining a high index of suspicion to non-suicidal self-injury, identifying alarm signs and establishing early preventive strategies.