Self-harm Events Research Articles

Plasma proteomics identifies proteins and pathways associated with incident depression in 46,165 adults

Proteomic alterations preceding the onset of depression offer valuable insights into its development and potential interventions. Leveraging data from 46,165 UK Biobank participants and 2920 plasma proteins profiled at baseline, we conducted a longitudinal analysis with a median follow-up of 14.5 years to explore the relationship between plasma proteins and incident depression. Linear regression was then used to assess associations between depression-related proteins and brain structures, genetic factors, and stress-related events. Our analysis identified 157 proteins associated with incident depression (P <1.71 × 10−5), including novel associations with proteins such as GAST, PLAUR, LRRN1, BCAN, and ITGA11. Notably, higher expression levels of GDF15 (P = 6.18 × 10−26) and PLAUR (P = 2.88 × 10−14) were linked to an increased risk of depression, whereas higher levels of LRRN1 (P = 4.28 × 10−11) and ITGA11 (P = 3.68 × 10−9) were associated with a decreased risk. Dysregulation of the 157 proteins is correlated with brain regions implicated in depression, including the hippocampus and middle temporal gyrus. Additionally, these protein alterations were strongly correlated with stress-related events, including self-harm events, adult, and childhood trauma. Biological pathway enrichment analysis highlighted the critical roles of the immune response. EGFR and TNF emerged as key proteins in the protein–protein interaction network. BTN3A2, newly linked to incident depression (P = 4.35 × 10−10), was confirmed as a causal factor through Mendelian randomization analysis. In summary, our research identified the proteomic signatures associated with the onset of depression, highlighting its potential for early intervention and tailored therapeutic avenues.

Medical Chart Review to Explore Suicidal and Self-Harm Thoughts and Behavior Among Psychiatric Inpatients.

Suicide and self-harm events are elevated in psychiatric inpatient populations. In this study, health data were retrospectively collected from the medical records of 183 patients (97 civil and 86 forensic) who had resided in, or been admitted to, a public psychiatric hospital in Saskatchewan, Canada from April 1 to December 31, 2021. Descriptive and inferential analyses were conducted to estimate prevalence and correlates of (non-fatal) suicide and self-harm events, including recent and lifetime occurrences, according to patients' health information. Nearly two-thirds (62%) of patients had any record of non-fatal suicide or self-harm events, including a lifetime history of self-harm (42%) and suicidal behavior (37%) as well as recent self-harm (24%) and suicidal (31%) thoughts or behaviors. Forensic patients were significantly more likely to have a record of suicide and self-harm events. This study emphasizes the need for further research into the course of suicidality and self-harm in psychiatric inpatients.

The weight of weights: Causal impact of overweight on major depressive disorder and its disparate association with suicide attempts in over 450,000 individuals of European ancestry (AM-SRNMA 003)

AimSome studies and societal discussions have suggested a potential link between overweight and a higher risk of mental disorders and suicidal ideation. However, the causal relationships between these factors remain unclear. This study aims to assess the bidirectional causal associations between overweight and mental disorders, including suicidal attempts. MethodWe conducted a Two-Sample Mendelian Randomization study utilizing data from over 450,000 individuals of European ancestry sourced from a comprehensive Genome-Wide Association Study database. We chose single-nucleotide polymorphisms as instrumental variables. ResultsOur analyses consistently supported a unidirectional causal association of overweight with the increased risk of major depressive disorder (MDD, β = 0.152, se = 0.069, P = 0.027), bipolar affective disorders (BD, β = 0.197, se = 0.092, P = 0.033), and attention-deficit / hyperactivity disorder (ADHD, β = 0.308, se = 0.080, P = 1.366 × 10−4). We observed no significant causal relationships for the exposure of overweight to anxiety disorder (AD), manic episode (MA), panic disorder (PD), schizophrenia (SZ), substance use disorder (SUD), autism spectrum disorder (ASD), ever attempted suicide, recent thoughts of suicide or self-harm, and suicide or other intentional self-harm events. ConclusionThis study has provided evidence for the causal relationship between overweight and MDD, BD, ADHD, with no observed relationship between overweight and AD, MA, PD, SZ, SUD, ASD, ever attempted suicide, recent thoughts of suicide or self-harm, and suicide or other intentional self-harm events.

Incidence of Influenza-associated Neurologic and Psychiatric Complications Requiring Hospitalization in Children Ages 5-17 Years.

The spectrum and incidence of influenza-associated neuropsychiatric complications are not well-characterized. The objective of this study was to define the incidence of specific neurologic and psychiatric complications associated with influenza in children and adolescents. We assembled a retrospective cohort of children 5-17 years of age with an outpatient or emergency department International Classification of Diseases, 10th revision influenza diagnosis and enrolled in Tennessee Medicaid from 2016 to 2020. Serious neurologic or psychiatric complications requiring hospitalization were identified using a validated algorithm. Incidence rates of complications were expressed per 100,000 person-weeks of influenza and 95% confidence intervals (CIs) were reported. A total of 156,661 influenza encounters (median age of 9.3 years) were included. The overall incidence of neurologic complications was 30.5 (95% CI: 24.0-38.6) per 100,000 person-weeks of influenza and 1880.9 (95% CI: 971.9-3285.5) among children with an underlying neurologic comorbidity. The distribution of antiviral treatment was similar among those with and without neurologic or psychiatric complications. The overall incidence of psychiatric complications was 20.2 (95% CI: 15.1-27.0) per 100,000 person-weeks of influenza and 111.8 (95% CI: 77.9-155.5) among children with an underlying psychiatric comorbidity. Seizures (17.5, 95% CI: 12.8-23.9) were the most common neurologic complications whereas encephalitis (0.5, 95% CI: 0.02-2.5) was rare. Mood disorders (17.5, 95% CI: 12.8-23.9) were the most frequent psychiatric complications and self-harm events (0.9, 95% CI: 0.3-3.3) were the least common. Our findings reveal that the incidence of neuropsychiatric complications of influenza is overall low; however, the incidence among children with underlying neurologic or psychiatric condition is significantly higher than among children without these conditions.

Intentional Self-Harm and Death by Suicide in Body Dysmorphic Disorder: A Nationwide Cohort Study

BackgroundBody dysmorphic disorder (BDD) is thought to be associated with considerable suicide risk. This nationwide cohort study quantified the risks of intentional self-harm—including nonsuicidal self-injuries and suicide attempts—and death by suicide in BDD. MethodsIndividuals with a validated ICD-10 diagnosis of BDD in the Swedish National Patient Register, registered between January 1, 1997, and December 31, 2020, were matched with 10 unexposed individuals (i.e., without BDD) from the general population on birth year, sex, and county of residence. Conditional Poisson regression models estimated incidence rate ratios and 95% CIs for intentional self-harm. Stratified Cox proportional hazards models estimated hazard ratios and 95% CIs for death by suicide. Models adjusted for sociodemographic variables and lifetime psychiatric comorbidities. ResultsAmong 2833 individuals with BDD and 28,330 unexposed matched individuals, 466 (16.45%) and 1071 (3.78%), respectively, had at least 1 record of intentional self-harm during the study period (incidence rate ratio = 3.37; 95% CI, 3.02–3.76). In the BDD group, about two-thirds (n = 314; 67%) had their first recorded self-harm event before their first BDD diagnosis. A total of 17 (0.60%) individuals with BDD and 27 (0.10%) unexposed individuals died by suicide (hazard ratio = 3.47; 95% CI, 1.76–6.85). All results remained robust to additional adjustment for lifetime psychiatric comorbidities. A higher proportion of individuals with BDD who died by suicide had at least 1 previous record of intentional self-harm compared with unexposed individuals (52.94% vs. 22.22%; p = .036). ConclusionsBDD was associated with a 3-fold increased risk of intentional self-harm and death by suicide.

Adolescents Who Do Not Endorse Risk via the Patient Health Questionnaire Before Self-Harm or Suicide

Given that the Patient Health Questionnaire (PHQ) item 9 is commonly used to screen for risk of self-harm and suicide, it is important that clinicians recognize circumstances when at-risk adolescents may go undetected. To understand characteristics of adolescents with a history of depression who do not endorse the PHQ item 9 before a near-term intentional self-harm event or suicide. This was a retrospective cohort study design using electronic health record and claims data from January 2009 through September 2017. Settings included primary care and mental health specialty clinics across 7 integrated US health care systems. Included in the study were adolescents aged 13 to 17 years with history of depression who completed the PHQ item 9 within 30 or 90 days before self-harm or suicide. Study data were analyzed September 2022 to April 2023. Demographic, diagnostic, treatment, and health care utilization characteristics. Responded "not at all" (score = 0) to PHQ item 9 regarding thoughts of death or self-harm within 30 or 90 days before self-harm or suicide. The study included 691 adolescents (mean [SD] age, 15.3 [1.3] years; 541 female [78.3%]) in the 30-day cohort and 1024 adolescents (mean [SD] age, 15.3 [1.3] years; 791 female [77.2%]) in the 90-day cohort. A total of 197 of 691 adolescents (29%) and 330 of 1024 adolescents (32%), respectively, scored 0 before self-harm or suicide on the PHQ item 9 in the 30- and 90-day cohorts. Adolescents seen in primary care (odds ratio [OR], 1.5; 95% CI, 1.0-2.1; P = .03) and older adolescents (OR, 1.2; 95% CI, 1.0-1.3; P = .02) had increased odds of scoring 0 within 90 days of a self-harm event or suicide, and adolescents with a history of inpatient hospitalization and a mental health diagnosis had twice the odds (OR, 2.0; 95% CI, 1.3-3.0; P = .001) of scoring 0 within 30 days. Conversely, adolescents with diagnoses of eating disorders were significantly less likely to score 0 on item 9 (OR, 0.4; 95% CI, 0.2-0.8; P = .007) within 90 days. Study results suggest that older age, history of an inpatient mental health encounter, or being screened in primary care were associated with at-risk adolescents being less likely to endorse having thoughts of death and self-harm on the PHQ item 9 before a self-harm event or suicide death. As use of the PHQ becomes more widespread in practice, additional research is needed for understanding reasons why many at-risk adolescents do not endorse thoughts of death and self-harm.

Severe Maternal Morbidity and Mental Health Hospitalizations or Emergency Department Visits

Severe maternal morbidity (SMM) can have long-term health consequences for the affected mother. The association between SMM and future maternal mental health conditions has not been well studied. To assess the association between SMM in the first recorded birth and the risk of hospitalization or emergency department (ED) visits for a mental health condition over a 13-year period. This population-based retrospective cohort study used data from postpartum individuals aged 18 to 55 years with a first hospital delivery between 2008 and 2021 in 11 provinces and territories in Canada, except Québec. Data were analyzed from January to June 2023. SMM, defined as a composite of conditions, such as septic shock, severe preeclampsia or eclampsia, severe hemorrhage with intervention, or other complications, occurring after 20 weeks' gestation and up to 42 days after a first delivery. The main outcome was a hospitalization or ED visit for a mental health condition, including mood and anxiety disorders, substance use, schizophrenia, and other psychotic disorder, or suicidality or self-harm event, arising at least 43 days after the first birth hospitalization. Cox regression models generated hazard ratios with 95% CIs, adjusted for baseline maternal comorbidities, maternal age at delivery, income quintile, type of residence, hospital type, and delivery year. Of 2 026 594 individuals with a first hospital delivery, 1 579 392 individuals (mean [SD] age, 30.0 [5.4] years) had complete ED and hospital records and were included in analyses; among these, 35 825 individuals (2.3%) had SMM. Compared with individuals without SMM, those with SMM were older (mean [SD] age, 29.9 [5.4] years vs 30.7 [6.0] years), were more likely to deliver in a teaching tertiary care hospital (40.8% vs 51.1%), and to have preexisting conditions (eg, ≥2 conditions: 1.2% vs 5.3%), gestational diabetes (8.2% vs 11.7%), stillbirth (0.5% vs 1.6%), preterm birth (7.7% vs 25.0%), or cesarean delivery (31.0% vs 54.3%). After a median (IQR) duration of 2.6 (1.3-6.4) years, 1287 (96.1 per 10 000) individuals with SMM had a mental health hospitalization or ED visit, compared with 41 779 (73.2 per 10 000) individuals without SMM (adjusted hazard ratio, 1.26 [95% CI, 1.19-1.34]). In this cohort study of postpartum individuals with and without SMM in pregnancy and delivery, there was an increased risk of mental health hospitalizations or ED visits up to 13 years after a delivery complicated by SMM. Enhanced surveillance and provision of postpartum mental health resources may be especially important after SMM.

Depression and comorbid obstructive sleep apnea: Association between positive airway pressure adherence, occurrence of self-harm events, healthcare resource utilization, and costs

ObjectivePrevious studies have shown that treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) therapy in patients with depression may improve depression symptoms and response to antidepressant therapy. We investigated the association between PAP therapy adherence, self-harm events, healthcare resource utilization (HCRU), and costs over 2 years in a national sample of patients with pre-existing depression and newly diagnosed comorbid OSA. MethodsAdministrative claims data were linked to objective PAP therapy usage. Inverse probability treatment weighting was used to compare outcomes over 2 years across PAP adherence levels. The predicted numbers of emergency room (ER) visits and hospitalizations by adherence level were assessed using risk-adjusted generalized linear models. Results37,459 patients were included. Relative to non-adherent patients, consistently adherent patients had fewer self-harm events (0.04 vs 0.05, p < 0.001) after 1 year, and significantly (all p < 0.001) fewer ER visits (0.66 vs 0.86) and all-cause hospitalizations (0.13 vs 0.17), and lower total ($11,847 vs $11,955), inpatient hospitalization ($1634 vs $2274), and ER visit ($760 vs $1006) costs per patient in the second year of PAP therapy. Consistently adherent patients showed lower risk for hospitalizations and ER visits. LimitationsUsing observational claims data, we were unable to assess clinical characteristics including sleep, sleepiness, and daytime symptoms, or important social determinants of health. We were limited in assessing care received outside of the included health plans. ConclusionConsistent adherence to PAP therapy over 2 years was associated with improved HCRU outcomes for patients with pre-existing depression newly diagnosed with comorbid OSA.

Childhood cognitive ability and self-harm and suicide in later life

BackgroundSelf-harm and suicide remain prevalent in later life. For younger adults, higher early-life cognitive ability appears to predict lower self-harm and suicide risk. Comparatively little is known about these associations among middle-aged and older adults. MethodsThis study examined the association between childhood (age 11) cognitive ability and self-harm and suicide risk among a Scotland-wide cohort (N = 53037), using hospital admission and mortality records to follow individuals from age 34 to 85. Multistate models examined the association between childhood cognitive ability and transitions between unaffected, self-harm, and then suicide or non-suicide death. ResultsAfter adjusting for childhood and adulthood socioeconomic conditions, higher childhood cognitive ability was significantly associated with reduced risk of self-harm among both males (451 events; HR = 0.90, 95% CI [0.82, 0.99]) and females (516 events; HR = 0.89, 95% CI [0.81, 0.98]). Childhood cognitive ability was not significantly associated with suicide risk among those with (Male: 16 events, HR = 1.05, 95% CI [0.61, 1.80]; Female: 13 events, HR = 1.08, 95% CI [0.55, 2.15]) or without self-harm events (Male: 118 events, HR = 1.17, 95% CI [0.84, 1.63]; Female: 31 events, HR = 1.30, 95% CI [0.70, 2.41]). LimitationsThe study only includes self-harm events that result in a hospital admission and does not account for self-harm prior to follow-up. ConclusionsThis extends work on cognitive ability and mental health, demonstrating that these associations can span the life course and into middle and older age.

Access, Utilization, and Quality of Behavioral Health Integration in Medicaid Managed Care

Many states have moved from models that carve out to those that carve in or integrate behavioral health in their Medicaid managed care organizations (MCOs), but little evidence exists about the effect of this change. To assess the association of the transition to integrated managed care (IMC) in Washington Medicaid with health services use, quality, health-related outcomes, and measures associated with social determinants of health. This cohort study used difference-in-differences analyses of Washington State's 2014 to 2019 staggered rollout of IMC on claims-based measures for enrollees in Washington's Medicaid MCO. It was supplemented with interviews of 24 behavioral health agency leaders, managed care administrators, and individuals who were participating in the IMC transition. The data were analyzed between February 1, 2023, and September 30, 2023. Claims-based measures of utilization (including specialty mental health visits and primary care visits); health-related outcomes (including self-harm events); rates of arrests, employment, and homelessness; and additional quality measures. This cohort study included 1 454 185 individuals ages 13 to 64 years (743 668 female [51.1%]; 14 306 American Indian and Alaska Native [1.0%], 132 804 Asian American and Pacific Islander [9.1%], 112 442 Black [7.7%], 258 389 Hispanic [17.8%], and 810 304 White [55.7%] individuals). Financial integration was not associated with changes in claims-based measures of utilization and quality. Most claims-based measures of outcomes were also unchanged, although enrollees with mild or moderate mental illness experienced a slight decrease in cardiac events (-0.8%; 95% CI, -1.4 to -0.2), while enrollees with serious mental illness experienced small decreases in employment (-1.2%; 95% CI -1.9 to -0.5) and small increases in arrests (0.5%; 95% CI, 0.1 to 1.0). Interviews with key informants suggested that financial integration was perceived as an administrative change and did not have substantial implications for how practices delivered care; behavioral health agencies lacked guidance on how to integrate care in behavioral health settings and struggled with new contracts and regulatory policies that may have inhibited the ability to provide integrated care. The results of this cohort study suggest that financial integration at the MCO level was not associated with significant changes in most measures of utilization, quality, outcomes, and social determinants of health. Additional support, including monitoring, training, and funding, may be necessary to drive delivery system changes to improve access, quality, and outcomes.

Predicting risk of suicidal behavior from insurance claims data vs. linked data from insurance claims and electronic health records.

Observational studies assessing effects of medical products on suicidal behavior often rely on health record data to account for pre-existing risk. We assess whether high-dimensional models predicting suicide risk using data derived from insurance claims and electronic health records (EHRs) are superior to models using data from insurance claims alone. Data were from seven large health systems identified outpatient mental health visits by patients aged 11 or older between 1/1/2009 and 9/30/2017. Data for the 5 years prior to each visit identified potential predictors of suicidal behavior typically available from insurance claims (e.g., mental health diagnoses, procedure codes, medication dispensings) and additional potential predictors available from EHRs (self-reported race and ethnicity, responses to Patient Health Questionnaire or PHQ-9 depression questionnaires). Nonfatal self-harm events following each visit were identified from insurance claims data and fatal self-harm events were identified by linkage to state mortality records. Random forest models predicting nonfatal or fatal self-harm over 90 days following each visit were developed in a 70% random sample of visits and validated in a held-out sample of 30%. Performance of models using linked claims and EHR data was compared to models using claims data only. Among 15 845 047 encounters by 1 574 612 patients, 99 098 (0.6%) were followed by a self-harm event within 90 days. Overall classification performance did not differ between the best-fitting model using all data (area under the receiver operating curve or AUC = 0.846, 95% CI 0.839-0.854) and the best-fitting model limited to data available from insurance claims (AUC = 0.846, 95% CI 0.838-0.853). Competing models showed similar classification performance across a range of cut-points and similar calibration performance across a range of risk strata. Results were similar when the sample was limited to health systems and time periods where PHQ-9 depression questionnaires were recorded more frequently. Investigators using health record data to account for pre-existing risk in observational studies of suicidal behavior need not limit that research to databases including linked EHR data.

Assessing the risk of intentional self-harm in montelukast users: an updated Sentinel System analysis using ICD-10 coding

Background Montelukast prescribing information includes a Boxed Warning issued in March 2020 regarding neuropsychiatric adverse events. A previous Sentinel System study of asthma patients from 2000 to 2015 did not demonstrate an increased risk of intentional self-harm measured using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, with montelukast compared to inhaled corticosteroids (ICS). Methods Using a new user cohort study design, we examined intentional self-harm events in patients aged 10 years and older who were incident users of either montelukast or ICS as monotherapy, with a diagnosis of asthma, between October 1, 2015, to June 30, 2022, in the Sentinel System. We measured intentional self-harm using ICD-10-CM codes, which may have better accuracy for capturing suicide attempts than ICD-9-CM codes. We used inverse probability of treatment weighting to balance baseline covariates. We performed subgroup analyses by age group, sex, psychiatric history, and pre/post Boxed Warning era and conducted sensitivity analyses varying type of care setting of the outcome and exposure episode gaps. Results Among 752,230 and 724,855 patients in the montelukast and ICS exposure groups respectively, we found no association between montelukast use and self-harm compared to ICS use [Hazard Ratio (95% Confidence Interval): 0.96 (0.85, 1.08)]. This finding was consistent across all subgroups, and sensitivity analyses. Conclusion Our results cannot exclude other neuropsychiatric idiosyncratic reactions to montelukast. Compared to the previous Sentinel study, this study identified about double the rate of self-harm events, suggesting a greater sensitivity of ICD-10 codes for measuring self-harm than ICD-9.

정신건강의학과 환자안전사고 분석(2017-2021)

The study was undertaken to investigate the occurrence and risk levels of patient safety incidents in the mental health department of domestic medical institutions, aiming to provide essential data for formulating strategies to prevent such incidents in the future.&#x0D; The data for this study were collected nationwide from medical institutions accredited by the Korean Institute for Healthcare Accreditation, with a focus on patient safety statistics. A total of 521 cases from comprehensive and tertiary hospitals with more than 200 beds, classified under the department of mental health and psychiatry, were analyzed. Data analysis was performed using SPSS/WIN 27.0 software, encompassing descriptive statistics, cross-tabulation analysis, and binary logistic regression.&#x0D; The results showed that the number of patient safety incidents increased slightly in 2020 and 2021 compared to 2017. However, the level of harm caused by these incidents indicated a trend of increasing near misses and decreasing adverse events from 2017 to 2021. Comprehensive hospitals had a significantly higher proportion of adverse events in patient safety incidents compared to tertiary hospitals. The results of binary logistic regression analysis revealed that comprehensive hospitals had a 2.459 times higher risk of adverse events compared to tertiary hospitals. When comparing incident types, the risk of adverse events for falls was 10.677 times higher, and for suicide and self-harm events, it was 66.103 times higher compared to medication errors. Regarding age groups, the risk of adverse events for the 20-39 age group was 3.335 times higher compared to the 0-19 age group. For the 40-59 age group, the risk was 4.911 times higher for the 60-79 age group, it was 5.340 times higher, and for the 80 years and above age group, it was 4.027 times higher . The goodness of fit test for the final model indicated a good fit, and the model's explanatory power was 30.2%.&#x0D; Based on the study results, there is a need for a systematic analysis of nursing staff levels in comprehensive hospitals and their relationship with patient safety incidents and it is crucial to prioritize comprehensive hospitals when devising patient safety incident prevention measures in mental health. Suicide and self-harm prevention, and fall prevention strategies, should be considered as indispensable components. Furthermore, it is recommended to give priority to implementing patient safety incident prevention strategies for individuals aged 60-79 years of age.

A retrospective study of attempted self-harm in a secondary care setting in rural India

Background: Suicides and non-suicidal self-injuries (NSSI) pose a serious public health problem, affecting communities all over the world. Adolescents and young adults are particularly vulnerable to commit self-harm (SH). SH causes serious emotional, physical, and economic repercussions, and leads to long-term health impacts. Methods: A retrospective study was conducted in a rural secondary care hospital from Feb 2020 to March 2022. Data regarding demographics, cause and type of SH, and treatment provided to 190 patients were analysed. Results: Majority of patients were in the 16-35 years age group. Poison consumption was the commonest method used. Pesticides and pills were the commonly-used agents. Agricultural activities and pre-existing illness in families facilitated access to these agents, as did the unregulated availability and unsafe storage. 31 patients disclosed the reason for SH, with the commonest reason being strained relationships. Emotional states described by the patients which pushed them to SH included dejection, hopelessness, anger, recklessness, altered mood, lack of purpose in life, cynicism and a sense of lack of support. 16% were discharged against medical advice. Conclusions: The study identified the need for methodical documentation, referral and follow-up of patients, with adequate psychiatric and counselling support. Access to care for SH patients is lacking especially in rural areas, and is at best available only for management of the SH event. SH should be considered not as a disease by itself, but as an outcome of stress due to socio-economic and other factors. Multi-stakeholder convergent approaches are needed to tackle this challenge in a holistic manner.

Stability of Suicide Risk Prediction Models During Changes in Health Care Delivery.

The authors aimed to use health records data to examine how the accuracy of statistical models predicting self-harm or suicide changed between 2015 and 2019, as health systems implemented suicide prevention programs. Data from four large health systems were used to identify specialty mental health visits by patients ages ≥11 years, assess 311 potential predictors of self-harm (including demographic characteristics, historical risk factors, and index visit characteristics), and ascertain fatal or nonfatal self-harm events over 90 days after each visit. New prediction models were developed with logistic regression with LASSO (least absolute shrinkage and selection operator) in random samples of visits (65%) from each calendar year and were validated in the remaining portion of the sample (35%). A model developed for visits from 2009 to mid-2015 showed similar classification performance and calibration accuracy in a new sample of about 13.1 million visits from late 2015 to 2019. Area under the receiver operating characteristic curve (AUC) ranged from 0.840 to 0.849 in the new sample, compared with 0.851 in the original sample. New models developed for each year for 2015-2019 had classification performance (AUC range 0.790-0.853), sensitivity, and positive predictive value similar to those of the previously developed model. Models selected similar predictors from 2015 to 2019, except for more frequent selection of depression questionnaire data in later years, when questionnaires were more frequently recorded. A self-harm prediction model developed with 2009-2015 visit data performed similarly when applied to 2015-2019 visits. New models did not yield superior performance or identify different predictors.

Self-Harm Events and Suicide Deaths Among Autistic Individuals in Ontario, Canada

Reasons for elevated suicide risks among autistic people are unclear, with insufficient population-based research on sex-specific patterns to inform tailored prevention and intervention. To examine sex-stratified rates of self-harm events and suicide death among autistic individuals compared with nonautistic individuals, as well as the associated sociodemographic and clinical risk factors. This population-based matched-cohort study using linked health administrative databases in Ontario, Canada included all individuals with physician-recorded autism diagnoses from April 1, 1988, to March 31, 2018, each matched on age and sex to 4 nonautistic individuals from the general population. Self-harm events resulting in emergency health care from April 1, 2005, to December 31, 2020, were examined for one cohort, and death by suicide and other causes from April 1, 1993, to December 31, 2018, were examined for another cohort. Statistical analyses were conducted between October 2021 and June 2023. Physician-recorded autism diagnoses from 1988 to 2018 from health administrative databases. Autistic and nonautistic individuals who were sex stratified a priori were compared using Andersen-Gill recurrent event models on self-harm events, and cause-specific competing risk models on death by suicide or other causes. Neighborhood-level income and rurality indices, and individual-level broad diagnostic categories of intellectual disabilities, mood and anxiety disorders, schizophrenia spectrum disorders, substance use disorders, and personality disorders were covariates. For self-harm events (cohort, 379 630 individuals; median age at maximum follow-up, 20 years [IQR, 15-28 years]; median age of first autism diagnosis claim for autistic individuals, 9 years [IQR, 4-15 years]; 19 800 autistic females, 56 126 autistic males 79 200 nonautistic females, and 224 504 nonautistic males), among both sexes, autism diagnoses had independent associations with self-harm events (females: relative rate, 1.83; 95% CI, 1.61-2.08; males: relative rate, 1.47; 95% CI, 1.28-1.69) after accounting for income, rurality, intellectual disabilities, and psychiatric diagnoses. For suicide death (cohort, 334 690 individuals; median age at maximum follow-up, 19 years [IQR, 14-27 years]; median age of first autism diagnosis claim for autistic individuals, 10 years [IQR, 5-16 years]; 17 982 autistic females, 48 956 autistic males, 71 928 nonautistic females, 195 824 nonautistic males), there was a significantly higher crude hazard ratio among autistic females (1.98; 95% CI, 1.11-3.56) and a nonsignificantly higher crude hazard ratio among autistic males (1.34; 95% CI, 0.99-1.82); the increased risks were associated with psychiatric diagnoses. This cohort study suggests that autistic individuals experienced increased risks of self-harm events and suicide death. Psychiatric diagnoses were significantly associated with the increased risks among both sexes, especially for suicide death, and in partially sex-unique ways. Autism-tailored and autism-informed clinical and social support to reduce suicide risks should consider multifactorial mechanisms, with a particular focus on the prevention and timely treatment of psychiatric illnesses.

Positive Predictive Value of ICD-10 Codes to Identify Acute Suicidal and Self Harm Behaviors.

The accuracy of diagnosis codes to identify suicidal behaviors, including suicide ideation (SI) and self-harm (SH) events, is unknown. The objective of this study was to determine the positive predictive value (PPV) of International Classification of Disease, 10th Revision codes to identify SI/SH events that may be used in studies using administrative and claims data. We performed a secondary analysis of a cross-sectional study of children 5 to 17 years of age hospitalized at 2 US children's hospitals with a discharge diagnosis of a neuropsychiatric event, including an SI or SH event. A true International Classification of Disease, 10th Revision SI or SH diagnosis was defined as SI or SH present on admission and directly related to hospitalization as compared with physician record review. PPV with 95% confidence intervals (CIs) were calculated overall and stratified by diagnosis order and age (5 to 11 years vs 12 to 17 years). There were 376 children or adolescents with a discharge diagnosis of an SI or SH event. The median age was 14 years, and the majority of individuals were female (58%), non-Hispanic White (69%), and privately insured (57%). A total of 332 confirmed SI/SH cases were identified with a PPV of 0.88 (95% CI 0.85-0.91). PPVs were similar when stratified by diagnosis order: primary 0.94 (95% 0.88-0.97) versus secondary 0.86 (95% CI 81-90). PPVs were also similar in adolescents (0.89, CI 0.85-0.92) compared with children (0.84, 95% CI 0.74-0.91). The use of these validated code sets to identify SI or SH events may minimize misclassification in future studies of suicidal and self-harm hospitalizations.

Psychosocial Factors Behind Deliberate Self-Poisoning in a Tertiary Care Hospital of Bangladesh: A Cross-Sectional Study.

Deliberate self-poisoning (DSP) is an important cause of hospital admissions and subsequent mortality. We conducted a cross-sectional observational study in a tertiary-level teaching hospital situated in the northeastern part of Bangladesh to analyze the psychosocial factors responsible forDSP. This cross-sectional observational study was carried out amongpatients with DSP admitted to the medicine ward from January to December 2017, irrespective of gender, except for cases involving poisoning due to spoiled food, food contaminated by infectious organisms, poisoning by venomous animals, and street poisoning (commuter or travel-related poisoning).Consultant psychiatrist in accordance with the Diagnostic & Statistical Manual of Mental Disorder - IV (DSM-IV) confirmed psychiatric disorders. Data were analyzed by SPSS (Statistical Package for social sciences) version 16.0 (IBM Corp., Armonk, NY). Total 100 patients were enrolled. Among them, 43%were male and 57%were female. The majority (85%) of the patients were young, aged below 30 years. The mean age of male patients was 26.2 years and that of females was 21.69 years. Most of the DSP patients were from the lower economic class (59%). The population sample was remarkable for students (Prevalence 37%). The highest percentage of patients (33%) had their educational status at the secondary level. The common reasons for DSP were a family problem in 31% patients, quarrel with boy/girlfriend in 20%, quarrel with a spouse in 13%, quarrel with parents or other family member in 7%, failure in examination in 6%, poverty in 3%, and unemployment in 3%. Prescription medicationwas the most common poison material (38%), followed by insecticides (36%), household cleaners (17%), and rodenticides (8%). Seven (7%) patients reported previous deliberate self-harm events and co-morbid psychiatric disorder was present in 30% patients among them major depressive disorder was found in 60%, and schizophrenia in 23.3% cases. DSP remains a problem mainly for the young with gender ratio-favoring females. The majority of DSPs were educated up to secondary level, unmarried, residents of rural areas, student, and belonged to the lower class. Familial disharmony and quarrel with spouse or friends were the common reason behind DSP. Prescription medication and insecticides were commonly used for DSP. Psychiatric disorders, primarily depressive disorder, and schizophreniawere common in cases of DSP.

0553 Prevalence of Insomnia and Anxiety in a National Sample of Patients with Obstructive Sleep Apnea and Depression

Abstract Introduction Insomnia and anxiety are highly comorbid both with depression and with obstructive sleep apnea (OSA). This retrospective study sought to characterize patients with these conditions among a national sample of individuals with depression and comorbid OSA. Methods A national sample of administrative claims data of OSA patients was used for this analysis. Included patients either had two healthcare encounters or one hospitalization with a depression ICD-10 diagnosis code the year prior to OSA diagnosis and before initiation on positive airway pressure (PAP) therapy for treatment of OSA. Anxiety, insomnia, and other comorbidities were identified by the presence of at least one ICD-10 code associated with healthcare encounters in the year prior to starting PAP therapy. Age, sex, and insurance coverage were characterized at the time of the first OSA diagnostic sleep test. Healthcare resource utilization was assessed for the year prior to starting PAP therapy. Results 36,668 patients with depression and comorbid OSA were included. 56% had comorbid anxiety, 28% had comorbid insomnia, and 35% had neither anxiety nor insomnia. Compared to those without anxiety or insomnia, patients with anxiety or insomnia were more commonly female (64% vs 57%) and had a higher prevalence of asthma (25% vs 20%), psychotic (14% vs 7%) and other mood disorders (24% vs. 14%), fibromyalgia (11% vs 7%) and GERD (43% vs 33%). Relative to individuals with insomnia or anxiety, patients without insomnia or anxiety experienced fewer ER visits, all-cause hospitalizations, depression-related hospitalizations, specialist visits, and self-harm events in the year prior to PAP initiation. Relative to patients with comorbid insomnia, those with comorbid anxiety demonstrated slightly higher healthcare resource use in the year prior to PAP initiation. Conclusion Anxiety and insomnia are prevalent comorbidities in patients with depression and obstructive sleep apnea, with more than half of patients suffering comorbid anxiety and a quarter of patients having comorbid insomnia. Future research should examine comprehensive patient care strategies that can be used in patients with comorbid anxiety or insomnia to encourage healthy sleep behaviors and successful acclimation to OSA treatment. Support (if any) ResMed

Characteristics Associated With Serious Self-Harm Events in Children and Adolescents.

To identify patterns of psychiatric comorbidity among children and adolescents with a serious self-harm event. We studied children aged 5 to 18 years hospitalized with a neuropsychiatric event at 2 children's hospitals from April 2016 to March 2020. We used Bayesian profile regression to identify distinct clinical profiles of risk for self-harm events from 32 covariates: age, sex, and 30 mental health diagnostic groups. Odds ratios (ORs) and 95% credible intervals (CIs) were calculated compared with a reference profile with the overall baseline risk of the cohort. We included 1098 children hospitalized with a neuropsychiatric event (median age 14 years [interquartile range (IQR) 11-16]). Of these, 406 (37%) were diagnosed with a self-harm event. We identified 4 distinct profiles with varying risk for a self-harm diagnosis. The low-risk profile (median 0.035 [IQR 0.029-0.041]; OR 0.08, 95% CI 0.04-0.15) was composed primarily of children aged 5 to 9 years without a previous psychiatric diagnosis. The moderate-risk profile (median 0.30 [IQR 0.27-0.33]; reference profile) included psychiatric diagnoses without depressive disorders. Older female adolescents with a combination of anxiety, depression, substance, and trauma disorders characterized the high-risk profile (median 0.69 [IQR 0.67-0.70]; OR 5.09, 95% CI 3.11-8.38). Younger males with mood and developmental disorders represented the very high-risk profile (median 0.76 [IQR 0.73-0.79]; OR 7.21, 95% CI 3.69-15.20). We describe 4 separate profiles of psychiatric comorbidity that can help identify children at elevated risk for a self-harm event and subsequent opportunities for intervention.