Suicide Attempts Among a Cohort of Transgender and Gender Diverse People

INTRODUCTION: Transgender and gender diverse people often face discrimination and may experience disproportionate emotional distress that leads to suicide attempts. Therefore, it is essential to estimate the frequency and potential determinants of suicide attempts among transgender and gender diverse individuals. METHODS: Longitudinal data on 6,327 transgender and gender diverse individuals enrolled in 3 integrated healthcare systems were analyzed to assess suicide attempt rates. Incidence was compared between transmasculine and transfeminine people by age and race/ethnicity and according to mental health status at baseline. Cox proportional hazards models examined rates and predictors of suicide attempts during follow-up. Data were collected in 2016, and analyses were conducted in 2019. RESULTS: During follow-up, 4.8% of transmasculine and 3.0% of transfeminine patients had at least 1 suicide attempt. Suicide attempt rates were more than 7 times higher among patients aged45 years, more than 3 times higher among patients with previous history of suicide ideation or suicide attempts than among those with no such history, and 2-5 times higher among those with 1-2 mental health diagnoses and more than 2 mental health diagnoses at baseline than among those with none. CONCLUSIONS: Among transgender and gender diverse individuals, younger people, people with previous suicidal ideation or attempts, and people with multiple mental health diagnoses are at a higher risk for suicide attempts. Future research should examine the impact of gender-affirming healthcare use on the risk of suicide attempts and identify targets for suicide prevention interventions among transgender and gender diverse people in clinical settings

Adolescent Psychiatry

Psychiatric disorders in adolescents are an important social problem relevant to almost all healthcare professionals. The prevalence of mood, anxiety, substance use and other psychiatric disorders among adolescents is high. However, medical professionals are not sufficiently trained about adolescent psychiatric disorders. Primary care providers correctly identify less than a fourth of youth with a depressive or anxiety disorder and many clinicians underestimate the importance of the problem of adolescent psychiatric illnesses and suicidal behavior. Multiple clinical, neurobiological, cultural and legal aspects of psychiatric disorders in adolescents are discussed in this book

Decreasing Suicidal Risks among Military Veterans with Posttraumatic Stress Disorder or Major Depression

Suicide is a major cause of death in the United States. Some populations, such as the veterans and active duty military personnel are at a higher risk of committing suicide compared to the general population. The risk is exacerbated by mental health conditions such as Posttraumatic Stress Disorder (PTSD) and major depression. Few reviews have explored the effects of the recommended psychotherapeutic interventions on suicidal ideations and suicide rates for these two disorders, focusing on the veteran population. To address this, a literature search was performed using a comprehensive search through electronic databases, applying the search criteria and keywords aimed at identifying appropriate journal articles. Treatment with CPT and PE for PTSD has been found effective in decreasing suicidal thoughts, intents, and attempts. On the other hand, CBT has been found effective in decreasing suicidal thoughts among veterans with various symptoms of depression. Given that the recommended PTSD and depression treatment can have the additional benefit of decreasing the risk of suicide, it is important for clinicians to always assess the risk of suicide for veterans diagnosed with these conditions. Future research should seek to explain the mechanism by which the explored psychotherapeutic interventions decrease suicidal thoughts, intents, and attempts in patients with PTSD or depression to address the inconsistencies in the present body of evidence

Psychotherapeutic Treatment of Post-Traumatic Disorder in Rural Veterans

Post-traumatic stress disorder (PTSD) is a significant health issue among the veteran population. PTSD can lead to adverse outcomes such as suicide, violence, substance abuse, and an overall decreased quality of life. Psychotherapy has demonstrated effectiveness in treating PTSD. However, providers may not be aware which specific types of psychotherapy have achieved the strongest levels of evidence . Additional challenges exist in treating rural veterans because of barriers such as geographical distance and a shortage of mental health providers. These obstacles may place rural veterans at higher risk. The purpose of this project was to explore the current evidence that supports the use of psychotherapy in the treatment of PTSD and discuss how these strategies might be implemented for veterans in a rural setting. Shapiro\u27s Adaptive Information Processing Model served as a theoretical framework for this project . The methods used to conduct this project consisted of first performing a literature review of pertinent articles and current practice guidelines. Expert clinicians within the community were consulted to gain further insight and directly observe some clinical applications of these therapies. Collaborative efforts were made with contacts from the Department of Defense Centers of Excellence and an upper-Midwest rural health agency . A variety of web-based training modules related to the practice of psychotherapy for veterans with PTSD were also reviewed . The findings of this project revealed that cognitive behavioral-based therapies, such as Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy as well as eye movement desensitization and reprocessing (EMDR) demonstrate the greatest level of efficacy in treating PTSD. Technological advances such as telemental health services or virtual reality-based interventions may improve accessibility to rural veterans . Integrating PTSD treatment options into primary care settings, such as community-based clinics may also improve barriers to seeking treatment. These results have been disseminated to local providers via informational pamphlets and poster presentations. Several accessible, online training websites have also been included as resources that can assist providers in gaining increased knowledge and understanding specific to the psychotherapies discussed as well as issues pertinent to military culture and programs. By increasing providers\u27 awareness of these evidence-based practices, it is hopeful that better care can be offered to rural veterans in treating their symptoms of PTSD and improving overall quality of life

Behavioral addictions in bipolar disorders: A systematic review

Clinical and epidemiological research suggests that behavioral addictions (BA) are associated with a wide range of psychiatric disorders. However, the relationship between BA and bipolar disorders (BD) has not been thoroughly explored. The aim of this systematic review was to critically summarize and evaluate the current available evidence regarding a possible association between BA and BD. A systematic review of major electronic databases according to PRISMA guidelines was conducted from inception to 31st December 2017. We sought quantitative studies data concerning prevalence of comorbidity, features and treatment related to BA-BD comorbidity. Data were narratively synthesized. Of the 1250 studies returned from the search, a total of 28 articles were included in this review. BA may be overrepresented in BD samples, and the other way around. Pathological gambling and kleptomania were the most prevalent conditions followed by compulsive buying, compulsive sexual behavior and internet addiction. BA was also associated with other mood disorders, anxiety disorders and substance use disorder. BD-BA comorbidity was related with more severe course of illness. Studies on treatment strategies for BD-BA comorbidity are rather limited; only one randomized controlled trial that fulfilled inclusion criteria was identified. Methodological heterogeneity in terms of design and results among studies was found. BD-BA commonly co-occurs although there is a need for rigorous studies. Routine screening and adequate assessment may be helpful in BD patients to identify individuals at risk for BA and to effectively manage the complex consequences associated with BA-BD comorbidity

Clinical features, comorbidity, and cognitive impairment in elderly bipolar patients

INTRODUCTION: Data specific to late-life bipolar disorder (BD) are limited. Current research is sparse and present guidelines are not adapted to this group of patients. OBJECTIVES: We present a literature review on clinical characteristics, comorbidities, and cognitive impairment in patients with late-life BD. This review discusses common comorbidities that affect BD elders and how aging might affect cognition and treatment. METHODS: Eligible studies were identified in MedLine by the Medical Subject Headings terms 'bipolar disorder' and 'aged'. We only included original research reports published in English between 2012 and 2015. RESULTS: From 414 articles extracted, 16 studies were included in the review. Cardiovascular and respiratory conditions, type II diabetes, and endocrinological abnormalities were observed as highly prevalent. BD is associated with a high suicide risk. Bipolar elderly had an increased risk of dementia and performed worse on cognitive screening tests compared to age-matched controls across different levels of cognition. Despite high rates of medical comorbidity among bipolar elderly, a systematic under-recognition and undertreatment of cardiovascular disease have been suggested. CONCLUSION: There was a high burden of physical comorbidities and cognitive impairment in late-life BD. Bipolar elderly might be under-recorded and undertreated in primary medical care, indicating that this group needs an adapted clinical assessment and specific clinical guidelines need to be established