Tag: Co-occurring medical illness

Optimizing Care to Prevent Diabetes and Promote Cardiovascular Health Among Younger Adults with Severe Mental Illness

Grant Details

Funder: NIMH

Grant number: 1K23MH126078

Grant period: 4/1/2022 – 3/31/2027

Brief narrative: People with severe mental illness (SMI) face double the risk for type 2 diabetes compared to the general population, contributing to higher rates of cardiovascular disease and premature death. Common use of antipsychotic medications contributes to these health risks due to prevalent metabolic side effects. Many younger adults with SMI do not receive targeted, evidence-based cardiometabolic disease prevention care. Underused strategies include: prescribing alternative, less obesogenic psychotropic medications; lifestyle change supports; additional risk-reducing medications; and smoking cessation therapies. Our preliminary qualitative data with patients and clinicians identified a need for tools to match prevention care to individuals’ risk level and preferences, and tools suited to population-based care strategies. Clinical Decision Support (CDS) tools are computer algorithms that use patients’ data, predictive analytics, and clinical guidelines to promote evidence-based care by helping patients and clinicians navigate complex treatment decisions. Through this mentored K23 career development award, Esti Iturralde, PhD will build upon her background as a clinical psychologist and behavioral diabetes researcher. Through planned mentoring, coursework, and career development activities, Dr. Iturralde will gain a strong understanding of psychopharmacology and cardiometabolic health, advanced predictive analytics, and implementation science, including methods for stakeholder-engaged intervention design and pragmatic clinical trials. As a researcher in the Kaiser Permanente Northern California (KPNC) Division of Research (DOR), she will leverage robust, longitudinal electronic health record (EHR) data (> 50,000 adults from diverse racial/ethnic groups) and stakeholder insights (patients, clinicians, and health system decision-makers) within health systems including KPNC and 2 others belonging to the NIMH-funded Mental Health Research Network (HealthPartners Institute and Henry Ford Health System). The proposed research will support the training goals while contributing to the development of a novel CDS tool seeking to increase targeted, evidence-based diabetes and cardiovascular disease prevention care for adults under age 45 who are starting antipsychotic medications. Specific research aims are to: (1) inform predictive analytics of the CDS tool by developing and validating diabetes risk prediction models for the target population; (2) engage stakeholders in the design of CDS tool messaging and implementation pathways; and field-test CDS tool messaging through a pragmatic clinical trial conducted within an existing KPNC telehealth-based population management program serving this population. A future R01 application will build on the results from this project to further refine and test the CDS tool within multiple health systems. The linked research and training aims will directly prepare Dr. Iturralde for success as an embedded health system researcher and prepare her to lead a programmatic line of studies developing and implementing data-driven, feasible, scalable interventions improving the cardiometabolic health of people with SMI.

Lead site: KPNC (PI Esti Iturralde)

Current Status

Summary of Findings

Publications

Mental/Physical Comorbidity

Goals / Mission

To discuss potential papers, projects and proposals related to co-morbid medical conditions in people with mental illness, both locally and collaboratively across MHRN.

Research Priorities

  • Improving integration of behavioral health and primary care
  • Understanding and decreasing morbidity and mortality in those with serious mental illness
  • Determining and decreasing readmission rates for those with medical illness and psychiatric comorbidities
  • Improving medical medication adherence in those with mental illness
  • Understanding and decreasing the long-term negative effects of antipsychotic medications

Contact:

Rebecca Rossom, MD, MSCR

Health Institute for Education and Research

8170 33rd Ave. S

Minneapolis, MN 55425

Phone: 952-883-5466

Rebecca.C.Rossom@HealthPartners.com

Care of Mental, Physical and Substance Use Syndromes (COMPASS)

Project Name:
Care of Mental, Physical and Substance Use Syndromes (COMPASS)
Principal Investigator:
Sanne Magnan, MD PhD; Evaluation Director: Leif Solberg, MD
Principal Investigator Contact Information:
sannemagnan@gmail.com; Leif.I.Solberg@Healthpartners.com
Principal Investigator institution:
Institute for Clinical Systems Improvement; HealthPartners Institute
Funder
Centers for Medicare & Medicaid Services (CMS) / Center for Medicare & Medicaid Innovation (CMMI)
Funding Period:
07/2012 – 06/2015
Abstract:
Health care increasingly needs to develop ways to manage individuals with multiple coexisting chronic conditions. COMPASS is a partnership among 9 organizations and 18 care delivery systems nationally to implement the Collaborative Care model for patients in primary care suffering from depression as well as diabetes and/or cardiovascular disease that are not under control. The initiative reached approximately 4,000 patients in seven states, and improved depression in 40% and achieved control in 23% with diabetes and 58% with hypertension while improving patient satisfaction with care and physician satisfaction with the resources needed to manage such patients.
Grant Number:
CMS-ICI-12-001
Participating Sites:               
AIMS (Advancing Integrated Mental Health Solutions) Center at the University of Washington
Community Health Plan of Washington (CHPW)
HealthPartners Institute
Kaiser Permanente Colorado (KPCO)
Kaiser Permanente Southern California (KPSC)
Michigan Center for Clinical Systems Improvement (Mi-CCSI)
Mount Auburn Cambridge Independent Practice Association (MACIPA)
Pittsburgh Regional Health Initiative (PRHI)
Institute for Clinical Systems Improvement (ICSI)
Investigators:
Sanne Magnan, MD, PhD
Claire Neeley, MD
Leif Solberg, MD
Arne Beck, PhD
Karen Coleman, PhD
Jurgen Unutzer, MD
Rebecca Rossom, MD, MS
Lauren Crain, PhD
Michael Maciosek, PhD
Robin Whitebird, PhD, MSW, LISW
Major Goals:
The major goals are to increase the proportion of these complex uncontrolled patients who are now under control by 20% for patients with diabetes or hypertension, and to improve depression in 40%, while reducing healthcare costs
Description of study sample:
This was a demonstration project aimed at adults with active depression plus either diabetes or cardiovascular disease that were not under control. We initially targeted patients with Medicare or Medicaid, but later added other patient groups because of the unexpected difficulty of identifying and recruiting such patients.
Current Status:
The project was completed in 6/15, but most participating medical groups have continued it with a variety of modifications to fit their settings and needs
Study Registration:
N/A
Publications:
Coleman KJ, Hemmila T, Valenti MD, Smith 4, Quarrell R, Ruona LK, Brandenfels E, Hann B, Hinnenkamp T, Parra MD, Monkman J, Vos S, Rossom RC. Understanding the experience of care managers and relationship with patient outcomes: the COMPASS initiative. Gen Hosp Psychiatry. 2016 Aug 18. pii: S0163-8343(16)30164-5. doi: 10.1016/j.genhosppsych.2016.03.003. [Epub ahead of print]Coleman KJ, Magnan S, Neely C, Solberg L, Beck A, Trevis J, Heim C, Williams M, Katzelnick D, Unützer J, Pollock B, Hafer E, Ferguson R, Williams S. The COMPASS initiative: description of a nationwide collaborative approach to the care of patients with depression and diabetes and/or cardiovascular disease. Gen Hosp Psychiatry. 2016 Aug 18. pii: S0163-8343(16)30166-9. doi: 10.1016/j.genhosppsych.2016.05.007. [Epub ahead of print]Rossom RC, Solberg LI, Magnan S, Crain AL, Beck A, Coleman KJ, Katzelnick D, Williams MD, Neely C, Ohnsorg K, Whitebird R, Brandenfels E, Pollock B, Ferguson R, Williams S, Unützer J. Impact of a national collaborative care initiative for patients with depression and diabetes or cardiovascular disease. Gen Hosp Psychiatry. 2016 Aug 18. pii: S0163-8343(16)30165-7. doi: 10.1016/j.genhosppsych.2016.05.006. [Epub ahead of print]Solberg LI, Ferguson R, Ohnsorg KA, Crain AL, Williams MD, Ziegenfuss JY, et al. The challenges of collecting and using patient care data from diverse care systems: lessons from COMPASS. Am J Med Qual 2017;32(5):494-499.Whitebird RR, Solberg LI, Crain AL, Rossom RC, Beck A, Neely C, Dreskin M, Coleman KJ. Clinician burnout and satisfaction with resources in caring for complex patients. Gen Hosp Psychiatry. 2017;44(1):91-95. Jul 16. pii: S0163-8343(16)30167-0. doi: 10.1016/j.genhosppsych.2016.03.004. [Epub ahead of print]Solberg LI, Ohnsorg KA, Parker ED, Ferguson R, Magnan S, Whitebird RR, Neely C, Brandenfels E, Williams MD, Dreskin M, Hinnenkamp T, Ziegenfuss JY. Preventable hospital and emergency department events: lessons from a large innovation project. The Permanente Journal 2018 (In press).
Resources:
N/A
Lessons Learned:
It is possible to have multiple diverse health care organizations collaborate on a common improvement project and to use a common data system to aggregate data for reporting and analysis, although there are many challenges to doing so. Other lessons are available in the above publications. Additional publication in development describes the relation between care manager contacts and systematic case review to depression improvement.
What’s next?
Most participating organizations are continuing to use individually adapted versions of the COMPASS model for care but there will be no follow-on group project.

Comparative Risks and Benefits of Gender Reassignment Therapies

Project Name:
Comparative Risks and Benefits of Gender Reassignment Therapies
Principal Investigator:
Michael Goodman, MD MPH
Principal Investigator Contact Information:
mgoodm2@emory.edu
Principal Investigator institution:
Emory University
Funder
PCORI
Funding Period:
05/2013 – 04/2016
Abstract:
The goal of this study is to understand the short- and long-term health issues among transgender persons who had or are planning to have a sex change treatment. Members of the transgender community and their doctors express concerns about mental and physical health problems in this group of people; however, large studies of transgender persons in the United States have not been conducted. This project is an electronic medical record-based study evaluating a group of 6,500 transgender individuals, whose care is covered by the Veterans Administration (nationally) or by Kaiser Permanente (in Georgia and in Northern and Southern California). In this study, we will compare frequencies of various diseases and deaths from various causes in transgender persons and separately in those who request female-to-male and male-to-female sex change to similar measures in a sample of men and women who are not transgender and are of the same age and race. We will also compare health problems by treatment categories (e.g., no medical treatment, versus treatment with hormones only, versus hormones plus surgery). The proposed project will be carried out by a team that includes experts in chronic and infectious diseases, mental disorders, and sexual minority health issues. All of the project activities will be implemented in consultation with the study advisors who will serve as advocates for the transgender community. This will likely be the largest study of transgender persons available to date, and the first study of its kind conducted in the United States.
Grant Number:
N/A
Participating Sites:               
Emory University
Kaiser Permanente Georgia
Kaiser Permanente Northern California
Kaiser Permanente Southern California
The Veterans Health Administration
Investigators:
Michael Goodman
Ashli Owen-Smith
Dennis Tolsma
Enid Hunkeler
Virginia Quinn
Douglas Roblin
Theresa Gillespie
Major Goals:
The goal of this study is to understand the short- and long-term health issues among transgender persons who had or are planning to have a sex change treatment.
Description of study sample:
6,500 transgender individuals, whose care is covered by the Veterans Administration (nationally) or by Kaiser Permanente (in Georgia and in Northern and Southern California).
Current Status:  
Project completed
Study Registration:
HSRP20143115
Publications:
Collin L, Reisner SL, Tangpricha V, Goodman M. Prevalence of Transgender Depends on the “Case” Definition: A Systematic Review. J Sex Med. 2016 Apr;13(4):613-26. doi: 10.1016/j.jsxm.2016.02.001. Epub 2016 Mar 25.Holz LE, Goodman M. Epidemiology of advanced prostate cancer: overview of known and less explored disparities in prostate cancer prognosis. Curr Probl Cancer. 2015 Jan-Feb;39(1):11-6. doi: 10.1016/j.currproblcancer.2014.11.003. Epub 2014 Nov 26.Reisner SL, Deutsch MB, Bhasin S, Bockting W, Brown GR, Feldman J, Garofalo R, Kreukels B, Radix A, Safer JD, Tangpricha V, T?Sjoen G, Goodman M. Advancing methods for US transgender health research. Curr Opin Endocrinol Diabetes Obes. 2016 Apr;23(2):198-207. doi: 10.1097/MED.0000000000000229.Roblin D, Barzilay J, Tolsma D, Robinson B, Schild L, Cromwell L, Braun H, Nash R, Gerth J, Hunkeler E, Quinn VP, Tangpricha V, Goodman M.  A novel method for estimating transgender status using electronic medical records. Ann Epidemiol. 2016 Mar;26(3):198-203. doi: 10.1016/j.annepidem.2016.01.004. Epub 2016 Feb 4.Goodman M, Adams N, Corneil T, Kreukels B, Motmans J, Coleman E. Size and distribution of transgender and gender non-conforming populations: A narrative review. Endocrinology and Metabolism Clinics of North America 2019 8(2):303-321Gerth J, Becerra-Culqui T, Bradlyn A, Getahun D, Hunkeler E, Lash T, Millman A, Nash R, Quinn V, Robinson B, Roblin D, Silverberg M, Tangpricha V, Vupputuri S, Goodman M. Agreement between medical records and self-reports: Implications for transgender health research.  Reviews in Endocrine and Metabolic Disorders 2018 19(3):263-269Getahun D, Nash R, Flanders D, Baird T, Becerra-Culqui T, Cromwell L, Hunkeler E, Lash T, Millman A, Quinn V, Robinson B, Roblin D, Silverberg M, Safer J, Slovis J, Tangpricha V, Goodman M. Cross-sex hormones and acute cardiovascular events in transgender persons:  A cohort study.  Annals of Internal Medicine 2018 169(4):205-213Nash R, Ward K, Jemal A, Sandberg D, Tangpricha V, Goodman M. Frequency and distribution of cancers among gender minority patients: an analysis of U.S. national surveillance data.  Cancer Epidemiology 2018 54(6):1-6Becerra-Culqui T, Liu Y, Nash R, Cromwell L, Flanders W, Getahun D, Giammattei S, Hunkeler E, Lash T, Millman A, Quinn V, Robinson B, Roblin D, Sandberg D, Silverberg M, Tangpricha V, Goodman M.  Mental health of transgender and gender non-conforming youth compared with their peers.  Pediatrics 2018 141(5): e20173845Owen-Smith A, Gerth J, Sineath C, Barzilay J, Becerra-Culqui T, Getahun D, Giammattei S, Hunkeler E, Lash T, Millman A, Nash R, Quinn V, Robinson B, Roblin D, Sanchez T, Silverberg M, Tangpricha V, Valentine C, Winter S, Woodyatt C, Goodman M.  Association between gender confirmation treatments and perceived gender congruence, body satisfaction and mental health in a cohort of transgender individuals.  Journal of Sexual Medicine 2018 15(4):591-600Quinn V, Nash R, Hunkeler E, Contreras R, Cromwell L, Becerra-Culqui T, Getahun D, Giammattei S, Lash T, Millman A, Robinson B, Roblin D, Silverberg M, Slovis J, Tangpricha V, Tolsma D, Valentine C, Ward K, Winter S, Goodman M.  Cohort profile:  study of transition, outcomes & gender (STRONG) to assess health status of transgender people.  BMJ Open 2017 7(12):e018121Silverberg M, Nash R, Becerra-Culqui T, Cromwell L, Getahun D, Hunkeler E, Lash T, Millman A, Quinn V, Robinson B, Roblin D, Slovis J, Tangpricha V, Goodman M. Cohort study of cancer risk among insured transgender people. Annals of Epidemiology 2017 27(8):499-501Braun H, Nash R, Tangpricha V, Brockman J, Ward K, Goodman M. Cancer in transgender people: Evidence and methodological considerations. Epidemiologic Reviews 2017 39(1):93-107Owen-Smith A, Sineath C, Sanchez T, Dea R, Giammattei S, Gillespie T, Helms M, Hunkeler E, Quinn V, Roblin D, Slovis J, Stephenson R, Sullivan P, Tangpricha V, Woodyatt C, Goodman M. Perception of community tolerance and prevalence of depression among transgender persons  Journal of Gay & Lesbian Mental Health 2017 21(1) 64-76Owen-Smith A, Woodyatt C, Sineath C, Hunkeler E, Barnwell L, Graham A, Goodman M. Perceptions of barriers to and facilitators of participation in health research among transgender people  Transgender Health 2016 1(1): 187-196.Sineath C, Woodyatt C, Sanchez Y, Giammattei S, Gillespie T, Hunkeler E, Owen-Smith A, Quinn V, Roblin D, Stephenson R, Sullivan P, Tangpricha V, Goodman M.  Determinants of and barriers to hormonal and surgical treatment receipt among transgender people.  Transgender Health 2016 1(1):129-136
Resources:
N/A
Lessons Learned:
To date-the study supported 15 publications.  Many additional analyses are on-going
What’s next?
We seeking additional funding to expand the cohort and extend follow up through 2025.

Reducing Excess Cardiovascular Risk in People with Serious Mental Illness

Project Name:
Reducing Excess Cardiovascular Risk in People with Serious Mental Illness
Principal Investigator:
Rebecca Rossom, MD, MS
Principal Investigator Contact Information:
Rebecca.C.Rossom@HealthPartners.com
Principal Investigator institution:
HealthPartners, Minneapolis, MN
Funder
NIMH
Funding Period:
08/2014 – 06/2019 
Abstract:
People with serious mental illness (SMI) (schizophrenia, schizoaffective disorder, bipolar disorder) die, on average, 20 years earlier than their peers. Cardiovascular (CV) disease is the predominant cause.  Primary care clinicians are often unaware of increased risk in patients with SMI and, even when they do identify elevated CV risk factors, often do not take appropriate clinical actions. Electronic health record-based clinical decision support can identify at-risk patients with SMI and systematically prompt more effective treatment of their CV risk factors, but its potential has been largely untapped. 
Grant Number:
U19MH092201
Participating Sites:
HealthPartners, Minneapolis, MN (Lead Site)
Essentia Health, Duluth, MN
Park Nicollet, Minneapolis, MN
Investigators:
Rebecca Rossom, MD, MS     
Steve Waring, PhD
Patrick O’Connor, MD, MS, MA
JoAnn Sperl-Hillen, MD
Lauren Crain, PhD
Kris Kopski, MD
Stephanie Hooker, PhD
Goals:
The objectives of this project were to improve CV risk factor care in patients with SMI through a pragmatic trial of a point-of-care electronic health record-based clinical decision support system (referred to as “CV Wizard”).  The trial was conducted in over 80 primary care clinics in three large healthcare systems.
Description of study sample:
Patients enrolled in the study were ages 18-75 with diagnoses of schizophrenia, schizoaffective disorder or bipolar disorder (i.e. serious mental illness (SMI)) and were not at goal for at least one of the following reversible cardiovascular risk factors: BMI, tobacco use, LDL, blood pressure, A1c or aspirin use.
Current Status:
The project was implemented in all 3 sites and completed patient enrollment in September 2018.   A total of 11,046 patients with SMI made at least one primary care visit during the study period, and 8937 patients made at least 2 primary care visits.
Study Registration:
ClinicalTrials.gov # NCT02451670
Publications:
Rossom RC, O’Connor PJ, Crain AL, Waring S, Ohnsorg K, Taran A, Kopski K, Sperl-Hillen JM. Pragmatic trial design of an intervention to reduce cardiovascular risk in people with serious mental illness. Contemp Clin Trials. 2020 Feb 20;91:105964. doi: 10.1016/j.cct.2020.105964. PubMed PMID: 32087336. Sperl-Hillen JM, Rossom RC, Kharbanda EO, Gold R, Geissal ED, Elliott TE, Desai JR, Rindal DB, Saman DM, Waring SC, Margolis KL, O’Connor PJ. Priorities Wizard: Multisite Web-Based Primary Care Clinical Decision Support Improved Chronic Care Outcomes with High Use Rates and High Clinician Satisfaction Rates. EGEMS (Wash DC). 2019 Apr 3;7(1):9. doi: 10.5334/egems.284. Review. PubMed PMID: 30972358; PubMed Central PMCID: PMC6450247.
Resources:
N/A
Lessons Learned:
N/A
What’s next?
Analyses and manuscript development are in progress.

Treatment Utilization Before Suicide

Project Name:
Treatment Utilization Before Suicide
Principal Investigator:
Brian Ahmedani, PhD
Principal Investigator Contact Information:
BAHMEDA1@HFHS.ORG
Principal Investigator institution:
Henry Ford Health System Research Centers
Funder:
NIMH
Funding Period:
03/2015 – 02/2020
Adult suicide rates in the United States rose by almost 30 percent between 1999 and 2010. These rates have not markedly improved in decades. To date, previous suicide attempts and psychiatric diagnoses are largely the only known clinical risk factors for suicide death. Recent research shows that most individuals who die by suicide make a health care visit in the weeks and months prior to their death. Most of these visits occur in primary care or outpatient medical specialty settings. However, over half of these visits do not include a psychiatric diagnosis. Thus, there is limited evidence available from health care users in the US general population to inform targeted suicide screening and risk identification efforts in general medical settings. New research is needed to investigate the general medical clinical factors associated with suicide risk among individuals without a known risk factor. This research project uses data on more than 4000 individuals who died by suicide and made health care visits to one of eight health care systems across the United States in the year prior to their death. These health systems are members of the Mental Health Research Network and have affiliated health plans. They are able to capture nearly all health care for their patients via the Virtual Data Warehouse (VDW). The VDW consists of electronic medical record and insurance claims data organized using standardized data structures and definitions across sites. These data are matched with official regional mortality data. This project includes the following Specific Aims: 1) Identify the types and timing of clinical factors prior to suicide, 2a) Compare clinical factors before suicide to a matched sample of health care users, 2b) Detect associations between additional clinical factors and suicide, and 3) Develop a prediction model of clinical factors prior to suicide. We employ a case-control study approach to test specific hypotheses, while also using novel environment-wide association study methods and latent class analysis to detect new risk factors. We develop a prediction model of clinical factors and suicide. Clinical factors to be studied include medical diagnoses, medications, health care procedures, and types of health care visits. These results will inform decisions about how to focus suicide prevention in medical settings and provide information in response to the 2012 National Action Alliance for Suicide Prevention and US Surgeon General report.
Grant Number:
R01MH103539
Participating Sites:       Henry Ford Health System
Harvard Pilgrim Healthcare
HealthPartners
Kaiser Permanente Hawaii
Kaiser Permanente Northwest
Kaiser Permanente Colorado
Kaiser Permanente Georgia
Kaiser Permanente Washington
Investigators:
Brian K. Ahmedani, PhD
Gregory E. Simon, MD, MPH
Rebecca Rossom, MD, MSCR
Arne Beck, PhD
Frances Lynch, PhD
Beth Waitzfelder, PhD
Christine Lu, PhD
Ashli Owen-Smith, PhD
Deepak Prabhakar, MD, MPH
L. Keoki Williams, MD, MPH
Edward Peterson, PhD
Cathrine Frank, MD
Major Goals:
The main goal of this project is to investigate general medical and other healthcare factors and risk of suicide to develop a comprehensive healthcare algorithm to predict suicide, with particular focus on general medical settings.
Description of study sample:
This large case-control study includes >3,000 individuals who died by suicide between 2000-2015 and >300,000 matched general population members of 8 large health systems across the United States. 
Current Status:
June 26, 2019: Aims 1-2 have been completed. The work in Aim 3 is currently underway, including developing a series of predictive models for the full sample and a series of subgroups..  We will complete data analysis and draft the manuscript in Winter 2019-2020.
Study Registration:
N/A
Publications:Ahmedani BK, Simon GE, Stewart C, Beck A, Waitzfelder BE, Rossom R, Lynch F, Owen-Smith A, Hunkeler EM, Whiteside U, Operskalski BH, Coffey MJ, Solberg LI. Health care contacts in the year before suicide death. J Gen Intern Med. 2014 Jun;29(6):870-7. doi: 10.1007/s11606-014-2767-3. PMID: 24567199Ahmedani BK, Stewart C, Simon GE, Lynch F, Lu CY, Waitzfelder BE, Solberg LI, Owen-Smith AA, Beck A, Copeland LA, Hunkeler EM, Rossom RC, Williams K. Racial/Ethnic differences in health care visits made before suicide attempt across the United States. Med Care. 2015 May;53(5):430-5. doi: 10.1097/MLR.0000000000000335. PMID: 25872151.Ahmedani BK, Peterson EL, Hu Y, Rossom RC, Lynch F, Lu CY, Waitzfelder BE, Owen-Smith AA, Hubley S, Prabhakar D, Williams LK, Zeld N, Mutter E, Beck A, Tolsma D, Simon GE. Major Physical Health Conditions and Risk of Suicide. Am J Prev Med. 2017 Sep;53(3):308-315. doi: 10.1016/j.amepre.2017.04.001. PMID: 28619532.Boggs JM, Simon GE, Ahmedani BK, Peterson E, Hubley S, Beck A. The Association of Firearm Suicide With Mental Illness, Substance Use Conditions, and Previous Suicide Attempts. Ann Intern Med. 2017 Aug 15;167(4):287-288. doi: 10.7326/L17-0111. PMID: 28672343.Prabhakar D, Peterson EL, Hu Y, Rossom RC, Lynch FL, Lu CY, Waitzfelder BE, Owen-Smith AA, Williams LK, Beck A, Simon GE, Ahmedani BK. Dermatologic Conditions and Risk of Suicide: A Case-Control Study. Psychosomatics. 2018; 59(1): 58-61. doi: 10.1016/j.psym.2017.08.001. PMID: 28890116.Boggs JM, Beck A, Hubley S, Peterson EL, Hu Y, Williams LK, Prabhakar D, Rossom RC, Lynch FL, Lu CY, Waitzfelder BE, Owen-Smith AA, Simon GE, Ahmedani BK.General Medical, Mental Health, and Demographic Risk Factors Associated With Suicide by Firearm Compared With Other Means. Psychiatric Services. 2018; 69(6):677-684. doi: 10.1176/appi.ps.201700237. PMID: 29446332.Owen-Smith AA, Ahmedani BK, Peterson E, Simon GE, Rossom RC, Lynch FL, Lu CY, Waitzfelder BE, Beck A, DeBar LL, Sanon V, Maaz Y, Khan S, Miller-Matero LR, Prabhakar D, Frank C, Drake CL, Braciszewski JM. The Mediating Effect of Sleep Disturbance on the Relationship Between Nonmalignant Chronic Pain and Suicide Death.  Pain Pract. 2019 Apr;19(4):382-389. doi: 10.1111/papr.12750. Epub 2019 Jan 18. PMID: 30462885Yeh HH, Westphal J, Hu Y, Peterson EL, Williams LK, Prabhakar D, Frank C, Autio K, Elsiss F, Simon GE, Beck A, Lynch FL, Rossom RC, Lu CY, Owen-Smith AA, Waitzfelder BE, Ahmedani BK. Diagnosed Mental Health Conditions and Risk of Suicide Mortality. Psychiatr Serv. 2019 Jun 12:appips201800346. doi: 10.1176/appi.ps.201800346. [Epub ahead of print]. PMID: 31185853
Resources:
None
Lessons Learned: Most individuals make healthcare visits before suicide. Most visits occur in primary care or general medical specialty settings. Approximately half of individuals do not have a mental health condition diagnosed during their health care visits before suicide. Among 19 physical health conditions under study, 17 were associated with increased risk for suicide after adjustment for age and sex, and 9 associations persisted after additional adjustment for mental health and substance use conditions.
What’s next?
The final predictive modeling analyses are underway for the final study aim. A series of papers are currently under review or in development based on data from Aims 1-2.