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The COVID-19 pandemic motivated rapid expansion of virtual care. In Winnipeg, Canada, the authors launched a virtual psychiatric acute care ward (vWARD) to divert patients from hospitalization through daily remote treatment by a psychiatry team using telephone or videoconferencing. This study examined vWARD patient characteristics, predictors of transfer to a hospital, use of acute care postdischarge, and costs of the vWARD compared with in-person hospitalization. Data for all vWARD admissions from March 23, 2020, to April 30, 2021, were retrieved from program documents and electronic records. Emergency department visits and hospitalizations in the 6 months before admission and the 30 days after discharge were documented. Logistic regression identified factors associated with transfer to a hospital. Thirty-day acute care use after discharge was modeled with Kaplan-Meier curves. A break-even cost analysis was generated with data for usual hospital-based care. The 132 vWARD admissions represented a diverse demographic and clinical population. Overall, 57% involved suicidal behavior, and 29% involved psychosis or mania. Seventeen admissions (13%) were transferred to a hospital. Only presence of psychosis or mania significantly predicted transfer (OR=34.2, 95% CI=3.3–354.6). Eight individuals were hospitalized in the 30 days postdischarge (cumulative survival=0.93). vWARD costs were lower than usual care across several scenarios. A virtual ward is a feasible, effective, and potentially cost-saving intervention to manage acute psychiatric crises in the community and avoid hospitalization. It has benefits for both the health system and the individual who prefers to receive care at home. [ABSTRACT FROM AUTHOR]

Objective: The life course of children and adolescents with mental disorders is an important area of investigation, yet it remains understudied. This study provides a first-ever comprehensive examination of the relationship between child and adolescent mental disorders and subsequent suicidal and adverse social outcomes in early adulthood using population-based data. Methods: De-identified administrative databases were used to create a birth cohort of 60,838 residents of Manitoba born between April 1980 to March 1985 who were followed until March 2015. Unadjusted and adjusted hazard ratios (aHRs) and odds ratios (aORs) were calculated to determine associations between physician-diagnosed mental disorders in childhood or adolescence and a range of adverse early adulthood (ages 18 to 35) outcomes. Results: Diagnoses of mood/anxiety disorders, attention-deficit hyperactivity disorder, substance use disorder, conduct disorder, psychotic disorder, personality disorders in childhood or adolescence were associated with having the same diagnoses in adulthood. These mental disorder diagnoses in childhood/adolescence were strongly associated with an increased risk of suicidal behaviors and adverse adult social outcomes in adulthood. Similarly, suicide attempts in adolescence conferred an increased risk in adulthood of suicide death (aHR: 3.6; 95% confidence interval [CI]: 1.9-6.9), suicide attempts (aHR: 6.2; CI: 5.0–7.6), social housing use (aHR: 1.7; CI 1.4–2.1), income assistance (aHR: 1.8; CI 1.6–2.1), criminal accusation (aHR: 2.2; CI 2.0–2.5), criminal victimization (aHR:2.5; CI 2.2–2.7), and not completing high school (aOR: 3.1; CI: 2.5–3.9). Conclusion: Mental disorders diagnosed in childhood and adolescence are important risk factors not only for mental disorders in adulthood but also for a range of early adult adversity. These findings provide an evidence-based prognosis of children's long-term well-being and a rationale for ensuring timely access to mental health services. Better population-level mental health promotion and early intervention for children and adolescents with mental disorders are promising for improving future adult outcomes. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of clinician prediction of risk to a standardized assessment of presentation status.Methods: All adult psychiatry emergency department consults in the two main hospitals in Winnipeg, Canada, were assessed using a standardized form (n = 5,376). This form includes two risk scales for a gestalt physician assessment of risk (Suicide Likelihood scale, suicide Attempt Likelihood scale) and the Columbia Classification Algorithm of Suicide Assessment (C-CASA). Regression determined whether assessments predicted future suicide attempts and deaths. The area under the curve (AUC) determined the prediction accuracy of these methods.Results: Although the regression results were significant, the AUCs were either moderate or poor. Clinician assessment was not effective at predicting deaths (AUC = .546, .36-.73), but moderately accurate at predicting future attempts (AUC = .728, .66-.79). C-CASA assessment was moderately accurate at predicting both attempts and deaths (AUC = .666 and .678).Conclusions: Clinician assessment does not significantly outperform a simple assessment of the occurrence of suicidal thoughts and behaviors during presentation to the emergency department. Behavior-based standardized assessments should be further researched in this field. Assessment of suicidality at presentation using C-CASA or similar assessment should be standard for psychiatric patients assessed in the emergency department. [ABSTRACT FROM AUTHOR]

Objective: To compare the rate of mental disorders (i.e., mood and anxiety, substance use, psychotic disorders) and suicide attempts within the same group of women across the pre-pregnancy, pregnancy, and postpartum periods, and between this perinatal cohort and a non-perinatal reference group.Method: Data were from an administrative repository of residents in Manitoba, Canada. The perinatal cohort consisted of women aged 18 to 45 years who experienced >1 live birth pregnancy between 2011 and 2014 (n = 45,362). Pre-pregnancy, pregnancy, and postpartum periods were defined over consecutive 40-week intervals. The non-perinatal cohort consisted of age-matched women with no pregnancies during the same period (n = 139,705). A reference 40-week interval was defined from the individual's birthdate in the year they entered the cohort. Rate ratios of diagnosed mental disorders were adjusted (aRR) for demographic factors, parity, and mental health history.Results: Within the perinatal cohort, pregnancy was associated with a lower rate of diagnosed mood or anxiety disorder, substance use disorder, and suicide attempt relative to pre-pregnancy (aRR range, 0.22-0.82). Pregnancy also had lower rates of all outcomes compared with the postpartum period (aRR, 0.44-0.87). Postpartum had a higher rate of psychotic disorder compared with pre-pregnancy (aRR, 1.61; 95% CI, 1.17-2.21), but a lower rate of mood or anxiety disorder and suicide attempt. Compared with non-perinatal women, pregnancy was associated with lower rates of all outcomes (aRR range, 0.25-0.87).Conclusions: Compared with a non-perinatal period, the rate of a diagnosed mental disorder is lower during pregnancy but begins to rise in the postpartum period, highlighting an important period for early identification and rapid access to intervention. [ABSTRACT FROM AUTHOR]

Administrative data have been used to determine the occurrence of suicide attempts and deliberate self-harm, but research about the accuracy of these sources is limited. This study used a clinical sample ( n = 5719) containing psychiatry consultations from the emergency departments and inpatient units of the two major tertiary hospitals in Winnipeg, Canada to validate the accuracy of inpatient hospital diagnosis codes at identifying presentations for self-harm and suicide attempts. The Columbia Classification Algorithm of Suicide Assessment (C-CASA) was used as the gold standard. International Classification of Diseases version 10 Canadian Enhancement codes for intentional self-harm, undetermined intent self-harm, and accidental poisoning were assessed. Measures of validity included Kappa ( κ), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Sensitivity of hospitalized attempts was low using intentional intent codes (36.9%, 95% confidence interval [CI]: 32.4-41.4%) but improved using unknown intent and accidental poisoning codes (44.8%, 95% CI: 40.2-49.4%). Agreement for suicide attempts did not increase with the addition of unknown intent and accidental poisoning codes ( κ = 0.465-0.481), but were better for any self-harm ( κ = 0.395-0.478). Hospital diagnosis codes undercount attempts and self-harm admissions. Including more data sources might improve the detection of events. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Importance: Bereavement after spousal suicide has been linked to mental disorders; however, a comprehensive assessment of the effect of spousal suicide is needed.Objective: To determine whether bereavement after spousal suicide was linked to an excessive risk of mental, physical, and social health outcomes when compared with the general population and spouses bereaved by other manners.Design, Setting, and Participants: This nationwide, register-based cohort study conducted in Denmark of 6.7 million individuals aged 18 years and older from 1980 to 2014 covered more than 136 million person-years and compared people bereaved by spousal suicide with the general population and people bereaved by other manners of death. Incidence rate ratios were calculated using Poisson regressions while adjusting for sociodemographic characteristics and the presence of mental and physical disorders.Main Outcomes and Measures: Mental disorders (any disorder, mood, posttraumatic stress disorder, anxiety, alcohol use disorders, drug use disorders, and self-harm); physical disorders (cancers, diabetes, sleep disorder, cardiovascular diseases, chronic lower respiratory tract diseases, liver cirrhosis, and spinal disc herniation); causes of mortality (all-cause, natural, unintentional, suicide, and homicide); social health outcomes; and health care use.Results: The total study population included 3 491 939 men, 4814 of whom were bereaved by spousal suicide, and 3 514 959 women, 10 793 of whom were bereaved by spousal suicide. Spouses bereaved by a partner's suicide had higher risks of developing mental disorders within 5 years of the loss (men: incidence rate ratio, 1.8; 95% CI, 1.6-2.0; women: incidence rate ratio, 1.7; 95% CI, 1.6-1.8) than the general population. Elevated risks for developing physical disorders, such as cirrhosis and sleep disorders, were also noted as well as the use of more municipal support, sick leave benefits, and disability pension funds than the general population. Compared with spouses bereaved by other manners of death, those bereaved by suicide had higher risks for developing mental disorders (men: incidence rate ratio, 1.7; 95% CI, 1.5-1.9; women: incidence rate ratio, 2.0; 95% CI, 1.9-2.2), suicidal behaviors, mortality, and municipal support. Additionally, a higher level of mental health care use was noted.Conclusions and Relevance: Exposure to suicide is stressful and affects the bereaved spouse on a broad range of outcomes. The excess risks of mental, physical, and social health outcomes highlight a need for more support directed toward spouses bereaved by suicide. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Context: Suicide bereavement remains understudied and poorly understood. Objectives: To examine outcomes of parents bereaved by the suicide death of their offspring and to compare these with both nonbereaved parent controls and par-ents who had offspring die in a motor vehicle crash (MVC). Design: Population-based case-control study. Suicide-bereaved parents were compared with nonbereaved matched control parents in the general population (n= 1415) and with MVC-bereaved parents (n = 1132) on the rates of physician-diagnosed mental and physical dis-orders, social factors, and treatment use in the 2 years after death of the offspring. Adjusted relative rates (ARRs) were generated by generalized estimating equation mod-els and adjusted for confounding factors. Setting: Manitoba, Canada. Participants: All identifiable parents who had an off-spring die by suicide between 1996 and 2007 (n= 1415). Main Outcome Measures: Mental and physical dis-orders, social factors, and treatment use. Results: Suicide bereavement was associated with an increased rate of depression (ARR, 2.14; 95% CI, 1.88-2.43), anxiety disorders (ARR, 1.41; 95% CI, 1.24-1.60), and marital breakup (ARR, 1.18; 95% CI, 1.13-1.23) in the 2 years after the suicide of an offspring, as compared with the 2 years prior to the death. Suicide-bereaved and MVC-bereaved parents had very few dif-ferences on predeath to postdeath outcomes. Depres-sion rate increases were greater for MVC-bereaved parents (19.9%) compared with suicide-bereaved parents (15.9%; P=.005), whereas suicide-bereaved parents had higher rate increases of hospitalization for mental illness (P=.049). Suicide-bereaved parents were more likely than their MVC-bereaved counterparts to have depression (ARR, 1.30; 95% CI, 1.06-1.61), physical disorders (ARR, 1.32; 95% CI, 1.19-1.45), and low income (ARR, 1.34; 95% CI, 1.18-1.51) before their offspring's death. Conclusions: Suicide bereavement is associated with ad-verse mental health and social outcomes. These conse-quences appear similar to those associated with MVC be-reavement. Parents who lose offspring to suicide appear to be a vulnerable group even prior to their offspring's death. [ABSTRACT FROM AUTHOR]

Background To date, sufficient data have not been available to examine ethnic differences in religiosity and mental health in the general population. However, evidence exists to suggest that the protective effects of religion may differ across ethnic groups. This study examined the relationship between religious attendance and mental health across ethnic groups. Methods The Collaborative Psychiatric Epidemiologic Survey ( N = 20,130) is a large, ethnically diverse sample of adult, US respondents. Frequency of attendance at religious services was measured as: at least once per week (reference group), one to three times per month, less than once per month, or less than once per year. Multiple logistic regression analyses examined associations between religious attendance and mood, anxiety and substance use disorders, as well as suicidal ideation and attempts. Models adjusted for sociodemographics and comorbidity. Results Results differed when performed within each ethnicity. Infrequent religious attendance was associated with substance use disorders in Whites and Africans only (Adjusted Odds Ratio (AOR) = 2.30 [95% CI = 1.77-2.99]; AOR = 1.86 [1.25-2.79], respectively), and with anxiety and suicidal ideation in Whites (AOR = 1.44 [1.10-1.88]; AOR = 1.58 [1.24-2.01]) and Hispanics only (AOR = 2.35 [1.17-4.73]; AOR = 1.70 [1.15-2.52]). Asians were the only group in which religious attendance was associated with mood disorders (AOR = 4.90 [1.54-15.60]). Interaction terms were nonsignificant. Conclusions The present study suggests that ethnicity is an important variable to consider in the relationship between religiosity and mental health. Future studies should attempt to either adjust for or stratify by ethnicity when examining these relationships. [ABSTRACT FROM AUTHOR]

Background This study is aimed to determine whether anxiety disorders are associated with suicide attempts with intent to die and to further investigate the characteristics of deliberate self-harm (DSH) among anxiety disorders. Method Data came from the Collaborative Psychiatric Epidemiological Surveys (N = 20,130; age 18 years and older; response rate = 72.3%). DSM-IV anxiety disorders were assessed using the World Mental Health Composite International Diagnostic Interview. People with an anxiety disorder endorsing a history of DSH were subcategorized as those who made suicide attempts (n = 159; individuals who intended to die), versus those who made nonsuicidal self-injuries (n = 85; individuals who did not intend to die). Results Anxiety disorders were associated with both suicide attempts and nonsuicidal self-injury (NSSI). People with generalized anxiety disorder and social phobia who engaged in DSH were more likely to have made a suicide attempt than a NSSI, independent of the effects of mood and substance use disorders. In addition, individuals with generalized anxiety disorder and social phobia who engaged in DSH were more likely to engage in this behavior multiple times, and at least one of those times was a suicide attempt. Conclusion This study suggests that anxiety disorders are associated with suicide attempts with intent to die. Social phobia and generalized anxiety disorder appear to be associated with the more worrisome patterns of DSH including multiple suicide attempts. Depression and Anxiety 0:1-8, 2011.© 2011 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article discusses anxiety disorders, the most common forms of mental illness that are disabling conditions associated with significant economic costs to society. These anxiety disorders are suggested to be diagnosed and treated early in their course to avoid comorbid mental illness like major depression. Further, following this approach will allegedly help in preventing suicidal behavior as it is inherent in depression, and the risks that affect society.

Our objective was to determine whether the presence of an anxiety disorder was a risk factor for future suicide attempts. Data were drawn from the 13-year follow-up Baltimore Epidemiological Catchment Area survey (n=1,920). Multiple logistic regression analysis was used to determine the association between baseline anxiety disorders (social phobia, simple phobia, obsessive-compulsive disorder, panic attacks, or agoraphobia) and subsequent onset suicide attempts. The presence of one or more anxiety disorders at baseline was significantly associated with subsequent onset suicide attempts (adjusted odds ratio 2.20, 95% confidence interval 1.04–4.64) after controlling for sociodemographic variables and all baseline mental disorders assessed in the survey. These findings suggest that anxiety disorders are independent risk factors for suicide attempts, and underscore the importance of anxiety disorders as a serious public health problem. Depression and Anxiety 0:1–5, 2007. Published 2007 Wiley-Liss. [ABSTRACT FROM AUTHOR]

To use latent class analysis to group patients consulted to an emergency psychiatry consultation service and assess occurrence of suicide attempts and all-cause mortality across groups. Latent class analysis was used to classify individuals assessed by psychiatry in the emergency department of the two teaching hospitals in Winnipeg, Canada. A second latent class analysis was done on individuals presenting with a suicide attempt. Indicators variables included a variety of clinically assessed factors, such as presentation suicidality and occurrence of anxiety/depression/psychosis, and prior medical treatment. Two post-treatment indicators were used; suicide attempt hospitalizations and all-cause mortality within 12 months of assessment. Latent class analysis identified 8 classes for all presentations (n = 5292) and 3 classes for the attempter subgroup (n = 730). Although there is considerable overlap in indicators among the classes certain indicators differentiated between the groups: suicide attempt presentation, prior psychiatric treatment, psychotropic medication polypharmacy, childhood abuse, and addictions. Although the presence of deaths and future attempts varied between the identified groups, there were no groups with a >10% proportion of individuals with either of these outcomes. Potential exists for latent class-based assessments, but additional samples with better indicators are needed. [ABSTRACT FROM AUTHOR]

Highlights: [•] Association of symptom clusters of PTSD and specific PTSD symptoms with suicide attempts. [•] Re-experiencing and avoidance clusters are associated with suicide attempts (SA) in individuals with PTSD. [•] Having physical reactions by reminders of the trauma associated with SA in individuals with PTSD. [•] Unable to recall aspects of the trauma associated with SA in individuals with PTSD. [•] Having the sense of a foreshortened future is associated with SA in individuals with PTSD. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study aimed to longitudinally examine the relationship between treatment utilization and suicidal behavior among people with major depressive disorder in a nationally representative sample. Methods: Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (Wave 1: N=43,093; Wave 2: N=34,653). Suicidal and non-suicidal individuals at Wave 1 were compared based on subsequent treatment utilization. Suicidal behavior at Wave 2 was compared between people with major depressive disorder who had sought treatment at Wave 1 versus those that had not. Results: Individuals with past year major depressive disorder at Wave 1 who attempted suicide were more likely to be hospitalized at follow up compared to non-suicidal people with major depressive disorder [adjusted odds ratio (AOR)=4.46; 95% confidence interval [95% CI]: 2.54–7.85]; however, they were not more likely to seek other forms of treatment. Among those with past year major depressive disorder who sought treatment at baseline, visiting an emergency room (AOR=3.08; 95% CI: 1.61–5.89) and being hospitalized (AOR=2.41; 95% CI: 1.13–5.14), was associated with an increased likelihood of attempting suicide within 3years even after adjusting for mental disorder comorbidity, depression severity, and previous suicidal behavior. Limitations: Unable to draw conclusions about completed suicide or adequacy of treatment. Conclusions: Suicidal behavior does not lead individuals with major depressive disorder to seek treatment with professionals or use antidepressant medications; instead, they are more likely to use emergency services. These findings suggest that treatment efforts for people with major depressive disorder who are suicidal need improvement. [Copyright &y& Elsevier]

Abstract: While placed on different axes of the DSM classification system, borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) have important relationships with trauma, and overlap between these disorders has long been recognized. The current study is the first to examine comorbidity of PTSD and BPD in a large nationally representative sample using a reliable and valid method of assessing Axis I and II mental disorders. Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Wave II (N=34,653; response rate 70.2%). Multiple regression models were used to examine differences in psychopathology, traumatic events and health-related quality of life across individuals with PTSD alone (n=1820), BPD alone (n=1290) and those with comorbid PTSD–BPD (n=643). The lifetime prevalence of PTSD and BPD were 6.6% and 5.9%, respectively. Of individuals with BPD, 30.2% were also diagnosed with PTSD, whereas 24.2% of individuals with PTSD were also diagnosed with BPD. Individuals with comorbid PTSD–BPD had a poorer quality of life, more comorbidity with other Axis I conditions, increased odds of a lifetime suicide attempt, and a higher prevalence of repeated childhood traumatic events than individuals with either condition alone. These results show that PTSD and BPD have a high degree of lifetime co-occurrence but are not entirely overlapping. Their concurrence is associated with poorer functioning compared to either diagnosis alone, emphasizing the clinical utility of diagnosing both conditions. Future research should explore the determinants of having either or both diagnoses with an aim toward improved identification, prevention, and intervention. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the six-item Inmate Security Assessment (ISA) tool used among detained youth in Manitoba, Canada. Method: Two hundred and forty-one recorded self-harm incidents among all incarcerated youth occurred between January 1, 2005 and December 31, 2010 (N=5102). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) for three categories of suicide risk (high, medium, and low) as well as each of the six suicide risk evaluation indicators were determined. Receiver operating characteristic (ROC) curves and area under the curve (AUC) calculations for the three suicide risk levels and the six indicators were created. Results: Having at least a low suicide risk level (93.8%) or at least one suicide risk factor (94.6%) provided high sensitivity. Specificity was high if an individual had at least a medium suicide risk level (94.2%) or at least three suicide risk indicators (96.7%). The PPV was low (8.9-16.2%) and the NPV was high (94.9-99.3%) for all suicide risk levels. The most sensitive risk factor for self-harm was a prior history of suicidal behavior or a family history of suicide (94.6%). All risk indicators had a low PPV (7.4-23.1%) and a high NPV (95.4-99.5%). A very low NLR was found for those without prior suicidal behavior or a family history of suicide (0.107). The AUC was 0.719 (95%CI = 0.692-0.746), indicating a fair test. Conclusion: The ISA is a moderately accurate tool for identifying risk for self-harm in detained youth. [ABSTRACT FROM AUTHOR]

Abstract: Background: There has recently been increased interest in the relationship between physical illness, mental illness, and suicide. The present study utilizes a large community-based sample to investigate the association between certain physical conditions and suicidal behavior, among those with a history of a mood disorder. Methods: Data came from the nationally representative German Health Survey (N=4181, age 18–65). Physical conditions were assessed by a general practice physician. DSM-IV mental disorders were assessed using a modified version of the Composite International Diagnostic Interview. Among those with a lifetime mood disorders, suicidal ideation, plans, and attempts were assessed by self-report. Multiple logistic regression analyses were used to examine the association between physical conditions and suicidal behavior among those with a history of mood disorder. Results: Anxiety and substance use disorders were significantly positively associated with suicidal behavior [OR 1.61, 95% CI 1.13–2.31 and 2.01, 95% 1.34–3.00, respectively]. After adjusting for anxiety and substance use disorders as well as sociodemographic variables, respiratory illness, hypertension, and number of physical disorders were significantly associated with suicidal behavior [AORs 1.72, 1.68, and 1.16, respectively]. Limitations: The findings of this study are limited to adults with a history of a mood disorder. Personality disorders were not assessed. Conclusion: The present study suggests that among people with mood disorder, respiratory illnesses, hypertension, and number of physical conditions are associated with suicidal behavior independent of the effects of comorbid mental illness. Clinicians should recognize the contributing risk of physical health problems to suicidal behavior. [Copyright &y& Elsevier]