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Suicide is the second leading cause of death in adolescents; a frequent precursor of suicide is suicidal ideation (SI). Literature indicates that Post-Traumatic Stress Disorder (PTSD) and SI are robust cross-sectional correlates of one another, with PTSD often being conceptualized as a risk factor (i.e., conferring risk) for SI. Indeed, PTSD is a well-established risk factor for SI; however, SI is an understudied risk factor for PTSD. It is possible that, yet unknown if, PTSD and SI promote each other over time in a bidirectional fashion. We investigated the bidirectional longitudinal associations between PTSD and SI in a large, diverse sample, who at baseline were adolescents. Participants were interviewed between 1995 and 1998 and again between 2004 and 2008. We hypothesized that PTSD and SI would be cross-sectionally, longitudinally, and bidirectionally related and that the number of traumas endorsed at baseline would be positively associated with PTSD and SI at baseline and follow-up. Indeed, PTSD and SI were cross-sectionally correlated at baseline, but not follow-up. PTSD predicted SI over nine years; however, SI during adolescence did not predict PTSD in adulthood. Finally, poly-trauma endorsed at baseline was associated with increased risk of SI, but not PTSD, over nine years. • PTSD and suicidal ideation were cross-sectionally related during adolescence. • PTSD and suicidal ideation were not cross-sectionally related during adulthood. • PTSD predicted suicidal ideation over the nine year follow-up period. • Suicidal ideation did not predict suicidal ideation over the nine-year follow-up. [ABSTRACT FROM AUTHOR]

Suicide is a public health concern which warrants considerable attention, especially with the onset of the COVID-19 pandemic. The current study sought to examine the relationship between behavioral, psychological, and economic impacts of COVID-19 on suicidal ideation severity in a sample of 90 undergraduate students who completed a comprehensive survey on mental health in January 2020 and were re-assessed in April, June, and July of 2020. Multiple regression analyses showed that changes in experience of loneliness, loneliness due to social distancing, pandemic-related concerns, COVID contagion anxiety, and quarantining alone positively and significantly correlated with peri-pandemic suicidal ideation severity after accounting for pre-pandemic suicidal ideation and sexual orientation, while time spent talking to romantic partner and time spent talking to friends and family were negatively correlated. Findings provide insights into the psychological and behavioral effects of social distancing measures and the pandemic, but further research is needed to generalize findings. [ABSTRACT FROM AUTHOR]

Suicidality disproportionately affects Veterans, and in 2020 the Military Health and Well-Being Project was conducted in part to study the link between risk and protective constructs with suicidality among Veterans. In the present study, we investigate the relative contribution of risk (i.e., military self-stigma, daily stress, combat exposure, substance use, traumatic brain injury, and moral injury) and protective constructs (i.e., social integration, social contribution, public service motivation, purpose and meaning, and help-seeking) with suicidality. Using cross-sectional Pearson correlation and linear regression models, we studied the independent and relative contribution of risk and protective correlates in a sample of 1469 Veterans (male: n = 985, 67.1 %; female: n = 476, 32.4 %; transgender, non-binary, prefer not to say: n = 8, 0.5 %). When we investigated protective constructs individually as well as simultaneously, social contribution (β = -0.39, t = -15.59, p < 0.001) was the strongest protective construct against suicidality. Social integration (β = -0.13, t = -4.88, p < 0.001) additionally accounted for significant reduction in suicidality when all protective constructs were considered together. When we investigated the contribution of risk constructs towards suicidality, moral injury was most strongly associated with suicidality (r = 0.519, p < 0.001), yet when studied simultaneously for their relative contribution none of the constructs accounted for a significant amount of the variance in suicidality (|t|s ≤ 1.98, ps ≥ 0.07). These findings suggest that among Veterans it is possible that social contribution is protective against suicidality and could be a possible treatment target for the prevention or reduction of suicidality among Veterans., Competing Interests: Declaration of competing interest There are no competing interests to disclose., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: The objective of this study was to investigate the impact of enhancing a structured-data-based suicide attempt risk prediction model with temporal Concept Unique Identifiers (CUIs) derived from clinical notes. We aimed to examine how different temporal schemes, model types, and prediction ranges influenced the model's predictive performance. This research sought to improve our understanding of how the integration of temporal information and clinical variable transformation could enhance model predictions., Materials and Methods: We identified modeling targets using diagnostic codes for suicide attempts within 30, 90, or 365 days following a temporally grouped visit cluster. Structured data included medications, diagnoses, procedures, and demographics, while unstructured data consisted of terms extracted with regular expressions from clinical notes. We compared models trained only on structured data (controls) to hybrid models trained on both structured and unstructured data. We used two temporalization schemes for clinical notes: fixed 90-day windows and flexible epochs. We trained and assessed random forests and hybrid LSTM neural networks using AUPRC and AUROC, with additional evaluation of sensitivity and PPV at 95% specificity., Results: The training set included 2,364,183 visit clusters with 2,009 30-day suicide attempts, and the testing set contained 471,936 visit clusters with 480 suicide attempts. Models trained with temporal CUIs outperformed those trained with only structured data. The window-temporalized LSTM model achieved the highest AUPRC (0.056 ± 0.013) for the 30-day prediction range. Hybrid models generally showed better performance compared to controls across most metrics., Discussion and Conclusion: This study demonstrated that incorporating EHR-derived clinical note features enhanced suicide attempt risk prediction models, particularly with window-temporalized LSTM models. Our results underscored the critical value of unstructured data in suicidality prediction, aligning with previous findings. Future research should focus on integrating more sophisticated methods to continue improving prediction accuracy, which will enhance the effectiveness of future intervention., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Objectives: To describe the impact of a standardized opioid prescribing intervention when implemented in three family medicine (FM) residency training - clinics-environments that face operational challenges including regular resident turnover., Design: We performed a retrospective cohort study to compare patterns of long-term opioid prescribing between residency and nonresidency clinics., Setting: This study took place within a large, academic, health system., Patients and Participants: Three FM residency clinics were compared with three nonresidency FM clinics., Interventions: A standardized opioid prescribing process was developed and implemented within the FM residency clinics. Nonresidency clinics used an independent process and were not exposed to the intervention., Main Outcome Measures: Descriptive comparisons were performed for treatment and control clinics' opioid prescribing from 2015 to 2018. The primary outcome was a patient's annual opioid exposure supplied from these select clinics. We also examine coprescribing with high-risk medications that potentiate the overdose risk of opioid prescriptions. Difference-in-difference modeling was used to control for clinic-level variation in practice., Results: Statistically significant decreases were observed in both residency and nonresidency clinics for the mean number of opioid prescriptions and the mean daily morphine milligram equivalent. These decreases were comparable between the residency and nonresidency clinics., Conclusions: Residency clinics face unique challenges and require innovative solutions to keep up with best practices in opioid prescribing. Our residency clinics' implementation of a standardized intervention, including electronic health record integration, standardized processes, and metric management, suggests steps that may be valuable in achieving outcomes comparable to nonresidency clinics in large health systems.

Background: Women are a growing portion of the U.S. veteran population, and every year the Veterans Health Administration (VHA) serves an increasing number of women seeking obstetrics services. Women veterans experience elevated rates of anxiety, depression, posttraumatic stress disorder (PTSD), and traumatic events, including military sexual trauma, as compared with women in the general population. It is possible that mental health disorders may be associated with birth experiences., Objectives: We investigated the link between anxiety, depression, PTSD, and military sexual trauma (MST; i.e., rape and sexual harassment) with perceived birth experience (i.e., Negative or Neutral vs. Positive)., Methods: Participants included 1,005 veterans who had recently given birth and were enrolled in the multisite, mixed methods study known as the Center for Maternal and Infant Outcomes Research in Translation study (COMFORT). Using χ 2 tests, we investigated the relationship between mental health conditions including anxiety, depression, and PTSD and MST with birth experience (coded as Negative/Neutral vs. Positive)., Results: Findings indicated that participants who endorsed PTSD (39.5%), MST-rape (32.1%), or MST-harassment (51.4%; all p < .05) were significantly more likely to report a Negative/Neutral birth experience (14.7%) versus a Positive birth experience (85.3%). Anxiety and depression were not associated with birth experience., Conclusions: Veterans with PTSD and/or who experienced MST were more likely to report a negative or neutral birth experience. Thus, screening for PTSD and MST during obstetrics services as well as providing trauma-informed obstetrics care during pregnancy, labor, birth, and recovery may be important among veterans seeking obstetric services., (Published by Elsevier Inc.)

Background: Short sleep duration is linked with suicide risk in adolescence. Sexual and gender minority (SGM) adolescents experience substantially increased risk for suicide compared to their non-SGM peers., Methods: We investigated the role of sleep duration in SGM adolescent suicide risk using population-based, cross-sectional data from the 2022 Minnesota Student Survey (MSS; N = 85,610, M age  = 14.8). Adolescents reported average school-night sleep duration; those reporting <6 h were classified as having very short sleep duration. The MSS additionally assessed past-year suicidal ideation and suicide attempt. Mediation analyses assessed the role of sleep duration in explaining associations between SGM identity and suicide risk. Further, to examine intervention mechanisms, among SGM adolescents (n = 20,171, 23.6%), a logistic regression model assessed associations among demographic factors, perceived parental care, and very short sleep duration., Results: As compared to non-SGM adolescents, SGM adolescents reported substantially higher prevalence of past-year suicidal ideation and suicide attempt and 2.6× higher prevalence of very short sleep duration (all p < 0.001). Mediation analyses demonstrated that very short sleep duration partially mediated the pathway between SGM identity and past-year suicidal ideation (15.5% mediated) and suicide attempt (17.2% mediated). Among SGM adolescents, a striking positive dose-response relationship was observed between level of perceived parental care and very short sleep duration. As perceived parental care decreased, so too did hours of sleep., Discussion: Sleep duration is a crucial and understudied mechanism underlying suicide risk disparities affecting SGM adolescents. Family-based interventions may improve SGM adolescent sleep and reduce suicide risk., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Suicide is a widespread public health concern, including among military Veterans. Traumatic brain injuries (TBIs) and lack of social integration have both been shown to increase risk for suicidality, an outcome that includes, among other suicide-related variables, suicidal ideation, suicide attempts, and suicide death. Interestingly, TBIs have also been identified as a risk factor for social integration problems. In this cross-sectional study we investigated associations between TBI, social integration, and suicidality. Additionally, mediation analysis was used to test whether social integration mediated the association between TBI and suicidality. A sample of 1469 military Veterans (male, n = 1004, 67.2 %; female, n = 457, 32.3 %; transgender/non-binary/prefer not to say, n = 8, 0.5 %) completed an online survey as part of the Military Health and Well-Being Project. TBI was negatively associated with social integration (r = -0.084, p < .001) and positively with suicidality (r = 0.205, p < .001). Social integration was negatively associated with suicidality (r = -0.161, p < .001). Finally, social integration partially mediated the relationship between TBI and social integration (B = 0.121, 95 % CI [0.031-0.23]). This work shows that in the context of TBI, lack of social integration may promote suicidality. It provides support for many theories of suicide which propose social problems as a risk factor of suicide-related outcomes. It further highlights social integration as potential fodder for novel interventions for suicidality, an approach that would have transtheoretical support., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2023. Published by Elsevier B.V.)

Objective: Standardized processes have evolved in response to the opioid epidemic. The impact of standardized processes on patients has not been adequately described., Methods: Five focus groups were held at four affiliated academic family medicine clinics. All participants experienced a transition to a standardized process for their ongoing opioid use for chronic, non-cancer pain. Data was analyzed and coded using a grounded theory approach with NVivo12 (QSR International)., Results: Thirty patients participated. Five main themes emerged: experience of pain; view of opioid medications; view of opioid prescribing process changes; "good patients" and trust; and experience with medical clinicians and clinics., Conclusions: Standardized processes created to improve the safety of opioid prescribing have burdened patients and resulted in a loss of trust and autonomy. Patients perceived greater risks for other patients prescribed opioids and processes are a result of their actions., Practice Implications: Healthcare systems must acknowledge patients' burden, shift away from interventions that are limited in supporting data, reinforce patient agency and shift the conversation to unsafe medications rather than supervision of "bad actors"., (Copyright © 2022. Published by Elsevier B.V.)

With increasingly complicated patients and faster throughput, time for thorough critical thinking and thoughtful clinical documentation is limited, especially in the training environment. Advocating for the value of clinical documentation as a robust opportunity for critical thinking, we describe the implementation and evaluation of a clinical reasoning and documentation curriculum for internal medicine residents. Our curriculum employed facilitated discussion, practical application, and a resident-as-teacher model. Resident surveys showed improved perceptions of the clinical and educational value of clinical documentation. Residents reported increased feedback to interns about their documentation and more appreciation of documentation as a venue for critical thinking., Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01570-5., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s) under exclusive licence to International Association of Medical Science Educators 2022.)

Introduction: A pediatric ED program sought to promote injury prevention through distribution of child restraint systems. Program funds are paid for child passenger safety technician certification of all personnel. Pediatric emergency nurses distributed child restraint systems at hospital discharge and dedicated technicians at fitting stations. Researchers described program characteristics, developed a baseline understanding of program outreach using geographic information systems, and evaluated adherence to manufacturer guidelines with a sensitivity analysis., Methods: This retrospective cross-sectional study used distribution forms linked to hospital records from 2013 to 2016. Testing for differences used nonparametric methods. Median values and interquartile ranges for weight and height of children were compared with manufacturer guidelines. Geographic information systems visualized recipients' street addresses and motor vehicle crashes on an underlying base map., Results: There were 312 child restraint systems distributed: of which 179 (57.4%) at the hospital, 126 (40.4%) at fitting stations, and 7 (2.2%) missing a location. Among those on Medicaid, 64.4% received a child restraint system at the hospital compared with 35.6% at fitting stations (χ 2  = 5.40, P < .02). Fitting stations had limited outreach to rural residents. Finally, results from the sensitivity analysis showed that devices were issued according to manufacturer guidelines., Discussion: Despite the workplace pressures of clinical care, pediatric emergency nurses delivered educational information and demonstrated hands-on installation at similar rates to dedicated technicians. Distribution of child restraint systems through the hospital reached a uniquely underserved population. Further research should investigate methods to improve fitting station outreach among Medicaid recipients., (Copyright © 2022 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Pediatric primary health care (PPHC) is of principal importance to the health and development of all children, helping them reach their true potential. Pediatricians, as the clinicians most intensively trained and experienced in child health, are the natural leaders of PPHC within the context of the medical home. Given the rapidly evolving models of pediatric health care delivery, including the explosion of telehealth in the wake of the COVID-19 pandemic, pediatricians, together with their representative national organizations such as the American Academy of Pediatrics (AAP), are the most capable clinicians to guide policy innovations on both the local and national stage., Competing Interests: FINANCIAL DISCLOSURE: The authors have indicated they do not have a financial relationship relevant to this article to disclose., (Copyright © 2022 by the American Academy of Pediatrics.)

The nature of the HIV epidemic in the United States and Canada has changed with a shift toward rural areas. Socioeconomic factors, geography, cultural context, and evolving epidemics of injection drug use are coalescing to move the epidemic into locations where populations are dispersed and health care resources are limited. Rural-urban differences along the care continuum demonstrate the implications of this sociogeographic shift. Greater attention is needed to build a more comprehensive understanding of the rural HIV epidemic in the United States and Canada, including research efforts, innovative approaches to care delivery, and greater community engagement in prevention and care.