Search

Power analysis for cluster randomized control trials is difficult to perform when a binary response is modeled using the generalized linear mixed-effects model (GLMM). Although methods for clustered binary responses exist such as the generalized estimating equations, they do not apply to the context of GLMM. Also, because popular statistical packages such as R and SAS do not provide correct estimates of parameters for the GLMM for binary responses, Monte Carlo simulation, a popular ad-hoc method for estimating power when the power function is too complex to evaluate analytically or numerically, fails to provide correct power estimates within the current context as well. In this paper, a new approach is developed to estimate power for cluster randomized control trials when a binary response is modeled by the GLMM. The approach is easy to implement and seems to work quite well, as assessed by simulation studies. The approach is illustrated with a real intervention study to reduce suicide reattempt rates among US Veterans. [ABSTRACT FROM PUBLISHER]

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Depression and anxiety in patients with heart disease and/or cancer have been shown to affect quality of life, adherence with medical management, and prognosis. We investigated the association of the diagnoses of cancer, heart disease, or both with self-reported symptoms consistent with serious mental illness (SMI). We used the K6 score to identify self-reported symptoms consistent with SMI from patients' responses to the 2017 National Health Interview Survey. Our final cohort included 24,777 individual surveys. Of those respondents, 1509 reported cancer, 2639 reported heart disease, and 534 reported both. About 96% of patients reported a K6 score <13, and 4% reported a K6 score ≥13, which is suggestive of SMI. Logistic regression identified significant associations between SMI and an inability to afford mental care/counseling, an inability to afford prescribed medications, and unemployed status, with odds ratios of 6.97, 2.94, and 3.49, respectively. Having both heart disease and cancer was independently associated with SMI (odds ratio = 2.57; 95% confidence interval, 1.53-4.31; P < 0.001). In conclusion, in a nationally representative self-reported questionnaire, patients with a combined diagnosis of cancer and heart disease were significantly more likely to report SMI than those with either diagnosis alone., (Copyright © 2020 Baylor University Medical Center.)

Objective: Intimate partner (IP) problems are risk factors for suicide among men. However, there is little understanding of why some male suicide decedents who had such problems killed their partners before death (i.e., "IP homicide-suicide"), while most of these decedents did not. To inform prevention efforts, this study identified correlates of IP homicide among male suicide decedents with known IP problems., Methods: We examined IP homicide correlates among male suicide decedents aged 18+ years who had known IP problems using 2003-2015 National Violent Death Reporting System data. Prevalence odds ratios and 95% confidence intervals were estimated for demographic, incident, and circumstance variables. IP homicide-suicide narratives were examined to identify additional prevention opportunities., Results: An estimated 1,504 (5.0%) of 30,259 male suicide decedents who had IP problems killed their partner. IP homicide-suicide perpetration was positively correlated with suicide by firearm and precipitating civil legal problems but negatively correlated with mental health/substance abuse treatment. An estimated 33.7% of IP homicide-suicides occurred during a breakup; 21.9% of IP homicide-suicide perpetrators had domestic violence histories., Conclusions: Connections between the criminal justice and mental health systems as well as stronger enforcement of laws prohibiting firearm possession among domestic violence offenders may prevent IP homicide-suicides., (© 2019 The American Association of Suicidology.)

Objective: This study examined trends and correlates of reported post-traumatic stress disorder (PTSD) among young male Veteran suicide decedents, using data from the National Violent Death Reporting System from 2005-2014 on 1,362 male U.S. Veteran suicide decedents aged 18-34 years., Methods: Prevalence of reported PTSD (i.e., diagnosis/symptoms) was determined by mental health diagnostic fields and narratives and examined by year. Demographic, incident, and precipitating circumstance characteristics correlated with reported PTSD were identified., Results: One-hundred ninety-eight (15%) decedents had PTSD evidence. A 30-fold increase in reported PTSD prevalence occurred among decedents aged 25-34 years; however, no increase was observed among younger decedents. Reported PTSD was associated with past deployments (odds ratio (OR): 14.5, 95% confidence interval (95% CI): 9.0-23.4); depression (OR: 1.8, 95% CI: 1.2-2.6); and divorce (OR: 1.7, 95% CI: 1.0-2.7). Recent crisis (OR: 0.6, 95% CI: 0.3-0.9) was inversely associated with reported PTSD., Conclusions: Reported PTSD prevalence substantially increased among Veteran suicide decedents aged 25-34 years suggesting it is beginning to play a larger role in suicide for this group. Few correlated suicide risk factors were found, suggesting that if symptoms of PTSD are present, heightened vigilance by providers for suicide risk might be warranted, irrespective of evidence of other risk factors., (© 2018 The American Association of Suicidology.)

Objectives: To examine opioid-related outcomes by using hospitalization and mortality data as an indicator of the current opioid crisis in West Virginia., Methods: We used data from the West Virginia University Medicine health care system to examine the trend in opioid overdoses and percentage of patients with a repeat overdose from 2008 to 2016. We obtained the opioid overdose death rate for the state from Centers for Disease Control and Prevention WONDER (Wide-ranging ONline Data for Epidemiologic Research) mortality data for 2008 to 2016., Results: The hospitalization rate for opioid overdoses increased (13%) on average each year in a similar fashion to the opioid overdose death rate for the state (12%) between 2008 and 2016. During the same time, the percentage of patients with a repeat opioid overdose increased annually by 13% on average., Conclusions: There continues to be a surge of opioid overdoses in West Virginia. These findings suggest a need to amplify comprehensive prevention and treatment efforts throughout the state. Public health initiatives to reduce the morbidity and mortality associated with overdoses should consider how the changes in potency may be influencing these outcomes.

Objective: Veterans in mental health care have high rates of firearm-related suicide; reducing firearm access during high-risk periods could save lives. We assessed veteran patients' attitudes towards voluntary interventions to reduce access., Methods: Descriptive data came from surveys mailed to random samples of veterans receiving mental health care in five geographically diverse VA facilities. Survey items inquired about the acceptability of seven voluntary health system interventions to address firearm access, ranging from lower-intensity interventions that addressed safety but might not reduce access (i.e., clinician screening; distribution of gunlocks) to interventions substantially limiting access (i.e., storage of firearms offsite; gun disposal). Mailings occurred between 5/11/15 and 10/19/15; 677 of 1354 veterans (50%) returned the surveys., Results: 93.2% of respondents endorsed one or more health system interventions addressing firearm access; 75.0% endorsed interventions substantially limiting access. Although veterans with household firearms were less likely to endorse interventions, fully 50.4% would personally participate in at least one intervention that substantially limited access., Discussion: A majority of veterans in VA mental health care endorse voluntary health system interventions addressing firearm access during high-risk periods for suicide. Approximately half of veterans with firearms would personally participate in an intervention that substantially limited firearm access., (Published by Elsevier Inc.)

This study assessed the risk of suicide by time since separation from the military for US veterans who served in Iraq or Afghanistan. Suicide risk was assessed by comparing the number of suicides among veterans, when stratified by active vs. reserve/National Guard status to the expected number based on rates of suicide in the US general population. Hazard rates were used to assess suicide risk since the time each veteran separated/deactivated from active duty service. Compared to the US general population, active duty veterans had a 56% increased risk of suicide and reserve/National Guard veterans had a 29% increased risk. Suicide risk decreased as time since separation/deactivation increased for both groups. The risk of suicide for both groups was greatest during the first year of follow-up.

Objective: The objective of this study was to determine the prevalence of respiratory exposures and the association between respiratory exposures and respiratory disease among veterans deployed to Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) compared with nondeployed veterans of this era., Methods: Data come from a national health survey of 20,563 deployed and nondeployed OEF/OIF era veterans. Prevalence estimates and adjusted odds ratios were calculated. Results were weighted to represent the population., Results: Prevalence of at least one respiratory exposure was high among both deployed and nondeployed groups (95% and 70%, respectively). In both groups, those with any respiratory exposure were at an increased risk for reporting a respiratory disease., Conclusion: Respiratory exposures are highly prevalent and are associated with increased odds of respiratory diseases among the OEF/OIF era population.

Objective: Frequency of suicidal ideation in the past two weeks, assessed by item 9 of the nine-item Patient Health Questionnaire (PHQ-9), has been positively associated with suicide mortality among patients in a setting other than the Veterans Health Administration (VHA). To inform suicide prevention activities at the VHA, it is important to evaluate whether item 9 is associated with suicide risk among patients in the VHA system., Methods: PHQ-9 assessments (N=447,245) conducted by the VHA between October 1, 2009, and September 30, 2010, were collected. National Death Index data were used to ascertain suicide mortality from the date of PHQ-9 assessment through September 30, 2011. Multivariable proportional hazards regressions were used to evaluate associations between responses to item 9 and suicide mortality., Results: After the analyses adjusted for covariates, a response of "several days" for item 9 was associated with a 75% increased risk of suicide (hazard ratio [HR]=1.75, 95% confidence interval [CI]=1.24-2.46), a response of "more than half the days" was associated with a 115% increased risk of suicide (HR=2.15, CI=1.32-3.51), and a response of "nearly every day" was associated with a 185% increased risk of suicide (HR=2.85, CI=1.81-4.47), compared with a response of "not at all." However, 71.6% of suicides during the study period occurred among patients who responded "not at all" to item 9 from their most recent PHQ-9., Conclusions: Higher levels of suicidal ideation, indicated by item 9 of the PHQ-9, were associated with increased risk of suicide among patients in the VHA system.

Background: Veterans receiving Veterans Affairs (VA) healthcare have increased suicide risk compared to the general population. Many patients see primary care clinicians prior to suicide. Yet little is known about the correlates of suicide among patients who receive primary care treatment prior to death., Objective: Our aim was to describe characteristics of veterans who received VA primary care in the 6 months prior to suicide; and to compare these to characteristics of control patients who also received VA primary care., Design: This was a retrospective case-control study., Subjects: The investigators partnered with VA operations leaders to obtain death certificate data from 11 states for veterans who died by suicide in 2009. Cases were matched 1:2 to controls based on age, sex, and clinician., Main Measures: Demographic, diagnosis, and utilization data were obtained from VA's Corporate Data Warehouse. Additional clinical and psychosocial context data were collected using manual medical record review. Multivariate conditional logistic regression was used to examine associations between potential predictor variables and suicide., Key Results: Two hundred and sixty-nine veteran cases were matched to 538 controls. Average subject age was 63 years; 97 % were male. Rates of mental health conditions, functional decline, sleep disturbance, suicidal ideation, and psychosocial stressors were all significantly greater in cases compared to controls. In the final model describing men in the sample, non-white race (OR = 0.51; 95 % CI = 0.27-0.98) and VA service-connected disability (OR = 0.54; 95 % CI = 0.36-0.80) were associated with decreased odds of suicide, while anxiety disorder (OR = 3.52; 95 % CI = 1.79-6.92), functional decline (OR = 2.52; 95 % CI = 1.55-4.10), depression (OR = 1.82; 95 % CI = 1.07-3.10), and endorsement of suicidal ideation (OR = 2.27; 95 % CI = 1.07-4.83) were associated with greater odds of suicide., Conclusions: Assessment for anxiety disorders and functional decline in addition to suicidal ideation and depression may be especially important for determining suicide risk in this population. Continued development of interventions that support identifying and addressing these conditions in primary care is indicated.

A paralytic poliomyelitis outbreak occurred in Namibia in 2006, almost exclusively among adults. Nineteen cases were virologically confirmed as due to wild poliovirus type 1 (WPV1), and 26 were classified as polio compatible. Eleven deaths occurred among confirmed and compatible cases (24%). Of the confirmed cases, 97% were aged 15-45 years, 89% were male, and 71% lived in settlement areas in Windhoek. The virus was genetically related to a virus detected in 2005 in Angola, which had been imported earlier from India. The outbreak is likely due to immunity gaps among adults who were inadequately vaccinated during childhood. This outbreak underscores the ongoing risks posed by poliovirus importations, the importance of maintaining strong acute flaccid paralysis surveillance even in adults, and the need to maintain high population immunity to avoid polio outbreaks in the preeradication period and outbreaks due to vaccine-derived polioviruses in the posteradication era., (© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Veterans comprise 10% of the population, and suicide among Veterans has garnered national media and policy attention. Existing research suggests that intimate partner violence (IPV) is a risk factor for suicidal behaviors among some high-risk populations. This report offers a new perspective: the intersection between Veterans' suicidal thoughts and IPV, both victimization and perpetration. The data were obtained from a northeast telephone survey of Veterans (n = 296) using Veterans Health Administration services and yielded a 27% participation rate. Findings suggest male Veterans who are IPV involved have increased odds of suicidal thoughts and behaviors., (© The Author(s) 2014.)

Using latent class growth analysis, we were interested in investigating how experiences of loneliness emerge in distinct developmental patterns over the course of middle childhood and adolescence (NICHD Study of Early Child Care, N = 832). Second, we examined the role of demographic, mental health, and behavioral variables in association with these discrete patterns of loneliness. Loneliness was measured at 3 time points: age 9, age 11, and age 15. Results indicated five discrete trajectories of loneliness from middle childhood to adolescence. Most children exhibited a stable and low level of loneliness over time. The remaining children were split among moderate increasing, high increasing, decreasing, and chronic loneliness groups. Ethnicity, income, age 7 social skills, age 7 depression, and age 7 aggression were associated with trajectory membership. In addition, the loneliness trajectories predicted self-reports of social skills deficits, depression, aggression, and suicidal ideation at age 15., (Published by Elsevier Ltd.)

The link between violence and suicide is well documented. Previous studies, however, largely rely on cross-sectional designs or only consider violence as an antecedent of suicide. The purpose of the current study was to investigate the longitudinal relationship between violence and suicide from adolescence into young adulthood. Data were derived from Wave II (1995-1996), Wave III (2001-2002), and Wave IV (2007-2008) of the National Longitudinal Study of Adolescent Health (N = 8,966). We tested (2011-2013) a series of path analysis models in Mplus to determine the longitudinal associations between violence and suicidality. Results from the path analyses indicated that violence and suicidality mutually affect each other from adolescence into young adulthood. We found some evidence that the association between suicidality and violence was stronger for males compared to females, particularly in early and young adulthood. The current study confirms previous findings by demonstrating that violence is a risk factor for future suicide. We also extended the previous literature by demonstrating that a history of suicidality is associated with future risk for violence. Our findings highlight the importance of further integrating prevention efforts to reduce violence and suicidality during adolescence and early/young adulthood., (© 2013 The American Association of Suicidology.)

Objectives: We examined the prevalence and correlates of self-reported lifetime diagnosis of asthma and current asthma among same-sex and opposite-sex partnered adults., Methods: Data were from the 2004 Behavioral Risk Factor Surveillance System, in which same-sex partnership was a response option to a family planning item in the core questionnaire. Self-reported lifetime diagnosis of asthma and current asthma were examined in logistic regression models adjusted for demographic characteristics and asthma-related confounding factors and stratified by both gender and same-sex partnership status., Results: Significantly higher proportions of same-sex partnered male and female respondents reported lifetime and current asthma compared with their opposite-sex partnered peers. In adjusted analyses, same-sex partnership status remained significantly associated with asthma outcomes among men and women, with odds ratios ranging from 1.57 to 2.34., Conclusions: Results corroborated past studies that indicated asthma disproportionately affects sexual minority populations. The addition of sexual minority status questions to federal survey projects is key to further exploring health disparities in this population. Future studies are needed to investigate the etiology of this disparity.

Objectives: To examine health indicators of same-sex partnered veterans as compared with their opposite-sex partnered veteran and nonveteran peers., Methods: Same-sex partner status was derived by self-reported same-sex partnerships in data from the 2004 Behavioral Risk Factor Surveillance System. Outcome variables included health risk disparities associated with sexual minority status (e.g., frequent mental distress) and veteran status (e.g., firearm ownership). Stratified multiple logistic regression models were used to examine the association of same-sex partnered veteran status with health indicators., Results: Same-sex partnered veterans had higher odds of being overweight and keeping firearms in the house compared with same-sex partnered nonveterans. Same-sex partnered veterans were less likely than opposite-sex partnered veterans to be overweight, and they were more than twice as likely to be current smokers when compared with opposite-sex partnered nonveterans., Conclusions: Findings suggest both that some health disparities patterns identified by same-sex partnership status among the general population also exist among veteran populations, and that some unique distinctions may exist, particularly related to BMI and firearm ownership. Collection of information about sexual minority status within Department of Veterans Affairs data sources is needed to more accurately assess the health of this minority population.

Comorbid mental disorders are common among suicide decedents. It is unclear if mental disorders in combination confer additive risk for suicide, in other words, if risk associated with two disorders is approximately the sum of the risk conferred by each disorder considered separately, or if there are departures from additivity such that the combined risk is less (i.e., subadditive) or more than additive (i.e., synergistic). Using a retrospective cohort design, all male Department of Veterans Affairs, Veterans Health Administration (VHA) service users who utilized VHA services in fiscal year (FY) 1999 and were alive at the start or FY 2000 (N = 2,962,810) were analyzed. Individuals were followed until death or the end of FY 2006. Using the VHA National Patient Care Database, diagnoses of mental disorders in FY 1999 were grouped into six categories (e.g., posttraumatic stress disorder). In proportional hazards models, 2-way interactions between disorders were used to examine departures from additive risk. There were 7,426 suicide deaths in the study period. Two-way interaction tests were nearly all statistically significant, indicating departures from additivity, and the results of these tests were consistent with subadditive risk. Sensitivity analyses examining the first year of follow-up showed similar results. Subadditive risk may be explained by factors that serve to lower the increased risk associated with a comorbid diagnosis, which may include common underlying causes of mental disorders, difficulties of differential diagnosis, the nature of etiological relationships between mental disorders, and intensive clinical care and monitoring of patients with comorbidity., (2013 APA, all rights reserved)

The objective of this study was to examine whether U.S. Veterans more frequently indicate suicide acceptability than non-Veterans. The 2010 General Social Survey, which employed a probability-based sample of U.S. adults, was analyzed by self-reported Veteran status on suicide acceptability in four, separate hypothetical situations regarding ending one's life (i.e., incurable illness, bankruptcy, bringing dishonor/shame upon family, tired of living and ready to die). Veterans were no more likely to endorse suicide as acceptable than their non-Veteran counterparts. Results suggest that attitudes approving of suicide are not different among Veterans in general and non-Veterans. However, future research may need to examine whether subpopulations of Veterans with elevated risk for suicide may report differential attitudes about suicide.

Unlabelled: Lesbian, gay, and bisexual (ie, sexual minority) populations have increased prevalence of both self-injurious and suicidal behaviors, but reasons for these disparities are poorly understood., Objective: To test the association between socially based stressors (eg, victimization, discrimination) and self-injurious behavior, suicide ideation, and suicide attempt., Participants: A national sample of college-attending 18- to 24-year-olds., Methods: Random or census samples from postsecondary educational institutions that administered the National College Health Assessment during the Fall 2008 and Spring 2009 semesters., Results: Sexual minorities reported more socially based stressors than heterosexuals. Bisexuals exhibited greatest prevalence of self-injurious and suicidal behaviors. In adjusted models, intimate partner violence was most consistently associated with self-injurious behaviors., Conclusions: Sexual minorities' elevated risks of self-injurious and suicidal behaviors may stem from higher exposure to socially based stressors. Within-group differences among sexual minorities offer insight to specific risk factors that may contribute to elevated self-injurious and suicidal behaviors in sexual minority populations.

The association between loneliness and suicidality has been documented in many studies, but these studies have been limited by cross-sectional designs and the use of adult-only populations. The purpose of the current study was to overcome these limitations by (a) investigating whether the link between loneliness and suicidal thoughts and behaviors occurs cross-sectionally, longitudinally, or both and (b) investigating how the link between loneliness and suicidality might be influenced by different demographic variables, including gender, ethnicity, and socioeconomic status. Logistic regression analyses were used to analyze data from a large sample (N = 937) of youth from the NICHD Study of Early Child Care. Results indicated that loneliness at age 15 years was concurrently associated with both suicidal ideation and suicidal behavior at age 15 years. Loneliness in middle childhood was longitudinally associated with suicidal behaviors at age 15 years, but not with suicidal ideation at age 15 years. None of the demographic characteristics influenced these associations.

Background: Low-level violent behavior, particularly school bullying, remains a critical public health issue that has been associated with negative mental and physical health outcomes. School-based prevention programs, while a valuable line of defense to stave off bullying, have shown inconsistent results in terms of decreasing bullying. This study explored whether school safety measures (eg, security guards, cameras, ID badges) were associated with student reports of different forms of peer victimization related to bullying., Methods: Data came from the 2007 School Crime Supplement of the National Crime Victimization Survey. Chi-square tests of independence were used to examine differences among categorical variables. Logistic regression models were constructed for the peer victimization outcomes. A count variable was constructed among the bullying outcomes (0-7) with which a Poisson regression model was constructed to analyze school safety measures' impacts on degree of victimization., Results: Of the various school safety measures, only having adults in hallways resulted in a significant reduction in odds of being physically bullied, having property vandalized, or having rumors spread. In terms of degree of victimization, having adults and/or staff supervising hallways was associated with an approximate 26% decrease in students experiencing an additional form of peer victimization., Conclusions: Results indicated that school safety measures overall were not associated with decreased reports of low-level violent behaviors related to bullying. More research is needed to further explore what best promotes comprehensive safety in schools., (© 2011, American School Health Association.)

Fatal and nonfatal intentional self-harm events in eight U.S. states were compared using emergency department, hospital, and vital statistics data. Nonfatal event rates increased by an estimated 24.20% over 6 years. Case fatality ratios varied widely, but two northeastern states' total event rates (fatal plus nonfatal) were very high (New Hampshire 206.5/100,000 person years; Massachusetts 166.7/100,000). Geographic context did not uniformly impact the likelihood of self-harm across event types. The state-level public health burden posed by such acts cannot, therefore, be accurately estimated from either mortality or morbidity data alone.