JAMA Psychiatry最新文献

{"title":"Announcing \"Technology and Psychiatry\" and Expanding Evidence-Based Comments and Reviews in JAMA Psychiatry.","authors":"Dost Öngür, Roy H Perlis","doi":"10.1001/jamapsychiatry.2024.4573","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.4573","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bright Light Therapy for Nonseasonal Depressive Disorders.","authors":"Hirofumi Hirakawa","doi":"10.1001/jamapsychiatry.2024.4480","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.4480","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depressive Symptoms and Amyloid Pathology.","authors":"Wietse A Wiels, Julie E Oomens, Sebastiaan Engelborghs, Chris Baeken, Christine A F von Arnim, Mercè Boada, Mira Didic, Bruno Dubois, Tormod Fladby, Wiesje M van der Flier, Giovanni B Frisoni, Lutz Fröhlich, Kiran Dip Gill, Timo Grimmer, Helmut Hildebrandt, Jakub Hort, Yoshiaki Itoh, Takeshi Iwatsubo, Aleksandra Klimkowicz-Mrowiec, Dong Young Lee, Alberto Lleó, Pablo Martinez-Lage, Alexandre de Mendonça, Philipp T Meyer, Elisabeth N Kapaki, Piero Parchi, Matteo Pardini, Lucilla Parnetti, Julius Popp, Lorena Rami, Eric M Reiman, Juha O Rinne, Karen M Rodrigue, Pascual Sánchez-Juan, Isabel Santana, Marie Sarazin, Nikolaos Scarmeas, Ingmar Skoog, Peter J Snyder, Reisa A Sperling, Sylvia Villeneuve, Anders Wallin, Jens Wiltfang, Henrik Zetterberg, Rik Ossenkoppele, Frans R J Verhey, Stephanie J B Vos, Pieter Jelle Visser, Willemijn J Jansen, Daniel Alcolea, Daniele Altomare, Simone Baiardi, Ines Baldeiras, Randall J Bateman, Kaj Blennow, Michel Bottlaender, Anouk den Braber, Mark A van Buchem, Min Soo Byun, Jirí Cerman, Kewei Chen, Elena Chipi, Gregory S Day, Alexander Drzezga, Marie Eckerström, Laura L Ekblad, Stéphane Epelbaum, Stefan Förster, Juan Fortea, Yvonne Freund-Levi, Lars Frings, Eric Guedj, Lucrezia Hausner, Sabine Hellwig, Edward D Huey, Julio F Jiménez-Bonilla, Keith A Johnson, Ane Iriondo Juaristi, Ramesh Kandimalla, George Paraskevas, Silke Kern, Bjørn-Eivind S Kirsebom, Johannes Kornhuber, Julien Lagarde, Susan M Landau, Nienke Legdeur, Jorge J Llibre Guerra, Nancy N Maserejian, Marta Marquié, Shinobu Minatani, Silvia Daniela Morbelli, Barbara Mroczko, Eva Ntanasi, Catarina Resende de Oliveira, Pauline Olivieri, Adelina Orellana, Richard J Perrin, Oliver Peters, Sudesh Prabhakar, Inez H Ramakers, Eloy Rodríguez-Rodriguez, Agustín Ruiz, Eckart Rüther, Per Selnes, Dina Silva, Hilkka Soininen, Luiza Spiru, Akitoshi Takeda, Marc Teichmann, Betty M Tijms, Charlotte E Teunissen, Loisa I Thompson, Jonathan Vogelgsangs, Jonathan Vöglein, Gunhild Waldemar, Åsa K Wallin, Mary Yannakoulia, Dahyun Yi, Anna Zettergren","doi":"10.1001/jamapsychiatry.2024.4305","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.4305","url":null,"abstract":"<p><strong>Importance: </strong>Depressive symptoms are associated with cognitive decline in older individuals. Uncertainty about underlying mechanisms hampers diagnostic and therapeutic efforts. This large-scale study aimed to elucidate the association between depressive symptoms and amyloid pathology.</p><p><strong>Objective: </strong>To examine the association between depressive symptoms and amyloid pathology and its dependency on age, sex, education, and APOE genotype in older individuals without dementia.</p><p><strong>Design, setting, and participants: </strong>Cross-sectional analyses were performed using data from the Amyloid Biomarker Study data pooling initiative. Data from 49 research, population-based, and memory clinic studies were pooled and harmonized. The Amyloid Biomarker Study has been collecting data since 2012 and data collection is ongoing. At the time of analysis, 95 centers were included in the Amyloid Biomarker Study. The study included 9746 individuals with normal cognition (NC) and 3023 participants with mild cognitive impairment (MCI) aged between 34 and 100 years for whom data on amyloid biomarkers, presence of depressive symptoms, and age were available. Data were analyzed from December 2022 to February 2024.</p><p><strong>Main outcomes and measures: </strong>Amyloid-β1-42 levels in cerebrospinal fluid or amyloid positron emission tomography scans were used to determine presence or absence of amyloid pathology. Presence of depressive symptoms was determined on the basis of validated depression rating scale scores, evidence of a current clinical diagnosis of depression, or self-reported depressive symptoms.</p><p><strong>Results: </strong>In individuals with NC (mean [SD] age, 68.6 [8.9] years; 5664 [58.2%] female; 3002 [34.0%] APOE ε4 carriers; 937 [9.6%] had depressive symptoms; 2648 [27.2%] had amyloid pathology), the presence of depressive symptoms was not associated with amyloid pathology (odds ratio [OR], 1.13; 95% CI, 0.90-1.40; P = .29). In individuals with MCI (mean [SD] age, 70.2 [8.7] years; 1481 [49.0%] female; 1046 [44.8%] APOE ε4 carriers; 824 [27.3%] had depressive symptoms; 1668 [55.8%] had amyloid pathology), the presence of depressive symptoms was associated with a lower likelihood of amyloid pathology (OR, 0.73; 95% CI 0.61-0.89; P = .001). When considering subgroup effects, in individuals with NC, the presence of depressive symptoms was associated with a higher frequency of amyloid pathology in APOE ε4 noncarriers (mean difference, 5.0%; 95% CI 1.0-9.0; P = .02) but not in APOE ε4 carriers. This was not the case in individuals with MCI.</p><p><strong>Conclusions and relevance: </strong>Depressive symptoms were not consistently associated with a higher frequency of amyloid pathology in participants with NC and were associated with a lower likelihood of amyloid pathology in participants with MCI. These findings were not influenced by age, sex, or education level. Mechanisms other than amyloid accumula","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Employment Nondiscrimination Protection and Mental Health Among Sexual Minority Adults.","authors":"Michael Liu, Vishal R Patel, Sahil Sandhu, Rishi K Wadhera, Alex S Keuroghlian","doi":"10.1001/jamapsychiatry.2024.4318","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.4318","url":null,"abstract":"<p><strong>Importance: </strong>In the 2020 Bostock v Clayton County decision, the US Supreme Court extended employment nondiscrimination protection to sexual minority adults. The health impacts of this ruling and similar policies related to sexual orientation-based discrimination are not currently known.</p><p><strong>Objective: </strong>To estimate changes in mental health following the Bostock decision among sexual minority adults in states that gained employment nondiscrimination protection (intervention states) compared with those in states with protections already in place (control states).</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used 2018-2022 data from the Behavioral Risk Factor Surveillance System and a difference-in-differences approach to evaluate changes in mental health after the Bostock decision by comparing sexual minority adults (aged ≥18 years and identifying as lesbian, gay, or bisexual) in 12 intervention states with those residing in 9 control states. Models were estimated for all participants and separately for employed participants. Data were analyzed between February and September 2024.</p><p><strong>Exposure: </strong>Residing in a state that gained employment nondiscrimination protection after the Bostock decision.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was number of poor mental health days during the past 30 days, and the secondary outcome was severe mental distress (defined as 14 or more past-month poor mental health days).</p><p><strong>Results: </strong>Of 597 462 participants (306 365 in intervention states [77.7% aged 18-64 years and 22.3% aged ≥65 years; 51.7% female] and 291 097 in control states [77.5% aged 18-64 years and 22.5% aged ≥65 years; 50.6% female]), 5.1% in intervention states and 6.0% in control states self-identified as sexual minority adults. The mean (SE) number of past-month poor mental health days was unchanged after the Bostock decision among sexual minority adults in both intervention (from 8.70 [0.27] to 9.59 [0.24] days; adjusted difference, 0.57 [95% CI, -1.02 to 2.16] days) and control (from 8.53 [0.21] to 10.15 [0.20] days; adjusted difference, 1.17 [95% CI, -0.46 to 2.79] days) states, resulting in no differential change between the 2 groups (difference-in-differences, -0.60 days; 95% CI, -1.25 to 0.06 days). Among the subset of employed sexual minority adults, the mean (SE) number of poor mental health days did not change in intervention states (from 7.99 [0.38] to 8.83 [0.30] days; adjusted difference, 0.87 [95% CI, -0.49 to 2.22] days) but increased in control states (from 7.75 [0.27] to 9.75 [0.26] days; adjusted difference, 1.84 [95% CI, 0.44-3.24] days). These findings corresponded to a significant relative reduction in poor mental health days among employed sexual minority adults in intervention vs control states (difference-in-differences, -0.97 days; 95% CI, -1.74 to -0.21 days). Mean (SE) rates of sever","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modifying Informed Consent to Help Address Functional Unmasking in Psychedelic Clinical Trials","authors":"Michelle Matvey, D. Parker Kelley, Ellen R. Bradley, Winston Chiong, Aoife O’Donovan, Josh Woolley","doi":"10.1001/jamapsychiatry.2024.4312","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.4312","url":null,"abstract":"ImportanceThere is unprecedented clinician, industry, and patient interest in the therapeutic development of psychedelic drugs. This is due to a combination of promising clinical trial results, positive media coverage, and the lack of novel pharmacologic treatments for psychiatric disorders in recent decades. However, the field faces a key methodological challenge: masking participants to treatment conditions in psychedelic clinical trials has been largely unsuccessful.ObjectiveWhen participants can tell whether they received active drug or placebo, their responses to clinical assessments, questionnaires, and even their functional imaging and biological data can be influenced by preconceptions about treatment effects. Positive patient expectancies combined with ineffective masking may skew outcomes and inflate effect sizes. This complicates efforts to determine the safety and efficacy of psychedelic drugs. Here, we explore a method to help address this problem: modifying informed consent to obscure information about the study design.Evidence ReviewWe reviewed all contemporary (2000-2024) clinical trials of psychedelic or methylenedioxymethamphetamine (MDMA) therapy and corresponded with the investigators to compile information on the use of modifications to informed consent in these studies.FindingsModifying informed consent to obscure details of the study design has been implemented in several psychedelic clinical trials and may offer a way to strengthen masking. However, this approach poses significant ethical risks. We examine examples of modifications used in the psychedelic literature, discuss the current regulatory landscape, and suggest strategies to mitigate risks associated with modified informed consent.Conclusions and RelevanceIncorporating modified informed consent in future psychedelic clinical trials may improve interpretability and impact, but this has not been explicitly tested. Modifications to informed consent may not be appropriate in all cases, and risks to participants should be minimized by implementing appropriate guardrails.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"82 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic Analysis of Retinal Cell Types in Neuropsychiatric Disorders","authors":"Emanuel Boudriot, Marius Stephan, Finn Rabe, Lukasz Smigielski, Andrea Schmitt, Peter Falkai, Michael J. Ziller, Moritz J. Rossner, Philipp Homan, Sergi Papiol, Florian J. Raabe","doi":"10.1001/jamapsychiatry.2024.4230","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.4230","url":null,"abstract":"ImportanceAs an accessible part of the central nervous system, the retina provides a unique window to study pathophysiological mechanisms of brain disorders in humans. Imaging and electrophysiological studies have revealed retinal alterations across several neuropsychiatric and neurological disorders, but it remains largely unclear which specific cell types and biological mechanisms are involved.ObjectiveTo determine whether specific retinal cell types are affected by genomic risk for neuropsychiatric and neurological disorders and to explore the mechanisms through which genomic risk converges in these cell types.Design, Setting, and ParticipantsThis genetic association study combined findings from genome-wide association studies in schizophrenia, bipolar disorder, major depressive disorder, multiple sclerosis, Parkinson disease, Alzheimer disease, and stroke with retinal single-cell transcriptomic datasets from humans, macaques, and mice. To identify susceptible cell types, Multi-Marker Analysis of Genomic Annotation (MAGMA) cell-type enrichment analyses were applied and subsequent pathway analyses performed. The cellular top hits were translated to the structural level using retinal optical coherence tomography (acquired between 2009 and 2010) and genotyping data in the large population-based UK Biobank cohort study. Data analysis was conducted between 2022 and 2024.Main Outcomes and MeasuresCell type–specific enrichment of genetic risk loading for neuropsychiatric and neurological disorder traits in the gene expression profiles of retinal cells.ResultsExpression profiles of amacrine cells (interneurons within the retina) were robustly enriched in schizophrenia genetic risk across mammalian species and in different developmental stages. This enrichment was primarily driven by genes involved in synapse biology. Moreover, expression profiles of retinal immune cell populations were enriched in multiple sclerosis genetic risk. No consistent cell-type associations were found for bipolar disorder, major depressive disorder, Parkinson disease, Alzheimer disease, or stroke. On the structural level, higher polygenic risk for schizophrenia was associated with thinning of the ganglion cell inner plexiform layer, which contains dendrites and synaptic connections of amacrine cells (B, −0.09; 95% CI, −0.16 to −0.03; <jats:italic>P</jats:italic> = .007; n = 36 349; mean [SD] age, 57.50 [8.00] years; 19 859 female [54.63%]). Higher polygenic risk for multiple sclerosis was associated with increased thickness of the retinal nerve fiber layer (B, 0.06; 95% CI, 0.02 to 0.10; <jats:italic>P</jats:italic> = .007; n = 36 371; mean [SD] age, 57.51 [8.00] years; 19 843 female [54.56%]).Conclusions and RelevanceThis study provides novel insights into the cellular underpinnings of retinal alterations in neuropsychiatric and neurological disorders and highlights the retina as a potential proxy to study synaptic pathology in schizophrenia.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"56 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Ventrolateral Prefrontal Cortical Activity During Reward Expectancy and Mania Risk.","authors":"Manan Arora, Henry Chase, Michele A Bertocci, Alexander S Skeba, Kristen Eckstrand, Genna Bebko, Haris A Aslam, Robert Raeder, Simona Graur, Osasumwen Benjamin, Yiming Wang, Richelle S Stiffler, Mary L Phillips","doi":"10.1001/jamapsychiatry.2024.4216","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.4216","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Mania/hypomania is the pathognomonic feature of bipolar disorder (BD). As BD is often misdiagnosed as major depressive disorder (MDD), replicable neural markers of mania/hypomania risk are needed for earlier BD diagnosis and pathophysiological treatment development.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To replicate the previously reported positive association between left ventrolateral prefrontal cortex (vlPFC) activity during reward expectancy (RE) and mania/hypomania risk, to explore the effect of MDD history on this association, and to compare RE-related left vlPFC activity in individuals with and at risk of BD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study was conducted from July 2014 to December 2023 at the University of Pittsburgh, Pittsburgh, Pennsylvania. Three samples were formed comprising young adults (aged 18 to 30 years) without BD and with a range of subsyndromal-syndromal affective and anxiety psychopathologies, including a new sample and 2 test samples from our previous research; a sample of individuals aged 18 to 30 years with euthymic BD was also included. All participants were recruited from the community through advertising.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Functional magnetic resonance imaging during an RE task.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;New sample: whole-brain activity during RE regressed to the Mood Spectrum Self-Report Lifetime Questionnaire (MOODS-SR-L) manic domain score in all participants and in those without history of MDD and RE-related whole-brain activity regressed to the MOODS-SR-L depressive domain score to determine specificity to mania/hypomania risk. Test samples: these associations were examined using parameter estimates of activity extracted from respective masks created from activity in the new sample. A tertile split of MOODS-SR-L manic domain score divided the new sample into 3 mania/hypomania risk groups. Comparison of RE-related activity (extracted parameter estimates) was performed in risk groups and individuals with BD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 113 individuals in the new sample, 73 were female, and the mean (SD) age was 23.88 (3.32) years. In each of the test samples, there were 52 individuals (39 female; mean [SD] age, 21.94 [2.12] years) and 65 individuals (47 female; mean [SD] age, 21.39 [2.11] years). The euthymic BD group had 37 individuals (30 female; mean [SD] age, 25.12 [3.81] years). In the new sample, 8 clusters of RE-related activity, including left vlPFC activity, showed a positive association with mania/hypomania risk, which remained after excluding individuals with MDD history and was specific to mania/hypomania risk. In the test samples, this association was shown in test sample 1 only (β, 0.21; 95% CI, 0.08-0.35; P = .002; q(false discovery rate [FDR]), 0.006; R2, 0.04). Test sample 2 had a higher proportion with MDD history (49 of 65 [75.3%] compared to 31 of 52 [59.6%] in sa","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Requests for Medical Assistance in Dying by Young Dutch People With Psychiatric Disorders.","authors":"Lizanne J S Schweren, Sanne P A Rasing, Monique Kammeraat, Leah A Middelkoop, Ruthie Werner, Saskia Y M Mérelle, Julian M Garcia, Daan H M Creemers, Sisco M P van Veen","doi":"10.1001/jamapsychiatry.2024.4006","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.4006","url":null,"abstract":"<p><strong>Importance: </strong>In the Netherlands, a growing group of young people request medical assistance in dying based on psychiatric suffering (MAID-PS). Little is known about this group, their characteristics, and outcomes.</p><p><strong>Objective: </strong>To assess the proportion of requests for and deaths by MAID-PS among young patients, outcomes of their application and assessment procedures, and characteristics of those patients who died by either MAID or suicide.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included Dutch individuals younger than 24 years requesting MAID-PS between January 1, 2012, and June 30, 2021, whose patient file had been closed by December 1, 2022, at the Expertisecentrum Euthanasie, a specialized health care facility providing MAID consultation and care.</p><p><strong>Main outcomes and measures: </strong>Outcomes of the MAID-PS assessment procedure (discontinued, rejected, or MAID-PS) and clinical characteristics of patients who died by MAID or suicide.</p><p><strong>Results: </strong>The study included 397 processed applications submitted by 353 individuals (73.4% female; mean [SD] age, 20.84 [1.90] years). Between 2012 and the first half of 2021, the number of MAID-PS applications by young patients increased from 10 to 39. The most likely outcome was application retracted by the patient (188 [47.3%]) followed by application rejected (178 [44.8%]). For 12 applications (3.0%), patients died by MAID. Seventeen applications (4.3%) were stopped because the patient died by suicide during the application process and 2 (0.5%) because the patient died after they voluntarily stopped eating and drinking. All patients who died by suicide or MAID (n = 29) had multiple psychiatric diagnoses (most frequently major depression, autism spectrum disorder, personality disorders, eating disorder, and/or trauma-related disorder) and extensive treatment histories. Twenty-eight of these patients (96.5%) had a history of suicidality that included multiple suicide attempts prior to the MAID application. Among 17 patients who died by suicide, 13 of 14 (92.9%) had a history of crisis-related hospital admission, and 9 of 12 patients who died by MAID (75.0%) had a history of self-harm.</p><p><strong>Conclusions and relevance: </strong>This cohort study found that the number of young psychiatric patients in the Netherlands who requested MAID-PS increased between 2012 and 2021 and that applications were retracted or rejected for most. Those who died by MAID or suicide were mostly female and had long treatment histories and prominent suicidality. These findings suggest that there is an urgent need for more knowledge about persistent death wishes and effective suicide prevention strategies for this high-risk group.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Determinants of Health and Suicide-Related Outcomes: A Review of Meta-Analyses.","authors":"Peter Jongho Na, Jeonghyun Shin, Ha Rim Kwak, Jaewon Lee, Dylan J Jester, Piumee Bandara, Jim Yong Kim, Christine Y Moutier, Robert H Pietrzak, Maria A Oquendo, Dilip V Jeste","doi":"10.1001/jamapsychiatry.2024.4241","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.4241","url":null,"abstract":"<p><strong>Importance: </strong>Preventing suicide is one of the top priorities in public health policy. Identifying key social determinants of health (SDOH) in suicide risk is critical for informing clinical practices, future research, and policy solutions to prevent suicide.</p><p><strong>Objective: </strong>To examine the associations of SDOH with suicide-related outcomes.</p><p><strong>Data sources: </strong>Studies published before July 2023 were searched through PubMed, PsycINFO, Embase, and Web of Science. The date of the search was August 4, 2023.</p><p><strong>Study selection: </strong>We included the most up-to-date meta-analyses reporting associations between SDOH and suicide-related outcomes.</p><p><strong>Data extraction and synthesis: </strong>Three independent reviewers extracted data and conducted quality assessment using the Joanna Briggs Institute Checklist for Systematic Reviews and Research Syntheses.</p><p><strong>Main outcomes and measures: </strong>The main outcomes of interest were suicide mortality, suicide attempt, and suicidal ideation.</p><p><strong>Results: </strong>A total of 46 meta-analyses met inclusion criteria. For suicide mortality, justice system-involved individuals in the community, exposure to others' and parental suicide, firearm accessibility, divorce, experience in foster care, release from incarceration, and midlife (age 35-65 years) unemployment were the SDOH with consistently strong effects. Individuals released from incarceration demonstrated a high prevalence of suicide mortality (114.5 per 100 000 persons). With regard to suicide attempt, experience of childhood abuse and maltreatment and sexual assault, gender and sexual minority status, and parental suicide mortality were the strongest risk factors. The prevalence of suicide attempt among homeless individuals (28.9%; 95% CI, 21.7%-37.2%) and incarcerated female youths (27%; 95% CI, 20%-34%) and adults (12.2%; 95% CI, 7.1%-17.2%) was high. For suicidal ideation, identification as bisexual and intimate partner violence in women were the strongest risk factors. The prevalence of lifetime suicidal ideation in homeless individuals was 41.6% (95% CI, 28.6%-56.0%). Protective factors associated with reduced risk of suicide mortality were religious affiliation and being married. School connectedness showed protective associations against suicide attempt and suicidal ideation.</p><p><strong>Conclusions and relevance: </strong>Tailoring interventions and future research for identified priority subpopulations, such as justice system-involved individuals in the community, and implementing policy measures addressing the SDOH that showed strong associations with suicide mortality, attempts, and ideation, such as gun licensing requirements, are critical to counteracting social and environmental forces that increase suicide risk.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What the Experiences of Young Persons Can Teach Us About Medical Aid in Dying for Psychiatric Illness.","authors":"Brent Kious","doi":"10.1001/jamapsychiatry.2024.3963","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2024.3963","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":22.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}