首页 > 最新文献

JAMA Psychiatry最新文献

英文 中文
Semaglutide in Psychiatry-Opportunities and Challenges. 塞马鲁肽在精神病学中的应用--机遇与挑战。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-01 DOI: 10.1001/jamapsychiatry.2024.2412
Sri Mahavir Agarwal, Margaret Hahn
{"title":"Semaglutide in Psychiatry-Opportunities and Challenges.","authors":"Sri Mahavir Agarwal, Margaret Hahn","doi":"10.1001/jamapsychiatry.2024.2412","DOIUrl":"10.1001/jamapsychiatry.2024.2412","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"955-956"},"PeriodicalIF":22.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017593","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}
引用次数: 0
Medical Debt and the Mental Health Treatment Gap Among US Adults. 美国成年人的医疗债务和心理健康治疗差距。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-01 DOI: 10.1001/jamapsychiatry.2024.1861
Kyle J Moon, Sabriya L Linton, Ramin Mojtabai

Importance: Medical debt is common in the US and may hinder timely access to care for mental disorders.

Objective: To estimate the prevalence of medical debt among US adults with depression and anxiety and its association with delayed and forgone mental health care.

Design, setting, and participants: Cross-sectional, nationally representative survey study of US adult participants in the 2022 National Health Interview Survey who had current or lifetime diagnoses of depression or anxiety.

Exposures: Self-reported lifetime clinical diagnoses of depression and anxiety; moderate to severe symptoms of current depression (Patient Health Questionnaire-8 score ≥10) and anxiety (Generalized Anxiety Disorder-7 score ≥10) irrespective of lifetime diagnoses; and past-year medical debt.

Main outcomes and measures: Self-reported delaying and forgoing mental health care because of cost in the past year.

Results: Among 27 651 adults (15 050 [54.4%] female; mean [SD] age, 52.9 [18.4] years), 5186 (18.2%) reported lifetime depression, 1948 (7.3%) reported current depression, 4834 (17.7%) reported lifetime anxiety, and 1689 (6.6%) reported current anxiety. Medical debt was more common among adults with lifetime depression (19.9% vs 8.6%; adjusted prevalence ratio [aPR], 1.97; 95% CI, 1.96-1.98), lifetime anxiety (19.4% vs 8.8%; aPR, 1.91; 95% CI, 1.91-1.92), current depression (27.3% vs 9.4%; aPR, 2.34; 95% CI, 2.34-2.36), and current anxiety (26.2% vs 9.6%; aPR, 2.24; 95% CI, 2.24-2.26) compared with adults without the respective mental disorders. Medical debt was associated with delayed health care among adults with lifetime depression (29.0% vs 11.6%; aPR, 2.68; 95% CI, 2.62-2.74), lifetime anxiety (28.0% vs 11.5%; aPR, 2.45; 95% CI, 2.40-2.50), current depression (36.9% vs 17.4%; aPR, 2.25; 95% CI, 2.13-2.38), and current anxiety (38.4% vs 16.9%; aPR, 2.48; 95% CI, 2.35-2.66) compared with those without these diagnoses. Medical debt was associated with forgone health care among adults with lifetime depression (29.4% vs 10.6%; aPR, 2.66; 95% CI, 2.61-2.71), lifetime anxiety (28.2% vs 10.7%; aPR, 2.63; 95% CI, 2.57-2.68), current depression (38.0% vs 17.2%; aPR, 2.35; 95% CI, 2.23-2.48), and current anxiety (40.8% vs 17.1%; aPR, 2.57; 95% CI, 2.43-2.75) compared with those without the diagnoses.

Conclusions and relevance: Medical debt is prevalent among adults with depression and anxiety and may contribute to the mental health treatment gap. In the absence of structural reform, new policies are warranted to protect against this financial barrier to mental health care.

重要性:医疗债务在美国很常见,可能会阻碍精神障碍患者及时获得医疗服务:目的:估算患有抑郁症和焦虑症的美国成年人中医疗债务的普遍程度,以及医疗债务与延迟和放弃精神健康护理之间的关系:横断面、具有全国代表性的调查研究,对象是参加 2022 年全国健康访谈调查、目前或终生被诊断为抑郁症或焦虑症的美国成年人:自我报告的终生抑郁症和焦虑症临床诊断;中度至重度的当前抑郁症状(患者健康问卷-8评分≥10分)和焦虑症状(广泛性焦虑症-7评分≥10分),与终生诊断无关;以及过去一年的医疗债务:主要结果和测量指标:自我报告在过去一年中因费用问题而推迟或放弃心理保健的情况:在 27 651 名成年人中(女性 15 050 [54.4%] 人;平均 [SD] 年龄 52.9 [18.4] 岁),有 5 186 人(18.2%)报告终生患有抑郁症,1948 人(7.3%)报告目前患有抑郁症,4834 人(17.7%)报告终生患有焦虑症,1689 人(6.6%)报告目前患有焦虑症。医疗债务在终生抑郁(19.9% 对 8.6%;调整患病率比 [aPR],1.97;95% CI,1.96-1.98)、终生焦虑(19.4% 对 8.8%;aPR,1.91;95% CI,1.91-1.92)、当前抑郁(27.9% 对 8.8%;调整患病率比 [aPR],1.97;95% CI,1.96-1.98)的成年人中更为常见。与没有相应精神障碍的成年人相比,医疗债务与延迟就医相关(27.3% vs 9.4%;aPR,2.34;95% CI,2.34-2.36)。在终生患有抑郁症(29.0% vs 11.6%;aPR,2.68;95% CI,2.62-2.74)、终生患有焦虑症(28.0% vs 11.5%;aPR,2.45;95% CI,2.与没有这些诊断的人相比,医疗债务与放弃的健康风险相关。在终生患有抑郁症(29.4% vs 10.6%;aPR,2.66;95% CI,2.61-2.71)、终生患有焦虑症(28.2% vs 10.7%;aPR,2.63;95% CI,2.57-2.68)、目前患有抑郁症(38.4% vs 16.9%;aPR,2.48;95% CI,2.35-2.66)的成年人中,医疗债务与放弃的医疗保健相关。68)、当前抑郁(38.0% vs 17.2%;aPR,2.35;95% CI,2.23-2.48)和当前焦虑(40.8% vs 17.1%;aPR,2.57;95% CI,2.43-2.75):医疗债务在患有抑郁症和焦虑症的成年人中很普遍,可能会导致心理健康治疗缺口。在缺乏结构性改革的情况下,有必要制定新的政策来防止这种心理健康护理的经济障碍。
{"title":"Medical Debt and the Mental Health Treatment Gap Among US Adults.","authors":"Kyle J Moon, Sabriya L Linton, Ramin Mojtabai","doi":"10.1001/jamapsychiatry.2024.1861","DOIUrl":"10.1001/jamapsychiatry.2024.1861","url":null,"abstract":"<p><strong>Importance: </strong>Medical debt is common in the US and may hinder timely access to care for mental disorders.</p><p><strong>Objective: </strong>To estimate the prevalence of medical debt among US adults with depression and anxiety and its association with delayed and forgone mental health care.</p><p><strong>Design, setting, and participants: </strong>Cross-sectional, nationally representative survey study of US adult participants in the 2022 National Health Interview Survey who had current or lifetime diagnoses of depression or anxiety.</p><p><strong>Exposures: </strong>Self-reported lifetime clinical diagnoses of depression and anxiety; moderate to severe symptoms of current depression (Patient Health Questionnaire-8 score ≥10) and anxiety (Generalized Anxiety Disorder-7 score ≥10) irrespective of lifetime diagnoses; and past-year medical debt.</p><p><strong>Main outcomes and measures: </strong>Self-reported delaying and forgoing mental health care because of cost in the past year.</p><p><strong>Results: </strong>Among 27 651 adults (15 050 [54.4%] female; mean [SD] age, 52.9 [18.4] years), 5186 (18.2%) reported lifetime depression, 1948 (7.3%) reported current depression, 4834 (17.7%) reported lifetime anxiety, and 1689 (6.6%) reported current anxiety. Medical debt was more common among adults with lifetime depression (19.9% vs 8.6%; adjusted prevalence ratio [aPR], 1.97; 95% CI, 1.96-1.98), lifetime anxiety (19.4% vs 8.8%; aPR, 1.91; 95% CI, 1.91-1.92), current depression (27.3% vs 9.4%; aPR, 2.34; 95% CI, 2.34-2.36), and current anxiety (26.2% vs 9.6%; aPR, 2.24; 95% CI, 2.24-2.26) compared with adults without the respective mental disorders. Medical debt was associated with delayed health care among adults with lifetime depression (29.0% vs 11.6%; aPR, 2.68; 95% CI, 2.62-2.74), lifetime anxiety (28.0% vs 11.5%; aPR, 2.45; 95% CI, 2.40-2.50), current depression (36.9% vs 17.4%; aPR, 2.25; 95% CI, 2.13-2.38), and current anxiety (38.4% vs 16.9%; aPR, 2.48; 95% CI, 2.35-2.66) compared with those without these diagnoses. Medical debt was associated with forgone health care among adults with lifetime depression (29.4% vs 10.6%; aPR, 2.66; 95% CI, 2.61-2.71), lifetime anxiety (28.2% vs 10.7%; aPR, 2.63; 95% CI, 2.57-2.68), current depression (38.0% vs 17.2%; aPR, 2.35; 95% CI, 2.23-2.48), and current anxiety (40.8% vs 17.1%; aPR, 2.57; 95% CI, 2.43-2.75) compared with those without the diagnoses.</p><p><strong>Conclusions and relevance: </strong>Medical debt is prevalent among adults with depression and anxiety and may contribute to the mental health treatment gap. In the absence of structural reform, new policies are warranted to protect against this financial barrier to mental health care.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"985-992"},"PeriodicalIF":22.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11255967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Gratitude and Mortality Among Older US Female Nurses. 美国老年女护士的感恩与死亡率。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-01 DOI: 10.1001/jamapsychiatry.2024.1687
Ying Chen, Olivia I Okereke, Eric S Kim, Henning Tiemeier, Laura D Kubzansky, Tyler J VanderWeele

Importance: Supporting healthy aging is a US public health priority, and gratitude is a potentially modifiable psychological factor that may enhance health and well-being in older adults. However, the association between gratitude and mortality has not been studied.

Objective: To examine the association of gratitude with all-cause and cause-specific mortality in later life.

Design, setting, and participants: This population-based prospective cohort study used data from self-reported questionnaires and medical records of 49 275 US older female registered nurses who participated in the Nurses' Health Study (2016 questionnaire wave to December 2019). Cox proportional hazards regression models estimated the hazard ratio (HR) of deaths by self-reported levels of gratitude at baseline. These models adjusted for baseline sociodemographic characteristics, social participation, physical health, lifestyle factors, cognitive function, and mental health. Data analysis was conducted from December 2022 to April 2024.

Exposure: Gratitude was assessed with the 6-item Gratitude Questionnaire, a validated and widely used measure of one's tendency to experience grateful affect.

Main outcomes and measures: Deaths were identified from the National Death Index, state statistics records, reports by next of kin, and the postal system. Causes of death were ascertained by physicians through reviewing death certificates and medical records.

Results: Among the 49 275 participants (all female; mean [SD] age at baseline, 79 [6.16] years), 4608 incident deaths were identified over 151 496 person-years of follow-up. Greater gratitude at baseline was associated with a lower hazard of mortality in a monotonic fashion. For instance, the highest tertile of gratitude, compared with the lowest tertile, was associated with a lower hazard of all-cause deaths (HR, 0.91; 95% CI, 0.84-0.99) after adjusting for baseline sociodemographic characteristics, social participation, religious involvement, physical health, lifestyle factors, cognitive function, and mental health. When considering cause-specific deaths, death from cardiovascular disease was inversely associated with gratitude (HR, 0.85; 95% CI, 0.73-0.995).

Conclusions and relevance: This study provides the first empirical evidence suggesting that experiencing grateful affect is associated with increased longevity among older adults. The findings will need to be replicated in future studies with more representative samples.

重要性:支持健康老龄化是美国公共卫生的优先事项,而感恩是一种潜在的可调节心理因素,可增强老年人的健康和幸福感。然而,感恩与死亡率之间的关系尚未得到研究:目的:研究感恩与晚年全因和特定原因死亡率之间的关系:这项基于人群的前瞻性队列研究使用了49 275名美国老年女性注册护士的自我报告问卷和医疗记录数据,这些护士参加了护士健康研究(2016年问卷调查至2019年12月)。考克斯比例危险回归模型根据基线时自我报告的感恩水平估算了死亡危险比(HR)。这些模型对基线社会人口特征、社会参与、身体健康、生活方式因素、认知功能和心理健康进行了调整。数据分析从 2022 年 12 月开始,到 2024 年 4 月结束。主要结果和测量方法:通过 6 项感恩问卷对感恩进行评估,该问卷是一种经过验证并被广泛使用的衡量个人感恩倾向的方法:死亡信息来自国家死亡指数、州统计记录、近亲报告和邮政系统。死亡原因由医生通过审查死亡证明和医疗记录确定:在 49 275 名参与者(均为女性;基线时的平均年龄为 79 [6.16]岁)中,在 151 496 人年的跟踪调查中发现了 4608 例死亡事件。基线年龄越大,死亡率越低。例如,在对基线社会人口特征、社会参与、宗教参与、身体健康、生活方式因素、认知功能和心理健康进行调整后,与最低三分位数相比,最高三分位数的感激之情与较低的全因死亡风险相关(HR,0.91;95% CI,0.84-0.99)。在考虑特定原因导致的死亡时,心血管疾病导致的死亡与感恩成反比(HR,0.85;95% CI,0.73-0.995):这项研究首次提供了实证证据,表明体验感恩情绪与老年人寿命的延长有关。这些发现还需要在今后更具代表性的样本研究中加以验证。
{"title":"Gratitude and Mortality Among Older US Female Nurses.","authors":"Ying Chen, Olivia I Okereke, Eric S Kim, Henning Tiemeier, Laura D Kubzansky, Tyler J VanderWeele","doi":"10.1001/jamapsychiatry.2024.1687","DOIUrl":"10.1001/jamapsychiatry.2024.1687","url":null,"abstract":"<p><strong>Importance: </strong>Supporting healthy aging is a US public health priority, and gratitude is a potentially modifiable psychological factor that may enhance health and well-being in older adults. However, the association between gratitude and mortality has not been studied.</p><p><strong>Objective: </strong>To examine the association of gratitude with all-cause and cause-specific mortality in later life.</p><p><strong>Design, setting, and participants: </strong>This population-based prospective cohort study used data from self-reported questionnaires and medical records of 49 275 US older female registered nurses who participated in the Nurses' Health Study (2016 questionnaire wave to December 2019). Cox proportional hazards regression models estimated the hazard ratio (HR) of deaths by self-reported levels of gratitude at baseline. These models adjusted for baseline sociodemographic characteristics, social participation, physical health, lifestyle factors, cognitive function, and mental health. Data analysis was conducted from December 2022 to April 2024.</p><p><strong>Exposure: </strong>Gratitude was assessed with the 6-item Gratitude Questionnaire, a validated and widely used measure of one's tendency to experience grateful affect.</p><p><strong>Main outcomes and measures: </strong>Deaths were identified from the National Death Index, state statistics records, reports by next of kin, and the postal system. Causes of death were ascertained by physicians through reviewing death certificates and medical records.</p><p><strong>Results: </strong>Among the 49 275 participants (all female; mean [SD] age at baseline, 79 [6.16] years), 4608 incident deaths were identified over 151 496 person-years of follow-up. Greater gratitude at baseline was associated with a lower hazard of mortality in a monotonic fashion. For instance, the highest tertile of gratitude, compared with the lowest tertile, was associated with a lower hazard of all-cause deaths (HR, 0.91; 95% CI, 0.84-0.99) after adjusting for baseline sociodemographic characteristics, social participation, religious involvement, physical health, lifestyle factors, cognitive function, and mental health. When considering cause-specific deaths, death from cardiovascular disease was inversely associated with gratitude (HR, 0.85; 95% CI, 0.73-0.995).</p><p><strong>Conclusions and relevance: </strong>This study provides the first empirical evidence suggesting that experiencing grateful affect is associated with increased longevity among older adults. The findings will need to be replicated in future studies with more representative samples.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"1030-1038"},"PeriodicalIF":22.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11223047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141492035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Subjective Cognitive Decline Plus and Longitudinal Assessment and Risk for Cognitive Impairment. 主观认知能力下降加纵向评估与认知障碍风险。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-01 DOI: 10.1001/jamapsychiatry.2024.1678
Moonil Kang, Clara Li, Arnav Mahajan, Jessica Spat-Lemus, Shruti Durape, Jiachen Chen, Ashita S Gurnani, Sherral Devine, Sanford H Auerbach, Ting Fang Alvin Ang, Richard Sherva, Wei Qiao Qiu, Kathryn L Lunetta, Rhoda Au, Lindsay A Farrer, Jesse Mez

Importance: Subjective cognitive decline (SCD) is recognized to be in the Alzheimer disease (AD) cognitive continuum. The SCD Initiative International Working Group recently proposed SCD-plus (SCD+) features that increase risk for future objective cognitive decline but that have not been assessed in a large community-based setting.

Objective: To assess SCD risk for mild cognitive impairment (MCI), AD, and all-cause dementia, using SCD+ criteria among cognitively normal adults.

Design, setting, and participants: The Framingham Heart Study, a community-based prospective cohort study, assessed SCD between 2005 and 2019, with up to 12 years of follow-up. Participants 60 years and older with normal cognition at analytic baseline were included. Cox proportional hazards (CPH) models were adjusted for baseline age, sex, education, APOE ε4 status, and tertiles of AD polygenic risk score (PRS), excluding the APOE region. Data were analyzed from May 2021 to November 2023.

Exposure: SCD was assessed longitudinally using a single question and considered present if endorsed at the last cognitively normal visit. It was treated as a time-varying variable, beginning at the first of consecutive, cognitively normal visits, including the last, at which it was endorsed.

Main outcomes and measures: Consensus-diagnosed MCI, AD, and all-cause dementia.

Results: This study included 3585 participants (mean [SD] baseline age, 68.0 [7.7] years; 1975 female [55.1%]). A total of 1596 participants (44.5%) had SCD, and 770 (21.5%) were carriers of APOE ε4. APOE ε4 and tertiles of AD PRS status did not significantly differ between the SCD and non-SCD groups. MCI, AD, and all-cause dementia were diagnosed in 236 participants (6.6%), 73 participants (2.0%), and 89 participants (2.5%), respectively, during follow-up. On average, SCD preceded MCI by 4.4 years, AD by 6.8 years, and all-cause dementia by 6.9 years. SCD was significantly associated with survival time to MCI (hazard ratio [HR], 1.57; 95% CI, 1.22-2.03; P <.001), AD (HR, 2.98; 95% CI, 1.89-4.70; P <.001), and all-cause dementia (HR, 2.14; 95% CI, 1.44-3.18; P <.001). After adjustment for APOE and AD PRS, the hazards of SCD were largely unchanged.

Conclusions and relevance: Results of this cohort study suggest that in a community setting, SCD reflecting SCD+ features was associated with an increased risk of future MCI, AD, and all-cause dementia with similar hazards estimated in clinic-based settings. SCD may be an independent risk factor for AD and other dementias beyond the risk incurred by APOE ε4 and AD PRS.

重要性:主观认知能力下降(SCD)被认为是阿尔茨海默病(AD)认知能力连续体的一部分。SCD倡议国际工作组最近提出了SCD+(SCD+)特征,这些特征会增加未来客观认知能力下降的风险,但尚未在大型社区环境中进行过评估:目的:在认知能力正常的成年人中使用 SCD+ 标准评估轻度认知障碍 (MCI)、注意力缺失症和全因痴呆症的 SCD 风险:弗雷明汉心脏研究是一项基于社区的前瞻性队列研究,在 2005 年至 2019 年期间对 SCD 进行了评估,随访时间长达 12 年。研究纳入了分析基线认知正常的 60 岁及以上参与者。Cox比例危险(CPH)模型对基线年龄、性别、教育程度、APOE ε4状态和AD多基因风险评分(PRS)的三等分进行了调整,但不包括APOE区域。数据分析时间为 2021 年 5 月至 2023 年 11 月。暴露:采用单一问题对 SCD 进行纵向评估,如果在最后一次认知正常的访问中认可,则认为存在 SCD。它被视为一个时变变量,从认知正常的连续就诊的第一次开始,包括最后一次:共识诊断的 MCI、AD 和全因痴呆:本研究共纳入 3585 名参与者(平均 [SD] 基线年龄为 68.0 [7.7] 岁;1975 名女性 [55.1%])。共有 1596 人(44.5%)患有 SCD,770 人(21.5%)为 APOE ε4 携带者。APOE ε4和AD PRS状态的三元组在SCD组和非SCD组之间没有显著差异。在随访期间,分别有 236 名参与者(6.6%)、73 名参与者(2.0%)和 89 名参与者(2.5%)被诊断为 MCI、AD 和全因痴呆。平均而言,SCD 比 MCI 早 4.4 年,比 AD 早 6.8 年,比全因痴呆症早 6.9 年。SCD与MCI的存活时间明显相关(危险比[HR],1.57;95% CI,1.22-2.03;P 结论及意义:这项队列研究的结果表明,在社区环境中,反映出 SCD+ 特征的 SCD 与未来 MCI、AD 和全因痴呆风险的增加有关,与在诊所环境中估计的危害相似。除了 APOE ε4 和 AD PRS 带来的风险外,SCD 可能是 AD 和其他痴呆症的独立风险因素。
{"title":"Subjective Cognitive Decline Plus and Longitudinal Assessment and Risk for Cognitive Impairment.","authors":"Moonil Kang, Clara Li, Arnav Mahajan, Jessica Spat-Lemus, Shruti Durape, Jiachen Chen, Ashita S Gurnani, Sherral Devine, Sanford H Auerbach, Ting Fang Alvin Ang, Richard Sherva, Wei Qiao Qiu, Kathryn L Lunetta, Rhoda Au, Lindsay A Farrer, Jesse Mez","doi":"10.1001/jamapsychiatry.2024.1678","DOIUrl":"10.1001/jamapsychiatry.2024.1678","url":null,"abstract":"<p><strong>Importance: </strong>Subjective cognitive decline (SCD) is recognized to be in the Alzheimer disease (AD) cognitive continuum. The SCD Initiative International Working Group recently proposed SCD-plus (SCD+) features that increase risk for future objective cognitive decline but that have not been assessed in a large community-based setting.</p><p><strong>Objective: </strong>To assess SCD risk for mild cognitive impairment (MCI), AD, and all-cause dementia, using SCD+ criteria among cognitively normal adults.</p><p><strong>Design, setting, and participants: </strong>The Framingham Heart Study, a community-based prospective cohort study, assessed SCD between 2005 and 2019, with up to 12 years of follow-up. Participants 60 years and older with normal cognition at analytic baseline were included. Cox proportional hazards (CPH) models were adjusted for baseline age, sex, education, APOE ε4 status, and tertiles of AD polygenic risk score (PRS), excluding the APOE region. Data were analyzed from May 2021 to November 2023.</p><p><strong>Exposure: </strong>SCD was assessed longitudinally using a single question and considered present if endorsed at the last cognitively normal visit. It was treated as a time-varying variable, beginning at the first of consecutive, cognitively normal visits, including the last, at which it was endorsed.</p><p><strong>Main outcomes and measures: </strong>Consensus-diagnosed MCI, AD, and all-cause dementia.</p><p><strong>Results: </strong>This study included 3585 participants (mean [SD] baseline age, 68.0 [7.7] years; 1975 female [55.1%]). A total of 1596 participants (44.5%) had SCD, and 770 (21.5%) were carriers of APOE ε4. APOE ε4 and tertiles of AD PRS status did not significantly differ between the SCD and non-SCD groups. MCI, AD, and all-cause dementia were diagnosed in 236 participants (6.6%), 73 participants (2.0%), and 89 participants (2.5%), respectively, during follow-up. On average, SCD preceded MCI by 4.4 years, AD by 6.8 years, and all-cause dementia by 6.9 years. SCD was significantly associated with survival time to MCI (hazard ratio [HR], 1.57; 95% CI, 1.22-2.03; P <.001), AD (HR, 2.98; 95% CI, 1.89-4.70; P <.001), and all-cause dementia (HR, 2.14; 95% CI, 1.44-3.18; P <.001). After adjustment for APOE and AD PRS, the hazards of SCD were largely unchanged.</p><p><strong>Conclusions and relevance: </strong>Results of this cohort study suggest that in a community setting, SCD reflecting SCD+ features was associated with an increased risk of future MCI, AD, and all-cause dementia with similar hazards estimated in clinic-based settings. SCD may be an independent risk factor for AD and other dementias beyond the risk incurred by APOE ε4 and AD PRS.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"993-1002"},"PeriodicalIF":22.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11223054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141492036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mental Health Diagnoses in People Experiencing Homelessness-Reply. 无家可归者的心理健康诊断--回复。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-01 DOI: 10.1001/jamapsychiatry.2024.2318
Rebecca Barry, Dallas Seitz
{"title":"Mental Health Diagnoses in People Experiencing Homelessness-Reply.","authors":"Rebecca Barry, Dallas Seitz","doi":"10.1001/jamapsychiatry.2024.2318","DOIUrl":"10.1001/jamapsychiatry.2024.2318","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"1047-1048"},"PeriodicalIF":22.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975681","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}
引用次数: 0
Heterogeneity in Antidepressant Treatment and Major Depressive Disorder Outcomes Among Clinicians. 临床医生在抗抑郁治疗和重度抑郁障碍结果方面的异质性。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-01 DOI: 10.1001/jamapsychiatry.2024.1778
Sarah Rathnam, Kamber L Hart, Abhishek Sharma, Pilar F Verhaak, Thomas H McCoy, Finale Doshi-Velez, Roy H Perlis

Importance: While abundant work has examined patient-level differences in antidepressant treatment outcomes, little is known about the extent of clinician-level differences. Understanding these differences may be important in the development of risk models, precision treatment strategies, and more efficient systems of care.

Objective: To characterize differences between outpatient clinicians in treatment selection and outcomes for their patients diagnosed with major depressive disorder across academic medical centers, community hospitals, and affiliated clinics.

Design, setting, and participants: This was a longitudinal cohort study using data derived from electronic health records at 2 large academic medical centers and 6 community hospitals, and their affiliated outpatient networks, in eastern Massachusetts. Participants were deidentified clinicians who billed at least 10 International Classification of Diseases, Ninth Revision (ICD-9) or Tenth Revision (ICD-10) diagnoses of major depressive disorder per year between 2008 and 2022. Data analysis occurred between September 2023 and January 2024.

Main outcomes and measures: Heterogeneity of prescribing, defined as the number of distinct antidepressants accounting for 75% of prescriptions by a given clinician; proportion of patients who did not return for follow-up after an index prescription; and proportion of patients receiving stable, ongoing antidepressant treatment.

Results: Among 11 934 clinicians treating major depressive disorder, unsupervised learning identified 10 distinct clusters on the basis of ICD codes, corresponding to outpatient psychiatry as well as oncology, obstetrics, and primary care. Between these clusters, substantial variability was identified in the proportion of selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors, and tricyclic antidepressants prescribed, as well as in the number of distinct antidepressants prescribed. Variability was also detected between clinician clusters in loss to follow-up and achievement of stable treatment, with the former ranging from 27% to 69% and the latter from 22% to 42%. Clinician clusters were significantly associated with treatment outcomes.

Conclusions and relevance: Groups of clinicians treating individuals diagnosed with major depressive disorder exhibit marked differences in prescribing patterns as well as longitudinal patient outcomes defined by electronic health records. Incorporating these group identifiers yielded similar prediction to more complex models incorporating individual codes, suggesting the importance of considering treatment context in efforts at risk stratification.

重要性:尽管已有大量工作研究了抗抑郁治疗结果中患者层面的差异,但对临床医生层面的差异程度却知之甚少。了解这些差异可能对开发风险模型、精准治疗策略和更有效的护理系统非常重要:目的:描述学术医疗中心、社区医院和附属诊所的门诊临床医生在为诊断为重度抑郁障碍的患者选择治疗方法和治疗结果方面的差异:这是一项纵向队列研究,使用的数据来自马萨诸塞州东部 2 家大型学术医疗中心和 6 家社区医院及其附属门诊网络的电子健康记录。参与者是2008年至2022年期间每年至少开具10份《国际疾病分类第九版》(ICD-9)或《国际疾病分类第十版》(ICD-10)重度抑郁障碍诊断账单的身份已被识别的临床医生。数据分析时间为 2023 年 9 月至 2024 年 1 月:处方的异质性,即某一临床医生开出的处方中75%的处方都使用了不同的抗抑郁药;开出指数处方后不再复诊的患者比例;接受稳定、持续的抗抑郁药治疗的患者比例:在治疗重度抑郁障碍的 11 934 名临床医生中,无监督学习根据 ICD 代码识别出了 10 个不同的群组,分别对应于精神科门诊、肿瘤科、产科和初级保健科。在这些群组之间,选择性血清素再摄取抑制剂、选择性去甲肾上腺素再摄取抑制剂和三环类抗抑郁药的处方比例以及不同抗抑郁药的处方数量存在很大差异。各临床医生群组之间的随访损失率和稳定治疗率也存在差异,前者从27%到69%不等,后者从22%到42%不等。临床医生群组与治疗结果有明显关联:治疗重度抑郁障碍患者的临床医生群体在处方模式以及电子健康记录所定义的患者纵向治疗结果方面存在明显差异。纳入这些群体标识符后,预测结果与纳入个体代码的更复杂模型相似,这表明在进行风险分层时考虑治疗背景非常重要。
{"title":"Heterogeneity in Antidepressant Treatment and Major Depressive Disorder Outcomes Among Clinicians.","authors":"Sarah Rathnam, Kamber L Hart, Abhishek Sharma, Pilar F Verhaak, Thomas H McCoy, Finale Doshi-Velez, Roy H Perlis","doi":"10.1001/jamapsychiatry.2024.1778","DOIUrl":"10.1001/jamapsychiatry.2024.1778","url":null,"abstract":"<p><strong>Importance: </strong>While abundant work has examined patient-level differences in antidepressant treatment outcomes, little is known about the extent of clinician-level differences. Understanding these differences may be important in the development of risk models, precision treatment strategies, and more efficient systems of care.</p><p><strong>Objective: </strong>To characterize differences between outpatient clinicians in treatment selection and outcomes for their patients diagnosed with major depressive disorder across academic medical centers, community hospitals, and affiliated clinics.</p><p><strong>Design, setting, and participants: </strong>This was a longitudinal cohort study using data derived from electronic health records at 2 large academic medical centers and 6 community hospitals, and their affiliated outpatient networks, in eastern Massachusetts. Participants were deidentified clinicians who billed at least 10 International Classification of Diseases, Ninth Revision (ICD-9) or Tenth Revision (ICD-10) diagnoses of major depressive disorder per year between 2008 and 2022. Data analysis occurred between September 2023 and January 2024.</p><p><strong>Main outcomes and measures: </strong>Heterogeneity of prescribing, defined as the number of distinct antidepressants accounting for 75% of prescriptions by a given clinician; proportion of patients who did not return for follow-up after an index prescription; and proportion of patients receiving stable, ongoing antidepressant treatment.</p><p><strong>Results: </strong>Among 11 934 clinicians treating major depressive disorder, unsupervised learning identified 10 distinct clusters on the basis of ICD codes, corresponding to outpatient psychiatry as well as oncology, obstetrics, and primary care. Between these clusters, substantial variability was identified in the proportion of selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors, and tricyclic antidepressants prescribed, as well as in the number of distinct antidepressants prescribed. Variability was also detected between clinician clusters in loss to follow-up and achievement of stable treatment, with the former ranging from 27% to 69% and the latter from 22% to 42%. Clinician clusters were significantly associated with treatment outcomes.</p><p><strong>Conclusions and relevance: </strong>Groups of clinicians treating individuals diagnosed with major depressive disorder exhibit marked differences in prescribing patterns as well as longitudinal patient outcomes defined by electronic health records. Incorporating these group identifiers yielded similar prediction to more complex models incorporating individual codes, suggesting the importance of considering treatment context in efforts at risk stratification.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"1003-1009"},"PeriodicalIF":22.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11238069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141563391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Classification of Suicide Attempt Risk Using Environmental and Lifestyle Factors in 3 Large Youth Cohorts. 利用环境和生活方式因素对 3 个大型青少年群体的自杀未遂风险进行分类。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-01 DOI: 10.1001/jamapsychiatry.2024.1887
Elina Visoki, Tyler M Moore, Xinhe Zhang, Kate T Tran, Christina Ly, Martinš M Gatavinš, Grace E DiDomenico, Leah Brogan, Joel A Fein, Varun Warrier, Sinan Guloksuz, Ran Barzilay
<p><strong>Importance: </strong>Suicide is the third-leading cause of death among US adolescents. Environmental and lifestyle factors influence suicidal behavior and can inform risk classification, yet quantifying and incorporating them in risk assessment presents a significant challenge for reproducibility and clinical translation.</p><p><strong>Objective: </strong>To quantify the aggregate contribution of environmental and lifestyle factors to youth suicide attempt risk classification.</p><p><strong>Design, setting, and participants: </strong>This was a cohort study in 3 youth samples: 2 national longitudinal cohorts from the US and the UK and 1 clinical cohort from a tertiary pediatric US hospital. An exposome-wide association study (ExWAS) approach was used to identify risk and protective factors and compute aggregate exposomic scores. Logistic regression models were applied to test associations and model fit of exposomic scores with suicide attempts in independent data. Youth from the Adolescent Brain Cognitive Development (ABCD) study, the UK Millennium Cohort Study (MCS), and the Children's Hospital of Philadelphia emergency department (CHOP-ED) were included in the study.</p><p><strong>Exposures: </strong>A single-weighted exposomic score that sums significant risk and protective environmental/lifestyle factors.</p><p><strong>Main outcome and measure: </strong>Self-reported suicide attempt.</p><p><strong>Results: </strong>A total of 40 364 youth were included in this analysis: 11 564 from the ABCD study (3 waves of assessment; mean [SD] age, 12.0 [0.7] years; 6034 male [52.2%]; 344 attempted suicide [3.0%]; 1154 environmental/lifestyle factors were included in the ABCD study), 9000 from the MCS cohort (mean [SD] age, 17.2 [0.3] years; 4593 female [51.0%]; 661 attempted suicide [7.3%]; 2864 environmental/lifestyle factors were included in the MCS cohort), and 19 800 from the CHOP-ED cohort (mean [SD] age, 15.3 [1.5] years; 12 937 female [65.3%]; 2051 attempted suicide [10.4%]; 36 environmental/lifestyle factors were included in the CHOP-ED cohort). In the ABCD discovery subsample, ExWAS identified 99 risk and protective exposures significantly associated with suicide attempt. A single weighted exposomic score that sums significant risk and protective exposures was associated with suicide attempt in an independent ABCD testing subsample (odds ratio [OR], 2.2; 95% CI, 2.0-2.6; P < .001) and explained 17.6% of the variance (based on regression pseudo-R2) in suicide attempt over and above that explained by age, sex, race, and ethnicity (2.8%) and by family history of suicide (6.3%). Findings were consistent in the MCS and CHOP-ED cohorts (explaining 22.6% and 19.3% of the variance in suicide attempt, respectively) despite clinical, demographic, and exposure differences. In all cohorts, compared with youth at the median quintile of the exposomic score, youth at the top fifth quintile were substantially more likely to have made a suicide attempt
重要性:自杀是导致美国青少年死亡的第三大原因。环境和生活方式因素会影响自杀行为,并能为风险分类提供信息,但将这些因素量化并纳入风险评估对可重复性和临床转化提出了巨大挑战:量化环境和生活方式因素对青少年自杀未遂风险分类的总体贡献:这是一项针对 3 个青少年样本的队列研究:设计:这是一项针对 3 个青少年样本的队列研究:2 个来自美国和英国的全国纵向队列,1 个来自美国一家三级儿科医院的临床队列。研究采用了全暴露体关联研究(ExWAS)的方法来识别风险和保护因素,并计算暴露体总分。在独立数据中,采用逻辑回归模型来检验暴露组得分与自杀企图的关联性和模型拟合度。研究对象包括来自青少年大脑认知发展(ABCD)研究、英国千年队列研究(MCS)和费城儿童医院急诊科(CHOP-ED)的青少年:主要结果和测量:自我报告的自杀未遂:本分析共纳入40 364名青少年:11 564名来自ABCD研究(3波评估;平均[SD]年龄,12.0[0.7]岁;6034名男性[52.2%];344名自杀未遂者[3.0%];1154个环境/生活方式因素被纳入ABCD研究),9000名来自MCS队列(平均[SD]年龄,17.2[0.3]岁;4593 名女性[51.0%];661 名企图自杀者[7.3%];2864 名环境/生活方式因素被纳入 MCS 队列);19800 名来自 CHOP-ED 队列(平均 [SD] 年龄,15.3 [1.5] 岁;12937 名女性[65.3%];2051 名企图自杀者[10.4%];36 名环境/生活方式因素被纳入 CHOP-ED 队列)。在 ABCD 发现子样本中,ExWAS 确定了 99 项与自杀未遂有显著相关性的风险和保护暴露。在一个独立的 ABCD 检测子样本中,将重要的风险暴露和保护暴露相加的单一加权暴露组学评分与自杀未遂相关(几率比 [OR],2.2;95% CI,2.0-2.6;P 结论和相关性:结果表明,自杀未遂的暴露组学评分提供了一种可通用的风险分类方法,可应用于临床或人口环境中的不同样本。
{"title":"Classification of Suicide Attempt Risk Using Environmental and Lifestyle Factors in 3 Large Youth Cohorts.","authors":"Elina Visoki, Tyler M Moore, Xinhe Zhang, Kate T Tran, Christina Ly, Martinš M Gatavinš, Grace E DiDomenico, Leah Brogan, Joel A Fein, Varun Warrier, Sinan Guloksuz, Ran Barzilay","doi":"10.1001/jamapsychiatry.2024.1887","DOIUrl":"10.1001/jamapsychiatry.2024.1887","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Suicide is the third-leading cause of death among US adolescents. Environmental and lifestyle factors influence suicidal behavior and can inform risk classification, yet quantifying and incorporating them in risk assessment presents a significant challenge for reproducibility and clinical translation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To quantify the aggregate contribution of environmental and lifestyle factors to youth suicide attempt risk classification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This was a cohort study in 3 youth samples: 2 national longitudinal cohorts from the US and the UK and 1 clinical cohort from a tertiary pediatric US hospital. An exposome-wide association study (ExWAS) approach was used to identify risk and protective factors and compute aggregate exposomic scores. Logistic regression models were applied to test associations and model fit of exposomic scores with suicide attempts in independent data. Youth from the Adolescent Brain Cognitive Development (ABCD) study, the UK Millennium Cohort Study (MCS), and the Children's Hospital of Philadelphia emergency department (CHOP-ED) were included in the study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;A single-weighted exposomic score that sums significant risk and protective environmental/lifestyle factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome and measure: &lt;/strong&gt;Self-reported suicide attempt.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 40 364 youth were included in this analysis: 11 564 from the ABCD study (3 waves of assessment; mean [SD] age, 12.0 [0.7] years; 6034 male [52.2%]; 344 attempted suicide [3.0%]; 1154 environmental/lifestyle factors were included in the ABCD study), 9000 from the MCS cohort (mean [SD] age, 17.2 [0.3] years; 4593 female [51.0%]; 661 attempted suicide [7.3%]; 2864 environmental/lifestyle factors were included in the MCS cohort), and 19 800 from the CHOP-ED cohort (mean [SD] age, 15.3 [1.5] years; 12 937 female [65.3%]; 2051 attempted suicide [10.4%]; 36 environmental/lifestyle factors were included in the CHOP-ED cohort). In the ABCD discovery subsample, ExWAS identified 99 risk and protective exposures significantly associated with suicide attempt. A single weighted exposomic score that sums significant risk and protective exposures was associated with suicide attempt in an independent ABCD testing subsample (odds ratio [OR], 2.2; 95% CI, 2.0-2.6; P &lt; .001) and explained 17.6% of the variance (based on regression pseudo-R2) in suicide attempt over and above that explained by age, sex, race, and ethnicity (2.8%) and by family history of suicide (6.3%). Findings were consistent in the MCS and CHOP-ED cohorts (explaining 22.6% and 19.3% of the variance in suicide attempt, respectively) despite clinical, demographic, and exposure differences. In all cohorts, compared with youth at the median quintile of the exposomic score, youth at the top fifth quintile were substantially more likely to have made a suicide attempt","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"1020-1029"},"PeriodicalIF":22.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11255979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Training Psychiatrist-Scientists-Excellence on Both Sides of the Hyphen. 培训精神病学家和科学家--连字符两边的卓越成就。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-01 DOI: 10.1001/jamapsychiatry.2024.2255
Jacob L Taylor, James B Potash
{"title":"Training Psychiatrist-Scientists-Excellence on Both Sides of the Hyphen.","authors":"Jacob L Taylor, James B Potash","doi":"10.1001/jamapsychiatry.2024.2255","DOIUrl":"10.1001/jamapsychiatry.2024.2255","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"953-954"},"PeriodicalIF":22.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897490","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}
引用次数: 0
Exploration-Exploitation and Suicidal Behavior in Borderline Personality Disorder and Depression. 边缘型人格障碍和抑郁症患者的探索-剥削和自杀行为。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-01 DOI: 10.1001/jamapsychiatry.2024.1796
Aliona Tsypes, Michael N Hallquist, Angela Ianni, Aleksandra Kaurin, Aidan G C Wright, Alexandre Y Dombrovski
<p><strong>Importance: </strong>Clinical theory and behavioral studies suggest that people experiencing suicidal crisis are often unable to find constructive solutions or incorporate useful information into their decisions, resulting in premature convergence on suicide and neglect of better alternatives. However, prior studies of suicidal behavior have not formally examined how individuals resolve the tradeoffs between exploiting familiar options and exploring potentially superior alternatives.</p><p><strong>Objective: </strong>To investigate exploration and exploitation in suicidal behavior from the formal perspective of reinforcement learning.</p><p><strong>Design, setting, and participants: </strong>Two case-control behavioral studies of exploration-exploitation of a large 1-dimensional continuous space and a 21-day prospective ambulatory study of suicidal ideation were conducted between April 2016 and March 2022. Participants were recruited from inpatient psychiatric units, outpatient clinics, and the community in Pittsburgh, Pennsylvania, and underwent laboratory and ambulatory assessments. Adults diagnosed with borderline personality disorder (BPD) and midlife and late-life major depressive disorder (MDD) were included, with each sample including demographically equated groups with a history of high-lethality suicide attempts, low-lethality suicide attempts, individuals with BPD or MDD but no suicide attempts, and control individuals without psychiatric disorders. The MDD sample also included a subgroup with serious suicidal ideation.</p><p><strong>Main outcomes and measures: </strong>Behavioral (model-free and model-derived) indices of exploration and exploitation, suicide attempt lethality (Beck Lethality Scale), and prospectively assessed suicidal ideation.</p><p><strong>Results: </strong>The BPD group included 171 adults (mean [SD] age, 30.55 [9.13] years; 135 [79%] female). The MDD group included 143 adults (mean [SD] age, 62.03 [6.82] years; 81 [57%] female). Across the BPD (χ23 = 50.68; P < .001) and MDD (χ24 = 36.34; P < .001) samples, individuals with high-lethality suicide attempts discovered fewer options than other groups as they were unable to shift away from unrewarded options. In contrast, those with low-lethality attempts were prone to excessive behavioral shifts after rewarded and unrewarded actions. No differences were seen in strategic early exploration or in exploitation. Among 84 participants with BPD in the ambulatory study, 56 reported suicidal ideation. Underexploration also predicted incident suicidal ideation (χ21 = 30.16; P < .001), validating the case-control results prospectively. The findings were robust to confounds, including medication exposure, affective state, and behavioral heterogeneity.</p><p><strong>Conclusions and relevance: </strong>The findings suggest that narrow exploration and inability to abandon inferior options are associated with serious suicidal behavior and chronic suicidal thoughts. By con
重要性:临床理论和行为学研究表明,经历自杀危机的人往往无法找到建设性的解决方案,也无法将有用的信息纳入决策中,从而导致过早地趋向于自杀,而忽视了更好的选择。然而,之前对自杀行为的研究并未正式考察个体如何在利用熟悉的选择和探索潜在的更好选择之间进行权衡:从强化学习的正式角度研究自杀行为中的探索和利用:在2016年4月至2022年3月期间,对一个大型一维连续空间的探索-利用进行了两项病例对照行为研究,并对自杀意念进行了为期21天的前瞻性流动研究。参与者从宾夕法尼亚州匹兹堡市的精神病住院部、门诊部和社区招募,并接受了实验室和门诊评估。研究对象包括被诊断为边缘型人格障碍(BPD)以及中年和晚年重度抑郁障碍(MDD)的成年人,每个样本都包括在人口统计学上等同的有高致死率自杀未遂史、低致死率自杀未遂史、有BPD或MDD但无自杀未遂史的人,以及无精神障碍的对照组。MDD 样本还包括一个有严重自杀意念的亚组:主要结果和测量指标:行为(无模型和模型衍生)探索和利用指数、自杀未遂致死率(贝克致死率量表)以及前瞻性评估的自杀意念:BPD组包括171名成年人(平均[标码]年龄为30.55[9.13]岁;女性135人[79%])。MDD 组包括 143 名成年人(平均 [SD] 年龄为 62.03 [6.82] 岁;81 [57%] 为女性)。在 BPD 组中(χ23 = 50.68; P 结论和相关性:研究结果表明,狭隘的探索和无法放弃劣质选择与严重的自杀行为和长期自杀想法有关。相比之下,本研究中从事低致死率自杀行为的个体对采取可能不利的行动表现出较低的阈值。
{"title":"Exploration-Exploitation and Suicidal Behavior in Borderline Personality Disorder and Depression.","authors":"Aliona Tsypes, Michael N Hallquist, Angela Ianni, Aleksandra Kaurin, Aidan G C Wright, Alexandre Y Dombrovski","doi":"10.1001/jamapsychiatry.2024.1796","DOIUrl":"10.1001/jamapsychiatry.2024.1796","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Clinical theory and behavioral studies suggest that people experiencing suicidal crisis are often unable to find constructive solutions or incorporate useful information into their decisions, resulting in premature convergence on suicide and neglect of better alternatives. However, prior studies of suicidal behavior have not formally examined how individuals resolve the tradeoffs between exploiting familiar options and exploring potentially superior alternatives.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate exploration and exploitation in suicidal behavior from the formal perspective of reinforcement learning.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;Two case-control behavioral studies of exploration-exploitation of a large 1-dimensional continuous space and a 21-day prospective ambulatory study of suicidal ideation were conducted between April 2016 and March 2022. Participants were recruited from inpatient psychiatric units, outpatient clinics, and the community in Pittsburgh, Pennsylvania, and underwent laboratory and ambulatory assessments. Adults diagnosed with borderline personality disorder (BPD) and midlife and late-life major depressive disorder (MDD) were included, with each sample including demographically equated groups with a history of high-lethality suicide attempts, low-lethality suicide attempts, individuals with BPD or MDD but no suicide attempts, and control individuals without psychiatric disorders. The MDD sample also included a subgroup with serious suicidal ideation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Behavioral (model-free and model-derived) indices of exploration and exploitation, suicide attempt lethality (Beck Lethality Scale), and prospectively assessed suicidal ideation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The BPD group included 171 adults (mean [SD] age, 30.55 [9.13] years; 135 [79%] female). The MDD group included 143 adults (mean [SD] age, 62.03 [6.82] years; 81 [57%] female). Across the BPD (χ23 = 50.68; P &lt; .001) and MDD (χ24 = 36.34; P &lt; .001) samples, individuals with high-lethality suicide attempts discovered fewer options than other groups as they were unable to shift away from unrewarded options. In contrast, those with low-lethality attempts were prone to excessive behavioral shifts after rewarded and unrewarded actions. No differences were seen in strategic early exploration or in exploitation. Among 84 participants with BPD in the ambulatory study, 56 reported suicidal ideation. Underexploration also predicted incident suicidal ideation (χ21 = 30.16; P &lt; .001), validating the case-control results prospectively. The findings were robust to confounds, including medication exposure, affective state, and behavioral heterogeneity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;The findings suggest that narrow exploration and inability to abandon inferior options are associated with serious suicidal behavior and chronic suicidal thoughts. By con","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"1010-1019"},"PeriodicalIF":22.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11238070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141563435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Population-Based Risk of Psychiatric Disorders Associated With Recurrent Copy Number Variants. 基于人群的与复发性拷贝数变异相关的精神疾病风险。
IF 22.5 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-10-01 DOI: 10.1001/jamapsychiatry.2024.1453
Morteza Vaez, Simone Montalbano, Xabier Calle Sánchez, Kajsa-Lotta Georgii Hellberg, Saeid Rasekhi Dehkordi, Morten Dybdahl Krebs, Joeri Meijsen, John Shorter, Jonas Bybjerg-Grauholm, Preben B Mortensen, Anders D Børglum, David M Hougaard, Merete Nordentoft, Daniel H Geschwind, Alfonso Buil, Andrew J Schork, Dorte Helenius, Armin Raznahan, Wesley K Thompson, Thomas Werge, Andrés Ingason
<p><strong>Importance: </strong>Recurrent copy number variants (rCNVs) have been associated with increased risk of psychiatric disorders in case-control studies, but their population-level impact is unknown.</p><p><strong>Objective: </strong>To provide unbiased population-based estimates of prevalence and risk associated with psychiatric disorders for rCNVs and to compare risks across outcomes, rCNV dosage type (deletions or duplications), and locus features.</p><p><strong>Design, setting, and participants: </strong>This genetic association study is an analysis of data from the Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH) case-cohort sample of individuals born in Denmark in 1981-2008 and followed up until 2015, including (1) all individuals (n = 92 531) with a hospital discharge diagnosis of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder, major depressive disorder (MDD), or schizophrenia spectrum disorder (SSD) and (2) a subcohort (n = 50 625) randomly drawn from the source population. Data were analyzed from January 2021 to August 2023.</p><p><strong>Exposures: </strong>Carrier status of deletions and duplications at 27 autosomal rCNV loci was determined from neonatal blood samples genotyped on single-nucleotide variant microarrays.</p><p><strong>Main outcomes and measures: </strong>Population-based rCNV prevalence was estimated with a survey model using finite population correction to account for oversampling of cases. Hazard ratio (HR) estimates and 95% CIs for psychiatric disorders were derived using weighted Cox proportional hazard models. Risks were compared across outcomes, dosage type, and locus features using generalized estimating equation models.</p><p><strong>Results: </strong>A total of 3547 rCNVs were identified in 64 735 individuals assigned male at birth (53.8%) and 55 512 individuals assigned female at birth (46.2%) whose age at the end of follow-up ranged from 7.0 to 34.7 years (mean, 21.8 years). Most observed increases in rCNV-associated risk for ADHD, ASD, or SSD were moderate, and risk estimates were highly correlated across these disorders. Notable exceptions included high ASD-associated risk observed for Prader-Willi/Angelman syndrome duplications (HR, 20.8; 95% CI, 7.9-55). No rCNV was associated with increased MDD risk. Also, rCNV-associated risk was positively correlated with locus size and gene constraint but not with dosage type. Comparison with published case-control and community-based studies revealed a higher prevalence of deletions and lower associated increase in risk for several rCNVs in iPSYCH2015.</p><p><strong>Conclusions and relevance: </strong>This study found that several rCNVs were more prevalent and conferred less risk of psychiatric disorders than estimated previously. Most case-control studies overestimate rCNV-associated risk of psychiatric disorders, likely because of selection bias. In an era where genetics is increa
重要性:在病例对照研究中,复发性拷贝数变异(rCNVs)与精神疾病风险的增加有关,但其对人群的影响尚不清楚:目的:提供基于人群的rCNVs患病率和与精神障碍相关风险的无偏估计值,并比较不同结果、rCNV剂量类型(缺失或重复)和位点特征的风险:这项遗传关联研究分析了灵北基金会综合精神病学研究计划(iPSYCH)的病例队列样本数据,这些样本于 1981-2008 年间在丹麦出生,并随访至 2015 年、其中包括:(1)出院诊断为注意力缺陷/多动障碍(ADHD)、自闭症谱系障碍(ASD)、双相情感障碍、重度抑郁障碍(MDD)或精神分裂症谱系障碍(SSD)的所有患者(n = 92 531);(2)从源人群中随机抽取的子队列(n = 50 625)。数据分析时间为 2021 年 1 月至 2023 年 8 月:通过单核苷酸变异微阵列对新生儿血液样本进行基因分型,确定27个常染色体rCNV位点缺失和重复的携带者状态:采用调查模型估算基于人群的rCNV患病率,并使用有限人群校正以考虑病例的过度采样。使用加权 Cox 比例危险模型得出了精神疾病的危险比 (HR) 估计值和 95% CI。使用广义估计方程模型对不同结果、剂量类型和病位特征的风险进行了比较:在 64 735 名出生时被分配为男性(占 53.8%)和 55 512 名出生时被分配为女性(占 46.2%)的个体中,共发现了 3547 个 rCNV,这些个体在随访结束时的年龄在 7.0 岁到 34.7 岁之间(平均 21.8 岁)。大多数观察到的与rCNV相关的ADHD、ASD或SSD风险的增加是适度的,并且这些疾病的风险估计值高度相关。值得注意的例外情况包括观察到普拉德-威利/安杰尔曼综合征重复基因与 ASD 相关的高风险(HR,20.8;95% CI,7.9-55)。没有 rCNV 与 MDD 风险增加相关。此外,rCNV 相关风险与基因座大小和基因限制呈正相关,但与剂量类型无关。与已发表的病例对照研究和基于社区的研究相比,iPSYCH2015 中几种 rCNV 的缺失发生率较高,相关风险增加较低:本研究发现,与之前的估计相比,几种 rCNVs 的流行率更高,所带来的精神障碍风险更低。大多数病例对照研究都高估了与 rCNV 相关的精神疾病风险,这很可能是由于选择偏差造成的。在遗传学越来越多地被应用于临床的今天,这些结果凸显了基于人群的风险估计对于遗传学预测的重要性。
{"title":"Population-Based Risk of Psychiatric Disorders Associated With Recurrent Copy Number Variants.","authors":"Morteza Vaez, Simone Montalbano, Xabier Calle Sánchez, Kajsa-Lotta Georgii Hellberg, Saeid Rasekhi Dehkordi, Morten Dybdahl Krebs, Joeri Meijsen, John Shorter, Jonas Bybjerg-Grauholm, Preben B Mortensen, Anders D Børglum, David M Hougaard, Merete Nordentoft, Daniel H Geschwind, Alfonso Buil, Andrew J Schork, Dorte Helenius, Armin Raznahan, Wesley K Thompson, Thomas Werge, Andrés Ingason","doi":"10.1001/jamapsychiatry.2024.1453","DOIUrl":"10.1001/jamapsychiatry.2024.1453","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Recurrent copy number variants (rCNVs) have been associated with increased risk of psychiatric disorders in case-control studies, but their population-level impact is unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To provide unbiased population-based estimates of prevalence and risk associated with psychiatric disorders for rCNVs and to compare risks across outcomes, rCNV dosage type (deletions or duplications), and locus features.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This genetic association study is an analysis of data from the Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH) case-cohort sample of individuals born in Denmark in 1981-2008 and followed up until 2015, including (1) all individuals (n = 92 531) with a hospital discharge diagnosis of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder, major depressive disorder (MDD), or schizophrenia spectrum disorder (SSD) and (2) a subcohort (n = 50 625) randomly drawn from the source population. Data were analyzed from January 2021 to August 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Carrier status of deletions and duplications at 27 autosomal rCNV loci was determined from neonatal blood samples genotyped on single-nucleotide variant microarrays.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Population-based rCNV prevalence was estimated with a survey model using finite population correction to account for oversampling of cases. Hazard ratio (HR) estimates and 95% CIs for psychiatric disorders were derived using weighted Cox proportional hazard models. Risks were compared across outcomes, dosage type, and locus features using generalized estimating equation models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 3547 rCNVs were identified in 64 735 individuals assigned male at birth (53.8%) and 55 512 individuals assigned female at birth (46.2%) whose age at the end of follow-up ranged from 7.0 to 34.7 years (mean, 21.8 years). Most observed increases in rCNV-associated risk for ADHD, ASD, or SSD were moderate, and risk estimates were highly correlated across these disorders. Notable exceptions included high ASD-associated risk observed for Prader-Willi/Angelman syndrome duplications (HR, 20.8; 95% CI, 7.9-55). No rCNV was associated with increased MDD risk. Also, rCNV-associated risk was positively correlated with locus size and gene constraint but not with dosage type. Comparison with published case-control and community-based studies revealed a higher prevalence of deletions and lower associated increase in risk for several rCNVs in iPSYCH2015.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This study found that several rCNVs were more prevalent and conferred less risk of psychiatric disorders than estimated previously. Most case-control studies overestimate rCNV-associated risk of psychiatric disorders, likely because of selection bias. In an era where genetics is increa","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"957-966"},"PeriodicalIF":22.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11209205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
JAMA Psychiatry
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1