Journal of psychiatric research最新文献_第5页

Differential prevalence of psychiatric disorders and mental health characteristics associated with lifetime suicide attempts in the Asian American and Pacific Islander adult population 在亚裔美国人和太平洋岛民成年人群中，与终生自杀未遂相关的精神障碍和心理健康特征的患病率存在差异。

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-09-30 DOI: 10.1016/j.jpsychires.2024.09.044

Background

Asian American and Pacific Islander (AAPI) adults are an understudied group in terms of their mental health and mental healthcare needs. This has been complicated by the difficulty of recruiting adequate national samples of AAPI adults for research.

Objective

This study aimed to analyze national data to examine the lifetime prevalence of major psychiatric disorders among AAPI adults relative to non-AAPI adults, as well as to identify and compare sociodemographic and clinical characteristics associated with lifetime suicide attempts among AAPI and non-AAPI adults.

Methods

Cross-sectional data on 36,109 adults, including 1801 AAPI adults, from the National Epidemiological Survey of Alcohol and Related Conditions-III (NESARC-III), were analyzed with a series of chi-square and logistic regression analyses.

Results

We found a significantly lower lifetime prevalence of mental health disorders in the AAPI versus the non-AAPI population nationally, including 2% of AAPI adults reporting lifetime suicide attempts as compared to about 5% of non-AAPI adults. Female sex and a history of major depressive disorder diagnosis were associated with lifetime suicide attempts in the AAPI and non-AAPI populations. Several unique factors were associated with having a history of suicide attempts in only the AAPI population, including a military service history and a diagnosis of panic disorder.

Discussion

Our analysis demonstrated the significant sectors of the AAPI population that merit research, support, and intervention, including the AAPI veteran population. This study identifies several characteristics among AAPI adults that may make them particularly vulnerable to psychiatric problems and suicide risk, which may inform targeted prevention and efforts to provide culturally competent care to this population.

背景：就心理健康和心理保健需求而言，亚裔美国人和太平洋岛民（AAPI）成年人是一个研究不足的群体。由于很难在全国范围内招募到足够的亚太裔成年人样本进行研究，这使得问题变得更加复杂：本研究旨在分析全国数据，研究亚裔美国人与非亚裔美国人中主要精神障碍的终生患病率，并识别和比较亚裔美国人与非亚裔美国人中与终生自杀未遂相关的社会人口学和临床特征：通过一系列卡方分析和逻辑回归分析，对美国国家酒精及相关疾病流行病学调查-III（NESARC-III）中的 36109 名成人（包括 1801 名亚裔美国人）的横断面数据进行了分析：结果：我们发现，亚裔美国人一生中的心理健康疾病发病率明显低于非亚裔美国人，其中有 2% 的亚裔美国人报告一生中有过自杀企图，而非亚裔美国人的这一比例约为 5%。在亚裔美国人和非亚裔美国人中，女性性别和重度抑郁障碍诊断史与终生企图自杀有关。只有在亚裔美国人群体中，一些独特的因素与自杀未遂史有关，包括服兵役史和恐慌症诊断：我们的分析表明，亚裔美国人中有许多值得研究、支持和干预的重要群体，包括亚裔美国人中的退伍军人群体。这项研究发现了亚太裔成年人的几个特点，这些特点可能使他们特别容易受到精神问题和自杀风险的影响，这可能为有针对性的预防和为这一人群提供符合其文化背景的护理提供信息。

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引用次数: 0

History of tobacco smoking and alcohol use can predict the effectiveness of electroconvulsive therapy in individuals with schizophrenia: A multicenter clinical trial 吸烟史和饮酒史可预测精神分裂症患者接受电休克疗法的效果：一项多中心临床试验。

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-09-30 DOI: 10.1016/j.jpsychires.2024.09.045

Background

Current research has found that factors such as gender, age, and family history can predict the efficacy of electroconvulsive therapy (ECT) in individuals with schizophrenia. In our clinical practice, we anecdotally observed that tobacco smokers and alcohol drinkers with schizophrenia seemed to respond more effectively to ECT than non-smokers and non-drinkers. The current study aimed to examine whether history of tobacco smoking or alcohol consumption serve as indicators for predicting therapeutic efficacy of ECT in individuals with schizophrenia.

Methods

A total of 481 individuals receiving ECT combined with antipsychotic medication (ECT + AP medication) completed a two-week (six sessions of ECT) follow-up; 106 individuals receiving only antipsychotic medication (AP medication) also completed a two-week follow-up. Smoking, alcohol consumption, and AP medication usage was recorded for these individuals. Severity of psychotic symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS).

Results

ECT + AP medication: Compared to schizophrenic individuals without a history of smoking (non-smokers), those with a history of smoking (smokers) showed a high decrease in negative symptoms (36.96% vs 24.76%; F = 5.974, p = 0.015). While, compared to individuals without a history of alcohol consumption (non-drinkers), those with a history of alcohol consumption (drinkers) showed a high decrease in positive symptoms (48.90% vs 41.47%; F = 5.074, p = 0.025). AP medication: No differences were found in symptom reduction between smokers and non-smokers or between drinkers and non-drinkers (p > 0.05).

Conclusions

Smoking history in schizophrenic individuals independently predicts better improvement in negative symptoms after ECT, while alcohol consumption history independently predicts better improvement in positive symptoms after ECT. This is a clinically significant finding.

背景：目前的研究发现，性别、年龄和家族史等因素可以预测电休克疗法（ECT）对精神分裂症患者的疗效。在临床实践中，我们发现吸烟和饮酒的精神分裂症患者似乎比不吸烟和不饮酒的患者对电休克疗法的反应更有效。本研究旨在探讨吸烟史或饮酒史是否可作为精神分裂症患者电痉挛疗法疗效的预测指标：共有481名接受电痉挛疗法和抗精神病药物治疗（电痉挛疗法+抗精神病药物治疗）的患者完成了为期两周（六次电痉挛疗法）的随访；106名仅接受抗精神病药物治疗（抗精神病药物治疗）的患者也完成了为期两周的随访。对这些患者的吸烟、饮酒和 AP 药物使用情况进行了记录。精神病症状的严重程度使用阳性和阴性综合量表（PANSS）进行评估：电痉挛疗法 + AP 药物治疗：与无吸烟史的精神分裂症患者（非吸烟者）相比，有吸烟史的精神分裂症患者（吸烟者）的阴性症状明显减少（36.96% vs 24.76%; F = 5.974, p = 0.015）。与无饮酒史者（不饮酒者）相比，有饮酒史者（饮酒者）的阳性症状下降幅度较大（48.90% vs 41.47%；F = 5.074，p = 0.025）。AP 药物治疗：吸烟者与非吸烟者、饮酒者与非饮酒者在症状减轻方面没有差异（P > 0.05）：结论：精神分裂症患者的吸烟史可独立预测电痉挛疗法后阴性症状的改善情况，而饮酒史则可独立预测电痉挛疗法后阳性症状的改善情况。这是一项具有临床意义的发现。

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引用次数: 0

Cannabis cue-reactivity in cannabis use disorder: Diverging evidence in two distinct cannabis cultures 大麻使用障碍中的大麻线索反应：两种不同大麻文化中的不同证据。

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-09-25 DOI: 10.1016/j.jpsychires.2024.09.030

Background

Cannabis policies and attitudes play a role in the development and presentation of cannabis use disorder (CUD), but it is unclear how these factors are related to biomarkers of addiction. The current study examined cross-cultural differences in cannabis attitudes, cannabis cue-reactivity in the brain and its associations with cannabis use measures and cannabis attitudes.

Design

Cross-sectional fMRI study.

Setting

The Netherlands (NL) and Texas (TX), USA.

Participants

104 cannabis users with CUD (44% female; NL-CUD = 54, TX-CUD = 50) and 83 non-using controls (52% female; NL-CON = 50, TX-CON = 33).

Measurements

Self-reported positive (perceived benefits) and negative (perceived harms) cannabis attitudes and tactile cannabis cue-reactivity assessed using a 3T MRI scanner.

Findings

While the CUD group overall was more positive and less negative about cannabis and reported higher craving, the TX-CUD group reported significantly more positive and less negative attitudes and less craving than the NL-CUD group. Cannabis cue-reactivity was observed in the CUD group in clusters including the precuneus, lateral occipital cortex, frontal medial cortex, nucleus accumbens, and thalamus. In the TX-CUD group, a positive association was observed between symptom severity and cue-induced craving and cannabis cue-reactivity in precuneus and occipital cortex clusters, while a negative association was observed in the NL-CUD group. In these clusters, individuals with more positive attitudes exhibited a positive association between craving and cue-reactivity and those with less positive attitudes exhibited a negative association. No associations with quantity of use were observed.

Conclusions

Cue-induced craving might be deferentially associated with cannabis cue-reactivity across distinct cannabis use environments.

背景：大麻政策和态度在大麻使用障碍（CUD）的发展和表现中起着一定作用，但这些因素与成瘾生物标志物之间的关系尚不清楚。本研究考察了大麻态度、大脑中大麻线索反应及其与大麻使用措施和大麻态度之间的跨文化差异：设计：横断面 fMRI 研究：环境：荷兰（NL）和美国德克萨斯州（TX）：104 名患有 CUD 的大麻使用者（44% 为女性；NL-CUD = 54 人，TX-CUD = 50 人）和 83 名未使用大麻的对照者（52% 为女性；NL-CON = 50 人，TX-CON = 33 人）：测量：使用 3T 磁共振成像扫描仪评估自我报告的积极（感知到的益处）和消极（感知到的危害）大麻态度以及触觉大麻线索反应：虽然 CUD 组总体上对大麻的态度更积极、更消极，并报告了更高的渴求度，但 TX-CUD 组报告的态度明显更积极、更消极，渴求度也比 NL-CUD 组低。在 CUD 组中，包括楔前叶、枕叶外侧皮层、额叶内侧皮层、伏隔核和丘脑在内的集群中观察到大麻线索反应。在 TX-CUD 组中，观察到症状严重程度与楔前皮层和枕叶皮层群中线索诱发的渴求和大麻线索反应之间存在正相关，而在 NL-CUD 组中则观察到负相关。在这些群组中，态度较积极的人表现出渴求和线索反应之间的正相关，而态度较不积极的人则表现出负相关。没有观察到与使用数量的关联：结论：在不同的大麻使用环境中，线索诱发的渴求可能与大麻线索反应有递减关系。

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引用次数: 0

Neurophysiological activity following gains and losses among young adults with non-suicidal self-injury: An ERP study 非自杀性自伤的年轻成年人在获得和失去后的神经生理活动：ERP研究

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-09-24 DOI: 10.1016/j.jpsychires.2024.09.029

Objective

Non-suicidal self-injury (NSSI) is an increasingly concerning issue that is linked to a range of mental health problems. However, little is known about the potential neurophysiological mechanisms underlying risk decision-making in Major depressive disorder (MDD) patients with NSSI—the present study aimed to fill this important literature gap.

Methods

A total of 81 MDD patients (with NSSI: n = 40, without NSSI: n = 41) and 44 matched healthy controls (HC) underwent a modified version of the Iowa Gambling Task (IGT) while an electroencephalogram was recorded. Feedback-related negativity (FRN) and P300 were examined during the feedback stage of the risky decision-making process.

Results

Behavioural findings revealed that individuals diagnosed with MDD displayed a greater tendency to make risky decisions compared to the control group. Furthermore, MDD patients with NSSI demonstrated a significantly more negative ΔFN (i.e., the difference in neural response to losses compared to gains) than those without NSSI. Further, NSSI patients showed a larger difference ΔFN (loss minus gain), which was associated with enhanced impulsivity.

Conclusions

Collectively, the findings suggest that there is an altered processing of risky decision-making in the electrophysiology of patients with MDD who engage in NSSI. The ΔFN may serve as a psychophysiological marker indicating risk for NSSI.

目的非自杀性自伤（NSSI）是一个日益令人担忧的问题，它与一系列心理健康问题有关。本研究旨在填补这一重要的文献空白。方法：81 名重度抑郁障碍（MDD）患者（有 NSSI：40 人，无 NSSI：41 人）和 44 名匹配的健康对照（HC）接受了改良版的爱荷华赌博任务（IGT），同时记录脑电图。结果行为学研究结果显示，与对照组相比，被诊断为 MDD 的患者更倾向于做出风险决策。此外，与无 NSSI 患者相比，有 NSSI 的 MDD 患者表现出明显更消极的 ΔFN（即对损失与收益的神经反应差异）。此外，NSSI 患者表现出更大的ΔFN 差异（损失减去收益），这与冲动性增强有关。ΔFN可作为一种心理生理学标记，指示NSSI的风险。

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引用次数: 0

Hyperarousal dynamics reveal an overnight increase boosted by insomnia 过度虑情绪的动态变化表明，失眠会在一夜之间加剧过度虑情绪

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-09-24 DOI: 10.1016/j.jpsychires.2024.09.032

Hyperarousal is a key symptom of anxiety, stress-related disorders, and insomnia. However, it has been conceptualized in many different ways, ranging from various physiological markers (e.g. cortisol levels, high-frequency EEG activity) to personality traits, or state assessments of subjective anxiety and tension. This approach resulted in partly inconsistent evidence, complicating unified interpretations. Crucially, no previous studies addressed the likely variability of hyperarousal within and across days, nor the relationship of such variability in hyperarousal with the night-by-night variability in sleep quality characteristic of insomnia.

Here, we present a novel data-driven approach to understanding dynamics of state hyperarousal in insomnia. Using ecological momentary assessment, we tracked fluctuations in a wide range of emotions across 9 days in 169 people with insomnia disorders and 38 controls without sleep problems. Exploratory factor analysis identified a hyperarousal factor, comprised of items describing tension and distress. People with insomnia scored significantly higher on this factor than controls at all timepoints. In both groups, the hyperarousal factor score peaked in the morning and waned throughout the day, pointing to a potential contributing role of sleep or other circadian processes. Importantly, the overnight increase in hyperarousal was stronger in people with in insomnia than in controls. Subsequent adaptive LASSO regression analysis revealed a stronger overnight increase in hyperarousal across nights of worse subjective sleep quality.

These findings demonstrate the relationship between subjective sleep quality and overnight modulations of hyperarousal. Disorders in which hyperarousal is a predominant complaint might therefore benefit from interventions focused on improving sleep quality.

过度焦虑是焦虑症、压力相关疾病和失眠症的一个主要症状。然而，人们对过度焦虑的概念有多种不同的理解，从各种生理指标（如皮质醇水平、高频脑电图活动）到人格特质，或主观焦虑和紧张的状态评估，不一而足。这种方法产生了部分不一致的证据，使统一的解释变得复杂。最重要的是，以前的研究没有涉及过度焦虑在日内和日间的可能变化，也没有研究过度焦虑的这种变化与失眠症特有的睡眠质量的逐夜变化之间的关系。在这里，我们提出了一种新颖的数据驱动方法，以了解失眠症中过度焦虑状态的动态变化。通过生态学瞬间评估，我们追踪了 169 名失眠症患者和 38 名无睡眠问题的对照组患者在 9 天内的各种情绪波动。探索性因子分析确定了一个过度焦虑因子，由描述紧张和痛苦的项目组成。在所有时间点上，失眠症患者在该因子上的得分都明显高于对照组。在这两组人中，过度焦虑因子的得分在早晨达到峰值，并在一天中逐渐减弱，这表明睡眠或其他昼夜节律过程可能起到了促进作用。重要的是，与对照组相比，失眠症患者的过度焦虑在一夜之间的增加更为强烈。随后进行的自适应 LASSO 回归分析表明，在主观睡眠质量较差的夜晚，过度焦虑在一夜之间的增加更为强烈。因此，以过度焦虑为主诉的失调症患者可能会受益于以改善睡眠质量为重点的干预措施。

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引用次数: 0

Predicted vitamin D levels and risk of depression in the SUN Project: A prospective cohort study 预测维生素 D 水平与 SUN 项目中的抑郁风险：前瞻性队列研究

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-09-24 DOI: 10.1016/j.jpsychires.2024.09.034

The current study aimed to investigate the association between predicted vitamin D status and depression in a prospective Spanish cohort of university graduates. The SUN Project is a dynamic cohort study designed to investigate multiple aspects of health and lifestyle. Participants were asked to complete a comprehensive questionnaire consisting of 556 items, that included a validated food-frequency questionnaire. Participants initially free of depression were classified as incident cases if they reported a medical diagnosis of depression during follow-up. Serum vitamin D levels were predicted by a previously validated equation. Vitamin D deficiency was defined as vitamin D levels below 20 ng/mL. Cox models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI). We included 15,175 Spanish university graduates [mean (SD) age: 36.9 year (11.5)] followed-up for a median of 12.7 years. Among 192,976 person-years of follow-up, we identified 753 incident cases of depression. Participants with vitamin D deficiency had a 27% higher risk of depression as compared to those with vitamin D sufficiency (HR: 1.27, 95% CI: 1.09–1.48; p = 0.002) after adjusting for potential confounders. Furthermore, a significant effect modification by female sex was observed with higher depression risks associated with vitamin D deficiency in women than in men (p for interaction = 0.034). In educated middle-aged Spanish adults, we observed a direct association between vitamin D deficiency and the risk of depression, that was stronger among women.

本研究旨在调查西班牙大学毕业生前瞻性队列中预测的维生素 D 状态与抑郁症之间的关系。SUN 项目是一项动态队列研究，旨在调查健康和生活方式的多个方面。研究人员要求参与者填写一份包含 556 个项目的综合问卷，其中包括一份经过验证的食物频率问卷。最初没有抑郁症的参与者如果在随访期间报告了抑郁症的医学诊断，则被归类为偶发病例。血清中的维生素 D 水平是通过之前验证过的公式预测的。维生素D缺乏症的定义是维生素D水平低于20纳克/毫升。Cox模型用于估算调整后的危险比（HR）和95%置信区间（95% CI）。我们对 15,175 名西班牙大学毕业生（平均（标清）年龄：36.9 岁（11.5））进行了中位数为 12.7 年的随访。在 192,976 人年的随访中，我们发现了 753 例抑郁症病例。在对潜在的混杂因素进行调整后，维生素 D 缺乏者患抑郁症的风险比维生素 D 充足者高 27%（HR：1.27，95% CI：1.09-1.48；P = 0.002）。此外，还观察到女性性别对抑郁症风险的明显影响，女性缺乏维生素 D 的抑郁症风险高于男性（交互作用 p = 0.034）。在受过教育的西班牙中年人中，我们观察到维生素 D 缺乏与抑郁风险之间存在直接联系，而这在女性中更为明显。

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引用次数: 0

How I think about how I feel: Personal beliefs about emotion prospectively predict suicide-related outcomes and depression symptoms 我如何看待自己的感受？关于情绪的个人信念可前瞻性地预测与自杀相关的结果和抑郁症状。

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-09-24 DOI: 10.1016/j.jpsychires.2024.09.033

One transdiagnostic process that may be critical to depression and suicidal ideation is beliefs about the nature of one's own emotions, both concurrently and longitudinally. In a sample of community adults (n = 143), we assessed personal emotion beliefs about the degree to which one's own emotions are malleable, unique, and last a long time. There were significant associations between stronger views that one's own emotions were fixed, unique to you, and had a longer duration and higher clinical symptom severity, including higher levels of current suicidal ideation, and less adaptive emotion regulation. Mediation analyses using longitudinal data clarified that the differential engagement in emotion regulation, specifically rumination, represented the link tying specific personal emotion beliefs to clinical symptoms and that, in certain cases, the opposite pathway is also significant – differences in clinical symptoms mediated the relationship between specific personal emotion beliefs and emotion regulation (rumination) longitudinally. Additionally, personal emotion beliefs varied based on depression status, as determined using a semi-structured clinical interview. For example, individuals meeting current criteria for Major Depressive Disorder (MDD) held stronger views that their emotions were unique to them compared to individuals with remitted MDD or no history of MDD. The current study's findings highlight the important role of specific personal emotion beliefs in clinical symptoms concurrently and longitudinally and mechanisms in these relationships. These results could guide future research on interventions to promote more adaptive beliefs about emotion to improve clinical outcomes.

一个可能对抑郁和自杀意念至关重要的跨诊断过程是对自身情绪性质的信念，包括并发信念和纵向信念。在一个社区成人样本（n = 143）中，我们评估了个人情绪信念，即自己的情绪在多大程度上具有可塑性、独特性和持久性。认为自己的情绪是固定的、独一无二的、持续时间较长的观点与较高的临床症状严重程度（包括较高的当前自杀意念水平）和较差的适应性情绪调节之间存在明显的关联。利用纵向数据进行的中介分析表明，参与情绪调节（特别是反刍）的差异代表了特定个人情绪信念与临床症状之间的联系，而且在某些情况下，相反的途径也很重要--临床症状的差异从纵向上中介了特定个人情绪信念与情绪调节（反刍）之间的关系。此外，个人情绪信念因抑郁状态而异，抑郁状态是通过半结构化临床访谈确定的。例如，与抑郁症缓解或无抑郁症病史的人相比，目前符合重度抑郁症（MDD）标准的人更倾向于认为自己的情绪是独一无二的。目前的研究结果凸显了特定个人情绪信念在临床症状中的并发和纵向重要作用，以及这些关系中的机制。这些结果可以指导未来的干预研究，以促进对情绪的更多适应性信念，从而改善临床结果。

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引用次数: 0

A novel approach to investigate the mechanism of electroconvulsive therapy in the treatment of major depression disorder: Diffusion kurtosis imaging 研究电休克疗法治疗重度抑郁症机制的新方法：扩散峰度成像

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-09-24 DOI: 10.1016/j.jpsychires.2024.09.036

Background

Major depression disorder (MDD) exhibits a high global incidence; however, its pathogenesis remains elusive. In this prospective study, we employed diffusion kurtosis imaging (DKI) to investigate changes in brain function among patients with MDD both pre- and post-electroconvulsive therapy (ECT).

Methods

We divided a sample of 22 MDD patients into ECT group, which received six treatments over a span of two weeks, and control group (n = 12). DKI scanning was performed before and after treatment. The Hamilton Depression Rating Scale (HAMD) and Life Satisfaction Rating Scale (LSRS) were administered to assess depressive symptoms at baseline, on the 14th day, and at month three.

Results

Significant differences were found between group, time and time × group in terms of HAMD score and LSRS score. In the ECT group compared to pre- ECT measurement, changes in mean diffusivity (MD), fractional Anisotropy (FA), mean kurtosis (MK), radial kurtosis (RK), FA of kurtosis (KA), and anxia kurtosis (AK) value were detected in specific regions such as the frontal, temporal lobe, and hippocampus. In the control group only MD and RK value increased in a limited number of area.

Conclusions

ECT holds the potential to elicit neuroplasticity in the brain, facilitating rapid structural modifications and amelioration of depressive symptoms in patients with MDD.

背景：重度抑郁障碍（MDD）在全球的发病率很高；然而，其发病机制仍然难以捉摸。在这项前瞻性研究中，我们采用弥散峰度成像（DKI）研究了电休克疗法（ECT）前后重度抑郁症患者大脑功能的变化：我们将 22 名 MDD 患者分为电休克治疗组（两周内接受六次治疗）和对照组（12 人）。在治疗前后进行 DKI 扫描。汉密尔顿抑郁量表（HAMD）和生活满意度量表（LSRS）用于评估基线、第14天和第3个月时的抑郁症状：在 HAMD 评分和 LSRS 评分方面，发现组间、时间间和时间×组间存在显著差异。与电痉挛治疗前的测量结果相比，电痉挛治疗组的额叶、颞叶和海马等特定区域的平均弥散度（MD）、分数各向异性（FA）、平均峰度（MK）、径向峰度（RK）、峰度的FA（KA）和缺失峰度（AK）值均发生了变化。在对照组中，只有少数区域的 MD 和 RK 值有所增加：结论：电痉挛疗法具有激发大脑神经可塑性的潜力，有助于快速改变 MDD 患者的结构并改善其抑郁症状。

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引用次数: 0

Using Natural Language Processing to develop risk-tier specific suicide prediction models for Veterans Affairs patients 利用自然语言处理技术为退伍军人事务患者开发风险等级特定的自杀预测模型

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-09-24 DOI: 10.1016/j.jpsychires.2024.09.031

Suicide is a leading cause of death. Suicide rates are particularly elevated among Department of Veterans Affairs (VA) patients. While VA has made impactful suicide prevention advances, efforts primarily target high-risk patients with documented suicide risk. This high-risk population accounts for less than 10% of VA patient suicide deaths. We previously evaluated epidemiological patterns among VA patients that had lower classified suicide risk and derived moderate- and low-risk groupings. Expanding upon VA's leading suicide prediction model, this study uses national VA data to refine high-, moderate-, and low-risk specific suicide prediction methods. We selected all VA patients who died by suicide in 2017 or 2018 (n = 4584), matching each case with five controls who remained alive during treatment year and shared suicide risk percentiles. We extracted all sample unstructured electronic health record notes, analyzed them using natural language processing, and applied machine-learning classification algorithms to develop risk-tier-specific predictive models. We calculated area under the curve (AUC) and suicide risk concentration to evaluate predictive accuracy and analyzed derived words.

Results

Our high-risk model (AUC = 0.621 (95% CI: 0.55–0.68)), moderate-risk (AUC = 0.669 (95% CI: 0.64–0.71)), and low-risk (AUC = 0.673 (95% CI: 0.63–0.72)) models offered significant predictive accuracy over VA's leading suicide prediction algorithm. Derived words varied considerably, the high-risk model including chronic condition service words, moderate-risk model including outpatient care, and low-risk model including acute condition care.

Study suggests benefit of leveraging unstructured electronic health records and expands prediction resources for non-high-risk suicide decedents, an historically underserved population.

自杀是导致死亡的主要原因之一。退伍军人事务部（VA）病人的自杀率尤其高。虽然退伍军人事务部在预防自杀方面取得了有影响力的进展，但主要针对的是有自杀风险记录的高危患者。在退伍军人事务部的自杀死亡患者中，这类高危人群所占比例不到 10%。我们之前评估了退伍军人事务部自杀风险分类较低的患者的流行病学模式，并得出了中度和低度风险分组。在退伍军人事务部领先的自杀预测模型的基础上，本研究使用退伍军人事务部的全国数据来完善高、中、低风险的特定自杀预测方法。我们选取了所有在 2017 年或 2018 年自杀身亡的退伍军人事务部患者（n = 4584），将每个病例与五个在治疗年度内仍然存活且自杀风险百分位数相同的对照组进行匹配。我们提取了所有非结构化电子健康记录笔记样本，使用自然语言处理对其进行了分析，并应用机器学习分类算法开发了风险等级特异性预测模型。结果我们的高风险模型（AUC = 0.621 (95% CI: 0.55-0.68)）、中度风险模型（AUC = 0.669 (95% CI: 0.64-0.71)）和低风险模型（AUC = 0.673 (95% CI: 0.63-0.72)）与退伍军人事务部领先的自杀预测算法相比具有显著的预测准确性。研究表明，利用非结构化电子健康记录很有益处，并为非高风险自杀死者这一历来服务不足的人群扩展了预测资源。

{"title":"Using Natural Language Processing to develop risk-tier specific suicide prediction models for Veterans Affairs patients","authors":"","doi":"10.1016/j.jpsychires.2024.09.031","DOIUrl":"10.1016/j.jpsychires.2024.09.031","url":null,"abstract":"<div><div>Suicide is a leading cause of death. Suicide rates are particularly elevated among Department of Veterans Affairs (VA) patients. While VA has made impactful suicide prevention advances, efforts primarily target high-risk patients with documented suicide risk. This high-risk population accounts for less than 10% of VA patient suicide deaths. We previously evaluated epidemiological patterns among VA patients that had lower classified suicide risk and derived moderate- and low-risk groupings. Expanding upon VA's leading suicide prediction model, this study uses national VA data to refine high-, moderate-, and low-risk specific suicide prediction methods. We selected all VA patients who died by suicide in 2017 or 2018 (n = 4584), matching each case with five controls who remained alive during treatment year and shared suicide risk percentiles. We extracted all sample unstructured electronic health record notes, analyzed them using natural language processing, and applied machine-learning classification algorithms to develop risk-tier-specific predictive models. We calculated area under the curve (AUC) and suicide risk concentration to evaluate predictive accuracy and analyzed derived words.</div></div><div><h3>Results</h3><div>Our high-risk model (AUC = 0.621 (95% CI: 0.55–0.68)), moderate-risk (AUC = 0.669 (95% CI: 0.64–0.71)), and low-risk (AUC = 0.673 (95% CI: 0.63–0.72)) models offered significant predictive accuracy over VA's leading suicide prediction algorithm. Derived words varied considerably, the high-risk model including chronic condition service words, moderate-risk model including outpatient care, and low-risk model including acute condition care.</div><div>Study suggests benefit of leveraging unstructured electronic health records and expands prediction resources for non-high-risk suicide decedents, an historically underserved population.</div></div>","PeriodicalId":16868,"journal":{"name":"Journal of psychiatric research","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142357112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

ICD-11 adjustment disorder: Translation and validation of the Danish international adjustment disorder questionnaire among a working population of social educators ICD-11 适应障碍：丹麦国际适应障碍问卷在社会教育工作者中的翻译和验证。

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-09-23 DOI: 10.1016/j.jpsychires.2024.09.035

Adjustment disorder is frequently used as a diagnostic category for work-related stress disorders in Denmark. However, the diagnostic category is poorly delineated in ICD-10 which has hampered clinical practice as well as research studying the development of work-related adjustment disorders. In ICD-11, the diagnostic category of adjustment disorder has been refined and a new self-report measure is available to operationalize symptoms. The aim of the current study is to translate the International Adjustment Disorder Questionnaire (IADQ) to Danish and test the psychometric properties of the scale in a sample of social educators. A total of 609 social educators in current employment participated in an online survey including the IADQ and data was analyzed using confirmatory factor analysis. Findings suggested that a two-factor model reflecting the distinction between preoccupation and failure to adapt as part of the diagnostic criterion fitted the data best, although strong factor correlations and one cross-factor loading suggests that differentiating between the dimensions of preoccupation and failure to adapt is difficult. Relationships to burnout, posttraumatic stress and general distress support the validity of the Danish translation of the IADQ. Further research should explore the structure of adjustment disorder among other working populations.

在丹麦，适应障碍经常被用作工作相关应激障碍的诊断类别。然而，ICD-10 中对这一诊断类别的界定并不清晰，这阻碍了临床实践以及对工作相关适应障碍发展的研究。在 ICD-11 中，适应障碍的诊断类别得到了细化，并提供了一种新的自我报告测量方法来操作症状。本研究旨在将国际适应障碍问卷（IADQ）翻译成丹麦语，并在社会教育工作者样本中测试该量表的心理测量特性。共有 609 名在职社会教育工作者参与了包括 IADQ 在内的在线调查，并使用确认性因素分析法对数据进行了分析。研究结果表明，双因子模型最符合数据，该模型反映了作为诊断标准一部分的先入为主和不适应之间的区别，尽管强烈的因子相关性和一个交叉因子负荷表明，区分先入为主和不适应两个维度是困难的。与职业倦怠、创伤后应激和一般痛苦的关系支持了丹麦语翻译的 IADQ 的有效性。进一步的研究应探讨其他工作人群中适应障碍的结构。

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引用次数: 0