Preventive medicine
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Preventive medicine · Nov 2021
How we ask matters: The impact of question wording in single-item measurement of suicidal thoughts and behaviors.
The present study aimed to extend prior literature on single-item assessment by examining response consistency (1) between several commonly used single-item assessments of suicidal ideation, planning, and attempts, and (2) across three timeframes (past month, past year, and lifetime) commonly employed in the literature. Participants (N = 613) were recruited from an online community, Amazon Mechanical Turk (mTurk). Participants were administered three sets of four distinct single-items assessing suicidal ideation, suicidal planning, and suicide attempt history, respecitvely. ⋯ Through examinations of intraclass correlations and confirmatory factor analyses, findings suggested mixed response agreement across most outcomes and timeframes. Response inconsistency among items assessing suicidal ideation and among items assessing suicidal planning were partly attributed to minor, yet important, language differences. Given findings that even minor language changes in suicidal ideation and planning items may inflate or restrict prevalence estimates in a meaningful way, it will be important for researchers and clinicians alike to pay close attention to the wording of single items in designing research studies, interpreting findings, and assessing patient risk.
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Suicide in old age represents a sad public health concern. Despite the global decline in rates of suicide and the general amelioration of quality of life and access to health care for older adults, their rates of suicide remain the highest virtually in every part of the world. ⋯ The Covid-19 pandemic is claiming the life of many older persons and creating unprecedented conditions of distress, particularly for this segment of the population. This article briefly examines the main characteristics of suicidal behavior in late life, including observations deriving from the spread of the Sars-2 coronavirus and possible strategies for prevention.
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Preventive medicine · Nov 2021
The fourth wave of the US opioid epidemic and its implications for the rural US: A federal perspective.
The current opioid epidemic in the United States has been characterized as having three waves: prescription opioid use, followed by heroin use, and then use of synthetic opioids (e.g., fentanyl), with early waves affecting a population that was younger, less predominantly male, and more likely to be Caucasian and rural than in past opioid epidemics. A variety of recent data suggest that we have entered a fourth wave which can be characterized as a stimulant/opioid epidemic, with mental illness co-morbidities being more evident than in the past. ⋯ These compound existing issues in addressing the opioid epidemic in rural areas, including the low density of populations and the scarcity of behavioral health resources (e.g., fewer credentialed behavioral health professionals, particularly those able to prescribe Buprenorphine). Considerations for addressing this new wave are discussed, along with the drawbacks of a wave perspective and persistent concerns in confronting drug abuse such as stigma.
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Preventive medicine · Nov 2021
Randomized Controlled TrialPosttraumatic stress disorder in individuals seeking treatment for opioid use disorder in vermont.
Posttraumatic stress disorder (PTSD) and opioid use disorder (OUD) may be associated with poor outcomes in rural areas where access to mental health services and opioid agonist treatment (OAT) is limited. This study examined the characteristics associated with a history of PTSD among a sample of individuals seeking buprenorphine treatment for OUD in Vermont, the second-most rural state in the US. Participants were 89 adults with OUD who participated in one of two ongoing randomized clinical trials examining the efficacy of an interim buprenorphine dosing protocol for reducing illicit opioid use during waitlist delays to OAT. ⋯ PTSD- individuals (ps < 0.05). These findings indicate that a history of PTSD is prevalent and associated with worse outcomes among individuals seeking treatment for OUD in Vermont. Dissemination of screening measures and targeted interventions may help address the psychiatric and medical needs of rural individuals with OUD and a history of PTSD.
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Preventive medicine · Nov 2021
Randomized Controlled TrialCumulative vulnerabilities as a potential moderator of response to reduced nicotine content cigarettes.
Risk for smoking increases in a summative manner corresponding to the number of co-occurring vulnerabilities present (cumulative vulnerability). We examined whether cumulative vulnerabilities moderate response to reduced nicotine content cigarettes in a secondary analysis of results from 775 participants in three 12-week randomized clinical trials examining research cigarettes varying in nicotine content (0.4, 2.4, 15.8 mg nicotine/g tobacco). Participants were categorized as having 0-1, 2-3, or ≥ 4 cumulative vulnerabilities. ⋯ The only exception across the other outcomes was on Questionnaire-on-Smoking-Urges Factor-2 ratings for usual-brand cigarettes where cumulative vulnerability, dose, and time interacted (P = 0.007), with craving at the 0.4 and 2.4 mg/g doses decreasing over time, but inconsistently across vulnerability categories. Overall, we saw little evidence that cumulative vulnerabilities moderate response to reduced nicotine content cigarettes suggesting that a policy reducing nicotine content in cigarettes to minimally addictive levels could benefit even highly vulnerable smokers including those residing in rural or other regions with overrepresentation of co-occurring vulnerabilities. Clinicaltrials.gov identifiers: NCT02232737, NCT02250664, NCT02250534.