Integrating topic modeling and word embedding to characterize violent deaths.

SignificanceWe introduce an approach to identify latent topics in large-scale text data. Our approach integrates two prominent methods of computational text analysis: topic modeling and word embedding. We apply our approach to written narratives of violent death (e.g., suicides and homicides) in the National Violent Death Reporting System (NVDRS). Many of our topics reveal aspects of violent death not captured in existing classification schemes. We also extract gender bias in the topics themselves (e.g., a topic about long guns is particularly masculine). Our findings suggest new lines of research that could contribute to reducing suicides or homicides. Our methods are broadly applicable to text data and can unlock similar information in other administrative databases.

Gendered Patterns in Manifest and Latent Mental Health Indicators Among Suicide Decedents: 2003-2020 National Violent Death Reporting System (NVDRS).

Objectives. To investigate differences in the documentation of mental health symptomology between male and female suicide decedents in the 2003-2020 US National Violent Death Reporting System (NVDRS). Methods. Using information on 271 998 suicides in the 2003-2020 NVDRS, we evaluated precoded mental health-related variables and topic model-derived latent mental health themes in the law enforcement and coroner or medical examiner death narratives compiled by trained public health workers. Results. Public health records of male compared with female suicides were less likely to include notations of mental health conditions or treatment interventions. However, topic modeling of death summaries revealed that male suicide decedents were more likely to evidence several subclinical cognitive and emotional indicators of distress. Conclusions. Suicide death records vary by gender, both in recorded evidence for mental health conditions at time of death and in accompanying narratives describing proximal circumstances surrounding these deaths. Our findings hint that patterns of subclinical mental health changes among men might be less well captured in commonly used mental health indicators, suggesting that prevention efforts may benefit from measures that also target assessment of subclinical distress. (Am J Public Health. 2024;114(S3):S268-S277. https://doi.org/10.2105/AJPH.2023.307427).

Prevalence of prescription and illicit drugs in suicides by non-poisoning means in the National Violent Death Reporting System 2003-2017.

Background: Prescription and illicit drugs are important social environmental variables in many suicides regardless of their role as an immediate cause of death. Objectives: To investigate the presence of prescription and illicit drugs, either through mention in the death record or toxicology reports, among suicides attributed to nonpoisonous causes to identify patterns of risk. Methods: Using the 2003-2017 National Violent Death Reporting System (NVDRS), we examined the presence of prescription and illicit drugs among 143,175 suicides (119,563 males 23,612 females) due to firearms and suffocation/hanging. The presence of drugs (opioids, stimulants, benzodiazepines, muscle relaxants, and cannabis) was determined from toxicology reports and text searches of coroner/medical examiner and law enforcement summaries. We fit multivariable logistic regression models to estimate associations between drug class and suicide method adjusting for decedent characteristics. Results: Overall prescription and illicit drugs were present in 22% of firearm deaths and 28% of suffocation deaths. Among victims with toxicology reports, over 20% tested positive for benzodiazepines. Benzodiazepines were mentioned in 4% of firearm and 5% of suffocation suicides without toxicology testing. Stimulants were more likely to occur in suffocation than firearm deaths among victims with toxicology testing (aOR = 1.44, 95% CI: 1.33-1.56) and without toxicology testing (aOR = 1.61, 95% CI: 1.31-1.98). Conclusions: Benzodiazepines were most frequently identified in both toxicology reports and narratives of suicides by firearms or suffocation. Better distinction of the presence of prescription and illicit drugs in the environment versus apparent ingestion among non-poisoning suicides are needed to inform prevention approaches.

Aggression, Escalation, and Other Latent Themes in Legal Intervention Deaths of Non-Hispanic Black and White Men: Results From the 2003‒2017 National Violent Death Reporting System.

Objectives. To investigate racial/ethnic differences in legal intervention‒related deaths using state-of-the-art topic modeling of law enforcement and coroner text summaries drawn from the 2003-2017 US National Violent Death Reporting System (NVDRS). Methods. Employing advanced topic modeling, we identified 8 topics consistent with dangerousness in death incidents in the NVDRS death narratives written by public health workers (PHWs). Using logistic regression, we then evaluated racial/ethnic differences in PHW-coded variables and narrative topics among 4981 males killed by legal intervention, while adjusting for age, county-level characteristics, and year. Results. Black, as compared with White, decedents were younger and their deaths were less likely to include PHW-coded mental health or substance use histories, weapon use, or positive toxicology for alcohol or psychoactive drugs, but more likely to include "gangs-as-an-incident-precipitant" coding. Topic modeling revealed less frequent thematic representation of "physical aggression" or "escalation" but more of "gangs or criminal networks" among Black versus White decedents. Conclusions. While Black males were more likely to be victims of legal intervention deaths, PHW-coded variables in the NVDRS and death narratives suggest lower threat profiles among Black versus similar White decedents. The source of this greater risk remains undetermined.

Parental Sexual Orientation and Children's Psychological Well-Being: 2013-2015 National Health Interview Survey.

Debate persists about whether parental sexual orientation affects children's well-being. This study utilized information from the 2013 to 2015 U.S., population-based National Health Interview Survey to examine associations between parental sexual orientation and children's well-being. Parents reported their children's (aged 4-17 years old, N = 21,103) emotional and mental health difficulties using the short form Strengths and Difficulties Questionnaire (SDQ). Children of bisexual parents had higher SDQ scores than children of heterosexual parents. Adjusting for parental psychological distress (a minority stress indicator) eliminated this difference. Children of lesbian and gay parents did not differ from children of heterosexual parents in emotional and mental health difficulties, yet, the results among children of bisexual parents warrant more research examining the impact of minority stress on families.

Chronic Physiologic Effects of Stress Among Lesbian, Gay, and Bisexual Adults: Results From the National Health and Nutrition Examination Survey.

OBJECTIVE: Social disadvantage is associated with markers of physiological dysregulation, which is linked to disease trajectories. Chronic experiences with discrimination are thought to result in the accumulation of physiological "wear and tear" known as allostatic load (AL) among socially marginalized populations such as sexual minorities. Using a nationally representative US sample, we examined whether (1) people who self-identified as homosexual or bisexual display higher levels of AL than heterosexual individuals and (2) subgroups of sexual identity would further differ from each other as a consequence of distinct experiences of marginalization. METHODS: We use data from the 2001-2010 National Health and Nutrition Examination Survey. Employing multivariate regression methods with sex-specific analyses, we examined AL score differences among lesbian/gay (n = 211), bisexual (n = 307), homosexually experienced (n = 424), and exclusively heterosexual (n = 12,969) individuals, adjusting for possible confounding due to demographics, health indicators, and, among men, HIV infection status. RESULTS: Results indicate that elevated AL was more common in bisexual men compared with exclusively heterosexual men (adjusted ß = 0.25, 95% confidence interval [CI] = 0.05 to 0.44), with significantly higher levels of glycosylated hemoglobin A1c (adjusted odd ratio = 3.51, 95% CI = 1.46-7.92) and systolic blood pressure (adjusted odd ratio = 2.07, 95% CI = 1.02 to 4.18). Gay-identified men evidenced significantly lower AL (adjusted ß = -0.22, 95% CI = -0.41 to -0.04). No significant differences in AL were observed among women. CONCLUSIONS: These findings indicate that physiological dysregulation is more common in bisexual males compared with all other men. The results are discussed with regard to differences in health outcomes between individuals with different sexual orientations.

Perceived Discrimination in Health Care and Mental Health/Substance Abuse Treatment Among Blacks, Latinos, and Whites.

BACKGROUND: Experiences of discrimination in health care settings may contribute to disparities in mental health outcomes for blacks and Latinos. We investigate whether perceived discrimination in mental health/substance abuse visits contributes to participants' ratings of treatment helpfulness and stopped treatment. RESEARCH METHODS: We used data from 3 waves of the California Quality of Life Survey, a statewide population-based telephone survey assessing mental health/substance disorders and their treatment. In a sample of 1099 adults (age 18-72) who indicated prior year mental health/substance abuse visits, we examined: experiences of discrimination that occurred during health care and mental health/substance abuse visits, ratings of treatment helpfulness, and reports of stopping treatment early. RESULTS: Fifteen percent of California adults reported discrimination during a health care visit and 4% specifically during mental health/substance abuse visits. Latinos, the uninsured, and those with past year mental disorders were twice as likely as others to report health care discrimination [adjusted odds ratio (AORs)=2.08, 2.77, and 2.51]. Uninsured patients were 7 times more likely to report discrimination in mental health/substance abuse visits (AOR=7.27, P<0.01). The most commonly reported reasons for health care discrimination were race/ethnicity for blacks (52%) and Latinos (31%), and insurance status for whites (40%). Experiences of discrimination in mental health/substance abuse visits were associated with less helpful treatment ratings for Latinos (AOR=0.09, P<0.05) and whites (AOR=0.25, P<0.01), and early treatment termination for blacks (AOR=13.38, P<0.05). CONCLUSIONS: Experiences of discrimination are associated with negative mental health/substance abuse treatment experiences and stopped treatment, and could be a factor in mental health outcomes.

Sexual Orientation and All-Cause Mortality Among US Adults Aged 18 to 59 Years, 2001-2011.

To determine whether sexual minorities have an earlier mortality than do heterosexuals, we investigated associations between sexual orientation assessed in the 2001 to 2010 National Health and Nutrition Examination Surveys (NHANES) and mortality in the 2011 NHANES-linked mortality file. Mortality follow-up time averaged 69.6 months after NHANES. By 2011, 338 individuals had died. Sexual minorities evidenced greater all-cause mortality than did heterosexuals after adjusting for demographic confounding. These effects generally disappeared with further adjustment for NHANES-detected health and behavioral differences.

Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use.

BACKGROUND: The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders. OBJECTIVE: To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services (MHS). DESIGN: Using national data from the Medical Expenditure Panel Survey, we conducted a lagged cross-sectional study of MHS use subsequent to participant reports of psychological distress and usual provider and practice characteristics. PARTICIPANTS: A total of 2,358 adults, aged 18-64 years, met the criteria for serious psychological distress and reported on their usual provider and practice characteristics. MAIN MEASURES: We defined "usual provider" as a primary care provider/practice, and "PCMH provider" as a usual provider that delivered accessible, comprehensive, patient-centered care as determined by patient self-reporting. The dependent variable, MHS, included self-reported mental health visits to a primary care provider or mental health specialist, counseling, and psychiatric medication treatment over a period of 1 year. RESULTS: Participants with a usual provider were significantly more likely than those with no usual provider to have experienced a primary care mental health visit (marginal effect [ME] = 8.5, 95 % CI = 3.2-13.8) and to have received psychiatric medication (ME = 15.5, 95 % CI = 9.4-21.5). Participants with a PCMH were additionally more likely than those with no usual provider to visit a mental health specialist (ME = 7.6, 95 % CI = 0.7-14.4) and receive mental health counseling (ME = 8.5, 95 % CI = 1.5-15.6). Among those who reported having had any type of mental health visit, participants with a PCMH were more likely to have received mental health counseling than those with only a usual provider (ME = 10.0, 95 % CI = 1.0-19.0). CONCLUSIONS: Access to a usual provider is associated with increased receipt of needed MHS. Patients who have a usual provider with PCMH qualities are more likely to receive mental health counseling.

Mortality risks among persons reporting same-sex sexual partners: evidence from the 2008 General Social Survey-National Death Index data set.

OBJECTIVES: We investigated the possibility that men who have sex with men (MSM) and women who have sex with women (WSW) may be at higher risk for early mortality associated with suicide and other sexual orientation-associated health risks. METHODS: We used data from the 1988-2002 General Social Surveys, with respondents followed up for mortality status as of December 31, 2008. The surveys included 17 886 persons aged 18 years or older, who reported at least 1 lifetime sexual partner. Of these, 853 reported any same-sex partners; 17 033 reported only different-sex partners. Using gender-stratified analyses, we compared these 2 groups for all-cause mortality and HIV-, suicide-, and breast cancer-related mortality. RESULTS: The WSW evidenced greater risk for suicide mortality than presumptively heterosexual women, but there was no evidence of similar sexual orientation-associated risk among men. All-cause mortality did not appear to differ by sexual orientation among either women or men. HIV-related deaths were not elevated among MSM or breast cancer deaths among WSW. CONCLUSIONS: The elevated suicide mortality risk observed among WSW partially confirms public health concerns that sexual minorities experience greater burden from suicide-related mortality.

Suicidality among veterans: implications of sexual minority status.

Using the California Quality of Life surveys, we examined suicidal ideation and attempts in 129 lesbian, gay, and bisexual (LGB) veterans and in 315 heterosexual veterans in 2008-2009 and 2012-2013. Although there were no significant differences in the past 12-month suicidal ideation and lifetime attempts, LGB veterans had higher odds of lifetime suicidal ideation than heterosexual veterans (adjusted odds ratio = 3.00; 95% confidence interval = 1.38, 6.53). Suicide assessment and prevention efforts in LGB veterans could benefit from a life-course perspective regarding suicide risk.

Does neighborhood social capital buffer the effects of maternal depression on adolescent behavior problems?

Neighborhood characteristics have been shown to impact child well-being. However, it remains unclear how these factors combine with family characteristics to influence child development. The current study helps develop that understanding by investigating how neighborhoods directly impact child and adolescent behavior problems as well as moderate the influence of family characteristics on behavior. Using multilevel linear models, we examined the relationship among neighborhood conditions (poverty and social capital) and maternal depression on child and adolescent behavior problems. The sample included 741 children, age 5­11, and 564 adolescents, age 12­17. Outcomes were internalizing (e.g. anxious/depressed) and externalizing (e.g. aggressive/hyperactive) behavior problems. Neighborhood poverty and maternal depression were both positively associated with behavior problems for children and adolescents. However, while neighborhood social capital was not directly associated with behavior problems, the interaction of social capital and maternal depression was significantly related to behavior problems for adolescents. This interaction showed that living in neighborhoods with higher levels of social capital attenuated the relationship between maternal depression and adolescent behavior problems and confirmed the expectation that raising healthy well-adjusted children depends not only on the family, but also the context in which the family lives.