The Suicide Prevention, Depression Awareness, and Clinical Engagement Program for Faculty and Residents at the University of California, Davis Health.

OBJECTIVE: The objective of the study is to present results of a depression and suicide screening and treatment referral program for physicians at an academic medical center. METHODS: An anonymous web-based screening questionnaire was sent to all physicians at a large academic center. Responses were classified as indicating either high, moderate, or low risk for depression and suicide. Physicians at high and moderate risk were contacted by a counselor through a messaging system. The counselor's message contained information on risk level and an invitation to meet in person. High-risk respondents who did not reply to the message or declined to meet received mental health resources. Respondents who met with the counselor were offered individualized treatment referrals and to participate in a 1-year follow-up of self-reports every 3 months. RESULTS: The questionnaire was sent to approximately 1800 residents, fellows, and faculty from February 2013 through March 2019. A total of 639 questionnaires were received, 100 were excluded for various reasons, and 539 were used to conduct analyses (14.4% response rate). The majority of respondents were classified at moderate (333 [62%]) or high (193 [36%]) risk for depression or suicide. Eighty-three respondents were referred for mental health care, and 14 provided data for the follow-up study. CONCLUSIONS: Results of screening physicians for depression and suicide at one academic medical center highlight the challenges of engaging most of them in this activity and the satisfaction of the minority who successfully engaged in a treatment referral program.

Fundamental differences between Arctic and Antarctic ozone depletion.

Antarctic ozone depletion is associated with enhanced chlorine from anthropogenic chlorofluorocarbons and heterogeneous chemistry under cold conditions. The deep Antarctic "hole" contrasts with the generally weaker depletions observed in the warmer Arctic. An unusually cold Arctic stratospheric season occurred in 2011, raising the question of how the Arctic ozone chemistry in that year compares with others. We show that the averaged depletions near 20 km across the cold part of each pole are deeper in Antarctica than in the Arctic for all years, although 2011 Arctic values do rival those seen in less-depleted years in Antarctica. We focus not only on averages but also on extremes, to address whether or not Arctic ozone depletion can be as extreme as that observed in the Antarctic. This information provides unique insights into the contrasts between Arctic and Antarctic ozone chemistry. We show that extreme Antarctic ozone minima fall to or below 0.1 parts per million by volume (ppmv) at 18 and 20 km (about 70 and 50 mbar) whereas the lowest Arctic ozone values are about 0.5 ppmv at these altitudes. At a higher altitude of 24 km (30-mbar level), no Arctic data below about 2 ppmv have been observed, including in 2011, in contrast to values more than an order of magnitude lower in Antarctica. The data show that the lowest ozone values are associated with temperatures below -80 °C to -85 °C depending upon altitude, and are closely associated with reduced gaseous nitric acid concentrations due to uptake and/or sedimentation in polar stratospheric cloud particles.

The Suicide Prevention, Depression Awareness, and Clinical Engagement Program for Faculty and Residents at the University of California, Davis Health System.

OBJECTIVE: The authors replicated a program developed by UC San Diego, identified medical staff at risk for depression and suicide using a confidential online survey, and studied aspects of that program for 1 year. METHODS: The authors used a 35-item, online assessment of stress and depression depression developed and licensed by the American Foundation for Suicide Prevention that aims to identify and suicide risk and facilitate access to mental health services. RESULTS: During 2013/2014, all 1864 UC Davis residents/fellows and faculty physicians received an invitation to take the survey and 158 responded (8% response rate). Most respondents were classified at either moderate (86 [59%]) or high risk for depression or suicide (54 [37%]). Seventeen individuals (11%) were referred for further evaluation or mental health treatment. Ten respondents consented to participate in the follow-up portion of the program. Five of the six who completed follow-up surveys reported symptom improvement and indicated the program should continue. CONCLUSIONS: This program has led to continued funding and a plan to repeat the Wellness Survey annually. Medical staff will be regularly reminded of its existence through educational interventions, as the institutional and professional culture gradually changes to promptly recognize and seek help for physicians' psychological distress.

Agreement was moderate between data-based and opinion-based assessments of biases affecting randomized trials within meta-analyses.

BACKGROUND AND OBJECTIVE: Randomized trials included in meta-analyses are often affected by bias caused by methodological flaws or limitations, but the degree of bias is unknown. Two proposed methods adjust the trial results for bias using empirical evidence from published meta-epidemiological studies or expert opinion. METHODS: We investigated agreement between data-based and opinion-based approaches to assessing bias in each of four domains: sequence generation, allocation concealment, blinding, and incomplete outcome data. From each sampled meta-analysis, a pair of trials with the highest and lowest empirical model-based bias estimates was selected. Independent assessors were asked which trial within each pair was judged more biased on the basis of detailed trial design summaries. RESULTS: Assessors judged trials to be equally biased in 68% of pairs evaluated. When assessors judged one trial as more biased, the proportion of judgments agreeing with the model-based ranking was highest for allocation concealment (79%) and blinding (79%) and lower for sequence generation (59%) and incomplete outcome data (56%). CONCLUSION: Most trial pairs found to be discrepant empirically were judged to be equally biased by assessors. We found moderate agreement between opinion and data-based evidence in pairs where assessors ranked one trial as more biased.