Feasibility of an eHealth service to support collaborative depression care: results of a pilot study.

BACKGROUND: Treatments and organizational changes supported by eHealth are beginning to play an important role in improving disease treatment outcome and providing cost-efficient care management. "Improvehealth.eu" is a novel eHealth service to support the treatment of patients with depressive disorder. It offers active patient engagement and collaborative care management by combining Web- and mobile-based information and communication technology systems and access to care managers. OBJECTIVES: Our objective was to assess the feasibility of a novel eHealth service. METHODS: The intervention--the "Improvehealth.eu" service--was explored in the course of a pilot study comparing two groups of patients receiving treatment as usual and treatment as usual with eHealth intervention. We compared patients' medication adherence and outcome measures between both groups and additionally explored usage and overall perceptions of the intervention in intervention group. RESULTS: The intervention was successfully implemented in a pilot with 46 patients, of whom 40 were female. Of the 46 patients, 25 received treatment as usual, and 21 received the intervention in addition to treatment as usual. A total of 55% (12/25) of patients in the former group and 45% (10/21) in the latter group finished the 6-month pilot. Available case analysis indicated an improvement of adherence in the intervention group (odds ratio [OR] = 10.0, P = .03). Intention-to-treat analysis indicated an improvement of outcome in the intervention group (ORs ranging from 0.35 to 18; P values ranging from .003 to .20), but confidence intervals were large due to small sample sizes. Average duration of use of the intervention was 107 days. The intervention was well received by 81% (17/21) of patients who reported feeling actively engaged, in control of their disease, and that they had access to a high level of information. In all, 33% (7/21) of the patients also described drawbacks of the intervention, mostly related to usability issues. CONCLUSIONS: The results of this pilot study indicate that the intervention was well accepted and helped the patients in the course of treatment. The results also suggest the potential of the intervention to improve both medication adherence and outcome measures of treatment, including reduction of depression severity and patients becoming "healthy."

Effects of training program on recognition and management of depression and suicide risk evaluation for Slovenian primary-care physicians: follow-up study.

AIM: To implement and evaluate an educational program for primary care physicians on recognition and treatment of depression and suicide prevention. METHOD: The study was conducted in 3 Slovenian neighboring regions (Celje, Ravne na Koroskem, and Podravska) with similar suicide rates and other health indicators. All primary care physicians from Celje (N=155) and Ravne na Koroskem (N=35) were invited to participate in the educational program on depression treatment and suicide risk recognition. From January to March 2003, approximately half of them (82 out of 190; educational group) attended the program, whereas the other half (108 out of 190; control group 1) and physicians from the Podravska region (N=164; control group 2) did not attend the program. The prescription rates of antidepressants and anxiolytics before and after the intervention were compared between the studied regions. Also, suicide rates three-years before and after the intervention were compared. RESULTS: From 2002 to 2003, there was a 2.33-fold increase in the rate of antidepressant prescriptions in the educational group (P<0.05) and only 1.28-fold (P<0.05) and 1.34-fold (P<0.05) increase in control groups 1 and 2, respectively. However, the 12% decrease in suicide rate in the intervention regions was not significantly greater than the 4% decrease in the non-intervention region (P>0.05). CONCLUSION: Our training program was beneficial for primary care physicians' ability to recognize and manage depression. However, there was no significant decrease in local suicide rates.

European collaborative study of early-onset bipolar disorder: Evidence for genetic heterogeneity on 2q14 according to age at onset.

Bipolar disorder has a genetic component, but the mode of inheritance remains unclear. A previous genome scan conducted in 70 European families led to detect eight regions linked to bipolar disease. Here, we present an investigation of whether the phenotypic heterogeneity of the disorder corresponds to genetic heterogeneity in these regions using additional markers and an extended sample of families. The MLS statistic was used for linkage analyses. The predivided sample test and the maximum likelihood binomial methods were used to test genetic homogeneity between early-onset bipolar type I (cut-off of 22 years) and other types of the disorder (later onset of bipolar type I and early-onset bipolar type II), using a total of 138 independent bipolar-affected sib-pairs. Analysis of the extended sample of families supports linkage in four regions (2q14, 3p14, 16p23, and 20p12) of the eight regions of linkage suggested by our previous genome scan. Heterogeneity testing revealed genetic heterogeneity between early and late-onset bipolar type I in the 2q14 region (P = 0.0001). Only the early form of the bipolar disorder but not the late form appeared to be linked to this region. This region may therefore include a genetic factor either specifically involved in the early-onset bipolar type I or only influencing the age at onset (AAO). Our findings illustrate that stratification according to AAO may be valuable for the identification of genetic vulnerability polymorphisms. © 2010 Wiley-Liss, Inc.

Suicidal ideation during treatment of depression with escitalopram and nortriptyline in genome-based therapeutic drugs for depression (GENDEP): a clinical trial.

BACKGROUND: Suicidal thoughts and behaviours during antidepressant treatment, especially during the first weeks of treatment, have prompted warnings by regulatory bodies. The aim of the present study is to investigate the course and predictors of emergence and worsening of suicidal ideation during tricyclic antidepressant and serotonin reuptake inhibitor treatment. METHODS: In a multicentre part-randomised open-label study, 811 adult patients with moderate to severe unipolar depression were allocated to flexible dosage of escitalopram or nortriptyline for 12 weeks. The suicidality items of three standard measures were integrated in a suicidal ideation score. Increases in this score were classified as treatment emergent suicidal ideation (TESI) or treatment worsening suicidal ideation (TWOSI) according to the absence or presence of suicidal ideation at baseline. RESULTS: Suicidal ideation decreased during antidepressant treatment. Rates of TESI and TWOSI peaked in the fifth week. Severity of depression predicted TESI and TWOSI. In men, nortriptyline was associated with a 9.8-fold and 2.4-fold increase in TESI and TWOSI compared to escitalopram, respectively. Retirement and history of suicide attempts predicted TWOSI. CONCLUSION: Increases in suicidal ideation were associated with depression severity and decreased during antidepressant treatment. In men, treatment with escitalopram is associated with lower risk of suicidal ideation compared to nortriptyline. Clinicians should remain alert to suicidal ideation beyond the initial weeks of antidepressant treatment. TRIAL REGISTRATION: EudraCT (No.2004-001723-38) and ISRCTN (No. 03693000).

Differential efficacy of escitalopram and nortriptyline on dimensional measures of depression.

BACKGROUND: Tricyclic antidepressants and serotonin reuptake inhibitors are considered to be equally effective, but differences may have been obscured by internally inconsistent measurement scales and inefficient statistical analyses. AIMS: To test the hypothesis that escitalopram and nortriptyline differ in their effects on observed mood, cognitive and neurovegetative symptoms of depression. METHOD: In a multicentre part-randomised open-label design (the Genome Based Therapeutic Drugs for Depression (GENDEP) study) 811 adults with moderate to severe unipolar depression were allocated to flexible dosage escitalopram or nortriptyline for 12 weeks. The weekly Montgomery-Asberg Depression Rating Scale, Hamilton Rating Scale for Depression, and Beck Depression Inventory were scored both conventionally and in a more novel way according to dimensions of observed mood, cognitive symptoms and neurovegetative symptoms. RESULTS: Mixed-effect linear regression showed no difference between escitalopram and nortriptyline on the three original scales, but symptom dimensions revealed drug-specific advantages. Observed mood and cognitive symptoms improved more with escitalopram than with nortriptyline. Neurovegetative symptoms improved more with nortriptyline than with escitalopram. CONCLUSIONS: The three symptom dimensions provided sensitive descriptors of differential antidepressant response and enabled identification of drug-specific effects.

Moderation of antidepressant response by the serotonin transporter gene.

BACKGROUND: There have been conflicting reports on whether the length polymorphism in the promoter of the serotonin transporter gene (5-HTTLPR) moderates the antidepressant effects of selective serotonin reuptake inhibitors (SSRIs). We hypothesised that the pharmacogenetic effect of 5-HTTLPR is modulated by gender, age and other variants in the serotonin transporter gene. AIMS: To test the hypothesis that the 5-HTTLPR differently influences response to escitalopram (an SSRI) compared with nortriptyline (a noradrenaline reuptake inhibitor). METHOD: The 5-HTTLPR and 13 additional markers across the serotonin transporter gene were genotyped in 795 adults with moderate-to-severe depression treated with escitalopram or nortriptyline in the Genome Based Therapeutic Drugs for Depression (GENDEP) project. RESULTS: The 5-HTTLPR moderated the response to escitalopram, with long-allele carriers improving more than short-allele homozygotes. A significant three-way interaction between 5-HTTLPR, drug and gender indicated that the effect was concentrated in males treated with escitalopram. The single-nucleotide polymorphism rs2020933 also influenced outcome. CONCLUSIONS: The effect of 5-HTTLPR on antidepressant response is SSRI specific conditional on gender and modulated by another polymorphism at the 5' end of the serotonin transporter gene.

Suicidal ideation and behavior and some psychological correlates in physically disabled motor-vehicle accident survivors.

BACKGROUND: Previous research has shown some maladaptive psychological reactions and even increased incidence of various mental disorders in patients with spinal cord injury during their rehabilitation. Self-concept and suicidal risk in particular have not been studied often in these samples. AIMS: Our principal goal was to explore suicidal ideation and behavior, self-concept, posttraumatic stress disorder (PTSD) symptoms, and correlations among these traits, in subjects after a motor vehicle accident (MVA) resulting in permanent physical disability. METHODS: Our sample consisted of 50 individuals with paraplegia, tetraplegia, or significant amputation, of whom eight had a family history of suicidal behavior. The following assessment instruments were used: an anamnestic data questionnaire; the Tennessee Self-Concept Scale; the Impact of Event Scale-Revised; and the Suicidal Ideations and Behaviour Questionnaire. RESULTS: Rehabilitating patients with spinal cord injury were characterized by low total self-concept, presence of PTSD symptoms, and suicidal ideation and behavior. PTSD symptoms were correlated with low self-concept and suicidal tendencies. CONCLUSIONS: While limited by small sample size, our study results support the need to further explore suicide risk and psychological correlates in patients with permanent physical disability.

Association between short sleep and suicidal ideation and suicide attempt among adults in the general population.

OBJECTIVE: To determine the association between sleep, mental disorders, and suicidal ideation (SI) and suicide attempt (SA) among adults in the community. DESIGN: Cross-sectional. SETTING: National Comorbidity Survey (n = 8098). PARTICIPANTS: A representative sample of adults in the United States. MEASUREMENTS AND RESULTS: Multiple logistic regression analyses were used to determine the association between usual number of hours of sleep during a 24-h period and SI and SA (past 12 months and lifetime). Analyses were adjusted for differences in demographic characteristics and comorbid mental disorders. Additional analyses examined the relationship between hours of sleep and the odds of SA among adults with SI, compared with SI without SA. Short sleep was associated with significantly increased odds of SI (OR 2.5, 95% CI: 1.6-3.9) and SA (OR 3.0, 95% CI: 1.4-6.4), and with SA among those with SI (past 12 months). These associations persisted after adjusting for differences in demographic characteristics and mental disorders, though the links between short sleep and SA among those with SI were no longer statistically significant after adjusting for panic, mood, and substance use disorders. CONCLUSIONS: Short sleep appears to be associated with increased likelihood of SI and SA, independent of the effects of comorbid mental disorders, among adults in the community. Among adults with SI, short sleep is associated with increased odds of SA, and this association seems largely related to the presence of panic attacks, mood, and substance use disorders. Future studies should investigate the nature of these relationships, and whether and how mental health problems may play a role.

Testing the Finno-Ugrian Suicide Hypothesis: geographic variation of elderly suicide rates across Europe.

The pattern of geographic variation in European suicide rates in the high-risk group of individuals aged 65 years and over was investigated, in order to provide a further test of the Finno-Ugrian Suicide Hypothesis, i.e. the assumption that genetic differences between populations may partially account for spatial differences seen in the suicide prevalence. National suicide rates (average of 1970-2002) of the elderly from 34 European countries were regressed on geographic position terms, i.e. capital cities' latitude and longitude, along with transformations (e.g. squared latitude) and interaction terms (e.g. latitude multiplied with longitude) of these, which statistically modeled various possible geographic gradients in the suicide rates. In these regression models, the strongest and statistically significant predictor of elderly suicide rates was an interaction term of squared latitude multiplied with longitude, indicating that suicide rates increased to the northeast. This accounted for 13.8% (total), 20.8% (males) and 11.6% (females) of the cross-national variance in elderly suicide rates. No further geographic position term accounted for a significant increment of further variance in suicide rates over and above this predictor. Controls for national quality of living conditions and alcohol consumption rates left these results essentially unchanged. Replicating previous evidence based on suicide rates of the general population, suicide rates of the elderly show a northeastern gradient across Europe. This J-shaped belt of high-suicide-rate countries spans from Central Europe (Austria, Hungary and Slovenia) to Northeastern Europe (Finland and the Baltic countries). There are early historical and genetic communalities among the populations inhabiting this area, but, in terms of culture, recent history, political systems and socioeconomic factors, there is great diversity between these countries. The current findings thus add to cumulated empirical evidence consistent with the Finno-Ugrian Suicide Hypothesis.

Suicide risk: where, why and how is it generated?

In this editorial we will first use the findings of epidemiological research to show that the closer we get to brain dysfunction, the higher is the suicide risk (Where?). Secondly, a distinction will be made between the proximate and ultimate causation of suicide behaviour as a biological phenomenon (Why?). Using the evolutionary psychiatry approach, the ultimate causation of suicide could answer the question why does suicidal behaviour exist at all? Third, we will review the most attractive recent molecular genetic findings in the field of suicidology genetics (How?). These three perspectives will in turn lead us to summarise where, why and how suicide risk is generated?

Sensitization of emotions as a risk factor for ischemic heart disease.

AIMS: Previous studies showed that sensitization could be important in cardiovascular disease subjects. The main aim of our study was to investigate further the relationship between sensitization of emotion on one side, and main risk factors for ischemic heart disease (IHD) and some psychological variables on the other. METHODS: A total of 374 patients with (187) or without (187) ischemic heart disease took part in our study. Owing to the lower percentage of women with IHD only men were included in the study. Patients were divided into three groups: repressors (those who report low subjective disturbance but react relatively strongly objectively; psychometrically, they have a high defensiveness score - L-EPQ and low trait anxiety score - EPQ-N), sensitizers (they have the opposite results: high N and low L score) and all the remaining subjects (the remaining two combinations of the N and L scores). Altogether, 12 exploratory variables (presence of IHD and main IHD risk factors; personality traits and coping styles) were explored in relation to sensitization of emotion. RESULTS: As predicted, sensitization of emotion was significantly more frequent in the group of patients with IHD (chi2=23.2; df=2; p<0.0001). We also showed some additional correlates of sensitization trait that could explain the association between this trait and IHD more in detail. In the group of IHD patients, the highest scores of psychoticism (F=12.14; df=2; p<0.001) and emotional coping styles (F=19.36; df=2; p<0.001) were shown in sensitizers, and the highest scores of detached emotional coping styles in the middle group of patients (F=7.58; df=2; p=0.001). Also, sensitizers were the youngest group (F=8.28; df=2; p<0.001) and had the highest frequency of smoking history (chi2=6.73; df=2; p=0.035). Some of these associations were in the same direction also significant in the group free of IHD, namely for psychoticism (F=9.15; df=2; p<0.001), emotional coping (F=11.07; df=2; p<0.001) and age (F=5.83; df=2; p=0.004). CONCLUSION: Among some other characteristics, sensitization of emotion also relates to more emotional and less detached ways of coping with stress, and more smoking on the other, which in turn increases the overall behavioral risk of developing this chronic disease.

Information technology tools to improve treatment of patients with depression: focus on guidelines implementation.

Information technology has the potential to improve and support the treatment of depression. Use of clinical guidelines can improve outcome of treatment, but implementation of guidelines is a demanding process and the resulting user compliance is often poor. Electronic health records, clinical decision support systems and other information technology tools seem at first glance to be a preferable way to implement clinical guidelines since they require user's active and problem oriented participation. This article reviews attempts made so far at use of information tools for implementation of clinical guidelines for depression treatment and discusses their effects. It turns out that there are few existing solutions, ambiguous effects and that usage is often limited. In future the factors determining development of successful electronic tools for clinical guidelines implementation will need to be further specified. Further research projects are underway in Slovenia to investigate these issues.

Nurses' attitudes towards depression: a study in Slovenia.

Our aim was to discover nurses' attitudes towards depression and to test for the impact of education on these attitudes. Negative attitudes towards depression are one of the reasons for underestimation of depressive disorders in the community and the clinical setting. We developed a questionnaire on attitudes towards depression by using the principal component analysis. We observed overall changes in attitudes and differences in each dimension and compared them between nurses who attended education workshops and those who did not. We learnt that nurses have positive attitudes towards people suffering from depressive disorder and towards curing and healing from depression itself, but a somewhat neutral opinion on possible complications caused by depression. Overall, nurses' attendance at education workshops contributed to improvement in their attitudes. This in turn probably led to a decrease in the stigmatisation of depression.

Problem solving for depressed suicide attempters and depressed individuals without suicide attempt.

BACKGROUND: Next to feelings of hopelessness, certain cognitive features such as problem solving deficiency, attentional bias and reduced future positive thinking are involved in the development and maintenance of suicidal behavior. The aim of this study was to examine feelings of hopelessness and problem solving ability in depressed suicide attempters and depressed individuals without a suicide attempt and to see whether these features change over time. METHOD: Three groups of participants, depressed suicide attempters (N=23), psychiatric control group (N=27) and healthy volunteers (N=27) completed measures of hopelessness and executive planning and problem solving abilities. The two clinical groups completed all measures shortly after admission and then again 7 weeks later whereas the non-clinical control group completed measures at baseline only. RESULTS: Both clinical groups displayed a higher level of hopelessness and poorer problem solving ability when compared to non-clinical volunteers. However, no differences were found between the two clinical groups. In neither of the clinical groups was improvement in problem solving ability between baseline and retesting observed despite the lowering of feelings of hopelessness. LIMITATIONS: The diagnoses in the psychiatric controls group were only obtained by the psychiatrist and not checked by further documentation or questionnaires. Furthermore we did not control for personality traits which might influence cognitive functioning. CONCLUSION: Since feelings of hopelessness decreased over time and problem solving ability nevertheless remained stable it is important that treatment not only focuses on mood improvement of depressed suicidal and depressed non-suicidal individuals but also on teaching problem solving techniques.

Changes in the seasonality of suicides over time in Slovenia, 1971 to 2002.

BACKGROUND: Recent studies have reported changes in the time patterns of suicide, with reduced seasonality in some European and Asian countries. Anyway conflicting data were reported on the fading of suicide seasonality, and in some countries a rising trend was reported. METHODS: Harmonic spectral analysis was used to analyze all suicides in Slovenia in the years 1971 to 2002 (14,325 among males; 4350 among females). Analyses of overall changes are based on data aggregated by intervals of 8 years. RESULTS: In both sexes, seasonal variance accounts for a statistically significant proportion of total variance (36.0% among males; 13.3% among females). Anyway in both sexes the season-attributable variance in the latest interval is considerably lower than in the preceding periods. LIMITATIONS: Data could not be analyzed according to age or to mental disorder diagnosis, since this information was not available. CONCLUSION: The seasonal effect on mortality by suicide is sensitive to change, but its causes seem not to be sex-dependant.

Suicidal and deliberate self-harm ideation among patients with physical illness: the role of coping styles.

The relationship between coping styles and suicidal ideation (SI) or deliberate self-harm (DSH) ideation among patients with physical illness was examined. Four hundred fifteen adult male medical inpatients completed the Coping Styles Questionnaire. Patients with and without SI, and with and without DSH, were compared on coping styles. Sixteen percent of patients (n = 67) had SI and 18.3% (n = 76) had DSH. SI was associated with higher scores on emotional coping and lower scores on rational and detachment coping styles, compared with those without SI. DSH, compared with those without DSH, was associated with significantly higher scores on avoidance coping strategies. These data suggest coping styles among medical patients with and without SI or DSH may differ. The mechanism of this link is not entirely clear, but it may be that coping styles reflect one possible pathway of the association between poor physical health and SI and DSH. Replication of these results in a longitudinal study is needed. If replicated, incorporation of these data into the development of intervention strategies focused on improving coping strategies may be worthwhile.

Individuals with diabetes mellitus with and without depressive symptoms: could social network explain the comorbidity?

OBJECTIVES: The main objective of the present study was to obtain an approximate prevalence of depressive symptoms in a community sample of persons with diabetes mellitus and to discover whether social networks could explain comorbidity of diabetes mellitus and depressive symptoms. METHOD: Subjects were persons with diabetes mellitus, members of the Diabetes Association of Ljubljana (N = 396, average age: 62.9 +/- 13.4, average duration of diabetes: 17.2 +/- 10.6). Firstly, subjects were screened with CESD (Centre for Epidemiological Studies Depression Scale) and demographic data were also gathered. Secondly, two samples (individuals with and without depressive symptoms) were compared on the basis of social network analysis. RESULTS: The prevalence of depressive symptoms was higher among persons with diabetes in comparison with general population. Individuals with depressive symptoms compared with individuals without depressive symptoms were less dissatisfied with diabetes (p = 0.011), and had better informational (p = 0.039) and instrumental support (p = 0.046), relations between them and support givers were closer (p = 0.050), more important and less conflicting (p = 0.042). Compared groups did not differ in quantitative characteristics of social networks (eg. size of the network or the network gender structure). CONCLUSIONS: The community sample results in Slovenia support the already reported association between diabetes mellitus and depression. Furthermore, social network analysis offered some potentially relevant explanation for comorbidity of diabetes mellitus and depressive symptoms.

Suicide prevention strategies: a systematic review.

CONTEXT: In 2002, an estimated 877,000 lives were lost worldwide through suicide. Some developed nations have implemented national suicide prevention plans. Although these plans generally propose multiple interventions, their effectiveness is rarely evaluated. OBJECTIVES: To examine evidence for the effectiveness of specific suicide-preventive interventions and to make recommendations for future prevention programs and research. DATA SOURCES AND STUDY SELECTION: Relevant publications were identified via electronic searches of MEDLINE, the Cochrane Library, and PsychINFO databases using multiple search terms related to suicide prevention. Studies, published between 1966 and June 2005, included those that evaluated preventative interventions in major domains; education and awareness for the general public and for professionals; screening tools for at-risk individuals; treatment of psychiatric disorders; restricting access to lethal means; and responsible media reporting of suicide. DATA EXTRACTION: Data were extracted on primary outcomes of interest: suicidal behavior (completion, attempt, ideation), intermediary or secondary outcomes (treatment seeking, identification of at-risk individuals, antidepressant prescription/use rates, referrals), or both. Experts from 15 countries reviewed all studies. Included articles were those that reported on completed and attempted suicide and suicidal ideation; or, where applicable, intermediate outcomes, including help-seeking behavior, identification of at-risk individuals, entry into treatment, and antidepressant prescription rates. We included 3 major types of studies for which the research question was clearly defined: systematic reviews and meta-analyses (n = 10); quantitative studies, either randomized controlled trials (n = 18) or cohort studies (n = 24); and ecological, or population- based studies (n = 41). Heterogeneity of study populations and methodology did not permit formal meta-analysis; thus, a narrative synthesis is presented. DATA SYNTHESIS: Education of physicians and restricting access to lethal means were found to prevent suicide. Other methods including public education, screening programs, and media education need more testing. CONCLUSIONS: Physician education in depression recognition and treatment and restricting access to lethal methods reduce suicide rates. Other interventions need more evidence of efficacy. Ascertaining which components of suicide prevention programs are effective in reducing rates of suicide and suicide attempt is essential in order to optimize use of limited resources.

Suicide attempts in the United States: the role of physical illness.

The study aimed to determine the relationship between physical illness, mental disorder, and the likelihood of suicide attempt among adults aged 15-54 in the United States. Data were drawn from the National Comorbidity Survey (N=8,098), a national probability sample of adults in the United States. Multivariate logistic regression analyses were used to determine the relationship between self-reported physical illness and the likelihood of suicide attempt. Lung disease (OR=1.8 (1.1, 2.7)), ulcer (OR=2.1 (1.3, 3.4)), and AIDS (OR=44.1 (10.5, 185.6)) were each associated with a significantly increased likelihood of suicide attempt, independent of the effects of mental disorders. Consistent with previous studies, the number of physical illnesses was linearly related to an increased odds of suicide attempt (OR=1.3 (1.2, 1.5)). Possible mechanisms for these associations are discussed. These findings call for the inclusion of a range of physical health problems, especially chronic illnesses, in future research on suicide attempts in the population.

Asthma and suicidal ideation among youth in the community.

OBJECTIVE: To determine the association between asthma and suicidal ideation among youth in the community. METHOD: Data were drawn from the MECA (n = 1285), a community-based study of youth aged 9-17 in the United States. Multiple logistic regression analyses were used to determine the association between asthma and suicidal ideation, adjusting for differences in sociodemographic characteristics and mental disorders. RESULTS: Asthma was associated with a significantly increased likelihood of suicidal ideation (OR = 3.25 [1.04, 10.1]), compared to youth without asthma. CONCLUSIONS: These data suggest that youth who are hospitalized for asthma may have higher than expected levels of suicidal ideation, compared with youth without asthma in the community. This association appears to persist after controlling for the effects of comorbid mental disorders. These findings are consistent with previous clinical reports of an association between physical illness and suicidal ideation, as well as with links between asthma and suicidal ideation among adults. More in-depth evaluation of the mental health of youth hospitalized for asthma may be indicated if these results are replicated.