Recorded Diagnosis of Gender Identity Disorder Is Strongly Associated with Suicide Mortality.

We assessed the association between gender identity disorder (GID) diagnosis and suicide in a retrospective case-control study (N=300,364) from nine health care systems between 2000 and 2015. Adjusting for age and sex, the odds ratio for GID was 18.6 (95% confidence interval 7.0-49.5). Adjusting additionally for comorbid psychiatric diagnoses, the odds ratio was 4.75 (1.78-12.68), higher than depressive (3.96, 3.64-4.31), alcohol use (3.42, 3.04-3.84), bipolar (2.42, 2.10-2.80), and psychotic disorders (1.44, 1.22-1.70). These U.S. data support prior research demonstrating increased suicide risk among patients with diagnosed GID, who may benefit from targeted screening and intervention within health care systems.

Correlates of Informant Discrepancies in Self-Harm Among Youth Involved in Child Protective Services.

Youth involved with child protective services (CPS) are at elevated risk for engaging in self-harm. Participation in interventions or treatments that may reduce youths' self-harm behaviors often depends on the accurate reporting of their self-injurious behaviors. However, informants often disagree on the presence or severity of self-harm engagement, making the identification of youth in need of treatment more challenging. The current study aims to characterize discrepancies between youth and caregiver reports of children's self-harm among a sample of youth with a history of CPS involvement, and to identify factors (e.g., demographics, youth and caregiver psychological impairments, aspects of the caregiving environment) associated with these discrepancies. Participants (N = 258) were drawn from a large, nationally representative sample of youth under the age of 18 (mean age = 13.8) and their caregivers who were investigated by CPS. Multinomial logistic regressions were used to examine correlates of discrepancies in caregiver and youth reports of youth self-harm. Results indicated that 10% of caregiver-child dyads agreed on children's engagement in self-harm. In 33% of cases, only the child reported self-harm and in 57% of cases, only the caregiver reported youth self-harm. Being a biological caregiver, child female sex, higher levels of internalizing symptoms; higher post-traumatic stress disorder (PTSD) symptoms; and greater caregiver alcohol use was associated with a lower likelihood of caregivers reporting self-harm only. Older child age; lower externalizing symptoms; higher PTSD symptoms, and greater levels of caregiver emotional security and structure were linked to lower odds of children reporting self-harm only. These results underscore important factors to consider when assessing self-harm among youth involved with CPS and have potential implications for practice guidelines in this population.

Cancer and psychiatric diagnoses in the year preceding suicide.

BACKGROUND: Patients with cancer are known to be at increased risk for suicide but little is known about the interaction between cancer and psychiatric diagnoses, another well-documented risk factor. METHODS: Electronic medical records from nine healthcare systems participating in the Mental Health Research Network were aggregated to form a retrospective case-control study, with ICD-9 codes used to identify diagnoses in the 1 year prior to death by suicide for cases (N = 3330) or matching index date for controls (N = 297,034). Conditional logistic regression was used to assess differences in cancer and psychiatric diagnoses between cases and controls, controlling for sex and age. RESULTS: Among patients without concurrent psychiatric diagnoses, cancer at disease sites with lower average 5-year survival rates were associated with significantly greater relative risk, while cancer disease sites with survival rates of >70% conferred no increased risk. Patients with most psychiatric diagnoses were at higher risk, however, there was no additional risk conferred to these patients by a concurrent cancer diagnosis. CONCLUSION: We found no evidence of a synergistic effect between cancer and psychiatric diagnoses. However, cancer patients with a concurrent psychiatric illness remain at the highest relative risk for suicide, regardless of cancer disease site, due to strong independent associations between psychiatric diagnoses and suicide. For patients without a concurrent psychiatric illness, cancer disease sites associated with worse prognoses appeared to confer greater suicide risk.

Identifying Causal Risk Factors for Self-Harm Among Adolescents With U.S. Child Protective Services Contact.

OBJECTIVES: To estimate effects of potentially modifiable risk factors for self-harm among adolescents in the Child Protective Services (CPS) system. METHODS: Data came from the National Survey of Child and Adolescent Well-being, a nationally representative longitudinal survey. Candidate risk factors included child's feelings of worthlessness, the presence of supportive adults in the child's life, and parental psychological aggression. Propensity score weighting (PSW) was used to control for observed confounders, and the average effect of experiencing the risk factor among those who did was estimated using weighted logistic regression. RESULTS: Odds ratios for self-harm comparing youth with low and high parental psychological aggression to none were 0.93 (0.35-2.45) and 1.25 (0.55-2.82), respectively. The OR for feelings of worthlessness was 1.73 (0.70-4.27), and for supportive adults 0.58 (0.28-1.19). The combination of survey and propensity score weights may have affected statistical power. CONCLUSIONS: Preventing self-harm in adolescents requires a multifaceted approach given the existing evidence base and lack of strong associations with individual risk factors. Fostering supportive relationships with adults merits future research given the observed, non-significant 42% reduction in odds of self-harm among CPS involved youth who had a supportive relationship with an adult, compared to those who did not.

Prospective examination of self-harm up to three years after contact with Child Protective Services (CPS).

We examined the prevalence and correlates of self-harm among adolescents in the three years following an investigation by U.S. Child Protective Services (CPS) into alleged child maltreatment. Participants (N = 1573, 47% Male, 45% White) were drawn from the National Survey of Child and Adolescent Well-Being, cohort II. Self-harm was assessed at the conclusion of the CPS investigation, and at 18- and 36-months follow-up. Descriptive statistics and multivariable logistic regression were used to assess differences in self-harm over time by demographic characteristics, maltreatment type, and out-of-home placement. The prevalence of self-harm among older adolescents (15-17 years) remained stable at ∼10%, while among younger adolescents (11-14 years), it declined from 13% to 3.5%. Approximately 4.5% of youth reported self-harm at multiple survey waves. Native American and Asian/Pacific Islander youth were five times more likely to report repeated self-harm. Further research is warranted to understand this heightened risk.

Marijuana Use Is Associated With Suicidal Ideation and Behavior Among US Adolescents at Rates Similar to Tobacco and Alcohol.

This study used data from the National Youth Risk Behavior Survey to examine the association between adolescent marijuana, tobacco, and alcohol use and suicidal ideation and attempts over a period of six years (2011-2017), as attitudes and laws became more permissive of marijuana use. We used logistic regression to control for possible confounders, estimate marginal prevalence ratios (PR's), and assess changes over time. Marijuana was more strongly associated with suicide attempts than ideation, and more frequent use was associated with significantly greater risk. The effect has not changed substantively since 2011, despite changing attitudes toward marijuana. Marijuana is broadly comparable to other substances: results for tobacco were similar, though frequent alcohol use had a significantly stronger association than other substances.

Preteen Behaviors and Sexual Orientation of High School Students Who Report Depressive Symptoms, United States, 2015-2017.

Unhealthy preteen behaviors are associated with adolescent depression. However, little is known about preteen factors among sexual minority young people, a group at increased risk for teen depression and suicide. We completed weighted multivariate logistic regression analyses on data from the national 2015 and 2017 Youth Risk Behavior Survey of 30 389 high school students in the United States. Preteen sex, cigarette smoking, and alcohol and marijuana use were significantly more prevalent among lesbian, gay, or bisexual (LGB) and questioning students who reported depressive symptoms than among their heterosexual peers (adjusted prevalence ratio [APR] range, 1.33-2.34; all significant at P < .05). The only exception was that marijuana use among questioning students was not significantly different from use among heterosexual peers (APR = 1.34; P = .11). Assessment of preteen sex and substance use-especially among LGB and questioning young people, who are more prone to depressive symptoms and more likely to initiate risky preteen behaviors than their heterosexual counterparts-will facilitate a life course approach to sexual minority mental health that should begin by early adolescence.

Impact of the introduction of the Haemophilus influenzae type b conjugate vaccine in an urban setting in southern India.

INTRODUCTION: Haemophilus influenzae type b was the leading cause of bacterial meningitis in infants and children below the age of two years prior to the introduction of H. influenzae type b conjugate vaccines. In December 2011, the Indian government introduced H. influenzae b vaccine in the state of Tamilnadu. A prospective surveillance for bacterial meningitis was established at the Institute of Child Health in Chennai to evaluate the etiology of meningitis and impact of the vaccine. MATERIAL AND METHODS: Infants aged one to 23 months who were admitted to the hospital with symptoms of suspected bacterial meningitis were enrolled and lumbar puncture was performed. Cerebrospinal fluid samples were analyzed for white blood cells, protein, and glucose. Bacterial culture and a latex agglutination test for common bacterial pathogens were performed. RESULTS: Between January 2009 and March 2014, 4,770 children with suspected bacterial meningitis were enrolled. Prior to the introduction of the vaccine, an average of 11.7 cases of H. influenzae b meningitis and 31.1 cases of probable meningitis with no etiology were identified each year. After introduction, the number of cases were reduced by 79% and 44% respectively. The average H. influenzae b vaccine coverage after introduction was 69% among all children with clinically suspected meningitis. In contrast, the mean number of aseptic meningitis and pneumococcal meningitis cases remained stable throughout the pre and post vaccination period; 28.2 and 4.8 per year, respectively. CONCLUSIONS: H. influenzae b conjugate vaccine reduced the number of cases of H. influenzae b meningitis and probable meningitis within the first two years of its introduction. The impact against meningitis was higher than the vaccination rate, indicating indirect effects of the vaccine. India has recently scaled up the use of Hib conjugate vaccine throughout the country which should substantially reduce childhood meningitis rates further in the country.

Invasive pneumococcal disease in children aged younger than 5 years in India: a surveillance study.

BACKGROUND: Invasive pneumococcal disease continues to be a major cause of morbidity and mortality among children younger than 5 years of age in India. We aimed to provide nationally representative data for the pattern of disease due to Streptococcus pneumoniae, trends in the serotype of invasive pneumococci, and invasive pneumococci antimicrobial resistance patterns, in India. METHODS: In this prospective hospital-based and retrospective laboratory-based surveillance study, we prospectively enrolled children aged younger than 5 years with suspected or proven invasive pneumococcal disease from 18 hospitals or institutional centres and retrospectively included laboratory-confirmed pneumococcal isolates from ten sentinel laboratories, together representing 11 states in India. Eligibility criteria were fever higher than 38°C without localising symptoms, clinical presentation of suspected meningitis or pneumonia, and evidence of radiographic pneumonia. We cultured blood and other normally sterile body fluids, reconfirmed and serotyped pneumococcal isolates, and established antimicrobial susceptibility using standard study protocols. FINDINGS: Between Jan 1, 2011, and June 30, 2015, we enrolled 4377 patients. Among 361 (8%) patients with culture-proven pneumococcal disease, all clinical data were known for 226 (63%); among these patients, 132 (58%) presented with pneumonia, 78 (35%) presented with meningitis, and 16 (7%) had other clinical conditions. 131 (3%) died overall and 29 (8%) patients with invasive pneumococcal disease died. Serotypes 14 (52 [14%] of 361), 1 (49 [14%]), 5 (37 [10%]), and 19F (33 [9%]) were the most common. Penicillin non-susceptibility occurred in isolates from 29 (8%) patients, co-trimoxazole resistance occurred in 239 (66%), erythromycin resistance occurred in 132 (37%), and chloramphenicol resistance occurred in 33 (9%). We found multidrug resistance in 33 (9%) of 361 patients. INTERPRETATION: The proportion of positive blood cultures, number of isolates, geographical representation, and data generated over the 4·5 years of the study are representative of data for most of India. Continued surveillance is warranted as the decision to introduce protein conjugated vaccine in India is made. FUNDING: GlaxoSmithKline India.

High cost is the primary barrier reported by physicians who prescribe vaccines not included in India's Universal Immunization Program.

Haemophilus influenzae type B (Hib) vaccine, pneumococcal conjugate vaccine (PCV) and rotavirus (RV) vaccine are available in the private market in India, but, except for Hib in eight states, are not included in India's Universal Immunization Program (UIP). Pediatricians were surveyed about administering non-UIP vaccines. Most give these vaccines to some of their patients (73-83%, depending on vaccine), but few give them to all patients (7-18%). High cost was the most frequently cited barrier (93-96%). Only 10-12% of respondents had concerns about the efficacy of PCV or RV vaccine, and concerns about Hib vaccine efficacy or any vaccine safety issues were rare (1-3%). Practice varied by type of healthcare facility, with pediatricians at government hospitals least likely to administer non-UIP vaccines. Support for the inclusion of all three in the UIP was high (83-95%). Including Hib vaccine, PCV and RV vaccine in India's UIP would be supported by pediatricians and help eliminate the current barrier of high cost of these immunizations.

Short report: Molecular insights for Giardia, Cryptosporidium, and soil-transmitted helminths from a facility-based surveillance system in Guatemala.

We molecularly characterized samples with Giardia, Cryptosporidium, and soil-transmitted helminths from a facility-based surveillance system for diarrhea in Santa Rosa, Guatemala. The DNA sequence analysis determined the presence of Giardia assemblages A (N = 7) and B (N = 12) and, Cryptosporidium hominis (N = 2) and Cryptosporidium parvum (N = 2), suggestive of different transmission cycles. All 41 samples with soil-transmitted helminths did not have the ß-tubulin mutation described for benzimidazole resistance, suggesting potential usefulness in mass drug administration campaigns.