Access to Psychotropic Medication via Prescription Is Associated With Choice of Psychotropic Medication as Suicide Method: A Retrospective Study of 27,876 Suicide Attempts.

OBJECTIVE: Whether physical access to psychotropic medication via prescription (ie, prescribed access) is associated with use of psychotropic medication as a means of subsequent suicide attempt remains unclear. In a population of suicide attempters, we investigated whether prescribed access to any psychotropic medication increased the likelihood of using any psychotropic drug in a suicide attempt and whether prescribed access to a specific psychotropic drug type increased the likelihood of using that specific psychotropic drug type in an attempt. METHODS: Case-control study design was used. We identified individuals receiving care for a suicide attempt (fatal or nonfatal) in emergency department and inpatient settings from a US insurance claims dataset (2006-2013) using relevant ICD-9-CM codes. Cases used a psychotropic drug in their suicide attempt, while controls used another method. Exposed individuals filled a psychotropic drug prescription within 90 days prior to the attempt. Multivariable logistic regression estimated odds ratios. RESULTS: A population of 27,876 (cases = 10,158, controls = 17,718) was included. Anxiolytics were used most in attempts (n = 6,037, 59.4%), followed by antidepressants (n = 3,573, 35.2%), antipsychotics or mood stabilizers (n = 1,168, 11.5%), and stimulants (n = 368, 3.6%). Thirteen percent (n = 1,316) used more than 1 type of psychotropic drug in the attempt. Across all psychotropic drug groups evaluated, individuals using psychotropic medication in a suicide attempt were significantly more likely to have had prescribed access (adjusted odds ratio [aOR] = 1.7; 95% CI, 1.6-1.9), with the highest drug type-specific odds ratios for antipsychotics or mood stabilizers (aOR = 6.5; 95% CI, 5.4-7.7) and stimulants (aOR = 7.6; 95% CI, 5.5-10.5). CONCLUSIONS: Individuals at high risk for suicide with prescribed access to any psychotropic medication should be targeted for means safety interventions.

Lower objectively measured physical activity is linked with perceived risk of hypoglycemia in type 1 diabetes.

AIMS: Compare physical activity (PA) levels in adults with and without type 1 diabetes and identify diabetes-specific barriers to PA. METHODS: Forty-four individuals with type 1 diabetes and 77 non-diabetic controls in the Coronary Artery Calcification in Type 1 Diabetes study wore an accelerometer for 2 weeks. Moderate-to-vigorous physical activity (MVPA) was compared by diabetes status using multiple linear regression. The Barriers to Physical Activity in Type 1 Diabetes questionnaire measured diabetes-specific barriers to PA, and the Clarke hypoglycemia awareness questionnaire measured hypoglycemia frequency. RESULTS: Individuals with type 1 diabetes engaged in less MVPA, fewer bouts of MVPA, and spent less time in MVPA bouts per week than individuals without diabetes (all p < 0.05), despite no difference in self-reported PA (p > 0.05). The most common diabetes-specific barrier to PA was risk of hypoglycemia. Individuals with diabetes reporting barriers spent less time in MVPA bouts per week than those not reporting barriers (p = 0.047). CONCLUSIONS: Individuals with type 1 diabetes engage in less MVPA than those without diabetes despite similar self-reported levels, with the main barrier being perceived risk of hypoglycemia. Adults with type 1 diabetes require guidance to meet current PA guidelines and reduce cardiovascular risk.

Suicide and High Altitude: An Integrative Review.

Reno, Elaine, Talia L. Brown, Marian E. Betz, Michael H. Allen, Lilian Hoffecker, Jeremy Reitinger, Robert Roach, and Benjamin Honigman. Suicide and high altitude: an integrative review. High Alt Med Biol 19:99-108, 2018. INTRODUCTION: Suicide rates are greater at high altitudes, and multiple mechanisms have been suggested for this relationship, including hypoxia, differences in population density, characteristics of suicide victims, and firearms ownership and access. To better understand these potential mechanisms, studies evaluating the associations between high altitude and suicide were examined. METHODS: A literature review of published studies on high altitude and suicide was conducted in Medline, Embase, Web of Science, the Cochrane Database of Systematic Reviews, and the Cochrane CENTRAL database. We extracted and analyzed all studies that met the inclusion criteria, excluding foreign language studies and letters. Most of the measurements and results were synthesized using modified Letts' criteria. RESULTS: Searches using an extensive list of keywords returned 470 articles, but only 6 met the inclusion criteria. The studies' samples ranged in size from 8871 to 596,704, while studies which did not document sample size reported suicide rates. In five of the studies selected, individuals living at high altitudes were at greater risk of suicide. Four studies used aggregated data at a county or state level to analyze variables, such as age, gender, race, socioeconomic factors, and firearms access. All the studies found that high altitude was independently associated with suicide. One study found that many individual characteristics of those who committed suicide were different at high altitudes than low altitude, including a lack of access or barriers to mental healthcare. Depression exacerbated by hypoxia was hypothesized as a possible biologic mechanism in three studies. CONCLUSION: These research studies published since 2009 support an association between high altitude and suicide rates at the state or county level, but do not provide sufficient data to estimate the effect of high altitude on an individuals' suicide risk. Although the impact of hypoxia on mood and depression has been hypothesized to be a contributing cause, many other individual factors likely play more important roles.

Influences of gender on cardiovascular disease risk factors in adolescents with and without type 1 diabetes.

BACKGROUND: Women with type 1 diabetes (T1D) have a four-fold increased risk for cardiovascular disease (CVD) compared to non-diabetic (non-DM) women, as opposed to double the risk in T1D men compared to non-DM men. It is unclear how early in life CVD risk differences begin in T1D females. Therefore, our objective was to compare CVD risk factors in adolescents with and without T1D to determine the effects of gender on CVD risk factors. METHODS: The study included 300 subjects with T1D (age 15.4±2.1 years, 50 % male, 80 % non-Hispanic White (NHW), glycated hemoglobin (A1c) 8.9±1.6 %, diabetes duration 8.8±3.0 years, BMI Z-score 0.62±0.77) and 100non-DM controls (age 15.4±2.1 years, 47 % male, 69 % NHW, BMI Z-score 0.29±1.04). CVD risk factors were compared by diabetes status and gender. Multivariate linear regression analyses were used to determine if relationships between diabetes status and CVD risk factors differed by gender independent of differences in A1c and BMI. RESULTS: Differences in CVD risk factors between T1D subjects and non-DM controls were more pronounced in girls. Compared to boys with T1D and non-DM girls, T1D girls had higher A1c (9.0 % vs. 8.6 % and 5.1 %, respectively), BMI Z-score (0.70 vs. 0.47 and 0.27), LDL-c (95 vs. 82 and 81 mg/dL), total cholesterol (171 vs. 153 and 150 mg/dL), DBP (68 vs. 67 and 63 mmHg), and hs-CRP (1.15 vs. 0.57 and 0.54 mg/dL) after adjusting for Tanner stage, smoking status, and race/ethnicity (p <0.05 for all). In T1D girls, differences in lipids, DBP, and hs-CRP persisted even after adjusting for centered A1c and BMI Z-score. Testing interactions between gender and T1D with CVD risk factors indicated that differences were greater between girls with T1D and non-DM compared to differences between boys with T1D and non-DM. Overall, observed increases in CVD risk factors in T1D girls remained after further adjustment for centered A1c or BMI Z-score. CONCLUSIONS: Interventions targeting CVD risk factors in addition to lowering HbA1c and maintaining healthy BMI are needed for youth with T1D. The increased CVD risk factors seen in adolescent girls with T1D in particular argues for earlier intervention to prevent later increased risk of CVD in women with T1D.