The role of mental health and substance use disorders on the relation of migraine with self-directed violence among women in the United States.

OBJECTIVES: Migraine disproportionately affects women of reproductive age, and is associated with self-directed violence (SDV) which confers substantial risk for suicides. Mental health disorders (MHD) and substance use disorders (SUD) are higher among persons with migraines. However, there's limited information on the influence of these conditions on SDV among women. We evaluated the interplay of MHD and SUD on the relation of migraine with SDV among US women. METHODS: We analyzed data from 96 million hospitalizations among women aged 15-49 years from the National Inpatient Sample (2004-2015). International Classification of Disease codes were used to identify hospitalizations for migraine and other health conditions. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: From 2004 to 2015 the prevalence (per 1000 hospitalizations) of migraine increased from 17.5 to 33.5, while SDV prevalence also increased from 10.5 to 38.9. A greater proportion of women hospitalized with migraine had epilepsy, suicidal ideations, SUD and MHD than women without migraine. In models adjusted for demographic and behavioral/lifestyle factors, menstrual disorders, pregnancy, health conditions and violent assault, hospitalization with migraine was positively associated with SDV (OR = 1.15, CI: 1.12-1.18). Women with migraine and either SUD (OR = 5.17, CI: 4.46-5.97) or MHD (OR = 14.13; CI: 12.1-16.47) had elevated odds of SDV, with the odds varying by type of MHD and SUD. CONCLUSIONS: A significant relation between hospitalization with migraine and SDV was observed especially among reproductive-age women with SUD and MHD. Clinicians should consider monitoring women with these characteristics for suicide risk.

The Association of Mental Health Disorders with Takotsubo Syndrome (Broken Heart Syndrome) Among Older Women.

Background: The prevalence of mental health disorders (MHD) and takotsubo syndrome (TS), also known as broken heart syndrome, is increasing and more common in older women. Mortality among persons with TS is comparable to that of persons with myocardial infarction. Although TS is poorly understood, it is thought to be precipitated by psychological stress. We examined the relationship between MHD and TS among elderly American women. Materials and Methods: Data consisted of 10.9 million hospitalizations among women aged ≥60 years recorded in the National Inpatient Sample from 2007 to 2015. International Classification of Diseases, Ninth Revision, codes were used to define TS, MHD, and other chronic conditions. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between MHD and TS. Results: The mean age of patients was 76 years, with 38% of them diagnosed with MHD. Over the 9-year period, the prevalence of TS hospitalizations increased by almost fourfold from 37.1/100,000 to 154.7/100,000, with a higher prevalence among patients with MHD. In multivariable adjusted models, MHD was associated with elevated odds of TS (OR = 1.25; 95% CI: 1.18-1.32), with the odds increasing with the frequency of MHD diagnosis. Among patients with one MHD, the odds of TS were significantly higher among those diagnosed with adjustment, anxiety, and mood disorders but lower among those with suicide ideations and personality disorders. Conclusions: The presence of MHD was associated with elevated odds of TS. Understanding underlying mechanisms linking MHD with TS will enhance MHD management.