Michael Grunebaum
Columbia University, Psychiatry, Faculty Member
Research Interests:
Research Interests:
Research Interests: Depression, Adolescent, Medicine, Comorbidity, Impulsivity, and 15 moreHumans, Personality Assessment Inventory, Major Depressive Disorder, Aggression, Female, Male, Aged, Middle Aged, Adult, Arachidonic Acid, Eicosapentaenoic Acid, Docosahexaenoic Acid, Impulsive behavior, Personality Inventory, and Medical and Health Sciences
Research Interests:
Research Interests: Psychology, Clinical Psychology, Psychiatry, Psychometrics, Personality, and 15 moreBipolar Disorder, Personality Assessment, Personality Disorders, Medicine, Comorbidity, Humans, Major Depressive Disorder, Female, Personality Disorder, Male, Patient Admission, Middle Aged, Adult, Hostility, and Major Depressive Episode
Research Interests: Psychiatry, Bipolar Disorder, Medication Adherence, Medicine, Comorbidity, and 15 moreHumans, Affective Disorders, Antidepressant, Major Depressive Disorder, Alcoholism, Female, Male, Patient Compliance, Middle Aged, Affective, Adult, Combination drug therapy, Alcohol use disorder, Medical and Health Sciences, and Antidepressive agents
ABSTRACT
Research Interests:
There is compelling evidence that suicide attempts are among the strongest predictors of suicide and future suicide attempts. This study aimed to examine psychopathology in multiple-suicide attempters. We compared the demographic and... more
There is compelling evidence that suicide attempts are among the strongest predictors of suicide and future suicide attempts. This study aimed to examine psychopathology in multiple-suicide attempters. We compared the demographic and clinical features of three groups: depressed patients without a history of suicide attempts (non-attempters), depressed patients with a history of one to three suicide attempts (attempters), and depressed patients with a history of four or more suicide attempts (multiple attempters). We found that attempters and multiple attempters had higher levels of depression, hopelessness, aggression, hostility, and impulsivity and were more likely to have borderline personality disorder and family history of major depression or alcohol use disorder compared with non-attempters, but did not differ between each other on these measures. Multiple attempters had greater suicidal ideation at study entry and were more likely to have family history of suicide attempt compared with attempters. Importantly, multiple attempters had greater suicide intent at the time of the most medically serious suicide attempt and more serious medical consequences during their most medically serious suicide attempt compared with attempters. The cross-sectional design of the study. Our data suggest that multiple-suicide attempters require careful evaluation as their behavior can have serious medical consequences.
Research Interests:
Research Interests: Demography, Borderline Personality Disorder, Dopamine, Impulsivity, Cerebrospinal Fluid, and 15 moreHumans, Alcoholism, Female, Male, Depressive Disorder, High Pressure Liquid Chromatography, High performance, Major Depression, Adult, Chi Square Distribution, Depressive Symptoms, Case Control Studies, Medical and Health Sciences, Major Depressive Episode, and Cigarette Smoke
Research Interests: Psychology, Psychiatry, Treatment Outcome, Medicine, Neurocognitive, and 14 moreHumans, Major Depressive Disorder, Female, Male, Middle Aged, Suicidal Ideation, Adult, Randomized Controlled Trial, Attempted Suicide, Cognition disorders, Paroxetine, bupropion, Psychology and Cognitive Sciences, and Medical and Health Sciences
Most previous studies compared suicidal behavior in subjects with and without a history of childhood abuse, whereas less attention was paid to the comparison of suicide attempters and nonattempters among subjects reporting childhood... more
Most previous studies compared suicidal behavior in subjects with and without a history of childhood abuse, whereas less attention was paid to the comparison of suicide attempters and nonattempters among subjects reporting childhood abuse. To identify risk and protective factors against suicidal behavior, we compared suicide attempters with nonattempters among the sample of 119 depressed inpatients who reported childhood abuse. Compared with nonattempters, suicide attempters were younger, had more self-rated depression severity and suicidal ideation, higher trait aggression and more cluster B personality disorder comorbidity, less coping potential, and fewer moral objections to suicide (MOS)/religious beliefs. Logistic regression showed that more severe suicidal ideation and fewer MOS/religious beliefs were associated with suicidal acts in subjects with reported childhood abuse. Furthermore, suicidal ideation and MOS/religious beliefs were significantly inversely correlated. The results of this clinical study add support to previous reports that religious/spiritual coping could serve as an additional resource in prevention of suicidal behavior for subjects with reported childhood abuse.
Research Interests: Clinical Psychology, Cognitive Science, Bipolar Disorder, Medicine, Comorbidity, and 15 moreHumans, Child, Major Depressive Disorder, Aggression, Child Abuse, Hospitalization, Female, Male, Ethnic Groups, Health Status, Clinical Sciences, Adult, Age Factors, Impulsive behavior, and cultural characteristics
Research Interests: Psychiatry, Adolescent, Medicine, Prospective studies, Humans, and 15 moreAntidepressant, Hospitalization, Female, Male, American, Depressive Disorder, Aged, Middle Aged, Adult, Aftercare, Age Factors, Poison Control, Proportional Hazards Models, Medical and Health Sciences, and Antidepressive agents
Research Interests:
Research Interests:
Research Interests:
Research Interests: Psychology, Psychiatry, Adolescent, Medicine, Humans, and 15 moreFemale, Male, Regression Analysis, Depressive Disorder, Melancholia, Risk factors, Aged, Middle Aged, Adult, Risk Factors, Attempted Suicide, Age of Onset, Marital Status, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests:
Research Interests: Psychology, Clinical Psychology, Psychiatry, Medicine, Anxiety, and 15 moreMood, Affect, Factor analysis, Humans, Affective Disorders, Female, Male, Beck Depression Inventory, Middle Aged, Affective, Adult, ANXIETY, Psychiatric Status Rating Scales, Psychology and Cognitive Sciences, and Medical and Health Sciences
ED FROM Wilcox HC, Kuramoto SJ, Brent D, et al. The interaction of parental history of suicidal behavior and exposure to adoptive parents’ psychiatric disorders on adoptee suicide attempt hospitalizations. Am J Psychiatry 2012;169:309–15.... more
ED FROM Wilcox HC, Kuramoto SJ, Brent D, et al. The interaction of parental history of suicidal behavior and exposure to adoptive parents’ psychiatric disorders on adoptee suicide attempt hospitalizations. Am J Psychiatry 2012;169:309–15. Correspondence to: Dr Holly C Wilcox, hwilcox1@jhmi.edu Sources of funding American Foundation of Suicide Prevention. The Notes is available online only at http://ebmh.bmj.com/content/early/recent CO M M EN TA RY This study adds to the literature on gene X environment (GxE) interaction particularly with respect to risk for suicidal behaviour. The strength of this study includes the large sample afforded by the national Swedish registry data from a 30-year period, a resource rare outside Scandinavia. The authors compared adoptees of biological parents with history of suicidal behaviour (BPSB) versus adoptees whose biological parents had a non-suicidal psychiatric hospitalisation (Biological Parents Psychiatric Hospitalisation – BPPH). They found that among adoptees whose adoptive mothers had a psychiatric hospitalisation before the adoptee was 18, the BPSB group had more than fourfold greater risk of suicide attempt hospitalisation than the BPPH group (HR=4.2, 95% CI 1.3 to 13.8; p=0.04). This suggests a GxE interaction whereby the genetic vulnerability presumably inherited by the BPSB offspring is expressed only in the setting of the environmental stress (ie, the adoptive mother’s psychiatric hospitalisation). The CI is wide, reflecting imprecision, and the p value is unlikely robust to correction for multiple tests. Nonetheless, HRs this large are uncommon in psychiatric research. The authors cite published studies which have shown that treating maternal depression has clear benefits for the mothers’ children. They conclude that prevention and treatment of maternal mental illness may also prevent suicidal behaviour among their children. The limitations, which are mostly discussed by the authors include: a very small sample with both GxE risk factors (N=38), high rates of missing data on biological fathers (46% in the BPSB group), potential residual confounding, risk of false positives from multiple statistical tests, absence of data on intrauterine environmental stressors and potential for racial genetic stratification. The sample was mostly Caucasian, and income and educational data were absent, limiting generalisability. The psychiatric genetics literature is full of findings that failed to replicate. Missing data means this study inadequately tested the influence of biological fathers. It remains to be seen whether the intriguing and wellresearched results of this study will stand the test of time. Nonetheless, as a converging line of evidence, it provides strong support to the notion that prevention and treatment of maternal mental illness is likely to have profoundly beneficial effects for their children.
Research Interests:
Substance use disorder (SUD) comorbidity in mood disorders increases suicide risk. Suicide attempters with active SUD appear to have distinct characteristics but little is known whether these characteristics persist during remission and... more
Substance use disorder (SUD) comorbidity in mood disorders increases suicide risk. Suicide attempters with active SUD appear to have distinct characteristics but little is known whether these characteristics persist during remission and if they are related to different aspects of suicidal behavior. In this study, suicide attempters with a DSM mood disorder and remitted SUD (AT+SUD) (N=135) were compared to those without lifetime SUD (AT−SUD) (N=219) in terms of demographic, clinical and suicidal behavioral characteristics. Factor analyses were conducted to generate subjective distress and impulsivity/aggression factors - previously identified by our group to predict suicide risk in mood disorders. Associations between these traits and SUD history and suicidal behavior characteristics were then tested. Compared with AT−SUD, AT+SUD were more likely to be male, less educated and to have a Cluster B personality disorder. AT+SUD individuals had greater impulsivity/aggression factor scores, but comparable subjective distress scores. AT+SUD made a greater number of suicide attempts, with higher lethality, despite comparable suicide intent and degree of planning with AT−SUD. Impulsivity/aggression was higher in multiple versus single attempters, but did not correlate with suicide attempt lethality. Among suicide attempters with mood disorders, a history of lifetime SUD was associated with more frequent and more lethal suicide attempts. Among other correlates of lifetime SUD in this sample, impulsive/aggressive traits may explain greater frequency of suicide attempts. The results underscore that persons with mood disorders and lifetime SUD are at particularly high risk of frequent and lethal suicide attempts where more intensive prevention efforts are warranted.
Research Interests:
Research Interests:
Prospective studies of predictors of suicidal acts in bipolar samples are rare. Among depressed bipolar attempters (n=57) randomized to lithium or valproate over 2.5 years, we identified predictors for "suicide event" defined as... more
Prospective studies of predictors of suicidal acts in bipolar samples are rare. Among depressed bipolar attempters (n=57) randomized to lithium or valproate over 2.5 years, we identified predictors for "suicide event" defined as a suicidal act or ideation with a plan requiring intervention. 29 suicide events (13 attempts) occurred in 24 (42%) patients, mostly within 6 months (21/29). Baseline depression predicted events (p=0.009). Later onset was protective (p=0.056) and impulsivity (p=0.065) and number of previous attempts (p=0.09) increased risk for events. Ongoing depression (H.R.=1.09, p=0.0024) and ongoing suicidal ideation (HR=1.09, p=0.054) both increased risk for events. For attempts, age was protective (HR=0.92, p=0.035) and baseline number of attempts (HR=1.5, p=0.019) and baseline ideation (HR=1.1, p=0.015) were risk factors. Ongoing aggression tended to predict attempts (HR=1.3, p=0.095). There were no differences in suicidal acts between patients on lithium or...
Research Interests:
Growing evidence suggests that the glutamatergic modulator ketamine has rapid antidepressant effects in treatment-resistant depressed subjects. The anticholinergic agent scopolamine has also shown promise as a rapid-acting antidepressant.... more
Growing evidence suggests that the glutamatergic modulator ketamine has rapid antidepressant effects in treatment-resistant depressed subjects. The anticholinergic agent scopolamine has also shown promise as a rapid-acting antidepressant. This study applied genome-wide markers to investigate the role of genetic variants in predicting acute antidepressant response to both agents. The ketamine-treated sample included 157 unrelated European subjects with major depressive disorder (MDD) or bipolar disorder (BD). The scopolamine-treated sample comprised 37 unrelated European subjects diagnosed with either MDD or BD who had a current Major Depressive Episode (MDE), and had failed at least two adequate treatment trials for depression. Change in Montgomery–Asberg Depression Rating Scale (MADRS) or the 17-item Hamilton Depression Rating Scale (HAM-D) scale scores at day 1 (24 h post-treatment) was considered the primary outcome. Here, we conduct pilot genome-wide association study (GWAS) ana...
Research Interests:
Michael F. Grunebaum’s name was misspelled/misstated as “Gruenbaum M.F.” in the original Article. This has now been updated in the HTML and PDF versions of this Article.
Research Interests:
ObjectiveWe examined the relationship of increasing prescription volume of newer antidepressants, introduced in Japan in 1999, to national rates of suicide.MethodThe relationship between annual changes in rates of suicide (obtained from... more
ObjectiveWe examined the relationship of increasing prescription volume of newer antidepressants, introduced in Japan in 1999, to national rates of suicide.MethodThe relationship between annual changes in rates of suicide (obtained from the Japanese Ministry of Health, Labor, and Welfare Vital Statistics Database) and prescription volume of the newer antidepressants paroxetine, fluvoxamine, and milnacipran (obtained from the database of IMS Japan K.K.), stratified by gender and age groups, was modeled statistically for the years 1999 through 2003. Effects of unemployment and alcohol consumption and the interaction of gender and age with antidepressant prescribing were assessed.ResultsFrom 1999 through 2003 in Japan, total antidepressant prescriptions increased 57% among males and 50% among females. Approximately 80% of this increase involved the selective serotonin reuptake inhibitors (SSRIs). To reduce a limitation of ecological analysis, we compared annual change in prescription and suicide rates, which eliminates the effect of long-term (secular) linear trends. We found an inverse association between year-to-year changes in the suicide rate and prescription volume of newer antidepressants (fluvoxamine, paroxetine, and milnacipran) (β = −1.34, p = .008) and SSRIs specifically (fluvoxamine, paroxetine) (β = −1.41, p = .019). An increase of 1 defined daily dose of SSRI use/1000 population/day was associated with a 6% decrease in suicide rate. Exploratory analysis suggested a stronger association in males, who experienced a greater increase in antidepressant use. Changes in unemployment and alcohol consumption rates did not explain the association.ConclusionIn Japan during 1999 through 2003, absent long-term linear trend effects, annual increases in prescribing of newer antidepressant medications, mainly SSRIs, were associated with annual decreases in suicide rates, particularly among males.
Research Interests: Psychiatry, Suicide, Japan, Adolescent, Medicine, and 15 moreHumans, Antidepressant, Female, Alcohol Drinking, Male, Aged, Middle Aged, Adult, Clinical Psychiatry, Paroxetine, Psychology and Cognitive Sciences, Medical and Health Sciences, Antidepressive agents, Drug prescriptions, and Medical prescription
Background Clinical trials of intravenous (IV) racemic (R,S)-ketamine (hereafter referred to as IV ketamine) have consistently reported rapid and substantial reductions in overall depressive symptoms compared with saline (inactive... more
Background Clinical trials of intravenous (IV) racemic (R,S)-ketamine (hereafter referred to as IV ketamine) have consistently reported rapid and substantial reductions in overall depressive symptoms compared with saline (inactive placebo) or midazolam (active placebo). The evidence for IV ketamine’s specific effects on suicidal ideation is less clear, however. This study sought to examine whether differential placebo (saline or midazolam) response to overall depressive symptoms vs suicidal ideation may help explain these divergent findings. Methods Data for this participant-level integrative data analysis were drawn from 151 participants across 10 studies, and linear regression was used to examine the relationship between placebo response for suicidal ideation vs other depressive symptoms indexed from standard rating scales—specifically, depressed mood, anhedonia, anxiety, and guilt—over time. Results For participants receiving saline placebo (n = 46), greater placebo response was ...
Research Interests:
Research Interests:
Studies suggest that male sex, a diagnosis of bipolar disorder and a history of suicide attempt are risk factors for suicidal behavior.1,2 Psychosocial impairment is also associated with suicidality. Several lines of evidence indicate... more
Studies suggest that male sex, a diagnosis of bipolar disorder and a history of suicide attempt are risk factors for suicidal behavior.1,2 Psychosocial impairment is also associated with suicidality. Several lines of evidence indicate that testosterone may be involved in the pathophysiology of aggressive and suicidal behavior in males.1 In this study, we examined whether higher testosterone levels predict future suicide attempts in males with bipolar disorder and a history of suicide attempt. Sixteen male suicide attempters with bipolar disorder were included in the study. Four of them made suicide attempts during the followup period. We limited this study to previous suicide attempters in order to have a highrisk group for suicide attempt on followup and thereby enhancing statistical power. Recruitment and clinical evaluation of study participants were described previously.3 Briefly, to be included, patients had to have a diagnosis of a bipolar disorder based on the Structured Clinical Interview: be in a depressive or mixed episode, have at least one past suicide attempt, and be 18 to 75 years of age. All participants provided written informed consent as approved by the New York State Psychiatric Institute Institutional Review Board. We used the male subsample of subjects included in our previous research report4 and included prospective observational data. Current severity of depression and lifetime aggression, impulsivity, and hostility were assessed by the Hamilton Depression Rating Scale (HDRS), Aggression History Scale (BrownGoodwin, revised), Barratt Impulsivity Scale, and BussDurkee Hostility Inventory, respectively. The severity of suicidal ideation, hopelessness during the previous week, the degree of medical damage caused by the most lethal suicide attempt, and reasons for living were measured with the Scale for Suicide Ideation, the Beck Hopelessness Scale, Medical Lethality Rating Scale, and Reasons for Living Inventory, respectively. Baseline plasma testosterone was assayed using a doubleantibody 125I radioimmunoassay procedure. Patients were followed up prospectively for up to 2.5 years. t Test was used to compare baseline testosterone levels in study participants who did or did not make a suicide attempt during the followup period. Taking into account multiple reports indicating that aggressive behavior in males is linked to testosterone levels,1 we used Pearson's correlations to test the relation between testosterone levels and Aggression History Scale items. Cox proportional hazards regression was used to analyze the time to the first suicide attempt. Demographic and clinical characteristics of study participants are presented in Table 1. At baseline, males with bipolar disorder who made suicide attempts during the followup period had significantly higher testosterone levels in comparison with those who did not attempt
Research Interests:
Studies demonstrate rapid antidepressant and anti-suicidal ideation effects of subanesthetic ketamine. The specific subcomponents of depression that are most closely tied to reduction of suicidal ideation with ketamine treatment are less... more
Studies demonstrate rapid antidepressant and anti-suicidal ideation effects of subanesthetic ketamine. The specific subcomponents of depression that are most closely tied to reduction of suicidal ideation with ketamine treatment are less explored. Exploratory, post hoc analysis of data from a randomized clinical trial of ketamine vs midazolam in patients with major depressive disorder (MDD) and clinically significant suicidal ideation examined changes in factor analysis-derived symptom clusters from standard measures of depression (Hamilton Depression Rating Scale, HDRS; Beck Depression Inventory, BDI) and mood disturbance (Profile of Mood States, POMS), and their relationship to severity of suicidal ideation (Beck Scale for Suicidal Ideation; SSI). Ratings obtained before and one day after blinded intravenous infusion were decomposed into component factors or published subscales. Treatment effects on factors/subscales were compared between drugs, correlations with changes in suicidal ideation were tested, and stepwise regression was used to derive predictors of change in SSI. Factor scores for HDRS Psychic Depression, HDRS Anxiety, BDI Subjective Depression, POMS Depression and POMS Fatigue improved more with ketamine than midazolam. Stepwise regression showed across both drugs that improvement in HDRS Psychic Depression, POMS Depression, and HDRS Anxiety predicted 51.6% of the variance in reduction of suicidal ideation. Secondary analysis of clinical trial data. Ketamine's rapid effects on suicidal ideation appear to be mostly a function of its effects on core mood and anxiety symptoms of MDD, with comparatively little contribution from neurovegetative symptoms with the potential exception of vigor/fatigue. Data used in this secondary analysis came from ClinicalTrials.gov identifier: NCT01700829.
Research Interests:
There is a public health need for improved suicide risk assessment tools. This pilot methodology study compared the assay sensitivity of computerized adaptive tests (CAT) of depression and suicidal ideation vs. traditional ratings in a... more
There is a public health need for improved suicide risk assessment tools. This pilot methodology study compared the assay sensitivity of computerized adaptive tests (CAT) of depression and suicidal ideation vs. traditional ratings in a randomized trial subgroup. The last 20 persons to enroll in a published ketamine trial in suicidal depression were studied. This subgroup received traditional and CAT ratings at baseline, 24 h post-infusion and follow-up week 2, 4, and 6: Hamilton Depression Rating Scale, Beck Depression Inventory, and Beck Scale for Suicidal Ideation vs. the CAT-Depression Inventory and CAT-Suicide Scale. Results showed larger effect sizes (ES) for CAT compared with traditional clinician-rated and self-report scales. Coefficients of variation for baseline measurements were lower for CAT compared with traditional scales. This is the first study to show that CAT may have greater assay sensitivity for treatment effects, particularly for suicidal ideation, compared with ...
Research Interests:
Supplemental material, Online_Appendix for Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta-analysis of treatment trials by Katrina Witt, Jennifer Potts, Anna Hubers, Michael F Grunebaum,... more
Supplemental material, Online_Appendix for Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta-analysis of treatment trials by Katrina Witt, Jennifer Potts, Anna Hubers, Michael F Grunebaum, James W Murrough, Colleen Loo, Andrea Cipriani and Keith Hawton in Australian & New Zealand Journal of Psychiatry
Research Interests:
Research Interests:
Objective: Ketamine may reduce suicidal ideation in treatment-resistant depression. But it is not known how quickly this occurs and how long it persists. We undertook a systematic review and meta-analysis to determine the short- and... more
Objective: Ketamine may reduce suicidal ideation in treatment-resistant depression. But it is not known how quickly this occurs and how long it persists. We undertook a systematic review and meta-analysis to determine the short- and long-term effectiveness of ketamine for suicidality. Method: CENTRAL, EMBASE, Medline, and PsycINFO were searched until 12 December 2018. Randomised controlled trials of ketamine or esketamine reporting data on suicidal ideation, self-harm, attempted or completed suicide in adults diagnosed with any psychiatric disorder were included. Two reviewers independently extracted data, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. Standardised mean difference was used for continuous outcomes. Results: Twenty-five reports from 15 independent trials, with a total of 572 participants diagnosed with predominately affective disorders, were included. The evidence was rated moderate to low. In m...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Background:Comorbid anxiety disorders have been considered a risk factor for suicidal behavior in patients with mood disorders, although results are controversial. The aim of this two-year prospective study was to determine if lifetime... more
Background:Comorbid anxiety disorders have been considered a risk factor for suicidal behavior in patients with mood disorders, although results are controversial. The aim of this two-year prospective study was to determine if lifetime and current comorbid anxiety disorders at baseline were risk factors for suicide attempts during the two-year follow-up.Methods:We evaluated 667 patients with mood disorders (504 with major depression and 167 with bipolar disorder) divided in two groups: those with lifetime comorbid anxiety disorders (n = 229) and those without (n = 438). Assessments were performed at baseline and at 3, 12, and 24 months. Kaplan-Meier survival analysis and log-rank test were used to evaluate the relationship between anxiety disorders and suicide attempts. Cox proportional hazard regression was performed to investigate clinical and demographic variables that were associated with suicide attempts during follow-up.Results:Of the initial sample of 667 patients, 480 had al...
Research Interests:
Suicidal behavior in first-degree relatives of people diagnosed with major depressive disorder (MDD) increases the risk of suicidal behavior. Such an effect may be the result of genetic risk factors or environmental ones, including... more
Suicidal behavior in first-degree relatives of people diagnosed with major depressive disorder (MDD) increases the risk of suicidal behavior. Such an effect may be the result of genetic risk factors or environmental ones, including imitation, or both. Surprisingly few studies have examined this question and thus, there still is little known about the effect of first-degree family history of suicidal behavior on the type of suicidal behavior and profile of risk factors related to the diathesis for suicidal behavior. Even less is known about intra-familial risk transmission. Patients with MDD (n = 252) experiencing a current major depressive episode and who had a previous suicide attempt were studied. Those with and without a family history of first-degree relatives who had made a suicide attempt or died by suicide were compared across clinical and suicide-related characteristics. Suicide attempters with (FDR, n = 59) and without a first-degree relative with suicide attempt or suicide...
Research Interests:
Oxytocin may moderate prosocial behaviors, but has also been implicated in negative mental health outcomes. A single-nucleotide polymorphism (SNP) of the oxytocin receptor gene (OXTR), rs53576, and a SNP of the CD38 gene, which regulates... more
Oxytocin may moderate prosocial behaviors, but has also been implicated in negative mental health outcomes. A single-nucleotide polymorphism (SNP) of the oxytocin receptor gene (OXTR), rs53576, and a SNP of the CD38 gene, which regulates oxytocin secretion, rs3796863, have been associated with depression and suicidal ideation. We conducted an exploratory study investigating the relationship of these two SNPs to history of suicide attempt. Secondary analyses explored relationships of genotype with sex, diagnosis, history of abuse, depression, suicidal ideation, and attachment and personality traits. Subjects were depressed adults with DSM-IV major depressive disorder (MDD; n = 161) or bipolar disorder (BD; n = 75). The A allele of rs53576 was associated with suicide attempt history. A differential effect of rs3796863 genotype on suicide attempt risk was found by diagnosis. In the BD sample, CC and AC genotypes were associated with higher odds of suicide attempt compared to AA, while ...
Research Interests:
To evaluate feasibility and effects of a sub-anesthetic infusion dose of ketamine versus midazolam on suicidal ideation in bipolar depression. Neurocognitive, blood and saliva biomarkers were explored. Sixteen participants with bipolar... more
To evaluate feasibility and effects of a sub-anesthetic infusion dose of ketamine versus midazolam on suicidal ideation in bipolar depression. Neurocognitive, blood and saliva biomarkers were explored. Sixteen participants with bipolar depression and a Scale for Suicidal Ideation (SSI) score of ≥4 were randomized to ketamine (0.5 mg/kg) or midazolam (0.02 mg/kg). Current pharmacotherapy was maintained excluding benzodiazepines within 24 hours. The primary clinical outcome was SSI score on day 1 post-infusion. Results supported feasibility. Mean reduction of SSI after ketamine infusion was almost 6 points greater than after midazolam, although this was not statistically significant (estimate=5.84, SE=3.01, t=1.94, P=.074, 95% confidence interval ([CI)]=-0.65 to 12.31). The number needed to treat for response (SSI <4 and at least 50% below baseline) was 2.2, and for remission (SSI=0) was 3.2. The strongest neurocognitive correlation was between memory improvement on the Selective R...
Research Interests:
We aimed to examine the relationship between religion and suicide attempt and ideation. Three hundred twenty-one depressed patients were recruited from mood-disorder research studies at the New York State Psychiatric Institute.... more
We aimed to examine the relationship between religion and suicide attempt and ideation. Three hundred twenty-one depressed patients were recruited from mood-disorder research studies at the New York State Psychiatric Institute. Participants were interviewed using the Structured Clinical Interview for DSM Disorders, Columbia University Suicide History form, Scale for Suicide Ideation, and Reasons for Living Inventory. Participants were asked about their religious affiliation, importance of religion, and religious service attendance. We found that past suicide attempts were more common among depressed patients with a religious affiliation (odds ratio, 2.25; p = 0.007). Suicide ideation was greater among depressed patients who considered religion more important (coefficient, 1.18; p = 0.026) and those who attended services more frequently (coefficient, 1.99; p = 0.001). We conclude that the relationship between religion and suicide risk factors is complex and can vary among different p...
Research Interests:
Research Interests: Psychology, Culture, Medicine, Humans, Female, and 15 moreMale, Religion and psychology, Patient Admission, New York, Middle Aged, Adult, Morals, Protective factors, Risk Factors, Psychiatric, Cross Sectional Studies, Protective Factor, Personality Inventory, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests:
We examined the relationship of increasing prescription volume of newer antidepressants, introduced in Japan in 1999, to national rates of suicide. The relationship between annual changes in rates of suicide (obtained from the Japanese... more
We examined the relationship of increasing prescription volume of newer antidepressants, introduced in Japan in 1999, to national rates of suicide. The relationship between annual changes in rates of suicide (obtained from the Japanese Ministry of Health, Labor, and Welfare Vital Statistics Database) and prescription volume of the newer antidepressants paroxetine, fluvoxamine, and milnacipran (obtained from the database of IMS Japan K.K.), stratified by gender and age groups, was modeled statistically for the years 1999 through 2003. Effects of unemployment and alcohol consumption and the interaction of gender and age with antidepressant prescribing were assessed. From 1999 through 2003 in Japan, total antidepressant prescriptions increased 57% among males and 50% among females. Approximately 80% of this increase involved the selective serotonin reuptake inhibitors (SSRIs). To reduce a limitation of ecological analysis, we compared annual change in prescription and suicide rates, wh...
Research Interests:
Objective: The purpose of the study was to determine predictors of missed appointments for psychiatric consultations among patients in a general medical clinic. Methods: The charts of 180 patients consecutively referred for psychiatric... more
Objective: The purpose of the study was to determine predictors of missed appointments for psychiatric consultations among patients in a general medical clinic. Methods: The charts of 180 patients consecutively referred for psychiatric consultations at a university-affiliated primary care clinic were reviewed. Ninety patients missed appointments for these consultations. Parametric and nonparametric tests were used to compare patients who missed and did not miss appointments on demographic and clinical variables, as well as measures related to patients’ interactions with the dinic and the referring clinician. Results: Logistic regression analysis revealed three significant predictors of missed appointments. Patients with mild distress and those with significant resistance to seeing a psychiatrist were more likely to miss appointments, as were those who had to wait longer between the referral and the appointment date. Conclusions: The results suggest that shortening the wait for a psy...
Research Interests:
BackgroundPatients with bipolar disorder have a high lifetime risk of suicide. Predicting, preventing and managing suicidal behavior are major goals in clinical practice. Changes in suicidal thoughts and behavior are common in the course... more
BackgroundPatients with bipolar disorder have a high lifetime risk of suicide. Predicting, preventing and managing suicidal behavior are major goals in clinical practice. Changes in suicidal thoughts and behavior are common in the course of treatment of bipolar disorder.MethodsUsing a dataset from a randomized clinical trial of bipolar disorder treatment (N=98), we tested predictors of future suicidal behavior identified through a review of literature and applied marginal variable selection and machine learning methods. The performance of the models was assessed using the optimism-adjusted C statistic.ResultsNumber of prior hospitalizations, number of prior suicide attempts, current employment status and Hamilton Depression Scale were identified as predictors and a simple logistic regression model was constructed. This model was compared with a model incorporating interactions with treatment group assignment, and more complex variable selection methods (LASSO and Survival Trees). Th...
Research Interests:
Substance use disorder (SUD) comorbidity in mood disorders increases suicide risk. Suicide attempters with active SUD appear to have distinct characteristics but little is known whether these characteristics persist during remission and... more
Substance use disorder (SUD) comorbidity in mood disorders increases suicide risk. Suicide attempters with active SUD appear to have distinct characteristics but little is known whether these characteristics persist during remission and if they are related to different aspects of suicidal behavior. In this study, suicide attempters with a DSM mood disorder and remitted SUD (AT+SUD) (N = 135) were compared to those without lifetime SUD (AT-SUD) (N = 219) in terms of demographic, clinical and suicidal behavioral characteristics. Factor analyses were conducted to generate subjective distress and impulsivity/aggression factors - previously identified by our group to predict suicide risk in mood disorders. Associations between these traits and SUD history and suicidal behavior characteristics were then tested. Compared with AT-SUD, AT+SUD were more likely to be male, less educated and to have a Cluster B personality disorder. AT+SUD individuals had greater impulsivity/aggression factor scores, but comparable subjective distress scores. AT+SUD made a greater number of suicide attempts, with higher lethality, despite comparable suicide intent and degree of planning with AT-SUD. Impulsivity/aggression was higher in multiple versus single attempters, but did not correlate with suicide attempt lethality. Among suicide attempters with mood disorders, a history of lifetime SUD was associated with more frequent and more lethal suicide attempts. Among other correlates of lifetime SUD in this sample, impulsive/aggressive traits may explain greater frequency of suicide attempts. The results underscore that persons with mood disorders and lifetime SUD are at particularly high risk of frequent and lethal suicide attempts where more intensive prevention efforts are warranted.