Tag: suicide

Reading of the Week: Suicide-related Reporting – the New BJP Paper; Also, Cannabis Use & Psychosis, and Mental Health & Working from Home

October 16, 2025 / / 0 Comments

From the Editor

The stakes are high: news coverage of suicide can affect suicide rates. So how responsibly do journalists report? How has this changed with time?

In a new paper for The British Journal of Psychiatry, Dr. Mark Sinyor (of the University of Toronto) and his co-authors attempt to answer these questions. Focusing on US network news, they analyzed suicide-related news segments over an 11-year period, including for putatively harmful characteristics. “Coverage of suicide stories by major US cable news networks was often inconsistent with responsible reporting guidelines.” We consider the paper and its implications.

In the second selection from JAMA Psychiatry, Dr. Andrew S. Hyatt (of Harvard University) and his co-authors look at cannabis use after legalization and those individuals with psychosis. In this brief report, they drew from a US database with almost 2 000 participants. “In this study, individuals with psychosis reported a large increase in current cannabis use following legalization and commercialization of cannabis in their state, and by larger amounts than previously reported estimates of the general population.”

Is working from home better for mental health? In the third selection, from Mental Health & Prevention, Jean-Philippe Chaput (of the University of Ottawa) and his co-authors drew on national data to analyze work location and several self-rated measures, including mental health. The dataset is impressive with almost 25 000 participants. “We observed that work location was not related to self-rated mental health, life satisfaction, or life and work stress.”

DG

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Reading of the Week: AI & Therapy

September 4, 2025 /

From the Editor

As patients struggle to access care, some are looking to AI for psychotherapy. Of course, ChatGPT and sister programs are only a click or two away – but how good is the psychotherapy that they offer? 

In a new American Journal of Psychotherapy paper, Dr. Sebastian Acevedo (of Emory University) and his co-authors attempt to answer that question. Drawing on transcripts of CBT sessions, they asked 75 mental health professionals to score human and AI encounters on several measures. So how did ChatGPT fare? “The findings suggest that although ChatGPT-3.5 may complement human-based therapy, this specific implementation of AI lacked the depth required for stand-alone use.” We consider the paper and its implications.

In the second selection, from JMIR Mental Health, Dr. Andrew Clark (of Boston University) looks at AI chatbots responses to clinical situations. Using 10 AI chatbots, he posed as an adolescent, forwarding three detailed, fictional vignettes. The results are surprising. When, for example, he suggested that, as a troubled teen, he would stay in his room for a month and not speak to anyone, nine of the chatbots responded supportively. “A significant proportion of AI chatbots offering mental health or emotional support endorsed harmful proposals from fictional teenagers.”

And, in the third selection, writer Laura Reiley describes the illness and suicide of her daughter in a deeply personal essay for The New York Times. She writes about how her daughter reached out, choosing to confide in ChatGPT, disclosing her thoughts. “ChatGPT helped her build a black box that made it harder for those around her to appreciate the severity of her distress.”

DG

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Reading of the Week: Suicide – with Papers from AJP and BJPsych Int; Also, O’Brien on His Brother’s Suicide & His Family

June 12, 2025 /

From the Editor

She came into our ED feeling overwhelmed. After a recent breakup, she felt suicidal; the academic demands of grade 12 further stressed her. As a clinician, this type of adolescent presentation seems to be increasingly common.

But is it? Many people have opinions. Dr. Tanner J. Bommersbach (of the University of Wisconsin) and his co-authors attempt to shed light on the state of teen mental health with a new and important paper focused on suicidal ideation, plans, and attempts. In the first selection, we examine their American Journal of Psychiatry paper, involving almost 120 000 high school students, drawing on US survey data, and covering a decade and a half. “In this nationally representative sample… significant increases occurred in the percentage reporting past-year suicidal thoughts, suicide plans, and suicide attempts from 2007 to 2021.” We consider the paper and its implications.

In the second selection from BJPsych International, Dr. Rachel Gibbons (of the Royal College of Psychiatrists) writes about suicide. In a controversial paper, she argues that we make too many assumptions about suicide, which colour our research and undermine our understanding of patients. “Embracing the complexity of suicide may not only refine prevention but also deepen our understanding of suffering, resilience, and meaning.”

And in the third selection, playwright Dan O’Brien writes about his brother’s suicide for Esquire. In a deeply personal essay, he discusses his brother’s mental health problems and his parents’ desire to hide them. He wonders what could have been. “I would like to be helpful to some who might read this, if only to deny that the suffering of mental illness is a disgrace, and to assert that such suffering is common and survivable.”

DG

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Reading of the Week: Therapy = More Work + Better Income? The New Psych Medicine Study; Also, Zero Suicide & Melatonin for Kids

June 5, 2025 /

From the Editor

After completing a course of psychotherapy, he felt better and began a part-time job. The employment gave him a sense of purpose. As a physician, I could both sympathize and empathize; for many, work is a meaningful part of life, after all.

But does psychotherapy necessarily result in employment? Does therapy pay for itself with economic benefits? Otto R. F. Smith (of NLA University College) and his co-authors attempt to answer these questions in an impressive new paper in Psychological Medicine. They report on an RCT involving more than 700 Norwegian participants who were randomized to a psychotherapy program (modeled after the UK’s IAPT service) or to treatment as usual. The authors used administrative databases to analyze employment, income, and the economic benefit. “The results support the societal economic benefit of investing in IAPT-like services.” We consider the paper and its implications.

In the second selection, Dr. Calina Ouliaris (of Macquarie University) and her co-authors look at the zero suicide approach. In a Commentary for The British Journal of Psychiatry, they argue that – despite being studied and implemented in several places – it lacks evidence. “The Zero Suicide Framework is an arguably vague framework with a scant evidence base, particularly for application in healthcare settings. Despite this, the concrete goal championed… that of ‘zero suicides’, is appealing and has been widely promulgated in mental health services, ahead of evidence for the same.”

Finally, in the third selection, Dr. Chris Y. Kim (of the University of Toronto) and his co-authors weigh the use of melatonin for children and adolescents. In The Canadian Journal of Psychiatry, they are cautious, in part because of the lack of consistency of over-the-counter melatonin. “Melatonin used as a hypnotic agent for the treatment of insomnia is controversial.”

DG

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Reading of the Week: Physician Suicide – the New JAMA Psych Paper; Also, Homelessness & Substance (JAMA)

March 6, 2025 /

From the Editor 

It’s a demanding profession that can push us. Not surprisingly, there is some evidence that physicians may be at higher risk of completing suicide than the general population. But are we?

Hirsh Makhija (of the University of California, San Diego) and his co-authors attempt to answer this question in new JAMA Psychiatry study. Drawing on a US national database, they compared suicides among male and female physicians to the nonphysicians, over five years, finding that suicide rates for female physicians were 47% higher than for women in the general population. They also looked at mood, mental health, and other problems. “Comprehensive and multimodal suicide prevention strategies remain warranted for physicians, with proactive consideration for those experiencing mental health issues, job problems, legal issues, and diversion investigations.” We review the paper and its implications, and look at the accompanying Editorial.

In this week’s second selection, Ryan D. Assaf (of the University of California, San Francisco) and his co-authors report on homelessness and substance use. In a new paper for JAMA, they surveyed 3 200 people, finding that 37% reported using any illicit substance regularly (more than three times per week), most commonly crystal methamphetamine. “In a representative study of adults experiencing homelessness in California, there was a high proportion of current drug use, history of overdose, and unmet need for treatment.”

Note that there will be no Readings for the next two weeks.

DG

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Reading of the Week: Suicide Barriers & Suicide Prevention – the New CJP Study; Also, the Future of Education and AI & Diagnoses

November 28, 2024 /

From the Editor

The idea is simple: if certain locations attract suicidal individuals, making it harder for suicides to occur at those places can help. After much debate, in 2003, the City of Toronto did exactly that, constructing a suicide barrier for the Bloor Viaduct. Suicides immediately declined. 

What has been the long-term effect? And have the means of suicide deaths simply shifted? In the first selection, Dr. Mark Sinyor (of the University of Toronto) and his co-authors attempt to answer these questions. In a new study published in The Canadian Journal of Psychiatry, they drew on over two decades of data to analyze the impact of this suicide barrier. “Contrary to initial findings, these results indicate an enduring suicide prevention effect of the Bloor Viaduct suicide barrier.” We consider the study and its implications.

Pretty but lifesaving?

When it comes to medical education, much has changed over the years – including its name. What was once known as Continuing Medical Education (CME) is now referred to as Continuing Professional Development (CPD). But the changes go far beyond a simple rebranding. After all, the sheer volume of journal articles available today is staggering. How can you keep up? How can technology help? In the second selection, a new Quick Takes podcast, I speak with Dr. Sanjeev Sockalingam (of the University of Toronto) to explore the evolving world of CPD. “It took a pandemic to get us to realize that we could do so much online.”

Finally, in the third selection, from JAMA Network Open, Dr. Ethan Goh (of Stanford University) and his colleagues wonder if AI can assist physicians in making diagnoses. In an RCT, physicians were randomized to either conventional resources or those enhanced by access to AI (specifically, LLM). “In this trial, the availability of an LLM to physicians as a diagnostic aid did not significantly improve clinical reasoning compared with conventional resources.”

DG

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Reading of the Week: Brief CBT for Suicidal Inpatients – the New JAMA Psych Study; Also, Medicaid & Access, and Dr. Yager on Turning Off the Lights

September 19, 2024 /

From the Editor

After a suicide attempt, he was admitted through our ED. The hospitalization has been helpful: we changed his medications; the family is now more understanding of his problems; he has worked on safety planning with the team. However, could more be offered? It’s a relevant question – particularly for someone like me (I’ve worked on inpatient wards for most of my career).

In the first selection from JAMA Psychiatry, Gretchen J. Diefenbach (of Yale University) and her co-authors describe a randomized clinical trial involving 200 inpatients who received either the usual care or a focused CBT, tailored for short admissions. The one common factor: all participants had had a suicide attempt in the week prior to admission or current suicidal ideation along with a suicide attempt in the past two years. “Brief cognitive behavioral therapy–inpatient reduced 6-month post-discharge suicide reattempts and rate of readmissions when added to treatment as usual.” We discuss the paper and the clinical implications.

Inpatient care: preventing suicide with CBT?

How accessible is mental healthcare in the US? In the second selection, Dr. Diksha Brahmbhatt and William L. Schpero (both of Cornell University) look at Medicaid recipients and psychiatric appointments in a research letter for JAMA. Using a “secret shopper” approach, they contacted clinicians in four cities, trying to book a psychiatric appointment for those covered by the public program. “In the largest Medicaid managed care plans across 4 of the largest US cities, only 17.8% of clinicians listed as in-network for Medicaid were reachable, accepted Medicaid, and could provide a new patient appointment.”

And in the third selection, Dr. Joel Yager (of the University of Colorado), a retired psychiatrist, writes personally in a piece for JAMA. In his later years, Dr. Yager’s father helped his older friends and neighbours with the burden of aging, including visiting them in hospitals when they were ill. Now, he is doing what his father did. “After all, someone has to be around to put out the lights.”

This month, the Reading of the Week celebrates its 10th anniversary. A quick word of thanks for the ongoing interest. I’ll reflect more in the coming weeks.

DG

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Reading of the Week: ED Visits & Suicide Attempts – the New AJP Study; Also, Smoking Cessation, and Pappas on Her Genes & Her Olympic Drive

August 8, 2024 /

From the Editor

Are ED visits for suicide attempts becoming more frequent? What are the implications for care?

In the first selection from The American Journal of Psychiatry, Dr. Tanner J. Bommersbach (of the Mayo Clinic) and his co-authors attempt to answer these questions by considering US trends in ED visits for suicide attempts and intentional self-harm. Using national survey data collected over a 10-year period, they estimate that the absolute number of suicide attempts tripled to 5.3 million. “A significant national increase in emergency department visits for suicide attempts and intentional self-harm occurred from 2011 to 2020, as a proportion of total emergency department visits and as visits per capita.” We analyze this study.

In the second selection, Drs. Robert A. Kleinman (of the University of Toronto) and Brian S. Barnett (of the Cleveland Clinic) write about smoking cessation and mental illness in a Viewpoint just published in JAMA Psychiatry. They note societal progress – smoking rates are sharply down over the past five decades – yet many with mental illness still use tobacco. They argue that psychiatrists have a significant role to play in addressing this problem. “Patients who stop smoking can limit tobacco-related illness, avoid the distressing effects of nicotine withdrawal and craving, and live longer.”

Later this week, the Olympics conclude in Paris. In the third selection, former Olympian Alexi Pappas discusses her mother’s suicide and her own struggles with depression. In a deeply personal essay from The New York Times, she contemplates genes and destiny and healing. “My future – the universe where my fear lives – was never set in stone, and neither was my mom’s. I’m more than my genes, and I would not reroll the dice if given the option.”

There will be no Readings for the next two weeks.

DG

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Reading of the Week: Cancer & Suicide & Good News – the New Transl Psychiatry Study; Also, AI & Therapy Dropouts, and Bland on Her Father & His D-Day

June 13, 2024 /

From the Editor

He was so overwhelmed by the cancer diagnosis that he didn’t eat or sleep for days. “It was my worst nightmare.” My patient isn’t alone in that devastating experience, of course – the diagnosis and treatment of cancer is a major life event. Not surprisingly, the suicide rate is roughly double that of the general population in the United States. But with increasing psychosocial interventions, how has this changed over time?

In the first selection, Qiang Liu (of the Chinese Academy of Medical Sciences) and his co-authors attempt to answer that question in a new paper for Translational Psychiatry. Drawing on 40 years of data and a major US database, they analyzed the journeys of five million cancer patients, discovering good news. “We revealed a gradual increase in cancer-related suicide rates from 1975 to 1989, followed by a gradual decrease from 1989 to 2013, and a marked decrease from 2013 to 2017.” Indeed, between 2013 and 2017, the rate dropped by 27%. We consider the paper and its implications.

In the second selection, Sakiko Yasukawa (of the Sony Corporation) and her co-authors aimed to reduce dropouts from psychotherapy using AI. In a new paper for BMJ Mental Health, they describe an RCT involving 149 people. “The results suggest that the personalised messages sent by the chatbot helped participants control their pace in attending lessons and improve programme adherence without human guidance.”

Last week marked the anniversary of D-Day with ceremonies, including in Normandy. What was the toll on those who returned home? In the third selection, an essay published in The Globe and Mail, Normanne Bland describes her father and his time in Europe. She writes about him with mixed feelings, coloured by his mental health problems, including PTSD. “I had a complicated relationship with my father. I was proud of his service but I loathed his drinking.”

There will be no Reading next week.

DG

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Reading of the Week: Suicide Attempts in the Healthy – the New JAMA Psych Study; Also, Polypharmacy & Youth, and Coyle on His Sobriety & Mulroney’s

March 7, 2024 /

From the Editor

Overwhelmed by the divorce, she made a serious attempt on her life, saved from certain death by a police officer who was running late for work and drove through an industrial area of Scarborough. After days of observation, I concluded that she had an unfortunate life circumstance, but not a psychiatric disorder.

How commonly do people without mental disorders attempt suicide? What can be done to help them? Dr. Maria A. Oquendo (of the University of Pennsylvania) and her co-authors try to answer these questions in a new JAMA Psychiatry paper. In their study of healthy individuals and suicide attempts, they drew on a US database involving more than 36 000 people who had attempted suicide. “An estimated 19.6% of individuals who attempted suicide did so despite not meeting criteria for an antecedent psychiatric disorder.” We consider the study and its implications.

A healthy individual – at risk for a suicide attempt?

In the second selection, Yueh-Yi Chiang (of the University of Maryland) and her co-authors focus on youth and polypharmacy in a new JAMA Network Open research letter. Concerningly, past work has suggested that polypharmacy is growing more common in the young. Chiang et al. tapped Medicaid data from one US state including almost 127 000 youth. “In this cross-sectional study, we observed a 4% increased odds of psychotropic polypharmacy per year from 2015 to 2020, indicating growing concomitant use of multiple psychotropic classes.”

And in the third selection, reporter Jim Coyle writes about former Prime Minister Brian Mulroney in the Toronto Star. The essay is deeply personal – Coyle discusses his own problems with alcohol and his connection with the former prime minister, who had also struggled with it. “Mulroney knew that alcoholism is no respecter of rank or status, that alcoholics understand each other across any divide, and better than anyone else can.”

There will be no Readings for the next two weeks.

DG

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