Tag: suicide

Reading of the Week: Doctors & Suicidality – the New CMAJ Study; Also, GLP-1 RAs & Eating Disorders, and Chin-Yee on the Death of the Consult Note

July 9, 2026 / / 0 Comments

From the Editor

His suicidal thoughts were so strong that he had written a suicide note. Yet, during the months before we met in the ED, he had hesitated to seek care. As a doctor, he knew he had severe depression but he told me that he felt he couldn’t get help. 

Such stories are all too common. In a CMAJ study, Dr. An Yi (Annie) Yu (of the University of Toronto) and her co-authors shed light on physicians’ seeking help for suicidality. They drew from the literature (literally): analyzing 52 narratives from academic papers, finding various barriers to seeking care, including aspects of medical culture, and identified facilitators, such as confidential services. “The pressure to achieve in medicine often discourages physicians from acknowledging their need for help, but the value of meaningful work emerged as a positive factor for mental health. The stigma regarding mental health concerns was substantially reduced through role modelling of help-seeking behaviour by colleagues.” We consider the study and its implications.

GLP-1 receptor agonists are having a moment because of the evidence for diabetes and other conditions. In the second selection, Nicholas C. Peiper (of the University of Louisville) and his co-authors focus on those with eating disorders, analyzing data to understand use and misuse in a new JAMA Psychiatry research letter. “This cross-sectional study found that GLP-1 RA use and misuse were common in a targeted sample of people with eating disorders.”

And in the third selection, from JAMA, Dr. Benjamin Chin-Yee (of Western University) writes about consult notes. He wonders what is lost in the “digital transformation” of templates and AI scribes. He worries about the future of the consult note. “The tools may evolve, but the art of pausing, thinking, and telling a story is still ours to preserve.”

DG

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Reading of the Week: Suicide – Papers from BJPsych & Lancet Psychiatry, and Dr. Mark Sinyor on Prevention

June 25, 2026 /

From the Editor

“Media reports about suicide have the potential to influence suicide rates. Most research in this area has focused on increased rates of suicide that follow widely reported stories of suicide death, often in celebrities, the so-called Werther effect. However, a small and growing literature has investigated the Papageno effect in which widely disseminated stories of mastery of suicide crises and survival are followed by fewer suicides.”

So opens a fascinating paper recently published in The British Journal of Psychiatry. In it, Sangsoo Shin (of the University of Melbourne) and her co-authors look at a highly publicized news story: the singer Jon Bon Jovi intervening to stop a woman’s suicide attempt in 2024. Was there a Papageno effect? The authors analyzed suicide mortality data spanning a decade in Tennessee and 19 other states with 60 subgroups. “This study provides the first evidence of a Papageno effect following a widely publicised, real-life survival story.” We consider the paper and its implications.

Suicide prevention has come a long way since the SAD PERSONS mnemonic that many of us learned in medical school. And the research continues to evolve. What to make of it all, and how should the latest research inform practice? In the second selection, an episode of Quick Takes, I speak with Dr. Mark Sinyor, professor at the University of Toronto and staff psychiatrist at Sunnybrook Health Sciences Centre. We discuss the efficacy of suicide-prevention barriers (think the Bloor Viaduct here in Toronto) and restricting highly lethal pesticides. “You don’t actually need billions of dollars to prevent suicide. You just need really good coordination.”

In the third selection, from Lancet Psychiatry, a medical student discusses her suicidal thoughts. The paper – which is written anonymously – argues that many providers take the wrong approach when speaking to patients who are suicidal. “All I am saying is, if medicine placed the same emphasis on healing as it does on survival, I believe our approaches would change and perhaps our outcomes would improve as well.”

DG

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Reading of the Week: Adolescent Mental Health With Papers on School-Based Mindfulness, Firearms & Youth Suicide, and GenAI

February 26, 2026 /

From the Editor

The MYRIAD Trial was ambitious, involving more than 8 300 adolescents at 84 schools, with the aim of preventing depression and improving mental well-being by teaching mindfulness through a universal school program. The only catch? There was no difference in outcomes at one year.

Would it be possible to identify adolescents who would benefit from mindfulness? Christian A. Webb (of Harvard University) and his co-authors attempt to answer that question, using AI. And so, a longstanding objective, prevention, was joined with a modern method, machine learning. In the first selection, a paper from JAMA Psychiatry, the authors detail a secondary analysis using two complementary machine learning approaches and the MYRIAD Trial data. “This study found that analyses using machine learning identified a subgroup of participants with a statistically detectable but clinically trivial differential intervention response. These findings highlight the substantial challenges in achieving clinically useful personalization in universal school-based prevention programs.” We consider the paper and its implications.

In the second selection, from the Journal of the American Academy of Child & Adolescent Psychiatry, Alison Athey (of Johns Hopkins University) and her co-authors evaluate the impact of child access prevention laws on youth suicide deaths by firearms. They drew on more than 30 years of mortality data from the Centers for Disease Control and Prevention. “Laws that require families to store firearms unloaded and secured in a locking device appear to effectively prevent youth suicide deaths and firearm-related youth deaths by accident and homicide.”

And in this week’s third selection, Dr. Scott Monteith (of Michigan State University) and his co-authors write about generative AI and adolescents for The British Journal of Psychiatry. They note a surge in use – some 80% of British teens use generative AI – and consider problems, from cyberbullying to mental healthcare. “There is a need to increase awareness of how GenAI may have a negative impact on the mental health of teenagers.”

DG

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Reading of the Week: Novel Depression Care – the New JAMA Psychiatry Study; Also, Psych Beds in the US and ChatGPT & Sensitive Conversations

November 6, 2025 /

From the Editor

He had several antidepressant trials. rTMS was helpful but the improvement faded quickly. Should he try ketamine? My patient had read good things and asked.

In a new paper for JAMA Psychiatry, Ana Jelovac (of Trinity College Dublin) and her co-authors attempt to answer that question. 62 hospitalized patients with depression were randomly assigned to receive either repeated ketamine or midazolam treatment and were followed for 24 weeks afterwards. “Serial adjunctive ketamine infusions were not more effective than serial midazolam infusions in reducing depressive symptoms in inpatients receiving usual psychiatric care.” We consider the paper and its implications.

How has the supply of US psychiatric beds changed with time? In the second selection, from JAMA Psychiatry, Karen Shen (of Johns Hopkins University) and her co-authors drew on US databases, finding a slight reduction in overall beds but perhaps an increase in acute care supply, albeit with an increase in beds from large for-profit hospital chains. “Given reports of safety concerns at large for-profit chains, our findings also underscore the need for research on the effects of growing corporatization of inpatient mental health care on patient outcomes.”

And in the third selection, published on their website, ChatGPT staff write about recent controversies involving those with mental health problems, suggesting that the organization has been moved to action. The essay describes their efforts to make advice safer and more appropriate for users who are psychotic, suicidal, or becoming emotionally reliant on AI. “We worked with more than 170 mental health experts to help ChatGPT more reliably recognize signs of distress, respond with care, and guide people toward real-world support – reducing responses that fall short of our desired behavior by 65-80%.”

DG

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Reading of the Week: Brief CBT for Suicidal Vets – the JAMA Psych Study; Also, Docs & Generative AI, and Lamas on Organ Transplants & Mental Illness

October 23, 2025 /

From the Editor

As psychotherapies have become increasingly more practical and relevant in recent years, we may ask: could a focused therapy help individuals who are suicidal?

In a new JAMA Psychiatry paper, Craig J. Bryan (of the Ohio State University) and his co-authors attempt to answer that question, reporting on a randomized clinical trial involving military personnel and veterans. 108 participants were offered brief cognitive therapy (BCBT) or another psychotherapy, present-centred psychotherapy (PCT), building on past work that has shown the potential of BCBT for those who are suicidal. “This randomized clinical trial found that BCBT reduced suicide attempts among US military personnel and veterans reporting recent suicidal ideation and/or suicidal behaviors compared with an active comparator.” We consider the paper and its implications.

In the second selection, from JAMA Internal Medicine, Dr. Daniel J. Morgan (of the University of Maryland) and his co-authors, ask what physicians can do to prepare for generative AI. They offer several useful suggestions. “All physicians will need to understand the basics of GenAI to practice medicine in the next decade. Those without this understanding may find themselves burdened by archaic workflows or responsible for errors that GenAI could have prevented.”

And in the third selection, Dr. Daniela J. Lamas (of Harvard University), an intensivist, looks at transplantation and those who have mental disorders. In a New York Times essay, she notes an historic bias against such individuals. Still, she wonders about the difficulties of the area. “Transplant is one of the most fraught decisions in medicine…”

DG

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

October 16, 2025 /

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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