Publications

The Gorkha earthquake (magnitude 7.8) on 25 April 2015 and later aftershocks struck South Asia, killing ~9000 people and damaging a large region. Supported by a large campaign of responsive satellite data acquisitions over the earthquake disaster zone, our team undertook a satellite image survey of the earthquakes' induced geohazards in Nepal and China and an assessment of the geomorphic, tectonic, and lithologic controls on quake-induced landslides. Timely analysis and communication aided response and recovery and informed decision-makers. We mapped 4312 coseismic and postseismic landslides. We also surveyed 491 glacier lakes for earthquake damage but found only nine landslide-impacted lakes and no visible satellite evidence of outbursts. Landslide densities correlate with slope, peak ground acceleration, surface downdrop, and specific metamorphic lithologies and large plutonic intrusions.

OBJECTIVE

To determine if trauma exposure is associated with suicidal ideation in a nationally representative sample of older adults.

METHODS

This study included 3,277 participants 55 years and older involved in the Collaborate Psychiatric Epidemiology Surveys (2001-2003).

RESULTS

Of the 84.8% of older adults who were exposed to any trauma, 2.2% endorsed late-life suicidal ideation. Multivariable models fully adjusted for sociodemographics, post-traumatic stress disorder, major depressive disorder, and substance use revealed exposure to serious accidents/illness was associated with suicidal ideation (odds ratio: 2.55; 95% confidence interval: 1.16-5.59; Wald χ(2) = 5.47, df = 1, p = 0.019). Investigation of specific traumas within the category revealed that life-threatening illness was specifically associated with suicidal ideation in older adults (odds ratio: 2.12; 95% confidence interval: 1.34-3.36; Wald χ(2) = 10.33, df = 1, p = 0.001).

CONCLUSION

These findings highlight the need for monitoring of suicidal ideation among older adults who have been informed of a life-threatening illness diagnosis.

BACKGROUND

Little is known about the association between trauma exposure and suicidal ideation across racial/ethnic groups. Our study aim was to determine the association between trauma exposure and suicidal ideation in a nationally representative ethnically diverse sample of adults.

METHODS

This study included 14,866 White, Hispanic, Black, and Asian participants 18 years and older involved in the Collaborate Psychiatric Epidemiology Surveys (2001-2003), comprised of three nationally representative studies (NCS-R, NSAL, and NLAAS). Lifetime history of suicidal ideation as assessed in the World Health Organization's World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (WMH-CIDI).

RESULTS

Of the 81% respondents who reported being exposed to trauma as assessed in the WMH-CIDI, 12.1% endorsed lifetime suicidal ideation. Additionally, of the 19% who did not report trauma, 1.1% endorsed lifetime suicidal ideation. Fully adjusted, multivariable logistic regression models revealed two traumas consistently associated with significantly higher odds for suicidal ideation across all four racial groups examined: Assaultive/interpersonal violence and child maltreatment. Asians, in particular, had the highest likelihood for suicidal ideation in both trauma categories, with a near threefold increased odds for assaultive/interpersonal violence exposure (OR: 2.56; 95% CI: 1.71-3.83) and nearly ninefold increased odds for child maltreatment exposure (OR: 8.43; 95% CI: 4.91-14.49).

DISCUSSION

Suicidal ideation in racially/ethnically diverse American adults is strongly associated with assaultive/interpersonal violence and child maltreatment, independent of PTSD, MDD, and substance use. These findings highlight the need for monitoring of suicidal behavior following assaultive/interpersonal trauma and child maltreatment, regardless of the presence of a psychiatric disorder.

OBJECTIVES

To identify comorbidity profiles of older patients last seen in primary care before a suicide attempt and assess attempt and clinical factors (eg, means and lethality of attempt) associated with these profiles.

DESIGN

Cohort study and latent class analysis using Department of Veterans Affairs (VA) national data (2012-2014).

SETTING

All VA medical centers in the United States.

PARTICIPANTS

A total of 2131 patients 65 years and older who were last seen by a primary care provider before a first documented suicide attempt.

MEASUREMENTS

Fatal suicide attempt and means were identified using the National Suicide Data Repository. Nonfatal attempt was defined using the National Suicide Prevention Applications Network. Medical and psychiatric diagnoses and other variables were determined from electronic medical records.

RESULTS

Patients (mean age = 74.4 y; 98.2% male) were clustered into five classes based on medical and psychiatric diagnoses: Minimal Comorbidity (23.2%); Chronic Pain-Osteoarthritis (30.1%); Depression-Chronic Pain (22.9%); Depression-Medical Comorbidity (16.5%); and High Comorbidity (7.3%). The patients in the Minimal Comorbidity and Chronic Pain-Osteoarthritis classes were most likely to attempt fatally compared with classes with a higher burden of comorbidities. Overall, 61% of the sample attempted fatally, and 82.5% of suicide decedents used firearms.

CONCLUSION

This study provides evidence that most comorbidity profiles (>50%) in primary care patients attempting suicide were characterized by minimal depression diagnoses and fatal attempts, mostly with firearms. These findings suggest that more than a depression diagnosis contributes to risk and that conversations about firearm safety by medical providers may play an important role in suicide intervention and prevention. J Am Geriatr Soc 67:2553-2559, 2019.

BACKGROUND

Understanding the differences in how patient complexity varies across surgical specialties can inform policy decisions about appropriate resource allocation and reimbursement. This study evaluated variation in patient complexity across surgical specialties and the correlation between complexity and work relative value units.

STUDY DESIGN

The 2017 American College of Surgeons National Surgical Quality Improvement Program was queried for cases involving otolaryngology and general, neurologic, vascular, cardiac, thoracic, urologic, orthopedic, and plastic surgery. A total of 10 domains of patient complexity were measured: American Society of Anesthesiologists class ≥4, number of major comorbidities, emergency operation, major complications, concurrent procedures, additional procedures, length of stay, non-home discharge, readmission, and mortality. Specialties were ranked by their complexity domains and the domains summed to create an overall complexity score. Patient complexity then was evaluated for correlation with work relative value units.

RESULTS

Overall, 936,496 cases were identified. Cardiac surgery had the greatest total complexity score and was most complex across 4 domains: American Society of Anesthesiologists class ≥4 (78.5%), 30-day mortality (3.4%), major complications (56.9%), and mean length of stay (9.8 days). Vascular surgery had the second greatest complexity score and ranked the greatest on the domains of major comorbidities (2.7 comorbidities) and 30-day readmissions (10.1%). The work relative value units did not correlate with overall complexity score (Spearman's ρ = 0.07; P < .01). Although vascular surgery had the second most complex patients, it ranked fifth greatest in median work relative value units. Similarly, general surgery was the fifth most complex but had the second-least median work relative value units.

CONCLUSION

Substantial differences exist between patient complexity across specialties, which do not correlate with work relative value units. Physician effort is determined largely by patient complexity, which is not captured appropriately by the current work relative value units.