JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. the Archives of Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES OF GENERAL PSYCHIATRY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 4, 2006)
ANTIDEPRESSANTS ASSOCIATED WITH INCREASED RISK FOR SUICIDE ATTEMPTS, DECREASED RISK FOR COMPLETED SUICIDE AND DEATH
ENHANCED DEPRESSION CARE MAY BE COST-EFFECTIVE FOR EMPLOYERS
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 4, 2006)
INCREASING NUMBERS OF CALIFORNIA TEENS ABUSE OVER-THE-COUNTER COLD MEDICINE
SURVEY OF MARINE CORPS MILITARY RECRUITS REVEALS RISK FACTORS FOR ALCOHOL DISORDERS IN YOUNG ADULTS
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, December 4, 2006
Media Advisory: To contact Jari Tiihonen, M.D., Ph.D., e-mail: Jari.Tiihonen{at}niuva.fi.
ANTIDEPRESSANTS ASSOCIATED WITH INCREASED RISK FOR SUICIDE ATTEMPTS, DECREASED RISK FOR COMPLETED SUICIDE AND DEATH
CHICAGO—Suicidal individuals taking antidepressant medications appear to have an increased risk of additional suicide attempts, but a reduced risk of dying from suicide or any other cause, according to a large Finnish study reported in the December issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Major depression is one of the most important risk factors for suicidal behavior, according to background information in the article. However, medications used to treat depression have also been linked to suicidal attempts and behavior, especially among children and adolescents taking a type of antidepressant known as selective serotonin reuptake inhibitors (SSRIs). The issue is difficult to study because the number of completed suicides is relatively low; an effective study would have to include tens of thousands of patients and last for several years. "Because previous suicide attempts are the most important risk factor for predicting suicide, a large cohort of suicidal patients would be an obvious choice to investigate the association between antidepressant treatment and the risk of suicide," the authors write.
Jari Tiihonen, M.D., Ph.D., University of Kuopio and Niuvanniemi Hospital, Kuopio, Finland, and colleagues analyzed data from all individuals hospitalized in Finland for suicide attempts between 1997 and 2003. Information about 15,390 hospitalized individuals—including age, sex, location, dates of admission and discharge, number of previous hospitalizations for attempted suicide and antidepressant prescriptions-was gathered through Finnish national registries and databases. The patients were followed for an average of 3.4 years to see if they attempted suicide again, completed suicide or died from another cause.
Among the 7,466 males and 7,924 females in the study, 602 suicides, 7,136 suicide attempts leading to hospitalization and 1,583 deaths were recorded during follow-up. The risk of completed suicide was 9 percent lower among those taking any antidepressants than among those not taking antidepressants. However, the association varied by antidepressant—individuals taking an SSRI known as fluoxetine had a 48 percent lower risk of suicide (6.7 deaths per 1,000 total years that individuals took the drug) compared with those not taking medication (11 deaths per 1,000 years), while those taking venlafaxine hydrochloride, another SSRI, had a 61 percent increased risk (22.5 suicide deaths per 1,000 total years of medication use). The risk of death from any cause was 31 percent to 41 percent lower among those taking antidepressants. Those taking SSRIs had a 61 percent reduced risk of death compared with those taking no antidepressants, a fact that could be attributed to a reduction in deaths related to cardiovascular disease and stroke.
Patients taking any kind of antidepressant had a 36 percent increased risk of a subsequent suicide attempt leading to hospitalization (204.7 per 1,000 total years of taking medications) compared with those taking no antidepressants (106.2 per 1,000 years); a slightly greater increase in risk was observed among those age 10 to 19 years (132.7 per 1,000 years for those taking antidepressants vs. 82.9 for those not taking antidepressants).
Among those who had ever taken antidepressants, current antidepressant use was associated with a 39 percent increase in risk of attempted suicide but a 32 percent decrease in risk of completed suicide and a 49 percent reduced risk of death from any cause. "This opposite type of effect on fatal vs. nonfatal suicidal behavior may be explained by an increased risk of intoxication because of easy availability of means (antidepressant medication), resulting in an increase in nonfatal suicidal behavior, and by a decrease in the incidence of violent and more fatal methods of suicide attempts, such as hanging and shooting," the authors write.
(Arch Gen Psychiatry. 2006;63:1358-1367. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by annual EVO financing (special government subsidies) from Niuvanniemi Hospital. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, December 4, 2006
Media Advisory: To contact Philip S. Wang, M.D., Dr. P.H., call Jules Asher at 301-443-4536.
ENHANCED DEPRESSION CARE MAY BE COST-EFFECTIVE FOR EMPLOYERS
CHICAGO—Offering additional depression screening and care may save employers about $3,000 per 1,000 workers over five years, according to a cost-effectiveness and cost-benefit analysis reported in the December issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
In addition to its toll on patients' health and well-being, depression is estimated to cost tens of billions of dollars in the United States each year, according to background information in the article. Most of these costs are associated with reduced productivity at work. Evidence suggests that currently available treatments and screening methods could reduce these costs, but remain underused.
Philip S. Wang, M.D., Dr.P.H., of Brigham and Women's Hospital and Harvard Medical School, Boston, and the National Institute of Mental Health, Bethesda, Md., and colleagues, constructed a computer model to analyze the costs and benefits associated with an enhanced depression care program. The program consisted of screening all employees for depression once and then providing telephone counseling and other depression management strategies for employees with positive results. In the model:
- Hypothetical employees were 40 years old, the median age of U.S. workers
- The workers were divided into six groups-never depressed; depressed but not in treatment; depressed and in treatment; recovered and in treatment; recovered but not in treatment; and dead-based on percentages of each group in the general population
- At the end of each three-month period, the model workers were moved between states based on estimates drawn from previous studies
- Depression treatment could be either adequate or substandard, to reflect realistic quality variations
- The cost of administering the depression screening was based on the cost of adding questions to existing health risk assessments for companies that currently administer them and of implementing new risk assessments for companies that do not
- Treatment and care management costs were based on averages from clinical literature and health plan data
They then completed two analyses of the data—one from a societal perspective, which assigned model employees either to usual care or to the enhanced program and followed them up until death, and another from an employer perspective, a five-year simulation in which the employee base was kept at a constant size by replacing those who left the company or died. In the societal analysis, the enhanced depression management program cost about $19,976 more per quality-adjusted life year than usual care. In other words, for every $19,976 in costs associated with the program, including medication costs and time spent in treatment, one employee would enjoy one additional year without depression because of the intervention. "These results are consistent with recent primary care effectiveness trials and within the range for medical interventions usually covered by employer-sponsored insurance," the authors write.
In the analysis performed from the employer's perspective, after five years the program would save the employer $2,895 per 1,000 workers. These results "may seem counterintuitive at first—namely, that a screening and care management intervention designed to increase the use and intensity of treatment for depression may actually save employers money," the authors write. "However, as our results suggest, the expected higher direct treatment costs are more than offset by savings from reduced absenteeism, presenteeism [when employees are at work, but unproductive] and employee turnover costs."
"If replicated in upcoming effectiveness trials that directly assess intervention effects on work outcomes, these findings suggest that it may be in society's and purchasers' interests to more widely disseminate successful programs of outreach and improved treatment quality for depression," they conclude.
(Arch Gen Psychiatry. 2006;63:1345-1353. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by grants from the National Institute of Mental Health and the Robert Wood Johnson Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, December 4, 2006
Media Advisory: To contact corresponding author Ilene B. Anderson, Pharm.D., call 415-502-2058.
INCREASING NUMBERS OF CALIFORNIA TEENS ABUSE OVER-THE-COUNTER COLD MEDICINE
CHICAGO—The number of reported cases of dextromethorphan abuse in California increased 10-fold between 1999 and 2004, an increase that parallels national trends, according to a report in the December issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. About three-quarters of the reported cases were among individuals age 9 to 17.
"Dextromethorphan has been used safely for years as a cough suppressant and is available in many over-the-counter (OTC) cough and cold preparations," the authors write as background information in the article. But when taken at high doses, the drug can cause hallucinations, and it has been abused for as many as four decades. Since the late 1990s, dextromethorphan abuse has increased among adolescents, in part because the drug is easily accessible and is perceived to be safe. Severe side effects have been reported at high doses, including rapid heartbeat, high blood pressure, agitation, loss of muscle control and psychosis (a loss of contact with reality).
Jodi K. Bryner, Pharm.D., School of Pharmacy, University of California, San Francisco, and colleagues analyzed the trend of dextromethorphan abuse in California as reflected in cases reported to the California Poison Control System (CPCS), a 24-hour emergency telephone service. The findings were then compared to national trends as reported to the American Association of Poison Control Centers and the Substance Abuse and Mental Health Service Administration's Drug Abuse Warning Network.
During the six-year period between 1999 and 2004, 1,411 calls to the CPCS were coded as dextromethorphan abuse. The researchers manually reviewed each one and found 1,382 non-duplicate cases. The frequency of dextromethorphan abuse calls increased by about 50 percent each year compared with the previous year, up to a total ten-fold increase (from .23 cases per 1,000 calls in 1999 to 2.15 cases per 1,000 calls in 2004). Calls involving youth aged 9 to 17 comprised 74.5 percent of those calls and increased 15-fold in that time period, from .11 to 1.68 cases per 1,000 calls, with the highest frequency among youth age 15 and 16. "The younger adolescent age distribution is further underscored by the observation that in CPCS reporting the combined frequency among 12- to 13-year-old subjects exceeded that of 18-year-old subjects," the authors write. The two national databases also experienced an increase in the number and proportion of dextromethorphan-related calls during the time period studied, as well as more frequent calls involving younger patients.
There are likely a number of reasons for this increase, the authors write. Products containing dextromethorphan are sold OTC at pharmacies and grocery stores, making them readily available and removing the stigma associated with illegal drugs. More children and teens now have unsupervised access to the Internet, where Web sites promoting abuse of the medication and even providing instructions proliferate. "Another factor is that it is easy to fool parents because these OTC products are commonly kept in the household," the authors write.
"In conclusion, this study showed an increasing trend of dextromethorphan abuse over a six-year period, particularly in adolescents younger than 18 years," they continue. "It is important for health care practitioners, manufacturers and retail establishments selling dextromethorphan-containing products to be aware of increasing dextromethorphan abuse to educate and hopefully prevent dextromethorphan abuse and the ensuing toxicity from occurring. Preventive measures, such as placing dextromethorphan-containing products behind pharmacy counters, may be an effective action to limit this increasing trend of abuse in adolescents."
(Arch Pediatr Adolesc Med. 2006;160:1217-1222. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported in part by a grant from the National Institute on Drug Abuse. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, December 4, 2006
Media Advisory: To contact corresponding author Margaret A. K. Ryan, M.D., M.P.H., e-mail Karl F. Van Orden, Ph.D., at VanOrden{at}nhrc.navy.mil.
SURVEY OF MARINE CORPS MILITARY RECRUITS REVEALS RISK FACTORS FOR ALCOHOL DISORDERS IN YOUNG ADULTS
CHICAGO—Young men age 18 to 20 are significantly more likely to be risky drinkers if they start drinking alcohol at a young age, according to a large survey of male Marine Corps recruits, the results of which are published in the December issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. Other risk factors for drinking problems include tobacco use, having a small or rural hometown and growing up in a household with alcohol abuse.
In 2004, about 2.3 percent of all 12-year-olds and 69.8 percent of all 21-year-olds reported that they currently drank alcohol, according to background information in the article. Approximately 4.4 million Americans used alcohol for the first time in 2004; 86.9 percent of them were younger than 21. A previous study found that male Marines age 18 to 25 drink heavily at twice the rate of civilians in the same age group (38.6 percent vs. 17.8 percent).
Sylvia Y. N. Young, M.D., M.P.H., of the Naval Health Research Center, San Diego, Calif., and colleagues studied the association between childhood experiences and risky underage drinking in 41,482 male Marine recruits age 18 to 20. All the men completed the Recruit Assessment Program questionnaire between June 2002 and April 2006, on which they provided demographic and other personal information and answered three questions designed to detect risky drinking. The questionnaire also included items to gauge a variety of adverse childhood experiences, including physical neglect, emotional and sexual abuse or domestic violence.
A total of 6,128 recruits (14.8 percent) were identified as risky drinkers, 18,693 (45.1 percent) as non-risky drinkers and 16,661 (40.2 percent) as non-drinkers. Among drinkers, age at first drink was most strongly associated with risky drinking—those who began drinking at age 13 or younger were 5.5 times as likely to be identified as risky drinkers. Risky drinkers were more likely than either non-risky drinkers or non-drinkers to be smokers, from a rural or small hometown, have experienced childhood sexual or emotional abuse, and to have a household member who had a drinking problem or mental illness. They also were more likely to report education beyond a high-school level, having more close family members or friends for personal support, and being motivated to join the military for travel, adventure or to leave problems at home.
"Factors inversely associated with risky drinking were being married, attending religious services weekly or more often, neither parent having completed high school, not knowing parental educational achievement and motivation to join the military 'to serve my country,' for education and new job skills, or for a 20-year military career. A history of emotional neglect was also inversely associated," the authors write.
"Our findings underscore the need for programs and policies to reduce underage drinking, such as the minimum legal drinking age of 21 years," they conclude. "Our study results also reinforce the need for public health efforts to prevent tobacco use and child abuse. After early age at first alcohol use, the factor most strongly associated with risky drinking was tobacco use. Whether reducing smoking will reduce risky drinking among youth is an important but unexplored question."
(Arch Pediatr Adolesc Med. 2006;160:1207-1214. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Department of Defense. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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