Creating an Evidence-Based Approach to Lifespan Suicide Prevention

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Keynote: Address:

Humans appear to be the only species on the planet that kill themselves, which is the apparent result of the unique properties of language and the fact that other humans are the principal predator and the principal source of safety in our lives. Last year, three times as many America’s died from suicide as died at the height of the polio epidemic in the 1950s: 36,000 deaths from suicide, versus 3,000 from polio.

A public-health approach across the lifespan is required to reduce this terrible suffering and injury. A public-health campaign is less about the warning signs of suicide than specific actions that disable the “pump handle” to the wells of despair that result in suicidality.

This talk lays out four key principles from a lead article in a special issue of the American Psychologist on prevention, by the presenter and colleagues [1]. These principles arise from the consilience of evolutionary, medical, and behavioral sciences. The principles are not limited to the prevention of suicide; indeed, they principles address prevention of multiple mental, emotional, behavioral, and related physical disorders as outlined by the Institute of Medicine [2].

This talk integrates these principles with low-cost evidence-based kernels [3] and behavioral vaccines [4, 5] that can operate as an integrated public-health model to prevent multiple mental, emotional, behavioral, and related disorders [6]. This talk specifically shows how several apparently simple strategies can be promoted to prevent suicide across the lifespan, illustrated by data and practical mechanisms with rapid results and cost savings for multiple-silos of government and the private sector. The net result is happier, healthier, and productive citizens of all ages.

Breakout #1: Preventing Future Suicide from Pregnancy through Childhood Evidence-based Kernels and Behavioral Vaccines

This breakout expands on the keynote with specific evidence-based kernels and behavioral vaccines, organization and implementation details for low-cost strategies that can avert suicidality 10 to 20 years later cost effectively. One specific strategy that will be covered in greater detail is the Good Behavior Game (which is being widely promoted by in the US and Canada), as the only early elementary school strategy with lifetime scientific data on reducing sucidality [7]. Presently, the Substance Abuse and Mental Health Services Administration (SAMSHA) is funding 30 sties to do the Good Behavior Game, with 28 of those being supervised by Dr. Embry and his colleagues.

Breakout #2: Preventing Suicide from Adulthood through Senior Years

This breakout explores what science we have that shows pathways for preventing suicide among adults of all ages, beyond signs of suicide. This breakout links the principles from the keynote with evidence-based kernels and behavioral vaccines that can be used in multiple contexts and initiatives. Policies and practices can be scale

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Creating an Evidence-Based Approach to Lifespan Suicide Prevention

  1. 1. Dennis D. Embry, Ph.D. Crea%ng  an  Evidence-­‐Based  Approach   President/Senior Scientist to  Lifespan  Suicide  Preven%on PAXIS InstituteMonday, April 15, 13 1
  2. 2. 38,000Monday, April 15, 13 2
  3. 3. The Polio EpidemicMonday, April 15, 13 3
  4. 4. The Polio EpidemicMonday, April 15, 13 3
  5. 5. The Polio Epidemic 3,000Monday, April 15, 13 3
  6. 6. A recent webinar experience on the topicMonday, April 15, 13 4
  7. 7. Monday, April 15, 13 5
  8. 8. Is this early prevention?Monday, April 15, 13 5
  9. 9. Monday, April 15, 13 6
  10. 10. Is this early prevention?Monday, April 15, 13 6
  11. 11. Monday, April 15, 13 7
  12. 12. Is this early prevention?Monday, April 15, 13 7
  13. 13. Monday, April 15, 13 8
  14. 14. Is this early prevention?Monday, April 15, 13 8
  15. 15. Thinking way upstream What might be the early malleable predictors? What if we started here with early suicide prevention?Monday, April 15, 13 9
  16. 16. Thinking way upstream What might be the early malleable predictors? Could we actually change those predictors easily and reliably? And what else might change as a consequence of the prevention or protection strategies.Monday, April 15, 13 10
  17. 17. risk factors during development from early childhood to adolescence Psychiatric problems in childhood and/or adolescence, including depression Child and/or adolescent externalizing disorders Childhood adversity (especially with the above) Low self-efficacy Aggressive or delinquent behavior Poor peer relations Prax Kinderpsychol Kinderpsychiatr. 2012;61(1):32-49.Monday, April 15, 13 11
  18. 18. risk factors during development from early childhood to adolescence Psychiatric problems in childhood and/or adolescence, including depression Child and/or adolescent externalizing disorders Childhood adversity (especially with the above) Low self-efficacy Aggressive or delinquent behavior Poor peer relations And prenatal and post-natal Prax Kinderpsychol Kinderpsychiatr. 2012;61(1):32-49.Monday, April 15, 13 11
  19. 19. Thinking way upstream What might be the early malleable predictors? Could we actually change those predictors easily and reliably? And what else might change as a consequence of the prevention or protection strategies.Monday, April 15, 13 12
  20. 20. Surveying the Past Foretells Our FuturesMonday, April 15, 13 13
  21. 21. Consider the cohort trends…#1 mental health disorderMonday, April 15, 13 14
  22. 22. Consider the cohort trends…#1 mental health disorderMonday, April 15, 13 14
  23. 23. Consider the cohort trends…#1 mental health disorder Born NOW?Monday, April 15, 13 14
  24. 24. Consider the cohort trends…#1 mental health disorder Born NOW?Monday, April 15, 13 14
  25. 25. Consider the cohort trends…#1 mental health disorder Born NOW? These trends are not the result of over- diagnosesMonday, April 15, 13 14
  26. 26. Cumulative prevalence of psychiatric Cumulative Prevalence disorders by young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study. 9 10 11 12 13 14 15 16 19 21 AGE Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 15
  27. 27. Cumulative prevalence of psychiatric Cumulative Prevalence disorders by Oldest Cohort young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study. 9 10 11 12 13 14 15 16 19 21 AGE Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 15
  28. 28. Cumulative prevalence of psychiatric Middle Cohort Cumulative Prevalence disorders by Oldest Cohort young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study. 9 10 11 12 13 14 15 16 19 21 AGE Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 15
  29. 29. Cumulative Youngest Cohort prevalence of psychiatric Middle Cohort Cumulative Prevalence disorders by Oldest Cohort young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study. 9 10 11 12 13 14 15 16 19 21 AGE Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 15
  30. 30. Cumulative Youngest Cohort prevalence of psychiatric Middle Cohort Cumulative Prevalence disorders by Oldest Cohort young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study. EARLIER START; Higher Prevalence 9 10 11 12 13 14 15 16 19 21 AGE Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 15
  31. 31. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 40% 35% 30% 25% 20% 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 16
  32. 32. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 40% 35% Anxiety 30% 25% 20% 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 16
  33. 33. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 40% 35% Anxiety 30% 25% Behavior 20% 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 16
  34. 34. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 40% 35% Anxiety 30% 25% Behavior 20% Mood 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 16
  35. 35. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 40% 35% Anxiety 30% 25% Substance Behavior 20% Mood 15% 10% 5% Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 16
  36. 36. Lifetime Prevalence of Disorders in US Adolescents (N=10,123) 40% 1-out-2 USA 35% young adults will be afflicted with Anxiety 30% one or more of these disorders 25% Substance Behavior by age 18 20% Mood 15% 10% NOTE 5% EARLY START Merikangas et al., 2010 0% 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Age in Years Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 16
  37. 37. The US had 75 million children and teens 2009 Wall Street Journal, 12-28-2010Monday, April 15, 13 17
  38. 38. The US had 75 million children and teens 2009 40.4 million kids had one psychotropic med in 2009 Wall Street Journal, 12-28-2010Monday, April 15, 13 17
  39. 39. How many of you know a blue-collar, middle-class, or upper-class family who is reasonably intact… Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 18
  40. 40. How many of you know a blue-collar, middle-class, or upper-class family who is reasonably intact… with a child, teen, or adult child with a mental, emotional, or behavioral disorder? Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 18
  41. 41. How do we handle this problem of mental illnesses?Monday, April 15, 13 19
  42. 42. Prevalence rates are increasing rapidly in North America How do we handle this problem of mental illnesses?Monday, April 15, 13 19
  43. 43. Common set of conditions producing these negative trends… Poor Health RNA IL6 DNA Epigenetic Changes Inspirational Credit: Clyde Hertzman Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 20
  44. 44. Common set of conditions producing these negative trends… HIgh Exposure to Toxic Influences/ACEs Exposure to Low Psychological Flexibility HIgh Exposure to Problematic Behaviors High Reinforcement of Anti-Social Behavior Poor Health • Mental Disorders RNA • Emotional Disorders IL6 DNA • Behavioral Disorders • Related Physical Disorders Epigenetic Changes Evolutionary Adaptations to a Predatory, Stressful World; Inspirational Credit: Clyde Hertzman worse social determinants Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 20
  45. 45. Multi-Inflammatory Brain & Body Response Major Connected Causes of the Adverse Trends Predicting MEBs & Related Illnesses Reinforcement Antecedents Physiological Verbal Relations more for anti-social cue anti-social influences trigger occasion perceived than prosocial acts and threats adverse biological threats and related behaviors mechanisms reactions The Same Mismatches Predict Multiple MACH DisordersMonday, April 15, 13 21
  46. 46. Mood Lo Reward Lo Executive Lo Behavioral Inattention Function Instability Delay Competencies Poor Immune- Motor Healing Skills Multi-Inflammatory Brain & Body Response Dysfunction Major Connected Causes of the Adverse Trends Predicting MEBs & Related Illnesses Reinforcement Antecedents Physiological Verbal Relations more for anti-social cue anti-social influences trigger occasion perceived than prosocial acts and threats adverse biological threats and related behaviors mechanisms reactions The Same Mismatches Predict Multiple MACH DisordersMonday, April 15, 13 21
  47. 47. Substance Work Obesity, Early Mental Illness Violence Cancer School Abuse Problems etc Sex Failure Mood Lo Reward Lo Executive Lo Behavioral Inattention Function Instability Delay Competencies Poor Immune- STD’s Motor Healing Special Skills Multi-Inflammatory Brain & Body Response Dysfunction Ed Major Connected Causes of the Adverse Trends Predicting MEBs & Related Illnesses Reinforcement Antecedents Physiological Verbal Relations more for anti-social cue anti-social influences trigger occasion perceived than prosocial acts and threats adverse biological threats and related behaviors mechanisms reactions The Same Mismatches Predict Multiple MACH DisordersMonday, April 15, 13 21
  48. 48. The America’s First Peoples… 26,000 to 12,000 B.E. 1491 AD Disease & War Extermination, OriginalHuman Marginalization, Migrations to & Suppression North America 30,000,000 300,000 ≈ Souls in ≈ Souls North America Residential Schools; Western Diet Evolutionary bottleneckMonday, April 15, 13 22
  49. 49. The America’s First Peoples… 26,000 to 12,000 B.E. 1491 AD Disease & War Extermination, OriginalHuman Marginalization, Migrations to & Suppression North America 30,000,000 300,000 ≈ Souls in ≈ Souls Today North America Residential Schools; Western Diet Evolutionary bottleneckMonday, April 15, 13 22
  50. 50. Slavery The Great African Americans 1863 Middle … 1500’s to Passage Institution of Slavery Jim Crow Migration North Original Human Populations in Africa Continuing ≈ Capture Trauma 30% to Separation, Exposure 50% + violence, to Toxins mortality malnutrition Evolutionary bottleneckMonday, April 15, 13 23
  51. 51. Slavery The Great African Americans 1863 Middle … 1500’s to Passage Institution of Slavery Jim Crow Migration North Original Human Populations in Africa Continuing ≈ Capture Trauma today 30% to Separation, Exposure 50% + violence, to Toxins mortality malnutrition Evolutionary bottleneckMonday, April 15, 13 23
  52. 52. Example Lasting Effects of Evolutionary Bottlenecks US Blacks Barbados St. Lucia Jamaica Political pundits say: Cameroon (urban) Cameroon (Rural) Nigeria (Rural) 40% “Slavery is over. Jim Slavery Exposure No Slavery Exposure Crow is over. Everybody 30% should be over all this.” 20% Evolution is bigger than 10% pundits, and epigensis is a solution to a past 0% evolutionary problem Hi Blood Pressure Percentage that might come back. Source: Scientific American, February, 1999 Evolution is conservative.Monday, April 15, 13 24
  53. 53. Epigenetic  Mechanisms Health  &  Behavior Yes, the social and •  Nurturing  environments •  Obesity,  asthma,  diabetes physical environment •  Toxic  environments •  Early  sex,  pregnancy of humans changes gene expression. •  Development/aging •  Violence,  DSM-­IV •  Cancer,  auto-­immune Epigenetic   Factor Add slide here about the epigenetic mechanisms; this shows how what children see, hear, do and feel in the brain, then cascades through neuro-hormones to change the genes. This will show that micro-environments matterMonday, April 15, 13 25
  54. 54. Ignore the What shall we do? Make problem? everybody Pretend mentally and everything is physically fine? healthier?Monday, April 15, 13 26
  55. 55. First, Devise Early Wins NOW Across Age Groups Trajectory of Mental, Behavioral, and Emotional Disorders (illustrative graph only) Past Predicted Possible Future Future with Prevention Science Pre-Conception Prevalence Rate ers i sord Pre-Natal al D ehavior B Infancy and o nal, oti Early Childhood l, Em fM enta ath o Elementary ent P Curr Adolescence Young Adults Adulthood YearsMonday, April 15, 13 27
  56. 56. First, Devise Early Wins NOW Across Age Groups Trajectory of Mental, Behavioral, and Emotional Disorders (illustrative graph only) Past Predicted Possible Future Future with Prevention Science Pre-Conception Prevalence Rate ers i sord Pre-Natal al D ehavior B Infancy and o nal, oti Early Childhood l, Em fM enta ath o Elementary ent P Curr Adolescence Young Adults Adulthood YearsMonday, April 15, 13 28
  57. 57. Conditions producing positive trends… Health RNA IL6 DNA Epigentic Changes Inspirational Credit: Clyde Hertsman Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 29
  58. 58. Conditions producing positive trends… Low Exposure to Toxic Influences Exposure to High Psychological Flexibility Low Exposure to Problematic Behaviors High Reinforcement of Prosocial-Social Behavior Health • Mental Health RNA • Emotional Health/Balance IL6 DNA • Behavioral Competence • Related Physical Health Epigentic Changes Evolutionary Adaptations to a Safe, Supportive World Inspirational Credit: Clyde Hertsman Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.orgMonday, April 15, 13 29
  59. 59. Devise Early Wins NOW with multiple footprints Universal multiple outcome Acccess to focus Prevention & Promotion Science multiple age-stage focusMonday, April 15, 13 30
  60. 60. Devise Early Wins NOW with multiple footprints Mental Health Emotional Health Universal multiple outcome Behavioral Health Acccess to focus Physical Health Prevention & Can imp Cognitive Ability Promotion rove multiple health outcomes for all ages Science Pre-conception multiple Infancy, Childhood age-stage focus Adolescence Young Adults & Adults SeniorsMonday, April 15, 13 31
  61. 61. Devise Early Wins NOW with multiple footprints Mental Health Biglan, Flay, Embry, & Irwin, 2012 Emotional Health Prosocialty Rich Reinforced Nurturing Low Problem Behaviors Universal multiple outcome Behavioral Health Environments Logic Model for Acccess to focus Physical Health population-level benefits Prevention & Can Low Toxic Psychological Better imp Cognitive Ability Influences Flexibility Promotion rove multiple Futures health outcomes for all ages Science for All Pre-conception Health multiple Infancy, Childhood IL6 RNA DNA age-stage focus Adolescence Epigensis Young Adults & Adults Seniors Inspirational Credit: Clyde HertsmanMonday, April 15, 13 32
  62. 62. Suicide Rates Not Evenly DistributedMonday, April 15, 13 33
  63. 63. Mothers and children in North America do not get sufficient Vitamin D via sunlight Mothers and children in North America do not eat foods sufficient in Vitamin D This evolutionary mismatch harms mental healthMonday, April 15, 13 34
  64. 64. D. K. Kinney et al. Mismatch, Latitude & Schizophrenia Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009 doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant Mortality, and Skin Color: A Role for Prenatal Vitamin D Deficiency and Infections? Dennis K. Kinney1–3, Pamela Teixeira2, Diane Hsu2, Siena derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2 2 Genetics Laboratory, McLean Hospital, Belmont, MA; 3De- Key words: epidemiology/etiology/immune function/ partment of Psychiatry, Harvard Medical School, Boston, MA; prenatal/geography/risk factor 4 Wellesley College, Wellesley, MA Fig. 1. Schizophrenia Prevalence and Latitude by Continent and Infant Mortality. Note: South Asia sites were from India and Indonesia; those sites had higher infant mortality rates than all but one of the East Asian sites. For theMonday, April 15, 13 regressionlinesinNorth America, those withinfantmortalityrates above 30 per 1000 weregroupedas having a higherrate, those below30 as having Introduction 35 Previous surveys found a large (>10-fold) variation in
  65. 65. D. K. Kinney et al. Mismatch, Latitude & Schizophrenia Semmelweis Reflex Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009 doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant Mortality, and Skin Color: A Role for Prenatal Vitamin D Deficiency and Infections? Dennis K. Kinney1–3, Pamela Teixeira2, Diane Hsu2, Siena derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2 2 Genetics Laboratory, McLean Hospital, Belmont, MA; 3De- Key words: epidemiology/etiology/immune function/ partment of Psychiatry, Harvard Medical School, Boston, MA; prenatal/geography/risk factor 4 Wellesley College, Wellesley, MA Fig. 1. Schizophrenia Prevalence and Latitude by Continent and Infant Mortality. Note: South Asia sites were from India and Indonesia; those sites had higher infant mortality rates than all but one of the East Asian sites. For theMonday, April 15, 13 regressionlinesinNorth America, those withinfantmortalityrates above 30 per 1000 weregroupedas having a higherrate, those below30 as having Introduction 35 Previous surveys found a large (>10-fold) variation in
  66. 66. D. K. Kinney et al. Mismatch, Fish Intake & Schizophrenia Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009 doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant Mortality, and Skin Color: A Role for Prenatal Vitamin D Deficiency and Infections? Dennis K. Kinney1–3, Pamela Teixeira2, Diane Hsu2, Siena derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2 2 Genetics Laboratory, McLean Hospital, Belmont, MA; 3De- Key words: epidemiology/etiology/immune function/ partment of Psychiatry, Harvard Medical School, Boston, MA; prenatal/geography/risk factor 4 Wellesley College, Wellesley, MA Fig. 2. Schizophrenia Prevalence and Latitude by Fish Intake. Note: Error bars represent 95% confidence limits. The slopes of linear regression lines were 0.03 for sites with high fish intake, 0.21 for sites withMonday, April 15, 13 moderate fish intake, and 0.17 for sitesIntroduction with low fish intake. For the subset of Scandinavian sites, the slope of linear regression for was 0.03 for 36 Previous surveys found a large (>10-fold) variation in
  67. 67. D. K. Kinney et al. Mismatch, Fish Intake & Schizophrenia Semmelweis Reflex Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009 doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant Mortality, and Skin Color: A Role for Prenatal Vitamin D Deficiency and Infections? Dennis K. Kinney1–3, Pamela Teixeira2, Diane Hsu2, Siena derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2 2 Genetics Laboratory, McLean Hospital, Belmont, MA; 3De- Key words: epidemiology/etiology/immune function/ partment of Psychiatry, Harvard Medical School, Boston, MA; prenatal/geography/risk factor 4 Wellesley College, Wellesley, MA Fig. 2. Schizophrenia Prevalence and Latitude by Fish Intake. Note: Error bars represent 95% confidence limits. The slopes of linear regression lines were 0.03 for sites with high fish intake, 0.21 for sites withMonday, April 15, 13 moderate fish intake, and 0.17 for sitesIntroduction with low fish intake. For the subset of Scandinavian sites, the slope of linear regression for was 0.03 for 36 Previous surveys found a large (>10-fold) variation in
  68. 68. e increased markedly economic status and healthcare, as indexed in our anal- ysis by the infant mortality rate, appears to be a muchrenia prevalence with weaker predictor of risk for schizophrenia than are lati- d is not due simply to Mismatch, Skin Color & Schizophrenia tude and winter temperature. A high infant mortality ratetic and ascertainmentalysis of data collected particularly informa-t controlled for possi- ences in prevalence at investigative person- were used to obtain ent sites within the Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009studied schizophrenia doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 ites in the same timeiagnostic criteria and Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant data showedSkin very A Role for Prenatal Vitamin D Deficiency and Infections? Mortality, and a Color: with both latitude w temperature (r = Dennis K. Kinney1–3, Pamela Teixeira2, Diane Hsu2, Siena derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2cially wide variation in 2 Key words: epidemiology/etiology/immune function/ 3 Genetics Laboratory, McLean Hospital, Belmont, MA; De-he equator, prevalenceSchool, Boston, MA; prenatal/geography/risk factor partment of Psychiatry, Harvard Medical 4 Wellesley College, Wellesley, MA Fig. 3. Schizophrenia Prevalence and Latitude by Skin Color.at is, for all groups and Note: Error bars represent 95% confidence limits. The slopes of the Monday, April 15, 13 Introduction 37 Previous surveys found a large (>10-fold) variation in
  69. 69. e increased markedly economic status and healthcare, as indexed in our anal- ysis by the infant mortality rate, appears to be a muchrenia prevalence with weaker predictor of risk for schizophrenia than are lati- d is not due simply to Mismatch, Skin Color & Schizophrenia tude and winter temperature. A high infant mortality ratetic and ascertainmentalysis of data collected Semmelweis particularly informa- Reflext controlled for possi- ences in prevalence at investigative person- were used to obtain ent sites within the Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009studied schizophrenia doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 ites in the same timeiagnostic criteria and Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant data showedSkin very A Role for Prenatal Vitamin D Deficiency and Infections? Mortality, and a Color: with both latitude w temperature (r = Dennis K. Kinney1–3, Pamela Teixeira2, Diane Hsu2, Siena derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2cially wide variation in 2 Key words: epidemiology/etiology/immune function/ 3 Genetics Laboratory, McLean Hospital, Belmont, MA; De-he equator, prevalenceSchool, Boston, MA; prenatal/geography/risk factor partment of Psychiatry, Harvard Medical 4 Wellesley College, Wellesley, MA Fig. 3. Schizophrenia Prevalence and Latitude by Skin Color.at is, for all groups and Note: Error bars represent 95% confidence limits. The slopes of the Monday, April 15, 13 Introduction 37 Previous surveys found a large (>10-fold) variation in
  70. 70. Latitude and Infantile Autism Grant, W. B. and C. M. Soles (2009). "Epidemiologic evidence supporting the role of maternal vitamin D deficiency as a risk factor for the development of infantile autism." Dermatoendocrinol 1(4): 223-228.Monday, April 15, 13 38
  71. 71. Latitude and Infantile Autism Semmelweis Grant, W. B. and C. M. Soles (2009). Reflex "Epidemiologic evidence supporting the role of maternal vitamin D deficiency as a risk factor for the development of infantile autism." Dermatoendocrinol 1(4): 223-228.Monday, April 15, 13 38
  72. 72. Estimated deaths per year would fall by 37,000 people, or about 16%-22% of annual mortality in Canada. And, $14 billionMonday, April 15, 13 39
  73. 73. Estimated deaths Semmelweis per year would fall by 37,000 people, Reflex or about 16%-22% of annual mortality in Canada. And, $14 billionMonday, April 15, 13 39
  74. 74. Among pregnant women, lower Vitamin D is associated with: • Adverse fertility • Primary cesarean section parameters (n = 2), (n = 1), • Preeclampsia (n = 5), • Few days (n = 2) shorter gestation, • Gestational diabetes or higher blood glucose • And, postpartum (n = 6), depression (n = 1) • Bacterial vaginosis (n = 4), Acta Obstet Gynecol Scand. 2012 Dec;91(12):1357-67. doi: 10.1111/ aogs.12000. Epub 2012 Oct 17. The impact of vitamin D on pregnancy: a systematic review. Christesen HT, Falkenberg T, Lamont RF, Jørgensen JS.Monday, April 15, 13 40
  75. 75. Among pregnant women, lower Vitamin D is associated with: Semmelweis • Adverse fertility • Primary cesarean section Reflex parameters (n = 2), (n = 1), • Preeclampsia (n = 5), • Few days (n = 2) shorter gestation, • Gestational diabetes or higher blood glucose • And, postpartum (n = 6), depression (n = 1) • Bacterial vaginosis (n = 4), Acta Obstet Gynecol Scand. 2012 Dec;91(12):1357-67. doi: 10.1111/ aogs.12000. Epub 2012 Oct 17. The impact of vitamin D on pregnancy: a systematic review. Christesen HT, Falkenberg T, Lamont RF, Jørgensen JS.Monday, April 15, 13 40
  76. 76. Suicidal ideation during pregnancy Pregnant moms with Suicidal ideation and omega-3 intake from seafood during pregnancy ALSPAC-Bristol suicidality or Prevalence of any suicidal thoughts (32wk) 11 postpartum 10 depression 9 confer higher 8 lifetime risk 7 for their child. 6 The same 5 study shows 4 n3 intake protects mom and infant through 8th year of life.Monday, April 15, 13 41
  77. 77. And Omega-3 protects their children Child&early&developmental&risks&with&low&n3&during&pregnancy& Strength"and"Difficul2es" Ques2onnaire"Results"at"Age"7" 20.00%& 15.00%& At&age& 10.00%& 7" 5.00%& 0.00%& s& y& s& s& m em em vit Prenatal le cB bl bl b ro ro ro ra pe &P &P t& p er al Hy uc on Pe nd oB Co Em No&n3&servings&per&Wk& 1F2&servings&per&Wk& >2&Servings&per&Wk&Monday, April 15, 13 42
  78. 78. How might we reduce alcohol, tobacco, and other drugs among women of child bearing ageMonday, April 15, 13 43
  79. 79. Which warning labels might work?Monday, April 15, 13 44
  80. 80. Trend line for humorous warnings on binge drinking by women of child-rearing No Warnings Humorous WarningsMonday, April 15, 13 45
  81. 81. Trend line for humorous warnings on binge drinking by women of child-rearing No Warnings Humorous Warnings 20 16 Percentage 12 8 4 0 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007Monday, April 15, 13 45
  82. 82. Trend line for humorous warnings on binge drinking by women of child-rearing No Warnings Humorous Warnings 20 16 Percentage 12 8 4 0 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007Monday, April 15, 13 45
  83. 83. Trend line for humorous warnings on binge drinking by women of child-rearing No Warnings Humorous Warnings 20 16 Percentage 12 8 4 0 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007Monday, April 15, 13 45
  84. 84. Rewarding Clerks & Stores for Not Selling to Minors Youth Who Smoked During the Last 30 Days Baseline Reward and Reminder Youth Who Smoked Every Day the Last 30 Days Baseline Reward and Reminder 45.0% 18.0% Wyoming Wyoming Source: Youth Risk 40.0% Youth Who Smoked During the Last 30 Days 16.0% Youth Who Smoked Every Day the Last 30 Days Behavior Survey 35.0% 45.0% Baseline Reward and Reminder 14.0% 18.0% Baseline Reward and Reminder A meta-analysis 30.0% 12.0% (YRBS), Centers for 25.0% 40.0% Wyoming 16.0% 10.0% Wyoming robustly Disease Control 20.0% 35.0% 8.0% 14.0% demonstrates that 15.0% 30.0% 10.0% 6.0% 12.0% cigarette smoking 4.0% 5.0% 25.0% 2.0% 10.0% is associated with 0.0% 20.0% 8.0% 18.0% an increased risk 40.0% 15.0% Wisconsin 16.0% 6.0% Wisconsin of completed 35.0% 10.0% 14.0% 4.0% suicide, consistent with a dose– 30.0% 12.0% 5.0% 25.0% 2.0% 10.0% 20.0% 0.0% 8.0% response 15.0% 6.0% 18.0% relationship. This 10.0% Wisconsin Wisconsin 40.0% 5.0% 4.0% 16.0% 2.0% conclusion has an 35.0% 0.0% 14.0% important public 18.0% 30.0% 40.0% United States 12.0% 16.0% United States health message. 25.0% 35.0% 10.0% 14.0% 30.0% 20.0% 12.0% 8.0% Journal of 25.0% 10.0% 15.0% 20.0% 6.0% 8.0% Psychiatric 10.0% 15.0% 4.0% 6.0% Research, Vol 10.0% 5.0% 4.0% 2.0% 46(10), Oct 2012, 5.0% 2.0% 0.0% 0.0% Source: YRBS, US Centers for Disease Control 0.0% Source: YRBS, US Centers for Disease Control 1257-1266. 1995 1997 1999 2001 2003 2005 2007 18.0% 1995 1997 1999 2001 2003 2005 2007 United States United States 40.0% = Trend = Wyoming 16.0% = Wisconsin =United States 35.0% 14.0%Monday, April 15, 13 30.0% 12.0% 46

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