11. Identifying the Elements of the Limitations & Implications
Go to the Limitations/Implications section(s) and identify the limitations of the study and how those limitations impacted the whole study.
12. Identifying the Elements of the Conclusion Section
Go to the Conclusion section and identify the conclusive statements of the study and the recommendations made for future research.
POST # 1 EDITHA
When assessing an adolescent with bipolar disorder, what are some of the diagnostic and treatment challenges the clinician might face?
Bipolar disorder is a serious mental health disorder that is often first diagnosed during young adulthood or adolescence. Symptoms of the illness, however, also can appear in early childhood. Although once thought rare in children, diagnosis of bipolar disorder in children has significantly increased over the last decade (Papolos & Bronsteen, 2018). Despite the increased diagnosis of bipolar disorder in children, assessment and diagnosis remain challenging and controversial. This is, in part, because of the lack of research on this disorder in children and adolescents and the growing recognition that the disease can present differently in children from how it presents in adults (AACAP, 2019). Over the years, more attention has focused on the unique presentation of bipolar disorder in the young that has introduced new ways of looking at this disease and assessing it in children.
The importance of identifying the presence of bipolar disease at an early age is highlighted by data showing that adults in whom bipolar disease started at an early age have a more severe course of the illness compared with adult-onset disease. Early-onset disease is associated with a higher risk of suicide; severe mood lability and polarity; lower quality of life and greater functional impairment; higher rates of comorbidity; and a higher risk of substance use disorders compared with adult-onset disease (Papolos & Bronsteen, 2018). Although some children meet the criteria established for adults categorized in the DSM-5, many children fall outside these classical categories, and diagnosis in these children is particularly challenging and difficult (APA, 2013). For these children, additional information beyond what is provided in the DSM may help make an accurate diagnosis which causes increased challenges in assessment and diagnosis.
References
Papolos, D, & Bronsteen A. (2018) bipolar disorder in children: assessment in general pediatric practice. Curr Opin Pediatr, 25(3):419-426.
American Academy of Child and Adolescent Psychiatry (AACAP). (2019) bipolar disorder: Parents’ Medication Guide for Bipolar Disorder in Children & Adolescents.
American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Association.
RESEARCH ARTICLE
Association of suicidal behavior with exposure
to suicide and suicide attempt: A systematic
...
This systematic review and meta-analysis examined the association between depressive symptoms and adherence to antiretroviral therapy (ART) among people living with HIV. It analyzed data from 111 studies with 42,366 participants across low, middle, and high income countries. The analysis found that the rate of depressive symptoms among people living with HIV ranged from 12.8% to 78% across studies, while the rate of good ART adherence (≥80%) ranged from 20% to 98%. There was no significant difference in depressive symptom rates by country income, but good adherence was significantly higher in lower income countries (86%) than higher income countries (67.5%). The meta-analysis showed that people living with HIV with depressive symptoms had a
Screening Youth for Suicide Risk inMedical SettingsTime to.docxWilheminaRossi174
Screening Youth for Suicide Risk in
Medical Settings
Time to Ask Questions
Lisa M. Horowitz, PhD, MPH, Jeffrey A. Bridge, PhD, Maryland Pao, MD, Edwin D. Boudreaux, PhD
From the Intra
of Mental He
Pediatric Prac
dren’s Hospit
Columbus, Oh
ment of Psyc
(Boudreaux),
Massachusetts
Address co
Institute of Me
5362, Bethesda
0749-3797/
http://dx.do
S170 Am J
This paper focuses on the National Action Alliance for Suicide Prevention’s Research Prioritization
Task Force’s Aspirational Goal 2 (screening for suicide risk) as it pertains specifically to children,
adolescents, and young adults. Two assumptions are forwarded: (1) strategies for screening youth for
suicide risk need to be tailored developmentally; and (2) we must use instruments that were created
and tested specifically for suicide risk detection and developed specifically for youth. Recommen-
dations for shifting the current paradigm include universal suicide screening for youth in medical
settings with validated instruments.
(Am J Prev Med 2014;47(3S2):S170–S175) Published by Elsevier Inc. on behalf of American Journal of
Preventive Medicine
Introduction
Suicide remains a leading cause of death for youth
worldwide.1 Screening for risk of suicide and
suicidal behavior is an important and necessary
first step toward suicide prevention in young people.
Implementing effective screening programs involves
targeting high-risk populations in favorable settings.2
Medical settings have been designated as key venues to
screen for suicide risk and are therefore the focus of this
article.
The National Action Alliance for Suicide Prevention
(Action Alliance) developed 12 Aspirational Goals as a
way of structuring a suicide prevention research agenda
aimed at decreasing suicides in the U.S. by 40% over the
next decade. Aspirational Goal 2 pertains to screening for
suicide risk: “to determine the degree of suicide risk
among individuals in diverse populations and in diverse
settings through feasible and effective screening and
assessment approaches.”3
As an adjunct to a separate article in this supplement
that proposes a paradigm shift for suicide screening
mural Research Program (Horowitz, Pao), National Institute
alth, NIH, Bethesda, Maryland; Center for Innovation in
tice (Bridge), The Research Institute at Nationwide Chil-
al and The Ohio State University College of Medicine,
io; and the Department of Emergency Medicine, Depart-
hiatry, and Department of Quantitative Health Sciences
University of Massachusetts Medical School, Worcester,
rrespondence to: Lisa M. Horowitz, PhD, MPH, National
ntal Health, Clinical Research Center, Building 10, Room 6-
MD 20892. E-mail: [email protected]
$36.00
i.org/10.1016/j.amepre.2014.06.002
Prev Med 2014;47(3S2):S170–S175 Published by E
instrument development and research aligned with this
Aspirational Goal,4 this paper focuses on suicide screen-
ing as it pertains specifically to children, adolescents, and
young adults. The aims of this paper are to desc.
Adult (Final) Psychiatric Outcomes of Bullying and Being BulliedAce Battiste
A longitudinal study found that individuals who were bullied and those who bullied others as children are at an elevated risk of psychiatric disorders as adults. Specifically, victims were more likely to develop anxiety disorders like agoraphobia and panic disorder. Those who were both bullies and victims, called "bully/victims", faced the highest risks, including depression, panic disorder, agoraphobia, and suicidal thoughts. Bully/victims were over 4 times more likely to experience depression and over 14 times more likely to develop panic disorder compared to those not involved in bullying. The study suggests bullying has long-term negative mental health effects and interventions are needed to reduce victimization and promote healthier development for children.
This document summarizes a study examining predictors of attempted suicide among youth living with perinatal HIV infection (AYALPHIV) and perinatally HIV-exposed but uninfected counterparts (AYAPHEU). The study found that AYALPHIV had a significantly higher prevalence of attempted suicide compared to AYAPHEU. Higher depressive symptoms and the presence of a behavior disorder increased the risk of attempted suicide for both groups. Religiosity was found to be protective against attempted suicide for AYALPHIV. The study highlights the need for suicide prevention efforts, as early mental health challenges were associated with increased risk.
1Running Head FINAL PROPOSAL CHILD ABUSE AND ADULT MENTAL HEAL.docxdrennanmicah
1
Running Head: FINAL PROPOSAL: CHILD ABUSE AND ADULT MENTAL HEALTH
2
FINAL PROPOSAL: CHILD ABUSE AND ADULT MENTAL HEALTH
Diamond Newton
Southern New Hampshire University
March 3, 2019
Problem Statement
Several adults struggle from a variety of mental health issues (suicidal thoughts and tendencies, alcoholism, depression, and drug abusers.) A lot of those issues may stem from what took place during an adult’s childhood that stem from a variety of reasons. Some adults seek help and some refuse to seek help. The adults who do seek help come to realize that their current issues stem from when they were a child and still developing as a human. Child abuse can come in many forms, physical, mental, and sexual. Adults who have been exposed or experienced this are likely to suffer from some form of mental health issue. It is important to figure out the root of mental health issues in adults so the root can be addressed. Children need to be in a healthy environment with nothing short of love and care. Exposing children to a harsh reality is only breeding them into an adult who suffers from mental health issues.
Literature Review
The study of psychology helps researchers to understand better what is going on with a person. Researchers studied what happened in a person's life that causes them to make the decisions they do and behave in a certain way. Adults have this stigmatism that they can do whatever they want because they are "grown." Many adults suffer from something that can cause to lead towards suicidal thoughts and tendencies, alcoholism, depression, and drug abusers. A lot of those issues may stem from what took place during an adult’s childhood. There could be some reasons adults tend to display certain mental health traits that have been studied in many different forms by researchers. What we will be reviewed is the abuse, physical or mental, that an adult endured as a child and how it affects them in their adulthood.
Blanco, C., Grant, B. F., Hasin, D. S., Lin, K. H., Olfson, M. Sugaya, L. (2012) recognized that child physical abuse had been associated with an increased risk of suicide attempts. The study conducted included Blacks, Hispanics and young adults between the ages of 18-24 in 2001-2002 and 2004-2005. In person, interviews were conducted in Wave 1. In Wave 2 used similar methods as Wave 1 but it excluded the individuals who were not eligible. Wave 2 also interviews went into depth about the questions asked for the participants first 17 years of life. There are many other variables that have been added to the data that relate to childhood physical abuse and mental health distress in adult years. Those other adversatives included the history of child sexual abuse and neglect, parental psychopathology, and perceived parental support, described as emotional neglect.
The advantages to this design would be the inclusion of other childhood adversities that could contribute to adult psychiatri.
Due Monday August 22, 2016 8am $40.00 please be 100 original OP.docxhasselldelisa
Due Monday August 22, 2016 8am
$40.00 please be 100% original
OPPOSITIONAL DISORDER DISEASE
The research paper will be any disease or condition of the body. The paper must include a thorough description of the disease/condition; current statistics of those affected - epidemiology; financial costs both terms of treatment and loss of productivity; explanations on how the various body systems (anatomically and/or physiologically) are affected; etiology; medications/treatments that are available; prognosis of those affected, and future outlook in general.
Research paper must have 1200 words no more then 1500 not to include abstract,cover paper,annotate.
* cover/title page (page 1)
* corrected abstract (page 2) ( abstract paper turn in I am missing a lot of work )
Must be in the abstract
Statistic/ Epidemiology
Financial cost
Anatomy & Physiology
Etiology (cause)
Diagnosis/ treatment/ prognosis
Abstract
In recent a post, oppositional disorder diseases has been on the rise, raising questions about the manner in which diseases is spreading especially among children. The high prevalence levels of the oppositional disorder have raised more concerns especially form the health, sectors thus developing the need to understand the disorder better. This research paper will, therefore, encompass a broad perspective of oppositional disorder disease to effectively understand how it is manifested, various ways in which it manifests itself to develop preventive strategy much earlier before the situation reaches full-blown.
Unlike the common conduct disorder where the patient is more aggressive towards people and animals, the oppositional disorder is more silent, and it takes time for it to be detected. The lifetime prevalence of the disease is estimated to be 10.2%. The disease is mostly observed in children and adolescents across the globe.
Some of the common symptoms of the disease involve a certain behavior where children’s behavior is much different compared to their peers. A patient suffering from oppositional disorder tends to have a turn in their behavior including regular loose of temper, being angry and resentful, argues with authorities without any significant reason. It is importance to note that the persistence and frequency of these behaviors should be used to differentiate between normal behavior and symptoms of the oppositional disorder. The disease causes a massive effect on patient’s mental and physical wellbeing.
The most common cause of the oppositional disorder is the genetic influence. Research has shown that parents tend to pass on expressing disorder to their children, and it may be displayed in multiple ways. The disease can be easily diagnosed basing on the extent at which the change of behavior causes distress to the family members or drastic changes in academic and social functioning. These behaviors must persist.
The number of existing functional somatic syndromes (fs ss) is an important r...Paul Coelho, MD
The study tested the hypothesis that the number of existing functional somatic syndromes (FSSs; e.g. fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome) predicts the development of new FSSs. The study found that the incidence of a new FSS increased with the number of pre-existing (antecedent) FSSs in both cases (women with interstitial cystitis) and controls. Specifically, the risk of a new FSS was highest for individuals with 3 or more antecedent FSSs. Logistic regression showed that the number of antecedent FSSs significantly predicted new FSSs even after accounting for other risk factors. This supports the idea that FSSs are linked
This document summarizes research from the REVEAL Study, which investigated the risks and benefits of disclosing genetic risk information for Alzheimer's disease based on APOE genotype. Key findings include:
- Those who received disclosure showed no significant short-term increases in anxiety or depression scores. Recall of risk information was generally accurate.
- Disclosure did not significantly change health behaviors or insurance purchasing in most participants. Some higher-risk individuals did increase exercise and cognitive activities.
- Most participants were satisfied with receiving their results and would undergo testing again. However, nearly half of accurate recallers still believed their risk was different.
- Condensed disclosure protocols may be as effective as more extensive counseling and
This systematic review and meta-analysis examined the association between depressive symptoms and adherence to antiretroviral therapy (ART) among people living with HIV. It analyzed data from 111 studies with 42,366 participants across low, middle, and high income countries. The analysis found that the rate of depressive symptoms among people living with HIV ranged from 12.8% to 78% across studies, while the rate of good ART adherence (≥80%) ranged from 20% to 98%. There was no significant difference in depressive symptom rates by country income, but good adherence was significantly higher in lower income countries (86%) than higher income countries (67.5%). The meta-analysis showed that people living with HIV with depressive symptoms had a
Screening Youth for Suicide Risk inMedical SettingsTime to.docxWilheminaRossi174
Screening Youth for Suicide Risk in
Medical Settings
Time to Ask Questions
Lisa M. Horowitz, PhD, MPH, Jeffrey A. Bridge, PhD, Maryland Pao, MD, Edwin D. Boudreaux, PhD
From the Intra
of Mental He
Pediatric Prac
dren’s Hospit
Columbus, Oh
ment of Psyc
(Boudreaux),
Massachusetts
Address co
Institute of Me
5362, Bethesda
0749-3797/
http://dx.do
S170 Am J
This paper focuses on the National Action Alliance for Suicide Prevention’s Research Prioritization
Task Force’s Aspirational Goal 2 (screening for suicide risk) as it pertains specifically to children,
adolescents, and young adults. Two assumptions are forwarded: (1) strategies for screening youth for
suicide risk need to be tailored developmentally; and (2) we must use instruments that were created
and tested specifically for suicide risk detection and developed specifically for youth. Recommen-
dations for shifting the current paradigm include universal suicide screening for youth in medical
settings with validated instruments.
(Am J Prev Med 2014;47(3S2):S170–S175) Published by Elsevier Inc. on behalf of American Journal of
Preventive Medicine
Introduction
Suicide remains a leading cause of death for youth
worldwide.1 Screening for risk of suicide and
suicidal behavior is an important and necessary
first step toward suicide prevention in young people.
Implementing effective screening programs involves
targeting high-risk populations in favorable settings.2
Medical settings have been designated as key venues to
screen for suicide risk and are therefore the focus of this
article.
The National Action Alliance for Suicide Prevention
(Action Alliance) developed 12 Aspirational Goals as a
way of structuring a suicide prevention research agenda
aimed at decreasing suicides in the U.S. by 40% over the
next decade. Aspirational Goal 2 pertains to screening for
suicide risk: “to determine the degree of suicide risk
among individuals in diverse populations and in diverse
settings through feasible and effective screening and
assessment approaches.”3
As an adjunct to a separate article in this supplement
that proposes a paradigm shift for suicide screening
mural Research Program (Horowitz, Pao), National Institute
alth, NIH, Bethesda, Maryland; Center for Innovation in
tice (Bridge), The Research Institute at Nationwide Chil-
al and The Ohio State University College of Medicine,
io; and the Department of Emergency Medicine, Depart-
hiatry, and Department of Quantitative Health Sciences
University of Massachusetts Medical School, Worcester,
rrespondence to: Lisa M. Horowitz, PhD, MPH, National
ntal Health, Clinical Research Center, Building 10, Room 6-
MD 20892. E-mail: [email protected]
$36.00
i.org/10.1016/j.amepre.2014.06.002
Prev Med 2014;47(3S2):S170–S175 Published by E
instrument development and research aligned with this
Aspirational Goal,4 this paper focuses on suicide screen-
ing as it pertains specifically to children, adolescents, and
young adults. The aims of this paper are to desc.
Adult (Final) Psychiatric Outcomes of Bullying and Being BulliedAce Battiste
A longitudinal study found that individuals who were bullied and those who bullied others as children are at an elevated risk of psychiatric disorders as adults. Specifically, victims were more likely to develop anxiety disorders like agoraphobia and panic disorder. Those who were both bullies and victims, called "bully/victims", faced the highest risks, including depression, panic disorder, agoraphobia, and suicidal thoughts. Bully/victims were over 4 times more likely to experience depression and over 14 times more likely to develop panic disorder compared to those not involved in bullying. The study suggests bullying has long-term negative mental health effects and interventions are needed to reduce victimization and promote healthier development for children.
This document summarizes a study examining predictors of attempted suicide among youth living with perinatal HIV infection (AYALPHIV) and perinatally HIV-exposed but uninfected counterparts (AYAPHEU). The study found that AYALPHIV had a significantly higher prevalence of attempted suicide compared to AYAPHEU. Higher depressive symptoms and the presence of a behavior disorder increased the risk of attempted suicide for both groups. Religiosity was found to be protective against attempted suicide for AYALPHIV. The study highlights the need for suicide prevention efforts, as early mental health challenges were associated with increased risk.
1Running Head FINAL PROPOSAL CHILD ABUSE AND ADULT MENTAL HEAL.docxdrennanmicah
1
Running Head: FINAL PROPOSAL: CHILD ABUSE AND ADULT MENTAL HEALTH
2
FINAL PROPOSAL: CHILD ABUSE AND ADULT MENTAL HEALTH
Diamond Newton
Southern New Hampshire University
March 3, 2019
Problem Statement
Several adults struggle from a variety of mental health issues (suicidal thoughts and tendencies, alcoholism, depression, and drug abusers.) A lot of those issues may stem from what took place during an adult’s childhood that stem from a variety of reasons. Some adults seek help and some refuse to seek help. The adults who do seek help come to realize that their current issues stem from when they were a child and still developing as a human. Child abuse can come in many forms, physical, mental, and sexual. Adults who have been exposed or experienced this are likely to suffer from some form of mental health issue. It is important to figure out the root of mental health issues in adults so the root can be addressed. Children need to be in a healthy environment with nothing short of love and care. Exposing children to a harsh reality is only breeding them into an adult who suffers from mental health issues.
Literature Review
The study of psychology helps researchers to understand better what is going on with a person. Researchers studied what happened in a person's life that causes them to make the decisions they do and behave in a certain way. Adults have this stigmatism that they can do whatever they want because they are "grown." Many adults suffer from something that can cause to lead towards suicidal thoughts and tendencies, alcoholism, depression, and drug abusers. A lot of those issues may stem from what took place during an adult’s childhood. There could be some reasons adults tend to display certain mental health traits that have been studied in many different forms by researchers. What we will be reviewed is the abuse, physical or mental, that an adult endured as a child and how it affects them in their adulthood.
Blanco, C., Grant, B. F., Hasin, D. S., Lin, K. H., Olfson, M. Sugaya, L. (2012) recognized that child physical abuse had been associated with an increased risk of suicide attempts. The study conducted included Blacks, Hispanics and young adults between the ages of 18-24 in 2001-2002 and 2004-2005. In person, interviews were conducted in Wave 1. In Wave 2 used similar methods as Wave 1 but it excluded the individuals who were not eligible. Wave 2 also interviews went into depth about the questions asked for the participants first 17 years of life. There are many other variables that have been added to the data that relate to childhood physical abuse and mental health distress in adult years. Those other adversatives included the history of child sexual abuse and neglect, parental psychopathology, and perceived parental support, described as emotional neglect.
The advantages to this design would be the inclusion of other childhood adversities that could contribute to adult psychiatri.
Due Monday August 22, 2016 8am $40.00 please be 100 original OP.docxhasselldelisa
Due Monday August 22, 2016 8am
$40.00 please be 100% original
OPPOSITIONAL DISORDER DISEASE
The research paper will be any disease or condition of the body. The paper must include a thorough description of the disease/condition; current statistics of those affected - epidemiology; financial costs both terms of treatment and loss of productivity; explanations on how the various body systems (anatomically and/or physiologically) are affected; etiology; medications/treatments that are available; prognosis of those affected, and future outlook in general.
Research paper must have 1200 words no more then 1500 not to include abstract,cover paper,annotate.
* cover/title page (page 1)
* corrected abstract (page 2) ( abstract paper turn in I am missing a lot of work )
Must be in the abstract
Statistic/ Epidemiology
Financial cost
Anatomy & Physiology
Etiology (cause)
Diagnosis/ treatment/ prognosis
Abstract
In recent a post, oppositional disorder diseases has been on the rise, raising questions about the manner in which diseases is spreading especially among children. The high prevalence levels of the oppositional disorder have raised more concerns especially form the health, sectors thus developing the need to understand the disorder better. This research paper will, therefore, encompass a broad perspective of oppositional disorder disease to effectively understand how it is manifested, various ways in which it manifests itself to develop preventive strategy much earlier before the situation reaches full-blown.
Unlike the common conduct disorder where the patient is more aggressive towards people and animals, the oppositional disorder is more silent, and it takes time for it to be detected. The lifetime prevalence of the disease is estimated to be 10.2%. The disease is mostly observed in children and adolescents across the globe.
Some of the common symptoms of the disease involve a certain behavior where children’s behavior is much different compared to their peers. A patient suffering from oppositional disorder tends to have a turn in their behavior including regular loose of temper, being angry and resentful, argues with authorities without any significant reason. It is importance to note that the persistence and frequency of these behaviors should be used to differentiate between normal behavior and symptoms of the oppositional disorder. The disease causes a massive effect on patient’s mental and physical wellbeing.
The most common cause of the oppositional disorder is the genetic influence. Research has shown that parents tend to pass on expressing disorder to their children, and it may be displayed in multiple ways. The disease can be easily diagnosed basing on the extent at which the change of behavior causes distress to the family members or drastic changes in academic and social functioning. These behaviors must persist.
The number of existing functional somatic syndromes (fs ss) is an important r...Paul Coelho, MD
The study tested the hypothesis that the number of existing functional somatic syndromes (FSSs; e.g. fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome) predicts the development of new FSSs. The study found that the incidence of a new FSS increased with the number of pre-existing (antecedent) FSSs in both cases (women with interstitial cystitis) and controls. Specifically, the risk of a new FSS was highest for individuals with 3 or more antecedent FSSs. Logistic regression showed that the number of antecedent FSSs significantly predicted new FSSs even after accounting for other risk factors. This supports the idea that FSSs are linked
This document summarizes research from the REVEAL Study, which investigated the risks and benefits of disclosing genetic risk information for Alzheimer's disease based on APOE genotype. Key findings include:
- Those who received disclosure showed no significant short-term increases in anxiety or depression scores. Recall of risk information was generally accurate.
- Disclosure did not significantly change health behaviors or insurance purchasing in most participants. Some higher-risk individuals did increase exercise and cognitive activities.
- Most participants were satisfied with receiving their results and would undergo testing again. However, nearly half of accurate recallers still believed their risk was different.
- Condensed disclosure protocols may be as effective as more extensive counseling and
This document summarizes research from the REVEAL studies, which explored the risks and benefits of disclosing genetic risk information for Alzheimer's disease based on APOE genotype. Key findings include:
- People generally did not experience long-term psychological harm from receiving risk information. Anxiety and depression scores returned to baseline.
- Participants were generally able to recall their risk information accurately over time.
- Disclosure did not negatively impact insurance purchasing or health behaviors, and sometimes increased preventative behaviors like exercise.
- Condensed education protocols could safely disclose risk information.
- Providing additional risk information for cardiovascular disease in addition to Alzheimer's disease further increased preventative behavior changes.
This document summarizes the results of a 2-year clinical trial evaluating the effectiveness of the Early Detection and Intervention for the Prevention of Psychosis (EDIPPP) program. The trial involved 337 young people aged 12-25 across 6 sites who were at clinical high risk or had very early first episodes of psychosis. Participants were assigned to receive either Family-aided Assertive Community Treatment (FACT) or community care based on their symptoms. After 2 years, FACT was found to be superior in improving symptoms and functioning compared to community care, though conversion rates were low and did not significantly differ between groups. The trial demonstrated the effectiveness of early intervention for preventing deterioration in at-risk youth across diverse clinical settings.
Rai, D., Lee, B. K., Dalman, C., Golding, J., Lewis, G., & Magnuss.docxmakdul
Rai, D., Lee, B. K., Dalman, C., Golding, J., Lewis, G., & Magnusson, C. (2013). Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: Population based case-control study. BMJ : British Medical Journal (Online), 346 doi:http://dx.doi.org.saintleo.idm.oclc.org/10.1136/bmj.f2059
Parental depression, maternal antidepressant use
during pregnancy, and risk of autism spectrum
disorders: population based case-control study
OPEN ACCESS
Dheeraj Rai clinical lecturer 1 2 3, Brian K Lee assistant professor 4, Christina Dalman associate
professor2, Jean Golding professor emeritus5, Glyn Lewis professor1, Cecilia Magnusson professor2
1Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK;
2Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; 3Avon and Wiltshire
Partnership Mental Health NHS Trust, Bristol, UK; 4Department of Epidemiology and Biostatistics, Drexel University School of Public Health,
Philadelphia, PA, USA; 5Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK
Abstract
Objective To study the association between parental depression and
maternal antidepressant use during pregnancy with autism spectrum
disorders in offspring.
Design Population based nested case-control study.
Setting Stockholm County, Sweden, 2001-07.
Participants 4429 cases of autism spectrum disorder (1828 with and
2601 without intellectual disability) and 43 277 age and sex matched
controls in the full sample (1679 cases of autism spectrum disorder and
16 845 controls with data on maternal antidepressant use nested within
a cohort (n=589 114) of young people aged 0-17 years.
Main outcome measure A diagnosis of autism spectrum disorder, with
or without intellectual disability.
Exposures Parental depression and other characteristics prospectively
recorded in administrative registers before the birth of the child. Maternal
antidepressant use, recorded at the first antenatal interview, was
available for children born from 1995 onwards.
Results A history of maternal (adjusted odds ratio 1.49, 95% confidence
interval 1.08 to 2.08) but not paternal depression was associated with
an increased risk of autism spectrum disorders in offspring. In the
subsample with available data on drugs, this association was confined
to women reporting antidepressant use during pregnancy (3.34, 1.50 to
7.47, P=0.003), irrespective of whether selective serotonin reuptake
inhibitors (SSRIs) or non-selective monoamine reuptake inhibitors were
reported. All associations were higher in cases of autism without
intellectual disability, there being no evidence of an increased risk of
autism with intellectual disability. Assuming an unconfounded, causal
association, antidepressant use during pregnancy explained 0.6% of
the cases of autism sp ...
This study investigated the relationships between childhood trauma, psychological symptoms, and barriers to seeking mental health care among college students. It was hypothesized that childhood trauma would be correlated with both psychological symptoms and barriers to care, and that psychological symptoms would mediate the relationship between childhood trauma and barriers. Participants completed questionnaires measuring these constructs. Results found childhood trauma was correlated with both psychological symptoms and barriers to care. Psychological symptoms also mediated the relationship between childhood trauma and barriers, such that the relationship was weaker when accounting for psychological symptoms. This suggests childhood trauma influences barriers indirectly through its effect on increasing psychological symptoms.
Serieswww.thelancet.com Vol 379 June 23, 2012 2373.docxlesleyryder69361
Self-harm and suicide are major public health problems among adolescents. Around 10% of adolescents report having self-harmed, with rates being higher in females. Important contributors include genetic, psychiatric, psychological, familial, social, and cultural factors. Prevention requires both universal measures for all youth and targeted initiatives for high-risk groups. There remains little evidence about effective treatments, and identifying successful prevention initiatives and treatments is a key need.
This study examined factors related to posttraumatic stress symptoms (PTSS) in pediatric cancer patients and their caregivers. The researchers analyzed surveys from 31 patient-caregiver dyads. They found that patient-reported PTSS was predicted by self-reported worry, while caregiver-reported patient PTSS was predicted by the caregiver's perception of the patient's physical appearance. Additionally, caregiver-reported caregiver PTSS was predicted by the caregiver's report of the patient's psychosocial functioning. The results suggest discrepancies between how patients and caregivers view factors related to PTSS.
Ольга Бермант-Полякова. Новейшие исследования в современной зарубежной психол...Olga Bermant-Polyakova
This document summarizes key aspects of evidence-based practice in psychology (EBPP) as defined by the American Psychological Association (APA). It discusses that EBPP involves integrating the best available research evidence with clinical expertise and patient characteristics, values, and context. It provides definitions for best research evidence, clinical expertise, and consideration of patient factors. It notes that the goal of EBPP is to promote effective psychological practice and enhance public health.
1) According to research, genetics play an important role in ADHD, with heritability estimates between 60-90% from twin and adoption studies. However, genome-wide association studies have not found significant genetic associations, suggesting the genetic factors are complex.
2) Prenatal factors like maternal smoking and stress during pregnancy increase the risk of ADHD in children. Perinatal risks like low birth weight and preterm birth are also associated with higher ADHD risk.
3) Various environmental exposures have been linked to ADHD, including lead, PCBs, pesticides, and certain food dyes and additives which some studies have found can exacerbate ADHD symptoms.
4) However
A Phenotypic Structure and Neural Correlates ofCompulsive Be.docxransayo
A Phenotypic Structure and Neural Correlates of
Compulsive Behaviors in Adolescents
Chantale Montigny1*, Natalie Castellanos-Ryan1, Robert Whelan7,20, Tobias Banaschewski3,17,19, Gareth J.
Barker5, Christian Büchel4, Jürgen Gallinat6, Herta Flor3,17,19, Karl Mann3,17,19, Marie-Laure Paillère-
Martinot8,9, Frauke Nees3,17,19, Mark Lathrop10, Eva Loth2,5, Tomas Paus11,12,13, Zdenka Pausova18, Marcella
Rietschel3,17,19, Gunter Schumann2,5, Michael N. Smolka14,15, Maren Struve3, Trevor W. Robbins16, Hugh
Garavan7,20, Patricia J. Conrod1,5, and the IMAGEN Consortium¶
1 Department of Psychiatry, Université de Montréal, CHU Ste Justine Hospital, Montreal, Canada, 2 MRC Social, Genetic and Developmental Psychiatry
(SGDP) Centre, London, United Kingdom, 3 Central Institute of Mental Health, Mannheim, Germany, 4 Universitaetsklinikum Hamburg Eppendorf, Hamburg,
Germany, 5 Institute of Psychiatry, King’s College London, United Kingdom, 6 Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité,
Universitätsmedizin Berlin, Germany, 7 Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland, 8 Institut National de la Santé et de la Recherche
Médicale, INSERM CEA Unit 1000 “Imaging & Psychiatry”, University Paris Sud, Orsay, France, 9 AP-HP Department of Adolescent Psychopathology and
Medicine, Maison de Solenn, University Paris Descartes, Paris, France, 10 Centre National de Génotypage, Evry, France, 11 Rotman Research Institute,
University of Toronto, Toronto, Canada, 12 School of Psychology, University of Nottingham, United Kingdom, 13 Montreal Neurological Institute, McGill
University, Montreal, Canada, 14 Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Germany, 15 Neuroimaging Center,
Department of Psychology, Technische Universität Dresden, Germany, 16 Behavioural and Clinical Neurosciences Institute, Department of Experimental
Psychology, University of Cambridge, United Kingdom, 17 Mannheim Medical Faculty, University of Heidelberg, Germany, 18 The Hospital for Sick Children,
University of Toronto, Toronto, Canada, 19 Central Institute of Mental Health, Medical Faculty Mannheim / Heidelberg University, Department of Addictive
Behaviour and Addiction Medicine, Manheim, Germany, 20 Departments of Psychiatry and Psychology, University of Vermont, Burlington, Vermont, United
States of America
Abstract
Background: A compulsivity spectrum has been hypothesized to exist across Obsessive-Compulsive disorder
(OCD), Eating Disorders (ED), substance abuse (SA) and binge-drinking (BD). The objective was to examine the
validity of this compulsivity spectrum, and differentiate it from an externalizing behaviors dimension, but also to look
at hypothesized personality and neural correlates.
Method: A community-sample of adolescents (N=1938; mean age 14.5 years), and their parents were recruited via
high-schools in 8 European study sites. Data on adolescents’ psychiatric symptoms, DSM diagnoses (DAWBA) and
s.
Depressive symptoms among student at Al-kindy college of medicine 2018-2019 r...Aseele HZ
This study examined depressive symptoms among students at Al-Kindy College of Medicine in Iraq from 2018-2019. The researchers surveyed 501 students using a depression questionnaire. The results found that 32% of students experienced some level of depression, with mild depression being most common at 23.6%. Depression was higher among female students and those in their 3rd and 6th years of study. Family problems were also associated with higher rates of depression compared to academic stress alone. The study concludes depression is a significant problem affecting around one-third of medical students, and recommends early screening and prevention programs to address student mental health issues.
This study examined the association between anxiety and depressive symptom severity and the presence of medical conditions in 989 adults diagnosed with anxiety disorders. The results showed that greater severity of anxiety and depressive symptoms was strongly associated with having more medical conditions, even after controlling for other factors. Specifically, increased anxiety and depressive symptom severity was linked to higher odds of having asthma, heart disease, back problems, ulcers, migraines, and eyesight difficulties. Anxiety symptoms uniquely predicted ulcers, while depressive symptoms uniquely predicted heart disease, migraines, and eyesight difficulties. These findings suggest that anxiety and depressive symptoms are independently associated with medical comorbidity in individuals with anxiety disorders.
prevalence and correlates bipolar spectrum disorder in the world mental healt...Priscila Navarro
This study examined the prevalence, clinical correlates, and treatment patterns of bipolar spectrum disorder in 61,392 participants across 11 countries. The key findings were:
1. The lifetime prevalence of bipolar I disorder was 0.6%, bipolar II was 0.4%, subthreshold bipolar disorder was 1.4%, and the total bipolar spectrum was 2.4%.
2. Across all countries, severity of symptoms, impairment, and suicidal behavior increased stepwise from subthreshold bipolar disorder to bipolar I disorder. Three-quarters of individuals with bipolar spectrum disorder also met criteria for another mental health condition, most commonly an anxiety disorder.
3. Less than half of individuals with a lifetime
Research-Based Interventions: Dissociative Identity Disorder 1
THIS IS AN EXAMPLE PLEASE DO NO COPY DO NOT PLAGiarism
Research-Based Interventions: Dissociative Identity Disorder
“Dissociative identity disorder is characterized by the presence of two or more identities or personality states, each with its relatively enduring pattern of perceiving, relating to, and thinking about the environment and the self” (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006). There are many characteristics used that accompany Dissociative Disorder (DID). One method to understanding would be to know how the disorders are classified and defined. DID may be conceptualized effectively using the diathesis-stress model. There are many different intervention strategies for this disorder as well. Over time researchers have discovered the most effective treatments and interventions that can be used regarding DID. When one dissociates, the person may not have conscious awareness of what is happening (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006).
Peer-reviewed Articles
One limitless, longitudinal, naturalistic, and prospective study investigated childhood maltreatment (CM) in adult intimate partner violence (IPV) victims among Dissociative Disorder (DD) patients with Dissociative Identity Disorder with CM rates of 80-95% and severe dissociative symptoms (Webermann, Brand, & Chasson, 2014). The methods of this study include 275 DD outpatient therapy patients who completed a self-reported measure of dissociation (Webermann, Brand, & Chasson, 2014). Analyses assessed associations between CM typologies, trait dissociation, and IPV (Webermann, Brand, & Chasson, 2014). The results of this study include emotional and physical child abuse associated with childhood witnessing of domestic violence, physical, and emotional IPV (Webermann, Brand, & Chasson, 2014) Two-tailed independent samples t -tests and z-tests were used in this study to represent data as well. “As an effect size, odds ratios (ORs) were calculated to predict the likelihood of a participant being in an abusive adult relationship if they experienced a particular type of CM” (Webermann, Brand, & Chasson, 2014, p. 5).
A double-blind study was conducted including 15 females with DID compared to 23 without psychopathology., chosen by self-disclosure results of a questionnaire along with a structured clinical interview by psychiatrists The objective was to examine the volumetric differences between amygdala and hippocampal volumes in patients with dissociative identity disorder, a disorder that has been associated with a history of severe childhood trauma (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006). These researchers used MRI to measure volumes of the amygdala and hippocampus. The results included the volume of the hippocampus being 19.2 % smaller and the amygdala being 31.6% smaller in patients with DID when compared to the other subjects without psychopath ...
This research study examined psychology doctoral students' ability to correctly diagnose obsessive-compulsive disorder (OCD) based on case presentations. The study found that prior to a video intervention, students were less aware of and more likely to misdiagnose OCD presentations that did not involve contamination or symmetry obsessions. After viewing an educational video about OCD, students' rates of misdiagnosing OCD decreased significantly. The results suggest that graduate training in mental health could benefit from targeted education to improve identification of diverse OCD symptoms beyond just contamination and symmetry.
This document describes the methodology of the Transitions Study, which aims to test a clinical staging model of mental illness progression in young people. The study involves a longitudinal cohort of 802 young people aged 12-25 who are receiving care at youth mental health services in Australia. Annual follow-up assessments will track participants over time to investigate psychological, social, and genetic markers that may define clinical stage or predict transition to more severe stages of mental disorders. The results could improve understanding of mental illness development and identify targets for preventing progression.
An Epidemiological Investigation of Age-Related Determinants of Anxiety and M...Wally Wah Lap Cheung
This study used data from the CAMH Monitor survey conducted between 2001-2009 to examine the prevalence and predictors of anxiety and mood disorders (AMD) across three age groups (18-30 years old, 31-54 years old, and 55+ years old) in Ontario, Canada. The study found that the prevalence of AMD was highest in the youngest age group (10.8%) and lowest in the oldest age group (6.5%). Logistic regression analysis showed that for the youngest group, being female, never married, lower income, and poor physical/mental health increased odds of AMD. For the middle-aged and older groups, the same factors as well as cannabis and alcohol problems increased odds of AMD. The study suggests
This study examined whether psychosocial factors like depression, anxiety, coping style, and social support influence survival outcomes in young women diagnosed with early-stage breast cancer. The study followed 708 Australian women under age 60 diagnosed with non-metastatic breast cancer for a median of 8.2 years. Psychosocial factors were assessed via questionnaires administered about 11 months after diagnosis. The study found no statistically significant associations between the measured psychosocial factors and distant disease-free survival or overall survival after adjusting for known prognostic factors like tumor characteristics and treatment. One unadjusted analysis found higher anxious preoccupation was linked to poorer outcomes, but this association was explained by its relationship to worse prognostic factors and disappeared after adjustment. The findings do not support
Assignment 2 Community Prevention ProgramAfter hearing that a n.docxBenitoSumpter862
Assignment 2: Community Prevention Program
After hearing that a neighbor’s child, Jeremy, age seven, was sexually assaulted in the local park, the parents of Cherry Hill township decide that their community needs a program to prevent sexual abuse of their children in the future.
Prepare a presentation for the parents, providing pertinent information they might like to include in a Sexual Assault Prevention program aimed at the children in their community. Suggest the psychoeducational and supportive approaches that can be effectively used at the community level, such as in community centers, schools, and social service agencies, to provide this information to the children. Address issues of gender, diversity, and ethics in your presentation.
Submit your PowerPoint presentation to the
W2: Assignment 2 Dropbox
by
Wednesday, July 19, 2017
. Your response should be at least 5 - 6 slides and include speaker notes for each slide. In addition, make sure you have included a title slide and a reference slide.
Assignment 2 Grading Criteria
Maximum Points
Analyzed pertinent information they deem relevant to the development of a Sexual Assault Prevention program
25
Described the psychoeducational information and supportive approaches that the community can effectively use to deal with the issue of sexual abuse of children
30
Addressed the issues of gender, diversity, and ethics in the context of intervention approaches
25
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources, displayed accurate spelling, grammar, and punctuation.
20
Total:
100
.
Assignment 2 Analyzing World CulturesMedia play a very large role.docxBenitoSumpter862
Assignment 2: Analyzing World Cultures
Media play a very large role in both the development and the perpetuation of cultural elements. You may never have watched a foreign movie or even clips evaluating other cultures. In this assignment, you will explore online videos or movies from a culture of your choice and analyze how cultural elements are presented, compared to your own culture.
Complete the following:
Choose a world culture you are not familiar with.
Identify two–three online videos or movies representative of this culture. These could be examples of cultural expressions such as a Bollywood movie from India or Anime videos from Japan.
Evaluate two hours of such a video. Using the readings for this module, the Argosy University online library resources, and the Internet, research articles about your selected culture.
Select a scholarly article that analyzes the same culture presented in the videos you have observed.
Write a paper describing the cultural differences you have observed in the video. How are these observations supported by the research article?
Be sure to include the following:
Describe the videos you have watched.
Explain the main points of the videos.
Examine what stood out about the culture.
Compare and contrast the similarities and differences of this culture with your own.
Examine the ways of this culture. Is it one you would want to visit or live in?
Would you experience culture shock if you immersed yourself in this culture? Why or why not?
Support your statements with examples and scholarly references.
Write a 2–3-page paper in Word format. Apply APA standards to citation of sources. Use the following file naming convention: LastnameFirstInitial_M2_A2.doc.
.
Assignment 2 Communicating Bad News Leaders and managers often ha.docxBenitoSumpter862
Assignment 2: Communicating Bad News
Leaders and managers often have to deliver unpleasant or difficult information to other employees or other internal or external stakeholders. How well this news is delivered can affect employee relations as well as public perceptions.
Review the following scenario:
A new company claims it manufactures the best dog food in the market. It employs around 250 people worldwide. After six months in business, one of the company’s brands is found to contain harmful bacteria. Overnight, reports start pouring in from all over the country about pets falling sick, some critically. The company wants to communicate with its stakeholders through a memo before major news channels start to cover the disease.
Assume that you are an assistant to the company’s chairperson. Based on your analysis of the scenario and using the reading material covered in this module, draft two memos for the chairperson. One memo should address the board of directors and the other the company’s employees.
Make assumptions about whether it is the food product that has bacteria or if there is another explanation for the pets’ sickness.
Write a 1–2-page paper in Word format. Apply APA standards to citation of sources. Use the following file naming convention: LastnameFirstInitial_M2_A2.doc.
.
Assignment 2 Communicating Bad NewsLeaders and managers often hav.docxBenitoSumpter862
Assignment 2: Communicating Bad News
Leaders and managers often have to deliver unpleasant or difficult information to other employees or other internal or external stakeholders. How well this news is delivered can affect employee relations as well as public perceptions.
Review the following scenario:
A new company claims it manufactures the best dog food in the market. It employs around 250 people worldwide. After six months in business, one of the company’s brands is found to contain harmful bacteria. Overnight, reports start pouring in from all over the country about pets falling sick, some critically. The company wants to communicate with its stakeholders through a memo before major news channels start to cover the disease.
Assume that you are an assistant to the company’s chairperson. Based on your analysis of the scenario and using the reading material covered in this module, draft two memos for the chairperson. One memo should address the board of directors and the other the company’s employees.
Make assumptions about whether it is the food product that has bacteria or if there is another explanation for the pets’ sickness.
Write a 1–2-page paper in Word format. Apply APA standards to citation of sources. Use the following file naming convention: LastnameFirstInitial_M2_A2.doc.
By
Wednesday, July 19, 2017
, submit your assignment to the
M2: Assignment 2 Dropbox
.
Assignment 2 Grading Criteria
Maximum Points
Effectively utilized the tips covered in the module, to write an appropriate memo addressing the board of directors to convey the bad news.
40
Effectively utilized the tips covered in the module, to write a suitable memo addressing the company’s employees to convey the bad news.
40
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources; and displayed accurate spelling, grammar, and punctuation.
20
Total:
100
.
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Research-Based Interventions: Dissociative Identity Disorder 1
THIS IS AN EXAMPLE PLEASE DO NO COPY DO NOT PLAGiarism
Research-Based Interventions: Dissociative Identity Disorder
“Dissociative identity disorder is characterized by the presence of two or more identities or personality states, each with its relatively enduring pattern of perceiving, relating to, and thinking about the environment and the self” (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006). There are many characteristics used that accompany Dissociative Disorder (DID). One method to understanding would be to know how the disorders are classified and defined. DID may be conceptualized effectively using the diathesis-stress model. There are many different intervention strategies for this disorder as well. Over time researchers have discovered the most effective treatments and interventions that can be used regarding DID. When one dissociates, the person may not have conscious awareness of what is happening (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006).
Peer-reviewed Articles
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Assignment 2: Community Prevention Program
After hearing that a neighbor’s child, Jeremy, age seven, was sexually assaulted in the local park, the parents of Cherry Hill township decide that their community needs a program to prevent sexual abuse of their children in the future.
Prepare a presentation for the parents, providing pertinent information they might like to include in a Sexual Assault Prevention program aimed at the children in their community. Suggest the psychoeducational and supportive approaches that can be effectively used at the community level, such as in community centers, schools, and social service agencies, to provide this information to the children. Address issues of gender, diversity, and ethics in your presentation.
Submit your PowerPoint presentation to the
W2: Assignment 2 Dropbox
by
Wednesday, July 19, 2017
. Your response should be at least 5 - 6 slides and include speaker notes for each slide. In addition, make sure you have included a title slide and a reference slide.
Assignment 2 Grading Criteria
Maximum Points
Analyzed pertinent information they deem relevant to the development of a Sexual Assault Prevention program
25
Described the psychoeducational information and supportive approaches that the community can effectively use to deal with the issue of sexual abuse of children
30
Addressed the issues of gender, diversity, and ethics in the context of intervention approaches
25
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources, displayed accurate spelling, grammar, and punctuation.
20
Total:
100
.
Assignment 2 Analyzing World CulturesMedia play a very large role.docxBenitoSumpter862
Assignment 2: Analyzing World Cultures
Media play a very large role in both the development and the perpetuation of cultural elements. You may never have watched a foreign movie or even clips evaluating other cultures. In this assignment, you will explore online videos or movies from a culture of your choice and analyze how cultural elements are presented, compared to your own culture.
Complete the following:
Choose a world culture you are not familiar with.
Identify two–three online videos or movies representative of this culture. These could be examples of cultural expressions such as a Bollywood movie from India or Anime videos from Japan.
Evaluate two hours of such a video. Using the readings for this module, the Argosy University online library resources, and the Internet, research articles about your selected culture.
Select a scholarly article that analyzes the same culture presented in the videos you have observed.
Write a paper describing the cultural differences you have observed in the video. How are these observations supported by the research article?
Be sure to include the following:
Describe the videos you have watched.
Explain the main points of the videos.
Examine what stood out about the culture.
Compare and contrast the similarities and differences of this culture with your own.
Examine the ways of this culture. Is it one you would want to visit or live in?
Would you experience culture shock if you immersed yourself in this culture? Why or why not?
Support your statements with examples and scholarly references.
Write a 2–3-page paper in Word format. Apply APA standards to citation of sources. Use the following file naming convention: LastnameFirstInitial_M2_A2.doc.
.
Assignment 2 Communicating Bad News Leaders and managers often ha.docxBenitoSumpter862
Assignment 2: Communicating Bad News
Leaders and managers often have to deliver unpleasant or difficult information to other employees or other internal or external stakeholders. How well this news is delivered can affect employee relations as well as public perceptions.
Review the following scenario:
A new company claims it manufactures the best dog food in the market. It employs around 250 people worldwide. After six months in business, one of the company’s brands is found to contain harmful bacteria. Overnight, reports start pouring in from all over the country about pets falling sick, some critically. The company wants to communicate with its stakeholders through a memo before major news channels start to cover the disease.
Assume that you are an assistant to the company’s chairperson. Based on your analysis of the scenario and using the reading material covered in this module, draft two memos for the chairperson. One memo should address the board of directors and the other the company’s employees.
Make assumptions about whether it is the food product that has bacteria or if there is another explanation for the pets’ sickness.
Write a 1–2-page paper in Word format. Apply APA standards to citation of sources. Use the following file naming convention: LastnameFirstInitial_M2_A2.doc.
.
Assignment 2 Communicating Bad NewsLeaders and managers often hav.docxBenitoSumpter862
Assignment 2: Communicating Bad News
Leaders and managers often have to deliver unpleasant or difficult information to other employees or other internal or external stakeholders. How well this news is delivered can affect employee relations as well as public perceptions.
Review the following scenario:
A new company claims it manufactures the best dog food in the market. It employs around 250 people worldwide. After six months in business, one of the company’s brands is found to contain harmful bacteria. Overnight, reports start pouring in from all over the country about pets falling sick, some critically. The company wants to communicate with its stakeholders through a memo before major news channels start to cover the disease.
Assume that you are an assistant to the company’s chairperson. Based on your analysis of the scenario and using the reading material covered in this module, draft two memos for the chairperson. One memo should address the board of directors and the other the company’s employees.
Make assumptions about whether it is the food product that has bacteria or if there is another explanation for the pets’ sickness.
Write a 1–2-page paper in Word format. Apply APA standards to citation of sources. Use the following file naming convention: LastnameFirstInitial_M2_A2.doc.
By
Wednesday, July 19, 2017
, submit your assignment to the
M2: Assignment 2 Dropbox
.
Assignment 2 Grading Criteria
Maximum Points
Effectively utilized the tips covered in the module, to write an appropriate memo addressing the board of directors to convey the bad news.
40
Effectively utilized the tips covered in the module, to write a suitable memo addressing the company’s employees to convey the bad news.
40
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources; and displayed accurate spelling, grammar, and punctuation.
20
Total:
100
.
Assignment 2 Case of Anna OOne of the very first cases that c.docxBenitoSumpter862
Assignment 2: Case of Anna O
One of the very first cases that caught Freud’s attention when he was starting to develop his psychoanalytic theory was that of Anna O, a patient of fellow psychiatrist Josef Breuer. Although Freud did not directly treat her, he did thoroughly analyze her case as he was fascinated by the fact that her hysteria was “cured” by Breuer. It is her case that he believes was the beginning of the psychoanalytic approach.
Through your analysis of this case, you will not only look deeper into Freud’s psychoanalytic theory but also see how Jung’s neo-psychoanalytic theory compares and contrasts with Freud’s theory.
Review the following:
The Case of Anna O.
One of the first cases that inspired Freud in the development of what would eventually become the Psychoanalytic Theory was the case of Anna O. Anna O. was actually a patient of one of Freud’s colleagues Josef Breuer. Using Breuer’s case notes, Freud was able to analyze the key facts of Anna O’s case.
Anna O. first developed her symptoms while she was taking care of her very ill father with whom she was extremely close. Some of her initial symptoms were loss of appetite to the extent of not eating, weakness, anemia, and development a severe nervous cough. Eventually she developed a severe optic headache and lost the ability to move her head, which then progressed into paralysis of both arms. Her symptoms were not solely physical as she would vacillate between a normal, mental state and a manic-type state in which she would become extremely agitated. There was even a notation of a time for which she hallucinated that the ribbons in her hair were snakes.
Toward the end of her father’s life she stopped speaking her native language of German and instead only spoke in English. A little over a year after she began taking care of her father he passed away. After his passing her symptoms grew to affect her vision, a loss of ability to focus her attention, more extreme hallucinations, and a number of suicidal attempts (Hurst, 1982).
Both Freud and Jung would acknowledge that unconscious processes are at work in this woman's problems. However, they would come to different conclusions about the origin of these problems and the method by which she should be treated.
Research Freud’s and Jung’s theories of personality using your textbook, the Internet, and the Argosy University online library resources. Based on your research, respond to the following:
•Compare and contrast Freud's view of the unconscious with Jung's view and apply this case example in your explanations.
•On what specific points would they agree and disagree regarding the purpose and manifestation of the unconscious in the case of Anna?
•How might they each approach the treatment of Anna? What might be those specific interventions? How might Anna experience these interventions considering her history?
Write a 2–3-page paper in Word format. Apply APA standards to citation of sources. Use .
Assignment 2 Bioterrorism Due Week 6 and worth 300 pointsAcco.docxBenitoSumpter862
Assignment 2: Bioterrorism
Due Week 6 and worth 300 points
According to the Department of Health and Human Services (2002), the nation's capacity to respond to bioterrorism depends largely on the ability of clinicians and public health officials to detect, manage, and effectively communicate in advance of and during a bioterrorism event.
Prepare a narrated presentation, using PowerPoint or other similar software, detailing a bioterrorism-related issue, analyzing the threat(s) that the bioterrorism-related issue poses.
In preparation for your presentation, research and review at least one (1) healthcare facility’s preparedness plan.
Note
: A video to help students record narration for the PowerPoint presentation is available in the course shell.
Prepare a twenty (20) slide presentation in which you:
Specify the key steps that healthcare managers should follow in preparing their organizations for a potential bioterrorism attack.
Outline at least two (2) possible early detection and surveillance strategies, and investigate the main ways those strategies may prompt timely interventions to effectively treat and diminish the impact of a bioterrorism threat.
Evaluate the specific preparation steps in the preparedness plan of a healthcare facility of your choosing.
Suggest at least one (1) possible improvement to promote early detection and enhanced surveillance.
Use at least four (4) recent (within the last five [5] years), quality academic resources in this assignment. Note: Wikipedia and other Websites do not qualify as academic resources.
Your assignment must follow these formatting requirements:
Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.
The specific course learning outcomes associated with this assignment are:
Apply decision making models to address difficult management situations.
Develop policies that ensure compliance of healthcare delivery systems with current legislation.
Use technology and information resources to research issues in Health Care Operations Management
.
Assignment 2 Affirmative ActionAffirmative Action is a controvers.docxBenitoSumpter862
Assignment 2: Affirmative Action
Affirmative Action is a controversial topic in American society. People of all races, genders, and classes are divided on where they stand on Affirmative Action. However, the media has oversimplified Affirmative Action and many do not truly understand the policy and what it means for schools and employers. For this assignment, you will examine Executive Order 10925 and determine where you stand on this topic.
Review Executive Order 10925. A copy can be found at:
http://www.thecre.com/fedlaw/legal6/eo10925.htm
.
Then, write an organized short response (3 paragraphs) where you explain:
What is Affirmative Action as a social policy?
What were the goals of Affirmative Action? Has it been successful?
What are the basic arguments for Affirmative Action and what are those against it? Which side do you find the most convincing and why?
Be sure to support your answer with references to the textbook, appropriate outside resources, and your own personal experiences.
Create a response in 3 paragraphs to the discussion question. Cite sources and include references in your response. Submit your response to the
Discussion Area
by
Saturday, August 26, 2017
. Through
Wednesday, August 30, 2017
, review and comment on at least two peers’ responses.
.
Assignment 2 Audit Planning and Control It is common industry kno.docxBenitoSumpter862
Assignment 2: Audit Planning and Control
It is common industry knowledge that an audit plan provides the specific guidelines auditors must follow when conducting an external audit. External public accounting firms conduct external audits to ensure outside stakeholders that the company’s financial statements are prepared in accordance with generally accepted accounting principles (GAAP) or International Financial Reporting Standards (IFRS) standards.
Use the Internet to select a public company that appeals to you. Imagine that you are a senior partner in a public accounting firm hired to complete an audit for the chosen public company.
Write a four to six (4-6) page paper in which you:
Outline the critical steps inherent in planning an audit and designing an effective audit program. Based upon the type of company selected, provide specific details of the actions that the company should undertake during planning and designing the audit program.
Examine at least two (2) performance ratios that you would use in order to determine which analytical tests to perform. Identify the accounts that you would test, and select at least three (3) analytical procedures that you would use in your audit.
Analyze the balance sheet and income statement of the company that you have selected, and outline your method for evidence collection which should include, but not be limited to, the type of evidence to collect and the manner in which you would determine the sufficiency of the evidence.
Discuss the audit risk model, and ascertain which sampling or non-sampling techniques you would use in order to establish your preliminary judgment about materiality. Justify your response.
Assuming that the end result is an unqualified audit report, outline the primary responsibilities of the audit firm after it issues the report in question.
Use at least two (2) quality academic resources in this assignment.
Note:
Wikipedia and other Websites do not qualify as academic resources.
Your assignment must follow these formatting requirements:
Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.
The specific course learning outcomes associated with this assignment are:
Plan and design a generalized audit program.
Determine the nature and extent of evidence accumulated to conduct an audit after considering the unique circumstances of an engagement.
Evaluate a company’s various risk factors and the related impact to the audit process.
Evaluate effective internal controls that minimize audit risk and potentially reduce the risk of fraud.
Use technology and information resources to r.
Assignment 2 American ConstitutionFollowing the Revolutionary War.docxBenitoSumpter862
Assignment 2: American Constitution
Following the Revolutionary War and separation from England, the need for a new government was clear. A group of men, who became known as the “nation’s founders” or Founding Fathers, developed a new government based on principles and beliefs they knew through their experiences, readings, and study. The Founding Fathers had a great deal in common with each other, including property interests, education, and extensive political experience. These common experiences and birthrights created a strong consensus about what should be incorporated into the government that would replace England’s.
Troubles developed immediately upon establishment of the United States of America with the 1781 Articles of Confederation and Perpetual Union. Economic difficulties and means of dividing power between leaders and competing interests caused conflict. The conflicts had to be resolved, and some of the Founding Fathers and others, who would come to be known as the Framers went to Philadelphia to revise the Articles of Confederation. However, it became apparent immediately that the Articles could not be revised, and therefore, they were abandoned, and the Framers set about to create a new form of government. Though the effort was eventually successful and resulted in the Constitution, there was a great deal of conflict during its development in the summer of 1787. The form of government established incorporated the ideas of diverse groups, as well as the Framers’ recognition of the need for compromise.
Research the history of the American Constitution using the Argosy University online library resources. Respond to
one
question from each of the question sets A and B.
A. Creating the Constitution
Consider the three constitutional proposals: the Virginia Plan, the New Jersey Plan, and the Great Compromise, also known as the Connecticut Compromise. If you were a delegate and without the experience of the past 200 years, which constitutional proposal would you have supported? Why?
Why do you think the framers were silent on the issue of slavery in the wording of the Constitution? What were the strengths and weaknesses of the Articles of Confederation?
What were the issues in the Constitutional Convention? Who were the Federalists and Anti-Federalists?
B. Living with the Constitution
What are the formal and informal methods of constitutional change?
How do checks and balances work in the lawmaking process today? Which current and important events do you think are examples of the success of checks and balances?
Do you think the Constitution is a relevant political document for the twenty-first century? What new amendments might be appropriate today?
Write your response to each in 150–200 words.
By
Saturday, February 4, 2017
, post your response to the appropriate
Discussion Area
. Through
Wednesday, February 8, 2017
, review and comment on at least three peers’ responses.
.
Assignment 2 A Crime in CentervaleWhile patrolling during his shi.docxBenitoSumpter862
Assignment 2: A Crime in Centervale
While patrolling during his shift, a Centervale police officer, Detective Johnson, saw two men standing on a street corner. Johnson observed the two proceed alternately back and forth between the street ahead and the corner, pausing and returning to conference. Detective Johnson found this strange as the Love's Jeweler shop was down the street. The two men repeated this ritual alternately three to four times, which appeared as if they were looking out for someone or were about to steal something. Detective Johnson saw a third man approach and handing something to one of the two men, which he stuffed into his pocket.
Detective Johnson approached the three men and identified himself as a policeman. He saw the man that stuffed the item in his pocket place his hand in his pocket again. Detective Johnson kept his eyes on the man and asked their names. Before they could answer, the detective turned the man around, patted down his outside clothing, and felt a hard object. The man objected saying, "Hey man, you can't do that. I have rights. I want my lawyer." Detective Johnson sneered, "Oh! you'll get your lawyer." Upon feeling the object, the officer removed his gun and asked the three to raise their hands and place them on the wall. The officer patted each man down and found a gun in the pocket of one man. He removed the jacket of another man and found a diamond ring in the inside pocket. The third man did not have anything in his pockets.
The three were taken to the police station and charged with grand theft and burglary. One of the men was also charged for carrying a concealed weapon. Detective Johnson ran the information concerning the gun and found that it matched the gun related to an aggravated battery and rape case from a year ago. The detective questioned Danny, the man who had the gun. At first, Danny did not want to say anything, but the detective continued questioning him. After three hours, Danny confessed to the aggravated battery and rape case. He denied being involved in the grand theft and burglary.
Danny had a first appearance in the court within three days, whereupon he is appointed an attorney but denied bail. Danny does not see his attorney until the next court appearance. The attorney asks what he wants to do and Danny said, "I want to fight it man." The attorney tells Danny, "That's not going to work; the DA is offering you a good deal if you plea." Over the objection of the victim in the court, the DA offers Danny probation if he testifies against the other two in the burglary case. The DA wants the other two to be sentenced to ten years in that case. While shaking his head, Danny pleads guilty above the cries of the victim. The DA asks the judge to hold off on sentencing until after he testifies in the other trial.
After Danny testifies against the other two defendants and they are sentenced to ten years, Danny goes back to the court. The judge, not agreeing with the deal, decides to sent.
Assignment 2 (RA 1) Analysis of Self-ImageIn this assignment, yo.docxBenitoSumpter862
Assignment 2: (RA 1): Analysis of Self-Image
In this assignment, you will identify and discuss factors that contribute to self-image during middle childhood and adolescence.
Write a 6-page research paper on factors influencing self-image during middle childhood and adolescence.
Tasks:
Conduct a review from professional literature—articles from peer-reviewed journals and relevant textbooks—on the factors influencing self-image during middle childhood and adolescence. Topics to consider include:
Family constellation
Risk and protective factors
Various aspects of cultural identity
Physical characteristics
Social interactions with peers
.
Assignment 1Write a 2-3 page outline describing the health to.docxBenitoSumpter862
Assignment
1:
Write a 2-3 page outline describing the health topic you’ve been assigned and develop a justification/rationale for an educational intervention.
Assignment
2:
Develop a graphic organizer for their topic.
The Graphic Organizer is intended to provide visual cues to enhance learning.
The graphic organizers should be included with your unit plan.
.
assignment 1The idea of living in a country where all policy sh.docxBenitoSumpter862
assignment 1
The idea of living in a country where “all policy shall be based on the weight of evidence” seems unreal for me. However this idea does not seems so crazy for Neil deGrasse Tyson, who believes this idea could work in a country. But could it really work?
The ‘Rationalia’ proposal is about that every idea need to be based on something. It means everything has to follow a process which is gathering data, observation, experimenting and having a conclusion. For a policy to get approved it needs to have the weight of evidence to support it, if it does not have it, then it will not get approve. I found it very interesting how white supremacy supported African slavery and how there was an effort to restricted the reproduction of other races. I feel like this would turn into a chaotic country because there are so many things that science cannot explain, scientist have theories only. Like most of the ancient civilization that had big constructions, ex: The Incas in Peru, there is no explanation for how the Machu Picchu ruins were constructed, or like the Pyramids in Egypt. As the scientist keep researching, new theories originate and no conclusion is made.
I do not think religion has all the answers also. Why were women not able to touch their husbands or feed their animals while menstruating? Why a women would be considered contaminated or not pure base on something as normal as menstruation. Or the idea of it is okay for men to have multiple wives but it was not okay for women to get married twice? I do believe that there is a God, but the idea of the men been superior in both science and religion makes me feel frustrated as a woman. It would be very difficult for a country to be ruled by science or by God only. I feel that there should always be a balance between science and religion, even though both want to compete with each other and have the ultimate opinion. There are somethings that I disagree with both of them. There is no need to keep fighting against each other, even the pope supported the scientific view of evolution, and as the article “Nonoverlapping Magisteria” by Stephen Jay Gould said “The Catholic Church had never opposed evolution and had no reason to do so”. For some people like me, science and religion go together.
assigment 2
In the first reading “Reflections on Rationalia” by Neil deGrasse Tyson, Tyson discusses an idea of developing a virtual world in which all its policies have to be founded based on evidence, meaning that the state would be undergoing constant research, forming a foundation for its government and how its citizens should think. Within the proposal for the new state, Tyson says that a great amount of funding will be given to the continued study of the human sciences, along with extensive training for the young to learn how to obtain, analyze and gather conclusions on data, and citizens would have the freedom to be irrational, simply no policies will be made with.
Assignment 1Recognizing the Role of Adhering to the Standar.docxBenitoSumpter862
Assignment 1:
Recognizing the Role of Adhering to the Standard of Care
When providing health care, there are standards of care which a reasonably prudent provider should follow. Providers at all levels are held to these standards of care. Failure to provide competent care to your patients will put you at risk for malpractice. Remaining current with the evidenced-based guidelines and providing optimal care will minimize the risk of liability.
For this Assignment, you will create a PowerPoint presentation that explains any legal implications that exist for failure to adhere to a standard of care, the key elements of malpractice, and compare the differences in malpractice policy options.
To prepare:
Consider the importance of using professional resources such as the National Guideline Clearinghouse to guide care delivered
Create a PowerPoint presentation no more than 15 slides in length that addresses the following:
Identify and explain any legal implications that exist for failure to adhere to a standard of care
Identify and explain the key elements of malpractice
Compare the differences in malpractice policy options
.
Assignment 1Argument MappingWrite a four to five (4-5.docxBenitoSumpter862
Assignment 1:
Argument Mapping
Write a four to five (4-5) page paper in which you:
(
Note:
Refer to Demonstration Exercise 3 located at the end of Chapter 1 for criteria 1-3.)
1.
Create an argument map based on the influence diagram presented in Case 1.3 and complete all the criteria provided in the exercise, beginning with this claim: “The U.S. should return to the 55- mph speed limit in order to conserve fuel and save lives.”
2.
Include in the map as many warrants, backings, objections, and rebuttals as possible.
3.
Assume that the original qualifier was
certainly;
indicate whether the qualifier changes as we move from a simple, static, uncontested argument to a complex, dynamic and contested argument.
(
Note:
Refer to Demonstration Exercise 3 located at the end of Chapter 8 for criterion 4.)
4.
Apply the argument mapping procedures presented in Chapter 8 to analyze the pros and cons (or strengths and weaknesses) of the recommendations that the United States should
not
intervene in the Balkans.
(
Note:
Refer to Demonstration Exercise 4 located at the end of Chapter 8 for criteria 5-7.)
Demonstration exercise 3 chapter 1
Create an argument map based on the influence diagram presented in Case 1.3. Begin with the following claim: “The United States should return to the 55 mph speed limit in order to conserve fuel and save lives.” Include in your map as many warrants, backings, objections, and rebuttals as you can. Assuming that the original qualifier was certainly, indicate whether the qualifier changes as we move from a simple, static, uncontested argument to a complex, dynamic, and contested argument
Influence diagram presented in case 1.3
CASE 1.3 THE INFLUENCE DIAGRAM AND DECISION TREE—STRUCTURING PROBLEMS OF ENERGY POLICY AND INTERNATIONAL SECURIY
Along with other policy-analytic methods discussed earlier in this chapter (Figure 1.1), the influence diagram and decision tree are useful tools for structuring policy problems.52 The influence diagram (Figure C1.3) displays the policy, the National Maximum Speed Limit, as a rectangle. A rectangle always refers to a policy choice or decision node, which in this case is the choice between adopting and not adopting the national maximum speed limit of 55 mph. To the right and above the decision node are uncertain events, represented as ovals, which are connected to the decision node with arrows showing how the speed limit affects or is affected by them. The rectangles with shaved corners represent valued policy outcomes or objectives. The objectives are to lower fuel consumption, reduce travel time, reduce injuries, and avert traffic fatalities. To the right of the objectives is another shaved rectangle, which designates the net benefits (benefits less costs) of the four objectives. The surprising result of using the influence diagram for problem structuring is the discovery of causally relevant economic events, such as the recession and unemployment, .
Assignment 121. Create a GUI application that contains textboxes.docxBenitoSumpter862
Assignment 12
1. Create a GUI application that contains
textboxes
for first name, last name and title. The app should also contain one button (with the text "Format!"). Once a user filles in textboxes and clicks the button the user-entered info should be displayed in a
label
formatted with one space between the title, first name, and last name.
2. Create a GUI higher/lower guessing game that lets a user guess a number between 1 and 111 (you can either randomly assign the secret number or hardcode it). Let the user enter his/her guess in a
textbox
then click a Submit button to submit his/her guess. If the guess is too low change the form color to YELLOW. If the guess is too high change the form color to BLUE. If the guess is correct change the form color to GREEN and display the number of guesses it took.
.
Assignment 1.3 Assignment 1.3 Article Review Read the article .docxBenitoSumpter862
Assignment 1.3
Assignment 1.3 Article Review
Read the article Social Service or Social Change, available in attachments. Review this article, using the Article Review format provided. Please note there are three sections of an article review.
The first is a brief summary of the article. The second, the Critique, is
about
your opinion of the information presented in the article, and the third, the Application, is about how you might use this information in the future. The Article Review template is located in attachments.
.
Assignment 1Answer the following questions concisely (no.docxBenitoSumpter862
Assignment 1
Answer the following questions concisely (no more than half a page per question)
1.
What is the National Prevention Strategy and who is responsible for it?
2. What are the differences among community health, population health, and global health?
3. Which federal department in the United States is the government’s principal agency for protecting the health of all Americans and for providing essential human services, especially to those who are least able to help themselves? What major services does this department provide?
4. How do state and local health departments interface?
5. What significance do you think Healthy People 2020 will have in the years ahead?
.
Assignment 1 Victims’ RightsThe death penalty is one of the mos.docxBenitoSumpter862
Assignment 1: Victims’ Rights
The death penalty is one of the most controversial topics in the criminal justice system. In the US criminal justice system, the government represents the victim. At the time of sentencing, many states allow victim impact statements. There are additional issues to consider in the application of the death penalty. Some of these issues are race, age, and cost.
Use the Argosy University Online Library resources to research the role of the victims in sentencing a defendant.
Submission Details:
By
June 28
, 2017
, post your responses to the following topics to this
Discussion Area
.
Discuss what you learned, focusing on such topics as racial disparity, juveniles, and victim impact statements. Be sure to cite your sources of information in the APA style.
Describe a specific case you learned about in the news where victims' rights figured prominently (either in a positive or in a negative way).
.
Assignment 1 Unreasonable Searches and SeizuresThe Fourth Amend.docxBenitoSumpter862
Assignment 1: Unreasonable Searches and Seizures
The Fourth Amendment to the US Constitution protects citizens' rights to be free from unreasonable governmental intrusion. The text of the amendment reads: "The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized."
There are many legal safeguards in place to ensure that police officers interfere with citizens' Fourth Amendment rights under limited circumstances. In Centervale, there have been several citizen complaints about Fourth Amendment violations by the local police department. The Centervale chief of police, Charles Draper, has determined that the behavior of some police officers reveals a lack of consistent understanding of the criminal justice concepts dealing with the Fourth Amendment prohibition against unreasonable searches and unreasonable seizures.
Submission Details:
By
Monday
, post to the
Discussion Area
your response to the following:
Explain what constitutes an unreasonable search or seizure.
Use examples to support your response.
Explain how the exclusionary rule and fruit of the poisonous tree apply.
.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
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International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
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How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
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11. Identifying the Elements of the Limitations & ImplicationsGo t
1. 11. Identifying the Elements of the Limitations & Implications
Go to the Limitations/Implications section(s) and identify the
limitations of the study and how those limitations impacted the
whole study.
12. Identifying the Elements of the Conclusion Section
Go to the Conclusion section and identify the conclusive
statements of the study and the recommendations made for
future research.
POST # 1 EDITHA
When assessing an adolescent with bipolar disorder, what are
some of the diagnostic and treatment challenges the clinician
might face?
Bipolar disorder is a serious mental health disorder that is often
first diagnosed during young adulthood or adolescence.
Symptoms of the illness, however, also can appear in early
childhood. Although once thought rare in children, diagnosis of
bipolar disorder in children has significantly increased over the
last decade (Papolos & Bronsteen, 2018). Despite the increased
diagnosis of bipolar disorder in children, assessment and
diagnosis remain challenging and controversial. This is, in part,
because of the lack of research on this disorder in children and
adolescents and the growing recognition that the disease can
present differently in children from how it presents in adults
(AACAP, 2019). Over the years, more attention has focused on
the unique presentation of bipolar disorder in the young that has
introduced new ways of looking at this disease and assessing it
in children.
The importance of identifying the presence of bipolar disease at
an early age is highlighted by data showing that adults in whom
2. bipolar disease started at an early age have a more severe course
of the illness compared with adult-onset disease. Early-onset
disease is associated with a higher risk of suicide; severe mood
lability and polarity; lower quality of life and greater functional
impairment; higher rates of comorbidity; and a higher risk of
substance use disorders compared with adult-onset disease
(Papolos & Bronsteen, 2018). Although some children meet the
criteria established for adults categorized in the DSM-5, many
children fall outside these classical categories, and diagnosis in
these children is particularly challenging and difficult (APA,
2013). For these children, additional information beyond what
is provided in the DSM may help make an accurate diagnosis
which causes increased challenges in assessment and diagnosis.
References
Papolos, D, & Bronsteen A. (2018) bipolar disorder in children:
assessment in general pediatric practice. Curr Opin Pediatr,
25(3):419-426.
American Academy of Child and Adolescent Psychiatry
(AACAP). (2019) bipolar disorder: Parents’ Medication Guide
for Bipolar Disorder in Children & Adolescents.
American Psychiatric Association (APA) (2013). Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
Washington, DC: American Psychiatric Association.
RESEARCH ARTICLE
Association of suicidal behavior with exposure
to suicide and suicide attempt: A systematic
3. review and multilevel meta-analysis
Nicole T. M. HillID
1,2*, Jo RobinsonID
1
, Jane Pirkis
3
, Karl AndriessenID
3
,
Karolina KrysinskaID
1
, Amber PayneID
1,4
, Alexandra Boland
1
, Alison ClarkeID
1
,
Allison Milner
5†
, Katrina Witt
1
, Stephan KrohnID
6,7‡
4. , Amit LampitID
6,7,8‡*
1 Orygen, Centre for Youth Mental Health, University of
Melbourne, Parkville, Victoria, Australia, 2 Telethon
Kids Institute, Perth, Western Australia, Australia, 3 Centre for
Mental Health, Melbourne School of
Population and Global Health, University of Melbourne,
Parkville, Victoria, Australia, 4 Northeastern
University, Boston, Massachusetts, United States of America, 5
Centre for Health Equity, School of
Population and Global Health, University of Melbourne,
Parkville, Victoria, Australia, 6 Department of
Neurology, Charité–Universitätsmedizin Berlin, Berlin,
Germany, 7 Berlin School of Mind and Brain,
Humboldt-Universität zu Berlin, Berlin, Germany, 8 Department
of Psychiatry, University of Melbourne,
Parkville, Victoria, Australia
† Deceased.
‡ These authors are joint senior authors on this work.
* [email protected] (NTMH); [email protected] (AL)
Abstract
Background
5. Exposure to suicidal behavior may be associated with increased
risk of suicide, suicide
attempt, and suicidal ideation and is a significant public heal th
problem. However, evidence
to date has not reliably distinguished between exposure to
suicide versus suicide attempt,
nor whether the risk differs across suicide-related outcomes,
which have markedly different
public health implications. Our aim therefore was to
quantitatively assess the independent
risk associated with exposure to suicide and suicide attempt on
suicide, suicide attempt,
and suicidal ideation outcomes and to identify moderators of
this risk using multilevel meta-
analysis.
Methods and findings
We systematically searched MEDLINE, Embase, PsycINFO,
CINAHL, ASSIA, Sociological
Abstracts, IBSS, and Social Services Abstracts from inception
to 19 November 2019. Eligi-
ble studies included comparative data on prior exposure to
suicide, suicide attempt, or sui-
cidal behavior (composite measure—suicide or suicide attempt)
6. and the outcomes of
suicide, suicide attempt, and suicidal ideation in relatives,
friends, and acquaintances.
Dichotomous events or odds ratios (ORs) of suicide, sui cide
attempt, and suicidal ideation
were analyzed using multilevel meta-analyses to accommodate
the non-independence of
effect sizes. We assessed study quality using the National Heart,
Lung, and Blood Institute
quality assessment tool for observational studies. Thirty-four
independent studies that pre-
sented 71 effect sizes (exposure to suicide: k = 42, from 22
independent studies; exposure
PLOS MEDICINE
PLOS Medicine | https://doi.org/10.1371/journal.pmed.1003074
March 31, 2020 1 / 27
a1111111111
a1111111111
a1111111111
a1111111111
a1111111111
OPEN ACCESS
7. Citation: Hill NTM, Robinson J, Pirkis J,
Andriessen K, Krysinska K, Payne A, et al. (2020)
Association of suicidal behavior with exposure to
suicide and suicide attempt: A systematic review
and multilevel meta-analysis. PLoS Med 17(3):
e1003074. https://doi.org/10.1371/journal.
pmed.1003074
Academic Editor: Vikram Patel, Harvard Medical
School, UNITED STATES
Received: August 12, 2019
Accepted: February 21, 2020
Published: March 31, 2020
Peer Review History: PLOS recognizes the
benefits of transparency in the peer review
process; therefore, we enable the publication of
all of the content of peer review and author
responses alongside final, published articles. The
editorial history of this article is available here:
10. odds of suicide (4 studies, N = 1,479; OR = 3.83, 95% CI = 2.38
to 6.17, P < 0.001) but not
suicide attempt (1 study, N = 666; OR = 1.10, 95% CI = 0.69 to
1.76, P = 0.90), a finding that
was inconsistent with the separate analyses of exposure to
suicide and suicide attempt. Key
limitations of this study include fair study quality and the
possibility of unmeasured confound-
ers influencing the findings. The review has been prospectively
registered with PROSPERO
(CRD42018104629).
Conclusions
The findings of this systematic review and meta-analysis
indicate that prior exposure to sui-
cide and prior exposure to suicide attempt in the general
population are associated with
increased odds of subsequent suicidal behavior, but these
exposures do not incur uniform
risk across the full range of suicide-related outcomes.
Therefore, future studies should
refrain from combining these exposures into single composite
measures of exposure to sui-
cidal behavior. Finally, future studies should consider designing
interventions that target sui-
11. cide-related outcomes in those exposed to suicide and that
include efforts to mitigate the
adverse effects of exposure to suicide attempt on subsequent
suicide attempt outcomes.
Author summary
Why was this study done?
• Exposure to suicidal behavior in others has been linked to
increased risk of suicidal
behavior, but it is not known whether the association differs
between types of exposure
(suicide versus suicide attempt) or different outcome measures
of suicidal thoughts and
behaviors.
• Distinguishing the relationships of different exposure types
with outcomes is important
for the development of targeted interventions and public health
approaches to suicide
prevention.
What did the researchers do and find?
• We conducted a systematic review and meta-analysis of 34
studies that investigated the
independent associations between exposure to different types of
12. suicidal behavior and
subsequent suicide, suicide attempt, and suicidal ideation
outcomes.
PLOS MEDICINE Association of suicidal behavior with
exposure to suicide and suicide attempt: A multilevel meta-
analysis
PLOS Medicine | https://doi.org/10.1371/journal.pmed.1003074
March 31, 2020 2 / 27
Information files. Summary data used in the
analyses are provided as S1 Data.
Funding: NH is a PhD student and was supported
by the Australian Rotary Health PhD Partnership
Scholarship (https://australianrotaryhealth.org.au).
JR was supported by a National Health and Medical
Research Council (NHMRC) Career Development
Fellowship (APP1142348, https://www.nhmrc.gov.
au). KA was supported by a NHMRC Early Career
Fellowship (APP1157796, https://www.nhmrc.gov.
au). AM was supported by a Victorian Health and
Medical Research Fellowship, Department of
13. Health and Human Services (https://www.vic.gov.
au). KW was supported by a post-doctoral
fellowship awarded by the American Foundation for
Suicide Prevention (PDF-0-145-16, https://afsp.
org). SK was supported by the German Federal
Ministry for Education and Research (BMBF grant
13GW0206D, https://www.bmbf.de). AL was
supported by a NHMRC-Australian Research
Council Dementia Research Development
Fellowship (APP1108520, https://www.nhmrc.gov.
au). The funders had no role in study design, data
collection and analysis, decision to publish, or
preparation of the manuscript.
Competing interests: The authors have declared
that no competing interests exist.
Abbreviations: OR, odds ratio.
https://doi.org/10.1371/journal.pmed.1003074
https://australianrotaryhealth.org.au
https://www.nhmrc.gov.au
https://www.nhmrc.gov.au
14. https://www.nhmrc.gov.au
https://www.nhmrc.gov.au
https://www.vic.gov.au
https://www.vic.gov.au
https://afsp.org
https://afsp.org
https://www.bmbf.de
https://www.nhmrc.gov.au
https://www.nhmrc.gov.au
• We showed that exposure to suicide is associated with
increased odds of both suicide
and suicide attempt, but found limited evidence of an
association with suicidal ideation.
Exposure to suicide attempt was associated with increased odds
of suicide attempt only.
• For exposure to suicide, degree of relationship (i.e., whether
the suicide exposure
occurred in a relative as compared to a friend or acquaintance)
did not materially affect
the magnitude of the association. The odds of suicidal behavior
(i.e., including
attempted suicide) were, however, greater when the exposure
occurred in a relative.
What do these findings mean?
• Exposure to suicide is associated with greater odds of suicide
and suicide attempt. Yet,
15. exposure to suicide attempt is associated with increased odds of
suicide attempt only.
• Researchers and public health practitioners should refrain
from combining suicide, sui-
cide attempt, and suicidal ideation into composite measures of
suicide exposures and
outcomes.
• We recommend that future public health policy include the
potential adverse effects of
exposure to suicide attempt.
Introduction
Suicide attempt and suicide are leading causes of global
morbidity and mortality. Approxi-
mately 800,000 people die by suicide annually [1], of which
about one-third are under the age
of 30 [2]. The prevalence of suicide attempt is significantly
greater than that of suicide death
and is associated with heightened risk of later death by suicide
[3,4] as well as psychosocial
adversities that persist later in life [5]. For every suicide death,
it is estimated that approxi-
mately 135 people are affected [6]. Over the course of a
lifetime, the proportion of people
16. exposed to the suicide of a relative, friend, or acquaintance is
approximately 21% [7]. Exposure
to suicide has been linked to increased risk of physical disease
and adverse mental health
including depression, posttraumatic stress disorder, and
complicated grief [8,9]. The deleteri-
ous effects associated with exposure to suicide may also render
some people, particularly ado-
lescents and young adults, at increased risk of suicide and
suicide attempt [10].
Combined, the large number of people exposed to suicide and
the potential increased risk
of suicide-related outcomes (suicide, suicide attempt, and
suicidal ideation) in others mean
that exposure to suicide is a significant public health concern
[1]. This is reflected in several
national suicide prevention strategies that recommend
postvention interventions for those
bereaved by suicide [11], as well as several international
frameworks for the prevention of sui-
cide-related contagion, and the management of suicide and self-
harm clusters [12–15]. These
public health strategies have largely focused on exposure to
suicide, despite a growing body of
17. evidence that suggests that exposure to suicide attempt, the
behavior most proximal to suicide,
may also be associated with increased risk of suicide-related
outcomes [16–19].
Distinguishing between the potential independent effects of
exposure to suicide and suicide
attempt is important since measures of morbidity and mortality
have markedly different pub-
lic health implications. Yet evidence regarding the independent
effects of exposure to suicide
and suicide attempt on subsequent suicide-related outcomes is
unclear. A systematic review
PLOS MEDICINE Association of suicidal behavior with
exposure to suicide and suicide attempt: A multilevel meta-
analysis
PLOS Medicine | https://doi.org/10.1371/journal.pmed.1003074
March 31, 2020 3 / 27
https://doi.org/10.1371/journal.pmed.1003074
and meta-analyses by Geulayov and colleagues [20] showed that
exposure to suicide and expo-
sure to suicide attempt of a parent were associated with
increased risk of suicide and suicide
attempt in offspring. However, the authors pooled mean effect
18. sizes across subgroups within
studies and did not take into account the dependencies between
effect sizes, an approach that
may distort the results of the meta-analyses [21]. Another
systematic review by Crepeau-Hob-
son and Leech [19] reported that both exposure to suicide and
exposure to suicide attempt
were associated with subsequent suicide-related behavior among
friends or acquaintances. But
the authors did not adequately control for studies that reported
lifetime prevalence, leaving the
causal direction between exposure to suicide attempt and
subsequent suicide-related outcomes
unclear.
Lack of guiding evidence has impeded translation of the
evidence into practice. For exam-
ple, it is not currently clear which populations may be at risk,
nor whether the risk differs
across outcomes involving suicide, suicide attempt, and suicidal
ideation. Sveen and Walby
[22] found inconclusive evidence supporting a relationship
between exposure to suicide and
increased risk of suicide-related behavior in others. However,
the authors combined studies
19. reporting exposure in relatives and friends or acquaintances,
which may incur different suicide
risk. More recently, systematic reviews that investigated
exposure to suicide in friends and
acquaintances have reported a positive association between
exposure to suicide and subse-
quent suicide-related outcomes [19,23]. Yet, as noted
previously, the causal direction between
exposure and outcome measures were confounded by the
inclusion of studies that reported
lifetime prevalence of exposure and outcome measures. Lastly,
some studies included outcome
measures that combined suicidal ideation with suicide attempt
[24,25] or combined exposure
to suicide and exposure to suicide attempt as a composite
measure of exposure to suicidal
behavior [26–28]. Composite measures of exposure to suicidal
behavior prevent us from iden-
tifying whether the observed effect is influenced by a true
association or the result of a cumula-
tive effect.
Consequently, the effects of prior exposure to suicide and
suicide attempt on suicide-related
20. outcomes have not been reliably quantified, and the factors that
moderate this risk are not cur-
rently known. We therefore aimed to conduct a systematic
review and multilevel meta-analysis
investigating the independent association between prior
exposure to suicide, suicide attempt,
and suicidal behavior (composite measure—suicide or suicide
attempt) and subsequent sui-
cide, suicide attempt, and suicidal ideation in relatives, friends,
and acquaintances. In doing
so, we aimed to quantify the association between exposure to
suicide and suicide attempt and
the full range of suicide-related outcomes, and to identify
whether factors such as relationship
to the person who engaged in the initial suicidal act, age of the
study population, and study
design characteristics moderate this risk. By using multilevel
meta-analyses, we were able to
account for dependencies among multiple effect sizes taken
from the same cohort within a
study, an extremely common and challenging aspect of
conducting meta-analyses of epidemi-
ological studies [29].
Methods
21. This work adheres to PRISMA (Preferred Reporting Items for
Systematic Reviews and Meta-
Analyses) [30] and MOOSE (Meta-analysis of Observational
Studies in Epidemiology) [31]
guidelines (S1 Text) and was prospectively registered with
PROSPERO (CRD42018104629).
Deviations from the protocol include the use of exposure to
suicidal behavior (composite) and
statistical analyses using multilevel meta-analyses. The
association between exposure to suicide
and suicide attempt and grief and mental health outcomes will
be reported in a separate sys-
tematic review and meta-analysis.
PLOS MEDICINE Association of suicidal behavior with
exposure to suicide and suicide attempt: A multilevel meta-
analysis
PLOS Medicine | https://doi.org/10.1371/journal.pmed.1003074
March 31, 2020 4 / 27
https://doi.org/10.1371/journal.pmed.1003074
Electronic search strategy
We searched MEDLINE, Embase, PsycINFO, Cumulative Index
to Nursing and Allied Health
22. Literature (CINAHL), Applied Social Sciences Index and
Abstracts (ASSIA), Sociological
Abstracts, International Bibliography of the Social Sciences
(IBSS), and Social Services
Abstracts from inception through 19 November 2019 for
observational studies examining the
effects of exposure to suicide, suicide attempt, or suicidal
behavior on 1 or more outcomes
relating to suicide, suicide attempt, or suicidal ideation. Search
terms relating to exposure to
suicide and suicide attempt as well suicide bereavement, suicide
contagion, and suicide clus-
ters were combined using Boolean logic (S2 Text). The search
was not limited by time, loca-
tion, year of publication, or language (articles written in a
language other than English were
translated using Google Translate). Additional articles were
identified by scanning the refer-
ence lists of included articles and previous reviews. One author
(NTMH) conducted the initial
search and screening of titles and abstracts. Three authors
independently screened the full text
of each potentially eligible article (NTMH, AB, KA, and KW).
Discrepancies were resolved by
23. the first author (NTMH), who also contacted the corresponding
authors of primary studies for
additional information.
Study selection and eligibility criteria
Eligible studies reported dichotomous events (both the exposure
and outcome were reported
as having occurred or not occurred, yielding a 2 × 2 matrix) or
odds ratios (ORs) for exposure
to suicide, suicide attempt, or suicidal behavior and subsequent
suicide, suicide attempt, or
suicidal ideation. Exposure to suicide, suicide attempt, or
suicidal behavior was determined
from self-reported measures, informant interviews, official
records (such as hospital admission
records), or data linkage to death certificates. Outcomes
involving suicide, suicide attempt, or
suicidal ideation were determined from self-reported measures,
informant interviews, or offi-
cial records, such as death certificates, coroner reports, or
hospital admission records. Cohort,
case–control, and cross-sectional study designs were eligible if
the study was reported in a
peer-reviewed journal and the temporal sequence between the
exposure and outcome was
24. specified. For cross-sectional studies, the temporal sequence
between exposure and outcome
was established if the outcome measurement occurred after the
exposure (e.g., the study asked
participants if they had made a suicide attempt after exposure to
the suicide of another). Par-
ticipants of any age who were exposed to prior suicide or
suicide attempt were eligible if the
sample was mainly, or solely, drawn from the general
population, as opposed to a clinical or
other high-risk population (e.g., inpatients or prison detainees).
Eligible control groups
included individuals who did not report prior exposure to
suicide, suicide attempt, or suicidal
behavior in others.
Studies were excluded if findings from a non-exposed (control)
group were not reported,
or the control group was composed of participants exposed to
other modes of death (e.g., acci-
dent or natural causes). Studies that reported estimates of
lifetime prevalence as well as studies
that did not establish the temporal sequence between exposure
and suicide-related outcomes
(e.g., the study reported 12-month prevalence of the outcome,
25. but prior exposure to suicide
was not indicated) were excluded. Finally, studies that reported
outcomes following exposure
to media reports of suicide (including fictional and non-
fictional portrayals) or non-suicidal
self-injury were excluded.
Data collection and coding
Two independent reviewers (NTMH and KK) extracted data
using a standardized data collec-
tion form. A description of the a priori moderators of risk
included in the study are presented
PLOS MEDICINE Association of suicidal behavior with
exposure to suicide and suicide attempt: A multilevel meta-
analysis
PLOS Medicine | https://doi.org/10.1371/journal.pmed.1003074
March 31, 2020 5 / 27
https://doi.org/10.1371/journal.pmed.1003074
in S1 Table. Dichotomous data were favored over ORs. When
dichotomous events were not
available, unadjusted ORs were recorded. For studies with
multiple follow-up time points,
only data from the longest time point were extracted [32].
Studies that included participants
26. from the same population during overlapping time periods (e.g.,
nationwide data registry stud-
ies that reported suicide deaths from overlapping time periods)
were included only if the stud-
ies reported different relationships (e.g., relatives and friends
and acquaintances) or different
suicide-related outcomes. When studies combined measures of
exposure to the suicide of a rel-
ative or friend, we contacted primary authors for disaggregated
data. If these data were not
available, the relationship between the exposed individual and
the individual(s) who engaged
in suicidal behavior was determined by a majority rule (the
relationship that occurred most
frequently as indicated in >50% of the total sample). Similarly,
if the age of participants
included a combination of youths and adults, the age of the
population was categorized in
favor of the age group that exceeded 50% of the overall
population. Study-level data are pro-
vided as S1 Data.
Multilevel meta-analysis rationale and data analysis
Since 16/34 (47%) studies reported multiple exposure and/or
27. outcome measures in the same
sample of participants, the assumption of independent estimates
for a traditional meta-analysis
was not met. We therefore used a 3-level meta-analysis, which
parallels traditional random
effects meta-analyses. The main difference is that dependent
effect sizes (due to multiple sub-
groups or outcome measures within studies) are nested within
studies (level 2) before these are
pooled across studies (level 3). Thus, t2
ð2Þ
is the variance within studies while t2
ð3Þ
is the variance
between studies. This approach allows for the investigation of
heterogeneity not only between
but also within studies [33]. For clarity, we use the general term
“multilevel” throughout to
describe our analyses.
We conducted a multilevel meta-analysis with the maximum
likelihood estimation method
using the metaSEM package [34] for R version 3.6.0. For the
main analysis, we used dichoto-
28. mous event data to calculate the pooled OR with the
accompanying 95% confidence interval
(CI) for risk of suicide, suicide attempt, and suicidal ideation
within exposed and non-exposed
individuals. When event data were not available, we used
unadjusted ORs. Meta-analyses were
conducted separately for exposure to suicide, suicide attempt,
and suicidal behavior. Heteroge-
neity was quantified as variance in true effects within (t2
ð2Þ
) and between (t2
ð3Þ
) studies. We also
report the I2 statistic, which represents the proportion of
variance in true effects out of total
variance for each level (i.e., I2
ð2Þ
and I2
ð3Þ
), along with its 95% confidence interval. Maximum
likelihood mixed-effects analyses were used to examine effect
moderators via subgroup analy-
sis and to explain heterogeneity (quantified as R2) for each
level. Since the multilevel model
does not provide study-level effect estimates, forest plots
29. present the mean OR of each study
but report the pooled 3-level estimate. Small study effect
(“publication bias”) was assessed by
visually inspecting funnel plots of mean log ORs against
standard error for asymmetry [35].
When at least 10 studies were available for analysis, we
formally assessed funnel plot asymme-
try using a multilevel analogue of Egger’s test of the intercepts
[36].
Risk of bias and quality assessment
Study quality was assessed using the National Heart, Lung, and
Blood Institute quality assess-
ment tool for observational studies [37]. The original tool
contains 14 criteria that determine
potential sources of bias in the study population and selection
of participants, outcome and
exposure measurement, blinding, confounding, and attrition. An
overall rating of “good,”
PLOS MEDICINE Association of suicidal behavior with
exposure to suicide and suicide attempt: A multilevel meta-
analysis
PLOS Medicine | https://doi.org/10.1371/journal.pmed.1003074
March 31, 2020 6 / 27
https://doi.org/10.1371/journal.pmed.1003074
30. “fair,” or “poor” was provided for each independent study.
Three independent reviewers con-
ducted assessments (NTMH, AP, and AC), and any
discrepancies were settled through discus-
sion and finalized by the primary author (NTMH).
Results
Study selection
The initial search identified 21,868 records, of which 8,320
were duplicates. A total of 13,548
records were screened based on title and abstract (Fig 1). The
full-text versions of 760 records
were assessed, 10 of which were obtained from searching the
reference lists of existing reviews.
The authors of 6 studies were contacted [38–43], and
information or additional data provided
for 2 studies [39,41]. A total of 167 records reported outcomes
relating to suicide, suicide
attempt, or suicidal ideation. Of these, 73 articles reported
lifetime prevalence estimates, 35
studies involved overlapping populations or superseded time
points, and 2 studies did not
report ORs or accompanying effect sizes: These articles were
31. therefore excluded from the meta-
analysis. One study [44] was excluded because it reported an
OR of 36.4, and 1 study [45] was
excluded because it reported an OR of 18; both studies were
prone to artifacts introduced by
quasi-separation (S2 Table; S3 Text). The final dataset included
34 independent studies, which
comprised 71 effect sizes (exposure to suicide: k = 42 across n
= 22 studies; exposure to suicide
attempt: k = 19 across n = 13 studies; exposure to suicidal
behavior: k = 10 across n = 5 studies).
Characteristics of studies
Thirty-four studies were included in the meta-analysis (N =
13,923,029; Table 1). In terms of
exposure to suicide, 22 studies (N = 13,607,708) provided a
total of 42 effect sizes for suicide (k
= 24), suicide attempt (k = 15), and suicidal ideation (k = 3).
For exposure to suicide attempt,
13 studies (N = 342,516) provided a total of 19 effect sizes for
suicide (k = 3) and suicide
attempt (k = 16). For exposure to suicidal behavior (composite
measure—suicide or suicide
attempt), 5 studies (N = 2,145) provided a total of 10 effect
sizes for suicide (k = 7) and suicide
attempt (k = 3). Studies were from a range of geographic
settings including Australia/New Zea-
land [46–48], North America [16,18,28,49–57], Europe
[17,41,58–63], East Asia [26,27,64–69],
the Middle East [39,42], and South America [70]. Overall,
32. 20/34 studies involved youths aged
25 years or less. Overall exposure was determined by informant
interviews in 14/34 (41%)
studies, self-report measures in 12/34 (35%) studies, and
official death records in 8/34 (24%)
studies. A total of 6/34 (18%) studies reported separate effect
sizes for exposure to suicide and
exposure to suicide attempt, and 5/34 (15%) studies reported
effect sizes for both exposure in
relatives and exposure in friends. In terms of outcome
measurements, most studies (23/34,
68%) used official hospital admission or death records,
followed by self-report measures (10/
34, 29%) and informant interviews (1/34, 3%). One study (1/34,
3%) reported outcomes for
both suicide attempt and suicidal ideation following exposure to
suicide. No studies reported
suicidal ideation outcomes following exposure to suicide
attempt or suicidal behavior. Lastly, 3
studies included exposure and outcome measurements of
deliberate self-harm, irrespective of
intent [48,59,62]. The remaining studies did not define suicide
attempt [16,18,42,52,54,57,
59,70], or defined suicide attempt as an act involving explicit
33. intent to die [16,17,28,39,47,49–
51,53,56,64].
Study quality
Studies were most commonly rated fair (13/34) and good
(13/34), followed by poor (8/34; S3
Table). The 13 good-quality studies tended to comprise cohort
or case–control study designs
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analysis
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https://doi.org/10.1371/journal.pmed.1003074
and had clearly defined and valid exposure and outcome
measures that were verified using
official hospital or death records. The 8 studies that were rated
poor tended to combine
Fig 1. Flowchart of included studies.
https://doi.org/10.1371/journal.pmed.1003074.g001
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exposure to suicide and suicide attempt: A multilevel meta-
analysis
34. PLOS Medicine | https://doi.org/10.1371/journal.pmed.1003074
March 31, 2020 8 / 27
https://doi.org/10.1371/journal.pmed.1003074.g001
https://doi.org/10.1371/journal.pmed.1003074
Table 1. Characteristics of included studies.
Study, location,
study design
Exposed
population, mean
age or age range
(years), percent
female, total sample
size
Exposure Definition of exposure Outcome(s) Definition of
outcome(s) Exposure ascertainment Study
quality
Agerbo 2003 [58],
Denmark, case–
control
35. Adult
b
, age
range = 9–44,
24.52% female, N =
4,444,297
Suicide of relative (any
relative)
a
Official records: Cause of
death register. Exposure(s)
determined by ICD codes for
suicide and self-inflicted
injury (ICD-8/9: E950–E959),
intentional self-harm (ICD-
10: X60–X84), and sequelae
of intentional self-harm
(ICD-10: Y870).
Suicide Official death records: Cause
of death register. Outcome(s)
36. determined by ICD codes for
suicide and self-inflicted
injury (ICD-8/9: E950–E959),
intentional self-harm (ICD-
10: X60–X84), and sequelae
of intentional self-harm
(ICD-10: Y870).
The outcome occurred after
the date of the exposure
determined through data
linkage.
Good
Almeida 2012 [46],
Australia, cross-
sectional
Adult, mean
age = 70.5, age
range = 60–101,
37. 58.7% female, N =
21,290
Suicide of relative (first-
degree relative)
b
Self-report: Participants were
asked if any immediate family
member had died by suicide.
Suicidal
ideation
Self-report: Participants
completed the Depressive
Symptom Inventory
Suicidality Subscale.
Determined by current
suicidal ideation (persistent
over the last 2 weeks).
Exposure occurred at least 2
months prior.
38. Good
Brent 1996a [51],
US, cohort
Youth, mean
age = 20.8, 46.6%
female, N = 341
Suicide of friend or
acquaintance
Informant: Suicide death in
the family.
Suicide
attempt
Self-report: Participants were
asked if they have engaged in
deliberate self-harm with
intent to die.
New onset of suicide
attempt since exposure.
39. Good
Brent 1996b [50],
US, cohort
Youth, mean
age = 20.2, 50%
female, N = 44
Suicide of relative
(sibling)
Self-report: Suicide death in
the family.
Suicide
attempt
Self-report: Participants were
asked if they have engaged in
deliberate self-harm with
intent to die.
New onset of suicide
attempt since exposure.
40. Good
Christiansen 2011
[59], Denmark,
case–control
Youth, mean
age = 17.49, 78.75%
female, N = 69,649
Suicide of relative
(parent)
Official records: Exposure(s)
determined by ICD codes for
suicide and self-inflicted
injury (ICD-8/9: E950–E959)
and intentional self-harm
(ICD-10: X60–X84).
Suicide
attempt
Hospital admission records:
41. Outcome(s) determined by
ICD codes for suicide and
self-inflicted injury (ICD-8/9:
E950–E959), intentional self-
harm (ICD-10: X60–X84),
self-poisoning event of
undetermined intent (ICD-
10: Y10–Y34), injury of
muscle and tendon at neck
level (ICD-10: S617–S619),
sequelae of poisoning by
drugs, medicaments and
biological substances (ICD-
10: T36–T60), and toxic effect
of unspecified substance
(ICD-10: T65).
The outcome occurred after
the date of the exposure
42. determined through data
linkage.
Good
Gravseth 2010 [61],
Norway, cohort
Adult
b
, age
range = 19–37,
48.82% female, N =
610,359
Suicide of relative
(parent)
Official records: Exposure(s)
determined by ICD codes for
suicide and self-inflicted
injury (ICD-8/9: E950–E959)
and intentional self-harm
ICD-10: (X60–X84).
Suicide Official death records:
43. Outcome(s) determined by
ICD codes for suicide and
self-inflicted injury (ICD-9:
E950–E959) and intentional
self-harm (ICD-10: X60–
X84).
The outcome occurred after
the date of the exposure
determined through data
linkage.
Good
Giupponi 2018 [41],
Italy, case–control
a
Adult, mean
age = 48.25, 38.16%
female, N = 262
Suicide of relative (any
44. relative)
Informant: Participants were
asked if there was a history of
suicide in the family.
Informed by at least 2 people
including relatives or close
friends.
Suicide Official death records: Cause
of death hospital forensic
post-mortem records.
Psychological autopsy—
suicide occurred after
exposure.
Fair
Lee 2018 [66],
Taiwan, cohort
Youth, 63.4% aged
<17, 47.75% female,
45. N = 438,330
Suicide of relative
(parent)
Official records: Taiwan
death registry. Exposure(s)
determined by ICD codes for
suicide and self-inflicted
injury (ICD-8/9: E950–E959),
intentional self-harm (ICD-
10: X60–X84), and sequelae
of intentional self-harm
(ICD-10: Y870).
Suicide Official death records:
Taiwan death registry.
Outcome(s) determined by
ICD codes for suicide and
self-inflicted injury (ICD-8/9:
E950–E959), intentional self-
46. harm (ICD-10: X60–X84),
and sequelae of intentional
self-harm (ICD-10: Y870).
The outcome occurred after
the date of the exposure
determined through data
linkage.
Good
(Continued)
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analysis
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https://doi.org/10.1371/journal.pmed.1003074
Table 1. (Continued )
Study, location,
study design
Exposed
47. population, mean
age or age range
(years), percent
female, total sample
size
Exposure Definition of exposure Outcome(s) Definition of
outcome(s) Exposure ascertainment Study
quality
Liu 2019 [67],
China, case–
control
a
Adult, mean
age = 60.87, 43.15%
female, N = 380
Suicide of relative (any
relative)
Informant: Informants were
asked if there was a history of
48. suicide in the family.
Informed by at least 1 relative
or close friend.
Suicide Official death records: Center
for Disease Control and
Prevention records of suicide.
Psychological autopsy—
suicide occurred after
exposure.
Fair
Conner 2007 [64],
China, case–control
Adult
b
, age range
<18 to 55+ (64%
aged <35), 76%
female, N = 554
Suicide of friend or
49. acquaintance
c
Self-report: Participants were
asked if there was a history of
suicide in an associate or
relative.
Suicide
attempt
Hospital admission records:
Hospital admission for
intentional suicide attempt.
All participants were
hospitalized for suicide
attempt at the time that
prior exposure was
measured.
Fair
Foster 1999 [60],
Ireland, case–
50. control
a
Adult
b
, age range
<20 to 79 (32%
aged <29), 28.2%
female, N = 230
Suicide of relative (any
relative)
Informant: Informants were
asked if there was a family
history of suicide. Informants
not indicated but were
“bereaved” by suicide.
Suicide Official death records:
Coroner-determined suicide
death.
Psychological autopsy—
51. suicide occurred after
exposure.
Fair
Gray 2014 [55], US,
case–control
a
Adult, mean
age = 39.9, 32.5%
female, N = 423
Suicide of relative (any
relative)
Informant: Informants were
asked if there was a family
history of suicide. Informed
by next of kin.
Suicide Official death records: Cause
of death register, Utah Office
of the Medical Examiner.
Psychological autopsy—
52. suicide occurred after
exposure.
Fair
Katibeh 2018 [42],
Iran, case–control
Youth, mean
age = 15.5, age
range � 18, percent
female not reported,
N = 300
Suicide of relative
(parent)
Self-report: Participants were
asked if there was a history of
suicide in their parents.
Suicide
attempt
Hospital admission records:
53. Hospital admission records
for suicide attempt.
All participants were
hospitalized for suicide
attempt at the time that
prior exposure was
measured.
Poor
Swanson & Colman
2013 [57], Canada,
cohort (cross-
sectional analyses)
Youth, age
range = 12–15,
50.1% female, N =
22,064
Suicide of friend or
acquaintance
54. Self-report: Participants were
asked whether anyone in
their school had died by
suicide (schoolmate’s suicide)
and whether they personally
knew anyone who had died
by suicide.
Suicide
attempt
and suicidal
ideation
Self-report (suicide attempt):
Participants were asked to
report the number of suicide
attempts they had made in
the past year, and participants
were asked if they had
seriously considered
55. attempting suicide in the past
year.
Prior exposure measured at
baseline, and subsequent
suicide attempt was based
on participants who
reported having made a
suicide attempt within the
2-year follow-up period.
Fair
Tidemalm 2011
[63], Sweden, case–
control
Adult
b
, population-
based study (all
ages), age/sex not
reported, N =
7,969,645
56. Suicide of relative
(sibling, parent, or
spouse)
Official records: Cause of
death register. Exposure(s)
determined by ICD codes for
suicide and self-inflicted
injury (ICD-8/9: E950–E959),
intentional self-harm (ICD-
10: X60–X84), and sequelae
of intentional self-harm
(ICD-10: Y870).
Suicide Official death records: Cause
of death register. Outcome(s)
determined by ICD codes for
suicide and self-inflicted
injury (ICD-8/9: E950–E959),
intentional self-harm (ICD-
57. 10: X60–X84), and sequelae
of intentional self-harm
(ICD-10: Y870).
The outcome occurred after
the date of the exposure.
Good
Vijayakumar 1999
[69], India, case–
control
a
Adult
b
, age
range = 15 to 60+
(48.5% aged �24),
45.0% female, N =
200
Suicide relative (any
relative)
Informant: Informants were
58. asked if there was a history of
completed suicide in the
family. Informed by family
members.
Suicide Official death records:
Coroner-determined suicide
death.
Psychological autopsy—
suicide occurred after
exposure.
Fair
Brent 2015 [49], US,
cohort
Youth, mean
age = 17.7, 48.1%
female, N = 42
Suicide attempt of
relative (parent)
59. Informant: Informants were
asked if a family member had
made a suicide attempt,
defined as a self-destructive
act that resulted in potential
or actual tissue damage with
inferred or explicit intent to
die. Informed by parents of
cases and controls.
Suicide
attempt
Self-report: Participants were
asked if they had made a
suicide attempt, defined as a
self-destructive act that
resulted in potential or actual
tissue damage with inferred
or explicit intent to die.
60. Number of new events of
suicide attempt during
5-year follow-up period.
Good
(Continued)
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Table 1. (Continued )
Study, location,
study design
Exposed
population, mean
age or age range
(years), percent
female, total sample
61. size
Exposure Definition of exposure Outcome(s) Definition of
outcome(s) Exposure ascertainment Study
quality
Gould 1996 [54],
US, case–control
a
Youth, age
range � 18, 20.1%
female, N = 267
Suicide attempt of
relative (parent)
Informant: Informants were
asked if there was a history of
first- and second-degree
relatives who died by suicide
or made a suicide attempt.
Informed by parents or other
adult who lived with the
62. deceased.
Suicide Official death records:
Coroner-determined suicide
death.
Psychological autopsy—
suicide occurred after
exposure.
Fair
Hu 2017 [48],
Australia, case–
control
Youth, age
range = 10–19,
62.4% female, N =
150,171
Suicide attempt of
relative (parent)
Official records: Data linkage
63. records for admission to
hospital for deliberate self-
harm.
Suicide
attempt
Hospital admission records:
Outcome(s) determined by
ICD codes for suicide and
self-inflicted injury (ICD-8/9:
E950–E959), injury
undetermined whether
accidentally or purposely
inflicted (ICD-8/9: E980–
E989), intentional self-harm
(ICD-10: X60–X84), and
sequelae of intentional self-
harm (ICD-10: Y870).
The outcome occurred after
64. the date of the exposure
determined through data
linkage.
Good
Lewinsohn 1994
[56], US, cohort
Youth, mean
age = 16.5, age
range = 14–18, 54%
female, N = 1,508
Suicide attempt of
friend or acquaintance
Self-report: Participants were
asked if they knew a friend
who had attempted suicide.
Suicide
attempt
Self-report: Participants were
65. asked if they have made an
attempt to kill themselves.
Prior exposure measured at
baseline, and subsequent
suicide attempt was based
on participants who
reported having made a
suicide attempt within the
1-year follow-up period.
Good
Mittendorfer-Rutz
2008 [62], Sweden,
case–control
Youth, mean
age = 19.1, 66.9%
female, N = 158,840
Suicide attempt of
relative (first-degree
66. relative)
Official records: Hospital
admissions inpatient care
register. Exposure(s)
determined by ICD codes for
suicide and self-inflicted
injury (ICD-8/9: E950–E959),
injury undetermined whether
accidentally or purposely
inflicted (ICD-8/9: E980–
E989), intentional self-harm
(ICD-10: X60–X84), and
sequelae of intentional self-
harm (ICD-10: Y870).
Suicide
attempt
Hospital admission records:
Outcome(s) determined by
67. ICD codes for suicide and
self-inflicted injury (ICD-8/9:
E950–E959), injury
undetermined whether
accidentally or purposely
inflicted (ICD-8/9: E980–
E989), intentional self-harm
(ICD-10: X60–X84), and
sequelae of intentional self-
harm (ICD-10: Y870).
All participants were
hospitalized for deliberate
self-harm at the time that
prior exposure was
measured.
Good
Nrugham 2008 [17],
Norway, cohort
68. Youth, mean
age = 14.9, age
range = 15–20,
50.8% female, N =
265
Suicide attempt of
friend or acquaintance
Self-report: Participants were
asked if they knew a friend
who had attempted suicide.
Suicide
attempt
Self-report: Participants were
asked if they have ever tried
to intentionally commit
suicide.
Prior exposure measured at
baseline, and subsequent
suicide attempt was based
69. on participants who
reported having made a
suicide attempt within the
1-year follow-up period.
Poor
Hishinuma 2018
[16], US, cohort
Youth, age
range = 13–21, 54%
female, N = 2,083
Suicide attempt of
relative (any relative)
and suicide attempt of
friend or acquaintance
Self-report: Participants were
asked if a family member or
friend had tried to commit
suicide.
70. Suicide
attempt
Self-report: Participants were
asked if they had tried to
commit suicide in the past 6
months (Major Life Events
Scale).
Prior exposure measured at
baseline, and subsequent
suicide attempt was based
on participants who
reported having made a
suicide attempt during the
5-year follow-up period.
Good
Ahmadi 2015 [39],
Iran, case–control
Youth, mean
71. age = 29 (60% aged
�25), 76.0% female,
N = 453
Suicide of relative (first
and second degree) and
suicide attempt of
relative (first and
second degree)
Self-report: Suicide history in
family and sibling, and
parent’s history of suicide
attempt.
Suicide
attempt
Hospital admission records:
Hospital admission for
deliberate self-inflicted
immolation with suicide
72. intent.
All participants were
hospitalized for suicide
attempt at the time that
prior exposure was
measured.
Fair
(Continued)
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analysis
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Table 1. (Continued )
Study, location,
study design
Exposed
population, mean
73. age or age range
(years), percent
female, total sample
size
Exposure Definition of exposure Outcome(s) Definition of
outcome(s) Exposure ascertainment Study
quality
Chachamovich 2015
[52], Canada, case–
control
a
Youth, mean
age = 23.4
d
age
range = 1–25, 7.5%
female, N = 240
Suicide of relative (any
relative); suicide
74. attempt of relative (any
relative)
Informant: Informants were
asked if there was a history of
suicide completion or suicide
attempt in family. Informed
by spouses, parents, or close
friends of the deceased.
Suicide Official death records:
Coroner-determined suicide
death.
Psychological autopsy—
suicide occurred after
exposure.
Fair
Chan 2018 [47],
New Zealand, cross-
sectional
75. Youth, age
range = 13–19
(98.7% aged �17),
54.3% female, N =
8,497
Suicide of relative (any
relative) and friend or
acquaintance; suicide
attempt of relative (any
relative) and friend or
acquaintance
Self-report: Participants were
asked if there was a history of
suicide among their family or
friends. For exposure to
suicide attempt, participants
were asked if anyone in their
family or friends ever tried to
kill themselves (attempted
76. suicide?).
Suicidal
ideation
Self-report: Participants were
asked if they have made an
attempt to kill themselves.
Exposure occurred >1 year
ago, but ideation based on
symptoms in the past year.
Fair
Garfinkel 1982 [53],
Canada, case–
control
Youth, mean
age = 15.2, age
range = 6–21, 75.4%
female, N = 1,010
Suicide of relative
77. (parent); suicide
attempt of relative
(parent)
Official records: Chart review
of family history of suicide
attempts or suicide
(completed suicide).
Suicide
attempt
Hospital admission records:
Hospital admission for
suicide attempt with a
conscious intent to die.
All participants were
hospitalized for suicide
attempt at the time that
prior exposure was
measured.
78. Poor
Palacio 2007 [70],
Colombia, case–
control
a
Adult
b
, median
age = 29, 19.4%
female, N = 216
Suicide of relative (any
relative); suicide
attempt of relative (any
relative)
Informant: Informants were
asked if there was a history of
suicide or suicide attempt in
the family. Informed by
relatives and medical
79. documents.
Suicide Official death records:
Medical legal records of
suicide cause of death.
Psychological autopsy—
suicide occurred after
exposure.
Poor
Thompson 2011
[18], US, cohort
Youth, mean
age = 15.5, age
range = 11–21,
49.1% female, N =
18,924
Suicide of relative (any
relative)
a
and friend or
80. acquaintance; suicide
attempt of relative (any
relative)
a
and friend or
acquaintance
Self-report: Participants were
asked if a friend or family
member had died by suicide.
For exposure to suicide
attempt, participants were
asked if a friend or family
member had made a suicide
attempt.
Suicide
attempt
Self-report: Participants were
asked whether they had
attempted suicide within the
81. 12 months before the survey.
Prior exposure measured at
baseline, and subsequent
suicide attempt was based
on participants who
reported having made a
suicide attempt during wave
III (7 years later).
Fair
Phillips 2002 [68],
China, case–
control
a
Adult
b
, age
range = 10 to 75+
(70% aged �30),
52% female, N =
1,055
82. Suicidal behavior
(composite) of relative
(any relative)
Informant: Informants were
asked if there was a family
history of suicidal behavior
(suicide attempts or suicide).
Informed by family members
of the deceased or close
associates.
Suicide Official death records:
Medical legal records of
suicide cause of death.
Psychological autopsy—
suicide occurred after
exposure.
Poor
Cheng 2000 [26],
83. Taiwan, case–
control
a
Adult
b
, mean
age = 43.9, age
range = 15–60,
39.8% female, N =
339
Suicidal behavior
(composite) of relative
(any relative)
Informant: Informants were
asked if there was a family
history of suicidal behavior
(suicide attempts or suicide).
Informed by family members
of the deceased.
Suicide Official death records: Suicide
84. as determined by prosecutor
and coroner reports.
Psychological autopsy—
suicide occurred after
exposure.
Poor
Maniam 1994 [27],
US, case–control
a
Adult
b
, mean
age = 28.5, age
range = 11–75, 50%
female, N = 40
Suicidal behavior
(composite) of relative
(any relative)
Informant: Informants were
85. asked if there was a family
history of suicidal behavior
(suicide attempts or suicide).
Informed by parents, spouses,
or other adults who lived with
the deceased.
Suicide Official death records:
Medical legal records of
suicide cause of death.
Psychological autopsy—
suicide occurred after
exposure.
Poor
Jollant 2014 [65],
US, case–control
a
Youth, age
range = 15–64
(56.25% aged �24),
86. 25% female, N = 45
Suicidal behavior
(composite) of relative
(any relative)
Informant: Informants were
asked if there was a family
history of suicidal behavior
(suicide attempts or suicide).
Informed by members of the
community who knew the
deceased.
Suicide Informant: Suicide death
reported by informants.
Psychological autopsy—
suicide occurred after
exposure.
Poor
(Continued)
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analysis
PLOS Medicine | https://doi.org/10.1371/journal.pmed.1003074
March 31, 2020 12 / 27
https://doi.org/10.1371/journal.pmed.1003074
exposure to suicide and suicide attempt into a composite
measure of exposure to suicidal
behavior, did not provide adequate definitions of exposure to
suicide or suicide attempt, and
did not provide information on case ascertainment for suicide-
related outcomes.
Results of the multilevel meta-analysis
Exposure to suicide. Across 42 effect sizes from 22 studies,
exposure to suicide was associated
with 2.94-fold (95% CI = 2.30 to 3.75, P < 0.001; Fig 2)
increased odds of suicidal behavior
(suicide or suicide attempt). Heterogeneity within and between
studies was comparable (t2
ð2Þ
=
0.13, I2
ð2Þ
88. = 47%, 95% CI 15% to 94%; t2
ð3Þ
= 0.132, I2
ð3Þ
= 48%, 95% CI 1% to 81%). The funnel
plot revealed evidence of asymmetry, which may indicate
evidence of small study effect
(Egger’s intercept = 0.675, 1-tailed P = 0.06; S1 Fig). Results
from the subgroup analysis
showed that exposure to suicide was associated with increased
odds of suicide (k = 24,
OR = 3.23, 95% CI = 2.32 to 4.51, P < 0.001) and suicide
attempt (k = 15, OR = 2.91, 95%
CI = 2.01 to 4.23, P < 0.001). However, there was no evidence
of an association with suicidal
ideation (k = 3, OR = 1.85, 95% CI = 0.97 to 3.51, P = 0.06; Q
between subgroups = 2.22,
df = 2, P = 0.33, R2
ð2Þ
= 11.8%, R2
ð3Þ
= 0%). The odds of later suicidal behavior were comparable
when the exposure to suicide occurred in relatives (k = 34, OR
= 3.07, 95% CI = 2.35 to 4.01)
and friends and acquaintances (k = 8, OR = 2.42, 95% CI = 1.50
to 3.91; Q = 0.77, df = 1, P =
0.38, R2
ð2Þ
89. = 0%, R2
ð3Þ
= 2.7%). No further significant moderators relating to study
design charac-
teristics were identified (Table 2).
Table 1. (Continued )
Study, location,
study design
Exposed
population, mean
age or age range
(years), percent
female, total
sample size
Exposure Definition of exposure Outcome
(s)
Definition of outcome(s) Exposure ascertainment Study
quality
Mercy 2001 [28],
90. US, case–control
Youth, age
range = 13–35
(50.3% aged
�24), 54.5%
female, N = 666
Suicidal behavior
(composite) of
relative (any
relative); suicidal
behavior
(composite) of friend
or acquaintance
Self-report: Participants
were asked if their friends
or family had committed
suicide or made a suicide
attempt.
91. Suicide
attempt
Hospital admission
records: Hospital
admission for nearly
lethal suicide attempt,
defined as those in which
the person probably
would have died if they
had not received
emergency medical or
surgical intervention or in
which the attempter
unequivocally used a
method with a high case
fatality ratio (i.e., a gun or
a noose) and sustained an
injury, regardless of
92. severity.
All participants were
hospitalized for suicide
attempt at the time that
prior exposure was
measured.
Fair
a
Psychological autopsy study.
b
Majority of the population aged >24 years and therefore
categorized as adults.
c
Exposure was a composite measure of suicide in a relative or
friend; however, the majority were exposed to a friend’s
suicide.
d
Exposure was a composite measure of suicidal behavior, but
exposure to suicide was only 1%, and therefore the exposure
was coded as exposure to suicide attempt.
ICD, International Classification of Diseases.
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Exposure to suicide attempt. Across 19 effect sizes from 13
studies, exposure to suicide
attempt was associated with 2.99-fold (95% CI = 2.19 to 4.09, P
< 0.001; Fig 3) increased odds
of suicidal behavior. Heterogeneity within studies was 9% (t2
ð2Þ
= 0.022, I2
ð2Þ
= 9%, 95% CI 1% to
54%), while heterogeneity between studies was substantially
larger (t2
ð3Þ
= 0.22, I2
ð3Þ
= 88%, 95%
CI 42% to 97%). Inspection of the funnel plot did not reveal
evidence of small study effect
(Egger’s intercept = −0.453, P = 0.33; S2 Fig). Results from
94. subgroup analysis revealed that
exposure to suicide attempt was associated with greater odds of
subsequent suicide attempt
(k = 16, OR = 3.53, 95% CI = 2.63 to 4.73, P < 0.001) but not
suicide death (k = 3, OR = 1.64,
95% CI = 0.90 to 2.98, P = 0.10; Q between subgroups = 4.22,
df = 1, P = 0.04, R2
ð2Þ
= 0%, R2
ð3Þ
=
3.8%). Significant between-group differences were observed for
study design, with cross-sec-
tional studies reporting greater odds of subsequent suicidal
behavior (k = 2, OR = 8.23, 95%
CI = 4.70 to 14.30, P < 0.001) compared to case–control studies
(k = 10, OR = 2.74, 95%
CI = 2.04 to 3.69, P < 0.001) and cohort studies (k = 7, OR =
2.69, 95% CI = 1.82 to 3.99, P <
0.001; Q between subgroups = 7.35, df = 2, P = 0.02, R2
ð2Þ
= 0%, R2
ð3Þ
= 72.8%). Finally, modera-
tor analyses revealed that psychological autopsy studies (k = 3,
OR = 1.64, 95% CI = 0.90 to
2.99, P = 0.127) were associated with reduced odds of suicidal
behavior compared to non-psy-
95. chological autopsy studies (k = 16, OR = 3.53, 95% CI = 2.63 to
4.73, P < 0.001, Q-between
subgroups = 4.22, df = 1, P = 0.03, R2
ð2Þ
= 0%, R2
ð3Þ
= 38.4%). No further significant differences
were observed for the remaining moderators (Table 3).
Exposure to suicidal behavior. Across 10 effect sizes from 5
independent studies, expo-
sure to suicidal behavior (composite measure—suicide or
suicide attempt) was associated with
2.58-fold (95% CI = 1.25 to 5.35, P = 0.01) increased odds of
suicidal behavior (Fig 4). Hetero-
geneity within and between studies was comparable (t2
ð2Þ
= 0.283 I2
ð2Þ
= 38%; t2
ð3Þ
= 0.40, I2
ð3Þ
=
53%). Visual inspection of the funnel plot did not reveal
evidence of small study effect (S3 Fig).
96. However, a formal test of asymmetry was not conducted due to
insufficient studies. Results
from the subgroup analysis revealed that exposure to suicidal
behavior was associated with
greater odds of suicide (k = 7, OR = 3.83, 95% CI = 2.38 to
6.17, P < 0.001) but not suicide
attempt (k = 3, OR = 1.10, 95% CI = 0.69 to 1.76, P = 0.90; Q
between subgroups = 5.02, df = 1,
P = 0.02, R2
ð2Þ
= 31.6%, R2
ð3Þ
= 100%). The odds of suicidal behavior were also greater when
the
exposure occurred in relatives (k = 8, OR = 3.09, 95% CI = 1.53
to 6.26, P = 0.001) compared
to friends and acquaintances (k = 2, OR = 1.33, 95% CI = 0.69
to 2.92, P = 0.48; Q between sub-
groups = 5.20, df = 1, P = 0.02, R2
ð2Þ
= 86.2%, R2
ð3Þ
= 0%). No significant differences were
observed for the remaining moderators (Table 4).
Discussion
97. Based on findings from 34 studies of mostly good and fair
quality, encompassing 13,923,029
participants and 71 effect sizes, we found that prior exposure to
suicide was associated with sig-
nificantly greater odds of suicidal behavior (suicide or suicide
attempt; OR = 2.94). Results of
the moderator analysis revealed that prior exposure to suicide
was associated with 3.23-fold
increased odds of suicide and 2.91-fold increased odds of
suicide attempt, while there was no
evidence of an association between exposure to suicide and
subsequent suicidal ideation.
These findings remained robust across cohort, case–control, and
cross-sectional studies, as
well as exposure and outcome measurements encompassing
informant interview, self-report,
and official records (e.g., coroner reports, hospital admission
records, or data linkage with
birth and death registries).
Exposure to suicide attempt was associated with increased odds
of suicidal behavior
(OR = 2.99). However, moderator analyses revealed that the
association of exposure to suicide
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attempt with suicide-related outcomes was significant only for
suicide attempt (OR = 3.53),
not for suicide death (OR = 1.64). These findings were
demonstrated across 19 effect sizes
from 13 studies of mostly fair quality, and corroborated by 3
large population-based studies
using data linkage or hospital admission records for suicide
attempt [48,59,62]. Exposure to
suicidal behavior (suicide or suicide attempt) was associated
with a 2.58-fold increased odds of
suicidal behavior, but moderator analysis revealed that this was
significant only for outcomes
relating to suicide death (OR = 3.83), not suicide attempt (OR =
1.10). These findings were
demonstrated across 10 effect sizes from 5 studies, the majority
of which involved psychologi-
cal autopsy methodologies.
Our analyses update and further specify the findings from
99. previous systematic reviews,
which included estimates from studies reporting lifetime
prevalence or did not differentiate
between the independent effects associated with exposure to
suicide and exposure to suicide
attempt [19,22,23]. The finding that exposure to suicide was
associated with an increased odds
of suicide and suicide attempt—in contrast to exposure to
suicide attempt, which was associ-
ated with an increased odds of suicide attempt only—indicates
that exposure to suicide and
suicide attempt do not incur uniform risk across the range of
suicide-related outcomes. This
was corroborated by our analysis of exposure to suicidal
behavior, which found that this com-
posite measure was associated with increased odds of suicide
but not suicide attempt, a finding
that was inconsistent with our separate analyses of exposure to
suicide and exposure to suicide
attempt. Taken together, the present findings raise questions
about the conceptual value of
combining suicide and suicide attempt as a composite measure
of suicidal behavior, and sug-
gest that future research and public health policies should
100. refrain from combining these expo-
sures and outcomes into 1 composite measure of suicidal
behavior.
Evidence from 2 studies [46,57] suggests that exposure to
suicide may be associated with
increased risk of suicidal ideation, especially in older adults
[46]. Conversely, results from a
single cohort study in youths [57] indicate higher risk for
suicide attempt than for suicidal ide-
ation, pointing once more to lack of uniformity across
populations and outcomes. Moreover,
theoretical and empirical accounts suggest that while exposure
to suicide may contribute to
subsequent suicidal ideation to some extent, its effect on people
with a history of suicidal idea-
tion may be more pronounced [71], as this experience might
reduce cognitive and practical
barriers to acting on one’s suicidal thoughts [46,72,73]. A more
comprehensive look at this
interaction may have important practical implications for
developing specific interventions for
this high-risk population, in particular interventions guided by
the “ideation-to-action frame-
work” [71] that aim to reduce acquired capability for suicidal
101. behavior among individuals
exposed to suicide.
The increased risks associated with exposure to suicide for
outcomes relating to suicide and
suicide attempt in the current meta-analyses suggest that further
consideration should be
given towards developing interventions that target suicide-
related outcomes in those bereaved
by suicide. To date, interventions targeting those exposed to
suicide have largely focused on
bereavement-related factors such as grief, reduced social
support, and stigma [74,75].
Although previous studies have shown that these factors are
elevated among those bereaved by
suicide as opposed to other modes of death, there remains a
dearth of studies that investigate
the effectiveness of interventions on suicide and suicide attempt
behavior. A recent review by
Andriessen and colleagues [74], for example, found 3 controlled
studies [76–78] that investi-
gated the effectiveness of an intervention on suicidal ideation
and found no studies that
included outcomes related to suicide or suicide attempt.
102. Although we did not observe a significant association between
exposure to suicide attempt
and subsequent suicide, the specific relationship between
exposure to suicide attempt and sub-
sequent suicide attempt is noteworthy, since suicide attempt is
associated with significant
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disruptions to an individual’s milieu, and has been linked to
adverse psychosocial and mental
health stressors that persist later in life [5]. The findings from
our analysis of exposure to
Fig 2. Forest plots of exposure to suicide and subsequent
suicide, suicide attempt, and suicidal ideation outcomes.
CI, confidence interval; OR, odds ratio.
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suicide attempt also provide some insight into the mechanisms
underlying the observed asso-
ciation between exposure to suicide and exposure to suicide
attempt and the suicide-related
outcomes. Arguably, the absence of bereavement-related factors
and the specific association
between exposure to suicide attempt and subsequent suicide
attempt support the hypothesis
that suicidal individuals may model, or imitate, suicide-related
behavior that they see in others
[10]. An imitation model is consistent with previous studies that
have shown that increased
risk of suicide-related behavior following exposure to both
suicide and suicide attempt is not
significantly moderated by preexisting risk factors such as
depression, anxiety, and hospital
admission for mental health [79,80]. The finding that exposure
to suicide is associated with sig-
nificant increased odds of suicide attempt is important since
public health approaches for the
104. prevention of behavioral contagion of both suicide and suicide
attempt, such as frameworks
for the prevention of suicide and self-harm clusters [12–15],
have focused largely on mitigation
efforts following exposure to suicide and therefore may benefit
from the inclusion of exposure
to suicide attempt in future mitigation efforts.
Limitations
The current systematic review and meta-analysis is the first to
our knowledge to quantify the
association between exposure to suicide and suicide attempt and
the full spectrum of suicide-
Table 2. Results of moderator analyses of exposure to suicide
across suicide, suicide attempt, and suicidal ideation outcomes.
Moderator Number of effect sizes Odds ratio (95% confidence
interval) P value R2(2) R
2
(3) ANOVA between-group P value
Proximity
Relative 34 3.07 (2.35 to 4.01) <0.001
Friend or acquaintance 8 2.42 (1.50 to 3.91) <0.001 <0.001 0.03
0.38
Population at risk
105. Adult 24 2.80 (2.00 to 3.92) <0.001
Youth 18 3.04 (2.14 to 4.32) <0.001 <0.001 0.06 0.74
Outcome measurement
Informant interview 2 1.53 (0.63 to 3.73) 0.35
Official records 30 3.10 (2.30 to 4.17) <0.001
Self-report 10 2.97 (1.86 to 4.75) <0.001 0.04 0.04 0.34
Exposure measurement
Informant interview 7 3.53 (2.13 to 5.83) <0.001
Official records 20 2.84 (1.93 to 4.18) <0.001
Self-report 15 2.66 (1.78 to 3.97) <0.001 <0.01 <0.01 0.68
Psychological autopsy
No 34 2.64 (2.64 to 3.50) <0.001
Yes 8 3.71 (2.38 to 5.78) <0.001 0.03 0.07 0.21
Study design
Case–control 29 2.85 (2.14 to 3.80) <0.001
Cohort 10 2.13 (1.35 to 3.36) 0.01
Cross-sectional 3 4.98 (2.73 to 9.08) <0.001 <0.01 0.47 0.12
Study quality
106. Good 23 2.61 (1.86 to 3.67) <0.001
Fair 15 3.03 (2.13 to 4.30) <0.001
Poor 4 5.15 (1.97 to 13.48) <0.001 <0.001 0.09 0.41
ANOVA, analysis of variance.
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related outcomes and has many strengths, including the use of
multilevel meta-analysis, the
large sample size, and the exclusion of estimates of lifetime
prevalence that do not take into
account the temporal sequence between exposure and suicide-
related outcomes. Despite this,
several limitations exist. Whilst we conducted an extensive
search of 21,868 records, there is
the possibility that some relevant studies were not detected.
Such studies are likely to create a
107. bias towards the null (i.e., the exposure not having a significant
effect). This is a limitation that
is common to many systematic reviews and was mitigated to the
best of our ability through
adherence to a screening protocol developed a priori.
Fig 3. Forest plots of exposure to suicide attempt and
subsequent suicide and suicide attempt outcomes. CI,
confidence
interval; OR, odds ratio.
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Furthermore, since most studies adjusted for different
covariates, we restricted our analysis
to unadjusted events and ORs. Whilst this is consistent with
previous meta-analyses in the
field [81,82], it meant that we could not investigate other risk
factors, such as frequency of
108. exposure, duration since exposure, and baseline mental health
diagnoses, and how these might
moderate the association between exposure to suicide and
suicide attempt and suicide-related
outcomes. For example, a previous systematic review on pre-
and post-loss features of suicide
bereavement in young people found evidence of a cumulative
effect of exposure to suicide on
subsequent suicide risk [83]. In the present meta-analysis, 2 out
of 34 studies included in our
analyses provided separate estimates for multiple exposures to
suicide [62] and suicide attempt
[48]. In 1 study [62], exposure to 2 or more suicide deaths
affected less than 1% of the popula-
tion, but was associated with 9.8-fold greater odds of suicide
attempt, compared to an OR of
3.8 among those who had been exposed to the suicide of 1
relative. Similarly, those exposed to
the suicide attempt of 2 parents were 5.67 times more likely to
make a suicide attempt, com-
pared to ORs of 2.89 and 3.89 (for paternal and maternal
exposures, respectively) among
youths who had been exposed to the suicide attempt of 1 parent
[48].
109. Indeed, in the present multilevel meta-analysis, within-study
heterogeneity remained
largely unchanged by study-level moderators for both exposure
to suicide and exposure to sui-
cide attempt. For example, we did not find evidence of a
significant difference in suicide-
related outcomes when the exposure to suicide or suicide
attempt occurred in relatives com-
pared to friends and acquaintances. Although previous registry-
based studies have shown a
Table 3. Results of moderator analyses of exposure to suicide
attempt across suicide, suicide attempt, and suicidal ideation
outcomes.
Moderator Number of effect sizes Odds ratio (95% confidence
interval) P value R2(2) R
2
(3) ANOVA between-group P value
Proximity
Relative 14 3.14 (2.25 to 4.38) <0.001
Friend or acquaintance 5 2.64 (1.72 to 4.03) <0.001 0.14 <0.001
0.39
Population at risk
Adult 1 1.43 (0.48 to 4.32) 0.52
110. Youth 18 3.19 (2.35 to 4.32) <0.001 <0.001 0.16 0.18
Outcome measurement
Official records 10 2.60 (1.75 to 3.87) <0.001
Self-report 9 3.62 (2.30 to 5.68) <0.001 <0.01 0.13 0.29
Exposure measurement
Informant interview 3 1.64 (0.90 to 2.99) 0.12
Official records 5 3.60 (2.12 to 6.10) <0.001
Self-report 11 3.49 (2.45 to 4.98) <0.001 0.01 0.38 0.12
Psychological autopsy
No 16 3.53 (2.63 to 4.73) <0.001
Yes 3 1.64 (0.90 to 2.99) 0.13 <0.001 0.38 0.03
Study design
Case–control 10 2.74 (2.04 to 3.69) <0.001
Cohort 7 2.69 (1.82 to 3.99) <0.001
Cross-sectional 2 8.23 (4.70 to 14.30) <0.001 0.01 0.73 0.02
Study quality
Good 7 3.74 (2.20 to 6.30) <0.001
Fair 9 2.95 (1.93 to 4.50) <0.001
111. Poor 3 2.18 (1.10 to 4.32) 0.02 0.02 0.18 0.48
ANOVA, analysis of variance.
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6-fold increase of suicide among biological relatives of
adoptees who have died by suicide [84],
in the present meta-analysis it was not possible to delineate
between relatives who resided in
the same household, and therefore shared many of the same
environmental risk factors, and
relatives who did not [9]. Understanding these factors is
important for identifying specifically
who within in the general population is most at risk. However,
the pooling of observational
studies meant that analyses of these factors were outside the
scope of the present study. An
important next step forward would therefore be examinations of
112. exposure to suicide and sui-
cide attempt while taking these risk factors into account using
individual participant data
meta-analyses.
In the present multilevel meta-analysis, between-study
heterogeneity remained moderate
(I2
ð3Þ
= 52.2%) across studies measuring exposure to suicide, which
was not sufficiently
explained by any of the included study design moderators. By
contrast, study design character-
istics accounted for 72.8% of between-study heterogeneity (I2
ð3Þ
= 87.8%) across studies measur-
ing exposure to suicide attempt. In this instance, cross-sectional
studies reported significantly
larger ORs (OR = 8.23) compared to case–control (OR = 2.74)
and cohort (OR = 2.69) studies.
In general, cross-sectional studies are prone to an inherently
greater number of biases, com-
pared to case–control and cohort studies. This may be
particularly pronounced in studies that
113. measure suicide attempt because recall of suicide attempt may
be less salient than recall of sui-
cide death, and is prone to multiple interpretations and
definitions [85].
It is noteworthy that we did not find evidence to support the
role of age as a risk moderator,
as suggested in previous reviews [9,10]. Yet these results
should be interpreted with caution, as
Fig 4. Forest plots of exposure to suicidal behavior ( composite
measure—suicide or suicide attempt) and subsequent
suicide and suicide attempt outcomes. CI, confidence interval;
OR, odds ratio.
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the dichotomization of study populations into the categories of
youths and adults was based
on a majority rule in 13 out of 34 studies [26–
28,39,58,60,61,63–65,68–70]. The finding that
114. age was not a risk moderator may therefore be an artifact
introduced by the imprecise age clas-
sification of the included population in individual studies.
Furthermore, whilst similar patterns
were observed across studies examining exposure to suicide
attempt in youths versus adults,
only 1 out of 13 studies [70] reported outcomes among adults,
which may have impacted our
ability to detect a statistically significant difference.
Finally, the results of the present study do not allow causality to
be inferred, and although
we show evidence of a temporal association between prior
exposure to suicide and suicide
attempt and subsequent suicide-related outcomes, cross-
sectional studies, by virtue of study
design, do not provide incidence estimates. To account for this
limitation, we only included
cross-sectional studies where participants were explicitly asked
about suicidal acts that
occurred after exposure to suicide or suicide attempt. But this
approach does not mitigate
errors in recall and other biases that are inherently more
common in cross-sectional studies.
115. Conclusions
Our findings suggest that prior exposure to suicide is associated
with increased risk of suicide
and suicide attempt. By contrast, exposure to suicide attempt is
associated with increased risk
of suicide attempt, but not suicide death. Future studies should
refrain from combining sui-
cidal behaviors into composite measures of suicide exposures
and outcomes as the relation-
ships between exposure to suicide and suicide attempt and
suicide-related outcomes are
markedly different. Lastly, future studies should consider
interventions that target suicide-
related outcomes in those exposed to suicide and include efforts
to mitigate the adverse effects
associated with exposure to suicide attempt.
Table 4. Results of moderator analyses of exposure to suicidal
behavior (composite measure—suicide or suicide attempt)
across suicide, suicide attempt, and sui-
cidal ideation outcomes.
Moderator Number of effect sizes Odds ratio (95% confidence
interval) P value R2(2) R
2
(3) ANOVA between-group P value
116. Proximity
Relative 8 3.09 (1.53 to 6.26) 0.001
Friend or acquaintance 2 1.33 (0.60 to 2.92) 0.48 0.86 <0.001
0.02
Population at risk
Adult 4 2.63 (0.96 to 7.22) 0.06
Youth 6 2.53 (0.86 to 7.43) 0.09 <0.001 0.01 0.96
Outcome measurement
Informant interview 3 8.34 (2.35 to 29.63) 0.01
Official records 7 1.90 (1.03 to 3.50) 0.05 <0.01 0.70 0.07
Exposure measurement
Informant interview 7 3.83 (2.37 to 6.19) <0.001
Self-report 3 1.04 (0.59 to 1.83) 0.89 0.32 1 0.02
Psychological autopsy
No 3 1.04 (0.59 to 1.83) 0.89
Yes 7 3.83 (2.37 to 6.19) <0.001 0.32 1 0.02
Study quality
Fair 3 1.04 (0.59 to 1.83) 0.89
Poor 7 3.83 (2.37 to 6.19) <0.001 0.32 1 0.02
117. ANOVA, analysis of variance.
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Supporting information
S1 Data. Summary data for all included studies.
(XLS)
S1 Fig. Exposure to suicide funnel plot. The solid vertical lines
indicate the 95% confidence
interval around the log odds ratio (LogOR). The dashed lines
indicate the summary log odds
ratio ± 1.96 × standard error for each of the standard errors on
the y-axis. The resulting trian-
gular region indicates the expected location of 95% of studies in
the absence of small study
effect.
(TIF)
118. S2 Fig. Exposure to suicide attempt funnel plot. The solid
vertical lines indicate the 95% con-
fidence interval around the log odds ratio (LogOR). The dashed
lines indicate the summary
log odds ratio ± 1.96 × standard error for each of the standard
errors on the y-axis. The result-
ing triangular region indicates the expected location of 95% of
studies in the absence of small
study effect.
(TIFF)
S3 Fig. Exposure to suicidal behavior funnel plot. The solid
vertical lines indicate the 95%
confidence interval around the log odds ratio (LogOR). The
dashed lines indicate the summary
log odds ratio ± 1.96 × standard error for each of the standard
errors on the y-axis. The result-
ing triangular region indicates the expected location of 95% of
studies in the absence of small
study effect.
(TIFF)
S1 Table. Description of a priori study moderators used for data
extraction.
(DOCX)
119. S2 Table. Excluded overlapping studies.
(DOCX)
S3 Table. Risk of bias.
(DOCX)
S1 Text. PRISMA checklist.
(DOC)
S2 Text. MEDLINE search strategy.
(DOCX)
S3 Text. Articles excluded from the systematic review and
meta-analysis.
(DOCX)
Author Contributions
Conceptualization: Nicole T. M. Hill, Jo Robinson, Allison
Milner, Katrina Witt, Amit
Lampit.
Data curation: Nicole T. M. Hill, Karl Andriessen, Karolina
Krysinska, Amber Payne, Alexan-
dra Boland, Alison Clarke, Katrina Witt, Stephan Krohn.
Formal analysis: Nicole T. M. Hill, Stephan Krohn, Amit
Lampit.
120. Investigation: Nicole T. M. Hill, Karolina Krysinska, Stephan
Krohn, Amit Lampit.
PLOS MEDICINE Association of suicidal behavior with
exposure to suicide and suicide attempt: A multilevel meta-
analysis
PLOS Medicine | https://doi.org/10.1371/journal.pmed.1003074
March 31, 2020 22 / 27
http://journals.plos.org/plosmedicine/article/asset?unique&id=in
fo:doi/10.1371/journal.pmed.1003074.s001
http://journals.plos.org/plosmedicine/article/asset?unique&id=in
fo:doi/10.1371/journal.pmed.1003074.s002
http://journals.plos.org/plosmedicine/article/asset?unique&id=in
fo:doi/10.1371/journal.pmed.1003074.s003
http://journals.plos.org/plosmedicine/article/asset?unique&id=in
fo:doi/10.1371/journal.pmed.1003074.s004
http://journals.plos.org/plosmedicine/article/asset?unique&id=in
fo:doi/10.1371/journal.pmed.1003074.s005
http://journals.plos.org/plosmedici ne/article/asset?unique&id=in
fo:doi/10.1371/journal.pmed.1003074.s006
http://journals.plos.org/plosmedicine/article/asset?unique&id=in
fo:doi/10.1371/journal.pmed.1003074.s007
http://journals.plos.org/plosmedicine/article/asset?unique&id=in
fo:doi/10.1371/journal.pmed.1003074.s008
http://journals.plos.org/plosmedicine/article/asset?unique&id=in
fo:doi/10.1371/journal.pmed.1003074.s009
http://journals.plos.org/plosmedicine/article/asset?unique&id=in
fo:doi/10.1371/journal.pmed.1003074.s010
https://doi.org/10.1371/journal.pmed.1003074
Methodology: Nicole T. M. Hill, Jane Pirkis, Karl Andriessen,
Karolina Krysinska, Allison
121. Milner, Katrina Witt, Stephan Krohn, Amit Lampit.
Project administration: Nicole T. M. Hill.
Resources: Nicole T. M. Hill.
Software: Nicole T. M. Hill, Stephan Krohn, Amit Lampit.
Supervision: Nicole T. M. Hill, Jo Robinson, Jane Pirkis,
Allison Milner, Amit Lampit.
Validation: Nicole T. M. Hill, Karl Andriessen, Karolina
Krysinska, Amber Payne, Alexandra
Boland, Stephan Krohn, Amit Lampit.
Visualization: Nicole T. M. Hill, Stephan Krohn, Amit Lampit.
Writing – original draft: Nicole T. M. Hill, Jo Robinson, Jane
Pirkis, Karl Andriessen, Karo-
lina Krysinska, Amber Payne, Alexandra Boland, Alison Clarke,
Allison Milner, Katrina
Witt, Stephan Krohn, Amit Lampit.
Writing – review & editing: Nicole T. M. Hill, Jo Robinson,
Jane Pirkis, Karl Andriessen, Kar-
olina Krysinska, Amber Payne, Alexandra Boland, Alison
Clarke, Allison Milner, Katrina
Witt, Stephan Krohn, Amit Lampit.
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