Persons diagnosed with PCOS face 8-fold increase in suicide risk

Embargoed for release until 5:00 p.m. ET on Monday 5 February 2024  
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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.  
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1. Persons diagnosed with PCOS face 8-fold increase in suicide risk

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2240

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A study of more than 18,000 women found that patients diagnosed with polycystic ovary syndrome (PCOS) were 8 times more likely to attempt suicide compared with control group. These findings highlight the importance of routine monitoring of mental health and suicide risk in persons diagnosed with PCOS. The study is published in Annals of Internal Medicine.

PCOS is a prevalent endocrine disorder, affecting up 10% of women in their reproductive years. Common attributes associated with PCOS include infertility, acne, dysmenorrhea, hirsutism, and obesity, which can collectively contribute to a decreased quality of life. In addition, a substantial body of evidence indicates that persons diagnosed with PCOS have higher risk for psychiatric conditions, such as depressive disorders, anxiety disorders, personality disorder, and schizoaffective disorder.

Researchers from Taipei Veterans General Hospital studied data from the Taiwanese nationwide database from 1997 to 2012 for 18,960 women diagnosed with PCOS to assess suicide risk, accounting for psychiatric comorbid conditions and age group. They found that persons diagnosed with PCOS faced an 8.47-fold increase in risk for suicide attempt compared with the control group, even after accounting for demographics, psychiatric comorbid conditions, physical conditions, and all-cause clinical visits. An adolescent subgroup had a notable 5.38-fold elevated risk for suicide attempt. The authors note that their findings remained robust when excluding the first year or the first 3 years of observation.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding authors, Mu-Hong Chen, MD, PhD or Chih-Sung Liang, MD, please contact lcsyfw@gmail.com.

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2. Recommending universal breast cancer screening at 40 risks confusion and harms women and USPSTF

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2908     

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A draft of an updated United States Preventive Services Task Force (USPSTF) breast cancer screening guideline recommends screening for all women at average risk starting at age 40. In an Annals of Internal Medicine commentary, Dr. Russell Harris, a former member of the USPSTF, says that many may not understand that this is a departure from previous USPSTF breast cancer screening recommendations even though no new high-quality evidence has emerged. 

The  commentary summarizes the development of evidence and USPSTF recommendations over the past 25 plus years.  Previous USPSTF recommendations were to start universal screening at age 50 and to assist women in their 40s make individual decisions about when to begin screening. There is always a chance of being harmed with screening. The rationale for this previous recommendation was that the potential benefit of starting screening at 40 is small, whereas the potential benefit is larger for women starting screening at age 50. Thus, the thinking was that women in their 40s should make an individual, informed choice about screening based on each woman’s preferences and values. 

The harms of screening include not only false alarms, with additional procedures and anxiety, but also finding a slow-growing “cancer” that would never progress to threaten the woman’s life.  This “overdiagnosis” leads then to unnecessary treatment and further life changing consequences.

Dr. Harris believes that recommending universal screening for average risk women in their 40s, with its attendant harms, is a departure from the USPSTF’s evidence-based approach.  He hopes that the commentary will help reduce confusion for clinicians and patients.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Russell P. Harris, MD, MPH, please contact russell_harris@med.unc.edu.

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3. Adults in serious psychological distress faced decreased access to outpatient mental health care during COVID-19 pandemic

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2824        

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A national survey found that the rate of serious psychological distress among adults increased between 2018 and 2021, but their access to outpatient mental health care decreased during the same period. These trends and patterns underscore the persistent challenges of connecting older adults, unemployed persons, and seriously distressed adults to outpatient mental health care. The study is published in Annals of Internal Medicine.

In addition to the physical disease burden of the COVID-19 pandemic, concern exists over its adverse mental health effects. Several factors, including fear and grief, COVID-19–related morbidity, social restrictions and isolation, financial uncertainty, and work and school disruptions, may have contributed to increasing psychological distress. While increased use of telemedicine may have boosted mental health care during the acute phase of the COVID-19 pandemic, there are new concerns that some patient groups have difficulty accessing these services, compounding existing disparities in outpatient mental health care.

Researchers from Columbia University and New York State Psychiatric Institute analyzed data for 86,658 adults from the 2018–2021 Medical Expenditure Panel Surveys (MEPS) conducted by the Agency for Healthcare Research and Quality to characterize trends in psychological distress and outpatient mental health care and to describe patterns of in-person, telephone, and video outpatient mental health care.

Responses indicated that the rate of serious psychological distress among adults increased from 3.5 to 4.2 percent during the study period. During the same period, the rate of outpatient mental health care increased from 11.2 to 12.4 percent overall. Despite this increase, the rate of care among adults with serious psychological distress decreased from 46.5 to 40.4 percent.

A significant increase in outpatient mental health care was observed for young adults and employed adults, but not among middle-aged, older, or unemployed adults, suggesting that for these patients, lack of broadband access, lower digital literacy, social isolation, and absence of support networks to assist with technological challenges might pose barriers to telehealth care. The authors suggest interventions to reduce these disparities.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Mark Olfson, MD, MPH, please contact Stephanie Berger at sb2247@cumc.columbia.edu.

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4. Use of decision support tools reduces low-value care from clinicians seeing older patients

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2183         

Editorial: https://www.acpjournals.org/doi/10.7326/M24-3501         

URL goes live when the embargo lifts   

A study of 371 primary care physicians and older patients at 60 clinics found that the use of point-of-care clinical decision support tools and education reduced instances of low-value care for patients aged 65 years and older. The study is published in Annals of Internal Medicine.

The overuse of low-value, unnecessary care remains a problem in American health care. Professional organizations have launched campaigns to raise awareness of these harms for physicians, but these practices stubbornly persist with variations across regions and health systems.

Researchers from Northwestern University Feinberg School of Medicine conducted an 18-month, single-blind, pragmatic, cluster randomized trial, with constrained randomization to evaluate the effects of a clinician decision support tool on care overuse among older patients. The trial included 371 primary care clinicians and their older adult patients from 60 primary care internal medicine, family medicine and geriatrics practices from September 2020 through February 2022. The authors delivered behavioral science–informed, point-of-care, clinical decision support tools plus brief case-based education addressing three categories of unnecessary testing in older adults: Prostate-specific antigen (PSA) testing in men aged 76 years and older without previous prostate cancer, urine testing for nonspecific reasons in women aged 65 years and older, and overtreatment of diabetes with hypoglycemic agents in patients aged 75 years and older and hemoglobin A1c (HbA1c) less than 7%. They found that the use of clinical decision support tools and education reduced all three categories of unnecessary testing more than interventions only focusing on education. According to the authors, these findings suggest that point-of-care behaviorally informed interventions can reduce overuse among older patients of primary care clinicians while preserving clinician discretion.

The author of an accompanying editorial from Johns Hopkins University discusses how various scientists, including behavioral, economists, and organizational theorists approach the complex problem of health care overuse. The author says that in their practice, the scientists at Johns Hopkins have been operationalizing points of intervention to reduce overuse using an agentic-structural framework considering both micro- and macro-level interventions that require different levels of work on the part of all affected by the issue. They look forward to additional randomized trials that test solutions to reducing low-value care.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Stephen D. Persell, MD, MPH, please contact Marla Paul at marla-paul@northwestern.edu.

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