Creating an Evidence-Based Approach to Lifespan Suicide Prevention

Dennis D. Embry, Ph.D.President/Senior ScientistPAXIS Institute

Crea%ng an Evidence-‐Based Approach to Lifespan Suicide Preven%on

1Monday, April 15, 13

38,000


The Polio Epidemic


The Polio Epidemic


The Polio Epidemic

3,000


A recent webinarexperienceon the topic



Is this earlyprevention?











Thinking way upstreamWhat might be the early malleable predictors?

What if we startedhere with early

suicide prevention?


Thinking way upstreamWhat might be the early malleable predictors?Could we actually change those predictors easily and reliably?And what else might change as a consequence of the prevention or protection strategies.


risk factors during development from early childhood to adolescence

Psychiatric problems in childhood and/or adolescence, including depression

Child and/or adolescent externalizing disorders

Childhood adversity (especially with the above)

Low self-efficacy

Aggressive or delinquent behavior

Poor peer relations

Prax Kinderpsychol Kinderpsychiatr. 2012;61(1):32-49.


http://www.ncbi.nlm.nih.gov/pubmed/22400377#


risk factors during development from early childhood to adolescence

Psychiatric problems in childhood and/or adolescence, including depression

Child and/or adolescent externalizing disorders

Childhood adversity (especially with the above)

Low self-efficacy

Aggressive or delinquent behavior

Poor peer relations

Prax Kinderpsychol Kinderpsychiatr. 2012;61(1):32-49.

And prenatal and post-natal




Thinking way upstreamWhat might be the early malleable predictors?Could we actually change those predictors easily and reliably?And what else might change as a consequence of the prevention or protection strategies.


Surveying the Past Foretells Our Futures 13Monday, April 15, 13

Consider the cohort trends…#1 mental health disorder





Born NOW?



Born NOW?



Born NOW?

These trends are not the result of over-

diagnoses


Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.org

Cumulative prevalence of psychiatric disorders by young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study.

C

umul

ativ

e Pr

eval

ence

AGE9 10 11 12 13 14 15 16 19 21


http://www.paxis.org




Oldest Cohort

C

umul

ativ

e Pr

eval

ence

AGE9 10 11 12 13 14 15 16 19 21






Middle Cohort

Oldest Cohort

C

umul

ativ

e Pr

eval

ence

AGE9 10 11 12 13 14 15 16 19 21






Youngest Cohort

Middle Cohort

Oldest Cohort

C

umul

ativ

e Pr

eval

ence

AGE9 10 11 12 13 14 15 16 19 21






Youngest Cohort

Middle Cohort

Oldest Cohort

EARLIER START;Higher Prevalence

C

umul

ativ

e Pr

eval

ence

AGE9 10 11 12 13 14 15 16 19 21





Lifetime Prevalence of Disorders in US Adolescents (N=10,123)

40%

35%

30%

25%

20%

15%

10%

5%

0%4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Age in Years

Merikangas et al., 2010






40%

35%

30%

25%

20%

15%

10%

5%

0%4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Age in Years

Anxiety







40%

35%

30%

25%

20%

15%

10%

5%

0%4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Age in Years

Anxiety

Behavior







40%

35%

30%

25%

20%

15%

10%

5%

0%4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Age in Years

Anxiety

Behavior

Mood







40%

35%

30%

25%

20%

15%

10%

5%

0%4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Age in Years

Anxiety

SubstanceBehavior

Mood







40%

35%

30%

25%

20%

15%

10%

5%

0%4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Age in Years

Anxiety

SubstanceBehavior

Mood


1-out-2 USA young adults will be afflicted with

one or more of these disorders

by age 18

NOTE EARLY START




The US had 75 million children and teens 2009

Wall Street Journal,

12-28-2010


The US had 75 million children and teens 2009

Wall Street Journal,

12-28-2010

40.4 million kids had one psychotropic med in 2009



How many of you know a blue-collar, middle-class, or upper-class family who is reasonably intact…





How many of you know a blue-collar, middle-class, or upper-class family who is reasonably intact…

with a child, teen, or adult child with a mental, emotional, or behavioral disorder?




How do we handle this problem of mental illnesses?


How do we handle this problem of mental illnesses?

Prevalence rates are increasing

rapidly in North America



IL6 DNARNA

Poor Health

Inspirational Credit: Clyde Hertzman

Epigenetic Changes

Common set of conditions producing these negative trends…





IL6 DNARNA

Poor Health

Inspirational Credit: Clyde Hertzman

Epigenetic Changes

Common set of conditions producing these negative trends…

High Reinforcement of Anti-Social Behavior

HIgh Exposure to Problematic Behaviors

HIgh Exposure to Toxic Influences/ACEs

Exposure to Low Psychological Flexibility

•Mental Disorders

• Emotional Disorders

• Behavioral Disorders

• Related Physical Disorders

Evolutionary Adaptations toa Predatory, Stressful World;worse social determinants




Physiologicalinfluences triggeradverse biological

mechanisms

Reinforcementmore for anti-social

than prosocialbehaviors

Antecedentscue anti-social

acts and threats

Verbal Relationsoccasion perceivedthreats and related

reactions

Major Connected Causes of the Adverse Trends Predicting MEBs & Related Illnesses

Multi-Inflammatory Brain & Body Response

The Same Mismatches Predict Multiple MACH Disorders21Monday, April 15, 13

MoodInstability Inattention Lo Reward

DelayLo ExecutiveFunction

Lo BehavioralCompetencies

PoorMotorSkills

Immune-Healing

Dysfunction


mechanisms




acts and threats


reactions


Multi-Inflammatory Brain & Body Response


MoodInstability Inattention Lo Reward

DelayLo ExecutiveFunction

Lo BehavioralCompetencies

PoorMotorSkills

Immune-Healing

Dysfunction


mechanisms




acts and threats


reactions


Mental Illness SubstanceAbuse Violence Work

ProblemsObesity,

etc CancerEarlySex

School Failure

STD’s SpecialEdMulti-Inflammatory Brain & Body Response


1491 ADOriginalHumanMigrations to

North America 30,000,000Souls in

North America

300,000 Souls≈ ≈

Disease & War26,000 to 12,000 B.E. Extermination,Marginalization,& Suppression

The America’s First Peoples…

Residential Schools;

Western Diet

Evolutionary bottleneck


1491 ADOriginalHumanMigrations to

North America 30,000,000Souls in

North America

300,000 Souls≈ ≈ Today

Disease & War26,000 to 12,000 B.E. Extermination,Marginalization,& Suppression

The America’s First Peoples…

Residential Schools;

Western Diet



Slavery1500’s to

1863Original Human

Populations in Africa

Capture

30% to 50% +

mortality

≈

MiddlePassage

Continuing Trauma

Institutionof Slavery

Separation,violence,

malnutrition

JimCrowAfrican Americans…

Exposureto Toxins

The GreatMigration

North



Slavery1500’s to

1863Original Human

Populations in Africa

Capture

30% to 50% +

mortality

≈ today

MiddlePassage

Continuing Trauma

Institutionof Slavery

Separation,violence,

malnutrition

JimCrowAfrican Americans…

Exposureto Toxins

The GreatMigration

North



Example Lasting Effects of Evolutionary Bottlenecks

Political pundits say:

“Slavery is over. Jim Crow is over. Everybody should be over all this.”

Evolution is bigger than pundits, and epigensis is a solution to a past evolutionary problem that might come back. Evolution is conservative.

0%

10%

20%

30%

40%

Hi Blood Pressure Percentage

US Blacks Barbados St. Lucia JamaicaCameroon (urban) Cameroon (Rural) Nigeria (Rural)

Slavery Exposure No Slavery Exposure

Source: Scientific American, February, 1999


Add slide here about the epigenetic mechanisms; this shows how what children see, hear, do and feel in the brain,then cascades through neuro-hormones to change the genes.

This will show that micro-environments matter

Epigenetic

Factor

Health & Behavior

• Obesity, asthma, diabetes

• Early sex, pregnancy

• Violence, DSM-IV

• Cancer, auto-immune

Epigenetic Mechanisms• Nurturing environments

• Toxic environments

• Development/aging

Yes, the social andphysical environmentof humans changes

gene expression.


Ignore the problem? Pretend everything is fine?

Make everybody

mentally and physically healthier?

What shall we do?


Prev

alen

ce R

ate

Years

Past

Current Path of Mental, Emotional, and Behavioral DisordersPre-Conception

Pre-Natal

Infancy

Adulthood

Early Childhood

Elementary

Adolescence

Young Adults

PredictedFuture

Possible Futurewith PreventionScience

Trajectory of Mental, Behavioral, and Emotional Disorders(illustrative graph only)

First, Devise Early Wins NOW Across Age Groups


Prev

alen

ce R

ate

Years

Past

Current Path of Mental, Emotional, and Behavioral DisordersPre-Conception

Pre-Natal

Infancy

Adulthood

Early Childhood

Elementary

Adolescence

Young Adults

PredictedFuture

Possible Futurewith PreventionScience

Trajectory of Mental, Behavioral, and Emotional Disorders(illustrative graph only)

First, Devise Early Wins NOW Across Age Groups



IL6 DNARNAHealth

Inspirational Credit: Clyde Hertsman

Epigentic Changes

Conditions producing positive trends…





IL6 DNARNAHealth

Inspirational Credit: Clyde Hertsman

Epigentic Changes

Conditions producing positive trends…

High Reinforcement of Prosocial-Social Behavior

Low Exposure to Problematic Behaviors

Low Exposure to Toxic Influences

Exposure to High Psychological Flexibility

•Mental Health

• Emotional Health/Balance

• Behavioral Competence

• Related Physical Health

Evolutionary Adaptations toa Safe, Supportive World




UniversalAcccess to

Prevention &Promotion

Science

multiple outcome

focus

multiple age-stage

focus

Devise Early Wins NOW with multiple footprints


Pre-conception

Infancy, ChildhoodAdolescence

Young Adults & AdultsSeniors

Mental HealthEmotional Health

Physical Health

Cognitive Ability

Behavioral HealthUniversalAcccess to


Science

multiple outcome

focus

multiple age-stage

focus

Can improve multiple health outcomes for all ages




Pre-conception

Infancy, ChildhoodAdolescence

Young Adults & AdultsSeniors

Mental HealthEmotional Health

Physical Health

Cognitive Ability

Behavioral HealthNurturingEnvironmentsLogic Model forpopulation-level

benefits

IL6 DNARNAHealth

EpigensisInspirational Credit: Clyde Hertsman

ProsocialtyRich Reinforced

Low Problem Behaviors

Low ToxicIn!uences

PsychologicalFlexibility Better

Futuresfor All

UniversalAcccess to


Science

multiple outcome

focus

multiple age-stage

focus

Biglan, Flay, Embry, & Irwin, 2012

Can improve multiple health outcomes for all ages


Suicide Rates Not Evenly Distributed


Mothers and children in North America do not eat foods sufficient in Vitamin D

Mothers and children in North America do not get sufficient Vitamin D via sunlight

This evolutionary mismatch harms mental health


Mismatch, Latitude & Schizophrenia

both latitude and low temperature are highly significant(P< .001 in each case), the correlationwith infantmortalityis not significant at the .05 level. Moreover, the direction(sign) of the respective correlations of prevalence withlatitude and cold are consistent across all continents

and subgroups. In contrast, the direction of the correla-tion of prevalence with infant mortality is inconsistentacross different continents.The best-fit regression lines in figure 1 also suggest that

the increase in prevalence with increasing latitude occurs

Fig. 1. Schizophrenia Prevalence and Latitude by Continent and Infant Mortality.Note: SouthAsia siteswere from Indiaand Indonesia; those sites hadhigher infantmortality rates than all but one of theEastAsian sites. For theregressionlinesinNorthAmerica,thosewithinfantmortalityratesabove30per1000weregroupedashavingahigherrate, thosebelow30ashavinga lower rate.Theslopesof linear regression lineswere0.15 for theEastAsiansites, 0.22 for theAfricansites, 0.086 for theSouthAsiansites,0.14 fortheNorthAmericansiteswithlowerinfantmortality,0.51fortheNorthAmericansiteswithhigherinfantmortality,and0.48fortheEuropeansites.

Table 3. Correlations of Schizophrenia Prevalence with Predictor Variables

Geographic Group ofSamples N Absolute Latitudea Temperatureb Infant Mortalityc Fish Intaked

All study samples 49 .46** !.60*** !.26! !.10

Europe 18 .58* !.81*** !.22 !.21

North AmericaAll samples 10 .75* !.74* .92*** !.64!

High infant mortality 3 .94 !.99* .97 n/aLow infant mortality 7 .68! !.62 .58 !.85*

AsiaAll samples 15 .58* !.56* .05 !.05South Asia 9 .51! !.51! .49 !.49East Asia 6 .78* !.69 .46 !.20

Africa 4 .53 !.67 .25 !.81

Othere 2 n/a n/a n/a n/a

n/a = data available on only 2 samples.aAbsolute latitude in degrees north or south of the equator.bMean low temperature for the coldest month of the year in degrees Fahrenheit.cInfant mortality rate is the number of cases per 1000 adult population.dFish intake (in kg/person/year); n = 48 because data were not available for Oxford Bay.68eIncludes Christchurch, New Zealand, and Buenos Aires, Argentina.!0.05 < P " .10; *P < 0.05; **P < 0.001; ***P < 0.0005; all P values are two tailed, for Pearson product-moment correlations.

588

D. K. Kinney et al.

Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, InfantMortality, and Skin Color: A Role for Prenatal Vitamin DDeficiency and Infections?

Dennis K. Kinney1–3, Pamela Teixeira2, Diane Hsu2, SienaC. Napoleon2,4, David J. Crowley2, Andrea Miller2,William Hyman2, and Emerald Huang2

2Genetics Laboratory, McLean Hospital, Belmont, MA; 3De-partment of Psychiatry, Harvard Medical School, Boston, MA;4Wellesley College, Wellesley, MA

Previous surveys found a large (>10-fold) variation inschizophrenia prevalence at different geographic sitesand a tendency for prevalence to increase with latitude.We conducted meta-analyses of prevalence studies to inves-tigate whether these findings pointed to underlying etiologicfactors in schizophrenia or were the result of methodolog-ical artifacts or the confounding of sites’ latitude with levelof healthcare at those sites. We found that these patternswere still present after controlling for an index of health-care—infant mortality—and focusing on 49 studies thatused similar diagnostic and ascertainment methods. Thetendencies for schizophrenia prevalence to increase withboth latitude and colder climate were still large and signif-icant and present on several continents. The increase inprevalence with latitude was greater for groups with lowfish consumption, darker skin, and higher infant mortali-ty—consistent with a role of prenatal vitamin D deficiencyin schizophrenia. Previous research indicates that poor pre-natal healthcare and nutrition increase risk for schizophre-nia within the same region. These adverse conditions aremore prevalent in developing countries concentrated nearthe equator, but schizophrenia prevalence is lowest atsites near the equator. This suggests that schizophrenia-producing environmental factors associated with higher lat-itude may be so powerful they overwhelm protective effectsof better healthcare in industrialized countries. The ob-served patterns of correlations of risk factors with preva-lence are consistent with an etiologic role for prenatalvitamin D deficiency and exposure to certain infectious dis-eases. Research to elucidate environmental factors that un-

derlie variations in schizophrenia prevalence deserves highpriority.

Key words: epidemiology/etiology/immune function/prenatal/geography/risk factor

Introduction

Schizophrenia is an unusually burdensome disorder be-cause of the great economic costs of extensive care andloss of economic productivity, as well as the personal suf-fering and stigma, which often affect a patient and his orher family for most of the patient’s life. Moreover, formost patients there is still no cure or even an effectiveway of treating many of the most disabling, ‘‘negative’’symptoms of the disorder. Therefore, a key goal of schizo-phrenia research is elucidation of etiologic factors, partic-ularly environmental ones that could be readily avoidedand used in effective, inexpensive, and ethically sound pri-mary prevention programs.In a comprehensive survey of schizophrenia prevalence

studies around the world that were published in Englishover a period of 4 decades, Torrey1 noted 2 importantpatterns. First, prevalence rates varied widely at differentgeographic sites, with the highest rate being more than 10times greater than the lowest. Second, there was a strongtendency for schizophrenia prevalence to increase withincreasing latitude; ie, prevalence rates tended to bevery low near the equator and to increase as one movedtoward the poles. Both of Torrey’s conclusions were alsoreached in a survey and meta-analysis by Saha et al,2

which included more recent studies as well as ones pub-lished in languages other than English. Several other sur-veys have also concluded that schizophrenia rates vary atleast 10-fold around the world, including studies usingmeasures of point prevalence, lifetime prevalence, andincidence.1,3–10

A number of explanations have been proposed for thisvariability inprevalence.Severalcomplementary linesofre-search suggest that the tendency for schizophrenia preva-lence to increase with latitude and cold climate may bedue, at least inpart, to someunderlyingpre-orperinatal en-vironmental influences. For example, several studies have

1To whom correspondence should be addressed; Genetics Lab-oratory, McLean Hospital, NB-G-28 115 Mill Street, Belmont,MA 02478; tel: 617-855-3439, fax: 617-855-2348, e-mail:[email protected].

Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009doi:10.1093/schbul/sbp023Advance Access publication on April 8, 2009

! The Author 2009. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved.For permissions, please email: [email protected].

582


Mismatch, Latitude & Schizophrenia

both latitude and low temperature are highly significant(P< .001 in each case), the correlationwith infantmortalityis not significant at the .05 level. Moreover, the direction(sign) of the respective correlations of prevalence withlatitude and cold are consistent across all continents

and subgroups. In contrast, the direction of the correla-tion of prevalence with infant mortality is inconsistentacross different continents.The best-fit regression lines in figure 1 also suggest that

the increase in prevalence with increasing latitude occurs

Fig. 1. Schizophrenia Prevalence and Latitude by Continent and Infant Mortality.Note: SouthAsia siteswere from Indiaand Indonesia; those sites hadhigher infantmortality rates than all but one of theEastAsian sites. For theregressionlinesinNorthAmerica,thosewithinfantmortalityratesabove30per1000weregroupedashavingahigherrate, thosebelow30ashavinga lower rate.Theslopesof linear regression lineswere0.15 for theEastAsiansites, 0.22 for theAfricansites, 0.086 for theSouthAsiansites,0.14 fortheNorthAmericansiteswithlowerinfantmortality,0.51fortheNorthAmericansiteswithhigherinfantmortality,and0.48fortheEuropeansites.

Table 3. Correlations of Schizophrenia Prevalence with Predictor Variables

Geographic Group ofSamples N Absolute Latitudea Temperatureb Infant Mortalityc Fish Intaked

All study samples 49 .46** !.60*** !.26! !.10

Europe 18 .58* !.81*** !.22 !.21

North AmericaAll samples 10 .75* !.74* .92*** !.64!

High infant mortality 3 .94 !.99* .97 n/aLow infant mortality 7 .68! !.62 .58 !.85*

AsiaAll samples 15 .58* !.56* .05 !.05South Asia 9 .51! !.51! .49 !.49East Asia 6 .78* !.69 .46 !.20

Africa 4 .53 !.67 .25 !.81

Othere 2 n/a n/a n/a n/a

n/a = data available on only 2 samples.aAbsolute latitude in degrees north or south of the equator.bMean low temperature for the coldest month of the year in degrees Fahrenheit.cInfant mortality rate is the number of cases per 1000 adult population.dFish intake (in kg/person/year); n = 48 because data were not available for Oxford Bay.68eIncludes Christchurch, New Zealand, and Buenos Aires, Argentina.!0.05 < P " .10; *P < 0.05; **P < 0.001; ***P < 0.0005; all P values are two tailed, for Pearson product-moment correlations.

588

D. K. Kinney et al.

Semmelweis Reflex







Introduction








582


Mismatch, Fish Intake & Schizophrenia

different sites around the world1,2 were not simply arti-facts of differences in diagnostic and ascertainment meth-ods used by different studies. Even though our analysesrestricted prevalence studies to those that used more sim-ilar research methods for diagnosis and ascertainment ofschizophrenia cases, our analyses also found (a) thatprevalence rates varied more than 10-fold across geo-graphic sites and (b) that prevalence increased markedlywith increasing latitude.

That the correlation of schizophrenia prevalence withlatitude is both robust and large, and is not due simply tobetween-site differences in diagnostic and ascertainmentmethods, is further suggested by analysis of data collectedby Lehtinen et al.42 Their study is particularly informa-tive because it is the study that best controlled for possi-ble methodological sources of differences in prevalence atdifferent geographic sites; the same investigative person-nel, as well as the same methods, were used to obtainprevalence rates at several different sites within thesame country. Those investigators studied schizophreniaprevalence at 5 different Finnish sites in the same timeperiod, using a consistent set of diagnostic criteria andascertainment methods, and their data showed a veryhigh correlation of prevalence with both latitude(r = .97, P < .01) and mean low temperature (r =!.99, P < .001).

Athigher latitudes, there isanespeciallywidevariation inprevalence rates. By contrast, near the equator, prevalencefor all sites tends to be quite low. That is, for all groups andcontinental regions for which there are data frommultiplesites, thebest-fit (least squares) regression lines all havepos-

itiveslopes,andtheslopes tendtobesteeper forsitesathigh-er latitudes.This is evident by inspecting table 1, but ismostreadily visualized in figure 1.The results suggest that etiologic factors closely asso-

ciated with latitude and cold climate may be much morepowerful contributors to risk for schizophrenia than isgenerally recognized. The general level of a population’seconomic status and healthcare, as indexed in our anal-ysis by the infant mortality rate, appears to be a muchweaker predictor of risk for schizophrenia than are lati-tude and winter temperature. A high infant mortality rate

Fig. 2. Schizophrenia Prevalence and Latitude by Fish Intake.Note:Errorbars represent95%confidence limits.Theslopesof linear regression lineswere0.03 for siteswithhighfish intake, 0.21 for siteswithmoderate fish intake, and 0.17 for siteswith low fish intake. For the subset of Scandinavian sites, the slope of linear regression forwas 0.03 forsites with high fish intake and 1.57 for sites with moderate fish intake.

Fig. 3. Schizophrenia Prevalence and Latitude by Skin Color.Note: Error bars represent 95% confidence limits. The slopes of thelinear regression lines were 0.24 for those with lightest skin, 0.43 forthosewithintermediateskincolor,and0.31forthosewithdarkestskin.

590

D. K. Kinney et al.







Introduction








582


Mismatch, Fish Intake & SchizophreniaSemmelweis

Reflex








590

D. K. Kinney et al.







Introduction








582


Mismatch, Skin Color & Schizophrenia








590

D. K. Kinney et al.







Introduction








582


Mismatch, Skin Color & SchizophreniaSemmelweis

Reflex








590

D. K. Kinney et al.







Introduction








582


Latitude and Infantile Autism

Grant, W. B. and C. M. Soles (2009). "Epidemiologic evidence supporting the role of maternal vitamin D deficiency as a risk factor for the development of infantile autism." Dermatoendocrinol 1(4): 223-228.


Latitude and Infantile AutismSemmelweis

ReflexGrant, W. B. and C. M. Soles (2009). "Epidemiologic evidence supporting the role of maternal vitamin D deficiency as a risk factor for the development of infantile autism." Dermatoendocrinol 1(4): 223-228.


Estimated deaths per year would fallby 37,000 people, or about 16%-22% of annual mortality

in Canada.

And, $14 billion


Semmelweis Reflex

Estimated deaths per year would fallby 37,000 people, or about 16%-22% of annual mortality

in Canada.

And, $14 billion


Among pregnant women, lower Vitamin D is associated with:• Adverse fertility

parameters (n = 2),

• Preeclampsia (n = 5),

• Gestational diabetes or higher blood glucose (n = 6),

• Bacterial vaginosis (n = 4),

• Primary cesarean section (n = 1),

• Few days' (n = 2) shorter gestation,

• And, postpartum depression (n = 1)

Acta Obstet Gynecol Scand. 2012 Dec;91(12):1357-67. doi: 10.1111/aogs.12000. Epub 2012 Oct 17.The impact of vitamin D on pregnancy: a systematic review.Christesen HT, Falkenberg T, Lamont RF, Jørgensen JS.


http://www.ncbi.nlm.nih.gov/pubmed?term=Christesen%20HT%5BAuthor%5D&cauthor=true&cauthor_uid=22974137


http://www.ncbi.nlm.nih.gov/pubmed?term=Falkenberg%20T%5BAuthor%5D&cauthor=true&cauthor_uid=22974137


http://www.ncbi.nlm.nih.gov/pubmed?term=Lamont%20RF%5BAuthor%5D&cauthor=true&cauthor_uid=22974137


http://www.ncbi.nlm.nih.gov/pubmed?term=J%C3%B8rgensen%20JS%5BAuthor%5D&cauthor=true&cauthor_uid=22974137


Among pregnant women, lower Vitamin D is associated with:• Adverse fertility

parameters (n = 2),

• Preeclampsia (n = 5),

• Gestational diabetes or higher blood glucose (n = 6),

• Bacterial vaginosis (n = 4),

• Primary cesarean section (n = 1),

• Few days' (n = 2) shorter gestation,

• And, postpartum depression (n = 1)

Acta Obstet Gynecol Scand. 2012 Dec;91(12):1357-67. doi: 10.1111/aogs.12000. Epub 2012 Oct 17.The impact of vitamin D on pregnancy: a systematic review.Christesen HT, Falkenberg T, Lamont RF, Jørgensen JS.

Semmelweis Reflex










Suicidal ideation during pregnancy

Suicidal ideation and omega-3 intake from seafood during pregnancy ALSPAC-Bristol

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Pregnant moms with suicidality or postpartum depression confer higher lifetime risk for their child. The same study shows n3 intake protects mom and infant through 8th year of life.


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How might we reduce alcohol, tobacco, and other drugs among women of child bearing age


Which warning labels might work?


Trend line for humorous warnings on binge drinking by women of child-rearing

No Warnings Humorous Warnings



1995 1997 1999 2001 2002 2003 2004 2005 2006 20070

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1995 1997 1999 2001 2002 2003 2004 2005 2006 20070

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1995 1997 1999 2001 2002 2003 2004 2005 2006 20070

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Rewarding Clerks & Stores for Not Selling to MinorsYouth Who Smoked Every Day the Last 30 Days

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

1995 1997 1999 2001 2003 2005 2007

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

Baseline Reward and Reminder

Source: YRBS, US Centers for Disease Control

Wyoming

Wisconsin

United States

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

1995 1997 1999 2001 2003 2005 2007

Wyoming

Wisconsin

United States

Youth Who Smoked During the Last 30 DaysBaseline Reward and Reminder


= Trend = Wyoming = Wisconsin =United States

Youth Who Smoked Every Day the Last 30 Days

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

1995 1997 1999 2001 2003 2005 2007

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%



Wyoming

Wisconsin

United States

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

1995 1997 1999 2001 2003 2005 2007

Wyoming

Wisconsin

United States




Source: Youth Risk Behavior Survey

(YRBS), Centers for Disease Control

A meta-analysis robustly demonstrates that cigarette smoking is associated with an increased risk of completed suicide, consistent with a dose–response relationship. This conclusion has an important public health message.

Journal of Psychiatric Research, Vol 46(10), Oct 2012, 1257-1266.


Rewarding Clerks & Stores for Not Selling to MinorsYouth Who Smoked Every Day the Last 30 Days

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

1995 1997 1999 2001 2003 2005 2007

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%



Wyoming

Wisconsin

United States

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

1995 1997 1999 2001 2003 2005 2007

Wyoming

Wisconsin

United States




Youth Who Smoked Every Day the Last 30 Days

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

1995 1997 1999 2001 2003 2005 2007

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%



Wyoming

Wisconsin

United States

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

1995 1997 1999 2001 2003 2005 2007

Wyoming

Wisconsin

United States




Source: Youth Risk Behavior Survey

(YRBS), Centers for Disease Control

A meta-analysis robustly demonstrates that cigarette smoking is associated with an increased risk of completed suicide, consistent with a dose–response relationship. This conclusion has an important public health message.

Journal of Psychiatric Research, Vol 46(10), Oct 2012, 1257-1266.


Happens BEFORE the

behavior

Wait for the Timer for tobacco addictions with SMI/CMI

AntecedentKernel


Writ

e a

thou

ght a

nd a

feelin

g on the leaf and put it on the thoughts and feelings “stream”

I am

hav

ing

the

thou

ght t

hat…

I am having a feeling of …

Copyright © 2007-2012, PAXIS Institute. All rights reserved. May be reproduced but not sold. www.paxtalk.com

I am having a sensation of …

Teaching Psychological flexibility by cognitive defusion


Writ

e a

thou

ght a

nd a

feelin


I am

hav

ing

the

thou

ght t

hat…




Teaching Psychological flexibility by cognitive defusion


Writ

e a

thou

ght a

nd a

feelin


I am

hav

ing

the

thou

ght t

hat…




Teaching Psychological flexibility by cognitive defusion Remember:

55% of young people who completed

suicide where in therapy.

Maybe current therapy doesn’t

work?


.6

.7

.8

.9

1.0

40 80 120

Days After Initial Release

Prop

ortio

n N

ot H

ospi

taliz

ed

Rehospitalization


.6

.7

.8

.9

1.0

40 80 120


Treatment as UsualPr

opor

tion

Not

Hos

pita

lized

Rehospitalization


ACT

.6

.7

.8

.9

1.0

40 80 120


Treatment as UsualPr

opor

tion

Not

Hos

pita

lized

Rehospitalization


ReinforcementKernel

Lifespan example of one kernel for prevention, intervention and

treatment

Happens AFTER the behavior

Available from Amazon.com for $45


Montrose WolfHarriet Barrish

Muriel Saunders invented the Game in 1967 as a first-year, 4th grade teacher.

Published as a study in 1969.

Copyright © 2012, PAXIS Institute, All rights reserved. May be reproduced with notice.


1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58

1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58

Perce

nt of

Interv

als Sc

ored f

or Be

havio

r

100%

75%

50%

25%

0%

100%

75%

50%

25%

0%

Math Period

Reading Period

Blurting

Blurting

Out-of-Seat

Out-of-Seat

Baseline

Baseline

Game 1

Game

Game 2Rev.

Source: Barrish, Saunders, & Wolf, 1969

JOURNAL OF APPLIED BEHAVIOR ANALYSIS

GOOD BEHAVIOR GAME: EFFECTS OF INDIVIDUALCONTINGENCIES FOR GROUP CONSEQUENCES ON

DISRUPTIVE BEHAVIOR IN A CLASSROOM'HARRIET H. BARRISH, MURIEL SAUNDERS, AND MONTROSE M. WOLF

UNIVERSITY OF KANSAS

Out-of-seat and talking-out behaviors were studied in a regular fourth-grade class that in-cluded several "problem children". After baseline rates of the inappropriate behaviors wereobtained, the class was divided into two teams "to play a game". Each out-of-seat and talking-out response by an individual child resulted in a mark being placed on the chalkboard, whichmeant a possible loss of privileges by all members of the student's team. In this manner acontingency was arranged for the inappropriate behavior of each child while the consequence(possible loss of privileges) of the child's behavior was shared by all members of this teamas a group. The privileges were events which are available in almost every classroom, suchas extra recess, first to line up for lunch, time for special projects, stars and name tags, aswell as winning the game. The individual contingencies for the group consequences weresuccessfully applied first during math period and then during reading period. The experi-mental analysis involved elements of both reversal and multiple baseline designs.

Researchers have recently begun to assessthe effectiveness of a variety of behavioralprocedures for management of disruptive class-room behavior. Some investigators have ar-ranged token reinforcement contingencies forappropriate classroom behavior (Birnbrauer,Wolf, Kidder, and Tague, 1965; O'Leary andBecker, 1967; Wolf, Giles, and Hall, 1968).However, these token reinforcers often havebeen dependent upon back-up reinforcers thatwere unnatural in the regular classroom, suchas candy and money. On the other hand,several investigators have utilized a reinforcerintrinsic to every classroom, i.e., teacher at-tention (Zimmerman and Zimmerman, 1962;

'This study is based upon a thesis submitted by thesenior author to the Department of Human Develop-ment in partial fulfillment of the requirements for theMaster of Arts degree. The research was supported bya Public Health Service Fellowship IFI MH-36, 964-01from the National Institute of Mental Health and bya grant (HD 03144) from the National Institute ofChild Health and Human Development to the Bureauof Child Research and the Department of HumanDevelopment, University of Kansas. The authors wishto thank Drs. Donald M. Baer and Don Bushell, Jr.,for helpful suggestions in preparation of the manu-script; Mr. Rex Shanks, Mr. Frank A. Branagan, andMrs. Betty Roberts for their invaluable help in con-ducting the study; and Mrs. Susan Zook, Mrs. SueChen, and Mr. Jay Barrish for their contributions oftime for reliability checks. Reprints may be obtainedfrom the authors, Department of Human Development,University of Kansas, Lawrence, Kansas 66044.

Hall and Broden, 1967; Becker, Madsen,Arnold, and Thomas, 1967; Hall, Lund, andJackson, 1968; Thomas, Becker, and Arm-strong, 1968; Madsen, Becker, and Thomas,1968). Even so, at least one group of investi-gators (Hall et al., 1968) encountered a teacherwho apparently did not have sufficient socialreinforcers in her repertoire to apply socialreinforcement procedures successfully. Thepresent study investigated the effects of a class-room behavior management technique basedon reinforcers natural to the classroom, otherthan teacher attention. The technique wasdesigned to reduce disruptive classroom be-havior through a game involving competitionfor privileges available in almost every class-room. The students were divided into twoteams and disruptive behavior by any memberof a team resulted in possible loss of privilegesfor every member of his team.

METHODSubjects and SettingThe study was conducted in a fourth-grade

classroom of 24 students. Seven of the studentshad been referred several times by the teacherto the school principal for such problems asout-of-seat behavior, indiscriminate noise andtalking, uncooperativeness, and general class-room disruption. Further, the school principalreported that a general behavior management

119

1969, 2, 119-124 NUMBER 2 (SUMMER 1969)

www.pubmed.gov



http://www.pubmed.gov


1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58

1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58

Perce

nt of

Interv

als Sc

ored f

or Be

havio

r

100%

75%

50%

25%

0%

100%

75%

50%

25%

0%

Math Period

Reading Period

Blurting

Blurting

Out-of-Seat

Out-of-Seat

Baseline

Baseline

Game 1

Game

Game 2Rev.












119

1969, 2, 119-124 NUMBER 2 (SUMMER 1969)

www.pubmed.gov





1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58

1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58

Perce

nt of

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als Sc

ored f

or Be

havio

r

100%

75%

50%

25%

0%

100%

75%

50%

25%

0%

Math Period

Reading Period

Blurting

Blurting

Out-of-Seat

Out-of-Seat

Baseline

Baseline

Game 1

Game

Game 2Rev.












119

1969, 2, 119-124 NUMBER 2 (SUMMER 1969)

www.pubmed.gov





1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58

1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58

Perce

nt of

Interv

als Sc

ored f

or Be

havio

r

100%

75%

50%

25%

0%

100%

75%

50%

25%

0%

Math Period

Reading Period

Blurting

Blurting

Out-of-Seat

Out-of-Seat

Baseline

Baseline

Game 1

Game

Game 2Rev.












119

1969, 2, 119-124 NUMBER 2 (SUMMER 1969)

www.pubmed.gov





1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58

1 2 5 8 10 11 13 15 20 21 23 26 33 36 41 43 45 48 50 51 53 55 58

Perce

nt of

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als Sc

ored f

or Be

havio

r

100%

75%

50%

25%

0%

100%

75%

50%

25%

0%

Math Period

Reading Period

Blurting

Blurting

Out-of-Seat

Out-of-Seat

Baseline

Baseline

Game 1

Game

Game 2Rev.












119

1969, 2, 119-124 NUMBER 2 (SUMMER 1969)

www.pubmed.gov





Longitudinal Johns Hopkins Studies of GBG

Every child rated by teachers

Kindergarden First Grade

GBG

NO GBG

Tested in 41 first- and second-grade classrooms

within 19 elementary schools with two

consecutive groups of first graders.

Young AdulthoodFollow Up

Age 19-21

Age 26

Age 30

Age 19-21

Age 26

Age 30

Purpose: To find out if GBG affected their adult

lives.

No More GBG

No GBG

Grades 2 thru 12Follow Up

Purpose: To find out if GBG affected their adolescent

lives.



Longitudinal Johns Hopkins Studies of GBG

Every child rated by teachers

Kindergarden First Grade

GBG

NO GBG

Tested in 41 first- and second-grade classrooms

within 19 elementary schools with two

consecutive groups of first graders.

Young AdulthoodFollow Up

Age 19-21

Age 26

Age 30

Age 19-21

Age 26

Age 30

Purpose: To find out if GBG affected their adult

lives.

No More GBG

No GBG

Grades 2 thru 12Follow Up

Purpose: To find out if GBG affected their adolescent

lives.



,JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 14, 317-345 (1993)

The Short-Term Impact of Two Classroom-Based Preventive

Interventions on Aggressive and Shy Behaviors and Poor Achievement

LAWRENCE J. DOLAN, SHEPPARD G. KELLAM, C . HENDRICKS BROWN ,

LISA WERTHAMER-LARSSON, GEORGE W . REBOK, LAWRENCE S. MAYER,

JOLENE LAUDOLFF, JAYLAN S. TURKKAN The Johns Hopkins School of Hygiene and Public Health

CARLA FORD LEONARD WHEELER

Baltimore City Public Schools

Two classroom-based preventive interventions were carried out on an epidem- iologically defined, varied population of children in a metropolitan area in the United States. This is a report of the short-term impact and specificity of the two interventions from fall through spring of first grade. The first intervention, the Good Behavior Game, was aimed at reducing aggressive behavior and shy behavior. Aggressive behavior has been shown to be an important developmental antecedent in first grade of later delinquency and heavy drug use, particularly when coupled

We acknowledge the contributions of the city of Baltimore, its families and children, and the administration, faculty, and staff of the Baltimore City Public Schools. In particular, we would like to thank Walter Amprey, Superintendent of Baltimore City Public Schools; Lillian Gonzales and Patsy Blacksheare, Deputy Superintendents; Juanita Lewis, Director; Denise Borders, Chief of Account- ability; Robert Solomon, Director, Special Education; Carla Ford, Specialist, Early Childhood Edu- cation; Louise Fink, Coordinator, Social Work Services; Dale Parker-Brown, Director, Compensatory Education; Matthew Riley, Director of the Eastern District; and Willie Foster, Director of Middle Schools. We also thank Alice Brogden for manuscript control and production; Fionnuala Regan for editorial preparation; and Pamela Spencer and Maria Corrada-Bravo for their contributions to data analyses. We thank Alan Harris for contributing to the development of the GBG intervention, and Lisa Crockett for her help in developing the Peer Assessment Inventory.

The studies on which this article is based have been supported by the following grants, with supplements from the National Institute on Drug Abuse: National Institute of Mental Health (NIMH) Grant No. P50 MH38725, Epidemiologic Prevention Center for Early Risk Behavior; NIMH Grant No. IR01 MH42968, Periodic Outcome of Two Preventive Trials; NIMH Grant No. 1R01 MH40859, Statistical Methods for Mental Health Preventive Trials.

Correspondence and requests for reprints should be sent to Lawrence Dolan, Department of Mental Hygiene, School of Hygiene and Public Health, 624 North Broadway, Baltimore, MD 21205.

317

By the early 1990s, multiple

studies including this randomized one proved that

GBG reduced the early predictive

behaviors.



Wow! In 1998, Drs. Kellam and Anthony showed that GBG reduced tobacco initiation—one of the middle predictors.

Tobacco Initiation (Age of First Use)



So now, let’s see if GBG affects suicide indicators among youth and young adults.

Wilcox, H. C., Kellam, S., Brown, C. H., Poduska, J., Ialongo, N., Wang, W., & Anthony, J. (2008). The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts. Drug & Alcohol

Dependence, 95(Suppl 1), 60-73.


















Timeline of Benefits…



Timeline of Benefits…

More time for teaching and learning

First MonthLess stress for

Staff & Students

Better Attendance

Better Academics

Less Illness

Fewer Service Needs

Fewer Referrals

First YearHappier Families

Less Vandalism

2nd & 3rd YearsADHD

AvertedOppositional

Defiance AvertedSpecial Education

Averted

5-15 YearsNo

TobaccoLess

AlcoholLess Conduct

DisordersLess

DepressionLess Crime,

Violence, SuicideHigh School Grad &

University



OUTCOMES STUDENT GROUPS GBG CLASSROOM STANDARD CLASSROOM

Drug abuse and All males 19 percent 38 percentdependence disorders

Highly aggressive males 29 percent 83 percent

Regular smoking All males 6 percent 19 percent

Highly aggressive males 0 percent 40 percent

Alcohol abuse and All males and females 13 percent 20 percent dependence disorders

Antisocial personality Highly aggressive males 40 percent 100 percent disorder (ASPD)

Violent and criminal Highly agressive males 34 percent 50 percent behavior (and ASPD)

Service use for All males 25 percent 42 percent problems with behavior, emotions, drugs, or alcohol

Suicidal thoughts All females 9 percent 19 percent

All males 11 percent 24 percent



Brain Brake



Brain Brake

How is this accomplished?




Loss by not protecting each Grade 1 cohort with example behavioral vaccine:$18 Billion in the US$182 Million in Oklahoma$3.1 Million in Tuttle city, OK

Estimates based on Washington State Institute for Policy Research:Aos, S., S. Lee, et al. (2011) Return on Investment: Evidence-Based Options to Improve Statewide Outcomes. 8




What if we provided parenting supports for every family?



Case Study #1:Universal Access to a Behavioral Vaccine for Families

NurturingOUR

Children

Biglan et al., American Psychologist, (4), 2012

Reduce Toxic In!uencesIncrease Psychological Flexibility

Richly Reinforce Pro-social BehaviorsLimit Problematic Behaviors

Credit: ITV





Case Study #1:Universal Access to a Behavioral Vaccine for Families

NurturingOUR

Children




✔

✔

✔

✔

Credit: ITV





Universal Access to Parenting Supports reduces child maltreatment in two years by…





Universal Access to Parenting Supports reduces child maltreatment in two years by…

25%





NurturingOUR

Children




Case Study from Ancient Wisdom:Universal Access to a Behavioral Vaccine for All





NurturingOUR

Children




✔

✔

✔

Case Study from Ancient Wisdom:Universal Access to a Behavioral Vaccine for All




Copyright © 2012-2013, PAXIS Institute. May be reproduced in entirety with copyright notice • 1-877-GO-PAXIS • www.paxis.org66Monday, April 15, 13



Omega-3 Status and US Military Suicide Deaths

e1J Clin Psychiatry

Suicide Deaths of Active-Duty US Military and Omega-3 Fatty-Acid Status: A Case-Control ComparisonMichael D. Lewis, MD; Joseph R. Hibbeln, MD; Jeremiah E. Johnson, RD; Yu Hong Lin, PhD; Duk Y. Hyun, BS; and James D. Loewke, BS

ABSTRACTBackground: The recent escalation of US military suicide deaths to record numbers has been a sentinel for impaired force efficacy and has accelerated the search for reversible risk factors.Objective: To determine whether deficiencies of neuroactive, highly unsaturated omega-3 essential fatty acids (n-3 HUFAs), in particular docosahexaenoic acid (DHA), are associated with increased risk of suicide death among a large random sample of active-duty US military.Method: In this retrospective case-control study, serum fatty acids were quantified as a percentage of total fatty acids among US military suicide deaths (n = 800) and controls (n = 800) matched for age, date of collection of sera, sex, rank, and year of incident. Participants were active-duty US military personnel (2002–2008). For cases, age at death ranged from 17–59 years (mean = 27.3 years, SD = 7.3 years). Outcome measures included death by suicide, postdeployment health assessment questionnaire (Department of Defense Form 2796), and ICD-9 mental health diagnosis data.Results: Risk of suicide death was 14% higher per SD of lower DHA percentage (OR = 1.14; 95% CI, 1.02–1.27; P < .03) in adjusted logistic regressions. Among men, risk of suicide death was 62% greater with low serum DHA status (adjusted OR = 1.62; 95% CI, 1.12–2.34; P < .01, comparing DHA below 1.75% [n = 1,389] to DHA of 1.75% and above [n = 141]). Risk of suicide death was 52% greater in those who reported having seen wounded, dead, or killed coalition personnel (OR = 1.52; 95% CI, 1.11–2.09; P < .01).Conclusion: This US military population had a very low and narrow range of n-3 HUFA status. Although these data suggest that low serum DHA may be a risk factor for suicide, well-designed intervention trials are needed to evaluate causality.J Clin Psychiatry© Copyright 2011 Physicians Postgraduate Press, Inc.

Submitted: January 24, 2011; accepted March 9, 2011.Online ahead of print: August 23, 2011 (doi:10.4088/JCP.11m06879).Corresponding author: Joseph R. Hibbeln, MD, USPHS, Section of Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcoholism and Alcohol Abuse, National Institutes of Health, 5625 Fishers Lane, Rm 3N-07, MSC 9410, Bethesda, MD 20892 ([email protected]).

Suicide rates among active-duty US military have increased to re-cord numbers, doubling since the inception of Operation Enduring

Freedom (Afghanistan) and Operation Iraqi Freedom and rivaling the battlefield in toll on the US military.1 Army Vice–Chief of Staff General Peter W. Chiarelli described the record suicide rate as “horrible” and voiced frustration that “the Army has not yet been able to identify any causal links among the suicide cases.”2(pA2)

Deficiencies of nutrients critical for brain function may be a signifi-cant contributing risk factor for psychiatric pathology, especially suicide and stress-related psychiatric symptoms.3 Highly unsaturated omega-3 essential fatty acids (n-3 HUFAs), in particular docosahexaenoic acid (DHA), are selectively concentrated in neural tissues and are required for optimal neural function.4 These fatty acids cannot be made de novo but are available only from dietary sources, with seafood being the richest source. Nutritional deficiencies in n-3 HUFAs may increase vulnerabil-ity to combat deployment stress, manifesting as psychiatric symptoms including adjustment disorders, major depression, impulsive violence, and suicide.5 In civilian populations, observational studies indicate that low fish consumption is associated with increased risk of completed sui-cides6,7 and greater suicidal ideation.8 Low DHA status was associated with increased risk of past suicide attempts9 and future suicide attempts.10 In comparison to placebo, 2 grams per day of n-3 HUFA reduced suicidal thinking and depressive symptoms and reduced the perception of stress among subjects (n = 49) with deliberate self-harm.11

These findings suggest that low DHA levels may be a contributing factor for adverse psychiatric symptoms. In this study, we posited that low DHA status would be associated with increased risk of suicide death among military personnel. Prospectively collected serum and supporting data were available from the Armed Forces Health Surveillance Center (AFHSC) for a large number of active-duty suicide deaths (n = 800) and matched controls (n = 800). To our knowledge, this is the largest study of biological factors among suicide deaths.

METHOD

Study DesignThis case-control study compared total serum fatty-acid composi-

tions from among 800 randomly selected active-duty US military suicide deaths to 800 matched controls (2002–2008). The AFHSC is a repository of more than 40 million serum samples with matched health data from US military personnel. Data from service members’ postdeployment health assessment (Department of Defense [DD] Form 2796, obtained within 6 months of completion of last deployment) closest to the date of serum sample provided information regarding time and theater of deployment (if applicable), exposure to stresses during deployment, self-report of mental health status, and indication for referral to mental health services; demographic data and frozen serum samples were provided by the AFHSC. Mental health and substance abuse–related ICD-9-CM diagnosis data reports were similarly obtained.


REVIEW Open Access

Clearance of fear memory from the hippocampusthrough neurogenesis by omega-3 fatty acids:a novel preventive strategy for posttraumaticstress disorder?Yutaka Matsuoka1,2

AbstractNot only has accidental injury been shown to account for a significant health burden on all populations, regardlessof age, sex and geographic region, but patients with accidental injury frequently present with the psychiatriccondition of posttraumatic stress disorder (PTSD). Prevention of accident-related PTSD thus represents a potentiallyimportant goal. Physicians in the field of psychosomatic medicine and critical care medicine have the opportunityto see injured patients in the immediate aftermath of an accident. This article first briefly reviews the prevalenceand associated factors of accident-related PTSD, then focuses on a conceptual model of fear memory andproposes a new, rationally hypothesized translational preventive intervention for PTSD through promotinghippocampal neurogenesis by omega-3 fatty acid supplementation. The results of an open-label pilot trial ofinjured patients admitted to the intensive care unit suggest that omega-3 fatty acid supplementation immediatelyafter accidental injury can reduce subsequent PTSD symptoms.

Matsuoka BioPsychoSocial Medicine 2011, 5:3http://www.bpsmedicine.com/content/5/1/3

Clearance of fear memory from the hippocampusthrough neurogenesis by omega-3 fatty acids: a novelpreventive strategy for posttraumatic stress disorder?Matsuoka

Matsuoka BioPsychoSocial Medicine 2011, 5:3http://www.bpsmedicine.com/content/5/1/3 (8 February 2011)

Omega-3 for PTSD symptoms could be used routinely for the patients exposed to trauma

REVIEW Open Access

Clearance of fear memory from the hippocampusthrough neurogenesis by omega-3 fatty acids:a novel preventive strategy for posttraumaticstress disorder?Yutaka Matsuoka1,2

AbstractNot only has accidental injury been shown to account for a significant health burden on all populations, regardlessof age, sex and geographic region, but patients with accidental injury frequently present with the psychiatriccondition of posttraumatic stress disorder (PTSD). Prevention of accident-related PTSD thus represents a potentiallyimportant goal. Physicians in the field of psychosomatic medicine and critical care medicine have the opportunityto see injured patients in the immediate aftermath of an accident. This article first briefly reviews the prevalenceand associated factors of accident-related PTSD, then focuses on a conceptual model of fear memory andproposes a new, rationally hypothesized translational preventive intervention for PTSD through promotinghippocampal neurogenesis by omega-3 fatty acid supplementation. The results of an open-label pilot trial ofinjured patients admitted to the intensive care unit suggest that omega-3 fatty acid supplementation immediatelyafter accidental injury can reduce subsequent PTSD symptoms.

Matsuoka BioPsychoSocial Medicine 2011, 5:3http://www.bpsmedicine.com/content/5/1/3

Clearance of fear memory from the hippocampusthrough neurogenesis by omega-3 fatty acids: a novelpreventive strategy for posttraumatic stress disorder?Matsuoka

Matsuoka BioPsychoSocial Medicine 2011, 5:3http://www.bpsmedicine.com/content/5/1/3 (8 February 2011)


2 hours


Estimate the costs of NOT acting…Estimate the benefits of acting to the public and private purse sort, medium and long term…

Predict Benefits (including economic)70Monday, April 15, 13

Quantify by epidemiology how much suffering will happen by NOT acting

Make the numbers real and human



Four fully loaded Boeing 747 with adults and children will land every day in Washington, DC to claim lifetime disabiity for mental, emotional and behavioral disorders…




Quantify by epidemiology the positive outcomes will happen from action

Four fully loaded Boeing 747 with adults and children will land every day in Washington, DC to claim lifetime disabiity for mental, emotional and behavioral disorders…

Everyday in America, 2,000+ more adults and children will wake up to happier, healthier, and more productive lives…



Create policy, advocacy, and organizational supports to foster cooperation for common good



Policy Example: Children’s Futures as Common Pool Resource





Develop community prevention scoreboards to monitor progress

You Win










C o u n ty : S a le s :

ADAMS 8 . 5 7 %

AS HLAND 3 . 4 5 %

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C ounties with 20% or lower illegal sa les are within thefederal goal. T he lower the numbers, the more clerksand retailers that are doing the right thing. C ountieswith rates lower than 10% of illegal tobacco sa les aremore likely to have an impact on reduce d tobacco useand addiction by Wisco nsin youth. R esu lts are inreal-time. B rowse this site and learn what you ca n doto help Wisco nsin Win.





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Dennis D. [email protected]

Thank you

Please see this and other presentations or papers at:

www.SlideShare.net/drdennisembry78Monday, April 15, 13

mailto:[email protected]

mailto:[email protected]

http://www.SlideShare.net/drdennisembry

http://www.SlideShare.net/drdennisembry

Health & Medicine

Creating an Evidence-Based Approach to Lifespan Suicide Prevention