The functional disability caused by IBM reduces QoL, but psychosocial factors such as mood affect QoL directly and by influencing the degree to which disease severity reduces QoL. Further study should follow the effects of IBM on QoL over time and look at the influence of other psychosocial factors. Such studies may point to psychosocial interventions that may help improve QoL in IBM even if the disease itself cannot be treated.

SUMMARY BackgroundIt is believed that women with inflammatory bowel disease (IBD) have heightened symptoms around their menses. However, there is little information regarding normative changes and which symptoms emerge in relation to menses.

Objective-Although prior research has identified a number of separate risk factors for suicide among patients with depression, little is known about how these factors may interact to modify suicide risks. Using an empirically-based decision tree analysis for a large national sample of Veterans Affairs (VA) health system patients treated for depression, we identify subgroups with particularly high or low rates of suicide.Method-We identified 887,859 VA patients treated for depression between April 1, 1999 and September 30, 2004. Randomly splitting the data into two samples (primary and replication samples), we developed a decision tree for the primary sample using recursive partitioning. We then tested whether the groups developed within the primary sample were associated with increased suicide risk in the replication sample.Results-The exploratory data analysis produced a decision tree with subgroups of patients at differing levels of risk for suicide. These were identified by a combination of factors including a co-occurring substance use disorder diagnosis, male gender, African American race and psychiatric hospitalization in the past year. The groups developed as part of the decision tree accurately discriminated between those with and without suicide in the replication sample. The patients at highest risk for suicide were those with a substance use disorder, who were non-African American and had an inpatient psychiatric stay within the past 12 months.Conclusions-Study findings suggest that the identification of depressed patients at increased risk for suicide is improved through the examination of higher order interactions between potential risk factors.

Background Studies report mixed findings regarding antidepressant agents and suicide risks, and few examine suicide deaths. Studies using observational data can accrue the large sample sizes needed to examine suicide death but selection biases must be addressed. We assessed associations between suicide death and treatment with the seven most commonly used antidepressants in a national sample of VA patients in depression treatment. Multiple analytic strategies were used to address potential selection biases. Methods We identified VA patients with depression diagnoses and new antidepressant starts between April 1, 1999 and September 30, 2004 (N=502,179). Conventional Cox regression models, Cox models with inverse probability of treatment weighting, propensity stratified Cox models, marginal structural models (MSM), and instrumental variable (IV) analyses were used to examine relationships between suicide and exposure to: bupropion, citalopram, fluoxetine, mirtazapine, paroxetine, sertraline, and venlafaxine. Results Crude suicide rates varied from 88 to 247/100,000 person-years across antidepressant agents. In multiple Cox and MSM models, sertraline and fluoxetine had lower risks for suicide death than paroxetine. Bupropion had lower risks than several antidepressants in Cox but not MSM models. IV analyses did not find significant differences across antidepressants. Discussion Most antidepressants did not differ in their risk for suicide death. However, across several analytic approaches, although not IV analyses, fluoxetine and sertraline had lower risks of suicide death than paroxetine. These findings are congruent with the FDA meta-analysis of RCTs reporting lower risks for “suicidality” for sertraline and a trend towards lower risks with fluoxetine than for other antidepressants. Nevertheless, divergence in findings by analytic approach suggests caution when interpreting results.

Objectives Naturalistic studies comparing differences in risks across antidepressant agents must take into account factors which influence selection of specific agents and may be associated with outcomes. We examined predictors of antidepressant choice among VA patients treated for depression Methods Retrospective cohort study of VA patients with depression diagnoses and a new start of one of the seven most commonly prescribed antidepressant agents between April 1, 1999-September 30, 2004 (N=502,179). We examined the relationship between patient and facility characteristics and new starts of bupropion, citalopram, fluoxetine, mirtazapine, paroxetine, sertraline, and venlafaxine. We also examined factors associated with new starts only among patients starting selective serotonin reuptake inhibitors (SSRIs). Results 33% of patients starting mirtazapine had at least 3 outpatient mental health visits in the prior year, compared to ≤ 24% of patients prescribed other antidepressants. Patients starting mirtazapine were also most likely to have received at least 2 other psychotropic medications in the prior year. Of the four SSRIs, 40% of patients ≥65 years old received sertraline while only 31% received fluoxetine. A comorbid anxiety disorder (other than PTSD) was diagnosed in 21% of paroxetine patients compared with ≤ 15% of other SSRI patients. Conclusion Choice of antidepressant medication for depressed VA patients was associated with important differences in demographic and clinical variables, including psychiatric illness severity, older age and likelihood of a comorbid anxiety disorder. These findings emphasize the importance of controlling for selection bias when using observational data to compare risks from or effect of mental health treatments.