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Subjects from the Epidemiologic Catchment Area Program, interviewed during 1979-1983, were linked to data in the National Death Index through 2007 to estimate the association of mental and behavioral disorders with death. There were more than 25 years of follow-up for 15,440 individuals, with 6,924 deaths amounting to 307,881 person-years of observation. Data were analyzed by using age as the time scale and parametric approaches to quantify the years of life lost due to disorders. Alcohol, drug use, and antisocial personality disorders were associated with increased risk of death, but there was no strong association with mood and anxiety disorders. Results of high- and low-quality matches with the National Death Index were similar. The 3 behavioral disorders were associated with 5-15 years of life lost, estimated along the life course via the generalized gamma model. Regression tree analyses showed that risk of death was associated with alcohol use disorders in nonblacks and with drug disorders in blacks. Phobia interacted with alcohol use disorders in nonblack women, and obsessive-compulsive disorder interacted with drug use disorders in black men. Both of these anxiety disorders were associated with lower risk of death early in life and higher risk of death later in life.

Future research needs to explore the association of psychotic experiences with physical health and lifestyle factors that may mediate the relationship of psychotic experiences with mortality.

Background In contrast to research on more restricted samples of drug users, epidemiological studies open up a view of death rates and survivorship of those who have tried heroin a few times, with no acceleration toward sustained use patterns often seen in treatment and criminal justice samples. At their best, epidemiological estimates of heroin effects on risk of dying are not subject to serious selection biases faced with more restricted samples. Methods Data are from 7207 adult participants aged 18–48 years in United States Epidemiologic Catchment Area Program field surveys, launched in 1980–1984. US National Death Index (NDI) records through 2007 disclosed 723 deaths. NDI enabled estimation of heroin-associated risk of dying as well as survivorship. Results Estimated cumulative mortality for all 18–48 year old participants is 3.9 deaths per 1000 person-years (95% confidence interval, CI = 3.7, 4.2), relative to 12.4 deaths per 1000 person-years for heroin users (95% CI = 8.7, 17.9). Heroin use, even when non-sustained, predicted a 3–4 fold excess of risk of dying prematurely. Post-estimation record review showed trauma and infections as top-ranked causes of these deaths. Conclusions Drawing strengths from epidemiological sampling, standardized baseline heroin history assessments, and very long-term NDI follow-up, this study of community-dwelling heroin users may help clinicians and public health officials who need facts about heroin when they seek to prevent and control heroin outbreaks. Heroin use, even when sporadic or non-sustained, is predictive of premature death in the US, with expected causes of death such as trauma and infections.

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Objective: Despite the interest in technology-enhanced preventive interventions for suicidality, there is minimal peer-reviewed research on conversations of text message hotlines. In this largescale study, the authors explored distinct classes of users of the Crisis Text Line who reported suicidality. Classes were based on texters' presenting psychosocial issues and were explored across frequency of hotline use and conversation number.Methods: Data included 153,514 conversations from 122,909 individuals collected by the Crisis Text Line (2013)(2014)(2015)(2016)(2017). Analyses were restricted to conversations from users who mentioned current or previous suicidality and excluded texters who discussed a third party. The authors used latent class analysis to identify distinct classes of texters on the basis of crisis counselor-assigned issue tags and across subgroups reflecting whether the conversation was the first or last contact with the hotline and frequency of use (one-time, twotime, or $3-time texters).Results: Three classes emerged in all subsamples. The largest class, "lower distress," had the lowest prevalence of all issues. The second largest class, "anxious distress," had the highest prevalence of anxiety or stress and elevated depression. The smallest class, "relational distress," had the highest prevalence of depression and self-harm and higher probability of endorsing relational indicators.Conclusions: Psychological and relational issues mostly distinguished the three classes. Despite differing frequency of hotline usage, most texters who reported suicidal ideation and behaviors endorsed similar issues, and these issues did not seem to vary across conversations. Yet there appeared to be distinct subgroups of texters with different presenting issues, which may inform how crisis counselors tailor strategies for both low-and high-volume texters.

Background While evidence suggests that depression is associated with medical morbidity and mortality, the potential role of mania has received less attention. This analysis evaluated the association between manic spectrum episodes and risk of all-cause mortality over a 26-year follow-up in a population-based study. Methods Participants included 14,870 adults (mean age 48.2 ± 20.3; 58.2% female; 31.1% non-white) from 4 sites of the Epidemiologic Catchment Area Study who completed the Diagnostic Interview Schedule (DIS) mania assessment between 1980 and 1983 and had vital status data available through 2007. Participants were grouped into 4 mutually exclusive categories based on DIS mania assessment: 1) manic episode (n=46); 2) hypomanic episode (n =195); 3) sub-threshold manic symptoms (n =1,041); and 4) no manic spectrum episodes (n =13,588). To determine vital status, participants were matched with the National Death Index. Participants with manic spectrum episodes were compared to those without such episodes with regard to mortality after 26 years. Results After adjusting for major depressive symptoms and demographic differences, odds of mortality at follow-up for participants with lifetime manic spectrum episodes in the 30-44 and 45-64 year age cohorts at baseline were higher than those with no lifetime manic spectrum episodes in the same age cohorts (OR=1.39, 95% CI = [1.00, 1.93] and OR=1.41, 95% CI = [1.02, 1.95] respectively). Conclusions History of lifetime manic spectrum episodes in early to mid adulthood is associated with increased risk of all-cause mortality in mid to late life. Limitations Future studies of mania and mortality should evaluate specific causes of mortality.

The Good Behavior Game (GBG) is a universal classroom-based preventive intervention directed at reducing early aggressive, disruptive behavior and improving children's social adaptation into the classroom. GBG is one of the few universal preventive interventions delivered in early elementary school that has been shown to reduce the risk for future suicide attempts. This paper addresses one potential mechanism by which the GBG lowers the risk of later suicide attempt. In this study we tested whether the GBG, by facilitating social adaptation into the classroom early on, including the level of social preference by classmates, thereby lowers future risk of suicide attempts. The measure of social adaptation is based on first and second grade peer reports of social preference (“which children do you like best?”; “which children don't you like?”). As part of the hypothesized meditational model, we examined the longitudinal association between childhood peer social preference and the risk of future suicide attempt, which has not previously been examined. Data were from an epidemiologically-based randomized prevention trial, which tested the GBG among two consecutive cohorts of first grade children in 19 public schools and 41 classrooms. Results indicated that peer social preference partially mediated the relationship between the GBG and the associated reduction of risk for later suicide attempts by adulthood, specifically among children characterized by their first grade teacher as highly aggressive, disruptive. These results suggest that positive childhood peer relations may partially explain the GBG-associated reduction of risk for suicide attempts and may be an important and malleable protective factor for future suicide attempt.