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Cheryl B. McCullumsmith

Bio: Cheryl B. McCullumsmith is an academic researcher from University of Toledo. The author has contributed to research in topics: Poison control & Suicidal ideation. The author has an hindex of 17, co-authored 36 publications receiving 706 citations. Previous affiliations of Cheryl B. McCullumsmith include University of Cincinnati Academic Health Center & University of Alabama at Birmingham.

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Journal ArticleDOI
TL;DR: This novel prospective, multimodal, multicenter, mixed demographic study used machine learning to measure and fuse two classes of suicidal thought markers: verbal and nonverbal, and provides insight into how advanced technology can be used for suicide assessment and prevention.
Abstract: Death by suicide demonstrates profound personal suffering and societal failure. While basic sciences provide the opportunity to understand biological markers related to suicide, computer science provides opportunities to understand suicide thought markers. In this novel prospective, multimodal, multicenter, mixed demographic study, we used machine learning to measure and fuse two classes of suicidal thought markers: verbal and nonverbal. Machine learning algorithms were used with the subjects' words and vocal characteristics to classify 379 subjects recruited from two academic medical centers and a rural community hospital into one of three groups: suicidal, mentally ill but not suicidal, or controls. By combining linguistic and acoustic characteristics, subjects could be classified into one of the three groups with up to 85% accuracy. The results provide insight into how advanced technology can be used for suicide assessment and prevention.

104 citations

Journal ArticleDOI
TL;DR: The use of novel technologies to incorporate routine self-reported screening for suicidal ideation and other health domains allows for timely detection and intervention for this life-threatening condition.
Abstract: Background. Human immunodeficiency virus (HIV) and AIDS continue to be associated with an underrecognized risk for suicidal ideation, attempted suicide, and completed suicide. Suicidal ideation represents an important predictor for subsequent attempted and completed suicide. We sought to implement routine screening of suicidal ideation and associated conditions using computerized patient-reported outcome (PRO) assessments. Methods. Two geographically distinct academic HIV primary care clinics enrolled patients who attended scheduled visits from December 2005 through February 2009. Touch-screen, computer-based PRO assessments were implemented into routine clinical care. Substance abuse, alcohol consumption, depression, and anxiety were assessed. The 9-item Patient Health Questionnaire assesses the frequency of suicidal ideation in the preceding 2 weeks. A response of “nearly every day” triggered an automated page to predetermined clinic personnel, who completed more detailed self-harm assessments. Results. Overall, 1216 patients (740 from the University of Alabama at Birmingham and 476 from the University of Washington) completed the initial PRO assessment during the study period. Patients were predominantly white (646 [53%]) and male (959 [79%]), with a mean age (� standard deviation) of years. Among surveyed 44 � 10 patients, 170 (14%) endorsed some level of suicidal ideation, whereas 33 (3%) admitted suicidal ideation nearly every day. In multivariable analysis, suicidal ideation risk was lower with advancing age (odds ratio [OR], 0.74 per 10 years; 95% confidence interval [CI], 0.58‐0.96) and was increased with current substance abuse (OR, 1.88; 95% CI, 1.03‐3.44) and more-severe depression (OR, 3.91 for moderate depression [95% CI, 2.12‐7.22] and 25.55 for severe depression [95% CI, 12.73‐51.30]). Discussion. Suicidal ideation was associated with current substance abuse and depression. The use of novel technologies to incorporate routine self-reported screening for suicidal ideation and other health domains allows for timely detection and intervention for this life-threatening condition.

91 citations

Journal ArticleDOI
TL;DR: The explanatory characteristics of the PRO model correlated best with factors known to be associated with poor ART adherence (substance abuse; depression) and may prove to be a complementary and potentially transformative health informatics technology for research and patient care.
Abstract: The availability of timely, accurate patient data is critical to clinical decision making at the point of care and the ability to conduct comparative effectiveness research. Historically, cohort research has relied upon data captured by clinicians during routine medical care encounters, typically drawing upon data recorded in patients’ paper medical records or electronic health records (EHR). However, the quality of data captured in routine care settings is affected by a number of factors. At the provider level, high patient volume may impact the comprehensiveness and quality of data capture [1]. At the patient level, factors such as comfort providing sensitive information to clinicians and social desirability bias may affect data capture [2–5]. As the validity of comparative effectiveness research ultimately depends on the precision and integrity of data collected as part of routine care, these issues can negatively impact cohort research efforts [6, 7]. In 2008, the University of Alabama at Birmingham 1917 HIV/AIDS Clinic implemented the routine capture of patient reported data or outcomes (PROs) across multiple healthcare domains. PROs consist of standardized, validated patient questionnaires administered directly to patients, a mode of capture promoted by the NIH in its PROMIS initiative [8]. Using touch-screen computer-based administration, PROs are used for direct capture of substance use, depression, tobacco use, at-risk alcohol use, and other domains using validated instruments during routine care visits. This process allows for routine, systematic capture of standardized PRO data at the point of care. Furthermore, this practice represents a new clinical data capture paradigm and has augmented the traditional model of provider-led data capture on patients treated at our site. Historically, in the pursuit of research initiatives, clinical cohorts such as ours have relied on clinician documentation in patients’ problem lists or diagnostic coding of data on psychiatric comorbidities like substance use, depression, tobacco use, and at-risk alcohol use. PROs offer an alternative method of data capture for these domains. In the present investigation, we evaluated psychiatric comorbidities that were captured by EHR problem lists versus those captured by PROs. Specifically, we sought to compare the rates of psychiatric comorbidities (such as substance use and depression) in data captured through EHR versus PROs. Furthermore, we compared the association of psychiatric comorbidity data captured via EHR versus PROs sources with adherence to antiretroviral therapy (ART), a comprehensively studied issue in HIV care [9–13]. We hypothesized that psychiatric comorbidities including substance use and depression, as measured by the PROs, would be more strongly associated with poor adherence to ART compared with these same domains captured in the EHR, suggesting more comprehensive and accurate capture of these psychiatric comorbidities by PROs.

80 citations

Journal ArticleDOI
TL;DR: Ketamine, a rapidly acting antidepressant with antisuicidal properties, might offer relief in depressed patients presenting to emergency departments with acute suicidal ideation.
Abstract: BACKGROUND Depressed patients presenting to emergency departments with acute suicidal ideation are a major public health concern. Ketamine, a rapidly acting antidepressant with antisuicidal properties, might offer relief. METHODS In a randomized, double-blind, placebo-controlled, proof-of-concept trial, 18 depressed subjects with acute suicidal ideation, who required hospitalization, were randomized to either an intravenous ketamine 0.2 mg/kg group or a saline placebo group. Safety and efficacy evaluations were scheduled for 15, 30, 60, 90, 120, 180, and 240 min, and on Days 1, 2, 3, 7, and 14 after infusion. The main outcome measure was suicidal ideation with secondary measures of depression. RESULTS Nine subjects were randomized to each group. There were no differences between groups at baseline in any demographic or assessment scales. A reduction in suicidal ideation was noted at 90-180 min (p < .05). Ninety minutes after infusion, 88% of the ketamine group had achieved remission of suicidal ideation compared with 33% in the placebo group (p < .05). No serious adverse events were noted. CONCLUSIONS Ketamine was safe and effective for rapid reduction in suicidal ideation in depressed, highly suicidal subjects presenting to the emergency department. Our results support further study of ketamine for acute suicidal ideation.

45 citations

Journal ArticleDOI
TL;DR: HIV clinics can routinely screen and treat depressive symptoms, but should consider accurate psychiatric diagnosis as well as co-occurring mental disorders.
Abstract: This study described characteristics, psychiatric diagnoses and response to treatment among patients in an outpatient HIV clinic who screened positive for depression. Depressed (25 %) were less likely to have private insurance, less likely to have suppressed HIV viral loads, had more anxiety symptoms, and were more likely to report current substance abuse than not depressed. Among depressed, 81.2 % met diagnostic criteria for a depressive disorder; 78 % for an anxiety disorder; 61 % for a substance use disorder; and 30 % for co-morbid anxiety, depression, and substance use disorders. Depressed received significantly more treatment for depression and less HIV primary care than not depressed patients. PHQ-9 total depression scores decreased by 0.63 from baseline to 6-month follow-up for every additional attended depression treatment visit. HIV clinics can routinely screen and treat depressive symptoms, but should consider accurate psychiatric diagnosis as well as co-occurring mental disorders.

44 citations


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08 Nov 2011
TL;DR: ThePHQ-9, GAD-7 and PHQ-15 are brief well-validated measures for detecting and monitoring depression, anxiety and somatization.
Abstract: BACKGROUND Depression, anxiety and somatization are the most common mental disorders in primary care as well as medical specialty populations; each is present in at least 5-10% of patients and frequently comorbid with one another. An efficient means for measuring and monitoring all three conditions would be desirable. METHODS Evidence regarding the psychometric and pragmatic characteristics of the Patient Health Questionnaire (PHQ)-9 depression, generalized anxiety disorder (GAD)-7 anxiety and PHQ-15 somatic symptom scales are synthesized from two sources: (1) four multisite cross-sectional studies (three conducted in primary care and one in obstetric-gynecology practices) comprising 9740 patients, and (2) key studies from the literature that have studied these scales. RESULTS The PHQ-9 and its abbreviated eight-item (PHQ-8) and two-item (PHQ-2) versions have good sensitivity and specificity for detecting depressive disorders. Likewise, the GAD-7 and its abbreviated two-item (GAD-2) version have good operating characteristics for detecting generalized anxiety, panic, social anxiety and post-traumatic stress disorder. The optimal cutpoint is > or = 10 on the parent scales (PHQ-9 and GAD-7) and > or = 3 on the ultra-brief versions (PHQ-2 and GAD-2). The PHQ-15 is equal or superior to other brief measures for assessing somatic symptoms and screening for somatoform disorders. Cutpoints of 5, 10 and 15 represent mild, moderate and severe symptom levels on all three scales. Sensitivity to change is well-established for the PHQ-9 and emerging albeit not yet definitive for the GAD-7 and PHQ-15. CONCLUSIONS The PHQ-9, GAD-7 and PHQ-15 are brief well-validated measures for detecting and monitoring depression, anxiety and somatization.

607 citations

Journal ArticleDOI
TL;DR: Results indicate that people who have been sexually assaulted report significantly worse psychopathology than unassaulted comparisons, and provide evidence that experiencing SA is major risk factor for multiple forms of psychological dysfunction across populations and assault types.

402 citations

Journal ArticleDOI
TL;DR: In this article, the authors meta-analyzed 27 studies comparing sociodemographic and clinical variables between attempters and ideators, and found that depression, alcohol use disorders, hopelessness, gender, race, marital status, and education all were similar in the two groups.
Abstract: Most suicide ideators do not attempt suicide. Thus, it is useful to understand what differentiates attempters from ideators. We meta-analyzed 27 studies comparing sociodemographic and clinical variables between attempters and ideators. When comparing ideators to nonsuicidal individuals, there were several large effects. For example, depression and PTSD were markedly elevated among ideators (d = .85–.90). In contrast, when comparing attempters to ideators, all 12 variables had negligible to moderate effects. Specifically, depression, alcohol use disorders, hopelessness, gender, race, marital status, and education all were similar in attempters and ideators (d = −.05 to .31). Anxiety disorders, PTSD, drug use disorders, and sexual abuse history were moderately elevated in attempters compared to ideators (d = .48–.52). Implications for theory and practice are discussed.

360 citations