Rates of US veteran suicidal thoughts dipped slightly during COVID-19
US veteran suicide ideation (SI) rates showed a slight decrease during the first year of the pandemic, according to a JAMA Psychiatry study yesterday. Among the associated risks, however, was having COVID-19, which doubled the odds of SI.
The researchers gave a longitudinal survey to 3,078 US veterans in November 2019 and then in November 2020. Almost all participants were men (91.6%), 79.3% were White, and the average age was 63.2 years. While 10.6% had suicidal thoughts in the year prior to the pandemic, at the follow-up survey, only 7.8% reported SI. About 0.3% of veterans attempted suicide during the pandemic, about half the rate of the US population pre-pandemic—a noteworthy insight as veterans are at higher risk of SI, according to the researchers.
About 2.6% of veterans developed new SI during the pandemic, with increased likelihood if they had attempted suicide before (odds ratio [OR], 6.31) or had low social support (OR, 2.77), lifetime post-traumatic stress disorder and/or depression (OR, 2.25), or deteriorating social relationships (OR, 1.47). Having COVID-19 increased SI odds 2.41-fold.
Those 18 to 64 years showed a decrease in SI rates and an increase in social support, which the researchers say could be due to their ability to use virtual technologies. On the other hand, those 65 years and above had significantly lower SI rates than younger veterans before and during the pandemic.
"Many older veterans have experienced multiple traumatic and stressful events, and may have been inoculated by these experiences to be better able to weather periods of prolonged stress," said senior author Robert Pietrzak, PhD, MPH, in a Yale University press release. "Having endured such events may have helped them develop adaptive coping strategies to better endure pandemic-related stress."
Breast cancer screening rates decreased during COVID-19
Across 32 US community health centers (CHCs), breast cancer screening rates dropped 8% from 2019 to 2020, and minorities and uninsured people were disproportionately affected, according to a Cancer study today. All sites included were part of an American Cancer Society grant program that worked to address disparities in breast cancer mortality through 2020.
After the CHCs began the grant program in 2018, the number of eligible women getting screened went up from 45.8% in June 2018 to 59.3% in July 2019 before dropping to 49.6% in July 2020, after the COVID-19 pandemic began. According to projections, had the pre-pandemic increase continued, more than 63% of eligible patients may have undergone a mammogram in 2020. (Eligible patients were considered 50- to 74-year-old women, with the target of having them go to a physician appointment every 12 months and have a mammogram every 27 months.)
While the 2020 rate was higher than the pre-grant baseline, CHCs with clientele consisting of more Black people, uninsured patients, or Hispanic populations saw noteworthy declines. For instance, centers consisting of more than 51% Black clients dropped 6.4 percentage points, going from 55.3% in 2019 to 48.9% in 2020.
"The imaging centers with a high percentage of Black representation returned to 98% of the 2018 screening baseline and to 88% of the 2019 screening baseline but technically started at a lower than desired screening rate in women aged 50 to 74 years," writes Lee G. Wilke, MD, in a related editorial. "The cumulative 'loss' of screening examinations in this population is, therefore, likely to have a greater impact because of the higher rate of missed cancers both in those who ultimately return for screening and in those who are not represented in the baseline screening volumes before the pandemic."
Because of the grant program's outcomes, Wilke adds that targeted community partnerships, telehealth communication platforms, and education programs may help recover breast screening rates.
Aug 26 Cancer study and editorial
Vaccination and preventive drugs reduce pediatric malaria rates 70%
Combining seasonal administration of malaria vaccine (RTS,S/AS01E) with antimalarial drugs (known as seasonal malaria chemoprevention, or SMC) prevented malaria in young children by about 70%, according to a New England Journal of Medicine study yesterday.
The study consisted of 6,861 children aged 5 to 17 months in Burkina Faso and Mali, and it tested whether targeted vaccination during the rainy months prevented more disease than SMC alone, and whether the two combined methods prevented more malaria incidence than either vaccination alone.
Researchers divided children into three groups: One group received four monthly doses of seasonal malaria treatment (current standard treatment), another received five doses of RTS,S/AS01E over 3 years (three initial doses and then two booster doses before subsequent rainy seasons), and the third group received both the vaccine and the treatment.
Episodes of clinical malaria, hospital admissions with severe malaria, and deaths from malaria were reduced by 62.8%, 70.5%, and 72.9%, respectively, in the combination group compared to the SMC alone group. Compared to the vaccine group alone, the combination group also saw those outcomes reduced by 59.6%, 70.6%, and 75.3%, respectively.
The study offers another tool in combatting resistance to standard antimalarial drugs, the authors said.
"The drugs currently used for chemoprevention (sulfadoxine-pyrimethamine and amodiaquine) remain effective in the trial areas, as shown by the results of our in vivo study involving asymptomatic children. However, if resistance to these drugs increases without an available alternative chemoprevention regimen, seasonal vaccination with RTS,S/AS01E could provide a potential alternative," the authors concluded, noting the seasonal malaria booster could be delivered before rainy season annually, similar to a flu shot.
Aug 25 N Engl J Med study