The edition · Psychiatry
Suicide risk in LGB patients rests on convincing evidence — and it belongs in the assessment
An umbrella review grades depression and suicide attempts in lesbian, gay and bisexual people among its most credible findings. Plus an app alongside medication for acute panic, a perinatal app trial and an olanzapine recall.
The edition in brief
An umbrella review in World Psychiatry pooled 22 meta-analyses covering 398 observational studies. Eight associations reached its highest credibility grade, including a doubled risk of depressive disorders in lesbian, gay and bisexual people (RR 2.05, 1.69 to 2.48) and a raised risk of suicide attempts (RR 2.51, 2.14 to 2.94) compared with heterosexual people. Bisexual people had higher odds of anxiety symptoms and self-injury than lesbian and gay people. These are associations, not measures of cause, but they are strong enough to justify asking about sexual orientation as part of a suicide risk assessment. In a Korean multicentre trial of 61 analysed patients with acute panic disorder, adding a prescribed self-guided CBT app to medication produced a larger 8-week fall in panic severity (40% vs 18%) and more responders (53% vs 17%). The trial was small and single-blind. A Japanese trial of 350 pregnant women found an interpersonal-therapy app made no difference in pregnancy but a small one at one month postpartum (SMD 0.28). The FDA lists a Class III recall of one 5 mg olanzapine product made by Macleods for the US market, for impurities above specification; Class III is the lowest-risk tier. The pearl: asking directly about suicidal thoughts does not plant them.
A prescribed CBT app alongside medication sped recovery in acute panic disorder
Consider adding self-guided CBT to medication from the start of treatment for acute panic disorder.
An interpersonal-therapy app in pregnancy: no change antenatally, a small one after birth
A self-guided interpersonal-therapy app was well accepted, but its benefit was small and seen only after birth.
FDA Class III recall: one US olanzapine 5 mg product for out-of-specification impurities
No change to olanzapine prescribing; this is a low-risk quality recall of specific US lots.
Asking about suicidal thoughts does not put them there
Ask directly about suicide, in plain words, at every assessment where mood is low.
Depression and suicide attempts in LGB people: evidence graded convincing
Ask, sensitively and confidentially, about sexual orientation when assessing depression and suicide risk.
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