The edition · Psychiatry
Caring letters did not change suicide mortality in veterans, depression is common in drug-resistant TB, and loneliness predicts poorer depression course
A very large Veterans Crisis Line analysis finds no mortality difference with caring letters, a pooled analysis puts depression at about four in ten people with drug-resistant TB, and a review links baseline loneliness to worse depression outcomes.
The edition in brief
A prespecified secondary analysis of a randomised trial plus a historical comparison, covering 227,502 US veterans who contacted the Veterans Crisis Line, found no difference in 12-month suicide mortality between those sent nine caring letters and those who were not (0.29% vs 0.27%, P = .31), and no difference between clinician-signed and peer-signed letters. A meta-analysis of 23 studies and 5,734 people with multidrug-resistant tuberculosis in low- and lower-middle-income countries estimated pooled depression prevalence at 41.89% (95% CI 32.63-51.15) with very high heterogeneity (I-squared 98.51%); stigma, comorbidities, medication side effects and financial hardship were associated with depression. A systematic review of 22 longitudinal studies found baseline loneliness consistently associated with poorer later depression outcomes; four studies in older adults with depression gave a pooled adjusted OR of 3.26 (95% CI 2.26-4.70), though only one adjusted for baseline severity. The FDA also logged a supplement to a generic clozapine application; the record gives no detail on its content.
Caring letters were not associated with lower suicide mortality in veterans who called a crisis line
Do not rely on caring letters alone to prevent suicide; keep safety planning and active follow-up as the core of post-crisis care.
About four in ten people with drug-resistant TB in lower-income countries have depression
Consider routine depression screening for people on drug-resistant TB treatment and link those who screen positive to psychosocial care.
FDA logs a supplement to a generic clozapine application
No action is needed from this entry alone; keep to existing clozapine monitoring and check the label if your supplier flags a change.
Asking about suicidal thoughts directly does not plant the idea
Ask directly about suicidal thoughts, then act on the answer with a safety plan and follow-up.
Loneliness at baseline is linked to a poorer course of depression
Consider asking every patient with depression about loneliness and use a positive answer to guide closer follow-up and social support.
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