Caring letters after a crisis call did not lower suicide deaths in 227,502 US veterans

The edition in brief

Today's psychiatry edition leads on suicide prevention. A prespecified secondary analysis in JAMA Psychiatry of the US Veterans Crisis Line caring letters programme found suicide mortality at 12 months of 0.29% among 87,926 veterans who received letters and 0.27% among 139,576 historical controls (P = .31); peer and clinician signatories did no differently. The letters-versus-none comparison was observational. A PLOS One meta-analysis of 23 studies in low- and lower-middle-income countries found depression in 41.9% of 5734 people with multidrug-resistant tuberculosis, with stigma, comorbidity and drug side effects among the strongest correlates. A German prognostic study of 564 people with major depression found machine-learning models predicted two-year relapse with balanced accuracy of at most 64%, and the best model used only a few clinical risk factors; imaging, genetics, blood markers and microbiome added nothing. A review of 42 studies found perinatal depressive symptoms consistently linked to self-reported cognitive complaints but not reliably to objective test performance. On the regulatory side, the FDA recorded a supplement to an existing generic olanzapine application held by an Indian manufacturer, an administrative action rather than a safety finding. The pearl covers how stopping smoking raises clozapine and olanzapine levels.