Mental illness, its treatment, and symptoms of mental and physical illness
This thesis is comprised of three studies that examined scientific issues of clinical and etiologic importance to psychiatry. The first study examined the association between severe headaches and development of suicidal thoughts or behaviors. This prospective cohort study found that severe headaches were associated with both a 39% increased odds of subsequently developing one or more of four suicidal thoughts/behaviors (thinking about death, wanting to die, thinking about committing suicide, and attempting suicide) and a 48% increased odds of developing the three thoughts/behaviors that specifically referred to respondents' own death or suicide (i.e., not including thoughts about death), after controlling for confounding. Depression did not confound these associations. The second study examined the association between schizophrenia-spectrum disorders (SSDs) and incidence of cardiovascular disease (CVD) symptoms. Among people 40-64 years old, SSDs were associated with more than a 4-fold increased odds of developing one or more of seven somatic CVD symptoms and more than a 50% increased odds of developing chest pain, alone. Atypical antipsychotic medications were not available at the time of the study and, thus, could not have caused symptoms among people with SSDs. These analyses controlled for measured confounders including psychiatric conditions and substance abuse, and assessed the magnitudes of possible confounding by unmeasured lifestyle factors using a sensitivity analysis technique. The third study examined the association between patients' involvement in treatment decisions and subsequent discontinuation of antidepressant therapy among adult individuals who were psychiatr cally hospitalized for treatment of major depressive disorder (MDD). Previous studies of antidepressant discontinuation have primarily focused on the effects of medication side effects. This study found that among patients treated for MDD who felt uninvolved in decisions the odds of discontinuing selective serotonin reuptake inhibitor antidepressant treatment during a 3-month period were 1.67 times the odds among patients who felt involved. This study controlled for confounding by medication side effects, the factor often assumed to be the dominant cause of antidepressant treatment discontinuation.
0347: Mental health