The processes and planning involved in choosing and attempting to die by a particular method of suicide are not well understood. Accounts from those who have thought about or attempted suicide using a specific method might allow us to better understand the ways in which people come to think about, plan and enact a suicide attempt.

To understand from first-person accounts the processes and planning involved in a suicide attempt on the railway.

Thematic analysis was conducted of qualitative interviews (N = 34) undertaken with individuals who had contemplated or attempted suicide by train.

Participants explained how they decided upon a particular method, time and place for a suicide attempt. Plans were described as being contingent on a number of elements (including the likelihood of being seen or interrupted), rather than being fixed in advance. Participants mentally rehearsed and evaluated a particular method, which would sometimes involve imagining in detail what would happen before, during and after an attempt. The extent to which this involved others (train drivers, partners, friends) was striking.

By giving people free reign to describe in their own words the processes they went through in planning and undertaking a suicide attempt, and by not interpreting such accounts through a lens of deficit and pathology, we can arrive at important insights into how people come to think and feel about, plan and enact a suicide attempt. The findings have implications in terms of understanding suicide risk and prevention more broadly.

Patients receiving treatment for opioid-use disorder (OUD) may experience psychological symptoms without meeting full criteria for psychiatric disorders. The impact of these symptoms on treatment outcomes is unclear.

To determine the prevalence of psychological symptoms in a cohort of individuals receiving medication-assisted treatment for OUD and explore their association with patient characteristics and outcomes in treatment.

Data were collected from 2788 participants receiving ongoing treatment for OUD recruited in two Canadian prospective cohort studies. The Maudsley Addiction Profile psychological symptoms subscale was administered to all participants via face-to-face interviews. A subset of participants (n = 666) also received assessment for psychiatric disorders with the Mini International Neuropsychiatric Interview. We used linear regression analysis to explore factors associated with psychological symptom score.

The mean psychological symptom score was 12.6/40 (s.d. = 9.2). Participants with psychiatric comorbidity had higher scores than those without (mean 16.8 v. 8.6, P<0.001) and 31% of those with psychiatric comorbidity reported suicidal ideation. Higher psychological symptom score was associated with female gender (B = 1.59, 95% CI 0.92–2.25, P<0.001), antidepressant prescription (B = 4.35, 95% CI 3.61–5.09, P<0.001), percentage of opioid-positive urine screens (B = 0.02, 95% CI 0.01–0.03, P<0.001), and use of non-opioid substances (B = 1.92, 95% CI 0.89–2.95, P<0.001). Marriage and employment were associated with lower psychological symptoms.

Psychological symptoms are associated with treatment outcomes in this population and the prevalence of suicidal ideation is an area of concern. Our findings highlight the ongoing need to optimise integrated mental health and addictions services for patients with OUD.

Cannabis is the most commonly used substance among patients in methadone maintenance treatment (MMT) for opioid use disorder. Current treatment programmes neither screen nor manage cannabis use. The recent legalisation of cannabis in Canada incites consideration into how this may affect the current opioid crisis.

Investigate the health status of cannabis users in MMT.

Patients were recruited from addiction clinics in Ontario, Canada. Regression analyses were used to assess the association between adverse health conditions and cannabis use. Further analyses were used to assess sex differences and heaviness of cannabis use.

We included 672 patients (49.9% cannabis users). Cannabis users were more likely to consume alcohol (odds ratio 1.46, 95% CI 1.04–2.06, P = 0.029) and have anxiety disorders (odds ratio 1.75, 95% CI 1.02–3.02, P = 0.043), but were less likely to use heroin (odds ratio 0.45, 95% CI 0.24–0.86, P = 0.016). There was no association between cannabis use and pain (odds ratio 0.98, 95% CI 0.94–1.03, P = 0.463). A significant association was seen between alcohol and cannabis use in women (odds ratio 1.79, 95% CI 1.06–3.02, P = 0.028), and anxiety disorders and cannabis use in men (odds ratio 2.59, 95% CI 1.21–5.53, P = 0.014). Heaviness of cannabis use was not associated with health outcomes.

Our results suggest that cannabis use is common and associated with psychiatric comorbidities and substance use among patients in MMT, advocating for screening of cannabis use in this population.

None.

Health Technology Assessment (HTA) and regulatory decisions involve value judgements. As patient groups, industry, and regulatory agencies conduct more preference studies to quantify these judgements, a better understanding of the methods and practices is needed. Currently, there is no systematic mapping of the use of preference data in Europe. This study aimed to identify (i) the use of quantitative preference data by all relevant HTA bodies and regulatory authorities of the European Union (EU) member states, and (ii) key standards and guidelines.

This study used a mixed method approach based on a systematic literature review, survey and subsequent interviews with decision makers and experts.

A total of 62 survey responses were received. Many respondents reported that their agencies were responsible for supporting more than one type of decision, with 69.0 percent supporting approval decisions, 64.3 percent supporting reimbursement decisions, 61.9 percent supporting pricing decisions, and 64.2 percent supporting guideline development. Respondents reported that their agencies supported these decisions in multiple ways: 78.6 percent by assessing health technologies; 54.8 percent by appraising health technologies; 45.2 percent by compiling an HTA report; 7.1 percent by conducting primary research; 9.5 percent by conducting secondary research. More than 40 percent (42.9 percent) of agencies had the final say on one of the decisions of interest – approval, reimbursement, or pricing. Of the 31 countries studied, 71 percent (n = 22) used quantitative preference data in their reimbursement and pricing decisions. Of those, 86 percent (n = 19) used general population preferences to inform the estimation of quality-adjusted life years (QALY) as part of cost utility analysis.

Much of this use of preference data can be understood within the standard framework of economic analysis adopted by many HTA agencies; either in in the form of: standard ways to estimate QALYs; ways to broaden the impacts of technologies captured in the QALY; or ways to weigh health gain with other decision-making criteria, such as disease severity or innovativeness.

Symptoms of anxiety relating to Parkinson's disease (PD) occur commonly and include symptomatology associated with motor disability and complications arising from PD medication. However, there have been relatively few attempts to profile such disease-specific anxiety symptoms in PD. Consequently, anxiety in PD is underdiagnosed and undertreated. The present study characterizes PD-related anxiety symptoms to assist with the more accurate assessment and treatment of anxiety in PD.

Ninety non-demented PD patients underwent a semi-structured diagnostic assessment targeting anxiety symptoms using relevant sections of the Mini International Neuropsychiatric Interview (MINI-plus). In addition, they were assessed for the presence of 30 PD-related anxiety symptoms derived from the literature, the clinical experience of an expert panel and the PD Anxiety-Motor Complications Questionnaire (PDAMCQ). The onset of anxiety in relation to the diagnosis of PD was determined.

Frequent (>25%) PD-specific anxiety symptoms included distress, worry, fear, agitation, embarrassment, and social withdrawal due to motor symptoms and PD medication complications, and were experienced more commonly in patients meeting DSM-IV criteria for an anxiety disorder. The onset of common anxiety disorders was observed equally before and after a diagnosis of PD. Patients in a residual group of Anxiety Not Otherwise Specified had an onset of anxiety after a diagnosis of PD.

Careful characterization of PD-specific anxiety symptomatology provides a basis for conceptualizing anxiety and assists with the development of a new PD-specific measure to accurately assess anxiety in PD.