Publications

BACKGROUND: In 2024, approximately 84,100 adolescents and young adults (AYAs) between 15 and 39 years old received a cancer diagnosis.

AIMS: Given their unique psychosocial, economic, and clinical stressors, we examined whether AYA cancer patients living in deprived neighborhoods have a higher risk of suicide when compared to those in the least deprived neighborhoods.

MATERIALS & METHODS: Our sample comprised 486,374 AYA cancer patients from the Surveillance, Epidemiology, and End Results (SEER) dataset between 2006 and 2020. We use Cox proportional hazard models to test the relation between quintiles of neighborhood deprivation, from Q1 (most deprived) to Q5 (least deprived), and survival months until suicide mortality from the time of cancer diagnosis.

RESULTS: We find that AYA cancer patients living in more deprived neighborhoods (Q1, Q2, Q4) have a higher risk of suicide when compared to those in the least deprived neighborhoods (Q5) (Q1: HR-1.82 [1.14-2.90]; Q2: HR-1.95 [1.35-2.81]; Q4: HR-1.48 [1.05-2.07]).

DISCUSSION: Mental health services and monitoring from treatment through survivorship may support suicide prevention efforts for young cancer patients.

CONCLUSION: Early identification of high-risk AYA cancer patients living in deprived areas may help target suicide prevention interventions.

INTRODUCTION: Opioid-related deaths among perinatal populations have increased sharply in the United States. Whether the recent ascendence of illicit fentanyl and other synthetic opioids in the drug supply translates to increasing prenatal opioid use disorder (OUD) remains unknown. This study tested whether California's comparatively late fentanyl influx, in 2019, was associated with a subsequent increase in OUD among pregnant people.

METHODS: This ecologic, repeated retrospective cohort study examined annual cohorts of individuals with an index live-birth delivery in California, 2010-2022. Analyses used statewide, all-payer linked hospitalization and emergency department (ED) records. Overall and subgroup-specific trends in prevalence of prenatal OUD, assessed using ICD-9/10-CM diagnoses recorded at delivery hospitalization and during prenatal ED visits, were examined using joinpoint and logistic regression analyses. Data analysis was conducted in 2025.

RESULTS: The study included 4,381,064 index deliveries. Between 2010 and 2022, prevalence of prenatal OUD doubled (as assessed at delivery: 0.15% to 0.30%; as assessed via prenatal OUD ED visits: 0.04% to 0.08%). Joinpoint analysis indicated that most of this increase occurred prior to 2018; annual percentage changes (APC) after 2018 were largely flat (at-delivery prevalence APC: 2.4%, 95% CI, -2.2% to 7.3%; ED prevalence APC: 1.4%, 95% CI, -7.0% to 3.8%). Differences in 2019-2022 vs. 2010-2018 prevalence of prenatal OUD were larger among non-Hispanic White and other/multiple-race individuals, and those covered by Medicaid.

CONCLUSIONS: The recent introduction of fentanyl to California was associated with only incremental increases in prevalence of prenatal OUD. Continued tracking of these trends is important for perinatal health.

Background: In the United States, suicide accounts for 1 out of every 20 deaths that occur during pregnancy and the first 12 months postpartum. Although nonfatal suicide attempts are the strongest known predictor of death by suicide, there are no prior population based estimates of the incidence of and clinical risk factors for pregnancy associated suicide attempts. Methods: This retrospective cohort study used statewide, all-payer, longitudinally linked hospital and emergency department (ED) patient records from California. Participants included all California residents with an index hospital delivery of a live infant between 2010 and 2020. Outcomes included ED presentation for nonfatal suicide attempt during pregnancy or up to 12 months postpartum. Clinical risk factors of interest included healthcare utilization patterns during pregnancy and behavioral health diagnoses recorded at index delivery. Results: Among delivering patients with an index delivery (N = 3,737,792), 0.13% (n = 4,968) had a suicide attempt during pregnancy or the postpartum period. After adjusting for background demographic characteristics, risks of a postpartum suicide attempt were increased 4- to 30-fold by several clinical factors, including prenatal suicide attempt ED visits, psychiatric ED visits, and assault ED visits, and by psychotic disorders, bipolar disorder, alcohol use disorder, recurrent and single-episode major depressive disorder, and anxiety disorders recorded at delivery. Conclusions: Risks of postpartum suicide attempt were substantially elevated for patients who had behavioral health related ED visits during pregnancy and by several psychiatric disorders at delivery. Clinical consideration should be given to monitoring these patients for suicide attempt risk.