Payan DD, Perez-Lua F, Goldman-Mellor S, Young M-EDT. Rural household food insecurity among Latino immigrants during the COVID-19 pandemic. Nutrients. 2022.
U.S. food insecurity rates rapidly increased during the COVID-19 pandemic, with disproportionate impacts on Latino immigrant households. We conducted a qualitative study to investigate how household food environments of rural Latino immigrants were affected during the COVID-19 pandemic. Thirty-one respondents (42% from low food security households) completed interviews (July 2020-April 2021) across four rural counties in California. A rural household food security conceptual framework was used to analyze the data. Early in the pandemic, food availability was impacted by school closures and the increased consumption of meals/snacks at home; food access was impacted by reduced incomes. Barriers to access included limited transportation, excess distance, and lack of convenience. Key resources for mitigating food insecurity were the Supplemental Nutrition Assistance Program (SNAP), the Pandemic Electronic Benefits Transfer (P-EBT), school meals, charitable food programs, and social capital, although the adequacy and acceptability of charitable food distributions were noted issues. Respondents expressed concern about legal status, stigma, and the public charge rule when discussing barriers to government nutrition assistance programs. They reported that food pantries and P-EBT had fewer access barriers. Positive coping strategies included health-promoting food substitutions and the reduced consumption of meals outside the home. Results can inform the development of policy and systems interventions to decrease food insecurity and nutrition-related health disparities among rural Latino immigrants.
Goldman-Mellor SJ, Bhat HS, Allen MH, Schoenbaum M. Suicide risk among hospitalized versus discharged deliberate self-harm patients: Generalized random forest analysis using a large claims data set. American Journal of Preventive Medicine. 2022;62(4):558-566.
Introduction: Suicide rates are extremely high among emergency department patients seen for deliberate self-harm. Inpatient hospitalization is often recommended for these patients, but evi- dence on the suicide prevention impacts of hospitalization is scarce. Confounding by indication and challenges to implementing randomized designs are barriers to advances in this field. Methods: Investigators used 2009−2012 statewide data on 57,312 self-harm emergency department patients from California, linked to mortality records. Naive 12-month and 30-day suicide risks were estimated among patients who were hospitalized versus those who were discharged. Then, generalized random forest methods were applied to estimate the average treatment impacts of hospitalization on suicide, conditioning on observable covariates. Associations were calculated separately for sex- and age-specific subgroups. Analyses were conducted in February 2019−August 2021. Results: In naive analyses, suicide risk was significantly higher in hospitalized than in discharged patients in each subgroup. In 12-month models accounting for the observed covariates through generalized random forest methods, hospitalized male patients had 5.4 more suicides per 1,000 patients (95% CI=3.0, 7.8), hospitalized patients aged 10−29 years had 2.4 more suicides per 1,000 (95% CI=1.1, 3.6), and those aged ≥50 years had 5.8 more suicides per 1,000 (95% CI=0.5, 11.2) than corresponding discharged patients. Hospitalization was not significantly associated with sui- cide among female patients or patients aged 30−49 years in generalized random forest analyses. Patterns were similar in 30-day generalized random forest models. Conclusions: Emergency department personnel intend to hospitalize self-harm patients with high suicide risk; this study suggests that this goal is largely realized. Analyses that control for confound- ing by observable covariates did not find clear evidence that hospitalization reduces suicide risk and could not rule out the possibility of iatrogenic effects.
Margerison CE, Roberts M, Gemmill A, Goldman-Mellor S. Pregnancy-associated deaths due to drugs, suicide, and homicide in the U.S. 2010-2019. Obstetrics and Gynecology. 2022;139:172-80.
OBJECTIVE: To estimate the prevalence of pregnancy- associated deaths due to drugs, suicide, and homicide nationwide from 2010 to 2019. METHODS: Using U.S. death certificate records from 2010 to 2019 for 33 states plus the District of Columbia, we identified pregnancy-associated deaths using the pregnancy checkbox and International Classification of Diseases, Tenth Revision codes, calculated pregnancy- associated death ratios, and categorized deaths by cause, timing relative to pregnancy, race or ethnicity, and age. RESULTS: Of 11,782 pregnancy-associated deaths iden- tified between 2010 and 2019, 11.4% were due to drugs, 5.4% were due to suicide, and 5.4% were due to homicide, whereas 59.3% were due to obstetric causes and the remaining 18.5% were due to other causes. Drug-related deaths, suicide, and homicide accounted for 22.2% of pregnancy-associated deaths. All three causes of death increased over the study period, with drug-related pregnancy-associated deaths increasing 190%. Homicide during pregnancy and drug-related deaths, suicides, and homicide in the late postpartum period (43–365 days) accounted for a larger proportion of all deaths in these time periods than the contribution of these causes to all deaths among females of reproduc- tive age. Pregnant and postpartum people identified as non-Hispanic American Indian or Alaska Native were at highest risk of drug-related and suicide death, and peo- ple identified as non-Hispanic Black were at highest risk of homicide. CONCLUSION: Deaths due to drug use, suicide, and homicide constitute more than one fifth of all deaths during pregnancy and the first year postpartum. Drug- related deaths and homicides have increased over the past decade. Substantial racial and ethnic inequities in these deaths exist.
Kaplan MS, Mueller-Williams AC, Goldman-Mellor S, Sakai-Bizmark R. Changing trends in suicide mortality and firearm involvement among Black young adults in the United States. Archives of Suicide Research. 2022:4-10.
The suicide rate among adolescents and young adults in the United States increased 57% between 2007 and 2018, from 6.8 to 10.7 deaths per 100 000 individuals. Recent research characterized as alarming the increases in overall suicide rates among young Black and other racial/ethnic minority populations. To assess the temporal trends in overall suicide and firearm suicide mortality rates among non-Hispanic Black young adults, we conducted a sex-specific Joinpoint regression analysis to identify changing trends in these rates between 1999 and 2019. Data were obtained from the Centers for Disease Control and Prevention s Web-based Injury Statistics Query and Reporting System. Results showed an 84.5% increase in the firearm suicide rate among young Black men and a 76.9% increase among young Black women between 2013 and 2019. Additional research is needed to investigate potential population- level exposures during or before 2013 that may have influenced suicide and firearm suicide risk.
Goldman-Mellor SJ, Olfson M, Schoenbaum M. Acute injury mortality and all-cause mortality following emergency department presentation for alcohol use disorder. Drug and Alcohol Dependence. 2022;236:109472.
Background. Alcohol-related morbidity and mortality have increased substantially in the U.S. Understanding the population health implications of these concerning trends, including by identifying clinical subgroups of alcohol users at increased risk for potentially preventable acute causes of mortality, is of critical importance. Methods. This retrospective cohort study used statewide, all-payer, longitudinally-linked ED patient record and mortality data from California. Participants comprised all residents presenting to a licensed ED at least once in 2009-2011 with a diagnosis of alcohol use disorder (AUD). Participants were followed for one year after index ED visit to assess acute injury (unintentional poisoning, suicide, homicide, motor vehicle crash, and fall- or fire-related injury) and all-cause mortality rates per 100,000 person-years. Age-, sex-, race/ethnicity-adjusted standardized mortality rates (SMRs) for acute injury causes of death were determined using statewide mortality data. Results. Among 437,855 patients with index non-fatal ED visits for AUD, the 12-month acute injury mortality rate was 608.6 per 100,000 (SMR=8.0; 95% CI=7.7, 8.3), and all-cause mortality was 5,700.7 per 100,000 (SMR=6.5; 95% CI=6.4, 6.6). Unintentional poisoning accounted for 46.5%, and suicide for 19.7%, of acute-injury deaths. Acute injury deaths comprised 71.7% of all-cause mortality among patients aged 10-24 years, but much lower proportions among older patients. Female AUD patients had lower rates for all mortality outcomes. Conclusions. Emergency department patients with a recognized AUD comprise a population at persistently elevated risk for mortality. Age-related AUD patient differences in common causes of death, including drug overdose and suicide, can inform the structure of future clinical interventions.
Reeves M, Bhat HS, Goldman-Mellor S. Resampling to address inequities in predictive modeling of suicide deaths. BMJ Health & Care Informatics. 2022;29(e100456).
Objective Improve methodology for equitable suicide death prediction when using sensitive predictors, such as race/ethnicity, for machine learning and statistical methods. Methods Train predictive models, logistic regression, naive Bayes, gradient boosting (XGBoost) and random forests, using three resampling techniques (Blind, Separate, Equity) on emergency department (ED) administrative patient records. The Blind method resamples without considering racial/ethnic group. Comparatively, the Separate method trains disjoint models for each group and the Equity method builds a training set that is balanced both by racial/ethnic group and by class. Results Using the Blind method, performance range of the models sensitivity for predicting suicide death between racial/ethnic groups (a measure of prediction inequity) was 0.47 for logistic regression, 0.37 for naive Bayes, 0.56 for XGBoost and 0.58 for random forest. By building separate models for different racial/ethnic groups or using the equity method on the training set, we decreased the range in performance to 0.16, 0.13, 0.19, 0.20 with Separate method, and 0.14, 0.12, 0.24, 0.13 for Equity method, respectively. XGBoost had the highest overall area under the curve (AUC), ranging from 0.69 to 0.79. Discussion We increased performance equity between different racial/ethnic groups and show that imbalanced training sets lead to models with poor predictive equity. These methods have comparable AUC scores to other work in the field, using only single ED administrative record data. Conclusion. We propose two methods to improve equity of suicide death prediction among different racial/ethnic groups. These methods may be applied to other sensitive characteristics to improve equity in machine learning with healthcare applications.


Catalano R, Goldman-Mellor S, Bruckner TA, Hartig T. Sildenafil and suicide in Sweden. European Journal of Epidemiology. 2021;36(5):531-537.
Much theory asserts that sexual intimacy sustains mental health. Experimental tests of such theory remain rare and have not provided compelling evidence because ethical, practical, and cultural constraints bias samples and results. An epidemiologic approach would, therefore, seem indicated given the rigor the discipline brings to quasi-experimental research. For reasons that remain unclear, however, epidemiologist have largely ignored such theory despite the plausibility of the processes implicated, which engender, for example, happiness, feelings of belonging and self-worth, and protection against depression. We use an intent-to-treat design, implemented via interrupted time-series methods, to test the hypothesis that the monthly incidence of suicide, a societally important distal measure of mental health in a population, decreased among Swedish men aged 50–59 after July 2013 when patent rights to sildenafil (i.e., Viagra) ceased, prices fell, and its use increased dramatically. The test uses 102 pre, and 18 post, price-drop months. 65 fewer suicides than expected occurred among men aged 50–59 over test months following the lowering of sildenafil prices. Our findings could not arise from shared trends or seasonality, biased samples, or reverse causation. Our results would appear by chance fewer than once in 10,000 experiments. Our findings align with theory indicating that sexual intimacy reinforces mental health. Using suicide as our distal measure of mental health further implies that public health programming intended to address the drivers of self-destructive behavior should reduce barriers to intimacy in the middle-aged populations.
Goldman-Mellor SJ, Hall C, Cerda M, Bhat H. Firearm suicide mortality among emergency department patients with physical health problems. Annals of Epidemiology. 2021;54:38-44.
Purpose: Individuals with poor physical and mental health may face elevated risk for suicide, particularly suicide by firearm. Methods: This retrospective cohort study used statewide, longitudinally linked emergency department (ED) patient record and mortality data to examine 12-month incidence of firearm suicide among ED patients presenting with a range of physical health problems. Participants included all residents pre- senting to a California ED in 2009e2013 with nonfatal visits for somatic diagnoses hypothesized to in- crease suicide risk, including myocardial infarction, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, diabetes, cancer, back pain, headache, joint disorder, and injuries. For each patient diagnostic group, we calculated rates of firearm suicide per 100,000 person-years and standardized mortality ratios (SMRs) relative to the demographically matched California population. Results: Firearm suicide rates per 100,000 person-years ranged from 9.6 (among patients presenting with unintentional injury) to 55.1 (patients with cancer diagnoses), with SMRs from 1.48 to 7.45 (all p
Hall C, Ha S, Yen IH, Goldman-Mellor S. Risk factors for hyperthermia mortality among emergency department patients. Annals of Epidemiology. 2021;64:90-95.
PURPOSE: This study examines risk factors for heat-related mortality due to hyperthermia in emergency department patients, a vulnerable population. METHODS: This matched case-control study used statewide, longitudinally linked emergency department (ED) data and death records from California. Cases comprised California residents (≥18 years) who presented to a state-licensed ED and died of hyperthermia during the study period (2009-2012). For each case, up to five ED patients were randomly selected as live controls and matched on sex and age. Patients demographic characteristics and history of ED utilization for alcohol use, drug use, psychiatric disorders, heart-related conditions, chronic respiratory disease, neurodegenerative disorders, and cerebrovascular disease were assessed in relationship to hyperthermia mortality. RESULTS: Using multivariate conditional logistic regression models, hyperthermia mortality cases had higher odds of prior ED utilization for alcohol use (OR=11.16, 95% CI=3.87, 32.17) compared to controls. Cases were also more likely than controls to have Medicare insurance (OR=5.80, 95% CI=1.70, 15.15) or self-pay (OR=5.39, 95% CI=1.73, 16.79), at their most recent ED visit. CONCLUSIONS: ED patients presenting with alcohol problems may face increased risk of hyperthermia mortality. To help reduce heat-related mortality, EDs should consider interventions that target patients vulnerable to heat exposure.
Margerison CE, Hettinger K, Kaestner R, Goldman-Mellor S, Gartner D. Medicaid expansion associated with some improvements in perinatal mental health. Health Affairs. 2021;40(10):1605-1611.
Poor perinatal mental health is a common pregnancy-related morbidity with potentially serious impacts that extend beyond the individual to their family. A possible contributing factor to poor perin...