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Heroin is an urgent concern in the United States, but little is known about the course and associated factors for heroin use disorder. Martins and colleagues examined data from 2 National Epidemiologic Surveys on Alcohol and Related Conditions (n = 43 093 and n = 36 309) and found that prevalence of heroin use disorder significantly increased over time, particularly among younger white individuals, as did nonmedical prescription opioid use preceding heroin use. These results highlight the growing public health challenge of heroin. In an editorial, Madras discusses the necessary responses by clinicians and policy makers.
The mental, physical, and social health outcomes after spousal suicide are not well understood. Erlangsen and colleagues studied the stress of spousal suicide in a Danish cohort of 6.7 million individuals, including 4814 men and 10 793 women, bereaved by a partner’s suicide. They found higher risk for developing mental disorders; elevated risk for developing physical disorders, such as cirrhosis and sleep disorders; and increased use of municipal support in the bereaved spouses. Caine discusses the importance of the findings in an editorial.
Compared with other anxiety disorders, generalized anxiety disorder remains poorly understood. Ruscio and colleagues used a survey of 147 264 adults in 27 countries to study the epidemiology of generalized anxiety disorder as currently defined in DSM-5. The 3.7% lifetime prevalence of generalized anxiety disorder varied widely, being highest in high-income countries. Comorbidity is high, particularly with mood and other anxiety disorders. Treatment is sought by approximately half of affected individuals.
Patients recently discharged from psychiatric inpatient services are at elevated risk of death, but the details of this risk are not well understood. Walter and colleagues examined a national Danish cohort of recently discharged first-time psychiatric patients aged 15 to 44 years and found that they had significantly elevated risk for all-cause mortality and risk for unnatural death within a year compared with persons not admitted. These findings identify the 1-year postdischarge period as a risk window and highlight the need for enhanced coordination of mental health services during this period.
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Detection of individuals at risk for developing psychosis remains an important goal. Fusar-Poli and colleagues measured the proportion of individuals with a first episode of psychosis detected by At Risk Mental State services in 91 000 patients in England. The 6-year risk of psychosis was 3.02. The At Risk Mental State designation and 2 diagnoses, brief psychotic and bipolar disorders, were associated with risk for psychosis. The authors present an online individualized risk calculator tool to assess probability of conversion to psychosis in secondary mental health care settings.
In This Issue. JAMA Psychiatry. 2017;74(5):429. doi:10.1001/jamapsychiatry.2016.2516