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In This Issue of JAMA Psychiatry
January 2020


JAMA Psychiatry. 2020;77(1):1. doi:10.1001/jamapsychiatry.2019.2779


Parental socioeconomic position may be linked to offspring’s schizophrenia risk, but parental socioeconomic mobility has not been investigated. Using a Danish national birth cohort of more than 1 million individuals, Hakulinen and colleagues examined parental income measured at birth year and at child ages 5, 10, and 15 years and found that regardless of parental income level at birth, upward income mobility was associated with significantly lower schizophrenia risk compared with downward mobility. In an Editorial, Frank discusses the implications of this work for the field.


Continuing Medical Education

Suicide is a public health problem, and suicide risk is difficult to predict. Gradus and colleagues conducted a case-cohort study nested within 8 national Danish health and social registries and used 1339 variables spanning domains of suicide risk factors to generate suicide risk prediction algorithms using machine learning. They found that individuals in the top 5% of predicted suicide risk account for 32.0% of all suicide cases in men and 53.4% of all cases in women. Fazel and O’Reilly place this work in context in an Editorial.


The quality of mental health care still leaves significant room for improvement. Ewbank and colleagues trained a deep-learning neural network model to categorize therapist utterances from approximately 90 000 hours of internet-enabled cognitive behavior therapy and associated these with patient improvements on a depression or anxiety measure. They found that both characteristics of cognitive behavior therapy change methods but also general psychotherapy approaches were associated with improvement in patient symptoms. The authors suggest that automated methods may be useful to improve psychotherapeutic efficacy.

Cardiovascular disease is among the deadly consequences of eating disorders in general and bulimia nervosa in particular, yet little is known about the association between these 2 disorders. Tith and colleagues used data from the study of hospital clientele registry from Quebec, Canada, to show that women with bulimia nervosa had a more than 4-fold risk of hospitalization for cardiovascular disease and death up to 8 years following the index bulimia hospitalization. They conclude that clinicians need to inform patients with bulimia about the risk of cardiovascular disease.


Approximately 1.4 million adults in the United States identify as transgender, and these individuals experience a high prevalence of adverse mental health outcomes. Turban and colleagues studied 27 715 US transgender adults and showed that recalled exposure to gender identity conversion efforts was associated with increased odds of both last-month severe psychological distress and lifetime suicide attempts when compared with transgender adults who had discussed their gender identity with a therapist but were not exposed to conversion efforts. They conclude that these data provide important evidence to reduce stigma for transgender individuals.