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Background: The role of traumatic event exposure and psychiatric disorders as central risk factors for suicidal behavior has been established, but there are limited data in high conflict regions with significant trauma exposures such as Afghanistan. Methods: A nationally representative, cross-sectional survey was conducted through systematic stratified random sampling in 8 regions of Afghanistan in 2017 (N = 4474). Well-validated instruments were used to establish trauma exposure, psychiatric disorders. Death preference, suicidal ideation, plan, and attempts were assessed. Results: In the total sample, 2.2% reported suicidal ideation in the past 12 months, and 7.1% of respondents reported that they had suicidal ideation at some point in their lives; 3.4% reported a suicide attempt. Women were at higher risk than men. All traumatic event exposures were strongly associated with suicidal behavior. Respondents who reported experiencing sexual violence were 4.4 times more likely to report lifetime suicide attempts (95% CI 2.3–8.4) and 5.8 times more likely to report past 12-month suicidal ideation (95% CI 2.7–12.4). Associations were strong and significant for all psychiatric disorders related to suicidal behavior. Respondents who met criteria for major depressive episodes (OR = 7.48; 95% CI 4.40–12.72), generalized anxiety disorder (OR = 6.61; 95% CI 3.54–12.33), and PTSD (OR = 7.26; 95% CI 4.21–12.51) had the highest risk of past 12-month suicidal ideation. Conclusion: Traumatic event exposures and psychiatric disorders increase risk of suicidal behavior in the Afghan general population; women are at high risk. Interventions to reduce trauma exposure, including expansion of a mental health workforce in the region, are critically important. [ABSTRACT FROM AUTHOR]

Sexual minority adolescents have worse sleep health than their peers. Adolescents who identify as heterosexual and report prior same-sex sexual contact (termed 'discordant heterosexuals') have elevated health risks, but little is known about this group's sleep health. This study examined 2015–2017 Youth Risk Behavior Survey data (n = 12,773 high school students) comparing discordant heterosexuals to their concordant (i.e. sexual identity is concordant with reported sex of sexual contact) heterosexual, bisexual, gay and lesbian peers on three sleep outcomes: sufficient (≥8 hours), short (≤6 hours) and extremely limited sleep (≤4 hours). Both discordant heterosexual (aOR:0.64, 95% CI:0.47, 0.86) and bisexual students (aOR:0.69, CI:0.56, 0.85) had lower odds of sufficient sleep compared to concordant heterosexuals, even after adjustment for demographic factors and substance use. Discordant heterosexual (aOR:1.29, CI:1.01, 1.66) and bisexual (aOR:1.74, CI:1.54, 1.98) students have higher odds of short sleep. Discordant heterosexual (aOR:1.94, CI:1.36, 2.77) and bisexual students (aOR:2.72, CI:2.23, 3.31) also had higher odds of extremely limited sleep. Victimization may partially explain some of these associations. Sleep health is one factor that may drive health disparities, and efforts to ensure that adolescents are safe and secure in sexual behavior and identity is important to reducing these disparities. [ABSTRACT FROM AUTHOR]

Objective: In the United States, adult cannabis use has increased over time, but less information is available on time trends in cannabis use disorder. The authors used Veterans Health Administration (VHA) data to examine change over time in cannabis use disorder diagnoses among veterans, an important population subgroup, and whether such trends differ by age group (<35 years, 35-64 years, ≥65 years), sex, or race/ethnicity.Methods: VHA electronic health records from 2005 to 2019 (range of Ns per year, 4,403,027-5,797,240) were used to identify the percentage of VHA patients seen each year with a cannabis use disorder diagnosis (ICD-9-CM, January 1, 2005-September 30, 2015; ICD-10-CM, October 1, 2015-December 31, 2019). Trends in cannabis use disorder diagnoses were examined by age and by race/ethnicity and sex within age groups. Given the transition in ICD coding, differences in trends were tested within two periods: 2005-2014 (ICD-9-CM) and 2016-2019 (ICD-10-CM).Results: In 2005, the percentages of VHA patients diagnosed with cannabis use disorder in the <35, 35-64, and ≥65 year age groups were 1.70%, 1.59%, and 0.03%, respectively; by 2019, the percentages had increased to 4.84%, 2.86%, and 0.74%, respectively. Although the prevalence of cannabis use disorder was consistently higher among males than females, between 2016 and 2019, the prevalence increased more among females than males in the <35 year group. Black patients had a consistently higher prevalence of cannabis use disorder than other racial/ethnic groups, and increases were greater among Black than White patients in the <35 year group in both periods.Conclusions: Since 2005, diagnoses of cannabis use disorder have increased substantially among VHA patients, as they have in the general population and other patient populations. Possible explanations warranting investigation include decreasing perception of risk, changing laws, increasing cannabis potency, stressors related to growing socioeconomic inequality, and use of cannabis to self-treat pain. Clinicians and the public should be educated about the increases in cannabis use disorder in general in the United States, including among patients treated at the VHA. [ABSTRACT FROM AUTHOR]