Research highlights – 21 October 2011

Research questions“Research highlights” is a weekly round-up of research papers appearing in the print BMJ. We start off with this week’s research questions, before providing more detail on some individual research papers and accompanying articles.

Suicidal behaviour from a lay perspective
Professionals may be well versed in risk factors for suicide, how to assess suicidal ideation, and manage risk accordingly, but what about the relatives, friends, and colleagues of those on the brink?

A qualitative study interviewed contacts of 18–34 year olds who had committed suicide, beginning: “Please tell me, in your own time, about [the deceased], about your relationship with him or her, and about what happened in the period leading up to his or her death.” Cristabel Owens and colleagues wanted to understand what the clues were and what stopped “significant others” from seeking help: none of the cases studied had been in contact with mental health services in the year leading up to the suicide.

The study is limited because the authors interviewed only significant others of people who had completed suicide, and their recollections may be hard to interpret. Despite this, a difficult role emerges; significant others “must collect and weigh evidence from a range of sources, correctly decipher and assess the significance of both signs and countersigns, identify the appropriate actions to take, and then summon the courage to take them. Risks are involved at every stage; cherished relationships are at stake,” explain the authors.

What implications does this study have for clinical care and policy? There are few proved strategies for reducing suicide, and “gatekeeping” shows promise, write Anthony Jorn and Betty Kitchener in their accompanying editorial. Traditionally, gatekeepers are trained professionals, but perhaps lay people also need training, such as via public health campaigns. 

Owens and colleagues suggest that friends and relatives seeking help “may need to be reassured that to act on their concerns may save life and that this may mean having to disregard customary codes of respect that usually limit intrusion into another person’s emotional life.”

Polycystic ovary syndrome and risk of adverse pregnancy outcome
Polycystic ovary syndrome has been linked with increased risk of gestational diabetes, hypertensive disease during pregnancy, and preterm birth. However, since such women often need assisted reproductive technology or ovulation induction to become pregnant in the first place, the extent to which adverse pregnancy outcomes should be attributed to the underlying disorder or to the infertility treatment is uncertain.

To clarify the situation, Nathalie Roos and colleagues surveyed a cohort of births recorded in the Swedish medical birth register that included 3787 births among women with polycystic ovary syndrome. They confirmed that the syndrome was strongly associated with several adverse outcomes that could not be attributed to the increased use of assisted reproductive technology or maternal characteristics such as advanced age or being overweight. They unsurprisingly conclude that women with polycystic ovary syndrome may need increased surveillance during pregnancy and birth.

Outcomes of elective surgery undertaken in independent sector treatment centres and NHS providers in England
This study confirms that patients undergoing elective surgery in independent sector treatment centres tended to be healthier and have less severe primary conditions than equivalent patients in NHS centres, and they had better outcomes from hip or knee replacement, but J Chard and colleagues found all the differences were small and their clinical relevance slight.

Maternal exposure to angiotensin converting enzyme inhibitors in the first trimester and risk of malformations in offspring
De-Kun Li and colleagues found that use of ACE inhibitors during the first trimester of pregnancy was associated with increased risk of heart defects in offspring compared with normotensive controls, but not compared with offspring of mothers who took other antihypertensive drugs in pregnancy or whose hypertension was untreated. The authors suggest that any increased risk is likely to be due to the underlying hypertension rather than to any drug.