Nevin Manimala

Otolaryngol Head Neck Surg. 2026 Jul 20. doi: 10.1002/ohn.70342. Online ahead of print.

ABSTRACT

OBJECTIVE: Given health system limitations, access to timely Auditory Brainstem Response (ABR) testing in infants is often challenging. The purpose of this study is to identify common barriers that may affect the number of ABRs needed to establish a definitive diagnosis of hearing loss in infants.

STUDY DESIGN: Retrospective review of variables impacting definitive diagnosis in infants who underwent ABRs from 2019 to 2024.

SETTING: Tertiary free-standing children’s hospital.

METHODS: Univariate and multivariable regression analyses were used to explore potential barriers with delays in time to definitive hearing loss diagnosis and management. All statistical tests were two-sided and performed at the 0.05 level of significance.

RESULTS: 630 patients met inclusion criteria. Of these, 579 (92%) had received a definitive diagnosis through ABR, 322 (55.6%) of which required only one ABR. 172 (29.7%) required two ABRs and 85 (14.7%) needed three or more. Time to hearing aid fitting was significantly influenced by time to definitive diagnosis. Patients diagnosed after 3 months of age were fit with a hearing aid at a significantly older age than those diagnosed by 3 months (11.2 vs 5.9 months, P = <.001). In the univariate analysis, otolaryngology consultation was associated with definitive hearing diagnosis at >3 months of age (386 vs 193, P = <.001). This association held true when controlling for other variables in multivariable analysis (aHR: 0.46, 95% CI: 0.38-0.55, P = <.001).

CONCLUSION: Primary common barriers impacting appropriate and timely EHDI guidelines: Infant sleep state, coordination with other providers, middle ear dysfunction, distance to facility, and scheduling constraints.

PMID:42475156 | DOI:10.1002/ohn.70342

Plast Reconstr Surg. 2026 Jul 20. doi: 10.1097/PRS.0000000000013328. Online ahead of print.

ABSTRACT

BACKGROUND: Immediate lymphatic reconstruction (ILR) following axillary lymph node dissection (ALND) has emerged as a potential strategy to mitigate breast cancer-related lymphedema (BCRL). This present study aims to evaluate the impact of ILR on lymphedema incidence in breast cancer patients undergoing ALND and identify potential risk factors for lymphedema despite ILR.

METHODS: A comprehensive search was performed using PubMed, Embase, Scopus, Ovid and Google Scholar databases. Thirty studies met inclusion criteria for the meta-analysis, comprised of seventeen comparative studies and thirteen non-comparative studies. The primary outcome was the incidence of lymphedema.

RESULTS: Overall, there was a 63% reduction in lymphedema risk with ILR. Among 1030 patients who underwent ILR, 14.5% developed lymphedema, compared to 25% of the 1260 patients in the control group. When pooling all ILR patients (including non comparative studies) across studies (n = 2080), 11% developed lymphedema. While BMI and the number of lymph nodes removed showed trends toward increased lymphedema risk in the ILR group, neither reached statistical significance (p > 0.05). There was significant variability among studies in terms of follow-up, post-operative management, and metrics for determining lymphedema. Notably, studies with longer follow-up reported higher lymphedema rates.

CONCLUSION: ILR is associated with a reduction in BCRL risk following ALND. Despite heterogeneity and risk of bias across studies, the meta-analysis suggests a favorable effect of ILR. Future studies should adopt standardized diagnostic criteria and assessment tools for lymphedema to enhance comparability and reduce heterogeneity.

PMID:42475134 | DOI:10.1097/PRS.0000000000013328

J Med Internet Res. 2026 Jul 20;28:e89780. doi: 10.2196/89780.

ABSTRACT

BACKGROUND: Digital health interventions can improve access to and outreach of evidence-based support for people living with chronic pain. How best to deliver such interventions remains unclear, however, and although guided or blended care models show promise, digital interventions are primarily delivered without support or follow-up.

OBJECTIVE: This study aimed to compare the use and effect of the evidence-based digital pain self-management intervention EPIO when (1) delivered through digital download without follow-up (ie, EPIO_NoFollowUp), compared with (2) delivery through a simple blended-care model (ie, EPIO_BlendedCare), or care-as-usual controls.

METHODS: People (n=73) with chronic pain received access to the EPIO program through individual download (EPIO_NoFollowUp). Program use and outcome measures were collected over 12 months and compared with findings from a separate randomized controlled trial in which people with chronic pain (n=266) were assigned to receive EPIO through a simple blended care model (EPIO_BlendedCare) or to a care-as-usual control group. Outcome measures were collected at baseline and at 3, 6, and 12 months and included pain interference (Brief Pain Inventory [BPI]; primary outcome), pain severity (BPI), anxiety and depression (Hospital Anxiety and Depression Scale), self-regulatory fatigue (Self-Regulatory Fatigue Scale-18), health-related quality of life (HRQoL; RAND 36-Item Health Survey), pain catastrophizing (Pain Catastrophizing Scale), and pain acceptance (Chronic Pain Acceptance Questionnaire-8). Generalized linear models for repeated measures were fitted to explore between-group differences over time. Interviews with the EPIO_NoFollowUp group (n=15) exploring perceived program experiences were analyzed using rapid analysis.

RESULTS: Participants (N=332) had a median age of 49 (IQR 39-55) years, were primarily women (271/332, 82%), and had a variety of pain conditions. Statistically significant between-group differences in favor of the EPIO_NoFollowUp group compared with the control group included improved HRQoL and pain acceptance and reduced pain catastrophizing. Intervention group comparison revealed only 1 significant between-group difference, for self-regulation, in favor of EPIO_BlendedCare. Participants receiving the EPIO_NoFollowUp delivery model displayed lower program use, averaging 10 (IQR 3-24) days of use vs 30 (IQR 13-44) days for EPIO_BlendedCare. Similarly, 23% (17/73) of the EPIO_NoFollowUp group participants completed ≥7 of 9 modules, compared with 62% (78/125) in EPIO_BlendedCare. Higher education level was associated with significant improvements in pain severity, anxiety, HRQoL, and pain catastrophizing, as well as higher module completion, in the EPIO_NoFollowUp group but not in the EPIO_BlendedCare group. Qualitative findings identified a preference for more follow-up, as well as positive changes in awareness, acceptance, and coping in the EPIO_NoFollowUp group.

CONCLUSIONS: The delivery model should be considered when providing access to digital self-management, and models with guidance appear to be the most helpful. When health care resources are limited, blended care delivery should likely be chosen for those who need it most, for example, those with lower education.

PMID:42475133 | DOI:10.2196/89780

J Am Acad Orthop Surg Glob Res Rev. 2026 Jul 20;10(7). doi: 10.5435/JAAOSGlobal-D-25-00201. eCollection 2026 Jul 1.

ABSTRACT

BACKGROUND: Women have a higher prevalence of osteoarthritis and report worse symptoms, yet they undergo joint replacement surgery (JRS) at lower rates than men. Studies suggest that cultural norms, healthcare access, physician biases, and patient preferences may contribute to disparities, but consensus on gender-specific barriers in JRS utilization remain unclear.

METHODS: From a database of JRS candidates seen in 2022 at two tertiary academic centers, patients who were offered but declined surgery were invited to participate in focus groups (FGs). Demographics, Kellgren-Lawrence grades, symptom duration, visual analog pain score, Charlson Comorbidity Index, and nonsurgical treatments were collected. Statistical analysis included chi-square, analysis of variance, and t-tests. FGs explored patient treatment experiences using code-based qualitative analysis.

RESULTS: The database cohort included 976 patients (140 shoulder, 493 hip, and 343 knee), with 60% female. No notable sex differences were found in JRS utilization. FG participants (n = 24) included 12 women and 12 men. Women were younger than men (70.9 ± 9.6 vs. 73.4 ± 6.1). Both men and women reported negative physician interactions and identified return to lifestyle as key in influencing surgery decisions. Men expressed concerns about hobbies, recovery support, and felt encouraged to undergo surgical treatment. Women prioritized household responsibilities, cosmetic outcomes, and trialed alternative treatments more often and endorsed age- and gender-based biases in care.

CONCLUSION: Gender-based differences influence patient experiences and decision making regarding JRS. Although men felt supported in pursuing surgery, women perceived bias and exhausted conservative treatments first. These findings highlight the need for shared decision-making frameworks that address gender-based disparities in surgical care.

PMID:42475122 | DOI:10.5435/JAAOSGlobal-D-25-00201

JAMA Netw Open. 2026 Jul 1;9(7):e2623265. doi: 10.1001/jamanetworkopen.2026.23265.

ABSTRACT

IMPORTANCE: Relapse limits survival after allogeneic hematopoietic cell transplant. Although human leukocyte antigen-matched related donors (MRDs) are traditionally preferred, mismatched unrelated donors (MMUDs) using posttransplant cyclophosphamide may provide stronger graft-vs-leukemia effects, potentially altering donor selection strategies.

OBJECTIVE: To compare outcomes between MRD and MMUD transplant in the posttransplant cyclophosphamide era and assess whether MMUD grafts are associated with lower relapse rates.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study (January 1, 2017, to August 31, 2024) assessed 1038 patients with acute leukemia or myelodysplastic syndromes and/or myeloproliferative neoplasms undergoing their first peripheral blood hematopoietic cell transplant using posttransplant cyclophosphamide. The MRD cohort was from a single tertiary center, and the MMUD cohort was from the Center for International Blood and Marrow Transplant Research. Data were analyzed between January 19, 2026, and April 2, 2026.

EXPOSURE: Transplant from MRD (n = 306) vs MMUD (n = 732).

MAIN OUTCOMES AND MEASURES: Disease-free survival (DFS), overall survival (OS), relapse, nonrelapse mortality, and graft-vs-host disease (GVHD). The study used inverse probability of treatment weighting with overlap weights and bootstrapping to address structural confounding, particularly donor age. Cox proportional hazard models were used to compare outcomes between groups and confirm that phrasing with the author.

RESULTS: Among 1038 patients (526 [50.7%] female), donors in the MRD group were older (median [IQR] age, 57 [45-64] years) than in the MMUD group (median [IQR] age, 28 [24-35] years) (P < .001). Recipient age was similar (median [IQR] age, 60 [47-66] vs 58 [47-65] years; P = .40). In patients with a high or very high Disease Risk Index (DRI), MMUD transplant was associated with significantly lower relapse hazard vs MRD (weighted hazard ratio [HR], 0.56; 95% CI, 0.33-0.94; P = .03), although DFS (HR, 0.71; 95% CI, 0.46-1.11; P = .14) and OS (HR, 0.85; 95% CI, 0.53-1.37; P = .51) were similar. Conversely, in patients with low to intermediate DRIs, hazard estimates for DFS (HR, 1.24; 95% CI, 0.92-1.66; P = .16) and OS (HR, 1.36; 95% CI, 0.99-1.88; P = .06) lacked precision. MMUD was associated with lower risk of grade III to IV acute GVHD (HR, 0.56; 95% CI, 0.32-0.98; P = .04) but higher chronic GVHD (HR, 2.82; 95% CI, 2.02-3.95; P < .001).

CONCLUSIONS AND RELEVANCE: In this cohort study, MMUD transplant was associated with lower relapse rates compared with MRD in patients with high-risk malignant tumors, potentially reflecting enhanced alloreactivity, although accompanied by increased chronic GVHD. These findings indicated that the immunologic role of human leukocyte antigen mismatch varies by disease risk, suggesting that MMUD grafts offered a distinct risk-benefit profile that warrants further investigation.

PMID:42475099 | DOI:10.1001/jamanetworkopen.2026.23265

JAMA Netw Open. 2026 Jul 1;9(7):e2623622. doi: 10.1001/jamanetworkopen.2026.23622.

ABSTRACT

IMPORTANCE: Radical cystectomy for bladder cancer is associated with high complication rates. Evidence supporting perioperative specialized immunonutrition for reducing complications is limited.

OBJECTIVE: To determine whether perioperative specialized immunonutrition reduces 30-day complications compared with standard oral nutrition support among adults undergoing radical cystectomy.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, randomized, double-blind, phase 3 clinical trial (SWOG S1600) conducted at 13 US academic and community sites within the National Cancer Institute National Clinical Trials Network and National Community Oncology Research Program enrolled patients from March 5, 2019, through October 19, 2023, with 30-day complications assessed through day 90 and survival outcomes through 2 years. Participants included adults with bladder cancer scheduled for radical cystectomy who could swallow oral liquids and did not have severe malnutrition. Statistical analysis was performed from January 2024 to December 2026.

INTERVENTIONS: Participants consumed drinks 3 times daily for 5 days before and after surgery. Both drinks used the same base formula. The immunonutrition product contained added l-arginine, ω-3 fatty acids, and dietary nucleotides. Adherence was 94.5% (52 of 55), measured using the plasma arachidonic acid to eicosapentaenoic acid biomarker.

MAIN OUTCOMES AND MEASURES: Analysis was performed on a modified intent-to-treat basis. The primary outcome was any 30-day complication (Clavien-Dindo grade ≥1). A 65% complication rate and a 35% relative reduction were prespecified. Secondary outcomes included high-grade complications at 30 and 90 days, adverse events, and 2-year disease-free and overall survival.

RESULTS: Of the 203 participants enrolled, the median age was 68.8 years (range 32.0-95.2 years) and 162 (79.8%) were male. Of 203 randomized (99 immunonutrition, 104 standard), 17 withdrew, and 8 lacked 30-day data, yielding 178 evaluable participants (90 immunonutrition, 88 standard). Any 30-day complication occurred in 62.2% of patients (56 of 90) receiving immunonutrition and 58.0% of patients (51 of 88) receiving standard nutrition (odds ratio [OR], 1.18; 95% CI, 0.64-2.18). High-grade 30-day complications occurred in 11.1% of patients (10 of 90) receiving immunonutrition vs 12.5% of patients (11 of 88) receiving standard nutrition (OR, 0.86; 95% CI, 0.34-2.17). Two-year overall survival was 87.4% among patients receiving immunonutrition vs 78.2% among patients receiving standard nutrition, and disease-free survival was 77.0% among patients receiving immunonutrition vs 67.5% among patients receiving standard nutrition. Adverse events occurred for 34.1% of patients (31 of 91) receiving immunonutrition and 20.5% of patients (18 of 88) receiving standard nutrition, with nausea most common.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of adults undergoing radical cystectomy, perioperative specialized immunonutrition did not reduce 30-day complications compared with standard oral nutrition. Differences in 2-year survival favored immunonutrition but were not statistically significant. Further mechanistic evaluation and subgroup analyses are warranted.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03757949.

PMID:42475098 | DOI:10.1001/jamanetworkopen.2026.23622

JAMA Netw Open. 2026 Jul 1;9(7):e2623952. doi: 10.1001/jamanetworkopen.2026.23952.

ABSTRACT

IMPORTANCE: The Patient Health Questionnaire-9 (PHQ-9) is widely used to assess depression, and the General Anxiety Disorder-7 (GAD-7) is widely used to assess anxiety, yet the extent to which subtle differences in instruction delivery influence symptom scores is poorly understood.

OBJECTIVE: To determine whether emphasizing instructional wording alters PHQ-9 and GAD-7 responses among US adults with depression or anxiety.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted from April 17 to May 30, 2025. Participants included US adults with self-reported clinician-diagnosed or treated major depressive disorder or generalized anxiety disorder, recruited via online advertisements and assessed by telephone.

INTERVENTIONS: Participants completed the PHQ-9 and the GAD-7 twice within the same session. Control participants received standard instructions for both administrations. Intervention participants received standard instructions initially and, for the second administration, were reminded to attend to the wording of the questionnaire instructions, with emphasis placed on the word bothered.

MAIN OUTCOMES AND MEASURES: The primary outcome was changes in PHQ-9 and GAD-7 total scores. Secondary outcomes were a score reduction greater than 20% and categorical change in score severity (eg, moderate to mild).

RESULTS: Among 200 total participants (n = 100 in the intervention group and n = 100 in the control group; mean [SD] age, 41.5 [15.4] years; 146 female [73%]), those in the intervention group demonstrated greater score reductions than those in the control group on the PHQ-9 (difference in changes: -2.60 [95% CI, -3.30 to -1.91]; P < .001) and the GAD-7 (difference in changes: -2.63 [95% CI, -3.35 to -1.99]; P < .001). Intervention participants had higher odds of achieving a score reduction greater than 20% (PHQ-9: adjusted odds ratio [AOR], 14.29 [95% CI, 5.95-34.48], P < .001; GAD-7: AOR, 10.20 [95% CI, 5.08-20.41], P < .001) and categorical improvement (PHQ-9: AOR, 9.17 [95% CI, 4.35-19.61], P < .001; GAD-7: AOR, 7.14 [95% CI, 3.57-14.29], P < .001) compared with control participants.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of instructional emphasis on PHQ-9 and GAD-7 scores among participants with anxiety or depression, findings suggest that variation in how questionnaire instructions are emphasized can influence PHQ-9 and GAD-7 scores, underscoring the need for standardized administration in clinical, research, and digital settings.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06956378.

PMID:42475096 | DOI:10.1001/jamanetworkopen.2026.23952

JAMA Netw Open. 2026 Jul 1;9(7):e2624047. doi: 10.1001/jamanetworkopen.2026.24047.

ABSTRACT

IMPORTANCE: Burnout is highly prevalent among emergency medicine (EM) residents and is associated with negative outcomes for physician well-being and patient care. Emerging evidence suggests sexual minority trainees may be at increased risk, but differences within EM residency are not well characterized.

OBJECTIVE: To determine if burnout prevalence among EM residents differs by sexual orientation after adjustment for key confounders.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included US resident physicians who took the 2024 American Board of Emergency Medicine In-Training Exam (ITE) postexamination survey and answered the question on sexual orientation.

EXPOSURE: Sexual minority status (heterosexual or straight and sexual minority [lesbian, gay, bisexual, queer or questioning, asexual, pansexual, or other sexual identity]), adjusted for age, gender, race and ethnicity, postgraduate training year, program length, and region.

MAIN OUTCOMES AND MEASURES: The primary outcome was burnout, assessed with an abbreviated 6-item Copenhagen Burnout Inventory: internal (personal or work-related) and external (patient-related) burnout. Prevalence ratios (PRs) were estimated for burnout stratified by sexual orientation, utilizing Poisson regression with robust standard errors.

RESULTS: Of 9478 residents who took the ITE, 7852 respondents (median [IQR] age, 30 [28-32] years; 4416 male [56%]; 3364 female [43%]; 56 nonbinary [1%]) were included, with 928 (12%) identifying as a sexual minority and 6924 (88%) identifying as heterosexual. Compared with heterosexual residents, sexual minority residents had higher prevalence of any burnout prevalence (431 of 803 residents [54%] vs 2786 of 5967 residents [47%]; P < .001) and internal burnout (311 of 802 residents [39%] vs 1902 of 5979 residents [32%]; P < .001). After adjustment, sexual minority status was associated with higher prevalence of internal burnout (PR, 1.12; 95% CI, 1.02-1.24) and any burnout (PR, 1.09; 95% CI, 1.01-1.17). Among sexual minority subgroups, bisexual residents had the highest adjusted prevalence of any burnout (PR, 1.17; 95% CI, 1.05-1.30), and queer residents had higher prevalence of internal burnout (PR, 1.28; 95% CI, 1.02-1.62).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of 7852 EM residents, those who identified as a sexual minority reported higher burnout, particularly internal burnout, compared with heterosexual peers. These findings indicate that targeted support for sexual minority trainees is needed to improve physician well-being, training experience, and patient care.

PMID:42475095 | DOI:10.1001/jamanetworkopen.2026.24047

JAMA Netw Open. 2026 Jul 1;9(7):e2624095. doi: 10.1001/jamanetworkopen.2026.24095.

ABSTRACT

IMPORTANCE: Food insecurity is associated with worse cardiovascular health. There is variation in state Supplemental Nutrition Assistance Program (SNAP) eligibility and administration policies that influence participation rates, but how such policies impact cardiovascular mortality is not known.

OBJECTIVE: To evaluate the association of SNAP-related policies with county-level cardiovascular mortality rates.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, using state-level SNAP policy data from the US Department of Agriculture, a SNAP policy index was created (range, 0-10), with higher values denoting adoption of policies associated with higher SNAP participation. Mortality data from the National Center for Health Statistics and population data from the Census Bureau were used to calculate county-level, age-adjusted, cardiovascular mortality rates for adults aged 20 years and older.

EXPOSURES: Changes in an index of state SNAP policies from 2006 to 2019.

MAIN OUTCOMES AND MEASURES: The primary outcome was county-level cardiovascular mortality rates. Using the g-computation procedure, a robust causal inference method, and a marginal structural model, the association between changes in the SNAP policy index and county-level cardiovascular mortality rates was estimated. Mortality rates were also estimated under different potential trajectories for the SNAP index.

RESULTS: Between 2006 and 2019, there were a total of 11 409 251 cardiovascular deaths among adults in 3127 US counties (5 713 305 deaths [50.1%] occurred among women; 9 266 123 deaths [81.2%] among adults aged ≥65 years). The median (IQR) SNAP policy index value increased from 3.7 (2.7-4.2) to 7.1 (5.6-7.5). After accounting for differences in demographic and economic factors, a 1-point absolute increase in the SNAP policy index was associated with a 1.02% (95% CI, 0.47%-1.60%; P < .001) lower county cardiovascular mortality rate. If all states had followed a high-generosity SNAP policy trajectory, compared with if they had followed a low-generosity trajectory, an estimated 46 123 (95% CI, 28 587-65 096) fewer adult cardiovascular deaths are estimated to have occurred in 2019.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of SNAP policies and cardiovascular mortality, an index of policies that can increase SNAP participation was associated with statistically significantly lower cardiovascular mortality rates. Adoption of such policies may play a role in improving cardiovascular health among lower-income adults.

PMID:42475094 | DOI:10.1001/jamanetworkopen.2026.24095

JAMA Netw Open. 2026 Jul 1;9(7):e2624114. doi: 10.1001/jamanetworkopen.2026.24114.

ABSTRACT

IMPORTANCE: Shifts in the demographic composition of US military veterans underscore the need for updated population-based estimates of suicidal thoughts and behaviors (STBs) to accurately characterize suicide risk in this population.

OBJECTIVE: To update prevalence estimates of and factors associated with STBs among US military veterans and to examine mental health treatment utilization among veterans with a history of STBs, stratified by use of the Veterans Health Administration as a primary source of health care.

DESIGN, SETTING, AND PARTICIPANTS: Population-based cross-sectional study of US military veterans drawn from the 2025 to 2026 National Health and Resilience in Veterans Study.

MAIN OUTCOMES AND MEASURES: Past 2-week and past-year suicidal ideation (SI), lifetime planning, and lifetime suicide attempt(s).

RESULTS: Among 2636 veterans (mean [SD] age, 62.4 [16.2] years; 2349 [88.5%] male), the prevalence of past 2-week SI was 13.4% and past-year SI was 14.0%, with past 2-week SI significantly higher in 2025 to 2026 than in 2019 to 2020 (13.4% vs 9.0%; z = 5.69; P < .001). In contrast, prevalence estimates of lifetime suicide planning (8.0% vs 7.3%; z = 1.06; P = .29) and suicide attempts (4.9% vs 3.9%; z = 1.97; P = .048) were similar to those observed in 2019 to 2020. After adjustment for sociodemographic and military characteristics, factors most strongly associated with past 2-week SI based on relative importance analyses included functional disability (odds ratio [OR], 1.10; 95% CI, 1.04-1.16), lifetime major depressive disorder (OR, 2.22; 95% CI, 1.63-3.02), and lifetime posttraumatic stress disorder (OR, 1.53; 95% CI, 1.09-2.13). Factors most strongly associated with past-year SI included functional disability (OR, 1.09; 95% CI, 1.07-1.11), lifetime major depressive disorder (OR, 2.33; 95% CI, 1.72-3.16), and lifetime posttraumatic stress disorder (OR, 1.62; 95% CI, 1.17-2.25). Factors most strongly associated with lifetime suicide planning included lifetime posttraumatic stress disorder (OR, 2.61; 95% CI, 1.82-3.76), lifetime major depressive disorder (OR, 2.61; 95% CI, 1.84-3.71), and younger age (OR, 2.11; 95% CI, 1.36-3.28). Factors most strongly associated with lifetime suicide attempts included greater adverse childhood experiences (OR, 1.39; 95% CI, 1.29-1.51), lifetime major depressive disorder (OR, 3.76; 95% CI, 2.31-6.10), and functional disability (OR, 1.04; 95% CI, 1.02-1.07).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of US military veterans, results suggest that SI was more prevalent in 2025 to 2026 relative to estimates from 2019 to 2020, whereas the prevalence of suicide planning and attempts remained stable. Younger and female veterans appear to carry disproportionate risk for STBs. Targeting key risk factors in vulnerable subpopulations may help mitigate suicide risk.

PMID:42475092 | DOI:10.1001/jamanetworkopen.2026.24114