Holly C Wilcox

Holly C Wilcox
Johns Hopkins Bloomberg School of Public Health | JHSPH · Department of Mental Health

About

182
Publications
40,819
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7,335
Citations
Citations since 2017
85 Research Items
4221 Citations
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Introduction
Holly C. Wilcox, PhD is a Professor in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health with joint appointments in the Department of Health Policy and Management as well as the Johns Hopkins Schools of Medicine and Education. Much of her work involves population-based research on suicidal behaviors, the evaluation of impact of community-based universal prevention programs, and data linkage strategies to inform suicide prevention.
Additional affiliations
July 2020 - July 2021
Johns Hopkins Medicine
Position
  • Professor (Full)

Publications

Publications (182)
Preprint
Objective: To understand patterns of Emergency Department (ED) utilization among pediatric patients at high-risk for suicide. Methods: Electronic health records were extracted for N=3,094 patients aged 8 - 22 years who screened positive for suicide risk and/or presented with a suicide-related chief complaint within an academic medical center ED. Re...
Article
Objectives: To estimate effects of potentially modifiable risk factors for self-harm among adolescents in the Child Protective Services (CPS) system. Methods: Data came from the National Survey of Child and Adolescent Well-being, a nationally representative longitudinal survey. Candidate risk factors included child's feelings of worthlessness, t...
Article
Introduction: This study conducted a systematic review and meta-analysis of the association between posttraumatic stress disorder (PTSD) and (i) death by suicide, (ii) attempted suicide (AS), and (iii) suicidal ideation (SI). Methods: The systematic review identified seven studies on PTSD and suicide, 33 studies for AS, and 20 studies for SI. A...
Article
Background: In the United States, suicide is one of the serious public health problems and a major cause of death. Several researchers and clinical settings use the patient health questionnaires (PHQ-9) to gauge depression and psychological distress among adults and to predict suicide and death. This study aimed to assess the sensitivity, specific...
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Objective: Suicide rates and frequency of pediatric emergency department (ED) visits for suicidal thoughts and behaviors have increased among Black preadolescents in the United States in recent years. This study examined whether characteristics of ED visits and treatment management of preadolescents with suicidal thoughts and behaviors differed by...
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Environmental factors contribute to risk of bipolar disorder (BD), but how environmental factors impact the development of psychopathology within the context of elevated genetic risk is unknown. We herein sought to identify epigenetic signatures operating in the context of polygenic risk for BD in young people at high familial risk (HR) of BD. Peri...
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Suicide rates in the United States (US) reached a peak in 2018 and declined in 2019 and 2020, with substantial and often growing disparities by age, sex, race/ethnicity, geography, veteran status, sexual minority status, socioeconomic status, and method employed (means disparity). In this narrative review and commentary, we highlight these many dis...
Article
Dimensional models of adversity, whereby experiences lie along dimensions of threat and deprivation, are increasingly popular; however, their empirical validation is limited. In a sample of emerging adults ( N = 1662; M age = 20.72; 53% female; 72% Black), we conducted exploratory factor analyses using adversities derived from items probing family...
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Reservation-based Native American youth are at disproportionate risk for high-risk substance use. The culture-as-treatment hypothesis suggests aspects of tribal culture can support prevention and healing in this context; however, the protective role of communal mastery and tribal identity have yet to be fully explored. The objectives of this study...
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The aim of this study was to identify independent risk and protective factors associated with self-reported suicidal thoughts and behaviors (STB) among young adolescents by examining self-report data on mental health, substance abuse, violence involvement, social and economic challenges and supports, physical health and demographics in relation to...
Article
Increasing rates of depression, anxiety, substance use, and suicidal thoughts and behaviors among college students were exacerbated by the COVID-19 pandemic. This report describes how components of the Johns Hopkins Suicide Prevention Awareness, Response and Coordination (JH-SPARC) Project aligned with a multi-faceted strategy for suicide preventio...
Article
Integrative data analysis (IDA) is an analytic tool that allows researchers to combine raw data across multiple, independent studies, providing an improved measurement of latent constructs as compared to single study analysis or meta-analyses. This is often achieved through the implementation of moderated non-linear factor analysis (MNLFA), an adva...
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Suicide is a leading cause of death in young adulthood. Identifying early prevention targets to reduce later suicide is a public health priority. Impulsivity and aggression in early childhood may represent actionable early prevention candidate endophenotypes for later suicidal behavior. Our objective is to to understand the association of aggressio...
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Three generations of developmental epidemiologically based randomized field trials of the Good Behavior Game (GBG) have been delivered to Baltimore elementary schools. With the collaboration of family and community partners, all three trials were directed at decreasing proximal targets of aggressive behavior and improving learning in first-grade cl...
Article
Background Though the association between anxiety disorders and suicidal behavior is well-described, the impact of anxiety symptoms on suicidal thoughts and behaviors (STB) across different mood disorders is still unclear. Methods We performed a registry-based retrospective study utilizing outcome measure data collected by the National Network of...
Article
Research has shown that the months after hospital discharge following treatment for suicidal thoughts or behaviors is a high-risk period for suicide. Moreover, the needs of a subset of youths at increased risk for suicide are not being met by community mental health providers, resulting in frequent emergency department (ED) visits. While undertakin...
Article
Objective: Ineligibility for and refusal to participate in randomized controlled trials (RCTs) can potentially lead to unrepresentative study samples and limited generalizability of findings. We examined the rates of exclusion and refusal in RCTs that have studied impact on suicide-related outcomes in the US. Data Sources: PubMed, the Cochrane Lib...
Chapter
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This chapter synthesizes data on health disparities in suicide rates and lack of service access and discusses current gaps in research, training, and program implementation for underserved populations. We highlight emerging best practices in underserved communities that are innovative and low cost (e.g., frugal interventions) and discuss their impl...
Preprint
The rising rates of suicide in the United States, particularly among young people of color, requires urgent attention. While the healthcare system is a critical service sector for suicide prevention given high levels of utilization by people at risk of suicide, it is not sufficient. Only approximately 50% of those identified as at-risk in an Emerge...
Article
Cover image: The cover image is based on the Research Article Effects of polygenic risk for suicide attempt and risky behavior on brain structure in young people with familial risk of bipolar disorder by Bronwyn Overs, Janice Fullerton et al., https://doi.org/10.1002/ajmg.b.32879. The cover image, by Overs et al., depicts right hemisphere cortical...
Article
Bipolar disorder (BD) is associated with a 20–30‐fold increased suicide risk compared to the general population. First‐degree relatives of BD patients show inflated rates of psychopathology including suicidal behaviors. As reliable biomarkers of suicide attempts (SA) are lacking, we examined associations between suicide‐related polygenic risk score...
Article
We examined the prevalence and correlates of self-harm among adolescents in the three years following an investigation by U.S. Child Protective Services (CPS) into alleged child maltreatment. Participants (N = 1573, 47% Male, 45% White) were drawn from the National Survey of Child and Adolescent Well-Being, cohort II. Self-harm was assessed at the...
Article
Objective: The purpose of this study was to describe the implementation of universal suicide risk screening in pediatric neurodevelopmental disabilities (NDD) medical clinics, analyze demographic and clinical characteristics of eligible patients, describe outcomes of positive screenings, and describe factors that influenced participation in screen...
Preprint
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Aims: Bipolar Disorder (BD) is associated with a 20-30 fold increased suicide risk compared to the general population. First-degree relatives of BD patients show inflated rates of psychopathology including suicidal behaviors. As reliable biomarkers of suicide attempts (SA) are lacking, we examined associations between suicide-related polygenic risk...
Article
Aim Brief screening and predictive modeling have garnered attention for utility at identifying individuals at risk of suicide. Although previous research has investigated these methods, little is known about how these methods compare against each other or work in combination in the pediatric population. Methods Patients were aged 8–18 years old wh...
Article
Suicide attempts (SA) among African Americans have increased at a greater rate than any other racial/ethnic group. Research in European ancestry populations has indicated that SA are genetically influenced; however, less is known about the genetic contributors that underpin SA among African Americans. We examined whether genetic propensity for depr...
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Objective: Fatty acids (FAs) are involved in the functioning of biological systems previously associated with suicidal behavior (eg, monoamine signaling and the immune system). We sought to determine (1) whether observed FA levels in a sample of military suicide decedents and living matched controls were consistent with latent classes having disti...
Preprint
Objective: To compare the accuracy, sensitivity and utility of brief screening to predictive modeling for identifying suicide-related outcomes in a pediatric emergency department. Our hypothesis was that predictive modeling would be more accurate and useful compared to brief screening. Methods: This was a retrospective cohort study at an urban pedi...
Article
This study used data from the National Youth Risk Behavior Survey to examine the association between adolescent marijuana, tobacco, and alcohol use and suicidal ideation and attempts over a period of six years (2011–2017), as attitudes and laws became more permissive of marijuana use. We used logistic regression to control for possible confounders,...
Article
This article examines mental health care utilization and psychiatric diagnoses among US military personnel who died by suicide. We employed an existing electronic health record dataset including 800 US military suicide decedents and 800 matched controls. Suicide decedents were more likely to have received outpatient and inpatient mental health care...
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While schools have the capacity to reach youth at-risk for suicide, there remains a gap between the number of youth with mental health issues and those who receive services. Accordingly, gatekeeper training programs, which teach community members signs of psychological distress and strategies to refer youth to mental health support, are often one c...
Article
Background Numerous reports have described increased rates of exposure to Toxoplasma gondii levels in individuals with a history of suicide attempts in comparison with well controls, or psychiatrically ill individuals, with no suicide attempt history. Such findings suggest that the behavioral effects this parasite exerts on rodent hosts extends to...
Article
Background: Suicidal thoughts and behaviors (STBs) are increasing among adolescents in the United States and are challenging to predict and prevent. The current study identifies subtypes of youth at risk for suicidal thoughts and behaviors (STBs) in school-based settings. Method: Data are from the CDC's 2015 and 2017 National Youth Risk Behavior...
Article
Background : Our objective was to systematically review non-experimental studies of parental bipolar disorder (BD), current family environment, and offspring psychiatric disorders to identify characteristics of family environment associated with parental BD and risk for offspring psychiatric disorders. Methods : CINAHL, Embase, PsycINFO, and PubMe...
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Background: Global risks of suicidal behaviours (SB) and being bullied as well as their association among adolescents have been poorly understood. We aimed to determine the risks of suicidal ideation (SI), suicide planning (SP), suicide attempt (SA) and being bullied in adolescents and their related associations across gender, countries and differ...
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Importance On October 1, 2018, Maryland’s extreme risk protection order (ERPO) law took effect. This was the first ERPO law in the United States to authorize clinicians to initiate a civil court process to temporarily prohibit people behaving dangerously and at risk of engaging in violence from purchasing and possessing firearms. This is the first...
Article
National Patient Safety Goal 15.01.01 requires all Joint Commission-accredited organizations to screen patients treated for behavioral health conditions for suicide risk. However, little is known about the ability of screening tools to identify suicide risk among youths with psychotic disorders. As part of this quality improvement initiative, youth...
Preprint
Evidence suggests that increased availability of mental health treatment has not significantly reduced depression prevalence and suicide in the US, and that significant personal (i.e., stigma) or practical/logistical barriers to effective mental health care remain. Mental health treatment has increased in the US since the early 1990s with greater u...
Article
Objectives: Investigate the association of sleep characteristics with suicidal ideation and suicide attempt among middle-aged and older adults with depressive symptoms in five low- and middle-income countries (LMICs). Design: Cross-sectional. Setting: China, Ghana, India, Russia, and South Africa. Participants: Adults aged ≥50 years with dep...
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Importance According to National Patient Safety Goal 15.01.01, all individuals being treated or evaluated for behavioral health conditions as their primary reason for care in hospitals and behavioral health care organizations accredited by The Joint Commission should be screened for suicide risk using a validated tool. Existing suicide risk screens...
Article
Psychotic experiences (PEs) are associated with suicidal ideation and attempts. However, studies examining the role of potential psychosocial confounders in these associations have yielded variable and inconclusive results. In the current study, data from 974 participants in a general population sample were analyzed. We fitted four regression model...
Article
Objective: To evaluate whether collegiate athletes and nonathlete college students differ in nonsuicidal self-injury (NSSI), suicidal ideation, suicide attempt, and help-seeking behaviors. Participants: 165,210 respondents to the American College Health Association's National College Health Assessment (NCHA), a survey administered to college stude...
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The Adolescent Depression Awareness Program, developed by psychiatrists and psychiatric nurses at the Johns Hopkins University School of Medicine, is a depression literacy program delivered to high school students by teachers. This mode of delivery represents an effective and sustainable way to increase awareness of mental health, reduce stigma, im...
Chapter
This chapter reviews the burden associated with suicide in the United States and around the world as a leading cause of death. There are many factors associated with higher risk for suicide, and there are a range of conceptual approaches to understanding it, including the sociological perspective, originally proposed by Durkheim in the 19th century...
Chapter
This chapter introduces the reader to the concept of genetics and disease and includes review of more than 200 family, twin, and adoption studies for six important mental and behavioral disorders. The heritability estimates range from 30% for depressive disorder to as high as 80% for schizophrenia. Genome-wide association and sequencing studies are...
Article
Children's perceptions are important to understanding family environment in the bipolar disorder (BD)high-risk context. Our objectives were to empirically derive patterns of offspring-perceived family environment, and to test the association of family environment with maternal or paternal BD accounting for offspring BD and demographic characteristi...
Article
Purpose: Depression is a debilitating illness with frequent onset during adolescence. Depression affects women more often than men; men are more likely to complete suicide and less likely to seek treatment. The Adolescent Depression Awareness Program (ADAP) is a school-based depression intervention that educates adolescents about depression sympto...
Article
Melatonin secretion and polysomnography (PSG) were compared among a group of healthy adolescents who were at high familial risk for bipolar disorder (HR) and a second group at low familial risk (LR). Adolescent participants (n = 12) were a mean age 14 ± 2.3 years and included 8 females and 4 males. Saliva samples were collected under standardized c...
Article
Background: Analysis of data from a NIMH-supported study was conducted to evaluate the effectiveness of the Adolescent Depression Awareness Program (ADAP) in promoting depression literacy and help-seeking behavior. Methods: Eighteen Pennsylvania schools were matched on size, sex, race, test scores, median income, and free/reduced lunch status. S...
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Purpose: Suicide is now the second leading cause of death among persons between the ages of adolescents and emerging adults and rates have increased despite more funding and broader implementation of youth suicide-prevention programs. A systematic review was conducted focusing on identifying youth suicide-prevention studies within the United State...
Article
Violence is a leading source of morbidity and mortality in the United States. In this article, we suggest a public health framework for preventing community violence, intimate partner violence and sexual violence, and suicide as key forms of interpersonal and self-directed violence. These types of violence often co-occur and share common risk and p...
Article
Background: Increased inflammatory markers have been linked to suicidal behavior in numerous studies. Measures of aggression and of impulsivity also comprise risks factors for suicidal behavior and there is evidence that inflammatory markers correlate with these traits. The following analyses compare suicide attempters and non-attempters to determ...
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Environmental and community factors may influence the development or course of depression and sleep problems. We evaluated the association of unconventional natural gas development (UNGD) with depression symptoms and disordered sleep diagnoses using the Patient Health Questionnaire-8 and electronic health record data among Geisinger adult primary c...
Article
Background: Individuals involved in out-of-home care are at higher risk of death by suicide. We aimed to determine whether parents with two generations of involvement in out-of-home care (themselves as children, and their own children) are at increased risk of death by suicide than parents with no involvement or parents with one generation of invo...
Poster
Introduction Cross-national studies of sleep disturbance and suicidal ideation and attempts among older adults are essential given the global aging of the population and cross-cultural variation in sleep patterns. As emerging economies with social change and older populations, middle-income countries (MICs) are particularly important to study to st...
Article
Persons with serious mental illness are at high risk for suicide, but this outcome is difficult to predict. Serological markers may help to identify suicide risk. We prospectively assessed 733 persons with a schizophrenia spectrum disorder, 483 with bipolar disorder, and 76 with major depressive disorder for an average of 8.15 years. The initial ev...
Article
Objective: This study aimed to identify correlates of service utilization and perceived need for care among college students with suicidal ideation. Participants: Respondents were recruited from introductory psychology courses at an undergraduate college during the Fall 2014 semester. Methods: Independent correlates of (1) mental health servic...
Article
Objective Bipolar disorder (BD) is one of the most heritable psychiatric conditions and is associated with high suicide risk. To explore the reasons for this link, this study examined the interaction between traumatic stress and BD polygenic risk score in relation to suicidal ideation, suicide attempt, and nonsuicidal self-injury (NSSI) in adolesce...
Article
Objectives: To determine the effectiveness of a universal school-based depression education program. Methods: In 2012-2015, we matched 6679 students from 66 secondary schools into pairs by state (Maryland, Delaware, Pennsylvania, Michigan, and Oklahoma) and randomized to the Adolescent Depression Awareness Program (ADAP; n = 3681) or to a waitli...
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Background: Although school climate is linked with youth educational, socioemotional, behavioral, and health outcomes, there has been limited research on the association between school climate and mental health education efforts. We explored whether school climate was associated with students' depression literacy and mental health stigma beliefs....
Article
Background: Adults with bipolar disorder (BD) have higher rates of substance use disorders (SUDs) compared to the general population. SUD rates in young offspring/relatives of BD probands, as well as factors which drive those rates, are not as well-characterized. Methods: We aimed to examine SUD prevalence among adolescent/young adult offspring...
Article
Objectives. Reducing access to firearms as a suicide prevention strategy is limited in the US today because of divergent cultural attitudes and political contentiousness surrounding gun restrictions. This research examined the effects of culturally-specific suicide prevention messages on the likelihood of restricting firearm access during periods o...
Article
Because suicide attempts are multi-determined events, multiple pathways to suicidal behaviors exist. However, as a low-frequency behavior, within group differences in trajectories to attempts may not emerge when examined in samples including non-attempters. We used longitudinal latent profile analysis to identify subtypes specific for suicide attem...
Article
Religiosity has been shown to be inversely associated with suicidal ideation, but few studies have examined associations by age group. This study aimed to examine the association between religiosity with suicidal ideation by age group. This study used a large nationally representative sample of 260,816 study participants from the National Survey on...
Article
Recent evidence suggests that police victimization is widespread in the USA and psychologically impactful. We hypothesized that civilian-reported police victimization, particularly assaultive victimization (i.e., physical/sexual), would be associated with a greater prevalence of suicide attempts and suicidal ideation. Data were drawn from the Surve...
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PurposeThis study aimed to compare young individuals who differed in terms of birth region and history of suicide attempt regarding socio-demographic and healthcare factors, and with regard to their risks of subsequent unemployment, sickness absence and disability pension. Methods Prospective cohort study based on register linkage of 2,801,558 Swed...
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Previous studies have identified elevations in markers of gastrointestinal inflammation in schizophrenia and mood disorders but studies have not measured the association between these markers and recent suicide attempts. We assessed 210 patients receiving treatment for schizophrenia, bipolar disorder, or major depression. We employed the Columbia S...
Article
Importance: Bereavement after spousal suicide has been linked to mental disorders; however, a comprehensive assessment of the effect of spousal suicide is needed. Objective: To determine whether bereavement after spousal suicide was linked to an excessive risk of mental, physical, and social health outcomes when compared with the general populat...
Article
As part of a five-site collaborative study, we are following 300 adolescents/young adults at high risk for bipolar disorder and related conditions (because they are close relatives of a bipolar proband), along with 150 age-matched controls. A new follow-up protocol is beginning over the next several months. The risk for major mood disorder is ~35%...
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Background: Linking national, state, and community data systems to data from prevention programs could allow for longer-term assessment of outcomes and evaluation of interventions to prevent suicide. Purpose: To identify and describe data systems that can be linked to data from prevention studies to advance youth suicide prevention research. Da...