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Stanley IH, Hom MA, Joiner TE. Suicide mortality among firefighters: Results from a large, urban fire department. Am J Ind Med 2016; 59:942-947. [PMID: 27219513 DOI: 10.1002/ajim.22587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Research regarding suicide mortality among firefighters within the U.S. has been sparse and has yielded inconsistent findings. This study aimed to: (i) describe suicide rates within a large, urban fire department; and (ii) compare firefighter suicide rates with demographically adjusted general population suicide rates. METHODS Rosters were obtained from the Philadelphia Fire Department (PFD) for all members employed by or separated from the department between 1993 and 2014 (N = 4,395). Vital statistics for each member were obtained from the CDC's National Death Index. RESULTS Overall, 272 deaths were recorded; 11 (4.0%) were certified as suicides. The overall suicide rate among firefighter affiliates of the PFD between 1993 and 2014 was 11.61 per 100,000 person-years. CONCLUSIONS The suicide rate among firefighters appears comparable to, and perhaps lower than, demographically adjusted general population estimates. Infrastructure to triangulate and monitor suicide rates from multiple departments, both career and volunteer, is needed to derive a more representative and informative estimate of firefighter suicide rates. Am. J. Ind. Med. 59:942-947, 2016. © 2016 Wiley Periodicals, Inc.
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Sheffler JL, Rushing NC, Stanley IH, Sachs-Ericsson NJ. The long-term impact of combat exposure on health, interpersonal, and economic domains of functioning. Aging Ment Health 2016; 20:1202-1212. [PMID: 26241200 DOI: 10.1080/13607863.2015.1072797] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Wartime combat exposure is linked to a broad array of negative outcomes. The current study identified potential differences between middle-to-older aged men exposed to combat and those not exposed for physical health, interpersonal, and economic functioning over 10 years. Post-traumatic stress disorder (PTSD) and social support were examined as moderators between combat exposure and outcomes. METHODS Data from the National Comorbidity Survey, baseline and 10-year follow-up, were utilized. Only men aged 50-65 at follow-up (N = 727) were included. Group differences between combat and non-combat men were examined. Regression analyses were performed to examine relationships between earlier combat and health, interpersonal, and economic outcomes over time, while controlling for important covariates. RESULTS Combat-exposed men were at increased risk for asthma, arthritis/rheumatism, lung diseases, headaches, and pain; they also had greater marital instability. However, combat-exposed men reported economic advantages, including higher personal earnings at follow-up. For combat-exposed men, PTSD did not increase risk for headaches; however, PTSD in non-combat men was associated with increased risk for headaches at follow-up. Whereas combat-exposed men with higher levels of social support were less likely to report chronic pain at follow-up, there were no group differences in pain at lower levels of social support. IMPLICATIONS Individuals who experience combat may be susceptible to later health and marital problems; however, as combat-exposed men age, they demonstrate some resilience, including in economic domains of life. Given that consequences of combat may manifest years after initial exposure, knowledge of combat exposure is necessary to inform treatments and the delivery of disability benefits.
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Smith PN, Stanley IH, Joiner TE, Sachs-Ericsson NJ, Van Orden KA. An Aspect of the Capability for Suicide-Fearlessness of the Pain Involved in Dying-Amplifies the Association Between Suicide Ideation and Attempts. Arch Suicide Res 2016; 20:650-62. [PMID: 26984289 PMCID: PMC5025334 DOI: 10.1080/13811118.2016.1162245] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The interpersonal theory of suicide posits that individuals who experience suicide ideation will only develop suicidal intent, and subsequently engage in suicidal behavior when they have concomitant fearlessness about death and tolerance for physical pain (i.e., the capability for suicide). The current studies examined the hypothesis that one aspect of the capability for suicide-fearlessness of the pain involved in dying-would amplify the positive association between current suicide ideation and a previous suicide attempt in two samples at high risk for experiencing suicide ideation and suicide attempts. Study 1 examined this relation using self-report methods in a sample of adults entering treatment in a mental health outpatient clinic. Study 2 utilized similar methods in a sample of adults admitted to inpatient psychiatry. Both studies indicated that those individuals who reported suicide ideation were more likely than non-ideators to report having attempted suicide only if they also reported greater fearlessness of the pain involved in dying. The current findings support the theorized role of the capability for suicide in the transition from ideation to attempt and also support assessing the capability for suicide in risk assessment.
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Stanley IH, Rufino KA, Rogers ML, Ellis TE, Joiner TE. Acute Suicidal Affective Disturbance (ASAD): A confirmatory factor analysis with 1442 psychiatric inpatients. J Psychiatr Res 2016; 80:97-104. [PMID: 27344228 DOI: 10.1016/j.jpsychires.2016.06.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/02/2016] [Accepted: 06/10/2016] [Indexed: 11/26/2022]
Abstract
Acute Suicidal Affective Disturbance (ASAD) is a newly proposed diagnostic entity that characterizes rapid onset suicidal intent. This study aims to confirm the factor structure of ASAD among psychiatric inpatients, and to determine the clinical utility of ASAD in predicting suicide attempt status. Overall, 1442 psychiatric inpatients completed a battery of self-report questionnaires assessing symptoms theorized to comprise the ASAD construct. Utilizing these data, a confirmatory factor analysis with a one-factor solution was performed. Regression analyses were employed to determine if the ASAD construct predicted past suicide attempts, and analyses of variance (ANOVAs) were employed to determine if ASAD symptoms differed by the presence and number of past suicide attempts. The one-factor solution indicated good fit: χ(2)(77) = 309.1, p < 0.001, Tucker-Lewis Index (TLI) = 0.96, comparative fit index (CFI) = 0.97, root-mean-square error of approximation (RMSEA) = 0.05. Controlling for depressive disorders and current symptoms, the ASAD construct significantly predicted the presence of a past suicide attempt. Moreover, ASAD differentiated in the expected directions between individuals with a history of multiple suicide attempts, individuals with a single suicide attempt, and individuals with no history of a suicide attempt. Acute Suicidal Affective Disturbance (ASAD) appears to be a unified construct that predicts suicidal behavior and is distinct from an already-defined mood disorder.
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Hom MA, Podlogar MC, Stanley IH, Joiner TE. Ethical Issues and Practical Challenges in Suicide Research. CRISIS 2016; 38:107-114. [PMID: 27561221 DOI: 10.1027/0227-5910/a000415] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Research with human subjects represents a critical avenue for suicide prevention efforts; however, such research is not without its ethical and practical challenges. Specifically, given the nature of research with individuals at elevated risk for suicide (e.g., increased concerns regarding participant safety, adverse events, liability, difficulties often arise during the institutional review board (IRB) evaluation and approval process. AIMS This paper aims to discuss IRB-related issues associated with suicide prevention research, including researcher and IRB panel member responsibilities, suicide risk assessment and management ethics and procedures, informed consent considerations, preparation of study protocols, and education and training. Points to consider and components to potentially include in an IRB application for suicide-related research are additionally provided. METHOD Literature relevant to ethics in suicide research and suicide risk assessment and management was reviewed and synthesized. RESULTS Suicide research can be conducted in accordance with ethical principles while also furthering the science of suicide prevention. CONCLUSION Despite the challenging nature of suicide prevention research, empirically informed solutions exist to address difficulties that may emerge in interfacing with IRBs. There remain areas for improvement in the IRB approval process that warrant further investigation and work.
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Stanley IH, Hom MA, Rogers ML, Hagan CR, Joiner TE. Understanding suicide among older adults: a review of psychological and sociological theories of suicide. Aging Ment Health 2016; 20:113-22. [PMID: 25693646 DOI: 10.1080/13607863.2015.1012045] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Older adults die by suicide at a higher rate than any other age group in nearly every country globally. Suicide among older adults has been an intractable clinical and epidemiological problem for decades, due in part to an incomplete understanding of the causes of suicide, as well as imprecision in the prediction and prevention of suicidal thoughts and behaviors in later life. Theory-driven investigations hold promise in addressing these gaps by systematically identifying testable, and thus falsifiable, mechanisms that may better explain this phenomenon and also point to specific interventions. METHOD In this article, we comprehensively review key extant psychological and sociological theories of suicide and discuss each theory's applicability to the understanding and prevention of suicide among older adults. RESULTS Despite a modest number of theories of suicide, few have undergone extensive empirical investigation and scrutiny, and even fewer have been applied specifically to older adults. CONCLUSION To advance the science and contribute findings with a measurable clinical and public health impact, future research in this area, from conceptual to applied, must draw from and integrate theory.
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Sachs-Ericsson NJ, Rushing NC, Stanley IH, Sheffler J. In my end is my beginning: developmental trajectories of adverse childhood experiences to late-life suicide. Aging Ment Health 2016; 20:139-65. [PMID: 26264208 DOI: 10.1080/13607863.2015.1063107] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Converging evidence suggests that the sequelae of adverse childhood experiences (ACEs) including childhood abuse (e.g., sexual, physical, emotional/verbal abuse, neglect) and other ACE (e.g., family dysfunction, parental loss, parental psychopathology, substance abuse, incarceration, and domestic violence) have pronounced effects on suicidal behaviors (suicidal ideation, attempts, and death by suicide) in older age. There are fundamental changes in the developmental trajectory of biological, psychological and behavioral processes that result from ACE and that exert influence throughout the life span. Different moderators and mediators may affect the extent and nature of the relationship. However, the literature on the specific mechanisms whereby ACE affects suicidality in later life has not been well identified. METHOD We review and draw from extant multidisciplinary evidence to develop a heuristic framework through which to understand how ACE may lead to suicide in later life. RESULTS Proposed mechanisms span biological factors (neurological, gene-environment), psychiatric and health functioning, and psychosocial development (cognitive biases, coping resources, interpersonal deficits). Evidence suggests that ACEs affect each of these constructs, and it is likely in the interaction of these constructs with late-life stressors that suicidality in older adulthood emerges. CONCLUSION ACEs have persistent and multifaceted effects on suicidality in late life. This association is due to multi-varied pathways. It is believed that the explanatory framework developed herein--in which biological, psychological and behavioral factors are organized, and the role of late-life stressors is highlighted--will spark further scientific inquiry into this important area.
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Chu C, Buchman-Schmitt JM, Hom MA, Stanley IH, Joiner TE. A test of the interpersonal theory of suicide in a large sample of current firefighters. Psychiatry Res 2016; 240:26-33. [PMID: 27078756 PMCID: PMC5333767 DOI: 10.1016/j.psychres.2016.03.041] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 01/18/2016] [Accepted: 03/25/2016] [Indexed: 02/02/2023]
Abstract
Recent research suggests that firefighters experience elevated rates of suicidal ideation and behaviors. The interpersonal theory of suicide may shed light on this finding. This theory postulates that suicidal desire is strongest among individuals experiencing perceived burdensomeness and thwarted belongingness, and that the combination of suicide desire and acquired capability for suicide is necessary for the development of suicidal behaviors. We tested the propositions of the interpersonal theory in a large sample of current United States firefighters (N=863). Participants completed self-report measures of perceived burdensomeness, thwarted belongingness, fearlessness about death (FAD; a component of acquired capability), and career suicidal ideation and suicide attempt history. Regression models were used to examine the association between interpersonal theory constructs, career suicidal ideation severity, and the presence of career suicide attempts. In line with theory predictions, the three-way interaction between perceived burdensomeness, thwarted belongingness, and FAD was significantly associated with career suicide attempts, beyond participant sex. However, findings were no longer significant after accounting for years of firefighter service or age. Contrary to predictions, the two-way interaction between perceived burdensomeness and thwarted belongingness was not significantly related to career suicidal ideation severity. Applications of the theory to firefighters and future research are discussed.
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Hom MA, Stanley IH, Joiner TE. The Web-Based Assessment of Suicidal and Suicide-Related Symptoms: Factors Associated With Disclosing Identifying Information to Receive Study Compensation. J Pers Assess 2016; 98:616-25. [PMID: 27248203 DOI: 10.1080/00223891.2016.1180528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
With the increasing utilization of Web-based surveys for suicide and suicide-related research, it is critical to understand factors that affect participants' decision to request study compensation (and thus potentially reveal their identity) or remain anonymous. This study evaluated differences in demographics, suicidal symptoms, and suicide-related constructs between participants electing and declining to provide identifying information to receive study compensation. A sample of 931 firefighters (91.5% male) participated in a Web-based mental health survey; on survey completion, individuals had the option to provide contact information to receive a $10 gift card. Logistic regression analyses were employed to investigate differences between those who did and did not provide this information. Overall, 82.8% provided identifying information, with younger individuals significantly more likely to do so. Participants reporting more severe suicidal symptoms and greater levels of suicide-related constructs appeared equally, and in some cases, significantly more, willing to provide identifying information. Findings indicate that individuals reporting more sensitive or stigmatizing experiences might not systematically opt out of receiving study compensation to remain anonymous on Web-based surveys. Additional research is warranted to replicate these findings in more representative samples and further delineate personality and other factors influencing the disclosure of contact information to receive study compensation.
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Hom MA, Stanley IH, Ringer FB, Joiner TE. Mental Health Service Use Among Firefighters With Suicidal Thoughts and Behaviors. Psychiatr Serv 2016; 67:688-91. [PMID: 26927574 DOI: 10.1176/appi.ps.201500177] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to characterize rates and correlates of mental health service use, as well as barriers to care, among a sample of firefighters reporting a history of suicide ideation, plans, or attempts during their firefighting careers. METHODS Participants (N=483) completed a Web-based survey assessing history of suicidal thoughts and behaviors, prior mental health service utilization, and barriers to treatment. RESULTS Overall, 77% of participants reported receipt of mental health services during their firefighting careers (attempt history, 93%; plan but no attempt, 77%; and ideation only 68%). Firefighters with fewer years of service were less likely than those with more years to have accessed treatment. Service nonusers were more likely than service users to report concerns regarding reputation and embarrassment as barriers to care. CONCLUSIONS Findings from this preliminary investigation suggest that the majority of firefighters with a history of elevated suicide risk have received mental health services.
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Joiner TE, Hom MA, Rogers ML, Chu C, Stanley IH, Wynn GH, Gutierrez PM. Staring Down Death. CRISIS 2016; 37:212-7. [PMID: 27427541 DOI: 10.1027/0227-5910/a000367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Abstract. Background: Lowered eye blink rate may be a clinically useful indicator of acute, imminent, and severe suicide risk. Diminished eye blink rates are often seen among individuals engaged in heightened concentration on a specific task that requires careful planning and attention. Indeed, overcoming one’s biological instinct for survival through suicide necessitates premeditation and concentration; thus, a diminished eye blink rate may signal imminent suicidality. Aims: This article aims to spur research and clinical inquiry into the role of eye blinks as an indicator of acute suicide risk. Method: Literature relevant to the potential connection between eye blink rate and suicidality was reviewed and synthesized. Results: Anecdotal, cognitive, neurological, and conceptual support for the relationship between decreased blink rate and suicide risk is outlined. Conclusion: Given that eye blinks are a highly observable behavior, the potential clinical utility of using eye blink rate as a marker of suicide risk is immense. Research is warranted to explore the association between eye blink rate and acute suicide risk.
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Rogers ML, Stanley IH, Hom MA, Chiurliza B, Podlogar MC, Joiner TE. Conceptual and Empirical Scrutiny of Covarying Depression Out of Suicidal Ideation. Assessment 2016; 25:159-172. [PMID: 27112535 DOI: 10.1177/1073191116645907] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Depression and suicidal ideation are highly intertwined constructs. A common practice in suicide research is to control for depression when predicting suicidal ideation, yet implications of this practice have not been subjected to sufficient empirical scrutiny. We explore what, precisely, is represented in a suicidal ideation variable with depression covaried out. In an adult psychiatric outpatient sample ( N = 354), we computed two variables-depression with suicidal ideation covaried out, and suicidal ideation with depression covaried out-and examined correlations between these residuals, three factors comprising a variegated collection of psychological correlates of suicidal ideation, psychiatric diagnoses, and past suicidal behavior. Findings indicated that suicidal ideation with depression covaried out appears to be characterized by fearlessness about death, self-sacrifice, and externalizing pathology. We propose that suicidal ideation may comprise two distinct components: desire for death (passive ideation and depressive cognitions) and will (self-sacrifice, fearlessness, externalizing behavior). Implications, limitations, and future directions are discussed.
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Joiner TE, Stanley IH. Can the Phenomenology of a Suicidal Crisis Be Usefully Understood As a Suite of Antipredator Defensive Reactions? Psychiatry 2016; 79:107-119. [PMID: 27724837 DOI: 10.1080/00332747.2016.1142800] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
When perceiving a dangerous predation threat, mammalian and other species activate antipredator defensive reactions. These include the seemingly paradoxical-but compatible-activation of overarousal (e.g., agitation, insomnia) and "shutdown" (e.g., mutism, withdrawal) states. Acute suicidal crises, too, are characterized by the co-occurrence of overarousal and shutdown behaviors. In the minutes, hours, and days prior to one's death by suicide, it is not uncommon for one to be simultaneously agitated and socially withdrawn, states that resemble antipredator defensive reactions. In this article, we present empirical, clinical, and philosophical grist for our conjecture that antipredator defensive reactions may serve as a useful way to understand the phenomenology of a serious suicidal crisis, and we reflect on the implications that soon-to-be suicide decedents are simultaneously killer and victim.
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Chu C, Stanley IH, Hom MA, Lim IC, Joiner TE. Deployment, Mental Health Problems, Suicidality, and Use of Mental Health Services Among Military Personnel. MILITARY BEHAVIORAL HEALTH 2016; 4:243-250. [PMID: 28959502 DOI: 10.1080/21635781.2016.1153533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Following deployment, soldiers may struggle to cope with the after-effects of combat service and experience increased suicidality. Therefore, connection to mental health services is vital. Research regarding the relationship between deployment, suicidality, and mental health connections has been equivocal, with some studies finding a link between deployment history and mental health outcomes, and others not. The purpose of this study was to examine the effects of military deployment on mental health and service utilization outcomes using a longitudinal design. Deployment history, mental health visits, symptoms of suicidality, and various mental health outcomes were assessed in a sample of 1,566 Army recruiters at study entry and 18-months follow-up. Deployment history was positively associated with mental health visits, number of major depressive episodes, and acquired capability for suicide at baseline; however, no significant relationship between deployment, mental health visits, and any other suicide or mental health-related outcomes emerged at baseline or follow-up. Findings suggest a disconnection from mental health services among military personnel. Implications for treatment and suicide prevention efforts among military personnel are discussed.
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Stanley IH, Hom MA, Joiner TE. A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and paramedics. Clin Psychol Rev 2015; 44:25-44. [PMID: 26719976 DOI: 10.1016/j.cpr.2015.12.002] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/01/2015] [Accepted: 12/07/2015] [Indexed: 02/06/2023]
Abstract
First responders-police officers, firefighters, emergency medical technicians (EMTs), and paramedics-experience significant job-related stressors and exposures that may confer increased risk for mental health morbidities (e.g., posttraumatic stress disorder [PTSD], suicidal thoughts and behaviors) and hastened mortality (e.g., death by suicide). Inherent in these occupations, however, are also factors (e.g., camaraderie, pre-enlistment screening) that may inoculate against the development or maintenance of psychiatric conditions. Several reviews of the literature have documented the prevalence and potency of PTSD among first responders; the value of these extant reviews is considerable. Nonetheless, the literature has not been systematically described with regard to suicidality. In this systematic review, we present 63 quantitative studies examining suicidal thoughts, behaviors, and/or fatalities among first responders; identify population-specific risk and protective factors; and pinpoint strengths and weaknesses of the existing literature. Findings reveal elevated risk for suicide among first responders; however, studies utilizing more rigorous methodologies (e.g., longitudinal designs, probability sampling strategies) are sorely needed. First responders have an armamentarium of resources to take care of others; it is the duty of researchers, clinicians, and the public to aid in taking care of their health as well, in part by reducing suicide risk.
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Stanley IH, Hom MA, Joiner TE. Mental Health Service Use Among Adults With Suicide Ideation, Plans, or Attempts: Results From a National Survey. Psychiatr Serv 2015; 66:1296-302. [PMID: 26174949 DOI: 10.1176/appi.ps.201400593] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Despite the existence of efficacious interventions that reduce suicide risk, connecting high-risk individuals with care remains a problem. Little is known about factors that may be associated with service use and nonuse among suicidal adults. This study aimed to identify correlates of mental health service use among adults reporting past-year ideation, plans, or attempts. METHODS Data from the 2013 National Survey on Drug Use and Health (NSDUH) were analyzed to identify correlates of mental health service use among a nationally representative sample of adults reporting past-year suicide ideation (N=2,126), plans (N=690), or attempts (N=345). Findings were compared with results for individuals reporting no past-year suicidality (N=35,106). RESULTS Approximately 50% of adults with past-year ideation, plans, or attempts reported contact with any type of mental health services in the past year. Individuals who were more likely to have connected with services in the past year included females, non-Hispanic whites, those in worse general medical health, and those with a more severe clinical picture (that is, presence of serious psychological distress or a past-year diagnosis of a major depressive episode). Among the groups with suicide ideation, plans, or attempts, no significant differences in service use emerged between veterans and nonveterans or between married and nonmarried individuals. CONCLUSIONS Findings underscore the low rates of service use among adults at elevated risk of suicide and reveal possible avenues by which to increase treatment engagement in this population. Additional research is warranted to examine correlates of service use within a prospective design.
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Stanley IH, Chu C, Brown TA, Sawyer KA, Joiner TE. Improved Clinical Functioning for Patients Receiving Fee Discounts That Reward Treatment Engagement. J Clin Psychol 2015; 72:15-21. [PMID: 26613565 DOI: 10.1002/jclp.22236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Financial incentives may have utility in promoting psychotherapy attendance and adherence, leading to improved clinical functioning. This study presents results from a novel application of financial incentives-a progressively lowered pay scale that rewards therapy attendance and adherence. METHOD Overall, 110 outpatients participated; 56 patients (51%) were enrolled in the financial incentives condition and received a 5% fee discount-applied iteratively across sessions-if they followed defined criteria (e.g., completed homework). RESULTS There were no statistically significant differences between groups in terms of the number of sessions attended, therapy duration, and number of no-shows and cancellations. However, adjusting for Global Assessment of Functioning (GAF) at intake, patients receiving the financial incentives had significantly higher GAF rating at termination compared with those who did not receive the intervention. CONCLUSIONS Financial incentives that reward therapy attendance and adherence with discounted fees is associated with improved clinical functioning.
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Stanley IH, Hom MA, Hagan CR, Joiner TE. Career prevalence and correlates of suicidal thoughts and behaviors among firefighters. J Affect Disord 2015; 187:163-71. [PMID: 26339926 DOI: 10.1016/j.jad.2015.08.007] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/10/2015] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Firefighters experience high-risk occupational hazards that may confer increased risk for suicide; however, prevalence rates of suicidal thoughts and behaviors among firefighters are unknown. The purpose of this study is to describe the career prevalence of suicide ideation, plans, attempts, and non-suicidal self-injury among firefighters, in addition to sociodemographic, physical health, and occupational correlates. METHODS Data were obtained from a cross-sectional convenience sample of 1027 current and retired firefighters who completed a nationwide web-based survey on mental health (mean age=38.49, SD=11.70; 91.2% male; 87.3% White). Sociodemographic, physical health, and occupational correlates were assessed via a structured questionnaire. Suicidal thoughts and behaviors were assessed using a modified version of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF). RESULTS The career prevalence estimates of suicide ideation, plans, attempts, and non-suicidal self-injury were found to be 46.8%, 19.2%, 15.5%, and 16.4%, respectively. Key factors associated with increased risk for reporting suicidal thoughts and behaviors included lower firefighter rank, fewer years of firefighter service, membership in an all-volunteer department, a history of professionally responding to a suicide attempt or death, and active duty military status. LIMITATIONS The current study utilized a cross-sectional convenience sample of firefighters. CONCLUSIONS Firefighters report an alarmingly high career prevalence of suicidal thoughts and behaviors. Our preliminary data are compelling, indicating the need for additional research as well as increased prevention and treatment efforts among firefighters to decrease suicide risk.
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Hom MA, Stanley IH, Joiner TE. Evaluating factors and interventions that influence help-seeking and mental health service utilization among suicidal individuals: A review of the literature. Clin Psychol Rev 2015; 40:28-39. [DOI: 10.1016/j.cpr.2015.05.006] [Citation(s) in RCA: 213] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 05/17/2015] [Accepted: 05/20/2015] [Indexed: 01/17/2023]
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Sachs-Ericsson N, Joiner TE, Cougle JR, Stanley IH, Sheffler JL. Combat Exposure in Early Adulthood Interacts with Recent Stressors to Predict PTSD in Aging Male Veterans. THE GERONTOLOGIST 2015. [DOI: 10.1093/geront/gnv036] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
OBJECTIVE Empirical efforts to measure use of mental health services among lesbian, gay, and bisexual (LGB) older adults have been notably lacking. Thus this study assessed associations between sexual orientation and mental health service use among older adults and determined the mediating role of nonspecific psychological distress, excessive alcohol use, and self-perceived poor general medical health. METHODS Data from the 2011 New York City Community Health Survey were analyzed. The analytic sample comprised 5,138 adults ages 50 and over. Logistic regression modeling was used to examine associations between sexual orientation (LGB versus heterosexual) and past-year mental health service use (counseling or medication), adjusting for sociodemographic and clinical characteristics. Mediation analyses using bootstrapping were conducted. RESULTS Among LGB older adults, 23.9% reported receiving counseling, and 23.4% reported taking psychiatric medication in the past year. LGB respondents were significantly more likely than heterosexuals to have received counseling (adjusted odds ratio [AOR]=2.16, 95% confidence interval [CI]=1.49-3.13) and psychiatric medication (AOR=1.97, CI=1.36-2.86). Psychological distress, excessive alcohol use, and self-perceived poor general medical health did not mediate the association between sexual orientation and mental health service use. CONCLUSIONS LGB older adults were more likely than heterosexuals to utilize mental health services, and this association was not explained by indicators of general medical, mental, or behavioral health.
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Gitlin LN, Winter L, Stanley IH. Compensatory Strategies: Prevalence of Use and Relationship to Physical Function and Well-Being. J Appl Gerontol 2015; 36:647-666. [PMID: 25873452 DOI: 10.1177/0733464815581479] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We examine prevalence of four compensatory strategies (assistive devices, receiving help, changing frequency, or method of performance) and their immediate and long-term relationship to well-being. A total of 319 older adults (>70 years) with functional difficulties at home provided baseline data; 285 (89%) provided 12-month data. For 17 everyday activities, the most frequently used strategy was changing method of performance ( M = 10.27 activities), followed by changing frequency ( M = 6.17), assistive devices ( M = 5.38), and receiving help ( M = 3.37; p = .001). Using each strategy type was associated with functional difficulties at baseline ( ps < .0001), whereas each strategy type except changing method predicted functional decline 12 months later ( ps < .0001). Changing frequency of performing activities was associated with depressed mood ( p < .0001) and poor mastery ( p < .0001) at both baseline and 12 months ( ps < .02). Findings suggest that strategy type may be differentially associated with functional decline and well-being although reciprocal causality and the role of other factors in these outcomes cannot be determined from this study.
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Gitlin LN, Marx K, Stanley IH, Hodgson N. Translating Evidence-Based Dementia Caregiving Interventions into Practice: State-of-the-Science and Next Steps. THE GERONTOLOGIST 2015; 55:210-26. [PMID: 26035597 DOI: 10.1093/geront/gnu123] [Citation(s) in RCA: 208] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/03/2014] [Indexed: 11/12/2022] Open
Abstract
Over the past 3 decades, more than 200 dementia caregiver interventions have been tested in randomized clinical trials and found to be efficacious. Few programs have been translated for delivery in various service contexts, and they remain inaccessible to the 15+ million dementia family caregivers in the United States. This article examines translational efforts and offers a vision for more rapid advancement in this area. We summarize the evidence for caregiver interventions, review published translational efforts, and recommend future directions to bridge the research-practice fissure in this area. We suggest that as caregiver interventions are tested external to service contexts, a translational phase is required. Yet, this is hampered by evidentiary gaps, lack of theory to understand implementation challenges, insufficient funding and unsupportive payment structures for sustaining programs. We propose ways to advance translational activities and future research with practical applications.
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Marx KA, Stanley IH, Van Haitsma K, Moody J, Alonzi D, Hansen BR, Gitlin LN. Knowing Versus Doing: Education and Training Needs of Staff in a Chronic Care Hospital Unit for Individuals With Dementia. J Gerontol Nurs 2014; 40:26-34; quiz 36-7. [DOI: 10.3928/00989134-20140905-01] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/28/2014] [Indexed: 11/20/2022]
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Gitlin LN, Marx KA, Stanley IH, Hansen BR, Van Haitsma KS. Assessing neuropsychiatric symptoms in people with dementia: a systematic review of measures. Int Psychogeriatr 2014; 26:1805-48. [PMID: 25096416 PMCID: PMC4435793 DOI: 10.1017/s1041610214001537] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) occur in people with dementia throughout disease course and across etiologies. NPS are associated with significant morbidities and hastened disease processes. Nevertheless, people with dementia are not systematically assessed for NPS in clinical settings. We review existing NPS measures for clinical and/or research purposes, and identify measurement gaps. METHODS We conducted a computerized search of peer-reviewed published studies of measures (January 1, 1980-December 1, 2013) using multiple search terms. Measures selected for review were in English, had adequate psychometric properties, and were developed for or used with people with dementia. Papers describing measures were evaluated by three coders along seven characteristics: behavioral domains, number of items, method of administration, response categories, targeted population, setting, and psychometric properties. RESULTS Overall, 2,233 papers were identified through search terms, and 36 papers from manual searches of references. From 2,269 papers, 85 measures were identified of which 45 (52.9%) had adequate psychometric properties and were developed or used with dementia populations. Of these, 16 (35.6%) were general measures that included a wide range of behaviors; 29 (64.4%) targeted specific behaviors (e.g. agitation). Measures differed widely as to behaviors assessed and measurement properties. CONCLUSIONS A robust set of diverse measures exists for assessing NPS in different settings. No measures identify risk factors for behaviors or enable an evaluation of the context in which behaviors occur. To improve clinical efforts, research is needed to evaluate concordance of behavioral ratings between formal and informal caregivers, and to develop and test measures that can identify known risks for behaviors and the circumstances under which behaviors occur.
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Stanley IH, Conwell Y, Bowen C, Van Orden KA. Pet ownership may attenuate loneliness among older adult primary care patients who live alone. Aging Ment Health 2014; 18:394-9. [PMID: 24047314 PMCID: PMC3944143 DOI: 10.1080/13607863.2013.837147] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Older adults who report feelings of loneliness are at increased risk for a range of negative physical and mental health outcomes, including early mortality. Identifying potential sources of social connectedness, such as pet ownership, could add to the understanding of how to promote health and well-being in older adults. The aim of this study is to describe the association of pet ownership and loneliness. METHOD The current study utilizes cross-sectional survey data from a sample (N = 830) of older adult primary care patients (age ≥ 60 years). RESULTS Pet owners were 36% less likely than non-pet owners to report loneliness, in a model controlling for age, living status (i.e., alone vs. not alone), happy mood, and seasonal residency (adjOR = 0.64, 95% CI = 0.41-0.98, p < 0.05). An interaction was found between pet ownership and living status (b = -1.60, p < 0.001) in which living alone and not owning a pet was associated with the greatest odds of reporting feelings of loneliness. CONCLUSION The findings suggest that pet ownership may confer benefits for well-being, including attenuating feelings of loneliness and its related sequelae, among older adults who live alone.
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Stanley IH, Snyder D, Westen S, Ballard ED, Teach SJ, Kapetanovic S, Wharff EA, Bridge JA, Ginnis K, Pao M, Horowitz LM. Self-Reported Recent Life Stressors and Risk of Suicide in Pediatric Emergency Department Patients. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2013; 14:35-40. [PMID: 23908600 DOI: 10.1016/j.cpem.2013.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Emergency departments (EDs) are important venues for detecting youth at risk for suicide. Children and adolescents who present to the ED and report a recent life stressor, such as stressors related to interpersonal relationships, may be at elevated risk for suicide. Utilizing data from three large, urban pediatric EDs, we examined the relationship between reported recent life stressors and suicide risk, as measured by the Suicidal Ideation Questionnaire. Overall, youth who reported a recent life stressor were at elevated risk of suicide [adjOR = 5.43 (95% CI, 3.18-9.26)]. Importantly, however, this finding was tempered by the fact that 20% of youth who screened positive for suicide risk did not report a stressor. Thus, while the knowledge of stressors may provide useful supplementary information to a suicide risk assessment, the presence or absence of a reported stressor is not sufficient to determine one's risk of suicide. ED clinicians are advised to include direct questions about suicidal thoughts and behaviors.
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