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Campbell GM, Perry MP, Milford J, Murphy D. Personalising veteran healthcare: recognising barriers to access for minority and under-represented groups of veterans. BMJ Mil Health 2024; 170:446-450. [PMID: 38897640 DOI: 10.1136/military-2024-002768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
Veterans are not a demographically homogenous group, yet minority groups continue to be under-represented in research and report feeling less able to access clinical services to seek support. While veteran-specific healthcare has responded to the needs of the majority, the success of veteran mental health services is contingent on serving the whole veteran population. Key to the personalisation of healthcare is the question of access and a need to address specific inequalities and barriers to help-seeking behaviour. In this paper, we explore the issues of access to veteran healthcare at three levels: those barriers common to all veterans; those common to all minority groups of veterans; and those relevant to specific minority groups of veterans. Stigma, military attitudes and culture (eg, stoicism), and access to services and professionals with veteran-specific knowledge are universal barriers across veteran groups. Minority groups report a heightening of these barriers, alongside being 'othered' in veteran care settings, a lack of representation of them or their experiences in service descriptions and advertising, a lack of professional cultural competencies on specific issue, and the veteran environment potentially being retraumatising. Finally, barriers specific to individual groups are discussed. Attending to these is essential in developing holistic approaches to personalised healthcare that meets the needs of all veterans.
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Affiliation(s)
- Gavin M Campbell
- Centre for Applied Military Health Research, Combat Stress, Leatherhead, UK
| | - M P Perry
- Op COURAGE North of England, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Sunderland, UK
| | - J Milford
- Op COURAGE North of England, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Sunderland, UK
| | - D Murphy
- Centre for Applied Military Health Research, Combat Stress, Leatherhead, UK
- King's Centre for Military Health Research, King's College London, London, UK
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2
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Chennapragada L, Osterberg T, Strouse M, Sullivan SR, Silver C, LaMarca M, Boucher C, Fonseca E, Goodman M. A PRISMA Scoping Review to Explore Interventions to Prevent Firearm-Related Injury and Suicide in Older Adults. Clin Gerontol 2024; 47:519-535. [PMID: 38626064 DOI: 10.1080/07317115.2024.2339366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
OBJECTIVES This scoping review aims to examine existing research into firearm safety interventions designed to prevent firearm injury and suicide in older adults. METHODS Select databases were searched in 5/2023. Included articles involved an/a 1. aim to develop or investigate firearm safety interventions, 2. focus on adults 50 years and older, and 3. primary analysis. RESULTS The search yielded 10 articles which primarily focused on firearm safety counseling with older adults with suicide risk or emerging impairment. The review found that older adults may be open to receiving firearm safety counseling but that providers feel ill-equipped to have these conversations and to reliably identify suicide risk. Two studies presented promising data on the impact and acceptability of training providers in a firearm safety intervention. The review also identified the importance of building trust between older patients and providers to have helpful discussions regarding firearms, and highlighted specific approaches that facilitate openness to participate in these exchanges. CONCLUSIONS Further research into adapting interventions to meet the clinical needs of older adults and treatment efficacy trials is necessary. CLINICAL IMPLICATIONS Training healthcare providers to conduct firearm safety interventions with older adults may be an acceptable and impactful avenue to prevent suicide.
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Affiliation(s)
- Lakshmi Chennapragada
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Terra Osterberg
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Madison Strouse
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Sarah R Sullivan
- Department of Psychology, The Graduate Center, City University of New York, New York, NY, USA
- Department of Psychology, Hunter College, City University of New York, New York, NY, USA
| | - Chana Silver
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Mary LaMarca
- Executive Division, National Center for PTSD Department of Veterans Affairs, White River Junction, Vermont, USA
| | - Caroline Boucher
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Emilia Fonseca
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Marianne Goodman
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Bond AE, Houtsma C, Shapiro ME, Bandel SL, Moceri-Brooks J, Anestis MD. Female military service members and veterans: Understanding treatment seeking behavior and previous suicide risk among suicide decedents. DEATH STUDIES 2024:1-8. [PMID: 38912977 DOI: 10.1080/07481187.2024.2370468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
To examine the differences in treatment seeking behaviors, previous suicidal thoughts, previous suicide attempts, and disclosure of suicidal thoughts among female service members (SM)/Veteran suicide decedents who used a firearm and those who used another method. Data was acquired from the National Violent Death Reporting System which is maintained and monitored by the Center for Disease Control and Prevention. Data included in the present study were from suicide deaths that occurred between 2003-2018. Female SM/Veterans who died by firearm suicide had lower proportions of current mental health or substance use treatment, lifetime mental health or substance use treatment, and previous suicide attempts compared to those who used another method. Female SM/Veterans who die by firearm suicide are less likely to encounter mental health services than those who use another method. Conversations on secure firearm storage need to occur outside of the health care setting.
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Affiliation(s)
- Allison E Bond
- The New Jersey Gun Violence Research Center, Rutgers The State University of New Jersey, New Brunswick, USA
- Department of Psychology, Rutgers University, USA
| | - Claire Houtsma
- Southeast Louisiana Veterans Health Care System, USA
- South Central Mental Illness Research, Education and Clinical Center, USA
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mary E Shapiro
- Southeast Louisiana Veterans Health Care System, USA
- South Central Mental Illness Research, Education and Clinical Center, USA
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Shelby L Bandel
- The New Jersey Gun Violence Research Center, Rutgers The State University of New Jersey, New Brunswick, USA
- Department of Psychology, Rutgers University, USA
| | - Jayna Moceri-Brooks
- The New Jersey Gun Violence Research Center, Rutgers The State University of New Jersey, New Brunswick, USA
| | - Michael D Anestis
- The New Jersey Gun Violence Research Center, Rutgers The State University of New Jersey, New Brunswick, USA
- School of Public Health, Rutgers University, New Brunswick, USA
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Martinez C, Levin D, Jones J, Finley PD, McMahon B, Dhaubhadel S, Cohn J, Oslin DW, Kimbrel NA, Beckham JC. Deep sequential neural network models improve stratification of suicide attempt risk among US veterans. J Am Med Inform Assoc 2023; 31:220-230. [PMID: 37769328 PMCID: PMC10746318 DOI: 10.1093/jamia/ocad167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 07/21/2023] [Accepted: 08/18/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE To apply deep neural networks (DNNs) to longitudinal EHR data in order to predict suicide attempt risk among veterans. Local explainability techniques were used to provide explanations for each prediction with the goal of ultimately improving outreach and intervention efforts. MATERIALS AND METHODS The DNNs fused demographic information with diagnostic, prescription, and procedure codes. Models were trained and tested on EHR data of approximately 500 000 US veterans: all veterans with recorded suicide attempts from April 1, 2005, through January 1, 2016, each paired with 5 veterans of the same age who did not attempt suicide. Shapley Additive Explanation (SHAP) values were calculated to provide explanations of DNN predictions. RESULTS The DNNs outperformed logistic and linear regression models in predicting suicide attempts. After adjusting for the sampling technique, the convolutional neural network (CNN) model achieved a positive predictive value (PPV) of 0.54 for suicide attempts within 12 months by veterans in the top 0.1% risk tier. Explainability methods identified meaningful subgroups of high-risk veterans as well as key determinants of suicide attempt risk at both the group and individual level. DISCUSSION AND CONCLUSION The deep learning methods employed in the present study have the potential to significantly enhance existing suicide risk models for veterans. These methods can also provide important clues to explore the relative value of long-term and short-term intervention strategies. Furthermore, the explainability methods utilized here could also be used to communicate to clinicians the key features which increase specific veterans' risk for attempting suicide.
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Affiliation(s)
- Carianne Martinez
- Sandia National Laboratories, Albuquerque, NM 87185, United States
- Arizona State University, Tempe, AZ 85287, United States
| | - Drew Levin
- Sandia National Laboratories, Albuquerque, NM 87185, United States
| | - Jessica Jones
- Sandia National Laboratories, Albuquerque, NM 87185, United States
| | - Patrick D Finley
- Sandia National Laboratories, Albuquerque, NM 87185, United States
| | - Benjamin McMahon
- Los Alamos National Laboratory, Los Alamos, NM 87544, United States
| | | | - Judith Cohn
- Los Alamos National Laboratory, Los Alamos, NM 87544, United States
| | | | | | - David W Oslin
- VISN 4 Mental Illness Research, Education, and Clinical Center, Center of Excellence, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, United States
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Nathan A Kimbrel
- Durham Veterans Affairs (VA) Health Care System, Durham, NC 27705, United States
- Education and Clinical Center, VA Mid-Atlantic Mental Illness Research, Durham, NC 27707, United States
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC 27701, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27701, United States
| | - Jean C Beckham
- Durham Veterans Affairs (VA) Health Care System, Durham, NC 27705, United States
- Education and Clinical Center, VA Mid-Atlantic Mental Illness Research, Durham, NC 27707, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27701, United States
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Miller-Matero LR, Yeh HH, Ahmedani BK, Rossom RC, Harry ML, Daida YG, Coleman KJ. Suicide attempts after bariatric surgery: comparison to a nonsurgical cohort of individuals with severe obesity. Surg Obes Relat Dis 2023; 19:1458-1466. [PMID: 37758538 PMCID: PMC10843496 DOI: 10.1016/j.soard.2023.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/14/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The rate of suicide is higher among individuals following bariatric surgery compared with the general population; however, it is not clear whether risk is associated with bariatric surgery beyond having severe obesity. OBJECTIVE To compare the risk of a suicide attempt among those who had bariatric surgery versus a nonsurgical cohort with severe obesity. SETTING Aggregate count data were collected from 5 healthcare systems. METHODS Individuals were identified in the surgical cohort if they underwent bariatric surgery between 2009 and 2017 (n = 35,522) and then were compared with a cohort of individuals with severe obesity who never had bariatric surgery (n = 691,752). Suicide attempts were identified after study enrollment date using International Classification of Diseases, Ninth and Tenth Editions (ICD-9 and ICD-10) diagnosis codes from 2009 to 2021. RESULTS The relative risk of a suicide attempt was 64% higher in the cohort with bariatric surgery than that of the nonsurgical cohort (2.2% versus 1.3%; relative risk = 1.64; 95% CI, 1.53-1.76). Within the cohort with bariatric surgery, suicide attempts were more common among the 18- to 39-year age group (P < .001), women (P = .002), Hawaiian-Pacific Islanders (P < .001), those with Medicaid insurance (P < .001), and those with a documented mental health condition at baseline (in the previous 2 years; P < .001). CONCLUSIONS The relative risk of suicide attempts was higher among those who underwent bariatric surgery compared with a nonsurgical cohort, though absolute risk remained low. Providers should be aware of this increased risk. Screening for suicide risk after bariatric surgery may be useful to identify high-risk individuals.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan.
| | - Hsueh-Han Yeh
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Brian K Ahmedani
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | | | | | - Karen J Coleman
- Kaiser Permanente Southern California, Irvine, California; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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Glasser NJ, Baker NA, Pollack HA, Hussaini SS, Tung EL. Age Trends And State Disparities In Firearm-Related Suicide In The US, 1999-2020. Health Aff (Millwood) 2023; 42:1551-1558. [PMID: 37931189 DOI: 10.1377/hlthaff.2023.00399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Using data from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System, we analyzed trends in firearm suicide across the life course, comparing age-related trends over time (2015-20 versus 1999-2014) and stratified by differences in state firearm policy environments. Overall, we found stable trends in firearm suicide rates across the life course, although with higher overall rates across all age groups in 2015-20 versus in 1999-2014. Ages 14-16 was the only age group with an accelerating life-course trend in firearm suicide rates in 2015-20 versus in 1999-2014. The state policy environment was associated with significant differences in firearm suicide, with an average of 4.62 more deaths per 100,000 people per year in states with less- versus more-strict environments. This was in contrast to nonfirearm suicides, for which we observed no consistent differences between states. The largest overall differences in firearm suicide between states occurred in adulthood through middle age. These findings can inform further research on health care-based approaches to reducing firearm suicide, such as health care screening for firearm ownership, screening for suicide risk among firearm owners, and motivational interviewing to promote safe firearm storage.
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Fischer IC, Nichter B, Aunon FM, Feldman DB, Levy BR, Esterlis I, Pietrzak RH. Suicidal Thoughts and Behaviors in Older U.S. Military Veterans: Results From the National Health and Resilience in Veterans Study. Am J Geriatr Psychiatry 2023; 31:844-852. [PMID: 37211498 PMCID: PMC10731861 DOI: 10.1016/j.jagp.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/10/2023] [Accepted: 04/15/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To identify the prevalence and correlates associated with suicidal thoughts and behaviors (STBs) in a nationally representative sample of older (55+) US military veterans. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (N = 3,356; mean age = 70.6). Self-report measures of past-year suicidal ideation (SI), lifetime suicide plan, lifetime suicide attempt(s), and future suicide intent were examined in relation to sociodemographic, neuropsychiatric, trauma, physical health, and protective factors. RESULTS A total of 6.6% (95% CI = 5.7%-7.8%) of the sample endorsed past-year SI, 4.1% (CI = 3.3%-5.1%) a lifetime suicide plan, 1.8% (CI = 1.4%-2.3%) a lifetime suicide attempt, and 0.9% (CI = 0.5%-1.3%) future suicide intent. Higher levels of loneliness and lower levels of purpose in life were most strongly associated with past-year SI; lifetime history of major depressive disorder with suicide plan and suicide attempt; and frequency of past-year SI and more negative expectations regarding emotional aging with future suicide intent. CONCLUSION These findings provide the most up-to-date nationally representative prevalence estimates of STBs among older military veterans in the United States. Several modifiable vulnerability factors were found to be associated with suicide risk in older US military veterans, suggesting that these factors may be targets for intervention in this population.
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Affiliation(s)
- Ian C Fischer
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder (ICF, IE, RHP), VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale School of Medicine (ICF, BN, FMA, IE, RHP), New Haven, CT.
| | - Brandon Nichter
- Department of Psychiatry, Yale School of Medicine (ICF, BN, FMA, IE, RHP), New Haven, CT
| | - Frances M Aunon
- Department of Psychiatry, Yale School of Medicine (ICF, BN, FMA, IE, RHP), New Haven, CT; VA Connecticut Healthcare System (FMA), West Haven, CT
| | - David B Feldman
- Department of Counseling Psychology, Santa Clara University (DBF), Santa Clara, CA
| | - Becca R Levy
- Department of Social and Behavioral Sciences, Yale School of Public Health (BRL. RHP), New Haven, CT
| | - Irina Esterlis
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder (ICF, IE, RHP), VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale School of Medicine (ICF, BN, FMA, IE, RHP), New Haven, CT
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder (ICF, IE, RHP), VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale School of Medicine (ICF, BN, FMA, IE, RHP), New Haven, CT; Department of Social and Behavioral Sciences, Yale School of Public Health (BRL. RHP), New Haven, CT
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Crasta D, Funderburk JS, Gray TD, Cordova JV, Britton PC. Brief relationship support as a selective suicide prevention intervention: Piloting the Relationship Checkup in veteran couples with relationship and mental health concerns. Suicide Life Threat Behav 2023; 53:787-801. [PMID: 37594162 PMCID: PMC10591926 DOI: 10.1111/sltb.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/02/2023] [Accepted: 07/19/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Close relationship problems play a key role in many contemporary theories of suicide. However, the potential of relationship support in suicide prevention is understudied. This study explores the feasibility, safety, acceptability, and promise of utilizing the 3-session Relationship Checkup (RC) in veterans with mental health and romantic relationship concerns. METHODS We conducted a single-arm pilot of telehealth RC in veterans with a positive mental health screen and their romantic partners. Couples completed baseline and post-treatment assessments of study outcomes. RESULTS Feasibility analyses showed we were able to recruit an elevated-risk sample (30% history of attempts or interrupted attempts), take them through the service (90% treatment completion), and had minimal harm events (no suicidal behavior, no physical harm in arguments). Multimethod acceptability analyses suggested high satisfaction with the program, though some desired more intensive services. Couples reported improvements in relationship functioning, emotional intimacy, thwarted belongingness, depression, and posttraumatic stress. Perceived burdensomeness only improved for identified patients and drinking did not change for either partner. CONCLUSION The RC is a feasible, safe, and acceptable strategy for providing relationship support to couples at elevated risk. Although further randomized trials are needed, RC shows promise to reduce relationship-level and individual-level suicide risk factors.
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Affiliation(s)
- Dev Crasta
- Center of Excellence for Suicide Prevention, US Department of Veterans Affairs, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Jennifer S Funderburk
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York, USA
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Tatiana D Gray
- Department of Psychology, Springfield College, Springfield, Massachusetts, United States
| | - James V Cordova
- Department of Psychology, Clark University, Worcester, Massachusetts, USA
| | - Peter C Britton
- Center of Excellence for Suicide Prevention, US Department of Veterans Affairs, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
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Rodway C, Ibrahim S, Westhead J, Bojanić L, Turnbull P, Appleby L, Bacon A, Dale H, Harrison K, Kapur N. Suicide after leaving the UK Armed Forces 1996-2018: A cohort study. PLoS Med 2023; 20:e1004273. [PMID: 37552686 PMCID: PMC10409259 DOI: 10.1371/journal.pmed.1004273] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/06/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND There are comparatively few international studies investigating suicide in military veterans and no recent UK-wide studies. This is important because the wider context of being a UK Armed Forces (UKAF) veteran has changed in recent years following a period of intensive operations. We aimed to investigate the rate, timing, and risk factors for suicide in personnel who left the UKAF over a 23-year period. METHODS AND FINDINGS We carried out a retrospective cohort study of suicide in personnel who left the regular UKAF between 1996 and 2018 linking national databases of discharged personnel and suicide deaths, using survival analysis to examine the risk of suicide in veterans compared to the general population and conditional logistic regression to investigate factors most strongly associated with suicide after discharge. The 458,058 individuals who left the UKAF accumulated over 5,852,100 person years at risk, with a median length of follow-up of 13 years, were mostly male (91%), and had a median age of 26 years at discharge. 1,086 (0.2%) died by suicide. The overall rate of suicide in veterans was slightly lower than the general population (standardised mortality ratio, SMR [95% confidence interval, CI] 94 [88 to 99]). However, suicide risk was 2 to 3 times higher in male and female veterans aged under 25 years than in the same age groups in the general population (age-specific mortality ratios ranging from 160 to 409). Male veterans aged 35 years and older were at reduced risk of suicide (age-specific mortality ratios 47 to 80). Male sex, Army service, discharge between the ages of 16 and 34 years, being untrained on discharge, and length of service under 10 years were associated with higher suicide risk. Factors associated with reduced risk included being married, a higher rank, and deployment on combat operations. The rate of contact with specialist NHS mental health services (273/1,086, 25%) was lowest in the youngest age groups (10% for 16- to 19-year-olds; 23% for 20- to 24-year-olds). Study limitations include the fact that information on veterans was obtained from administrative databases and the role of pre-service vulnerabilities and other factors that may have influenced later suicide risk could not be explored. In addition, information on contact with support services was only available for veterans in contact with specialist NHS mental health services and not for those in contact with other health and social care services. CONCLUSIONS In this study, we found suicide risk in personnel leaving the UKAF was not high but there are important differences according to age, with higher risk in young men and women. We found a number of factors which elevated the risk of suicide but deployment was associated with lower risk. The focus should be on improving and maintaining access to mental health care and social support for young service leavers, as well as implementing general suicide prevention measures for all veterans regardless of age.
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Affiliation(s)
- Cathryn Rodway
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Jodie Westhead
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Lana Bojanić
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Andy Bacon
- Armed Forces Team, NHS England, London, United Kingdom
- Westminster Centre for Research in Veterans, University of Chester, Chester, United Kingdom
| | - Harriet Dale
- Ministry of Defence, Defence Statistics Health, Bristol, United Kingdom
| | - Kate Harrison
- Ministry of Defence, Defence Statistics Health, Bristol, United Kingdom
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Research Centre, University of Manchester, Manchester, United Kingdom
- Mersey Care NHS Foundation Trust, Liverpool, United Kingdom
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10
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Edwards ER, Coolidge B, Ruiz D, Epshteyn G, Krauss A, Gorman D, Connelly B, Redden C, El-Meouchy P, Geraci J. Situational stress and suicide attempt behavior in Army soldiers and veterans: Insights from the Army Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study. Suicide Life Threat Behav 2023; 53:642-654. [PMID: 37306332 DOI: 10.1111/sltb.12970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/07/2023] [Accepted: 05/07/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Prevention of suicide-related behaviors is considered a top clinical priority within the Departments of Veterans Affairs and Defense. Despite previous literature attesting to the likely importance of situational stress as a key correlate of acute changes in suicide risk, longitudinal research into associations between situational stress and suicide-related outcomes among military personnel has been relatively limited. METHODS The current study examined associations between situational stress, recent suicide attempt, and future suicide attempt using data from 14,508 Army soldiers and recently discharged veterans enrolled in the Army Study to Assess Risk and Resilience in Servicemembers-Longitudinal Studies (STARRS-LS). RESULTS Recent situational stress was more common among recently discharged veterans (vs. soldiers), those with a recent suicide attempt (vs. those without), and those with a subsequent suicide attempt (vs. those without). Job loss was more closely associated with suicide attempts among soldiers, whereas financial crisis, police contact, and death, illness, or injury of close others were more closely associated with suicide attempts among recently discharged veterans. CONCLUSION Findings further highlight situational stress as a salient risk factor for suicide-related outcomes among military personnel, particularly among recently discharged veterans. Implications for screening and treatment of at-risk military personnel are discussed.
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Affiliation(s)
- Emily R Edwards
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Brettland Coolidge
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Psychology, University of Central Florida, Orlando, Florida, USA
| | - Danny Ruiz
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
| | - Gabriella Epshteyn
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Alison Krauss
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Health Care System, Waco, Texas, USA
| | - Daniel Gorman
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
| | - Brigid Connelly
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
| | - Clare Redden
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
| | - Paul El-Meouchy
- Department of Psychology, Fielding Graduate University, Santa Barbara, California, USA
| | - Joseph Geraci
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
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11
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Decreasing patterns of depression in living alone across middle-aged and older men and women using a longitudinal mixed-effects model. Soc Sci Med 2023; 317:115513. [PMID: 36450172 DOI: 10.1016/j.socscimed.2022.115513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/23/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022]
Abstract
There is little evidence regarding the association between living arrangement and depression, and no studies have examined the age- and gender-specific differences in this association. The present study sought to examine the longitudinal changes in depression patterns between isolative living versus living in company among middle-aged and older men and women by obtaining data from waves 1-7 of the Korean Longitudinal Study of Aging (KloSA), which comprises a sample of persons at least 45 years of age in the Republic of Korea (2273 middle-aged and 1387 older men, 2805 middle aged and 1862 older women). Depression scores were based on the self-reported Center for Epidemiologic Studies Depression Scale (CES-D-10) short forms. Using mixed-effect linear regression models, we estimated depression patterns by living arrangement across age- and gender groups. Our findings from the mixed-effects model revealed that over a 14-year follow-up period, there were significant decreasing patterns of depression were among middle-aged men and women, and older men living alone compared to living with a spouse and living with others. However, living alone still had the highest depression compared to other living arrangement types. On the other hand, the depression of older women living alone changed to a level similar to those living with others during the follow-up period. In conclusion, these findings indicate that living alone significantly increases the risk of depression, but the risk decreases over time. Additionally, depression patterns by living arrangement proved to differ across age and gender groups.
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12
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Carlson KF, Gilbert TA, DeFrancesco S, Wright DA, Shen X, Cook LJ. Accuracy of behavioral health variables in Oregon national violent death reporting system data: a linked cohort study. Inj Epidemiol 2022; 9:29. [PMID: 36100875 PMCID: PMC9469595 DOI: 10.1186/s40621-022-00393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background The National Violent Death Reporting System (NVDRS) collects data on the circumstances of violent deaths, and all firearm-related deaths, across states and territories in the USA. This surveillance system is critical to understanding patterns and risk factors for these fatalities, thereby informing targets for prevention. NVDRS variables include behavioral health conditions among decedents, but the validity of the reported behavioral health data is unknown. Using Department of Veterans Affairs (VA) healthcare records as a criterion standard, we examined the accuracy of NVDRS-reported behavioral health variables for veteran decedents in a sample state (Oregon) between 2003 and 2017.
Methods We linked Oregon NVDRS data to VA healthcare data to identify veteran decedents who used VA services within two years of death. Veterans’ VA diagnoses within this time frame, including depression, post-traumatic stress disorder (PTSD), anxiety, and substance use disorders, were compared to behavioral health variables identified in the Oregon NVDRS. Concordance, sensitivity, and correlates of sensitivity were examined over time and by decedent characteristics.
Results We identified 791 VA-using veterans with violent and/or firearm-related fatal injuries documented in the Oregon NVDRS between 2003 and 2017. In this cohort, the Oregon NVDRS accurately identified only 49% of decedents who were diagnosed with depression, 45% of those diagnosed with PTSD, and 17% of those diagnosed with anxiety by the VA. Among 211 veterans diagnosed by the VA with a substance use disorder, the Oregon NVDRS coded only 56% as having a substance use problem. In general, the sensitivity of behavioral health variables in the Oregon NVDRS remained the same or decreased over the study period; however, the sensitivity of PTSD diagnoses increased from 21% in 2003–2005 to 54% in 2015–2017. Sensitivity varied by some decedent characteristics, but not consistently across behavioral health variables.
Conclusions NVDRS data from one state missed more than half of behavioral health diagnoses among VA-using veterans who died from violence or from firearm injuries. This suggests that reports of behavioral health conditions among decedents nationally may be severely undercounted. Efforts to improve validity of these variables in state NVDRS data are needed.
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13
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Unemployment, homelessness, and other societal outcomes in patients with schizophrenia: a real-world retrospective cohort study of the United States Veterans Health Administration database : Societal burden of schizophrenia among US veterans. BMC Psychiatry 2022; 22:458. [PMID: 35804314 PMCID: PMC9264584 DOI: 10.1186/s12888-022-04022-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden associated with schizophrenia is substantial. Impacts on the individual, healthcare system, and society may be particularly striking within the veteran population due to the presence of physical and mental health comorbidities. Disease burden is also influenced by a complex interplay between social determinants of health and health disparities. The objective of the current study was to compare non-healthcare societal outcomes between veterans with and without schizophrenia in the United States Veterans Health Administration (VHA). METHODS A retrospective cohort study was conducted using the VHA database (01/2013-09/2019; study period). Veterans with schizophrenia (≥2 diagnoses of ICD-9295.xx, ICD-10 F20.x, F21, and/or F25.x during the study period) were identified; the index date was the earliest observed schizophrenia diagnosis. Veterans with schizophrenia were propensity score-matched to those without schizophrenia using baseline characteristics. A 12-month baseline and variable follow-up period were applied. The frequency of unemployment, divorce, incarceration, premature death, and homelessness were compared between the matched cohorts using standardized mean difference (SMD). Risk of unemployment and homelessness were estimated using logistic regression models. RESULTS A total of 102,207 veterans remained in each cohort after matching (91% male; 61% White [per AMA]; median age, 59 years). Among veterans with schizophrenia, 42% had a substance use disorder and 30% had mental health-related comorbidities, compared with 25 and 15%, respectively, of veterans without schizophrenia. Veterans with schizophrenia were more likely to experience unemployment (69% vs. 41%; SMD: 0.81), divorce (35% vs. 28%; SMD: 0.67), homelessness (28% vs. 7%; SMD: 0.57), incarceration (0.4% vs. 0.1%; SMD: 0.47), and premature death (14% vs. 12%; SMD < 0.1) than veterans without schizophrenia. After further adjustments, the risk of unemployment and of homelessness were 5.4 and 4.5 times higher among veterans with versus without schizophrenia. Other predictors of unemployment included Black [per AMA] race and history of substance use disorder; for homelessness, younger age (18-34 years) and history of mental health-related comorbidities were additional predictors. CONCLUSION A greater likelihood of adverse societal outcomes was observed among veterans with versus without schizophrenia. Given their elevated risk for unemployment and homelessness, veterans with schizophrenia should be a focus of targeted, multifactorial interventions to reduce disease burden.
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14
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Seamans MJ, Mays VM, Arseniev-Koehler A, Cochran SD. Prevalence of prescription and illicit drugs in suicides by non-poisoning means in the National Violent Death Reporting System 2003-2017. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:464-470. [PMID: 35579600 PMCID: PMC10919380 DOI: 10.1080/00952990.2022.2053981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 06/15/2023]
Abstract
Background: Prescription and illicit drugs are important social environmental variables in many suicides regardless of their role as an immediate cause of death. Objectives: To investigate the presence of prescription and illicit drugs, either through mention in the death record or toxicology reports, among suicides attributed to nonpoisonous causes to identify patterns of risk. Methods: Using the 2003-2017 National Violent Death Reporting System (NVDRS), we examined the presence of prescription and illicit drugs among 143,175 suicides (119,563 males 23,612 females) due to firearms and suffocation/hanging. The presence of drugs (opioids, stimulants, benzodiazepines, muscle relaxants, and cannabis) was determined from toxicology reports and text searches of coroner/medical examiner and law enforcement summaries. We fit multivariable logistic regression models to estimate associations between drug class and suicide method adjusting for decedent characteristics. Results: Overall prescription and illicit drugs were present in 22% of firearm deaths and 28% of suffocation deaths. Among victims with toxicology reports, over 20% tested positive for benzodiazepines. Benzodiazepines were mentioned in 4% of firearm and 5% of suffocation suicides without toxicology testing. Stimulants were more likely to occur in suffocation than firearm deaths among victims with toxicology testing (aOR = 1.44, 95% CI: 1.33-1.56) and without toxicology testing (aOR = 1.61, 95% CI: 1.31-1.98). Conclusions: Benzodiazepines were most frequently identified in both toxicology reports and narratives of suicides by firearms or suffocation. Better distinction of the presence of prescription and illicit drugs in the environment versus apparent ingestion among non-poisoning suicides are needed to inform prevention approaches.
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Affiliation(s)
- Marissa J. Seamans
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Vickie M. Mays
- Department of Psychology, College of Letters and Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alina Arseniev-Koehler
- Department of Sociology, College of Social Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Susan D. Cochran
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Statistics, College of Physical Sciences, University of California, Los Angeles, Los Angeles, CA, USA
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15
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Stark KM, Basit SA, Mitchell BG. Impact of Lithium on Suicidality in the Veteran Population. Fed Pract 2022; 39:130-135. [PMID: 35444394 PMCID: PMC9014926 DOI: 10.12788/fp.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Background Lithium has known antisuicidal properties making it an important agent to study in veterans with psychiatric conditions, a population at high risk for suicide. Methods A single-site, retrospective chart review was conducted at a US Department of Veterans Affairs (VA) teaching hospital. Patients taking lithium for at least 6 months were identified using the VA Lithium Lab Monitoring Dashboard. The primary and secondary objectives were to evaluate the change in number of suicide attempts and suicidal ideation from 3 months prior to lithium initiation to 3 months after a 6-month duration of lithium. Results The review included 98 patients; 47 (47.9%) received concomitant psychotherapy, 50 (51.0%) were taking an antipsychotic, and 29 (29.6%) an additional mood stabilizer. During the 6-month intervention period, 75 (76.5%) patients had a lithium level drawn and 28 were in the therapeutic range. Of the 98 patients, hospitalization for suicide attempt decreased from 4.1% before lithium use to 0% after lithium use for 6 months (P = .045). Hospitalization for suicidal ideation also decreased from 13.3% before lithium use to 1.0% after lithium use for 6 months (P = .0004). Conclusions We observed a statistically significant reduction in hospitalization for suicide attempts and suicidal ideation in veterans prescribed lithium following nonfatal suicide behavior and suicidal ideation.
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Affiliation(s)
- Kelsie M Stark
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Saadia A Basit
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - Brian G Mitchell
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Baylor College of Medicine, Houston, Texas
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16
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Karel MJ, Wray LO, Adler G, Hannum AOR, Luci K, Brady LA, McGuire MH. Mental Health Needs of Aging Veterans: Recent Evidence and Clinical Recommendations. Clin Gerontol 2022; 45:252-271. [PMID: 31971092 DOI: 10.1080/07317115.2020.1716910] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Large numbers of older Americans have a history of military service, which may be positively or negatively associated with mental health in late life. We reviewed literature with the aim of better understanding the mental health needs of older Veterans.Methods: Articles included those published in 2009-2018 and focused on prevalence/risk for mental illness and suicide among older Veterans; utilization of mental health services; effectiveness of evidence-based behavioral treatments; and pertinent care delivery models.Results: Older Veterans are generally resilient. A significant minority experience mental health concerns that are associated with poor outcomes including a substantial number of suicides. Most published research is based on the approximately one third of Veterans who use the Veterans Health Administration (VHA) for care. Older Veterans with mental health diagnoses are less likely to utilize mental health services compared to younger Veterans, but as likely to benefit once engaged. Integrated care models in primary and geriatric care settings are promising.Conclusions: Aging Veterans are a large subset of Americans whose mental health needs are complex and deserve attention.Clinical Implications: Clinicians should ask about history of military service (i.e., Veteran status) and utilize available resources when providing care for older Veterans.
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Affiliation(s)
- Michele J Karel
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, DC, United States
| | - Laura O Wray
- VA Center for Integrated Healthcare, VA Western New York Health Care System, Buffalo, New York, United States.,Jacobs School of Medicine and Biomedical Sciences, SUNY University at Buffalo, Buffalo, New York, United States
| | - Geri Adler
- VA South Central Mental Illness Research, Education, and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
| | - Alisa O' Riley Hannum
- Mental Health Service, VA Eastern Colorado Healthcare System, Colorado Springs, Colorado, United States
| | - Katherine Luci
- Center for Aging and Neurocognitive Services, Salem VA Medical Center, Salem, Virginia, United States.,Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Blacksburg, Virginia, United States
| | - Laura A Brady
- Jacobs School of Medicine and Biomedical Sciences, SUNY University at Buffalo, Buffalo, New York, United States
| | - Marsden H McGuire
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, DC, United States
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17
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Wood L, Flatau P, Seivwright A, Wood N. Out of the trenches; prevalence of Australian veterans among the homeless population and the implications for public health. Aust N Z J Public Health 2021; 46:134-141. [PMID: 34709717 DOI: 10.1111/1753-6405.13175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 06/01/2021] [Accepted: 09/01/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To examine the prevalence of Australian Defence Force veterans among people sleeping rough and explore their health and social needs relative to non-veteran rough sleepers. METHOD Analysis of responses to the Vulnerability Index - Service Prioritisation Decision Assistance Tool (VI-SPDAT) collected from 8,027 rough sleepers across five Australian States from 2010-2017. RESULTS Veterans were found to comprise 5.6% of people sleeping rough in Australia, with veterans reporting having spent an average of 6.3 years on the street or in emergency accommodation (compared with an average of five years for their non-veterans counterparts). Veterans had a higher prevalence of self-reported physical health, mental health and social issues compared with non-veteran rough sleepers. CONCLUSIONS This is the first study of its kind to elucidate the presence of Australian veterans among people sleeping rough. That they are likely to have spent more years on the street, and have a higher prevalence of health and social issues, highlights the imperative for earlier intervention and prevention of veteran homelessness itself, and its health impacts. Implications for public health: Veteran homelessness has been comparatively hidden in Australia compared to other countries, and consequently the myriad of health, psychosocial and adjustment issues faced by homeless veterans has also been hidden. With heightened attention on veteran suicide and self-harm, earlier intervention to prevent veterans becoming homeless constitutes sound public health prevention and mental health policy.
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Affiliation(s)
- Lisa Wood
- School of Population and Global Health, University of Western Australia
| | - Paul Flatau
- Centre for Social Impact, Business School, University of Western Australia
| | - Ami Seivwright
- Centre for Social Impact, Business School, University of Western Australia
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18
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Kaboli PJ, Augustine MR, Haraldsson B, Mohr NM, Howren MB, Jones MP, Trivedi R. Association between acute psychiatric bed availability in the Veterans Health Administration and veteran suicide risk: a retrospective cohort study. BMJ Qual Saf 2021; 31:442-449. [PMID: 34400537 DOI: 10.1136/bmjqs-2020-012975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/08/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Veteran suicides have increased despite mental health investments by the Veterans Health Administration (VHA). OBJECTIVE To examine relationships between suicide and acute inpatient psychiatric bed occupancy and other community, hospital and patient factors. METHODS Retrospective cohort study using administrative and publicly available data for contextual community factors. The study sample included all veterans enrolled in VHA primary care in 2011-2016 associated with 111 VHA hospitals with acute inpatient psychiatric units. Acute psychiatric bed occupancy, as a measure of access to care, was the main exposure of interest and was categorised by quarter as per cent occupied using thresholds of ≤85%, 85.1%-90%, 90.1%-95% and >95%. Hospital-level analyses were conducted using generalised linear mixed models with random intercepts for hospital, modelling number of suicides by quarter with a negative binomial distribution. RESULTS From 2011 to 2016, the national incidence of suicide among enrolled veterans increased from 39.7 to 41.6 per 100 000 person-years. VHA psychiatric bed occupancy decreased from a mean of 68.2% (IQR 56.5%-82.2%) to 65.4% (IQR 53.9%-79.9%). VHA hospitals with the highest occupancy (>95%) in a quarter compared with ≤85% had an adjusted incident rate ratio (IRR) for suicide of 1.10 (95% CI 1.01 to 1.19); no increased risk was observed for 85.1%-90% (IRR 0.96; 95% CI 0.89 to 1.03) or 90.1%-95% (IRR 0.96; 95% CI 0.89 to 1.04) compared with ≤85% occupancy. Of hospital and community variables, suicide risk was not associated with number of VHA or non-VHA psychiatric beds or amount spent on community mental health. Suicide risk increased by age categories, seasons, geographic regions and over time. CONCLUSIONS High VHA hospital occupancy (>95%) was associated with a 10% increased suicide risk for veterans whereas absolute number of beds was not, suggesting occupancy is an important access measure. Future work should clarify optimal bed occupancy to meet acute psychiatric needs and ensure adequate bed distribution.
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Affiliation(s)
- Peter J Kaboli
- Veterans Rural Health Resource Center-Iowa City, VA Office of Rural Health, and Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, IA, USA .,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Matthew R Augustine
- James J Peters VA Medical Center, Department of Medicine, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, Department of Medicine, New York, NY, USA
| | - Bjarni Haraldsson
- Veterans Rural Health Resource Center-Iowa City, VA Office of Rural Health, and Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, IA, USA
| | - Nicholas M Mohr
- Veterans Rural Health Resource Center-Iowa City, VA Office of Rural Health, and Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, IA, USA.,Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - M Bryant Howren
- Veterans Rural Health Resource Center-Iowa City, VA Office of Rural Health, and Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, IA, USA.,Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Michael P Jones
- Veterans Rural Health Resource Center-Iowa City, VA Office of Rural Health, and Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, IA, USA.,Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Ranak Trivedi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Division of Public Mental Health and Population Sciences, Deptartment of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
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19
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Fitzke RE, Davis JP, Pedersen ER. Co-use of Tobacco Products and Cannabis among Veterans: A Preliminary Investigation of Prevalence and Associations with Mental Health Outcomes. J Psychoactive Drugs 2021; 54:250-257. [PMID: 34334112 DOI: 10.1080/02791072.2021.1956026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
While tobacco product (such as combustible cigarettes and nicotine vaping products) and cannabis use rates remain high in the general United States (U.S.) population, veterans from the conflicts in Iraq and Afghanistan (i.e., OEF/OIF veterans) are at high risk of high rates of cannabis and tobacco use. Co-use of tobacco and cannabis (i.e., using both substances within a specified period of time or combining the drugs within the same device for use) is of growing prevalence in the U.S. However, little is understood about the prevalence rates of tobacco and cannabis co-use among U.S. veterans and its associations with mental health symptomatology. The current study conducted a preliminary analysis of co-use patterns of tobacco and cannabis and associated mental health outcomes among a sample of OEF/OIF veterans (N = 1,230). Results indicated high rates of lifetime and past 30-day use of both substances. Past 30-day co-users endorsed significantly higher levels of stress, PTSD, depression, and anxiety compared to singular product users. Results suggest that the addition of cannabis use in conjunction with tobacco use may be associated with greater mental health symptoms among veterans. Findings indicate veteran tobacco and cannabis co-users may benefit from mental health care to help mitigate poor mental health symptoms.
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Affiliation(s)
- Reagan E Fitzke
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, University of Southern California, Los Angeles, CA, USA
| | - Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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20
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Sander LB, Lemor ML, Van der Sloot RJA, De Jaegere E, Büscher R, Messner EM, Baumeister H, Terhorst Y. A Systematic Evaluation of Mobile Health Applications for the Prevention of Suicidal Behavior or Non-suicidal Self-injury. Front Digit Health 2021; 3:689692. [PMID: 34713162 PMCID: PMC8521855 DOI: 10.3389/fdgth.2021.689692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/22/2021] [Indexed: 12/12/2022] Open
Abstract
People with suicidal ideation and non-suicidal self-injury (NSSI) behavior face numerous barriers to help-seeking, which worsened during the COVID-19 pandemic. Mobile health applications (MHA) are discussed as one solution to improve healthcare. However, the commercial app markets are growing unregulated and rapidly, leading to an inscrutable market. This study evaluates the quality, features, functions, and prevention strategies of MHA for people with suicidal ideation and NSSI. An automatic search engine identified MHA for suicidal behavior and NSSI in the European commercial app stores. MHA quality and general characteristics were assessed using the Mobile Application Rating Scale (MARS). MHA of high quality (top 25%) were examined in detail and checked for consistency with established suicide prevention strategies. Of 10,274 identified apps, 179 MHA met the predefined inclusion criteria. Average MHA quality was moderate (M = 3.56, SD = 0.40). Most MHA provided emergency contact, but lacked security features. High-quality MHA were broadly consistent with the best-practice guidelines. The search revealed apps containing potentially harmful and triggering content, and no randomized controlled trial of any included MHA was found. Despite a large heterogeneity in the quality of MHA, high-quality MHA for suicidal behavior and NSSI are available in European commercial app stores. However, a lack of a scientific evidence base poses potential threats to users.
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Affiliation(s)
- Lasse B. Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Marie-Luise Lemor
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Racine J. A. Van der Sloot
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Eva De Jaegere
- Department of Head and Skin, Flemish Centre of Expertise in Suicide Prevention, Ghent University, Ghent, Belgium
| | - Rebekka Büscher
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Eva-Maria Messner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
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21
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Theis J, Hoops K, Booty M, Nestadt P, Crifasi C. Firearm Suicide Among Veterans of the U.S. Military: A Systematic Review. Mil Med 2021; 186:e525-e536. [PMID: 33231686 DOI: 10.1093/milmed/usaa495] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/23/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION In the United States, firearm suicide represents a major cause of preventable, premature death among veterans. The purpose of this systematic review was to characterize the body of literature on veteran firearm suicide and identify areas for future research, which may facilitate the development of firearm suicide interventions in Veterans Health Administration (VHA) and non-Veterans Health Administration clinical settings. MATERIALS AND METHODS All randomized controlled trials, quasi-experimental, naturalistic, observational, and case study designs published between January 1, 1990 and February 21, 2019 were included in our review. Following title and abstract review, 65 papers were included in our full-text review and 37 studies were included in our analysis. We based our approach on a modification of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies were grouped into broad, nonmutually exclusive categories: (1) heterogeneity of datasets and veteran status determination for inclusion, (2) service histories, (3) firearm ownership, storage, behaviors, and risk perceptions, (4) patient and clinician attitudes toward firearm restriction interventions, (5) firearm suicide risk factors by study population, and (6) assessments of clinical firearm interventions. RESULTS This body of literature consists predominately of cross-sectional studies with mixed definitions and validation of veteran status, which revealed high concordance of increased risk of firearm suicide compared with nonveterans. Veterans have higher rates of firearm ownership than the general population, primarily citing personal protection as the reason for gun ownership. Veterans often exhibit risky firearm usage and storage behaviors but tend to favor measures that limit access to firearms by at-risk individuals. Despite this, there remains persistent hesitation among clinicians to screen and counsel veterans on firearm safety. CONCLUSIONS This systematic review highlights an urgent need to produce higher quality evidence and new data with standard definitions that are critical to inform clinical practice and enhance public health measures to reduce firearm suicide among veterans.
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Affiliation(s)
- Jason Theis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Katherine Hoops
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine Charlotte R Bloomberg Children's Center, Baltimore, MD 21287, USA
| | - Marisa Booty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Paul Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA
| | - Cassandra Crifasi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Suicide attempts and deaths in older persons in Ghana: A media surveillance approach. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-018-9932-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hall DM, Rings JA, Anderson T. Military Life Narratives and Identity Development among Black Post-9/11 Veterans. JOURNAL OF VETERANS STUDIES 2020. [DOI: 10.21061/jvs.v6i3.216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Morales DA, Barksdale CL, Beckel-Mitchener AC. A call to action to address rural mental health disparities. J Clin Transl Sci 2020; 4:463-467. [PMID: 33244437 PMCID: PMC7681156 DOI: 10.1017/cts.2020.42] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/19/2020] [Accepted: 04/14/2020] [Indexed: 01/19/2023] Open
Abstract
Rural residents in the USA experience significant disparities in mental health outcomes even though the prevalence of mental illness in rural and metropolitan areas is similar. This is a persistent problem that requires innovative approaches to resolve. Adopting and appropriately modifying the National Institute on Minority Health and Health Disparities research framework are the potential approaches to understanding how these disparities might be addressed through research. Using this research framework can facilitate interrogation of multiple levels of influence, encompassing complex domains of influence and consideration of the entire life course trajectory, which is consistent with several National Institute of Mental Health priorities.
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Affiliation(s)
- Dawn A. Morales
- Office for Disparities Research and Workforce Diversity, National Institute of Mental Health, Bethesda, MD, USA
| | - Crystal L. Barksdale
- Office for Disparities Research and Workforce Diversity, National Institute of Mental Health, Bethesda, MD, USA
| | - Andrea C. Beckel-Mitchener
- Office for Disparities Research and Workforce Diversity, National Institute of Mental Health, Bethesda, MD, USA
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Aslan M, Radhakrishnan K, Rajeevan N, Sueiro M, Goulet JL, Li Y, Depp C, Concato J, Harvey PD. Suicidal ideation, behavior, and mortality in male and female US veterans with severe mental illness. J Affect Disord 2020; 267:144-152. [PMID: 32063566 DOI: 10.1016/j.jad.2020.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/20/2019] [Accepted: 02/06/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND We compared male and female American veterans with schizophrenia or bipolar disorder regarding clinical characteristics associated with lifetime suicidal ideation and behavior. Subsequent mortality, including death by suicide, was also assessed. METHODS Data from questionnaires and face-to-face evaluations were collected during 2011-2014 from 8,049 male and 1,290 female veterans with schizophrenia or bipolar disorder. In addition to comparing male-female characteristics, Cox regression models-adjusted for demographic information, medical-psychiatric comorbidities, and self-reported suicidal ideation and behavior-were used to examine gender differences in associations of putative risk factors with suicide-specific and all-cause mortality during up to six years of follow-up. RESULTS Women overall were younger, more likely to report a history of suicidal behavior, less likely to be substance abusers, and had lower overall mortality during follow-up. Among women only, psychiatric comorbidity was paradoxically associated with lower all-cause mortality (hazard ratio [HR]=0.53, 95% CI, 0.29-0.96, p = 0.037 for 1 disorder vs. none; HR=0.44, 95% CI, 0.25-0.77, p = 0.004 for ≥2 disorders vs. none). Suicide-specific mortality involved relatively few events, but crude rates were an order of magnitude higher than in the U.S. general and overall veteran populations. LIMITATIONS Incomplete cause-of-death information and low statistical power for male-female comparisons regarding mortality. CONCLUSIONS Female veterans with SMI differed from females in the general population by having a higher risk of suicide attempts. They also had more lifetime suicide attempts than male veterans with same diagnoses. These differences should inform public policy and clinical planning.
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Affiliation(s)
- Mihaela Aslan
- VA Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, United States; Department of Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Krishnan Radhakrishnan
- VA Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, United States; College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Nallakkandi Rajeevan
- VA Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, United States; Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT, United States
| | - Melyssa Sueiro
- Research Service, Bruce W. Carter Veterans Affairs (VA) Medical Center, Miami, FL, United States
| | - Joseph L Goulet
- Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT, United States; Pain, Research, Informatics, Multimorbidities, & Education Center, West Haven, CT, United States
| | - Yuli Li
- VA Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, United States; Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT, United States
| | - Colin Depp
- VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - John Concato
- VA Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, United States; Department of Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Philip D Harvey
- Research Service, Bruce W. Carter Veterans Affairs (VA) Medical Center, Miami, FL, United States; Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, United States.
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Caetano R, Kaplan MS, Kerr W, McFarland BH, Giesbrecht N, Kaplan Z. Suicide, Alcohol Intoxication, and Age Among Whites and American Indians/Alaskan Natives. Alcohol Clin Exp Res 2020; 44:492-500. [PMID: 31782530 PMCID: PMC7018549 DOI: 10.1111/acer.14251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/18/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Among American Indians/Alaskan Natives (AI/ANs), suicides are disproportionately high among those younger than 40 years of age. This paper examines suicide and alcohol intoxication (postmortem BAC ≥ 0.08 g/dl) by age among Whites and AI/ANs to better understand the reasons for the high rate of suicide among AI/ANs for those younger than 40. METHODS Data come from the restricted 2003 to 2016 National Violent Death Reporting System (NVDRS), with postmortem information on 79,150 White and AI/AN suicide decedents of both genders who had a BAC test in 32 states of the United States. RESULTS Among Whites, 39.3% of decedents legally intoxicated are younger than 40 years of age, while among AI/ANs the proportion is 72.9% (p < 0.001). Multivariable logistic regression with data divided by age shows that in the 18 to 39 age group, AI/ANs are about 2 times more likely than Whites to have a postmortem BAC ≥ 0.08. Veteran status compared to nonveteran, and history of alcohol problems prior to suicide were also associated with BAC ≥ 0.08. Suicide methods other than by firearm and a report of the presence of 2 or more suicide precipitating circumstances were protective against BAC ≥ 0.08. Results for the age group 40 years of age and older mirror those for the younger group with 1 exception: Race/ethnicity was not associated with BAC level. CONCLUSIONS The proportion of suicide decedents with a BAC ≥ 0.08 is higher among AI/ANs than Whites, especially among those 18 to 39 years of age. However, acute alcohol intoxication does not fully explain differences in suicide age structure between AI/ANs and Whites.
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Affiliation(s)
- Raul Caetano
- Prevention Research Center, Berkeley, California
| | - Mark S Kaplan
- Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, California
| | | | - Bentson H McFarland
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Norman Giesbrecht
- Social & Epidemiological Research Department, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Zoe Kaplan
- Prevention Research Center, Berkeley, California
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Wood DS, Wood BM, Watson A, Sheffield D, Hauter H. Veteran Suicide Risk Factors: A National Sample of Nonveteran and Veteran Men Who Died by Suicide. HEALTH & SOCIAL WORK 2020; 45:23-30. [PMID: 31953537 DOI: 10.1093/hsw/hlz037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/21/2019] [Accepted: 04/05/2019] [Indexed: 06/10/2023]
Abstract
Veteran suicide is a serious public health problem. Some data suggest that veteran suicide risk profiles differ from those of nonveterans. Records for veteran (n = 21,692) and nonveteran (n = 83,430) men who died by suicide were examined from 17 U.S. states using the National Violent Death Reporting System data. Seventeen precipitating factors were examined and combined through meta-analysis of proportions. Many precipitating factors were found to be less frequent for veterans. A smaller number of factors were found to be higher in the veteran population, including physical health problems. A sizable cumulative effect size (1.02) was observed, suggesting that veteran and nonveteran men show meaningful and substantive differences in their risk profiles-differences that should be considered when planning and implementing suicide prevention and intervention efforts. The conspicuous role of physical health problems among veterans who die by suicide is discussed. The article concludes with specific practice recommendations for social workers.
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Affiliation(s)
- David S Wood
- School of Social Work, Brigham Young University, 2190 JFSB, Provo, UT 84602
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Johnson CC, Phillips KM, Miller SN. Suicidal Ideation among Veterans Living with Cancer Referred to Mental Health. Clin Gerontol 2020; 43:24-36. [PMID: 31680645 DOI: 10.1080/07317115.2019.1686719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objectives: Eliminating Veteran suicide is a top priority for the Department of Veterans' Affairs (VA). This study identified factors associated with suicidal ideation (SI) among a rarely studied subgroup of Veterans: those with cancer.Methods: Veterans (age M = 61.83) with cancer (N= 175) referred for psychological evaluation completed measures of pain, sleep, depressive, anxiety, and PTSD symptoms. SI was defined by endorsing on paper-and-pencil questionnaire thoughts of killing oneself in the past 2 weeks or during clinical interview.Results: 25.1% reported SI. Compared to those without SI, Veterans with SI had higher ratings on measures of depression, anxiety, and PTSD symptoms. History of suicide attempt(s) was included in the model due to clinical significance. Logistic regression was performed with these variables as predictors of SI. The omnibus model was significant (p< .001). However, only anhedonia and depressed mood had a statistically significant contribution to the model (β = 0.540, p= .001).Conclusions: Anhedonia and depressed mood predicted SI among Veterans with cancer above and beyond other risk factors.Clinical Implications: This study's findings highlight the importance of incorporating suicide risk screenings in oncology clinics across VA medical centers.
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Affiliation(s)
- Candice C Johnson
- Mental Health and Behavioral Sciences, C. W. Bill Young Veterans Affairs Healthcare System, Bay Pines, Florida, USA
| | - Kristin M Phillips
- Mental Health and Behavior Sciences, James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Stephanie N Miller
- Mental Health and Behavior Sciences, James A. Haley Veterans' Hospital, Tampa, Florida, USA
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Byeon H. Relationship between Physical Activity Level and Depression of Elderly People Living Alone. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16204051. [PMID: 31652619 PMCID: PMC6843978 DOI: 10.3390/ijerph16204051] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 11/16/2022]
Abstract
Background and objectives: Only a few studies analyzed the physical activity level of elderly people living alone in local communities and evaluated the relationship between it and mental health. The purpose of this study was to investigate the relationship between regular physical activity and depression in the elderly living alone and to provide basic data for the prevention of depression in the elderly. Materials and Methods: We analyzed 256 elderly people living alone aged 65 years or older who completed the 2014 Korea National Health and Nutrition Examination Survey. Depression was defined as a score of 10 or higher using Patient Health Questionnaire-9 (PHQ-9). This study investigated walking per week, days of muscular strength exercise performance in the past 1 week, days of flexibility exercise in the past 1 week, mean hours in a sitting position per day, the numbers of days and hours conducting a high intensity physical activity in the past 1 week, and numbers of days and hours conducting a medium intensity physical activity in the past 1 week to define physical activity. Our study presented prevalence odds ratios (pOR) and 95% confidence interval (CI) by using complex sample logistic regression analysis in order to identify the relationship between physical activity and depression. Results: The results of complex sample logistic regression analysis showed that flexibility exercise was significantly related to depression (p < 0.05). On the other hand, the mean hours in a sitting position per day, aerobic physical activity, walking, and muscular strength exercise were not significantly related to geriatric depression. Conclusions: The results of our study implied that persistent flexibility exercise might be more effective to maintain a healthy mental status than muscular strength exercise. A longitudinal study is required to prove the causal relationship between physical activity and depression in the old age.
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Affiliation(s)
- Haewon Byeon
- Department of Speech Language Pathology, School of Public Health, Honam University, 417, Eodeung-daero, Gwangsan-gu, Gwangju 62399, Korea.
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Kaplan MS, Mueller-Williams AC. The Hidden Epidemic of Firearm Suicide in the United States: Challenges and Opportunities. HEALTH & SOCIAL WORK 2019; 44:276-279. [PMID: 31651029 DOI: 10.1093/hsw/hlz029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/06/2019] [Indexed: 06/10/2023]
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Leung C, Kaplan MS, Xuan Z. The Association between Firearm Control Policies and Firearm Suicide among Men: A State-Level Age-Stratified Analysis. HEALTH & SOCIAL WORK 2019; 44:249-258. [PMID: 31665312 DOI: 10.1093/hsw/hlz028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/22/2019] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Abstract
This study examined the association between state-specific firearm control policies and firearm suicide rates among men after adjusting for state-level demographics. This cross-sectional study used state-level mortality data from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System and the Brady Campaign State Scorecard in 2017. An age-stratified (15-24 years, 25-44 years, 45-64 years, and ≥ 65 years) multivariable analysis was conducted to identify gun control policies that are associated with firearm suicide rates among men in each age group. Results indicate that the associations of specific firearm control policies and firearm suicide rates differ across the age span. In particular, more policies (for example, dealer regulations and waiting periods) are negatively associated with firearm suicide rate among men 15 to 24 years of age. The findings underscore the importance of designing gender- and age-specific policy advocacy programs directed at lowering the rate of firearm suicide. This study also suggests that California, known for its innovative gun safety legislation efforts, could serve as a model for other states starting preventive programs to reduce the firearm suicide rate. Implications of the findings for social work practice are discussed.
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Steelesmith DL, Fontanella CA, Campo JV, Bridge JA, Warren KL, Root ED. Contextual Factors Associated With County-Level Suicide Rates in the United States, 1999 to 2016. JAMA Netw Open 2019; 2:e1910936. [PMID: 31490540 PMCID: PMC6735416 DOI: 10.1001/jamanetworkopen.2019.10936] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE Understanding geographic and community-level factors associated with suicide can inform targeted suicide prevention efforts. OBJECTIVES To estimate suicide rates and trajectories, assess associated county-level contextual factors, and explore variation across the rural-urban continuum. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included all individuals aged 25 to 64 years who died by suicide from January 1, 1999, to December 31, 2016, in the United States. Spatial analysis was used to map excess risk of suicide, and longitudinal random-effects models using negative binomial regression tested associations of contextual variables with suicide rates as well as interactions among county-level contextual variables. Data analyses were conducted between January 2019 and July 2019. EXPOSURE County of residence. MAIN OUTCOMES AND MEASURES Three-year county suicide rates during an 18-year period stratified by rural-urban location. RESULTS Between 1999 and 2016, 453 577 individuals aged 25 to 64 years died by suicide in the United States. Decedents were primarily male (349 082 [77.0%]) with 101 312 (22.3%) aged 25 to 34 years, 120 157 (26.5%) aged 35 to 44 years, 136 377 (30.1%) aged 45 to 54 years, and 95 771 (21.1%) aged 55 to 64 years. Suicide rates were higher and increased more rapidly in rural than in large metropolitan counties. The highest deprivation quartile was associated with higher suicide rates compared with the lowest deprivation quartile, especially in rural areas, although this association declined during the period studied (rural, 1999-2001: incidence rate ratio [IRR], 1.438; 95% CI, 1.319-1.568; P < .001; large metropolitan, 1999-2001: 1.208; 95% CI, 1.149-1.270; P < .001; rural, 2014-2016: IRR, 1.121; 95% CI, 1.032-1.219; P = .01; large metropolitan, 2014-2016: IRR, 0.942; 95% CI, 0.887-1.001; P = .06). The presence of more gun shops was associated with an increase in county-level suicide rates in all county types except the most rural (rural: IRR, 1.001; 95% CI, 0.999-1.004; P = .40; micropolitan: IRR, 1.005; 95% CI, 1.002-1.007; P < .001; small metropolitan: IRR, 1.010; 95% CI, 1.006-1.014; P < .001; large metropolitan: IRR, 1.012; 95% CI, 1.006-1.018; P < .001). High social capital was associated with lower suicide rates than low social capital (IRR, 0.917; 95% CI, 0.891-0.943; P < .001). High social fragmentation, an increasing percentage of the population without health insurance, and an increasing percentage of veterans in a county were associated with higher suicide rates (high social fragmentation: IRR, 1.077; 95% CI, 1.050-1.103; P < .001; percentage of population without health insurance: IRR, 1.005; 95% CI, 1.004-1.006; P < .001; percentage of veterans: IRR, 1.025; 95% CI, 1.021-1.028; P < .001). CONCLUSIONS AND RELEVANCE This study found that suicide rates have increased across the nation and most rapidly in rural counties, which may be more sensitive to the impact of social deprivation than more metropolitan counties. Improving social connectedness, civic opportunities, and health insurance coverage as well as limiting access to lethal means have the potential to reduce suicide rates across the rural-urban continuum.
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Affiliation(s)
- Danielle L. Steelesmith
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
| | - Cynthia A. Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
| | - John V. Campo
- Rockefeller Neuroscience Institute, Behavioral Medicine and Psychiatry, West Virginia University, Morgantown
| | - Jeffrey A. Bridge
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
- Departments of Pediatrics, Psychiatry, and Behavioral Health, The Ohio State University, Columbus
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Thompson JM, Heber A, VanTil L, Simkus K, Carrese L, Sareen J, Pedlar D. Life course well-being framework for suicide prevention in Canadian Armed Forces Veterans. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2019. [DOI: 10.3138/jmvfh.2018-0020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: The risks of suicidality (suicidal ideation or behaviour) are higher in Canadian Armed Forces (CAF) Veterans (former members) than in the Canadian general population (CGP). Suicide prevention is everyone’s responsibility, but it can be difficult for many to see how they can help. This article proposes an evidence-based theoretical framework for discussing suicide prevention. The framework informed the 2017 joint CAF – Veterans Affairs Canada (VAC) suicide prevention strategy. Methods: Evidence for the framework was derived from participation in expert panels conducted by the CAF in 2009 and 2016, a review of findings from epidemiological studies of suicidality in CAF Veterans released since 1976, suicide prevention literature reviews conducted at VAC since 2009, and published theories of suicide. Results: Common to all suicide theories is the understanding that suicide causation is multifactorial, complex, and varies individually such that factors interact rather than lie along linear causal chains. Discussion: The proposed framework has three core concepts: a composite well-being framework, the life course view, and opportunities for prevention along the suicide pathway from ideation to behaviour. Evidence indicates that Veterans are influenced onto, along, and off the pathway by variable combinations of mental illness, stressful well-being problems and life events, individual factors including suicidal diathesis vulnerability, barriers to well-being supports, acquired lethal capability, imitation, impulsivity, and access to lethal means. The proposed framework can inform discussions about both whole-community participation in prevention, intervention and postvention activities at the individual and population levels, and the development of hypotheses for the increased risk of suicidality in CAF Veterans.
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Affiliation(s)
- James M. Thompson
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
- Queen’s University, Kingston, Ontario, Canada
| | - Alexandra Heber
- Veterans Affairs Canada, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Linda VanTil
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | | | - Lina Carrese
- Veterans Affairs Canada, Montreal, Quebec, Canada
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Sabic H, Kious B, Boxer D, Fitzgerald C, Riley C, Scholl L, McGlade E, Yurgelun-Todd D, Renshaw PF, Kondo DG. Effect of Altitude on Veteran Suicide Rates. High Alt Med Biol 2019; 20:171-177. [PMID: 31045435 PMCID: PMC6602111 DOI: 10.1089/ham.2018.0130] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/15/2019] [Indexed: 11/12/2022] Open
Abstract
Aims: Suicide rates in the general population in the United States are correlated with altitude. To explore factors contributing to suicide among military veterans, we examined the relationship between veteran state-level suicide rates and altitude for 2014, including firearm-related and nonfirearm-related rates. Methods: Pearson's coefficients were calculated for altitude and each outcome. Mixed linear models were used to determine the association between suicide and altitude while adjusting for demographic confounds. Results: State mean altitude was significantly correlated with total veteran suicide rate (r = 0.678, p < 0.0001), veteran firearm-related suicide rate (r = 0.578, p < 0.0001), and veteran nonfirearm suicide rate (r = 0.609, p < 0.0001). In mixed models, altitude was significantly correlated with total veteran suicide rate (β = 0.331, p < 0.05), veteran firearm suicides (β = 0.282, p < 0.05), and veteran nonfirearm suicides (β = 0.393, p < 0.05). Conclusion: This study adds to evidence linking altitude and suicide rates, arguing for additional research into the relationship between altitude and suicide among veterans.
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Affiliation(s)
- Hana Sabic
- Brain Institute, University of Utah, Salt Lake City, Utah
| | - Brent Kious
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
| | - Danielle Boxer
- Brain Institute, University of Utah, Salt Lake City, Utah
| | | | - Colin Riley
- Brain Institute, University of Utah, Salt Lake City, Utah
| | - Lindsay Scholl
- Brain Institute, University of Utah, Salt Lake City, Utah
| | - Erin McGlade
- Brain Institute, University of Utah, Salt Lake City, Utah
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
- Veterans Integrated Service Network 19 Mental Illness Research Education Clinical, Centers of Excellence, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Deborah Yurgelun-Todd
- Brain Institute, University of Utah, Salt Lake City, Utah
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
- Veterans Integrated Service Network 19 Mental Illness Research Education Clinical, Centers of Excellence, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Perry F. Renshaw
- Brain Institute, University of Utah, Salt Lake City, Utah
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
- Veterans Integrated Service Network 19 Mental Illness Research Education Clinical, Centers of Excellence, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Douglas G. Kondo
- Brain Institute, University of Utah, Salt Lake City, Utah
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
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Abstract
In the next few years, the youngest of the baby boomers will reach age 65, resulting in the greatest proportion of elderly adults in US history. Concurrent with this demographic change is the growing number of adults living with chronic conditions that increase risk of vascular disease, including hypertension, obesity, hypercholesterolemia, insulin resistance and diabetes mellitus. We address how these conditions contribute to age-related cerebrovascular changes and lead to subsequent effects on mood and cognitive function, with an emphasis on the role of “vascular depression” as a focus of treatment. The case of an elderly gentleman with vascular disease associated with psychiatric symptoms and cognitive changes is presented. We discuss vascular depression in the context of suicide in late life and provide perspectives on treatment that focus not merely on pharmacologic and psychotherapeutic management of depressive symptoms but also emphasize the importance of sleep and health maintenance strategies. Guidelines are offered to help reduce the burden of disability associated with this condition among our older population.
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Affiliation(s)
- Warren D Taylor
- From the Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tenn.; the Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville; the Center of Innovation on Disability and Rehabilitation Research, VA Health Services Research and Development Service, James A. Haley Veterans Hospital, Tampa, Fla.; the Department of Psychiatry and Behavioral Sciences and the Department of Psychology, University of South Florida, Tampa; and the Department of Psychiatry, University of Connecticut Health Center, Farmington
| | - Susan K Schultz
- From the Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tenn.; the Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville; the Center of Innovation on Disability and Rehabilitation Research, VA Health Services Research and Development Service, James A. Haley Veterans Hospital, Tampa, Fla.; the Department of Psychiatry and Behavioral Sciences and the Department of Psychology, University of South Florida, Tampa; and the Department of Psychiatry, University of Connecticut Health Center, Farmington
| | - Vanessa Panaite
- From the Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tenn.; the Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville; the Center of Innovation on Disability and Rehabilitation Research, VA Health Services Research and Development Service, James A. Haley Veterans Hospital, Tampa, Fla.; the Department of Psychiatry and Behavioral Sciences and the Department of Psychology, University of South Florida, Tampa; and the Department of Psychiatry, University of Connecticut Health Center, Farmington
| | - David C Steffens
- From the Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tenn.; the Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville; the Center of Innovation on Disability and Rehabilitation Research, VA Health Services Research and Development Service, James A. Haley Veterans Hospital, Tampa, Fla.; the Department of Psychiatry and Behavioral Sciences and the Department of Psychology, University of South Florida, Tampa; and the Department of Psychiatry, University of Connecticut Health Center, Farmington
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Brown LA, Gallagher T, Petersen J, Benhamou K, Foa EB, Asnaani A. Does CBT for anxiety-related disorders alter suicidal ideation? Findings from a naturalistic sample. J Anxiety Disord 2018; 59:10-16. [PMID: 30107264 DOI: 10.1016/j.janxdis.2018.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 07/20/2018] [Accepted: 08/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Anxiety disorders commonly co-occur with suicidal ideation (SI). To our knowledge, no studies have reported on the baseline prevalence of SI and the reduction in SI in a naturalistic sample receiving cognitive behavior therapy (CBT) for anxiety-related disorders. METHODS Participants (n = 355) recruited from an anxiety specialty clinic reported SI at pre-, mid-, and post-CBT. Multilevel mixed effects logistic regression models compared differences in SI endorsement over Time. RESULTS Posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD) were associated with significantly elevated baseline SI relative to specific phobia. PTSD and unspecified anxiety-related disorders were associated with significant reductions in SI, whereas reductions in SAD, GAD, OCD, and panic disorder did not reach significance. Rates of new onset and exacerbation of SI were low. DISCUSSION CBT for anxiety disorders was associated with significant reductions in SI over time, with no evidence for exacerbation of suicide risk. Clinical implications are discussed, as well as future research directions to further understand the effect of anxiety disorder treatments on SI.
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Affiliation(s)
- Lily A Brown
- University of Pennsylvania, Center for the Treatment and Study of Anxiety, Department of Psychiatry, 3535 Market Street Suite 600 N, Philadelphia, PA 19104, USA.
| | - Thea Gallagher
- University of Pennsylvania, Center for the Treatment and Study of Anxiety, Department of Psychiatry, 3535 Market Street Suite 600 N, Philadelphia, PA 19104, USA
| | - Julie Petersen
- University of Pennsylvania, Center for the Treatment and Study of Anxiety, Department of Psychiatry, 3535 Market Street Suite 600 N, Philadelphia, PA 19104, USA
| | - Kathy Benhamou
- University of Pennsylvania, Center for the Treatment and Study of Anxiety, Department of Psychiatry, 3535 Market Street Suite 600 N, Philadelphia, PA 19104, USA
| | - Edna B Foa
- University of Pennsylvania, Center for the Treatment and Study of Anxiety, Department of Psychiatry, 3535 Market Street Suite 600 N, Philadelphia, PA 19104, USA
| | - Anu Asnaani
- University of Pennsylvania, Center for the Treatment and Study of Anxiety, Department of Psychiatry, 3535 Market Street Suite 600 N, Philadelphia, PA 19104, USA.
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Ames D, Erickson Z, Youssef NA, Arnold I, Adamson CS, Sones AC, Yin J, Haynes K, Volk F, Teng EJ, Oliver JP, Koenig HG. Moral Injury, Religiosity, and Suicide Risk in U.S. Veterans and Active Duty Military with PTSD Symptoms. Mil Med 2018; 184:e271-e278. [DOI: 10.1093/milmed/usy148] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/21/2018] [Accepted: 05/25/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Donna Ames
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA
- University of California – Los Angeles, 760 Westwood Plaza, Los Angeles, CA
- Duke University Medical Center, 2301 Erwin Rd, Durham, NC
| | - Zachary Erickson
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA
| | - Nagy A Youssef
- Medical College of Georgia at Augusta University, and Charlie Norwood VA Medical Center, Augusta, Georgia
| | - Irina Arnold
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA
| | | | - Alexander C Sones
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA
- University of California – Los Angeles, 760 Westwood Plaza, Los Angeles, CA
| | - Justin Yin
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA
- University of California – Los Angeles, 760 Westwood Plaza, Los Angeles, CA
| | - Kerry Haynes
- South Texas Veterans Healthcare System, San Antonio, TX
| | - Fred Volk
- Department of Counselor Education and Family Studies, School of Behavioral Sciences, Liberty University, Lynchburg, Virginia
| | - Ellen J Teng
- Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX
| | - John P Oliver
- Durham Veterans Affairs Health Care System, Durham, NC
| | - Harold G Koenig
- Duke University Medical Center, 2301 Erwin Rd, Durham, NC
- Durham Veterans Affairs Health Care System, Durham, NC
- King Abdulaziz University, Jeddah, Saudi Arabia
- Ningxia Medical University, 692 Shengli St, Xingqing Qu, Yinchuan Shi, Ningxia Huizuzizhiqu, China
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Stanley IH, Buchman-Schmitt JM, Chu C, Rogers ML, Gai AR, Wagner RK, Gutierrez PM, Joiner TE. The Military Suicide Research Consortium Common Data Elements: An Examination of Measurement Invariance Across Current Service Members and Veterans. Assessment 2018; 26:963-975. [DOI: 10.1177/1073191118777635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Suicide rates within the U.S. military are elevated, necessitating greater efforts to identify those at increased risk. This study utilized a multigroup confirmatory factor analysis to examine measurement invariance of the Military Suicide Research Consortium Common Data Elements (CDEs) across current service members ( n = 2,015), younger veterans (<35 years; n = 377), and older veterans (≥35 years; n = 1,001). Strong factorial invariance was supported with adequate model fit observed for current service members, younger veterans, and older veterans. The structures of all models were generally comparable with few exceptions. The Military Suicide Research Consortium CDEs demonstrate at least adequate model fit for current military service members and veterans, regardless of age. Thus, the CDEs can be validly used across military and veteran populations. Given similar latent structures, research findings in one group may inform clinical and policy decision making for the other.
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Affiliation(s)
| | | | - Carol Chu
- Florida State University, Tallahassee, FL, USA
| | | | - Anna R. Gai
- Florida State University, Tallahassee, FL, USA
| | | | - Peter M. Gutierrez
- University of Colorado School of Medicine, Denver, CO, USA
- Denver Veterans Affairs Medical Center, Denver, CO, USA
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39
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Lemle RB. Choice Program Expansion Jeopardizes High-Quality VHA Mental Health Services. Fed Pract 2018; 35:18-24. [PMID: 30766345 PMCID: PMC6368051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Russell B Lemle
- is the VA-Community Care Workgroup Lead for the Association of VA Psychologist Leaders
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40
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Paniagua FA, Black SA, Gallaway MS. Psychometrics of Behavioral Health Screening Scales in Military Contexts. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Freddy A. Paniagua
- Behavioral and Social Health Outcomes Program, United States Army Public Health Command, Aberdeen Proving Ground, Maryland
| | - Sandra A. Black
- Behavioral and Social Health Outcomes Program, United States Army Public Health Command, Aberdeen Proving Ground, Maryland
| | - M. Shayne Gallaway
- Behavioral and Social Health Outcomes Program, United States Army Public Health Command, Aberdeen Proving Ground, Maryland
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41
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Khazem LR, Houtsma C, Gratz KL, Tull MT, Green BA, Anestis MD. Firearms Matter: The Moderating Role of Firearm Storage in the Association Between Current Suicidal Ideation and Likelihood of Future Suicide Attempts Among United States Military Personnel. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000099] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Claire Houtsma
- Department of Psychology, University of Southern Mississippi
| | - Kim L. Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | - Matthew T. Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
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Rasmussen KA, King DA, Gould MS, Cross W, Tang W, Kaukeinen K, Tu X, Knox KL. Concerns of Older Veteran Callers to the Veterans Crisis Line. Suicide Life Threat Behav 2017; 47:387-397. [PMID: 27935103 DOI: 10.1111/sltb.12313] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 05/14/2016] [Indexed: 11/28/2022]
Abstract
When the Veterans Crisis Line (VCL) was implemented, it was uncertain if veterans, and particularly older male veterans, would utilize the service. We examined VCL use by a growing group of veterans at increased risk for suicide: those aged 60 and older. Real-time clinical data were gathered from a weekly random sampling of calls. Approximately 25% of calls were from veterans aged 60 or older; over 80% reported benefit from the call. Several significant differences in presenting concerns between older and younger callers were found. Targeted outreach to encourage older veterans to use the VCL is suggested.
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Affiliation(s)
- Kathy A Rasmussen
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Deborah A King
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Madelyn S Gould
- Division of Child and Adolescent Psychiatry, Department of Epidemiology, Columbia University, New York, NY, USA.,New York State Psychiatric Institute, New York, NY, USA
| | - Wendi Cross
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Wan Tang
- Department of Biostatistics, University of Rochester Medical Center, Rochester, NY, USA
| | - Kimberly Kaukeinen
- Department of Biostatistics, University of Rochester Medical Center, Rochester, NY, USA
| | - Xin Tu
- Department of Biostatistics, University of Rochester Medical Center, Rochester, NY, USA
| | - Kerry L Knox
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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Factors associated with suicide among adolescents and young adults not in mental health treatment at time of death. J Trauma Acute Care Surg 2017; 81:S25-9. [PMID: 27488480 DOI: 10.1097/ta.0000000000001175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Suicide is the third-leading cause of death among Illinois residents aged 15 to 24 years. The Illinois Violent Death Reporting System (IVDRS) was developed to help prevent these deaths by providing timely, complete data. Understanding the circumstances surrounding suicide for those aged 15 to 24 years who are not receiving mental health treatment can help others: (1) recognize signs of potential crisis and (2) connect them to mental health treatment. METHODS The IVDRS data were collected from five Illinois counties-Cook, DuPage, Kane, McHenry, and Peoria-from 2005 to 2010. All cases with the manner suicide, aged 15 to 24 years, were extracted for analysis. Data were described using frequencies and percentages, and statistical differences between groups were determined using χ analysis. RESULTS There were a total of 386 suicides in those aged 15 to 24 years in IVDRS from 2005 to 2010. Most 15- to 19-year-olds (67%) and 20- to 24-year-olds (78%) were not receiving mental health treatment at the time of death. Among those not receiving mental health treatment, 22% and 13% of those aged 15 to 19 and 20 to 24 years, respectively, had disclosed their intent to commit suicide to another. One third were identified as being depressed or in a depressed mood (not necessarily a clinical diagnosis) in both age groups. One quarter in both age groups experienced a crisis (current, acute precipitating, or forthcoming event) within 2 weeks of their suicides. CONCLUSIONS The majority of adolescents and young adults were not in mental health treatment at the time death. Among those not in mental health treatment at the time of death, the 15- to 19-year-olds were more likely to share their suicidal intentions than the 20- to 24-year-olds. LEVEL OF EVIDENCE Epidemiological study, level IV.
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Crosby AE, Mercy JA, Houry D. The National Violent Death Reporting System: Past, Present, and Future. Am J Prev Med 2016; 51:S169-S172. [PMID: 27745605 PMCID: PMC5569389 DOI: 10.1016/j.amepre.2016.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/06/2016] [Accepted: 07/27/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Alex E Crosby
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - James A Mercy
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Debra Houry
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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45
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Population mental health among U.S. military veterans: results of the Veterans Health Module of the Behavioral Risk Factor Surveillance System, 2011–2012. Ann Epidemiol 2016; 26:592-596. [DOI: 10.1016/j.annepidem.2016.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/14/2016] [Accepted: 06/16/2016] [Indexed: 11/21/2022]
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Male suspected suicide decedents in Utah: A comparison of Veterans and nonveterans. Compr Psychiatry 2016; 69:1-10. [PMID: 27423339 DOI: 10.1016/j.comppsych.2016.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 04/11/2016] [Accepted: 04/23/2016] [Indexed: 12/29/2022] Open
Abstract
UNLABELLED There has been significant debate regarding suicide risk in Veterans compared to nonveterans. However, few studies have examined similarities and differences between Veteran and nonveteran suicide decedents using a combination of next of kin psychological autopsy and data from a state Office of the Medical Examiner (OME). For the current study, next of kin of a one-year cohort of male suspected suicide decedents in Utah completed psychological autopsy interviews with trained research staff. Next of kin of 70 Veterans and 356 nonveterans completed the interviews, which included demographic, behavioral, psychosocial, and clinical variables. The psychological autopsy data then were combined with OME data for the presented analyses. Results showed that Veteran and nonveteran suicide decedents differed on multiple factors, including age at death. Specifically, male nonveteran suicide decedents were younger at age of death compared to Utah Veterans and to a national sample. Veteran decedents also were more likely to have a history of suicide attempts and more likely to have access to firearms compared to nonveterans. Other between-group differences, including Veterans being more likely to have lived alone and method of death (e.g., gunshot, hanging, etc.), were no longer statistically significant after adjustment for age at death. CONCLUSIONS these findings have significant clinical and practical importance, as they highlight the risk for suicide in younger nonveterans and older Veterans in Utah.
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47
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Karmakar C, Luo W, Tran T, Berk M, Venkatesh S. Predicting Risk of Suicide Attempt Using History of Physical Illnesses From Electronic Medical Records. JMIR Ment Health 2016; 3:e19. [PMID: 27400764 PMCID: PMC4960407 DOI: 10.2196/mental.5475] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/23/2016] [Accepted: 02/26/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Although physical illnesses, routinely documented in electronic medical records (EMR), have been found to be a contributing factor to suicides, no automated systems use this information to predict suicide risk. OBJECTIVE The aim of this study is to quantify the impact of physical illnesses on suicide risk, and develop a predictive model that captures this relationship using EMR data. METHODS We used history of physical illnesses (except chapter V: Mental and behavioral disorders) from EMR data over different time-periods to build a lookup table that contains the probability of suicide risk for each chapter of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes. The lookup table was then used to predict the probability of suicide risk for any new assessment. Based on the different lengths of history of physical illnesses, we developed six different models to predict suicide risk. We tested the performance of developed models to predict 90-day risk using historical data over differing time-periods ranging from 3 to 48 months. A total of 16,858 assessments from 7399 mental health patients with at least one risk assessment was used for the validation of the developed model. The performance was measured using area under the receiver operating characteristic curve (AUC). RESULTS The best predictive results were derived (AUC=0.71) using combined data across all time-periods, which significantly outperformed the clinical baseline derived from routine risk assessment (AUC=0.56). The proposed approach thus shows potential to be incorporated in the broader risk assessment processes used by clinicians. CONCLUSIONS This study provides a novel approach to exploit the history of physical illnesses extracted from EMR (ICD-10 codes without chapter V-mental and behavioral disorders) to predict suicide risk, and this model outperforms existing clinical assessments of suicide risk.
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Affiliation(s)
- Chandan Karmakar
- Centre for Pattern Recognition and Data Analytics, Deakin University, Geelong, Australia.
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48
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Improving Treatment Engagement for Returning Operation Enduring Freedom and Operation Iraqi Freedom Veterans With Posttraumatic Stress Disorder, Depression, and Suicidal Ideation. J Nerv Ment Dis 2016; 204:339-43. [PMID: 26894313 PMCID: PMC4833550 DOI: 10.1097/nmd.0000000000000489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with increased risk of suicidal ideation among veterans of Operation Enduring Freedom and Operation Iraqi Freedom. This report examined the effectiveness of a brief phone-based cognitive-behavioral intervention on treatment seeking among suicidal and nonsuicidal Operation Enduring Freedom and Operation Iraqi Freedom veterans who screened positive for PTSD. Participants were randomized to the intervention or control conditions. We found that suicidal participants, regardless of condition, were twice as likely to attend treatment as nonsuicidal participants. Participants assigned to the control condition who did not indicate suicidality at baseline were less likely to attend treatment at both the 1- and 6-month follow-up interviews. Qualitative findings of the suicidal participants indicated PTSD and depressive symptoms, low social support, and infrequent positive coping mechanisms. Our finding indicates the effectiveness of an intervention to motivate veterans with PTSD to initiate and remain in treatment. The intervention might be particularly useful prior to experiencing a psychological crisis.
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Comiford AL, Sanderson WT, Chesnut L, Brown S. Predictors of intimate partner problem-related suicides among suicide decedents in Kentucky. J Inj Violence Res 2016; 8:81-7. [PMID: 27092956 PMCID: PMC4967366 DOI: 10.5249/jivr.v8i2.776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 03/17/2016] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Suicide is the 10th leading cause of death in the United States. Furthermore, intimate partner problems are amid the top precipitating circumstances among suicide decedents. The aim of this study was to determine circumstantial associations of intimate partner problem-related suicides in suicide decedents in Kentucky. METHODS All suicides that were reported to the Kentucky Violent Death Reporting System between 2005 and 2012 were eligible for this study. Multiple logistic regression was used to explore predictors (precipitating health-related problems, life stressors, and criminal/legal issues) of intimate partner problem-related suicides. RESULTS Of the 4,754 suicides, included in this study, approximately 17% had intimate partner problems prior to suicide. In the adjusted analysis, mental health issues, alcohol problems, history of suicides attempts, suicides precipitated by another crime, and other legal problems increased the odds of having an intimate partner-related suicide. However, having physical health problems, prior to the suicide, decreased the odds of intimate partner-related suicide. CONCLUSIONS These results provide insight for the development of suicide interventions for individuals with intimate partner problems by targeting risk factors that are prevalent among this population. Moreover, these results may help marriage/relationship and/or family/divorce court representatives identify individuals with intimate partner problems more at risk for suicide and alleviate the influence these suicide risk factors have on individuals experiencing Intimate partner problems.
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Kaskie BP, Leung C, Kaplan MS. Deploying an Ecological Model to Stem the Rising Tide of Firearm Suicide in Older Age. J Aging Soc Policy 2016; 28:233-45. [DOI: 10.1080/08959420.2016.1167512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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