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Akinyemi O, Ogundare T, Weldeslase T, Andine T, Fasokun M, Odusanya E, Hughes K, Mallory W, Luo G, Cornwell E. The association between community-level economic deprivation and incidences of emergency department visits on account of attempted suicides in Maryland. Front Public Health 2024; 12:1353283. [PMID: 38384877 PMCID: PMC10879598 DOI: 10.3389/fpubh.2024.1353283] [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: 12/10/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024] Open
Abstract
Background Suicide is a major cause of mortality in the United States, accounting for 14.5 deaths per 100,000 population. Many emergency department (ED) visits in the United States are due to attempted suicides. Suicide attempts predict subsequent completed suicides. Socioeconomic factors, such as community-level socioeconomic deprivation, significantly affect many traditional risk factors for attempted suicides and suicides. Aim To determine the association between community-level socioeconomic deprivation and ED visits for attempted suicide in Maryland. Methods A retrospective analysis of attempted suicides in the Maryland State Emergency Department Database from January 2018 to December 2020. Community-level socioeconomic deprivation was measured using the Distress Community Index (DCI). Multivariate regression analyses were conducted to identify the association between DCI and attempted suicides/self-harm. Results There were 3,564,987 ED visits reported in the study period, with DCI data available for 3,236,568 ED visits; 86.8% were younger than 45 years, 64.8% were females, and 54.6% non-Hispanic Whites. Over the study period, the proportion of ED visits due to attempted suicide was 0.3%. In the multivariate logistic regression, compared to prosperous zones, those in comfortable (OR = 0.80, 95% CI: 0.73-0.88, p < 0.01), Mid-Tier (OR = 0.76, 95%CI:0.67-0.86, p < 0.01), At-Risk (OR = 0.77; 95%CI: 0.65-0.92, p < 0.01) and Distressed zones (OR = 0.53; 95% CI:0.42-0.66, p < 0.01) were less likely to visit the ED for attempted suicide. Conclusion Prosperous communities had the highest rate of attempted suicides, with the risk of attempted suicide increasing as individuals move from the least prosperous to more prosperous areas.
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Affiliation(s)
- Oluwasegun Akinyemi
- Clive O Callender Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Temitope Ogundare
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Terhas Weldeslase
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Tsion Andine
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Mojisola Fasokun
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Eunice Odusanya
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Kakra Hughes
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Williams Mallory
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Guoyang Luo
- Department of Obstetrics and Gynecology, Howard University College of Medicine, Washington, DC, United States
| | - Edward Cornwell
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
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Peterson A, Chen J, Bozzay M, Bender A, Chu C. Suicide risk profiles among service members and veterans exposed to suicide. J Clin Psychol 2024; 80:65-85. [PMID: 37659101 DOI: 10.1002/jclp.23592] [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: 02/01/2023] [Revised: 08/10/2023] [Accepted: 08/24/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVES Rates of suicide exposure are high among service members and Veterans and are especially concerning given the link between suicide exposure and subsequent suicide risk. However, to date, it is unclear which individuals who are exposed to suicide are subsequently at high risk for suicide. Latent profile analysis (LPA) can provide information on unique risk profiles and subgroups of service members and Veterans who have higher suicide risk after suicide exposure, which has not yet been empirically studied. The purpose of this study was to utilize LPA to identify subgroups of service members and Veterans who are at the highest risk for suicidal thoughts and behaviors following suicide exposure. METHODS We analyzed data using LPA from 2570 service members and Veterans (82.1% male, 69.5% White, and 12.1% Latino/a/x) who completed the Military Suicide Research Consortium's Common Data Elements, a battery of self-report suicide-related measures. Psychopathology, substance use, mental health service utilization, interpersonal theory of suicide, and suicide exposure variables were used to validate classes. RESULTS Three latent classes emerged from analyses, one low-risk class and two-high risk classes with differing profile compositions (one primarily differentiated by anxiety symptoms and one differentiated by substance use). CONCLUSION Class-specific recommendations for suicide prevention efforts will be discussed.
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Affiliation(s)
- Amanda Peterson
- Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Jason Chen
- Portland VA Health Care System, Portland, Oregon, USA
| | - Melanie Bozzay
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
| | - Ansley Bender
- Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - Carol Chu
- Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
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Lai K, Jameson JT, Russell DW. Prevalence and correlates of destructive behaviors in the US Naval Surface Forces from 2010-2020. BMC Psychol 2023; 11:103. [PMID: 37029407 PMCID: PMC10080869 DOI: 10.1186/s40359-023-01134-1] [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: 03/05/2022] [Accepted: 03/21/2023] [Indexed: 04/09/2023] Open
Abstract
PURPOSE To estimate the prevalence of domestic violence, sexual assault, and suicide for United States Navy (USN) personnel between 2010 and 2020 and identify potential associated factors. METHODS Official report data were used to calculate prevalence rates and odds ratios, accounting for sample and general USN population demographic data to assess differences in over- or underrepresentation of destructive behaviors. RESULTS Domestic violence and sexual assault offenders tended to be younger lower-ranked males. For sexual assaults, offenders were three times more likely to be senior to the victim, which was not the case for domestic violence. Females were overrepresented in terms of suicidal ideation and attempts relative to the USN population, while males accounted for more actual suicides. The relative rates of suicidal ideation and attempts for females exceeded those for males (i.e., comparing the sample rate against the USN male and female populations), but the sample proportion for completed suicides (compared to the USN population) were greater for males than for females. Those in the junior enlisted (E1-E3) paygrades exhibited greater odds of suicide attempts versus suicidal ideations relative to those in the Petty Officers (E4-E6) paygrades, although E4-E6s completed more suicides. CONCLUSION The descriptive profile of destructive behaviors in a representative sample of USN personnel provides an overview of the possible factors associated with destructive behaviors and includes an exploration of the relational dynamics and nature of the incidents. The results suggest that sexual assault and domestic violence are characterized by unique relational dynamics and that these destructive behaviors should not necessarily be classified together as male-oriented aggressions (i.e., mainly perpetrated by males against female victims). Those in the E1-E3 and E4-E6 paygrades displayed different patterns in suicidal ideation, attempts, and actual suicides. The results highlight individual characteristics to help inform the development of targeted policies, practices, and interventions for military and other hierarchical organizations (e.g., police).
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Affiliation(s)
- Kevin Lai
- Leidos, Naval Health Research Center, 329 Ryne Road, San Diego, CA, 92152, USA
| | - Jason T Jameson
- Leidos, Naval Health Research Center, 329 Ryne Road, San Diego, CA, 92152, USA
| | - Dale W Russell
- Commander, Naval Surface Force, U.S. Pacific Fleet, Coronado, CA, USA.
- Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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Schmied EA, Jun HJ, Glassman LH, Pippard N, Walter KH. Investigating the effects of suicide exposure among a clinical sample of active duty service members. J Trauma Stress 2023; 36:310-324. [PMID: 36728175 DOI: 10.1002/jts.22909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/16/2022] [Accepted: 12/05/2022] [Indexed: 02/03/2023]
Abstract
Suicide exposure warrants further investigation as a risk factor for suicide among military service members. This study aimed to examine associations among suicide exposure, suicidal ideation (SI), and psychological symptoms in a clinical sample of service members (N = 1,565, 64.4% suicide-exposed) and identify how one's relationship with the deceased impacts suicidality and psychological health in exposed individuals. A secondary analysis of cross-sectional survey data was conducted. Generalized linear regression analyses were used to identify associations between suicide exposure and both current SI and psychological symptoms among all participants; the associations between suicide exposure characteristics and psychological symptoms were only examined among exposed individuals. Exposure was not significantly associated with higher SI, β = .007, SE = .16, p = .965, but was associated with PTSD, β = 1.60, SE = 0.49, p = .001; anxiety, β = .68, SE = .31, p = .031; and insomnia symptoms, β = .98, SE = .25, p < .001. Among participants who had been exposed, high/long impact of exposure was positively associated with SI, β = 0.94, SE = .26, p < .001, and psychological symptoms, PTSD: β = 2.32, SE = .77, p = .002; anxiety: β = 1.39, SE = .50, p = .005; insomnia: β = .96, SE = .39, p = .015. Results illustrate the significant issue of suicide exposure within the military and show consideration of suicide exposure as a potential risk factor for adverse psychological outcomes is warranted.
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Affiliation(s)
- Emily A Schmied
- School of Public Health, San Diego State University, San Diego, California, USA.,Institute for Behavioral and Community Health, San Diego State University, San Diego, California, USA
| | - Hee-Jin Jun
- School of Public Health, San Diego State University, San Diego, California, USA.,Institute for Behavioral and Community Health, San Diego State University, San Diego, California, USA
| | - Lisa H Glassman
- Leidos, Inc., San Diego, California, USA.,Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, California, USA.,University of California, San Diego, La Jolla, California, USA
| | - Nicole Pippard
- University of California, San Diego-San Diego State University Joint Doctoral Program, Public Health, University of California, San Diego, California, USA
| | - Kristen H Walter
- School of Public Health, San Diego State University, San Diego, California, USA.,Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, California, USA
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Tanji F, Miyamoto S, Iwasawa A, Ohta H, Ono K. Association Between History of Psychiatric Disorder and Degree of Physical Injury Among Suicide Attempters: Secondary Data Analysis in a Japanese Rural Area. J Prim Care Community Health 2023; 14:21501319231212317. [PMID: 37981733 PMCID: PMC10658764 DOI: 10.1177/21501319231212317] [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: 09/27/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/21/2023] Open
Abstract
INTRODUCTION While there may be differences in the choice of suicide methods between attempters with and those without a history of psychiatric disorders, it is not clear whether these differences predict the actual degree of physical injury. The present study aimed to investigate the association between the history of psychiatric disorder and the degree of physical injury among suicide attempters in a Japanese rural area. METHODS We conducted a cross-sectional study analyzing secondary data of 806 suicide attempters from April 2012 to March 2022 obtained from a Japanese rural city. The exposure variable was a history of psychiatric disorders. The primary outcome was the degree of physical injury of suicide attempters: moderate and severe. We conducted a multivariate Poisson regression analysis to estimate the prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS Among 806 suicide attempters, a significant negative association between the history of psychiatric disorder and the degree of physical injury was observed (PR = 0.40; 95% CI, 0.28-0.59). Those with and without psychiatric disorders were more likely to choose low- and severe-lethality suicide methods such as drug or psychotropic overdoses and hanging or deep wrist injuries, respectively (P < .001). CONCLUSIONS The present study highlights the importance of considering suicide attempters, both with and without psychiatric disorders, while formulating targeted suicide prevention strategies.
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Affiliation(s)
- Fumiya Tanji
- Akita University Graduate School of Health Sciences, Akita, Japan
- Akita University Suicide Prevention Research Center, Akita, Japan
| | - Syohei Miyamoto
- Akita University Suicide Prevention Research Center, Akita, Japan
| | - Atsushi Iwasawa
- Akita University Suicide Prevention Research Center, Akita, Japan
| | - Hidenobu Ohta
- Akita University Graduate School of Health Sciences, Akita, Japan
- Akita University Suicide Prevention Research Center, Akita, Japan
| | - Kyoichi Ono
- Akita University Suicide Prevention Research Center, Akita, Japan
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Liu X, Liu M, Li H, Mo L, Liu X. Transition from Depression to Suicidal Attempt in Young Adults: The Mediation Effect of Self-Esteem and Interpersonal Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14342. [PMID: 36361235 PMCID: PMC9656722 DOI: 10.3390/ijerph192114342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Depression increases the risk of suicide. Depression and suicide attempts are significantly impacted by low self-esteem and interpersonal needs (i.e., thwarted belongingness (TB) and perceived burdensomeness (PB)). More research is required to clarify how these factors affected the change from depression to suicidal attempts, which would dramatically lower the suicide fatality rate. We sought to examine the mediating roles of self-esteem, TB, and PB in Chinese young adults, since previous research shows that self-esteem has a strong relationship with TB, while TB and PB have strong relationships with suicide attempts. METHODS Measures on depression, interpersonal needs, and attempted suicide were completed by a sample of 247 Chinese social media users who had stated suicidal ideation online. RESULTS The findings showed that people who attempted suicide had significantly higher levels of TB and PB. Suicidal attempts were also impacted by depression via the mediational chains, which included self-esteem, TB, and PB. CONCLUSIONS Our findings might contribute to the expansion of the interpersonal theory of suicide and have an impact on effective suicide prevention.
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Affiliation(s)
- Xingyun Liu
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan 430079, China
| | - Miao Liu
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan 430079, China
| | - He Li
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
| | - Liuling Mo
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
| | - Xiaoqian Liu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
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McCutchan PK, Yates BT, Jobes DA, Kerbrat AH, Comtois KA. Costs, benefits, and cost-benefit of Collaborative Assessment and Management of Suicidality versus enhanced treatment as usual. PLoS One 2022; 17:e0262592. [PMID: 35113921 PMCID: PMC8812929 DOI: 10.1371/journal.pone.0262592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 12/30/2021] [Indexed: 11/19/2022] Open
Abstract
Suicide rates have been steadily increasing in both the U.S. general population and military, with significant psychological and economic consequences. The purpose of the current study was to examine the economic costs and cost-benefit of the suicide-focused Collaborative Assessment and Management of Suicidality (CAMS) intervention versus enhanced treatment as usual (ETAU) in an active duty military sample using data from a recent randomized controlled trial of CAMS versus ETAU. The full intent-to-treat sample included 148 participants (mean age 26.8 years ± 5.9 SD years, 80% male, 53% White). Using a micro-costing approach, the cost of each condition was calculated at the individual level from a healthcare system perspective. Benefits were estimated at the individual level as cost savings in past-year healthcare expenditures based on direct care reimbursement rates. Cost-benefit was examined in the form of cost-benefit ratios and net benefit. Total costs, benefits, cost-benefit ratios, and net benefit were calculated and analyzed using general linear mixed modeling on multiply imputed datasets. Results indicated that treatment costs did not differ significantly between conditions; however, CAMS was found to produce significantly greater benefit in the form of decreased healthcare expenditures at 6-month follow-up. CAMS also demonstrated significantly greater cost-benefit ratios (i.e., benefit per dollar spent on treatment) and net-benefit (i.e., total benefit less the cost of treatment) at 12-month follow-up. The current study suggests that beyond its clinical effectiveness, CAMS may also convey potential economic advantages over usual care for the treatment of suicidal active duty service members. Our findings demonstrate cost savings in the form of reduced healthcare expenditures, which theoretically represent resources that can be reallocated toward other healthcare system needs, and thus lend support toward the overall value of CAMS.
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Affiliation(s)
- Phoebe K. McCutchan
- Department of Psychology, American University, Washington, DC, United States of America
| | - Brian T. Yates
- Department of Psychology, American University, Washington, DC, United States of America
| | - David A. Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, United States of America
| | - Amanda H. Kerbrat
- Center for Suicide Prevention and Recovery, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States of America
| | - Katherine Anne Comtois
- Center for Suicide Prevention and Recovery, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States of America
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Vitale A, Byma L, Sun S, Podolak E, Wang Z, Alter S, Galfalvy H, Geraci J, Langhoff E, Klingbeil H, Yehuda R, Haghighi F, Feder A. Effectiveness of Complementary and Integrative Approaches in Promoting Engagement and Overall Wellness Toward Suicide Prevention in Veterans. J Altern Complement Med 2021; 27:S14-S27. [PMID: 33788604 PMCID: PMC8035924 DOI: 10.1089/acm.2020.0245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective: Suicide is a major public health problem, specifically among U.S. veterans, who do not consistently engage in mental health services, often citing stigma as a barrier. Complementary and Integrative Health (CIH) interventions are promising alternatives in promoting patient engagement and further, they may play a critical role in transitioning people into mental health care. Toward this goal, the Resilience and Wellness Center (RWC) was developed to break through the stigma barrier by addressing risk factors of suicide through multimodal CIH interventions via cohort design, promoting social connectedness and accountability among participants. Design: This is a program evaluation study at a large urban VA medical center, where assessments were evaluated from pre- to post-program completion to determine the effectiveness of an intensive multimodal CIH 4-week group outpatient intervention for suicide prevention. Outcome measures: Primary outcomes measured included group connectedness, severity of depression and hopelessness symptoms, suicidal ideation, sleep quality, and diet. Secondary outcomes included measures of post-traumatic stress disorder (PTSD), generalized anxiety severity stress/coping skills, pain, and fatigue. Results: The RWC showed high participant engagement, with an 84%-95% attendance engagement rate depending on suicide risk history. Data from 15 cohorts (N = 126) demonstrate favorable outcomes associated with participation in this comprehensive program, as evidenced by a reduction in suicidal ideation, depression, and hopelessness, but not sleep quality and diet. In addition, in a subset of veterans with a history of suicidal ideation or attempt, significant improvements were noted in pain, PTSD/anxiety symptoms, and stress coping measures. Conclusions: The RWC shows that an intensive complement of CIH interventions is associated with a significant improvement with high veteran engagement. Findings from this program evaluation study can be used to aid health care systems and their providers in determining whether or not to utilize such multimodal CIH integrated interventions as an effective treatment for at-risk populations as a part of suicide prevention efforts.
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Affiliation(s)
| | - Lauren Byma
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Shengnan Sun
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan Podolak
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Zhaoyu Wang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sharon Alter
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Erik Langhoff
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Rachel Yehuda
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fatemeh Haghighi
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ann Feder
- James J. Peters VA Medical Center, Bronx, NY, USA
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9
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Straud CL, Moore BA, Hale WJ, Baker M, Gardner CL, Shinn AM, Cigrang JA, Litz BT, Mintz J, Lara-Ruiz JM, Young-McCaughan S, Peterson AL. Demographic and Occupational Risk Factors Associated With Suicide-Related Aeromedical Evacuation Among Deployed U.S. Military Service Members. Mil Med 2020; 185:e1968-e1976. [PMID: 32776113 PMCID: PMC7980481 DOI: 10.1093/milmed/usaa201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Suicide is a significant problem in the U.S. military, with rates surpassing the U.S. general population as of 2008. Although there have been significant advances regarding suicide risk factors among U.S. military service members and veterans, there is little research about risk factors associated with suicide that could be potentially identified in theater. One salient study group consists of service members who receive a psychiatric aeromedical evacuation out of theater. The primary aims of this study were as follows: (1) determine the incidence of suicide-related aeromedical evacuation in deployed service members, (2) identify demographic and military characteristics associated with suicide-related aeromedical evacuation, and (3) evaluate the relationship between suicide-related aeromedical evacuation from a deployed setting and military separation. MATERIALS AND METHODS This was an archival analysis of U.S. Transportation Command Regulating and Command and Control Evacuation System and Defense Manpower Data Center electronic records of U.S. military service members (N = 7023) who were deployed to Iraq or Afghanistan and received a psychiatric aeromedical evacuation out of theater between 2001 and 2013. χ2 tests of independence and standardized residuals were used to identify cells with observed frequencies and proportions, respectively, that significantly differed from what would be expected by chance. In addition, odds ratios were calculated to provide context about the nature of any significant relationships. RESULTS For every 1000 psychiatric aeromedical evacuations that occurred between 2001 and 2013, 34.4 were suicide related. Gender, ethnicity, branch of service, occupation classification, and deployment theater were associated with suicide-related aeromedical evacuation (odds ratios ranged from 1.37 to 3.02). Overall, 53% of all service members who received an aeromedical evacuation for any psychiatric condition had been separated from the military for a variety of reasons (both voluntary and involuntary) upon record review in 2015. Suicide-related aeromedical evacuation was associated with a 37% increased risk of military separation compared to evacuation for another psychiatric condition (P < 0.02). CONCLUSIONS Findings provide novel information on risk factors associated with suicide-related aeromedical evacuation as well as military separation following a suicide-related aeromedical evacuation. In many cases, the psychiatric aeromedical evacuation of a service member for suicidal ideations and their subsequent separation from active duty is in the best interest of the individual and the military. However, the evacuation and eventual military separation can be costly for the military and the service member. Consequently, the military should focus on indicated prevention interventions for individuals who show sufficient early signs of crisis and functional problems so that specialized interventions can be used in theater to prevent evacuation. Indicated prevention interventions should start with leaders' awareness and mitigation of risk and, when feasible, evidence-based interventions for suicide risk provided by behavioral health (eg, brief cognitive behavioral therapy for suicide). Future research should evaluate the feasibility, safety, and efficacy of delivering suicide-related interventions in theater.
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Affiliation(s)
- Casey L Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX 78229
- Department of Psychology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249
| | - Brian A Moore
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX 78229
| | - Willie J Hale
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX 78229
- Department of Psychology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249
| | - Monty Baker
- Wilford Hall Ambulatory Surgical Center, JBSA-Lackland, 2200 Bergquist Drive, San Antonio, TX 78236
| | - Cubby L Gardner
- Wilford Hall Ambulatory Surgical Center, JBSA-Lackland, 2200 Bergquist Drive, San Antonio, TX 78236
| | - Antoinette M Shinn
- Wilford Hall Ambulatory Surgical Center, JBSA-Lackland, 2200 Bergquist Drive, San Antonio, TX 78236
| | - Jeffrey A Cigrang
- School of Professional Psychology, Wright State University, 3640 Colonel Glenn Hwy, Dayton, OH 45435
| | - Brett T Litz
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, 150 South Huntington Avenue, Jamaica Plain, Boston, MA 02130
- Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Boston, MA 02118
- Department of Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA 02215
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX 78229
| | - Jose M Lara-Ruiz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX 78229
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX 78229
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX 78229
- Department of Psychology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249
- Office of Research and Development, South Texas Veterans Health Care System, 7400 Merton Minter Boulevard, San Antonio, TX 78229
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Wyman PA, Pisani AR, Brown CH, Yates B, Morgan-DeVelder L, Schmeelk-Cone K, Gibbons RD, Caine ED, Petrova M, Neal-Walden T, Linkh DJ, Matteson A, Simonson J, Pflanz SE. Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training: A Cluster Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2022532. [PMID: 33084901 PMCID: PMC7578767 DOI: 10.1001/jamanetworkopen.2020.22532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Suicide has been a leading manner of death for US Air Force personnel in recent years. Universal prevention programs that reduce suicidal thoughts and behaviors in military populations have not been identified. OBJECTIVES To determine whether the Wingman-Connect program for Airmen-in-training reduces suicidal ideation, depression, and occupational problems compared with a stress management program and to test the underlying network health model positing that cohesive, healthy units are protective against suicidal ideation. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized clinical trial was conducted from October 2017 to October 2019 and compared classes of personnel followed up for 6 months. The setting was a US Air Force technical training school, with participants studied to their first base assignment, whether US or international. Participants in 216 classes were randomized, with an 84% retention rate. Data analysis was performed from November 2019 to May 2020. INTERVENTIONS The Wingman-Connect program used group skill building for cohesion, shared purpose, and managing career and personal stressors (3 blocks of 2 hours each). Stress management training covered cognitive and behavioral strategies (2 hours). Both conditions had a 1-hour booster session, plus text messages. MAIN OUTCOMES AND MEASURES The primary outcomes were scores on the suicidal ideation and depression scales of the Computerized Adaptive Test for Mental Health and self-reports of military occupational impairment. Class network protective factors hypothesized to mediate the effect of Wingman-Connect were assessed with 4 measures: cohesion assessed perceptions that classmates cooperate, work well together, and support each other; morale was measured with a single item used in other studies with military samples; healthy class norms assessed perceptions of behaviors supported by classmates; and bonds to classmates were assessed by asking each participant to name classmates whom they respect and would choose to spend time with. RESULTS A total of 215 classes including 1485 individuals (1222 men [82.3%]; mean [SD] age, 20.9 [3.1] years) participated; 748 individuals were enrolled in the Wingman-Connect program and 737 individuals were enrolled in the stress management program. At 1 month, the Wingman-Connect group reported lower suicidal ideation severity (effect size [ES], -0.23; 95% CI, -0.39 to -0.09; P = .001) and depression symptoms (ES, -0.24; 95% CI, -0.41 to -0.08; P = .002) and fewer occupational problems (ES, -0.14; 95% CI, -0.31 to -0.02; P = .02). At 6 months, the Wingman-Connect group reported lower depression symptoms (ES, -0.16; 95% CI, -0.34 to -0.02; P = .03), whereas the difference in suicidal ideation severity was not significant (ES, -0.13; 95% CI, -0.29 to 0.01; P = .06). The number needed to treat to produce 1 fewer participant with elevated depression at either follow-up point was 21. The benefits of the training on occupational problems did not extend past 1 month. The Wingman-Connect program strengthened cohesive, healthy class units, which helped reduce suicidal ideation severity (estimate, -0.035; 95% CI, -0.07 to -0.01; P = .02) and depression symptom scores (estimate, -0.039; 95% CI, -0.07 to -0.01; P = .02) at 1 month. CONCLUSIONS AND RELEVANCE Wingman-Connect is the first universal prevention program to reduce suicidal ideation and depression symptoms in a general Air Force population. Group training that builds cohesive, healthy military units is promising for upstream suicide prevention and may be essential for ecological validity. Extension of the program to the operational Air Force is recommended for maintaining continuity and testing the prevention impact on suicidal behavior. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04067401.
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Affiliation(s)
- Peter A Wyman
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Anthony R Pisani
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bryan Yates
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Lacy Morgan-DeVelder
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Karen Schmeelk-Cone
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Robert D Gibbons
- Department of Medicine, Biological Sciences, The University of Chicago, Chicago, Illinois
- Department of Public Health Sciences, Biological Sciences, The University of Chicago, Chicago, Illinois
| | - Eric D Caine
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Mariya Petrova
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
- Now with Miller School of Medicine, University of Miami, Miami, Florida
| | - Tracy Neal-Walden
- US Air Force Surgeon General's Office, Falls Church, Virginia
- Now with Cohen Veterans Network, Silver Spring, Maryland
| | - David J Linkh
- US Air Force Surgeon General's Office, Falls Church, Virginia
| | | | | | - Steven E Pflanz
- US Air Force Surgeon General's Office, Falls Church, Virginia
- Now with Syracuse Veterans Affairs Medical Center, Syracuse, New York
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Peterson A, Bozzay M, Bender A, Monahan M, Chen J. Those left behind: A scoping review of the effects of suicide exposure on veterans, service members, and military families. DEATH STUDIES 2020; 46:1176-1185. [PMID: 32762420 PMCID: PMC8162890 DOI: 10.1080/07481187.2020.1802628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Veteran and service member suicide remains a significant public health concern. One factor that may impact suicide risk is suicide exposure-knowing someone who has died by suicide or attempted suicide. However, the majority of the extant literature has focused on nonmilitary samples, which may not generalize to military veterans and service members. The current review synthesizes findings regarding suicide exposure in military veterans, service members, their families, and military systems. Our review suggests that the relationship between suicide exposure, suicide risk, and mental health outcomes remains inconsistent. Future research should further explore this important area.
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Affiliation(s)
- Amanda Peterson
- Department of Psychology, College of Arts and Science, University of South Florida, Tampa, Florida, USA
| | - Melanie Bozzay
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Ansley Bender
- Department of Psychology, College of Arts and Science, University of South Florida, Tampa, Florida, USA
| | - Maureen Monahan
- Department of Psychology, College of Arts and Science, University of South Florida, Tampa, Florida, USA
| | - Jason Chen
- HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA
- Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
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12
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Blow AJ, Farero A, Ganoczy D, Walters H, Valenstein M. Intimate Relationships Buffer Suicidality in National Guard Service Members: A Longitudinal Study. Suicide Life Threat Behav 2019; 49:1523-1540. [PMID: 30507054 DOI: 10.1111/sltb.12537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/29/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Members of the U.S. military are at a high suicide risk. While studies have examined predictors of suicide in the U.S. military, more studies are needed which examine protective factors for suicide. Informed by the interpersonal theory of suicide, this study examined the strength of the intimate relationship and its role as a buffer of suicidality in National Guard service members. METHOD A total of 712 National Guard residing in a Midwestern state, who had all recently returned home from a deployment, took part in this study and completed surveys at 6 and 12 months postdeployment. They were assessed on suicide risk, mental health (depression, post-traumatic stress disorder, anxiety), and relationship satisfaction. RESULTS Lower relationship satisfaction and more depressive symptoms at the 6-month assessment were significantly related to greater suicide risk at 12 months. Each interaction between couple satisfaction and three mental health variables (PTSD, depression, and anxiety) at the 6-month assessment was significantly associated with suicide risk at 12 months. CONCLUSIONS The strength of the intimate relationship serves as a buffer for suicide in National Guard service members who have PTSD, anxiety, or depression. Interventions that strengthen these intimate relationships could reduce suicide in service members.
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Affiliation(s)
- Adrian J Blow
- Department of Human Development and Family Studies, Michigan State University, East Lansing, MI, USA
| | - Adam Farero
- Department of Human Development and Family Studies, Michigan State University, East Lansing, MI, USA
| | - Dara Ganoczy
- Veterans Health Administration, Ann Arbor, MI, USA
| | | | - Marcia Valenstein
- Department of Psychiatry University of Michigan and VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI, USA
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13
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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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Pak K, Ferreira KE, Ghahramanlou-Holloway M. Suicide Postvention for the United States Military: Literature Review, Conceptual Model, and Recommendations. Arch Suicide Res 2019; 23:179-202. [PMID: 29393834 DOI: 10.1080/13811118.2018.1428704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Suicide continues to be a significant public health problem in the United States and the Department of Defense (DoD). Timely and systematic postvention efforts can play an instrumental role in helping family members, peers, and military command to best manage the aftermath of a suicide. To date, several postvention efforts have been implemented in the military. However, there continues to be an overall lack of understanding of the specific short- and long-term effects of exposure to military suicide. In addition, more emphasis needs to be placed on empirically driven approaches to postvention and program evaluation. The purpose of this article is threefold: (1) to provide a summary of the postvention literature with special emphasis placed on the military organization; (2) to propose a conceptual model as a framework for understanding Military-Unit Suicide Survivorship; and (3) to briefly highlight postvention strategies within the DoD in the context of a number of research, clinical, and policy recommendations.
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Mahar AL, Cramm H, Aiken AB, Whitehead M, Tien H, Fear NT, Kurdyak P. A retrospective cohort study comparing non-fatal self-harm emergency department visits between Canadian veterans living in Ontario and matched civilians. Int Rev Psychiatry 2019; 31:25-33. [PMID: 30994372 DOI: 10.1080/09540261.2019.1580685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This was a retrospective cohort study linking provincial administrative databases to compare rates of non-fatal self-harm between CAF and RCMP veterans living in Ontario and age-matched civilians. This study included male veterans who registered for provincial health insurance between 2002 and 2013. A civilian comparator group was matched 4:1 on age and sex. Self-harm emergency department (ED) visits were identified from provincial ED admission records until death or December 31, 2015. Multivariable Poisson regression compared the risk of self-harm. Analyses adjusted for age, geography, income, rurality, and major physical and mental comorbidities. In total, 9514 male veterans and 38,042 age- and sex-matched civilians were included. Overall, 0.55% of veterans had at least one non-fatal self-harm ED visit, compared with 0.81% of civilians. The rate of ED self-harm visits was 40% lower in the veteran population, compared to the civilian population (RR = 0.60; 95% CI = 0.41-0.87). In both groups, psychosocial and physical comorbidities, and death by suicide were more common in those who self-harmed than those who did not. A better understanding of why veterans have a lower rate of self-harm emergency department visits and how it is related to the number of completed suicides is an important area for future consideration.
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Affiliation(s)
- Alyson L Mahar
- a Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | - Heidi Cramm
- b School of Rehabilitation Therapy , Queen's University , Kingston , Canada
| | | | | | - Homer Tien
- e Canadian Armed Forces , Ottawa , Canada
| | - Nicola T Fear
- f Psychological Medicine , Kings College London , London , UK
| | - Paul Kurdyak
- d IC/ES , Toronto , Canada.,g Centre for Addiction and Mental Health , Toronto , Canada
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16
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Sheehan L, Oexle N, Armas SA, Wan HT, Bushman M, Glover L, Lewy SA. Benefits and risks of suicide disclosure. Soc Sci Med 2019; 223:16-23. [PMID: 30690334 DOI: 10.1016/j.socscimed.2019.01.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 12/07/2018] [Accepted: 01/14/2019] [Indexed: 11/29/2022]
Abstract
RATIONALE Individuals who attempt suicide are often subject to stigma and may feel ashamed to talk openly about their experiences with suicide. However, failure to disclose could interfere with care-seeking, increase distress, and limit social support. While research on other concealable stigmatized conditions (e.g. mental illness and HIV) has identified the complexities of disclosure decisions, little is known about disclosure for suicide attempt survivors. OBJECTIVE Given the lack of research in this area, this study aimed to explore suicide attempt survivor perspectives on risks and benefits of suicide disclosure. METHODS Academic researchers partnered with a community-based participatory research team to develop and conduct the research. The team conducted group and individual interviews with U.S. suicide attempt survivors (n = 40), using thematic analysis to code responses into themes for benefits (n = 12) and risks/barriers (n = 10) of disclosing. RESULTS Participants collectively identified how disclosure could benefit them (n = 9) through enhanced social support, strengthening of personal relationships, access to treatment, and opportunities for self-reflection. Participants described how disclosure could benefit others (n = 3) by reducing stigma, allowing attempt survivors to help peers who are currently struggling with suicidal ideation, and by providing psychoeducation on suicidality. Participants also described ways that disclosure could put them at risk (n = 8), in terms of stigma, unsupportive reactions, unwanted treatment, or loss of privacy. Participants were concerned that disclosure could put confidants at risk (n = 2) of being overburdened or triggered. CONCLUSION While the study methodology did not allow for an exploration of which benefits or risks may be most salient for suicide attempt survivors, this study lays groundwork for future research on disclosure of suicidal thoughts and behaviors. Furthermore, these results can be used by service providers to support suicide attempt survivors in strategic disclosure decisions that maximize benefits and reduce risks.
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Naifeh JA, Mash HBH, Stein MB, Fullerton CS, Kessler RC, Ursano RJ. The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS): progress toward understanding suicide among soldiers. Mol Psychiatry 2019; 24:34-48. [PMID: 30104726 PMCID: PMC6756108 DOI: 10.1038/s41380-018-0197-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 06/22/2018] [Accepted: 07/02/2018] [Indexed: 01/11/2023]
Abstract
Responding to an unprecedented increase in the suicide rate among soldiers, in 2008 the US Army and US National Institute of Mental Health funded the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), a multicomponent epidemiological and neurobiological study of risk and resilience factors for suicidal thoughts and behaviors, and their psychopathological correlates among Army personnel. Using a combination of administrative records, representative surveys, computerized neurocognitive tests, and blood samples, Army STARRS and its longitudinal follow-up study (STARRS-LS) are designed to identify potentially actionable findings to inform the Army's suicide prevention efforts. The current report presents a broad overview of Army STARRS and its findings to date on suicide deaths, attempts, and ideation, as well as other important outcomes that may increase suicide risk (e.g., mental disorders, sexual assault victimization). The findings highlight the complexity of environmental and genetic risk and protective factors in different settings and contexts, and the importance of life and career history in understanding suicidal thoughts and behaviors.
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Affiliation(s)
- James A. Naifeh
- 0000 0001 0421 5525grid.265436.0Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Holly B. Herberman Mash
- 0000 0001 0421 5525grid.265436.0Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Murray B. Stein
- 0000 0001 2107 4242grid.266100.3Department of Psychiatry and Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA USA ,0000 0004 0419 2708grid.410371.0VA San Diego Healthcare System, San Diego, CA USA
| | - Carol S. Fullerton
- 0000 0001 0421 5525grid.265436.0Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Ronald C. Kessler
- 000000041936754Xgrid.38142.3cDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Robert J. Ursano
- 0000 0001 0421 5525grid.265436.0Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD USA
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18
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Ursano RJ, Naifeh JA, Kessler RC, Gonzalez OI, Fullerton CS, Mash HH, Riggs-Donovan CA, Ng THH, Wynn GH, Dinh HM, Kao TC, Sampson NA, Heeringa SG, Stein MB. Nonfatal Suicidal Behaviors in the Administrative Records of Activated U.S. Army National Guard and Army Reserve Soldiers, 2004-2009. Psychiatry 2018; 81:173-192. [PMID: 30028239 PMCID: PMC6880748 DOI: 10.1080/00332747.2018.1460716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The U.S. Army suicide rate increased sharply during the wars in Iraq and Afghanistan. There is limited information about medically documented, nonfatal suicidal behaviors among soldiers in the Army's Reserve Component (RC), which is composed of the Army National Guard and Army Reserve. Here we examine trends and sociodemographic correlates of suicide attempts, suspicious injuries, and suicide ideation among activated RC soldiers. METHODS Data come from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) Historical Administrative Data Study (HADS), which integrates administrative records for all soldiers on active duty for the years 2004 through 2009 (n = 1.66 million). RESULTS We identified 2,937 unique RC soldiers on active duty with a nonfatal suicidal event documented at some point during the HADS study period. There were increases in the annual incidence rates of suicide attempts (71 to 204/100,000 person-years) and suicide ideation (326 to 425/100,000 person-years). Incidence rates for suspicious injuries also generally increased but were more variable. Using hierarchical classification rules, we identified the first instance of each soldier's most severe behavior (suicide attempt versus suspicious injury versus suicide ideation). For each of those suicide- or injury-related outcomes, we found increased risk among those who were female, younger, non-Hispanic White, less educated, never married, and lower-ranking enlisted. These sociodemographic associations significantly differed across outcomes, although the patterns were similar. CONCLUSION Results provide a broad overview of nonfatal suicidal trends in the RC during the period 2004 through 2009. They also demonstrate that integration of multiple administrative data systems enriches analysis of the predictors of such events.
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20
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Adler A, Chadhury S, Stanley B, Ghahramanlou-Holloway M, Bush A, Brown GK. A qualitative analysis of strategies for managing suicide-related events during deployment from the perspective of Army behavioral health providers, chaplains, and leaders. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2017.1420979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Abby Adler
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sadia Chadhury
- Department of Psychiatry, Columbia University, New York City, New York
| | - Barbara Stanley
- Department of Psychiatry, Columbia University, New York City, New York
| | | | - Ashley Bush
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory K. Brown
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
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21
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Ursano RJ, Stein MB, Mash HBH, Naifeh JA, Fullerton CS, Zaslavsky AM, Ng THH, Aliaga PA, Wynn GH, Dinh HM, McCarroll JE, Sampson NA, Kao TC, Schoenbaum M, Heeringa SG, Kessler RC. Documented family violence and risk of suicide attempt among U.S. Army soldiers. Psychiatry Res 2018; 262:575-582. [PMID: 28965813 PMCID: PMC6444361 DOI: 10.1016/j.psychres.2017.09.046] [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: 04/07/2017] [Revised: 08/11/2017] [Accepted: 09/17/2017] [Indexed: 01/16/2023]
Abstract
Suicide attempt (SA) rates in the U.S. Army increased substantially during the wars in Afghanistan and Iraq. This study examined associations of family violence (FV) history with SA risk among soldiers. Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), we identified person-month records of active duty, Regular Army, enlisted soldiers with medically documented SAs from 2004 to 2009 (n = 9650) and a sample of control person-months (n = 153,528). Logistic regression analyses examined associations of FV with SA, adjusting for socio-demographics, service-related characteristics, and prior mental health diagnosis. Odds of SA were higher in soldiers with a FV history and increased as the number of FV events increased. Soldiers experiencing past-month FV were almost five times as likely to attempt suicide as those with no FV history. Odds of SA were elevated for both perpetrators and those who were exclusively victims. Male perpetrators had higher odds of SA than male victims, whereas female perpetrators and female victims did not differ in SA risk. A discrete-time hazard function indicated that SA risk was highest in the initial months following the first FV event. FV is an important consideration in understanding risk of SA among soldiers.
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Affiliation(s)
- Robert J. Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA,Corresponding Author: Robert J. Ursano M.D., , Address: Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, Phone: 301-295-9797
| | - Murray B. Stein
- Department of Psychiatry and Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California and VA San Diego Healthcare System, San Diego, California, USA
| | - Holly B. Herberman Mash
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - James A. Naifeh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Carol S. Fullerton
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Tsz Hin Hinz Ng
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Pablo A. Aliaga
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Gary H. Wynn
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Hieu M. Dinh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - James E. McCarroll
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Tzu-Cheg Kao
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | - Steven G. Heeringa
- University of Michigan, Institute for Social Research, Ann Arbor, Michigan, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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Han B, Compton WM, Blanco C, Colpe L, Huang L, McKeon R. National Trends in the Prevalence of Suicidal Ideation and Behavior Among Young Adults and Receipt of Mental Health Care Among Suicidal Young Adults. J Am Acad Child Adolesc Psychiatry 2018; 57:20-27.e2. [PMID: 29301664 DOI: 10.1016/j.jaac.2017.10.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 09/26/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study examined national trends in the prevalence of suicidal ideation and behavior among young adults and receipt of mental health care among suicidal young adults. METHOD We examined restricted data from 145,800 persons aged 18 to 25 years who participated in the 2009 to 2015 National Surveys on Drug Use and Health. Descriptive analyses and bivariable and multivariable logistic regressions were applied. RESULTS Among US young adults during 2009 to 2015, the 12-month prevalence of suicidal ideation increased from 6.1% to 8.3%, the 12-month prevalence of suicide plan increased from 2.0% to 2.7%, and 12-month prevalence of suicide attempt increased from 1.1% to 1.6%. After adjusting for personal factors and changes in residing county's population characteristics, we found upward trends in suicidal ideation among non-Hispanic whites and Hispanics, an upward trend in suicide plan among young adults overall, and an upward trend in suicide attempt among those without major depressive episodes (MDE). Among young adults with MDE, the prevalence of suicide attempt remained high and unchanged. During 2009 to 2015, trends in receipt of mental health care remained unchanged among most suicidal young adults and declined slightly among uninsured suicidal young adults. The annual average prevalence of receipt of mental health care was 36.2% among suicidal young adults. CONCLUSION During 2009 to 2015, suicidal ideation, suicide plan, and suicide attempt increased among young adults overall, but receipt of mental health care among suicidal young adults did not increase. Our results suggest that effective efforts are needed for suicide prevention and promotion of mental health care among young adults.
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Affiliation(s)
- Beth Han
- Substance Abuse and Mental Health Services Administration, Rockville, MD.
| | - Wilson M Compton
- National Institute on Drug Abuse of the National Institutes of Health, Bethesda, MD
| | - Carlos Blanco
- National Institute on Drug Abuse of the National Institutes of Health, Bethesda, MD
| | - Lisa Colpe
- National Institute of Mental Health, Bethesda
| | - Larke Huang
- Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Richard McKeon
- Substance Abuse and Mental Health Services Administration, Rockville, MD
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Kessler RC, Heeringa SG, Colpe LJ, Fullerton CS, Gebler N, Hwang I, Naifeh JA, Nock MK, Sampson NA, Schoenbaum M, Zaslavsky AM, Stein MB, Ursano RJ. Response bias, weighting adjustments, and design effects in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Int J Methods Psychiatr Res 2013; 22:288-302. [PMID: 24318218 PMCID: PMC3992816 DOI: 10.1002/mpr.1399] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 07/15/2013] [Indexed: 11/08/2022] Open
Abstract
The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multi-component epidemiological and neurobiological study designed to generate actionable recommendations to reduce US Army suicides and increase knowledge about determinants of suicidality. Three Army STARRS component studies are large-scale surveys: one of new soldiers prior to beginning Basic Combat Training (BCT; n = 50,765 completed self-administered questionnaires); another of other soldiers exclusive of those in BCT (n = 35,372); and a third of three Brigade Combat Teams about to deploy to Afghanistan who are being followed multiple times after returning from deployment (n = 9421). Although the response rates in these surveys are quite good (72.0-90.8%), questions can be raised about sample biases in estimating prevalence of mental disorders and suicidality, the main outcomes of the surveys based on evidence that people in the general population with mental disorders are under-represented in community surveys. This paper presents the results of analyses designed to determine whether such bias exists in the Army STARRS surveys and, if so, to develop weights to correct for these biases. Data are also presented on sample inefficiencies introduced by weighting and sample clustering and on analyses of the trade-off between bias and efficiency in weight trimming.
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Affiliation(s)
| | | | | | - Carol S. Fullerton
- Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University School of MedicineBethesdaMDUSA
| | - Nancy Gebler
- University of MichiganInstitute for Social ResearchAnn ArborMIUSA
| | - Irving Hwang
- Department of Health Care PolicyHarvard Medical SchoolBostonMAUSA
| | - James A. Naifeh
- Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University School of MedicineBethesdaMDUSA
| | | | - Nancy A. Sampson
- Department of Health Care PolicyHarvard Medical SchoolBostonMAUSA
| | | | | | - Murray B. Stein
- Departments of Psychiatry and Family and Preventive MedicineUniversity of California San DiegoLa JollaCAUSA
- VA San Diego Healthcare SystemSan DiegoCAUSA
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University School of MedicineBethesdaMDUSA
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24
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Heeringa SG, Gebler N, Colpe LJ, Fullerton CS, Hwang I, Kessler RC, Naifeh JA, Nock MK, Sampson NA, Schoenbaum M, Zaslavsky AM, Stein MB, Ursano RJ. Field procedures in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Int J Methods Psychiatr Res 2013; 22:276-87. [PMID: 24038395 PMCID: PMC3992884 DOI: 10.1002/mpr.1400] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 07/15/2013] [Indexed: 01/19/2023] Open
Abstract
The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multi-component epidemiological and neurobiological study of unprecedented size and complexity designed to generate actionable evidence-based recommendations to reduce US Army suicides and increase basic knowledge about determinants of suicidality by carrying out coordinated component studies. A number of major logistical challenges were faced in implementing these studies. The current report presents an overview of the approaches taken to meet these challenges, with a special focus on the field procedures used to implement the component studies. As detailed in the paper, these challenges were addressed at the onset of the initiative by establishing an Executive Committee, a Data Coordination Center (the Survey Research Center [SRC] at the University of Michigan), and study-specific design and analysis teams that worked with staff on instrumentation and field procedures. SRC staff, in turn, worked with the Office of the Deputy Under Secretary of the Army (ODUSA) and local Army Points of Contact (POCs) to address logistical issues and facilitate data collection. These structures, coupled with careful fieldworker training, supervision, and piloting, contributed to the major Army STARRS data collection efforts having higher response rates than previous large-scale studies of comparable military samples.
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Affiliation(s)
| | - Nancy Gebler
- University of MichiganInstitute for Social ResearchAnn ArborMIUSA
| | | | - Carol S. Fullerton
- Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University School of MedicineBethesdaMDUSA
| | - Irving Hwang
- Department of Health Care PolicyHarvard Medical SchoolBostonMAUSA
| | | | - James A. Naifeh
- Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University School of MedicineBethesdaMDUSA
| | | | - Nancy A. Sampson
- Department of Health Care PolicyHarvard Medical SchoolBostonMAUSA
| | | | | | - Murray B. Stein
- Departments of Psychiatry and Family and Preventive MedicineUniversity of California San DiegoLa JollaCAUSA
- VA San Diego Healthcare SystemSan DiegoCAUSA
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University School of MedicineBethesdaMDUSA
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25
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Kessler RC, Santiago PN, Colpe LJ, Dempsey CL, First MB, Heeringa SG, Stein MB, Fullerton CS, Gruber MJ, Naifeh JA, Nock MK, Sampson NA, Schoenbaum M, Zaslavsky AM, Ursano RJ. Clinical reappraisal of the Composite International Diagnostic Interview Screening Scales (CIDI-SC) in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Int J Methods Psychiatr Res 2013; 22:303-21. [PMID: 24318219 PMCID: PMC4027964 DOI: 10.1002/mpr.1398] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 07/15/2013] [Indexed: 11/06/2022] Open
Abstract
A clinical reappraisal study was carried out in conjunction with the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) All-Army Study (AAS) to evaluate concordance of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses based on the Composite International Diagnostic Interview Screening Scales (CIDI-SC) and post-traumatic stress disorder (PTSD) checklist (PCL) with diagnoses based on independent clinical reappraisal interviews (Structured Clinical Interview for DSM-IV [SCID]). Diagnoses included: lifetime mania/hypomania, panic disorder, and intermittent explosive disorder; six-month adult attention-deficit/hyperactivity disorder; and 30-day major depressive episode, generalized anxiety disorder, PTSD, and substance (alcohol or drug) use disorder (abuse or dependence). The sample (n = 460) was weighted for over-sampling CIDI-SC/PCL screened positives. Diagnostic thresholds were set to equalize false positives and false negatives. Good individual-level concordance was found between CIDI-SC/PCL and SCID diagnoses at these thresholds (area under curve [AUC] = 0.69-0.79). AUC was considerably higher for continuous than dichotomous screening scale scores (AUC = 0.80-0.90), arguing for substantive analyses using not only dichotomous case designations but also continuous measures of predicted probabilities of clinical diagnoses.
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Affiliation(s)
| | - Patcho N. Santiago
- Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University of the Health SciencesBethesdaMDUSA
| | | | - Catherine L. Dempsey
- Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University of the Health SciencesBethesdaMDUSA
| | - Michael B. First
- Department of PsychiatryColumbia UniversityNew YorkUSA
- New York State Psychiatric InstituteNew YorkUSA
| | | | - Murray B. Stein
- Departments of Psychiatry and Family and Preventive MedicineUniversity of California San DiegoLa JollaCAUSA
- VA San Diego Healthcare SystemSan DiegoCAUSA
| | - Carol S. Fullerton
- Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University of the Health SciencesBethesdaMDUSA
| | | | - James A. Naifeh
- Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University of the Health SciencesBethesdaMDUSA
| | | | - Nancy A. Sampson
- Department of Health Care PolicyHarvard Medical SchoolBostonMAUSA
| | | | | | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University of the Health SciencesBethesdaMDUSA
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