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Ee JS, Culp PA, Bevis ZJ, Dogbey GY, Agnello RN, Chang MH. Chronic Pain and Childhood Adversity Experiences Among U.S. Military Personnel. Mil Med 2023; 188:561-566. [PMID: 37948239 DOI: 10.1093/milmed/usad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/14/2023] [Accepted: 06/25/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Chronic pain in a military population is prevalent, is costly, and can limit daily activities and affect soldier readiness. It has been associated with childhood adversity (CA) within the veteran, adult, and pediatric populations. Given the need to maximize soldier resiliency, an examination of the link between CA and chronic pain in an active duty population for a better understanding that informs treatment options is warranted. MATERIALS AND METHODS The analytic sample comprised 32 men and 8 women drawn from a retrospective review of 203 intake assessments at an interdisciplinary pain management center. We identified a group (CA) of 20 patients who reported a history of pre-adolescent sexual abuse or living in an "abusive" childhood home and compared it with a control group (no-CA) of 20 patients, matched for age, gender, pain history duration, and pain problem. Validated measures were used to assess pain intensity, interference in functioning and well-being, emotional sequelae of pain as reflected in symptoms of depression and anxiety, and pain-related catastrophic thinking. Data were analyzed using descriptive statistics and independent samples t-test analyses. RESULTS Differences in current, worst, and average pain ratings were non-significant between groups. The CA group reported significantly greater effect of pain on mood (mean: 6.20 versus 4.25, P < .02) and showed a trend toward higher pain interference in functioning (mean: 17.70 versus 15.05, P = .053). The CA patients had significantly more serious depression (mean: 12.65 versus 4.50, P < .001) and anxiety symptoms (mean: 10.60 versus 2.35, P < .001) and significantly higher pain catastrophizing tendency (mean: 30.05 versus 20.50, P < .03). CONCLUSIONS Overall, the findings suggest that childhood trauma should be considered by providers when treating depression and anxiety in soldiers with chronic pain. Being mindful of trauma-informed care may have implications, perhaps, for cases perceived as treatment resistant.
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Affiliation(s)
- Juliana S Ee
- Department of Family Medicine, Womack Army Medical Center, Fort Liberty, NC 28310, USA
| | - Phillip A Culp
- Department of Family Medicine, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA
| | - Zachary J Bevis
- Department of Family Medicine, Womack Army Medical Center, Fort Liberty, NC 28310, USA
| | - Godwin Y Dogbey
- Department of Research and Medical Education, Campbell University, Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC 27546, USA
| | - Robert N Agnello
- Department of Family Medicine, Campbell University, Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC 27546, USA
| | - Min Ho Chang
- Department of Medicine, Womack Army Medical Center, Fort Liberty, NC 28310, USA
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Lee JI, Wu CY, Huang W, Lee MB, Chan CT, Chen CY. Prevalence of bullying victimization and its association with self-perceived health, psychopathology, and suicidality: A nationwide population-based survey in Taiwan. J Formos Med Assoc 2022; 121:2416-2423. [PMID: 36031488 DOI: 10.1016/j.jfma.2022.07.008] [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: 05/23/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The current study aimed to assess the prevalence of bullying victimization (BV) and its association with psychopathology and suicidality in a nationwide general population. METHODS The target population were all the people living in Taiwan, the study samples were obtained by the following processes. A computer-assisted telephone interview was performed to identify potential respondents using telephone numbers selected with the stratified proportional randomization method. Self-reported data were evaluated. Moreover, data obtained using the validated Brief Symptom Rating Scale (BSRS-5) and Concise Mental Health Checklist (CMHC) were used to evaluate psychopathological symptoms and overall suicidal risks, respectively. Results were further analyzed using the chi-square tests and logistic regression model. RESULTS In total, 1930 respondents from a national general population survey were included in the analysis. The weighted prevalence of lifetime BV in the general population was 13.5%. Based on the chi-square analysis, individuals exposed to BV were at high risk for psychopathology (a BSRS-5 score of ≥6 (x2 = 45.5, P ≤ .001) and high BSRS-5 scores for all five items). Bullying exposure was significantly associated with lifetime suicide ideation and suicide attempt (x2 = 85.7, P ≤ .001; x2 = 17.0, P ≤ .001, respectively). The help-seeking behavior of respondents exposed to bullying did not differ significantly (x2 = 4.6, P = .327). CONCLUSION Bullying exposure is associated with recent psychopathology and lifetime suicidality. Multifactorial interactive processes contribute to long-term harmful health implications in adulthood. Nevertheless, further research on the relevant mechanisms associated with bullying and potential interventions that can decrease morbidity must be conducted.
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Affiliation(s)
- Jia-In Lee
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chia-Yi Wu
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan; Taiwan Suicide Prevention Center, Taiwan
| | - William Huang
- Department of Psychiatry, Shin-Kong Hospital, Taipei, Taiwan.
| | - Ming-Been Lee
- Taiwan Suicide Prevention Center, Taiwan; Department of Psychiatry, Shin-Kong Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Ta Chan
- Taiwan Suicide Prevention Center, Taiwan; Department of Psychiatry, Shin-Kong Hospital, Taipei, Taiwan
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Nichter B, Monteith LL, Norman SB, Maguen S, Hill ML, Herzog S, Pietrzak RH. Differentiating U.S. military veterans who think about suicide from those who attempt suicide: A population-based study. Gen Hosp Psychiatry 2021; 72:117-123. [PMID: 34450447 DOI: 10.1016/j.genhosppsych.2021.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Several vulnerability factors for suicidal behavior in U.S. veterans have been identified. However, little is known about factors that differentiate veterans who contemplate suicide from those who attempt suicide. This study examined sociodemographic and clinical characteristics that distinguish veterans who think about suicide from those who attempt suicide. METHOD Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a population-based sample of 4069 veterans. Analyses estimated the lifetime prevalence of suicide ideation (SI) and suicide attempts (SA); and examined differences between veterans with a history of attempt(s), and SI without a history of attempt(s). RESULTS A total 25.9% of U.S. veterans reported lifetime SI and 3.9% reported a SA. Several factors distinguished veterans with a history of SA from those with SI only: the strongest were younger age (odds ratio [OR] = 0.97, 95% CI = 0.95-0.98), nonsuicidal self-injury (OR = 1.81, 95% CI = 1.11-3.03), adverse childhood experiences (OR = 1.14; 95% CI = 1.06-1.23), alcohol use disorder (OR = 1.99; 95% CI = 1.28-3.12), lower household income (OR = 0.62; 95% CI = 0.40-0.95), and physical disability (OR = 1.69; 95% CI = 1.07-2.70). CONCLUSIONS Although a quarter of U.S. veterans contemplate suicide in their lifetimes, the majority do not attempt suicide. Specific sociodemographic and clinical features may differentiate veterans who contemplate versus attempt suicide.
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Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
| | - Lindsey L Monteith
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; National Center for PTSD, White River Junction, VT, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Shira Maguen
- San Francisco VA Health Care System, San Francisco, CA, USA; University of California - San Francisco, San Francisco, USA
| | - Melanie L Hill
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Sarah Herzog
- Department of Psychiatry, Columbia University, Irving Medical Center, New York, NY, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - Robert H Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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4
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Naifeh JA, Mash HBH, Stein MB, Vance MC, Aliaga PA, Fullerton CS, Dinh HM, Wynn GH, Kao TC, Sampson NA, Kessler RC, Ursano RJ. Sex Differences in US Army Suicide Attempts During the Wars in Iraq and Afghanistan. Med Care 2021; 59:S42-S50. [PMID: 33438882 PMCID: PMC7810153 DOI: 10.1097/mlr.0000000000001425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine sex differences in risk for administratively documented suicide attempt (SA) among US Army soldiers during the Iraq/Afghanistan wars. METHOD Using administrative person-month records of Regular Army enlisted soldiers from 2004 to 2009, we identified 9650 person-months with a first documented SA and an equal-probability control sample (n=153,528 person-months). Person-months were weighted to the population and pooled over time. After examining the association of sex with SA in a logistic regression analysis, predictors were examined separately among women and men. RESULTS Women (an estimated 13.7% of the population) accounted for 25.2% of SAs and were more likely than men to attempt suicide after adjusting for sociodemographic, service-related, and mental health diagnosis (MHDx) variables (odds ratio=1.6; 95% confidence interval, 1.5-1.7). Women with increased odds of SA in a given person-month were younger, non-Hispanic White, less educated, in their first term of enlistment, never or previously deployed (vs. currently deployed), and previously received a MHDx. The same variables predicted SA among men. Interactions indicated significant but generally small differences between women and men on 6 of the 8 predictors, the most pronounced being time in service, deployment status, and MHDx. Discrete-time survival models examining risk by time in service demonstrated that patterns for women and men were similar, and that women's initially higher risk diminished as time in service increased. CONCLUSIONS Predictors of documented SAs are similar for US Army women and men. Differences associated with time in service, deployment status, and MHDx require additional research. Future research should consider stressors that disproportionately affect women.
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Affiliation(s)
- James A. Naifeh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Holly B. Herberman Mash
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Murray B. Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California San Diego, La Jolla
- VA San Diego Healthcare System, San Diego, CA
| | - Mary C. Vance
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Pablo A. Aliaga
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Carol S. Fullerton
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
| | - Hieu M. Dinh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Gary H. Wynn
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
| | - Tzu-Cheg Kao
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Robert J. Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
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5
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Naifeh JA, Nock MK, Dempsey CL, Georg MW, Bartolanzo D, Ng THH, Aliaga PA, Dinh HM, Fullerton CS, Mash HBH, Kao TC, Sampson NA, Wynn GH, Zaslavsky AM, Stein MB, Kessler RC, Ursano RJ. Self-injurious thoughts and behaviors that differentiate soldiers who attempt suicide from those with recent suicide ideation. Depress Anxiety 2020; 37:738-746. [PMID: 32291817 DOI: 10.1002/da.23016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/05/2020] [Accepted: 03/22/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Risk for suicide attempt (SA) versus suicide ideation (SI) is clinically important and difficult to differentiate. We examined whether a history of self-injurious thoughts and behaviors (SITBs) differentiates soldiers with a recent SA from nonattempting soldiers with current/recent SI. METHODS Using a unique case-control design, we administered the same questionnaire (assessing the history of SITBs and psychosocial variables) to representative U.S. Army soldiers recently hospitalized for SA (n = 132) and soldiers from the same Army installations who reported 30-day SI but did not make an attempt (n = 125). Logistic regression analyses examined whether SITBs differentiated attempters and ideators after controlling for previously identified covariates. RESULTS In separate models that weighted for systematic nonresponse and controlled for gender, education, posttraumatic stress disorder, and intermittent explosive disorder, SA was positively and significantly associated with the history of suicide plan and/or intention to act (odds ratio [OR] = 12.1 [95% confidence interval {CI} = 3.6-40.4]), difficulty controlling suicidal thoughts during the worst week of ideation (OR = 3.5 [95% CI = 1.1-11.3]), and nonsuicidal self-injury (NSSI) (OR = 4.9 [95% CI = 1.3-18.0]). Area under the curve was 0.87 in a full model that combined these SITBs and covariates. The top ventile based on predicted risk had a sensitivity of 24.7%, specificity of 99.8%, and positive predictive value of 97.5%. CONCLUSIONS History of suicide plan/intention, difficult to control ideation, and NSSI differentiate soldiers with recent SA from those with current/recent SI independent of sociodemographic characteristics and mental disorders. Longitudinal research is needed to determine whether these factors are prospectively associated with the short-term transition from SI to SA.
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Affiliation(s)
- James A Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Catherine L Dempsey
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Matthew W Georg
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Danielle Bartolanzo
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Tsz Hin Hinz Ng
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Pablo A Aliaga
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Hieu M Dinh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Carol S Fullerton
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Holly B Herberman Mash
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Tzu-Cheg Kao
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Gary H Wynn
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Murray B Stein
- Department of Psychiatry and Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California.,VA San Diego Healthcare System, San Diego, California
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Ikeda T, Hori D, Ikeda Y, Takahashi T, Shiraki N, Andrea CS, Ohtaki Y, Doki S, Oi Y, Sasahara S, Saito T, Matsuzaki I. School Ijime (Bullying) Experience Is a Possible Risk Factor for Current Psychological Distress among Science City Workers: A Cross-Sectional Study in Tsukuba, Japan. TOHOKU J EXP MED 2020; 250:223-231. [PMID: 32281543 DOI: 10.1620/tjem.250.223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Early-life adversities are considered to have long-term impact on health. There have been many studies regarding the experience of being bullied and its harmful psychological influence, but such influence on workers remains to be investigated in Japan. We therefore aimed to examine the prevalence of workers with experiences of being bullied or bullying others during childhood and adolescence and to clarify the relation between those experiences and current psychological distress. A cross-sectional study using an anonymous self-report web questionnaire was conducted in November 2017. The study population was 19,481 workers belonging to the Tsukuba Science City Network, and we analyzed the data of 6,015 participants (3,715 men and 2,300 women, aged between 20 years and 59 years). The percentages of participants with experiences of being bullied were 51.5% for men and 56.2% for women; those with experiences of bullying others were 36.5% of men and 29.4% of women. Relations between experiences of bullying and psychological distress were assessed using Chi-squared tests. Logistic regression analyses with psychological distress as an objective variable and experiences of bulling as explanatory variables were performed using those who had no bulling experiences as control. In both men and women, experiences of being bullied were significantly associated with psychological distress after adjustment socioeconomic factors (the odds ratios were 1.26 for men (95% CI = 1.05-1.52) and 1.72 for women (95% CI = 1.39-2.13)). Consideration of past social experiences, such as being bullied, is useful for mental health management among workers reporting psychological distress.
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Affiliation(s)
- Tomohiko Ikeda
- Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | | | - Yu Ikeda
- Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Tsukasa Takahashi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Nagisa Shiraki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | | | | | | | - Yuichi Oi
- Faculty of Medicine, University of Tsukuba
| | | | | | - Ichiyo Matsuzaki
- Faculty of Medicine, University of Tsukuba.,International Institute for Integrative Sleep Medicine
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Lippard ET, Nemeroff CB. The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders. Am J Psychiatry 2020; 177:20-36. [PMID: 31537091 PMCID: PMC6939135 DOI: 10.1176/appi.ajp.2019.19010020] [Citation(s) in RCA: 219] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A large body of evidence has demonstrated that exposure to childhood maltreatment at any stage of development can have long-lasting consequences. It is associated with a marked increase in risk for psychiatric and medical disorders. This review summarizes the literature investigating the effects of childhood maltreatment on disease vulnerability for mood disorders, specifically summarizing cross-sectional and more recent longitudinal studies demonstrating that childhood maltreatment is more prevalent and is associated with increased risk for first mood episode, episode recurrence, greater comorbidities, and increased risk for suicidal ideation and attempts in individuals with mood disorders. It summarizes the persistent alterations associated with childhood maltreatment, including alterations in the hypothalamic-pituitary-adrenal axis and inflammatory cytokines, which may contribute to disease vulnerability and a more pernicious disease course. The authors discuss several candidate genes and environmental factors (for example, substance use) that may alter disease vulnerability and illness course and neurobiological associations that may mediate these relationships following childhood maltreatment. Studies provide insight into modifiable mechanisms and provide direction to improve both treatment and prevention strategies.
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Affiliation(s)
- Elizabeth T.C. Lippard
- Department of Psychiatry, Dell Medical School, University of Texas, Austin, TX, USA,Institute of Early Life Adversity Research, Dell Medical School, University of Texas, Austin, TX USA,Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX USA,Department of Psychology, University of Texas, Austin, TX, USA,Mulva Clinic for Neuroscience, Dell Medical School, University of Texas, Austin, TX
| | - Charles B. Nemeroff
- Department of Psychiatry, Dell Medical School, University of Texas, Austin, TX, USA,Institute of Early Life Adversity Research, Dell Medical School, University of Texas, Austin, TX USA,Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX USA,Mulva Clinic for Neuroscience, Dell Medical School, University of Texas, Austin, TX
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8
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Naifeh JA, Ursano RJ, Kessler RC, Zaslavsky AM, Nock MK, Dempsey CL, Bartolanzo D, Ng THH, Aliaga PA, Zuromski KL, Dinh HM, Fullerton CS, Kao TC, Mash HBH, Sampson NA, Wynn GH, Stein MB. Transition to suicide attempt from recent suicide ideation in U.S. Army soldiers: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Depress Anxiety 2019; 36:412-422. [PMID: 30549394 PMCID: PMC6488405 DOI: 10.1002/da.22870] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/20/2018] [Accepted: 12/01/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Most people with suicide ideation (SI) do not attempt suicide (SA). Understanding the transition from current/recent SI to SA is important for mental health care. Our objective was to identify characteristics that differentiate SA from 30-day SI among representative U.S. Army soldiers. METHODS Using a unique case-control design, soldiers recently hospitalized for SA (n = 132) and representative soldiers from the same four communities (n = 10,193) were administered the same questionnaire. We systematically identified variables that differentiated suicide attempters from the total population, then examined whether those same variables differentiated all 30-day ideators (n = 257) from the total population and attempters from nonattempting 30-day ideators. RESULTS In univariable analyses, 20 of 23 predictors were associated with SA in the total population (0.05 level). The best multivariable model included eight significant predictors: interpersonal violence, relationship problems, major depressive disorder, posttraumatic stress disorder (PTSD), and substance use disorder (all having positive associations), as well as past 12-month combat trauma, intermittent explosive disorder (IED), and any college education (all having negative associations). Six of these differentiated 30-day ideators from the population. Three differentiated attempters from ideators: past 30-day PTSD (OR = 6.7 [95% CI = 1.1-39.4]), past 30-day IED (OR = 0.2 [95% CI = 0.1-0.5]), and any college education (OR = 0.1 [95% CI = 0.0-0.6]). The 5% of ideators with highest predicted risk in this final model included 20.9% of attempters, a four-fold concentration of risk. CONCLUSIONS Prospective army research examining transition from SI to SA should consider PTSD, IED, and education. Combat exposure did not differentiate attempters from ideators. Many SA risk factors in the Army population are actually risk factors for SI.
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Affiliation(s)
- James A Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Catherine L Dempsey
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Danielle Bartolanzo
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Tsz Hin Hinz Ng
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Pablo A Aliaga
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Kelly L Zuromski
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Hieu M Dinh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Carol S Fullerton
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Tzu-Cheg Kao
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Holly B Herberman Mash
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Gary H Wynn
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Murray B Stein
- Department of Psychiatry and Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, La Jolla, CA, USA
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9
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Campbell-Sills L, Kessler RC, Ursano RJ, Sun X, Heeringa SG, Nock MK, Jain S, Stein MB. Nicotine Dependence and Pre-Enlistment Suicidal Behavior Among U.S. Army Soldiers. Am J Prev Med 2019; 56:420-428. [PMID: 30777160 PMCID: PMC6383784 DOI: 10.1016/j.amepre.2018.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Identification of modifiable risk factors for suicidal behaviors is a priority for the U.S. Army. This study investigated associations of nicotine dependence with suicidal behaviors among incoming soldiers. METHODS Lifetime DSM-IV nicotine dependence, mental disorders, suicidal behaviors, and their ages of onset were retrospectively assessed in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) New Soldier Study. Discrete-time survival analysis of person-year data from 30,436 soldiers was performed to evaluate associations of nicotine dependence with subsequent suicidal ideation, plans, and attempts. Among respondents with lifetime ideation (n=4,060), models tested associations of nicotine dependence with progression from ideation to first onset of plan, from plan to first attempt, and, among ideators without plans, from ideation to first unplanned attempt. A hierarchy of models incorporated increasing controls for other risk factors. Data were collected in 2011-2012 and analyzed in 2017-2018. RESULTS In models controlling for sociodemographic characteristics, nicotine dependence was associated with onset of all suicidal behaviors (AORs, 2.07-4.08, p<0.001) and with each type of progression of suicidal behavior (AORs, 1.48-2.44, p<0.005). After adjusting for childhood adversities and mental disorders, nicotine dependence remained associated with onset of ideation (AOR=1.27, 95% CI=1.10, 1.46, p=0.001) and attempt (AOR=1.83, 95% CI=1.41, 2.37, p<0.001); and with progression from ideation to unplanned attempt (AOR=2.03, 95% CI=1.17, 1.74, p<0.001). CONCLUSIONS Nicotine dependence exhibited associations with onset of suicidal ideation and suicide attempt-and with progression from ideation to unplanned attempt-that were independent of other measured risk factors. Awareness of associations of nicotine dependence with suicidal behaviors may inform risk assessment, facilitate targeting of prevention efforts, and provide further impetus for reducing nicotine dependence.
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Affiliation(s)
- Laura Campbell-Sills
- Department of Psychiatry, University of California, San Diego, La Jolla, California.
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Steven G Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Murray B Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, California; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California; VA San Diego Healthcare System, San Diego, California
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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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11
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Bernecker SL, Zuromski KL, Gutierrez PM, Joiner TE, King AJ, Liu H, Nock MK, Sampson NA, Zaslavsky AM, Stein MB, Ursano RJ, Kessler RC. Predicting suicide attempts among soldiers who deny suicidal ideation in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Behav Res Ther 2018; 120:103350. [PMID: 30598236 DOI: 10.1016/j.brat.2018.11.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/01/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
Most nonfatal suicide attempts and suicide deaths occur among patients who deny suicidal ideation (SI) during suicide risk screenings. Little is known about risk factors for suicidal behaviors among such patients. We investigated this in a representative sample of U.S. Army soldiers who denied lifetime SI in a survey and were then followed through administrative records for up to 45 months to learn of administratively-recorded suicide attempts (SA). A novel two-stage risk assessment approach was used that combined first-stage prediction from administrative records to find the subsample of SI deniers with highest subsequent SA risk and then used survey reports to estimate a second-stage model identifying the subset of individuals in the high-risk subsample at highest SA risk. 70% of survey respondents denied lifetime SI. Administrative data identified 30% of this 70% who accounted for 81.2% of subsequent administratively-recorded SAs. A relatively small number of self-report survey variables were then used to create a prediction model that identified 10% of the first-stage high-risk sample (i.e., 3% of all soldiers) at highest SA risk (accounting for 45% of SAs in the total sample). We close by discussing potential applications of this approach for identifying future SI deniers at highest SA risk.
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Affiliation(s)
- Samantha L Bernecker
- Department of Psychology, Harvard University, 33 Kirkland St, Cambridge, MA, USA; Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA, USA
| | - Kelly L Zuromski
- Department of Psychology, Harvard University, 33 Kirkland St, Cambridge, MA, USA; Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA, USA
| | - Peter M Gutierrez
- Department of Psychiatry, University of Colorado School of Medicine; and Rocky Mountain Mental Illness Research, Education, and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Andrew J King
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA, USA
| | - Howard Liu
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, 33 Kirkland St, Cambridge, MA, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA, USA
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA, USA
| | - Murray B Stein
- Department of Psychiatry and Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA, USA.
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12
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Hourani LL, Williams J, Lattimore PK, Morgan JK, Hopkinson SG, Jenkins L, Cartwright J. Workplace victimization risk and protective factors for suicidal behavior among active duty military personnel. J Affect Disord 2018; 236:45-51. [PMID: 29715608 DOI: 10.1016/j.jad.2018.04.095] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/26/2018] [Accepted: 04/08/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Workplace victimization is a potential risk factor for suicidal behaviors (SB) among military personnel that has been largely overlooked. This paper examines both the impact of workplace victimization on reported SB and several potential protective factors associated with such suicidal behaviors in a large sample of active duty soldiers. METHODS A case-control study was conducted with 71 soldiers who reported SB in the past 12 months, each matched on sociodemographic characteristics to two others without reported suicidal behaviors. A multiple regression model was estimated to assess the effects of risk and protective factors while controlling for other variables. RESULTS SB was associated with several aspects of victimization, mental health and substance abuse conditions, pain, impulsivity, stressors, negative life events, work-family conflict, active coping behaviors and positive military-related factors. Controlling for other variables, those with SB were more likely to have sought mental health or substance abuse services, to be depressed, anxious, impulsive, and less resilient than non-SB personnel. LIMITATIONS Study limitations included the use of retrospective self-report data, absence of some known SB predictors, and a population restricted to active duty Army personnel. CONCLUSIONS SB among active duty personnel is associated with victimization since joining the military and is protected by resiliency. These findings suggest that in addition to the usual mental health factors, these additional predictors should be accounted for in SB intervention and prevention planning for active duty personnel.
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Affiliation(s)
- Laurel L Hourani
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC 27709, USA.
| | - Jason Williams
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC 27709, USA
| | - Pamela K Lattimore
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC 27709, USA
| | - Jessica K Morgan
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC 27709, USA; Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310, USA
| | - Susan G Hopkinson
- Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310, USA
| | - Linda Jenkins
- Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310, USA
| | - Joel Cartwright
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC 27709, USA; Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310, USA
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