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Moceri-Brooks J, Garand L, Sekula LK, Zoucha R, Joiner T. The Purple Heart and suicide risk in Post-9/11 U.S. Army Combat Veterans with a traumatic brain injury: A mixed methods study. MILITARY PSYCHOLOGY 2024; 36:443-455. [PMID: 37262299 PMCID: PMC11197889 DOI: 10.1080/08995605.2023.2204790] [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: 09/12/2022] [Accepted: 03/30/2023] [Indexed: 06/03/2023]
Abstract
Active service members and Veterans with a combat-related traumatic brain injury (TBI) are four times more likely to attempt suicide than those without a TBI. TBIs are the signature injuries of the Post-9/11 conflicts and Combat Veterans (i.e., current and former service members who deployed in support of a combat mission) with these injuries are entitled to receive the Purple Heart medal. However, potentially tens of thousands of Combat Veterans did not receive, or were denied the Purple Heart during the first decade of the Global War on Terrorism because a TBI was not documented during the deployment. To our knowledge, this is the first study to explore the meaning of the Purple Heart and examine the impact of the Purple Heart on Army Combat Veterans with a combat-related TBI. Findings from this mixed methods study revealed that not receiving the Purple Heart is associated with increased suicide risk and lower quality of life after a brain injury. Additionally, thwarted belongingness, perceived burdensomeness, and perceived military institutional betrayal are associated with increased suicide risk in Army Combat Veterans with a TBI. This mixed methods study provides important insights into how Army culture is perceived and the power of the Purple Heart among this high-risk group of Combat Veterans.
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Affiliation(s)
| | - Linda Garand
- School of Nursing, Duquesne University, Pittsburgh, Pennsylvania
| | | | - Rick Zoucha
- School of Nursing, Duquesne University, Pittsburgh, Pennsylvania
| | - Thomas Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida
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Moceri-Brooks J, Garand L, Sekula LK, Joiner TE. Exploring the use of the Interpersonal Needs Questionnaire to examine suicidal thoughts and behaviors among Post-9/11 U.S. Combat Veterans: An integrative review. MILITARY PSYCHOLOGY 2024; 36:340-352. [PMID: 38661461 PMCID: PMC11057638 DOI: 10.1080/08995605.2023.2178223] [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: 06/06/2022] [Accepted: 02/01/2023] [Indexed: 03/05/2023]
Abstract
This integrative review expands on the work of Kramer et al. (2020), by reviewing studies that utilized the Interpersonal Needs Questionnaire (INQ) to examine the interpersonal constructs (thwarted belongingness and perceived burdensomeness) of the Interpersonal Theory of Suicide (ITS) to understand suicidal thoughts and behaviors among service members and Veterans with combat experience. Very few studies (n = 9) in the literature were identified, however important relationships were revealed between combat exposure/experiences, thwarted belongingness, perceived burdensomeness, and suicidal thoughts and behaviors among military samples. Studies also reported risk factors for high levels of thwarted belongingness or perceived burdensomeness in military samples, such as moral injuries, betrayal, and aggression. This review highlights the utility of the INQ to measure ITS constructs among Post-9/11 U.S. Combat Veterans.
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Affiliation(s)
| | - Linda Garand
- Duquesne University School of Nursing, Pittsburgh, Pennsylvania
| | | | - Thomas E. Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida
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Shelef L, Nir I, Tatsa-Laur L, Yavnai N, Gold N, Cohen G, Ben Yehuda A. Factors associated with self-harm behaviors during military service in the Israel Defense Forces, rates of such behaviors and their outcomes. MILITARY PSYCHOLOGY 2024; 36:158-167. [PMID: 38377251 PMCID: PMC10880502 DOI: 10.1080/08995605.2022.2151815] [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: 03/23/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
The military environment involves stressful situations that may trigger or aggravate suicidal behaviors, such as suicide attempts (SAs), which significantly increase the likelihood of future suicide. This cross-sectional study aims to assess risk factors for severe SAs and non-suicidal self-injury (NSSI) among Israel Defense Forces (IDF) soldiers. Data were retrieved from an IDF computerized self-harm surveillance database and were based on the criteria of the Columbia Suicide Severity Rating Scale (C-SSRS) and the Suicide Attempt Self-Injury Interview (SASII). The cohort included all 1,238 occurrences of self-harm behavior, during 2017-2021. Other investigated variables included adjustment difficulty (AD, as per IDF definition) and psychiatric diagnosis (PD) as reported by mental health officers (MHOs) during recruitment. Higher rates of adjustment difficulties were found among soldiers who had conducted NSSIs. Higher rates of previous psychiatric diagnoses were found among individuals with SAs, and their risk of dying by suicide during military service was twice as high (OR = 2.356; p < .001). If the latter also served in a combat unit, the risk was almost fourfold (OR = .3.860; p < .001). The current study demonstrates a clear difference between IDF soldiers who conduct NSSI vs. those conducting SA with regard to adjustment difficulty (as per IDF definition) and PD.
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Affiliation(s)
- Leah Shelef
- Department of Health and Well-Being, Medical Corps, Israeli Defense Forces, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- The School of Social Work, Sapir Academic College, D.N. Hof Ashkelon, Israel
| | - Ishai Nir
- Department of Health and Well-Being, Medical Corps, Israeli Defense Forces, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lucian Tatsa-Laur
- Department of Health and Well-Being, Medical Corps, Israeli Defense Forces, Ramat Gan, Israel
| | - Nirit Yavnai
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Niv Gold
- Department of Health and Well-Being, Medical Corps, Israeli Defense Forces, Ramat Gan, Israel
| | - Gadi Cohen
- Department of Health and Well-Being, Medical Corps, Israeli Defense Forces, Ramat Gan, Israel
| | - Ariel Ben Yehuda
- Department of Health and Well-Being, Medical Corps, Israeli Defense Forces, Ramat Gan, Israel
- Shalvata Mental Health Center, Clalit Health Services, Hod Hasharon, Israel
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Fox H, Preston TJ, Morabito D, Schmidt NB, Albanese BJ. The interactive effects of AS and trauma exposure on suicide capability and suicide risk. J Psychiatr Res 2023; 167:100-107. [PMID: 37862905 DOI: 10.1016/j.jpsychires.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 09/04/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Trauma exposure has been linked with heightened suicide risk purportedly through habituation to threatening stimuli, thereby reducing fear of suicide. However, no research has examined variables that may influence this process. Anxiety sensitivity (AS) is one cognitive-affective factor that may strengthen the relationship between trauma exposure and reduced fear of suicide by amplifying traumatic reactivity. The present study evaluated this by examining the interaction of AS and trauma exposure type (e.g., direct vs. witnessed) predicting fear of suicide and self-reported suicide risk. METHODS Participants (n = 124) were recruited for a long-term (∼3-4 years) follow-up after participation in a clinical trial targeting suicide risk factors and were asked to complete self-report measures of trauma history, AS, fear of suicide, and suicide risk. RESULTS Significant interactions emerged such that a greater number of direct traumasexperienced predicted lower fear of suicide and greater suicide risk among those with greater AS. The interactive effect of witnessed traumas and AS predicting suicidality was insignificant. Results remained even after including relevant covariates. DISCUSSION The current findings suggest that AS augments the effects of repeated trauma exposure on fear of suicide and suicide risk. It is plausible these painful and provocative events are more potent among those with high AS due to the amplification of traumatic affective responses, though future research examining the longitudinal relations is needed to confirm this process.
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Affiliation(s)
- Hailey Fox
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Thomas J Preston
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Danielle Morabito
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Brian J Albanese
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA.
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Samuels J, Bienvenu OJ, Krasnow J, Grados MA, Cullen BA, Goes FS, McLaughlin NC, Rasmussen SA, Fyer AJ, Knowles JA, McCracken JT, Geller D, Riddle MA, Piacentini J, Stewart SE, Greenberg BD, Nestadt G, Nestadt P. Prevalence and correlates of lifetime suicide attempt in obsessive-compulsive disorder with major depression. J Psychiatr Res 2023; 161:228-236. [PMID: 36940628 PMCID: PMC10149608 DOI: 10.1016/j.jpsychires.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Little is known about specific obsessive-compulsive clinical features associated with lifetime history of suicide attempt in individuals with obsessive-compulsive disorder (OCD) and major depression. METHODS The study sample included 515 adults with OCD and a history of major depression. In exploratory analyses, we compared the distributions of demographic characteristics and clinical features in those with and without a history of attempted suicide and used logistic regression to evaluate the association between specific obsessive-compulsive clinical features and lifetime suicide attempt. RESULTS Sixty-four (12%) of the participants reported a lifetime history of suicide attempt. Those who had attempted suicide were more likely to report having experienced violent or horrific images (52% vs. 30%; p < 0.001). The odds of lifetime suicide attempt were more than twice as great in participants with versus without violent or horrific images (O.R. = 2.46, 95%, CI = 1.45-4.19; p < 0.001), even after adjustment for other risk correlates of attempted suicide, including alcohol dependence, post-traumatic stress disorder, parental conflict, excessive physical discipline, and number of episodes of depression. The association between violent or horrific images and attempted suicide was especially strong in men, 18-29 year olds, those with post-traumatic stress disorder, and those with particular childhood adversities. CONCLUSIONS Violent or horrific images are strongly associated with lifetime suicide attempts in OCD-affected individuals with a history of major depression. Prospective clinical and epidemiological studies are needed to elucidate the basis of this relationship.
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Affiliation(s)
- Jack Samuels
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Janice Krasnow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marco A Grados
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bernadette A Cullen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicole C McLaughlin
- Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, Providence, RI, USA
| | - Steven A Rasmussen
- Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, Providence, RI, USA
| | - Abby J Fyer
- Department of Psychiatry, College of Physicians, Surgeons at Columbia University and the New York State Psychiatric Institute, New York City, New York, USA
| | - James A Knowles
- Department of Cell Biology, SUNY Downstate Medical Center College of Medicine, Brooklyn, NY, USA
| | - James T McCracken
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, School of Medicine, Los Angeles, CA, USA
| | - Dan Geller
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mark A Riddle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, School of Medicine, Los Angeles, CA, USA
| | - S Evelyn Stewart
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, USA
| | - Benjamin D Greenberg
- Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, Providence, RI, USA
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Moscardini EH, Pardue-Bourgeois S, Oakey-Frost DN, Powers J, Bryan CJ, Tucker RP. Suicide Cognitions Scale: Psychometric Support in a Community Sample Using Bifactor Modeling and Altered Item Content. Assessment 2023; 30:302-315. [PMID: 34654322 DOI: 10.1177/10731911211050894] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The Suicide Cognitions Scale (SCS) measures suicide-related beliefs proposed by the Fluid Vulnerability Theory. A recent investigation of a revised version of the SCS (i.e., SCS-R) which omits items explicitly referencing suicide has indicated that the measure is highly influenced by a general factor and may be useful for distinguishing severity levels of suicidal thoughts and behaviors; however, limited concurrent validity studies with a range of suicide-related experiences have been conducted. As such, this study replicated and extended previous psychometric research on the SCS-R in an online survey study with a community sample of N = 10,625 U.S. adults. Results confirmed the unidimensional structure of the SCS-R. Logistic regression analyses indicated that the total score of the SCS-R is useful in distinguishing varying levels of suicidal thoughts and behaviors such as past-month planning for suicide without attempt versus past-month suicide attempt. Implications and limitations are discussed.
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Affiliation(s)
| | | | | | | | - Craig J Bryan
- The Ohio State University Wexner Medical Center, Columbus, USA
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Balzen KM, Goette WF, Sachs R, Krantz SM, Heerschap J, Kennard BD, Emslie GJ, Stewart SM. Borderline personality features influence treatment response to suicide prevention. J Affect Disord 2022; 311:515-522. [PMID: 35623481 DOI: 10.1016/j.jad.2022.05.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 04/29/2022] [Accepted: 05/15/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Suicide is a notable risk for individuals with features of borderline personality disorder. Given the centrality of interpersonal difficulties in this disorder, we proposed that the negative interpersonal cognitions (perceived burdensomeness and thwarted belongingness) identified by the Interpersonal Theory of Suicide (IPTS) may explain the associations between suicidal ideation and borderline personality features. METHOD Participants were 322 suicidal youth (74% girls) aged 11-18 years (M, SD = 14.74, 1.6) in an intensive outpatient program in the southwest United States. Youth completed measures assessing borderline personality features at program entry, and suicidal ideation and IPTS variables at entry and exit. RESULTS Borderline personality features did not moderate associations of IPTS variables and suicidal ideation. For the entire sample, changes in suicidal ideation from entry to discharge occurred in tandem with changes in perceived burdensomeness and depressive symptoms, but not thwarted belongingness. Youth with elevated borderline personality features entered with greater suicidal ideation, but improved more from treatment entry to exit. Regardless of level of borderline personality features, changes in negative interpersonal cognitions over treatment were associated with changes in suicidal ideation. LIMITATIONS Self-report measures and lack of sample diversity are study limitations. CONCLUSIONS This research highlights the clinical utility of the IPTS variables and the importance of promoting competence and interpersonal connectedness when treating this population. Findings indicate that the IPTS variables carry the same fundamental information for contributing to suicidal ideation, regardless of level of borderline personality features.
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Affiliation(s)
- Kennedy M Balzen
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - William F Goette
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Raney Sachs
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Savannah M Krantz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Jessica Heerschap
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Division of Psychology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Department of Psychiatry, Children's Health Children's Medical Center, Dallas, TX, United States of America
| | - Betsy D Kennard
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Division of Psychology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Department of Psychiatry, Children's Health Children's Medical Center, Dallas, TX, United States of America
| | - Graham J Emslie
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Department of Psychiatry, Children's Health Children's Medical Center, Dallas, TX, United States of America
| | - Sunita M Stewart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Division of Psychology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Department of Psychiatry, Children's Health Children's Medical Center, Dallas, TX, United States of America.
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8
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Soberay KA, Cerel J, Brown MM, Maple M. An Examination of Suicide Exposure and Fearlessness about Death on Suicide Risk among Active Duty Service Members, Veterans, and Civilians. Arch Suicide Res 2022; 26:1198-1218. [PMID: 33465319 DOI: 10.1080/13811118.2020.1868365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Suicide exposure is associated with an increased risk for suicide. There is limited research on the mechanisms that increase this risk. This study aims to: (1) compare suicide exposure and associated variables in veteran, active duty, and civilian participants, (2) examine the extent to which fearlessness about death and suicide risk factors differ as a function of group membership and suicide exposure, and (3) determine the degree to which relationship to the decedent, perceived closeness, and reported impact of the death are associated with fearlessness about death and suicide-related outcomes. 1,533 participants were included, of whom 48% of active duty service members, 65% of veterans, and 58% of civilians reported knowing someone who died by suicide. A series of regressions were conducted. There were group differences by military service on the suicide exposure variables. Furthermore, there were significant main effects for military service group and suicide exposure on the outcome variables. In general, civilians reported greater suicide risk and active duty service members reported greater fearlessness about death. Fearlessness about death mediated the associations between perceived closeness and a history of suicide attempts. The loss of a military colleague to suicide was found to be unique and distinguishable from other important relationships. Results suggest the need to consider suicide exposure and closeness as salient variables associated with fearlessness about death and suicide risk factors. Inquiring about suicide exposure, closeness to the decedent, fearlessness about death, and beyond familial losses to suicide may indicate important avenues of intervention.
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9
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Wingman-Connect Program increases social integration for Air Force personnel at elevated suicide risk: Social network analysis of a cluster RCT. Soc Sci Med 2022; 296:114737. [DOI: 10.1016/j.socscimed.2022.114737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/15/2021] [Accepted: 01/19/2022] [Indexed: 11/23/2022]
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Blain RC, Pukay-Martin ND, Martin CE, Dutton-Cox CE, Chard KM. Residential Cognitive Processing Therapy Decreases Suicidality by Reducing Perceived Burdensomeness in Veterans with Posttraumatic Stress Disorder. J Trauma Stress 2021; 34:1199-1208. [PMID: 33128808 DOI: 10.1002/jts.22618] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/15/2020] [Accepted: 09/13/2020] [Indexed: 12/21/2022]
Abstract
The interpersonal theory of suicide (Joiner, 2005) may help explain high suicide rates among veterans with posttraumatic stress disorder (PTSD). It suggests that suicidal ideation results from believing that one is a burden on others (i.e., perceived burdensomeness) and does not belong among family, friends, or other social groups (i.e., thwarted belongingness). Evidence-based PTSD treatments, including cognitive processing therapy (CPT), decrease suicidal ideation, potentially through changes in these two theory constructs. The current study examined whether (a) changes in PTSD severity and suicidal ideation and (b) changes in negative cognitions about self and suicidal ideation were indirectly associated through changes in perceived burdensomeness and thwarted belongingness across PTSD treatment. Participants (N = 107) were veterans in a residential treatment program who were diagnosed with full or subthreshold PTSD and received CPT. Changes in PTSD symptom severity and negative cognitions about self predicted changes in suicidal ideation, B = 0.18, p < .001 and B = 0.50, p < .001, respectively. Changes in PTSD symptom severity and negative cognitions about self were indirectly associated with suicidal ideation through changes in perceived burdensomeness, B = 0.16, 95% CI [0.07, 0.25]; B = 0.27, 95% CI [0.05, 0.50], but not thwarted belongingness, B = -0.002; 95% CI [-0.06, 0.06]; B = 0.06, 95% CI [-0.12, 0.21] in separate models. These findings suggest that residential CPT may be uniquely equipped to decrease suicidality by restructuring negative beliefs, including perceptions of being a burden on others, and/or by alleviating the objective burden of PTSD.
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Affiliation(s)
- Rachel C Blain
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA
| | | | - Colleen E Martin
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA
| | | | - Kathleen M Chard
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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11
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Lyons VH, DeCou CR, Niehoff E, Moore M, Rivara FP, Rowhani-Rahbar A. Life experiences preceding high lethality suicide attempts in adolescents at a level I regional trauma center. Suicide Life Threat Behav 2021; 51:836-843. [PMID: 33665874 DOI: 10.1111/sltb.12740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/31/2020] [Accepted: 01/04/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe life experiences associated with patterns of medically treated and documented self-directed violence among youth who attempted suicide using highly lethal means to understand precipitating factors among youth using such lethal means. METHOD Using data from a regional, level 1 Trauma center, we identified all youth suicide attempt survivors who received treatment from 2010 to 2018 for a suicide attempt with a firearm, hanging, or jump from height injury (n = 42). We described differences in patient demographics and life experiences associated with patterns of self-directed violence by suicide attempt mechanism. We additionally assessed mechanisms used in any prior suicide attempts to identify potential increasing lethality of mechanism selection. RESULTS There were 42 eligible patients included, of whom 40.5% attempted suicide with a firearm, 26.2% with hanging, 33.3% with jumping injury. A greater proportion of patients with firearm injuries endorsed social support and had fewer preparatory acts, history of self-harming behavior, prior suicide behaviors, and fewer prior attempts compared to patients who attempted suicide with other mechanisms. CONCLUSIONS Given our findings, means safety should remain a key strategy to prevent highly lethal suicidal behavior among adolescents, especially with firearms, given that such attempts may occur prior to formal contact with mental health services.
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Affiliation(s)
- Vivian H Lyons
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA.,Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
| | - Christopher R DeCou
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Elizabeth Niehoff
- Massachusetts General Hospital, Cancer Center Protocol Office, Boston, MA, USA
| | - Megan Moore
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,School of Social Work, University of Washington, Seattle, WA, USA
| | - Frederick P Rivara
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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12
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Keefner TP, Stenvig T. Rethinking Suicide Risk With a New Generation of Suicide Theories. Res Theory Nurs Pract 2021; 34:389-408. [PMID: 33199410 DOI: 10.1891/rtnp-d-19-00128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Suicide is a global concern to nurses and other health-care providers. However, deaths by suicide are only part of the spectrum of suicide, as suicidal thinking and behaviors may precede a suicide attempt. Theoretical models are used infrequently in research to explain how the individual progresses from suicidal ideation to a suicide attempt. Thus, there is a critical need to advance the study of suicide with useful theoretical models to describe and explain processes whereby suicidal thoughts transition to attempts and to suicide. PURPOSE This article provides a conceptual discussion and scoping review comparing historical and contemporary ideation-to-action theories of suicide. METHOD Systematic reviews and meta-analyses from three databases (CINAHL, JSTOR, and PsychINFO) were reviewed to find literature describing suicide theories. RESULTS Historically, theory applications have limited capacity to differentiate between those individuals with suicidal ideations and those who attempt suicide. Newer theories, grounded in the ideation-to-action framework, propose distinct processes explaining what moves an individual from suicidal ideations toward suicidal behaviors. IMPLICATIONS FOR PRACTICE The ideation-to-action theories can guide health-care providers' assessment of at-risk individuals beyond merely asking about suicidal thinking. CONCLUSION The new generation of suicide theories suggest that suicidal ideations are only one component of risk. The common factor in ideation-to-action theories that distinguishes ideators from attempters is the acquired capability for suicide.
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Affiliation(s)
- Tamara P Keefner
- College of Nursing, South Dakota State University, Brookings, South Dakota
| | - Thomas Stenvig
- College of Nursing, South Dakota State University, Brookings, South Dakota
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13
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Bauer BW, Gai AR, Joiner TE, Capron DW. The Frequency and Subjective Impact of Painful and Provocative Events on the Acquired Capability for Suicide. Arch Suicide Res 2021; 25:715-729. [PMID: 32336213 DOI: 10.1080/13811118.2020.1756017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Leading theoretical explanations for suicide state that for suicide death to occur, a person must have sufficient capability to enact an attempt. Exposure to painful and provocative events is hypothesized to play an important role in acquiring the capability for suicide over a lifetime. Unfortunately, assessment tools for painful and provocative events have focused solely on the frequency of events, neglecting the potential contributions of perceived impact. Further, past measurements have used predetermined items for painful and provocative events thereby neglecting other relevant events. The current study uses visual analog scales (VAS) to assess both the frequency and impact of painful and provocative events and how these contribute to the capability for suicide. METHOD Data were collected from 787 adults via Amazon's online platform. RESULTS Findings indicated that the frequency VAS and impact VAS both had a moderate correlation with the original Painful and Provocative Events Scale. Greater scores on the frequency VAS were associated with increased capability, whereas lower scores on the subjective impact VAS were associated with increased capability scores. Both VAS independently predicted capability above and beyond the PPES. LIMITATIONS Temporal or causal associations are unable to be drawn due to cross-sectional data. In addition, the sample was largely homogenous (White = 72%, female = 63.5%), limiting generalizability. CONCLUSIONS These initial findings demonstrate individuals who perceive painful and provocative events as being less impactful may have increased capability, and that VAS may be appropriate to approximate the impact and frequency of painful and provocative events.
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Nordmo M, Hystad SW, Sanden S, Johnsen BH. Mental Health During Naval Deployment: The Protective Role of Family Support. Mil Med 2021; 185:e703-e710. [PMID: 31838503 DOI: 10.1093/milmed/usz436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Minor mental health problems among service members deployed in combat areas are relatively common, but social support is a protective factor. With the advent of digital communication, as well as more frequent family separations, a stable family support system may be more important than before. In this exploratory study, we aimed to test the relationship between perceived family support and the development of minor psychiatric symptoms during a 4-month naval counter piracy mission in the Gulf of Aden. MATERIALS AND METHODS We measured minor mental health problems with the general health questionnaire 12 (GHQ-12) and family support at three intervals, 3 weeks before deployment, 2 months into the mission, and at the end of deployment. We used mixed multilevel regression analysis to analyze the main effects of family support and time, as well as their interaction. All analyses were controlled for military rank. RESULTS We found that minor psychiatric symptoms increased at both midway (B = 0.51, P < 0.05) and toward the end of the mission (B = 0.72, P < 0.01). The results also showed that receiving more family support is associated with fewer psychiatric symptoms (B = -0.87, P < 0.01). Family support also moderated the development of symptoms toward the end of the mission (B = -0.73, P < 0.01). The buffering effect was such that service members with a high degree of family support experienced no increase in minor psychiatric symptoms during the deployment. CONCLUSIONS The results indicate that naval deployment is associated with a small increase in minor mental health problems and that having a high degree of family support buffers this effect. Efforts to increase support among military families may positively influence the wellbeing of naval sailors during combat missions.
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Affiliation(s)
- Morten Nordmo
- Department of Psychosocial Science, University of Bergen, Norway
| | | | | | - Bjørn Helge Johnsen
- Department of Psychosocial Science, University of Bergen, Norway.,Royal Norwegian Navy, Naval Medicine Center, Norway
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Förtsch EMAD, Baumgart P, Teismann T, Ruscheweyh R, Hasenbring MI. No game, more pain - Examining possible long term effects and underlying mechanisms of habitual violent video gaming on the acquired capability for suicide. Psychiatry Res 2021; 295:113512. [PMID: 33213935 DOI: 10.1016/j.psychres.2020.113512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
According to Joiner`s interpersonal-psychological theory of suicide repeated engagement in suicidal behavior or so-called painful and provocative events constitutes the acquired capability for suicide (ACS) comprising two facets: enhanced pain tolerance and fearlessness about death (FAD). Recent research showed that single bouts of violent-video-gaming (VVG) increase pain tolerance. It is unknown whether individuals who habitually play VVGs at a high frequency rate show higher signs of ACS in terms of low pain sensitivity, high tolerance and lowered FAD compared to non-gamers. In a cross-sectional case-control study, we compared pain sensitivity and tolerance during a 5-min Cold-Pressor-Test (CPT) besides FAD in young males, playing VVGs highly frequent (n = 18) vs. non-gamers (n = 17). Mood was rated before and after the CPT. We found higher CPT-pain tolerance, lower intensity ratings and higher FAD scores among gamers compared to non-gamers. A significant time x group interaction of pain ratings indicated a process of habituation in the gamers. An increase of positive mood in the gamers emphasizes the role of opponent processes. The results suggest that habitual VVG might reflect a repetitive behavior enhancing the ACS.
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Affiliation(s)
- E-M A D Förtsch
- Department of Medical Psychology and Sociology, Faculty of Medicine, Ruhr-University of Bochum, Universitätsstr. 150, 44780 Bochum, Germany.
| | - P Baumgart
- Department of Medical Psychology and Sociology, Faculty of Medicine, Ruhr-University of Bochum, Universitätsstr. 150, 44780 Bochum, Germany
| | - T Teismann
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Ruhr University of Bochum, Bochum, Germany
| | - R Ruscheweyh
- Department of Neurology, Ludwig Maximilians University Munich, Munich, Germany
| | - M I Hasenbring
- Department of Medical Psychology and Sociology, Faculty of Medicine, Ruhr-University of Bochum, Universitätsstr. 150, 44780 Bochum, Germany
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16
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Nichter B, Hill M, Norman S, Haller M, Pietrzak RH. Impact of specific combat experiences on suicidal ideation and suicide attempt in U.S. military veterans: Results from the National Health and Resilience in Veterans Study. J Psychiatr Res 2020; 130:231-239. [PMID: 32846327 DOI: 10.1016/j.jpsychires.2020.07.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/01/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND A burgeoning body of research suggests that specific types of combat experiences may be a stronger predictor of suicidality among veterans than a history of combat exposure itself. To date, however, little population-based data exist about these associations in representative samples of veterans. This study examined the association between overall severity of combat exposure and specific combat experiences with suicidal ideation and suicide attempt(s) (SI/SA) in a nationally representative sample of combat veterans. METHODS Data were from the National Health and Resilience in Veterans Study, a nationally representative survey of U.S. combat veterans (n = 1100). Analyses (a) compared veterans with/without current SI and lifetime SA on sociodemographic, military, and clinical characteristics; and (b) examined associations between overall combat exposure and specific combat experiences, and SI/SA. RESULTS Hierarchical regression analyses revealed that overall combat exposure was positively, albeit weakly, associated with SI/SA, after adjusting for sociodemographic characteristics and lifetime trauma burden [odds ratios (ORs) = 1.02-1.03]. Combat experiences involving direct exposure to death, killing, or grave injury were independently associated with SI/SA (ORs = 1.46-1.70), whereas several general combat experiences (e.g., combat patrols) were negatively associated with SI/SA (ORs = 0.44-0.65). DISCUSSION Results indicate that U.S. combat veterans who have witnessed others be killed or wounded in combat are at substantially higher risk for SI/SA relative to those without such histories. Collectively, findings suggest that combat exposure, when examined as an aggregate severity measure, may yield a poor prognostication of suicide risk, as it may be insufficiently sensitive to detect the effects of specific combat-related experiences.
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Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, University of California, San Diego, CA, USA.
| | - Melanie Hill
- Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Sonya Norman
- Department of Psychiatry, University of California, San Diego, CA, USA; National Center for PTSD, White River Junction, VT, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Moira Haller
- Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, 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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Raines AM, Allan NP, Franklin CL, Huet A, Constans JI, Stecker T. Correlates of Suicidal Ideation and Behaviors Among Former Military Personnel Not Enrolled in the Veterans Health Administration. Arch Suicide Res 2020; 24:517-533. [PMID: 33250005 DOI: 10.1080/13811118.2019.1660286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The current study sought to explore suicidal concomitants, both demographic and psychological, among former military personal. The sample included 645 veterans who are at increased risk for suicide but have not yet pursued Veterans Health Administration (VHA) services. Descriptive statistics revealed that these veterans are primarily young Caucasian males who served in the U.S. Army. In terms of psychological characteristics, the current sample reported clinically significant levels of depression, post-traumatic stress, and insomnia. Furthermore, respondents acknowledged use of various substances and high levels of perceived burdensomeness and thwarted belongingness. The demographic and psychological makeup of our sample was somewhat similar to that of VHA-connected veterans except that our sample was slightly more educated and reported less physical pain.
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18
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Chu C, Zuromski KL, Bernecker SL, Gutierrez PM, Joiner TE, Liu H, Naifeh JA, Stein MB, Ursano RJ, Nock MK. A test of the interpersonal theory of suicide in a large, representative, retrospective and prospective study: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Behav Res Ther 2020; 132:103688. [PMID: 32731055 PMCID: PMC10351027 DOI: 10.1016/j.brat.2020.103688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/28/2020] [Accepted: 06/19/2020] [Indexed: 11/28/2022]
Abstract
The interpersonal theory of suicide hypothesizes that perceived burdensomeness, thwarted belongingness, and hopelessness lead to active suicidal thoughts and individuals with active suicidal thoughts and elevated capability for suicide are most likely to attempt suicide. We retrospectively and prospectively tested this theory in a large sample of 7677 U.S. Army soldiers followed post-deployment for up to nine months. The interaction of perceived burdensomeness and hopelessness (OR = 2.59) was significantly associated with lifetime suicidal thoughts; however, the interactions of thwarted belongingness and perceived burdensomeness and of thwarted belongingness and hopelessness were not. Consistent with the theory, capability for suicide prospectively predicted suicide attempts during and following deployment (OR = 1.22); however, among soldiers reporting lifetime suicidal thoughts, capability did not predict attempts, only perceived burdensomeness did (OR = 1.36). Results supported some, but not all, theory hypotheses, suggesting that additional constructs may be needed to better identify the psychological factors that lead soldiers to attempt suicide.
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Affiliation(s)
- Carol Chu
- Department of Psychology, Harvard University, Cambridge, MA, USA.
| | - Kelly L Zuromski
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | | | - Peter M Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA; University of Colorado School of Medicine, Department of Psychiatry, Aurora, CO, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Howard Liu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - James A Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine in Bethesda, MD, USA
| | - Murray B Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine in Bethesda, MD, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
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19
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Lear MK, Penzenik ME, Forster JE, Starosta A, Brenner LA, Nazem S. Characteristics of nonsuicidal self-injury among veterans. J Clin Psychol 2020; 77:286-297. [PMID: 32662073 DOI: 10.1002/jclp.23027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/23/2020] [Accepted: 06/11/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The current study aimed to (a) assess basic nonsuicidal self-injury (NSSI) characteristics using a validated clinical interview among a sample of veterans not recruited for specific diagnostic or environmental criteria and (b) examine the relation between NSSI and medical severity of prior suicide attempts (SAs) among veterans. DESIGN We conducted secondary data analyses among a combined sample of veterans (N = 165) from two parent studies conducted at a large VA Medical Center that implemented identical recruitment protocols. No psychiatric criteria were utilized for inclusion or exclusion purposes. RESULTS Approximately 16% of participants reported NSSI history and almost 21% reported SA history. NSSI history was associated with probability of prior SA but not the medical severity of prior SA. CONCLUSIONS NSSI is a prevalent concern among veterans and is associated with probability of SA. It remains unclear whether prior NSSI is associated with more medically serious SA in this population.
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Affiliation(s)
- Mary K Lear
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, Oregon, USA
| | - Molly E Penzenik
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amy Starosta
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarra Nazem
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
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20
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Kramer EB, Gaeddert LA, Jackson CL, Harnke B, Nazem S. Use of the acquired capability for suicide scale (ACSS) among United States military and Veteran samples: A systematic review. J Affect Disord 2020; 267:229-242. [PMID: 32217223 DOI: 10.1016/j.jad.2020.01.153] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/26/2019] [Accepted: 01/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Military personnel and Veterans are at increased risk for suicide. Theoretical and conceptual arguments have suggested that elevated levels of acquired capability (AC) could be an explanatory factor accounting for this increased risk. However, empirical research utilizing the Acquired Capability for Suicide Scale (ACSS) in military populations has yielded mixed findings. METHODS To better ascertain what factors are associated with AC, and whether methodological limitations may be contributing to mixed findings, a systematic review was conducted. RESULTS A total of 31 articles utilized the ACSS to examine factors associated with AC, including combat history, in United States (U.S.) military personnel and Veterans. Nearly all studies (96.8%) were rated high risk of bias. Use of the ACSS varied, with seven different iterations utilized. Nearly all studies examined correlations between the ACSS and sample characteristics, mental health and clinical factors, Interpersonal Theory of Suicide constructs, and/or suicide-specific variables. Results of higher-level analyses, dominated by cross-sectional designs, often contradicted correlational findings, with inconsistent findings across studies. LIMITATIONS Included studies were non-representative of all U.S. military and Veteran populations and may only generalize to these populations. CONCLUSIONS Due to the high risk of bias, inconsistent use of the ACSS, lack of sample heterogeneity, and variability in factors examined, interpretation of current ACSS empirical data is cautioned. Suggestions for future research, contextualized by these limitations, are discussed.
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Affiliation(s)
- Emily B Kramer
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Building G3, Room 189, Aurora, CO 80045, USA
| | - Laurel A Gaeddert
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Building G3, Room 189, Aurora, CO 80045, USA
| | - Christine L Jackson
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Building G3, Room 189, Aurora, CO 80045, USA
| | - Ben Harnke
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, 12950 E. Montview Blvd., MS A003, Aurora, CO 80045, USA
| | - Sarra Nazem
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Building G3, Room 189, Aurora, CO 80045, USA; Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado Anschutz School of Medicine, 13001 E. 17th Place, Room C2000C, Aurora, CO 80045, USA.
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21
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Hill RM, Katusic M. Examining suicide risk in individuals with autism spectrum disorder via the interpersonal theory of suicide: clinical insights and recommendations. CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2020.1741360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ryan M. Hill
- Department of Pediatrics, Baylor College of Medicine & Texas Children’s Hospital, Houston, TX, USA
| | - Maja Katusic
- Department of Pediatrics, Baylor College of Medicine & Texas Children’s Hospital, Houston, TX, USA
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22
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A randomized clinical trial investigating perceived burdensomeness as a mediator of brief intervention effects on posttraumatic stress symptoms. J Affect Disord 2020; 262:344-349. [PMID: 31740111 PMCID: PMC6917918 DOI: 10.1016/j.jad.2019.11.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/25/2019] [Accepted: 11/09/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is a prevalent and impairing condition that often involves difficulties with interpersonal functioning. Targeting interpersonal difficulties may be a promising alternative approach to reducing PTSD symptoms, particularly given the relatively low rates of treatment engagement and efficacy for first-line treatments for PTSD. Recent research has identified perceived burdensomeness (i.e., feelings of being a burden on others) and thwarted belongingness (i.e., feeling isolated and as if one does not belong) as two specific interpersonal factors related to increased PTSD symptoms. Thus, the current study tested whether a brief, computerized intervention would reduce PTSD symptoms via reductions in perceived burdensomeness and thwarted belongingness, vs. a repeated contact control condition. METHOD Hypotheses were tested among 250 trauma-exposed participants who were randomized to receive one of two active computerized interventions designed to target interpersonal factors (i.e., perceived burdensomeness or thwarted belongingness) or anxiety sensitivity, or participate in a repeated contact control condition, as part of a larger randomized clinical trial. Participants were then followed over six-months. RESULTS Results indicated a direct effect of the active interventions on PTSD symptoms at month-one, that was not detected at months three or six. However, there was a significant indirect effect of condition at all-time points, such that reductions in perceived burdensomeness mediated condition effects on PTSD symptoms. CONCLUSIONS Findings identify perceived burdensomeness as a potential etiological factor in the maintenance of PTSD symptoms, and suggest that targeting perceived burdensomeness may be an effective approach to reducing PTSD symptoms.
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Fadoir NA, Kuhlman STW, Smith PN. Suicide Risk and Restricted Emotions in Women: The Diverging Effects of Masculine Gender Norms and Suicide Capability. Arch Suicide Res 2020; 24:S323-S339. [PMID: 31199205 DOI: 10.1080/13811118.2019.1599480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study investigated whether gender moderated the association between masculine socialization pressures of restrictive emotionality and suicide risk through suicide capability (i.e., fearlessness about death). A sample of inpatients admitted for recent suicidality (n = 194) completed validated measures of restrictive emotionality, fearlessness about death, and current suicide risk. A moderated mediation effect was found opposite the hypothesized direction: fearlessness about death mediated the relationship between endorsement of the masculine gender norm of restrictive emotionality and suicide risk in women, but not men. Gender did not moderate the association between restrictive emotionality and fearlessness about death. The diverging gender effects suggest that the masculine gender norm of restrictive emotionality is associated with suicide capability in men and women, while acquired fearlessness about death is more informative of risk for suicide in women than men.
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24
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Martin RL, Assavedo BL, Bryan AO, Green BA, Capron DW, Rudd MD, Bryan CJ, Anestis MD. The Relationship between Post-Battle Experiences and Thwarted Belongingness and Perceived Burdensomeness in Three United States Military Samples. Arch Suicide Res 2020; 24:156-172. [PMID: 30300101 DOI: 10.1080/13811118.2018.1527266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Suicide rates within the military are elevated relative to the general population; however, research suggests that many of the suicide risk factors for military personnel are similar to the suicide risk factors for civilians. Given that many military specific experiences (e.g., number of deployments) are not considered robust predictors of either suicidal ideation or behavior, it has been posited that deployment specific experiences (e.g., post-battle experiences) may be better able to explain the increased rates of suicide among military personnel. Therefore, the current study aimed to examine the relationship between post-battle experiences and perceived burdensomeness (PB), thwarted belongingness (TB), and suicidal ideation within 3 different military samples: a non-clinical sample of Army National Guard personnel, a non-clinical sample of active duty U.S. Air Force Security Forces personnel, and a clinical sample of U.S. Army personnel receiving outpatient treatment. Post-battle experiences were found to be significantly associated with TB in both non-clinical samples; however, the association between post-battle experiences and TB was non-significant within the clinical sample. Furthermore, results indicated that post-battle experiences were not significantly associated with either PB or suicidal ideation in any of the samples. These findings suggest that in non-clinical samples, post-battle experiences impact a soldier's ability to feel connected to others. Within clinical samples, results indicate that post-battle experiences may not be a direct contributor to either PB or TB. These results indicate a need for universal intervention promoting interpersonal support of military personnel and their families prior to development of further need for psychological interventions. This upstream approach may decrease further development of TB and potentially prevent suicidal desire.
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Aboussouan A, Snow A, Cerel J, Tucker RP. Non-suicidal self-injury, suicide ideation, and past suicide attempts: Comparison between transgender and gender diverse veterans and non-veterans. J Affect Disord 2019; 259:186-194. [PMID: 31446379 DOI: 10.1016/j.jad.2019.08.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/10/2019] [Accepted: 08/17/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transgender and gender diverse (TGD) individuals, especially veterans, experience elevated rates of non-suicidal self-injury (NSSI) and suicide related behaviors compared to gender majority individuals. Research has yet to compare TGD veterans to non-veterans or look at correlates of NSSI and related behaviors to suicide related outcomes. This study examines prevalence and suicide related correlates of NSSI among TGD veterans and TGD non-veterans. METHOD Data analyzed in the were part of the Trans Lifeline Mental Health Survey. Both TGD veterans (N = 313) and non-veterans (N = 3,972) completed an online, cross-sectional survey that included self-report measures of NSSI, suicidal ideation (SI), and suicidal attempt (SA) along with lifetime hospitalization and avoidance of care due to NSSI. RESULTS Results of this paper indicate that prevalence of NSSI, SI, and SA are elevated in both the TGD veterans and non-veteran subpopulations. Further, veterans compared to non-veterans have a lower prevalence of NSSI but higher prevalence of hospitalization when self-harm is inflicted, reflecting more healthcare utilization or increased severity of NSSI episodes. Additionally, veterans were less likely to avoid care due to NSSI. Further, veteran status seemed to be a protective factor against demographic differences that increased rates of NSSI history in non-veteran TGD individuals. LIMITATIONS The limitations of this study include its cross-sectional study design, one question assessing SA, and few TGD male veterans. CONCLUSION NSSI is an important risk factor in future suicide related outcome such as SI and SA. Further, differences in healthcare utilization among TGD veterans and non-veterans are apparent.
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Affiliation(s)
- Alix Aboussouan
- Louisiana State University, 216 Audubon, Baton Rouge, LA 70803, United States.
| | | | | | - Raymond P Tucker
- Louisiana State University, 216 Audubon, Baton Rouge, LA 70803, United States
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26
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Anestis MD, Tull MT, Butterworth SE, Richmond JR, Houtsma C, Forbes CN, Gratz KL. The Role of Opioid Use in Distinguishing between Suicidal Ideation and Attempts. Suicide Life Threat Behav 2019; 49:1680-1692. [PMID: 31141194 DOI: 10.1111/sltb.12557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/29/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Opioid use disorders are associated with heightened suicidal ideation, suicide attempts, and suicide death. This study aimed to examine the extent to which opioid differentiates between those with suicide attempts from those with lifetime suicidal ideation but no history of attempt. METHODS Participants were drawn from the US National Guard and a residential substance use treatment facility. Multinomial logistic regression was utilized to determine the extent to which a lifetime history of nonmedical opioid use differentiated between (1) individuals with no lifetime history of suicidal ideation or attempt, (2) individuals with a history of suicidal ideation but no attempt, and (3) individuals with a history of at least one suicide attempt. RESULTS History of opioid use among National Guard personnel and opioid use disorders among substance-dependent patients were associated with an increased likelihood of having at least one suicide attempt relative to both a history of suicidal ideation but no attempts and no history of ideation or attempts. Findings held when accounting for lifetime nonmedical use of other substances and the presence of other lifetime substance use disorders. CONCLUSIONS Results highlight the importance of assessing for suicide risk among opioid users.
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Affiliation(s)
- Michael D Anestis
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Sarah E Butterworth
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | | | - Claire Houtsma
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | | | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA
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27
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Martin RL, Bauer BW, Ramsey KL, Green BA, Capron DW, Anestis MD. How Distress Tolerance Mediates the Relationship Between Posttraumatic Stress Disorder and the Interpersonal Theory of Suicide Constructs in a U.S. Military Sample. Suicide Life Threat Behav 2019; 49:1318-1331. [PMID: 30368865 DOI: 10.1111/sltb.12523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/26/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Despite the general suicide rate within the military being comparable to the general population when comparing peers, there are certain branches of the military that have elevated risk. Specifically, the U.S. National Guard has suicide rates that are constantly higher than other military branches and civilian peers. The National Guard are a unique military population in which they frequently transition between military and civilian life. With these unique experiences and heightened risk, military suicide prevention efforts may benefit from further research within this population. Posttraumatic stress disorder (PTSD) is another concern amongst military personnel and has been linked to suicidal behavior. METHODS The current study examined the indirect effects that distress tolerance, a protective factor against suicide, has on the relationship between PTSD and constructs within a well-validated theory for suicide (the Interpersonal-Psychological Theory for suicidal behaviors) in a sample of U.S. Army National Guard personnel. RESULTS Results indicated that distress tolerance had a significant indirect effect on the relationship between PTSD and thwarted belongingness, perceived burdensomeness, and capability for suicide. CONCLUSIONS These findings are consistent with previous literature examining the relationship between distress tolerance and our outcome variables. These results could have important clinical implications, mainly that intervention strategies targeting distress tolerance could have significant impacts on suicide-relate thoughts.
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Affiliation(s)
- Rachel L Martin
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Brian W Bauer
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Kathleen L Ramsey
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Bradley A Green
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Daniel W Capron
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Michael D Anestis
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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Baer MM, LaCroix JM, Browne JC, Hassen HO, Perera KU, Weaver J, Soumoff A, Ghahramanlou-Holloway M. Lack of Emotional Awareness is Associated with Thwarted Belongingness and Acquired Capability for Suicide in a Military Psychiatric Inpatient Sample. Suicide Life Threat Behav 2019; 49:1395-1411. [PMID: 30457162 DOI: 10.1111/sltb.12530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 09/17/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To examine potential links between facets of impulsivity and emotion dysregulation to components of the Interpersonal-Psychological Theory of Suicide (thwarted belongingness, perceived burdensomeness, and acquired capability) among U.S. military personnel. METHOD The current study performed secondary data analysis from a randomized control trial testing the efficacy of a cognitive therapy for 134 service members (71.64% male, 68.66% Caucasian; mean age: 30.14) admitted to a psychiatric inpatient unit for a suicide-related crisis. We utilized the Difficulties in Emotion Regulation Scale, the Barratt Impulsivity Scale, the Acquired Capability for Suicide Scale, and the Interpersonal Needs Questionnaire. RESULTS All emotion dysregulation dimensions and one impulsivity facet (attentional) were positively correlated with perceived burdensomeness and thwarted belongingness. Lack of emotional awareness was positively associated with acquired capability. After controlling for depression, hopelessness, and demographic covariates, lack of emotional awareness was significantly associated with both thwarted belongingness and acquired capability, but not perceived burdensomeness, and impulsivity dimensions did not link to any variable of interest. CONCLUSIONS Findings imply that individuals with reduced emotional awareness may have difficulty cultivating interpersonal bonds and be more vulnerable to elevated acquired capability. Lack of emotional awareness may be a potential contributor to both suicidal desire and capability.
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Affiliation(s)
- Margaret M Baer
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jessica M LaCroix
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Joy C Browne
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Helena O Hassen
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Kanchana U Perera
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Alyssa Soumoff
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Marjan Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Bauer BW, Martin RL, Allan NP, Fink-Miller EL, Capron DW. An Investigation into the Acquired Capability for Suicide. Suicide Life Threat Behav 2019; 49:1105-1118. [PMID: 30091246 DOI: 10.1111/sltb.12502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 07/11/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The acquired capability for suicide (ACS) is one of the most important breakthroughs in suicide research. ACS refers to an individual's increased fearlessness about death over time from experiencing painful and provocative events (PPE) and is based on opponent-process theory-a habituation model. Few studies have investigated how ACS develops and found that ACS remained relatively stagnant. METHOD This study sought to expand these findings by observing how ACS develops in two cross-sectional data sets involving high-risk nonclinical samples of physicians (n = 419) and veterinary students (n = 124). Participants completed online questionnaires assessing both general PPEs (e.g., witnessing abuse) and job-specific PPEs (e.g., exposure to euthanasia), as well as ACS. RESULTS Our results partially replicated prior findings indicating that more PPEs do not significantly affect ACS. CONCLUSIONS Limitations of this study include the use of cross-sectional data and self-report measures. These results, in combination with existing models of habituation, suggest ACS may not progress linearly.
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Affiliation(s)
- Brian W Bauer
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Rachel L Martin
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | | | | | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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Lear MK, Kozina RM, Stacy SE, Clapp JD, Pepper CM. Interpersonal needs and suicide risk: The moderating roles of sex and brooding. J Clin Psychol 2019; 75:1572-1584. [DOI: 10.1002/jclp.22800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 09/12/2018] [Accepted: 11/28/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Mary K. Lear
- Department of PsychologyUniversity of WyomingLaramie Wyoming
| | - Ryan M. Kozina
- Department of PsychologyUniversity of WyomingLaramie Wyoming
| | | | - Joshua D. Clapp
- Department of PsychologyUniversity of WyomingLaramie Wyoming
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Smith PN, Schuler K, Fadoir N, Marie L, Basu N. Socio-ecological context and the interpersonal theory of suicide: A response to hjelmeland & knizek. DEATH STUDIES 2019; 44:547-551. [PMID: 30940051 DOI: 10.1080/07481187.2019.1586799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The current paper is a response to Hjelmeland & Knizek's critique of the interpersonal theory of suicide. These authors raise a number of important points that have the potential to advance the understanding and prevention of suicide. However, the authors' message becomes lost in a series of errors in logic and misinterpretations of the theory. We attempt to clarify these errors and add some of our own ideas about how the theory and science examining it can be advanced.
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Affiliation(s)
- Phillip N Smith
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Kaitlyn Schuler
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Nicholas Fadoir
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Laura Marie
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Natasha Basu
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
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Bottomley JS, Abrutyn S, Smigelsky MA, Neimeyer RA. Exposure to Nonfatal Suicidal Behavior: Examining Pathways to Suicide Risk Using the Interpersonal-Psychological Theory of Suicide (IPTS). JOURNAL OF LOSS & TRAUMA 2019. [DOI: 10.1080/15325024.2019.1565107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Seth Abrutyn
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Melissa A. Smigelsky
- Mental Health and Chaplaincy Program, Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, USA
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33
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DeCou CR, Kaplan SP, Spencer J, Lynch SM. Trauma-Related Shame, Sexual Assault Severity, Thwarted Belongingness, and Perceived Burdensomeness Among Female Undergraduate Survivors of Sexual Assault. CRISIS 2019; 40:134-140. [DOI: 10.1027/0227-5910/a000549] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background and Aim: This study evaluated trauma-related shame as a mediator of the association between sexual assault severity and perceived burdensomeness and thwarted belongingness. Method: A total of 164 female undergraduates who reported attempted or completed sexual assault completed self-report measures of sexual assault, trauma-related shame, perceived burdensomeness, and thwarted belongingness. Results: Using path analysis, trauma-related shame mediated the association between sexual assault severity and perceived burdensomeness, and between sexual assault severity and thwarted belongingness. Limitations: The findings of this study are limited by the retrospective, self-report, and cross-sectional nature of these data, and do not allow for causal inference. Conclusion: Trauma-related shame warrants additional investigation as a mechanism that explains the association between sexual assault and psychosocial risk factors for suicidal ideation and behavior.
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Affiliation(s)
- Christopher R. DeCou
- Department of Psychiatry and Behavioral Sciences, University of Washington, School of Medicine, Seattle, WA, USA
- Department of Psychology, Idaho State University, Pocatello, ID, USA
| | | | - Julie Spencer
- Department of Psychology, Idaho State University, Pocatello, ID, USA
| | - Shannon M. Lynch
- Department of Psychology, Idaho State University, Pocatello, ID, USA
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Peterson AL, Baker MT, Moore CBA, Hale WJ, Joseph JS, Straud CL, Lancaster CL, McNally RJ, Isler WC, Litz BT, Mintz J. Deployed Military Medical Personnel: Impact of Combat and Healthcare Trauma Exposure. Mil Med 2019; 184:e133-e142. [PMID: 29931192 DOI: 10.1093/milmed/usy147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/25/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction Limited research has been conducted on the impact of deployment-related trauma exposure on post-traumatic stress symptoms in military medical personnel. This study evaluated the association between exposure to both combat experiences and medical duty stressors and post-traumatic stress symptoms in deployed military medical personnel. Materials and Methods U.S. military medical personnel (N = 1,138; 51% male) deployed to Iraq between 2004 and 2011 were surveyed about their exposure to combat stressors, healthcare stressors, and symptoms of post-traumatic stress disorder (PTSD). All participants were volunteers, and the surveys were completed anonymously approximately halfway into their deployment. The Combat Experiences Scale was used as a measure of exposure to and impact of various combat-related stressors such as being attacked or ambushed, being shot at, and knowing someone seriously injured or killed. The Military Healthcare Stressor Scale (MHSS) was modeled after the Combat Experiences Scale and developed for this study to assess the impact of combat-related healthcare stressors such as exposure to patients with traumatic amputations, gaping wounds, and severe burns. The Post-traumatic Stress Disorder Checklist-Military Version (PCL-M) was used to measure the symptoms of PTSD. Results Eighteen percent of the military medical personnel reported exposure to combat experiences that had a significant impact on them. In contrast, more than three times as many medical personnel (67%) reported exposure to medical-specific stressors that had a significant impact on them. Statistically significant differences were found in self-reported exposure to healthcare stressors based on military grade, education level, and gender. Approximately 10% of the deployed medical personnel screened positive for PTSD. Approximately 5% of the sample were positive for PTSD according to a stringent definition of caseness (at least moderate scores on requisite Diagnostic and Statistical Manual for Mental Disorders criteria and a total PCL-M score ≥ 50). Both the MHSS scores (r(1,127) = 0.49, p < 0.0001) and the Combat Experiences Scale scores (r(1,127) = 0.34, p < 0.0001) were significantly associated with PCL-M scores. However, the MHSS scores had statistically larger associations with PCL-M scores than the Combat Experiences Scale scores (z = 5.57, p < 0.0001). The same was true for both the minimum criteria for scoring positive for PTSD (z = 3.83, p < 0.0001) and the strict criteria PTSD (z = 1.95, p = 0.05). Conclusions The U.S. military has provided significant investments for the funding of research on the prevention and treatment of combat-related PTSD, and military medical personnel may benefit from many of these treatment programs. Although exposure to combat stressors places all service members at risk of developing PTSD, military medical personnel are also exposed to many significant, high-magnitude medical stressors. The present study shows that medical stressors appear to be more impactful on military medical personnel than combat stressors, with approximately 5-10% of deployed medical personnel appearing to be at risk for clinically significant levels of PTSD.
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Affiliation(s)
- Alan L Peterson
- University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.,South Texas Veterans Health Care System, 7400 Merton Minter Boulevard, San Antonio, TX.,University of Texas at San Antonio, One UTSA Circle, San Antonio, TX
| | - Monty T Baker
- Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Drive, San Antonio, TX
| | - Cpt Brian A Moore
- University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.,University of Texas at San Antonio, One UTSA Circle, San Antonio, TX
| | - Willie J Hale
- University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.,University of Texas at San Antonio, One UTSA Circle, San Antonio, TX
| | - Jeremy S Joseph
- University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX
| | - Casey L Straud
- University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX
| | | | - Richard J McNally
- Harvard University, 1230 William James Hall, 33 Kirkland Street, Cambridge, MA
| | - William C Isler
- Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Drive, San Antonio, TX
| | - Brett T Litz
- VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA.,Boston University, 64 Cummington Mall, Boston, MA
| | - Jim Mintz
- University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX
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35
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Bilsker D, Fogarty AS, Wakefield MA. Critical Issues in Men's Mental Health. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:590-596. [PMID: 29673272 PMCID: PMC6109879 DOI: 10.1177/0706743718766052] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This narrative review highlights key issues in men's mental health and identifies approaches to research, policy and practice that respond to men's styles of coping. Issues discussed are: 1) the high incidence of male suicide (80% of suicide deaths in Canada, with a peak in the mid-50 s age group) accompanied by low public awareness; 2) the perplexing nature of male depression, manifesting in forms that are poorly recognised by current diagnostic approaches and thus poorly treated; 3) the risky use of alcohol among men, again common and taking a huge toll on mental and physical health; 4) the characteristic ways in which men manage psychological suffering, the coping strengths to be recognised, and the gaps to be addressed; 5) the underutilization of mental health services by men, and the implication for clinical outcomes; and 6) male-specific approaches to service provision designed to improve men's accessing of care, with an emphasis on Canadian programs. The main conclusion is that a high proportion of men in Western society have acquired psychological coping strategies that are often dysfunctional. There is a need for men to learn more adaptive coping approaches long before they reach a crisis point. Recommendations are made to address men's mental health through: healthcare policy that facilitates access; research on tailoring interventions to men; population-level initiatives to improve the capacity of men to cope with psychological distress; and clinical practice that is sensitive to the expression of mental health problems in men and that responds in a relevant manner.
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Affiliation(s)
- Dan Bilsker
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Andrea S. Fogarty
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Matthew A. Wakefield
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
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36
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Mandracchia J, Sylvara A, Wikowsky A, Tieman K, Smith P. An Exploratory Analysis of Violent Offending and the Acquired Capability for Suicide in Male Prisoners. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2018; 62:3436-3446. [PMID: 29611438 DOI: 10.1177/0306624x17740558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Recently, the Interpersonal Theory of Suicide has offered some understanding as to why inmates are at a disproportionately high risk to die by suicide. The present study was designed to investigate how one aspect of the theory, the acquired capability for suicide, may differ between prison inmates with violent offenses versus those without. Data from 343 male prisoners within the Mississippi Department of Corrections were used to examine potential differences between these two groups on scales of the Acquired Capability for Suicide Scale. Contrary to the hypothesis that violent offenders would evidence higher levels of acquired capability, only the Spectator Enjoyment of Violence subscale was significantly different between the two groups, with nonviolent offenders producing higher scores. Potential explanations for these findings and implications for correctional mental health care providers are discussed.
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37
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Butterworth SE, Daruwala SE, Anestis MD. Firearm storage and shooting experience: Factors relevant to the practical capability for suicide. J Psychiatr Res 2018; 102:52-56. [PMID: 29605786 DOI: 10.1016/j.jpsychires.2018.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/14/2018] [Accepted: 03/25/2018] [Indexed: 11/29/2022]
Abstract
The capability for suicide is posited to facilitate the relatively rare transition from suicidal ideation to suicidal behavior, although the operational definition of the construct continues to evolve. The Three Step Theory proposes that capability is multifaceted and includes practical capability for suicide, defined as comfort with and access to lethal means. Empirical examinations of this construct are thus far limited. Two previous studies have examined the association between firearm storage and shooting experience and common measures of capability for suicide. This study expands the generalizability of previous findings by investigating the relationship between capability for suicide, firearm storage practices, and experience shooting a firearm in a sample of 300 American firearm owners. We found that individuals who store their firearms unsafely (loaded, in a non-secure location, or without a locking device) and who have greater experience shooting firearms have significantly higher capability for suicide. These findings extend the evidence for the construct of practical capability as it relates to firearms and highlight the need for firearm-specific means safety measures to prevent suicide.
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38
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Bell CM, Ridley JA, Overholser JC, Young K, Athey A, Lehmann J, Phillips K. The Role of Perceived Burden and Social Support in Suicide and Depression. Suicide Life Threat Behav 2018; 48:87-94. [PMID: 28093796 DOI: 10.1111/sltb.12327] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 11/08/2016] [Indexed: 11/29/2022]
Abstract
In a sample of 114 military veterans with depression histories, perceived burden was related to depression symptoms and suicide attempt history. After accounting for perceived burden, sense of belonging was negatively related to depression. Among the areas of social support, family support was inversely related to both depression and suicide history. After accounting for family support, personal meaning from relationships and friend support were related to depression. The results of this study suggest that perceived burdensomeness may be a stronger determinant of suicidality than sense of belonging or social support. This study highlights the contribution of perceived burdensomeness to suicide and depression.
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Affiliation(s)
- Christopher M Bell
- Psychology, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Josephine A Ridley
- Psychology, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | | | - Kevin Young
- Louis Stokes Cleveland VA Medical Center Mental Health Services, Cleveland, OH, USA
| | - Alison Athey
- Psychology, Case Western Reserve University, Cleveland, OH, USA
| | | | - Kristie Phillips
- Louis Stokes Cleveland VA Medical Center Mental Health Services, Cleveland, OH, USA
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39
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Khazem LR, Houtsma C, Gratz KL, Tull MT, Green BA, Anestis MD. Firearms Matter: The Moderating Role of Firearm Storage in the Association Between Current Suicidal Ideation and Likelihood of Future Suicide Attempts Among United States Military Personnel. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000099] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Claire Houtsma
- Department of Psychology, University of Southern Mississippi
| | - Kim L. Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | - Matthew T. Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
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40
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Chu C, Buchman-Schmitt JM, Stanley IH, Hom MA, Tucker RP, Hagan CR, Rogers ML, Podlogar MC, Chiurliza B, Ringer-Moberg FB, Michaels MS, Patros C, Joiner TE. The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research. Psychol Bull 2017; 143:1313-1345. [PMID: 29072480 PMCID: PMC5730496 DOI: 10.1037/bul0000123] [Citation(s) in RCA: 561] [Impact Index Per Article: 80.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Over the past decade, the interpersonal theory of suicide has contributed to substantial advances in the scientific and clinical understanding of suicide and related conditions. The interpersonal theory of suicide posits that suicidal desire emerges when individuals experience intractable feelings of perceived burdensomeness and thwarted belongingness and near-lethal or lethal suicidal behavior occurs in the presence of suicidal desire and capability for suicide. A growing number of studies have tested these posited pathways in various samples; however, these findings have yet to be evaluated meta-analytically. This paper aimed to (a) conduct a systematic review of the unpublished and published, peer-reviewed literature examining the relationship between interpersonal theory constructs and suicidal thoughts and behaviors, (b) conduct meta-analyses testing the interpersonal theory hypotheses, and (c) evaluate the influence of various moderators on these relationships. Four electronic bibliographic databases were searched through the end of March, 2016: PubMed, Medline, PsycINFO, and Web of Science. Hypothesis-driven meta-analyses using random effects models were conducted using 122 distinct unpublished and published samples. Findings supported the interpersonal theory: the interaction between thwarted belongingness and perceived burdensomeness was significantly associated with suicidal ideation; and the interaction between thwarted belongingness, perceived burdensomeness, and capability for suicide was significantly related to a greater number of prior suicide attempts. However, effect sizes for these interactions were modest. Alternative configurations of theory variables were similarly useful for predicting suicide risk as theory-consistent pathways. We conclude with limitations and recommendations for the interpersonal theory as a framework for understanding the suicidal spectrum. (PsycINFO Database Record
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Affiliation(s)
- Carol Chu
- Florida State University, Department of Psychology, Tallahassee, FL
- McLean Hospital, Belmont, MA
- Harvard Medical School, Department of Psychiatry, Cambridge, MA
| | | | - Ian H. Stanley
- Florida State University, Department of Psychology, Tallahassee, FL
| | - Melanie A. Hom
- Florida State University, Department of Psychology, Tallahassee, FL
| | - Raymond P. Tucker
- Louisiana State University, Department of Psychology, Baton Rouge, LA
| | | | - Megan L. Rogers
- Florida State University, Department of Psychology, Tallahassee, FL
| | | | - Bruno Chiurliza
- Florida State University, Department of Psychology, Tallahassee, FL
| | | | | | - Connor Patros
- Temple University, Department of Psychology, Philadelphia, PA
| | - Thomas E. Joiner
- Florida State University, Department of Psychology, Tallahassee, FL
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41
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Butterworth SE, Green BA, Anestis MD. The association between specific combat experiences and aspects of the Interpersonal Theory of Suicide. Compr Psychiatry 2017; 78:9-18. [PMID: 28704761 DOI: 10.1016/j.comppsych.2017.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/04/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Studies examining the relationship between combat exposure and suicide risk typically focus on combat exposure overall, combining numerous different combat experiences. Our study expands upon prior research by examining the association between specific combat experiences and components of both suicidal desire and the capability for suicide. METHOD We hypothesized that most combat experiences would be associated with capability for suicide. Furthermore, we hypothesized that experiences that involved direct exposure to death and injury (e.g. personally witnessing the death or injury of other soldiers) would be associated with higher levels of thwarted belongingness, perceived burdensomeness, and suicidal ideation. Participants were 400 service members drawn largely from the Army National Guard who had been deployed at least once and endorsed having experienced combat. RESULTS Consistent with hypotheses, combat experiences involving direct exposure to injury or death exhibited a more pronounced pattern of associations with suicide risk factors than did other experiences. However, only a minority of combat experiences were associated with the capability for suicide. DISCUSSION These results, while preliminary, indicate that different combat experiences are associated with different outcomes and that, in this sense, not all combat experiences are created equal with respect to suicide risk.
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42
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Anestis MD, Law KC, Jin H, Houtsma C, Khazem LR, Assavedo BL. Treating the Capability for Suicide: A Vital and Understudied Frontier in Suicide Prevention. Suicide Life Threat Behav 2017; 47:523-537. [PMID: 27862187 DOI: 10.1111/sltb.12311] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 06/28/2016] [Indexed: 11/29/2022]
Abstract
Current efforts at suicide prevention center largely on reducing suicidal desire among individuals hospitalized for suicidality or being treated for related psychopathology. Such efforts have yielded evidence-based treatments, and yet the national suicide rate has continued to climb. We propose that this disconnect is heavily influenced by an unmet need to consider population-level interventions aimed at reducing the capability for suicide. Drawing on lessons learned from other public health phenomena that have seen drastic declines in frequency in recent decades (HIV, lung cancer, motor vehicle accidents), we propose that current suicidality treatment efforts trail current suicidality theories in their lack of focus on the extent to which individuals thinking about suicide are capable of transitioning from ideation to attempt. We summarize extant evidence for specific capability-centered approaches (e.g., means safety) and propose other options for improving our ability to address this largely overlooked variable. We also note that population-level approaches in this regard would represent an important opportunity to decrease risk in individuals who either lack access to evidence-based care or underreport suicidal ideation, as a reduced capability for suicide would theoretically diminish the potency of suicidal desire and, in this sense, lower the odds of a transition from ideation to attempt.
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Affiliation(s)
| | - Keyne C Law
- University of Southern Mississippi, Hattiesburg, MS, USA
| | - Hyejin Jin
- University of Southern Mississippi, Hattiesburg, MS, USA
| | - Claire Houtsma
- University of Southern Mississippi, Hattiesburg, MS, USA
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43
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Wilson KG, Kowal J, Caird SM, Castillo D, McWilliams LA, Heenan A. Self-perceived burden, perceived burdensomeness, and suicidal ideation in patients with chronic pain. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2017; 1:127-136. [PMID: 35005348 PMCID: PMC8730634 DOI: 10.1080/24740527.2017.1368009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Background: Self-perceived burden and perceived burdensomeness are two apparently related constructs that have arisen independently from research in physical and mental health, respectively. Although both are associated with suicidal ideation in individuals with chronic pain, they have yet to be examined concurrently in the same group of patients. Aims: The aim of this study was to investigate the relationship between the two constructs and their differential prediction of suicidal ideation. Methods: Participants were 260 outpatients of an interdisciplinary chronic pain treatment program. Each participant completed the Self-Perceived Burden Scale (SPBS), the Interpersonal Needs Questionnaire Perceived Burdensomeness Scale (INQPBS), the Beck Scale for Suicide Ideation, and the thoughts of self-harm item of the Patient Health Questionnaire-9. Results: The SPBS and the INQPBS were both unifactorial measures with good internal consistency. They correlated significantly with one another (r = 0.50, P < 0.001), as well as with scores on the two measures of suicidal ideation (rs ranging from 0.29 to 0.62, Ps < 0.001). However, the INQPBS correlated more highly with suicidal ideation than did the SPBS. In regression analyses, the INQPBS predicted unique variance in suicidal ideation after adjusting for the SPBS. Conversely, the SPBS did not contribute uniquely when the INQPBS was entered first. Conclusions: Patients with chronic pain who believe that they have become “a burden to others” are at increased risk for suicidal ideation. The conceptual similarities and differences between the constructs of self-perceived burden and perceived burdensomeness are reviewed to explain why perceived burdensomeness is the stronger predictor of this increased risk.
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Affiliation(s)
- Keith G. Wilson
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - John Kowal
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Anaesthesiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Sara M. Caird
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Dyana Castillo
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Lachlan A. McWilliams
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Adam Heenan
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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44
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Bryan CJ, Grove JL, Kimbrel NA. Theory-driven models of self-directed violence among individuals with PTSD. Curr Opin Psychol 2017; 14:12-17. [DOI: 10.1016/j.copsyc.2016.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/26/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
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45
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Rigby A, Fink-Miller EL, Isaiah JD. Preoperative Risk Factors for Suicide in Candidates for Weight Loss Surgery. Bariatr Surg Pract Patient Care 2017. [DOI: 10.1089/bari.2016.0040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrea Rigby
- Penn State Health Milton S. Hershey Medical Center, Department of Surgery, Hershey, Pennsylvania
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Initial Psychometric Validation of the Non-Suicidal Self-Injury Scar Cognition Scale. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2017; 39:546-562. [PMID: 28824225 DOI: 10.1007/s10862-017-9595-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Given the growing literature on the detrimental psychological consequences of NSSI, it is surprising that scarce research has focused on the permanent physical consequences of NSSI, scarring to one's tissue (Burke et al. 2015; Lewis 2016). Indeed, with recent research suggesting that upwards of half of those with a history of NSSI bear scarring as a result of the behavior (Burke et al. 2016), the psychological implications of scarring are important to understand. Given preliminary literature suggesting that the vast majority of individuals who bear NSSI scars ascribe a great deal of meaning to their scarring, and that this meaning varies widely, a psychometrically sound scale is needed to comprehensively and systematically assess NSSI scar-related cognitions. The present study examined the psychometric properties of the Non-Suicidal Self-Injury Scar Cognition Scale (NSSI-SCS). A sample of 110 undergraduates with at least one scar from NSSI completed the NSSI-SCS as well as measures of concurrent and divergent validity. Exploratory Factor Analysis was conducted to determine the factor structure of the NSSI-SCS. Results indicated that a five-factor solution offered the best fit for the data. Psychometric analyses support the validity of the NSSI-SCS given evidence of concurrent validity, divergent validity, and reliability. Future research should examine the test-retest reliability of the NSSI-SCS, as well as its sensitivity to change, particularly in the context of treatment research.
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47
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Du J, Zhu M, Bao H, Li B, Dong Y, Xiao C, Zhang GY, Henter I, Rudorfer M, Vitiello B. The Role of Nutrients in Protecting Mitochondrial Function and Neurotransmitter Signaling: Implications for the Treatment of Depression, PTSD, and Suicidal Behaviors. Crit Rev Food Sci Nutr 2017; 56:2560-2578. [PMID: 25365455 DOI: 10.1080/10408398.2013.876960] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Numerous studies have linked severe stress to the development of major depressive disorder (MDD) and suicidal behaviors. Furthermore, recent preclinical studies from our laboratory and others have demonstrated that in rodents, chronic stress and the stress hormone cortisol cause oxidative damage to mitochondrial function and membrane lipids in the brain. Mitochondria play a key role in synaptic neurotransmitter signaling by providing adenosine triphosphate (ATP), mediating lipid and protein synthesis, buffering intracellular calcium, and regulating apoptotic and resilience pathways. Membrane lipids are similarly essential to central nervous system (CNS) function because cholesterol, polyunsaturated fatty acids, and sphingolipids form a lipid raft region, a special lipid region on the membrane that mediates neurotransmitter signaling through G-protein-coupled receptors and ion channels. Low serum cholesterol levels, low antioxidant capacity, and abnormal early morning cortisol levels are biomarkers consistently associated with both depression and suicidal behaviors. In this review, we summarize the manner in which nutrients can protect against oxidative damage to mitochondria and lipids in the neuronal circuits associated with cognitive and affective behaviors. These nutrients include ω3 fatty acids, antioxidants (vitamin C and zinc), members of the vitamin B family (Vitamin B12 and folic acid), and magnesium. Accumulating data have shown that these nutrients can enhance neurocognitive function, and may have therapeutic benefits for depression and suicidal behaviors. A growing body of studies suggests the intriguing possibility that regular consumption of these nutrients may help prevent the onset of mood disorders and suicidal behaviors in vulnerable individuals, or significantly augment the therapeutic effect of available antidepressants. These findings have important implications for the health of both military and civilian populations.
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Affiliation(s)
- Jing Du
- a School of Medicine, Yunnan University , Kunming , Yunnan , China.,c Laboratory of Molecular Pathophysiology, Intramural Research Program, NIMH, NIH , Bethesda , Maryland , USA
| | - Ming Zhu
- a School of Medicine, Yunnan University , Kunming , Yunnan , China
| | - Hongkun Bao
- a School of Medicine, Yunnan University , Kunming , Yunnan , China
| | - Bai Li
- a School of Medicine, Yunnan University , Kunming , Yunnan , China
| | - Yilong Dong
- a School of Medicine, Yunnan University , Kunming , Yunnan , China
| | - Chunjie Xiao
- a School of Medicine, Yunnan University , Kunming , Yunnan , China
| | - Grace Y Zhang
- c Laboratory of Molecular Pathophysiology, Intramural Research Program, NIMH, NIH , Bethesda , Maryland , USA
| | - Ioline Henter
- d Molecular Imaging Branch, Intramural Research Program, NIMH, NIH , Bethesda , Maryland , USA
| | - Matthew Rudorfer
- b Division of Service and Intervention Research, NIMH, NIH , Rockville , Maryland , USA
| | - Benedetto Vitiello
- b Division of Service and Intervention Research, NIMH, NIH , Rockville , Maryland , USA
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48
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Poindexter EK, Nazem S, Forster JE. Painful and provocative events scale and fearlessness about death among Veterans: Exploratory factor analysis. J Affect Disord 2017; 208:528-534. [PMID: 27817911 DOI: 10.1016/j.jad.2016.10.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/21/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The interpersonal theory of suicide suggests three proximal risk factors for suicide: perceived burdensomeness, thwarted belongingness, and acquired capability. Previous literature indicates that repetitive exposure to painful and provocative events is related to increased acquired capability for suicide. Despite this, research related to the assessment of painful and provocative events has been insufficient. Research has inconsistently administered the Painful and Provocative Events Scale (PPES; a painful and provocative events assessment), and no study has examined the factor structure of the English PPES. This study explored the factor structure of the PPES and the relation between factors and fearlessness about death. METHODS The sample was a cross-sectional, self-report study comprised of 119 Veterans (Mage = 46.5, SD = 13.5). RESULTS Findings from an exploratory factor analysis indicated a four-factor solution for the PPES; however, no factor from the PPES significantly related to fearlessness about death (measured by the Acquired Capability for Suicide Scale - Fearlessness About Death Scale; all p >.21). LIMITATIONS Cross-sectional, small Veteran sample. CONCLUSIONS Findings suggest that the PPES lacks the psychometric properties necessary to reliably investigate painful and provocative factors. Consequently, this measure may not reliably capture and explain how painful and provocative events relate to fearlessness about death, which is a barrier to improving suicide risk assessment and prediction. Recommendations for the construction of a new PPES are offered.
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Affiliation(s)
- Erin K Poindexter
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), USA; Texas Tech University, USA
| | - Sarra Nazem
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), USA; University of Colorado Anschutz Medical Campus, USA.
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), USA; University of Colorado Anschutz Medical Campus, USA
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Houtsma C, Khazem LR, Green BA, Anestis MD. Isolating effects of moral injury and low post-deployment support within the U.S. military. Psychiatry Res 2017; 247:194-199. [PMID: 27918969 DOI: 10.1016/j.psychres.2016.11.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 10/21/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
Abstract
Suicide rates within U.S. military components, particularly the National Guard, are significantly higher than the general population suicide rate. To better understand and prevent suicide within this population, we must identify mechanisms of risk contributing to these discrepancies. One risk factor relevant to military service is moral injury, a term for experiences that violate one's moral beliefs. Using a series of hierarchical multiple regressions, the current study examined the moderating role of post-deployment social support on the association between moral injury (self-transgressions, other-transgressions, and betrayal) and thwarted belongingness among military personnel. The current sample was comprised of 552 military personnel with at least one previous deployment. Partially consistent with hypotheses, results revealed that other-transgressions and betrayal were significantly associated with thwarted belongingness at low, but not mean or high levels of post-deployment support. In contrast, the interaction of self-transgressions and post-deployment support was not significantly associated with thwarted belongingness, nor was there a significant main effect of self-transgressions on thwarted belongingness. This suggests that experiencing other-perpetrated morally injurious events (i.e., watching a fellow soldier die, being betrayed by a comrade) can be compounded by low post-deployment social support, increasing risk for thwarted belongingness. Implications for prevention and treatment are discussed.
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Affiliation(s)
- Claire Houtsma
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, US.
| | - Lauren R Khazem
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, US
| | - Bradley A Green
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, US
| | - Michael D Anestis
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, US
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Khazem LR, Anestis MD. Thinking or doing? An examination of well-established suicide correlates within the ideation-to-action framework. Psychiatry Res 2016; 245:321-326. [PMID: 27575650 DOI: 10.1016/j.psychres.2016.08.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/08/2016] [Accepted: 08/08/2016] [Indexed: 11/24/2022]
Abstract
Limited research has examined differences in well-established suicide correlates between individuals with various histories of suicidality within the ideation to action framework. We hypothesized that individuals without a history of elevated suicidality would exhibit lowest levels of suicide correlates (perceived burdensomeness, thwarted belongingness, emotion dysregulation, depressive symptoms), and group differences would not be present between those with a history of suicidal ideation relative to those with a history of suicide attempts on variables not theorized to contribute to the capability for suicide. Lastly, we hypothesized that those with a prior history of suicide attempt(s) would exhibit higher levels of lifetime painful and provocative events and fearlessness about death relative to those with a history of ideation only. A community sample of adults (N=378) recruited in part on the basis of a history of suicidality completed self-report questionnaires online. The results were largely consistent with our hypotheses. However, there were no differences in fearlessness about death between those with a history of suicidal ideation and those with a history of attempts. Many variables considered robust correlates of suicide may only directly relate to suicidal ideation rather than suicide attempts, thereby limiting their utility in understanding the transition from ideation to action.
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Affiliation(s)
- Lauren R Khazem
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA.
| | - Michael D Anestis
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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