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Miziara ID, Miziara CSMG. Suicide victims and alcohol-related consumption in Brazil: An observational study and a narrative review of the literature. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00766-4. [PMID: 38151659 DOI: 10.1007/s12024-023-00766-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 12/29/2023]
Abstract
Deaths due to external causes, mainly suicide, are a severe public health problem in Brazil. Evidence shows that the tendency to impulsive behavior is exacerbated after alcohol consumption. The relationship between alcohol and suicide is poorly described in the medical literature. The study aims to analyze the relationship between victims' blood alcohol levels and suicides in some municipalities in Greater São Paulo, Brazil. We reviewed the data from the medical records of 805 necropsies performed at the Medical Legal Institute of Sao Paulo in Franco da Rocha, Brazil, from 2001 to 2017. The manner of death was established based on the result of police inquiry. Deaths due to suicide (n=41) were selected for the study. Descriptive statistics and Student t-test was applied when appropriate. The variables studied were sex, age, suicide mechanism, and blood alcohol level (BAC). In all cases we could not determine how much time the deceased consumed alcohol before suicide. Of the individuals analyzed, 85.36% were male, and 14.64% were female. The most prevalent age range for males was between 18 and 23 (19.5%). For females, it was between 12 and 23 years (33.2%). Most suicides (48.78%) were due to hanging, followed by self-poisoning (22.08%) and firearms (17.1%). 38 victims (92.68%) presented a positive BAC, over 0.3 mg/dl. The higher levels were in the group of suicide by hanging (2.3 mg/ml). Thus, alcohol intoxication is common among suicide victims, and it can contribute to the fatal outcome as a risk factor. Further studies are necessary for a better comprehension of the effect of alcohol on suicide victims.
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Affiliation(s)
- Ivan Dieb Miziara
- Legal Medicine, Sao Paulo University Faculty of Medicine, Rua Teodoro Sampaio, São Paulo, SP, 352-22, Brazil.
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He Z, Lei Q, Hu X, Xiong M, Liu J, Wen J, Shi X, Wang Z. Moral injury and suicidal ideation among health professionals: The role of mental health. J Affect Disord 2023; 333:58-64. [PMID: 37080491 PMCID: PMC10111858 DOI: 10.1016/j.jad.2023.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/23/2023] [Accepted: 04/14/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND The prolonged COVID-19 pandemic has burdened health professionals mentally and physically. This study aims to explore the relationship between moral injury (MI) and suicidal ideation (SI), and the role of mental health conditions in this relationship. METHODS Three-wave repeated online cross-sectional study with a total of 10,388 health professionals were conducted in different stages (2020-2022) of the COVID-19 pandemic in mainland China. Participants completed the Chinese version of the Moral Injury Symptoms Scale-Health Professional, Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5 coupled with a blanket of scales. RESULTS The prevalence of SI and MI among health professionals was 9.8 % and 40.2 %, respectively. The prevalence risk of SI was lower in wave 2 (OR = 0.64, 95 % CI: 0.54-0.77) and wave 3 (OR = 0.71, 95 % CI: 0.60-0.84) when compared with wave 1. MI (OR = 4.66, 95 % CI: 3.99-5.43), medical error (OR = 1.15, 95 % CI: 1.00-1.32), workplace violence (OR = 1.13, 95 % CI: 0.97-1.32), depression (OR = 94.08, 95 % CI: 63.37-139.69), anxiety (OR = 25.54, 95 % CI: 21.22-30.74), PTSD (OR = 24.51, 95 % CI: 19.01-31.60) were associated with a higher risk of SI. The mediation model revealed that depressive, anxiety, and PTSD symptoms explained 90.6 % of the total variance in the relationship between MI and SI. CONCLUSIONS The risk of SI has reduced among health professionals since the first peak of the COVID-19 pandemic in China. MI may contribute to prevalent SI, and mental health conditions, especially depressive symptoms, play a significant role as mediators. LIMITATIONS Cross-sectional design precludes the investigation of casual relationships. The nonrandom sampling method limits the generalization.
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Affiliation(s)
- Zhehao He
- Department of Epidemiology and Health Statistics, School of Public Health at Guangdong Medical University, Dongguan 560001, China
| | - Qiuhui Lei
- Department of Epidemiology and Health Statistics, School of Public Health at Guangdong Medical University, Dongguan 560001, China
| | - Xue Hu
- Department of Epidemiology and Health Statistics, School of Public Health at Guangdong Medical University, Dongguan 560001, China
| | - Mengyun Xiong
- Department of Epidemiology and Health Statistics, School of Public Health at Guangdong Medical University, Dongguan 560001, China
| | - Jun Liu
- Department of Preventive Medicine, School of Public Health at Zunyi Medical University, Zunyi 56006, China
| | - Jing Wen
- Department of Epidemiology and Health Statistics, School of Public Health and Management at Ningxia Medical University, China
| | - Xiuquan Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China.
| | - Zhizhong Wang
- Department of Epidemiology and Health Statistics, School of Public Health at Guangdong Medical University, Dongguan 560001, China; The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan 523808, China.
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Sampson L, Cohen GH, Fink DS, Conroy C, Calabrese JR, Wryobeck JM, Elhai JD, King AP, Liberzon I, Galea S. Cohort profile: the Ohio Army National Guard Mental Health Initiative (OHARNG-MHI). Soc Psychiatry Psychiatr Epidemiol 2021; 56:2107-2116. [PMID: 34480595 PMCID: PMC8577754 DOI: 10.1007/s00127-021-02166-x] [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] [Received: 03/01/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Rates of mental disorders in the United States military have increased in recent years. National Guard members may be particularly at risk for mental disorders, given their dual role as citizen-soldiers and their increased involvement in combat deployments during recent conflicts. The Ohio Army National Guard Mental Health Initiative (OHARNG-MHI) was launched to assess the prevalence, incidence, and potential causes and consequences of mental disorders in this unique population. METHODS OHARNG-MHI is a decade-long dynamic cohort study that followed over 3,000 National Guard members yearly through structured telephone interviews. RESULTS Findings thus far have applied a pre-, peri-, post-deployment framework, identifying factors throughout the life course associated with mental disorders, including childhood events and more recent events, both during and outside of deployment. An estimated 61% of participants had at least one mental disorder in their lifetime, the majority of which initiated prior to military service. Psychiatric comorbidity was common, as were alcohol use and stressful events. Latent class growth analyses revealed four distinct trajectory paths of both posttraumatic stress and depression symptoms across four years. Only 37% of soldiers with probable past-year mental disorders accessed mental health services in the subsequent year, with substance use disorders least likely to be treated. CONCLUSION Strengths of this study include a large number of follow-up interviews, detailed data on both military and non-military experiences, and a clinical assessment subsample that assessed the validity of the telephone screening instruments. Findings, methods, and procedures of the study are discussed, and collaborations are welcome.
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Affiliation(s)
- Laura Sampson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Gregory H. Cohen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, U.S.A
| | - David S. Fink
- New York State Psychiatric Institute, New York, NY, U.S.A
| | - Carla Conroy
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, U.S.A
| | - Joseph R. Calabrese
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, U.S.A
| | - John M. Wryobeck
- Department of Psychiatry, University of Toledo, Toledo, OH, U.S.A
| | - Jon D. Elhai
- Department of Psychology, University of Toledo, Toledo, OH, U.S.A
| | - Anthony P. King
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, U.S.A
| | - Israel Liberzon
- Department of Psychiatry, College of Medicine, Texas A&M, College Station, TX, U.S.A
| | - Sandro Galea
- Office of the Dean, Boston University School of Public Health, Boston, MA, U.S.A
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Lee M, Lee U, Park JH, Shin YC, Sim M, Oh KS, Shin DW, Jeon SW, Seol J, Cho SJ. The Association Between Alcohol Use and Suicidal Ideation Among Employees. Psychiatry Investig 2021; 18:977-985. [PMID: 34525778 PMCID: PMC8542748 DOI: 10.30773/pi.2021.0122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/28/2021] [Accepted: 08/31/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE The risk of suicide is assessed by identifying the relationship between alcohol-use patterns and suicidal ideation in Korean employees. METHODS The study involved 13,858 employees who underwent workplace mental health screening at the Workplace Mental Health Institute of Kangbuk Samsung Hospital over a 6-year period between 2014 and 2019. Analysis was performed separately for Alcohol Use Disorders Identification Test-Korea (AUDIT-K) items related to the frequency/volume of alcohol consumption (items 1 to 3, AUDIT-C) and those regarding alcohol dependence/related problems (items 4 to 10, AUDIT-D/P). Subjects were then classified into three groups on the basis of the presence or absence of clinical depression and suicidal ideation. The groups' sociodemographic factors and clinical features of depression, anxiety, and alcohol-use patterns were analyzed with a chi-square test as well as one-way analysis of variance, followed by a post hoc test using the Bonferroni correction. RESULTS AUDIT-K and AUDIT-D/P scores were significantly associated with the presence or absence of clinical depression as well as the presence or absence of suicidal ideation (p<0.05). However, no significant differences were found among the three groups with regard to the AUDIT-C score (p=0.054). CONCLUSION Identifying or treating alcohol dependence/related problems can help lower the occurrence of mental health problems, and suicidal ideation in particular, in employees and reduce social costs.
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Affiliation(s)
- Miji Lee
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ung Lee
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Hyun Park
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Young-Chul Shin
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Mikyung Sim
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kang-Seob Oh
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Won Shin
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Won Jeon
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jinmi Seol
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Joon Cho
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Kelly LM, Liu RT, Zajac K. Comorbid alcohol-related problems and suicidality disproportionately impact men and emerging adults among individuals with depressive symptoms. J Affect Disord 2021; 293:329-337. [PMID: 34229286 PMCID: PMC8352104 DOI: 10.1016/j.jad.2021.06.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 06/12/2021] [Accepted: 06/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Depressive disorders are common among adults with alcohol use disorder and with suicidality; however, demographic differences in comorbid alcohol use disorder, binge drinking, and suicidality are understudied. The objective of this study was to determine the extent to which comorbid suicidality and alcohol use disorders and comorbid suicidality and binge drinking differ by age and gender among adults with depressive symptoms. METHOD The sample included adults (unweighted N=29,460) in the United States who completed the 2015-2018 National Survey of Drug Use and Heath and screened positively for depression. Gender and age groups odds of alcohol use disorder only, suicidality only, and alcohol use disorder+suicidality were compared to neither problem. Similar analyses were conducted for binge drinking. RESULTS Men showed disproportional odds of alcohol use disorder only, all suicidality and alcohol use disorder comorbidities, and binge drinking+active suicidal ideation than women. Emerging adults showed higher odds of: passive and active suicidal ideation only and suicidality+alcohol use disorder than adults 35 and older; binge drinking only, binge drinking+passive suicidal ideation, and binge drinking+active suicidal ideation than all older adults; binge drinking+suicide planning and binge drinking+attempts than adults 50 and older. LIMITATIONS Because participants all reported depression symptoms either at the subclinical or clinical level, demographic differences in suicidality, alcohol use disorder, and binge drinking found in this study cannot be generalized to non-depressed samples. CONCLUSIONS Treatment providers should be aware of disproportionately higher odds of comorbid suicidality and alcohol use disorder, and suicidality and binge drinking among men and emerging adults.
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Affiliation(s)
- Lourah M Kelly
- University of Connecticut School of Medicine, Farmington, CT, United States
| | - Richard T Liu
- Massachusetts General Hospital, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Kristyn Zajac
- University of Connecticut School of Medicine, Farmington, CT, United States.
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Bilevicius E, Kempe T, Pankratz L, Wardell JD, Johnson EA, Keough MT. Shame's Associations with Depression and Problem Drinking: An Ecological Momentary Study. Subst Use Misuse 2021; 56:1715-1725. [PMID: 34253147 DOI: 10.1080/10826084.2021.1949616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Depression and problem drinking are comorbid in emerging adulthood, yet the processes that link them are not well understood. Research has argued that shame has a unique influence on the experience of problematic drinking, but this has rarely been assessed at the state level. Using ecological momentary assessments (EMAs), we assessed whether shame, and not guilt, mediated the association between baseline depression and alcohol use and problems. METHODS One hundred and eighty-four emerging adults (Mage= 19.27) completed a 12-day EMA study. Multilevel models were used to test hypotheses. RESULTS In a model with alcohol use as the outcome, there were no significant associations between shame or guilt and alcohol use at the within- or between-subjects level. In a model with alcohol problems as the outcome, guilt was positively associated with alcohol problems but only at the daily level. At the between-subjects level and after controlling for guilt, there was a significant association between depression, shame, and alcohol problems; average levels of shame mediated the association between depression and alcohol problems. In post-hoc reverse directionality models, average alcohol problems mediated the relationship between depression and shame and guilt at the between-person level. No mediation was present for alcohol use. CONCLUSION After controlling for guilt, shame is an emotion that helps explain risk for alcohol problems among depressed emerging adults, which has implications for targeted interventions. Reciprocal associations between shame, guilt, and alcohol problems emerged highlighting the need for more fulsome assessments of shame and guilt in future EMA research.
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Affiliation(s)
- Elena Bilevicius
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tyler Kempe
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lily Pankratz
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeffrey D Wardell
- Department of Psychology, York University, Toronto, Ontario, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Edward A Johnson
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew T Keough
- Department of Psychology, York University, Toronto, Ontario, Canada
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Perez J, Beale E, Overholser J, Athey A, Stockmeier C. Depression and alcohol use disorders as precursors to death by suicide. DEATH STUDIES 2020; 46:619-627. [PMID: 32238058 DOI: 10.1080/07481187.2020.1745954] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The combined presence of depression with alcohol abuse can increase suicide risk. We used psychological autopsy to evaluate 101 individuals who died by suicide, to understand relationships between stressful life events, alcohol abuse, and depression. As compared to suicidal adults with depression only, individuals meeting criteria for both a depressive disorder and alcohol use disorder tended to be younger and experienced higher rates of stressful life events during the six months prior to death. Alcohol abuse likely influences interpersonal conflict, financial distress, and legal problems. Interventions focusing on managing life problems may help to reduce suicide risk.
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Affiliation(s)
- Jalessa Perez
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Eleanor Beale
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - James Overholser
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alison Athey
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Craig Stockmeier
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Psychiatry and Human Behavior, Division of Neurobiology and Behavior Research, Translational Research Center (TR415), University of Mississippi Medical Center, Cleveland, Ohio, USA
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Boscarino JA, Adams RE, Urosevich TG, Hoffman SN, Kirchner HL, Dugan RJ, Boscarino JJ, Withey CA, Figley CR. Guard/Reserve service members and mental health outcomes following deployment: Results from the Veterans' Health Study. Gen Hosp Psychiatry 2020; 62:102-103. [PMID: 30910352 DOI: 10.1016/j.genhosppsych.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 01/25/2023]
Affiliation(s)
- Joseph A Boscarino
- Department of Epidemiology & Health Services Research, Geisinger Clinic, 100 N. Academy Ave, MC 44-00, Danville, PA 17822, United States of America.
| | - Richard E Adams
- Department of Sociology, Kent State University, 215 Merrill Hall, Kent, OH 44242, United States of America
| | - Thomas G Urosevich
- Ophthalmology Service, Geisinger Clinic, 126 Market Way, Mount Pocono, PA 18344, United States of America
| | - Stuart N Hoffman
- Department of Sleep Medicine, Geisinger Clinic, 100 N. Academy Ave, Danville, PA 17822, United States of America
| | - H Lester Kirchner
- Biomedical &Translational Informatics, Geisinger Clinic, 100 N. Academy Ave, Danville, PA 17822, United States of America
| | - Ryan J Dugan
- Department of Epidemiology & Health Services Research, Geisinger Clinic, 100 N. Academy Ave, MC 44-00, Danville, PA 17822, United States of America
| | - Joseph J Boscarino
- Clinical Psychology Department, William James College, 96 Madison Ave, Newton, MA 02460, United States of America
| | - Carrie A Withey
- Department of Epidemiology & Health Services Research, Geisinger Clinic, 100 N. Academy Ave, MC 44-00, Danville, PA 17822, United States of America
| | - Charles R Figley
- School of Social Work, Tulane University, 127 Elk Place, New Orleans, LA 70112, United States of America
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Wolford-Clevenger C, Cropsey KL. Depressive symptoms and age of alcohol use onset interact to predict suicidal ideation. DEATH STUDIES 2019; 44:540-546. [PMID: 30938583 PMCID: PMC6774920 DOI: 10.1080/07481187.2019.1586798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Distal risk factors of alcohol use may increase suicidal ideation in the presence of proximal risk factors, such as depressive symptoms. We tested whether depressive symptoms and age at onset of alcohol use interact to predict suicidal ideation in 500 individuals (67% men; 68% Black/African American) under criminal justice supervision. Regression analysis revealed that age of onset negatively associated with suicidal ideation only at average and high levels of depressive symptoms while controlling for suicide attempt history. Clinicians may consider individuals with an early age of onset of alcohol use and current depressive symptoms at risk for suicidal ideation.
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Affiliation(s)
| | - Karen L Cropsey
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama-Birmingham, Birmingham, Alabama, USA
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Stokes CM, Naifeh JA, Kessler RC, Stein MB, Fullerton CS, Mash HBH, Riggs-Donovan CA, Ng THH, Aliaga PA, Wynn GH, Dinh HM, Kao TC, Gonzalez OI, Sampson NA, Ursano RJ. Risk factors and timing of suicide attempts among US Army Reserve Component soldiers during deployment to the Afghanistan and Iraq wars: Results from the Army Study to Assess Risk and Resilience in Servicemembers. Psychiatry 2019; 82:240-255. [PMID: 31566520 PMCID: PMC7446572 DOI: 10.1080/00332747.2019.1653056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Objective: During the wars in Afghanistan and Iraq, suicidal behaviors increased among U.S. Army soldiers. Although Reserve Component (RC) soldiers (National Guard and Army Reserve) comprise approximately one third of those deployed in support of the wars, few studies have examined suicidal behaviors among these "citizen-soldiers". The objective of this study is to examine suicide attempt risk factors and timing among RC enlisted soldiers. Methods: This longitudinal, retrospective cohort study used individual-level person-month records from Army and Department of Defense administrative data systems to examine socio-demographic, service-related, and mental health predictors of medically documented suicide attempts among enlisted RC soldiers during deployment from 2004-2009. Data were analyzed using discrete-time survival models. Results: A total of 230 enlisted RC soldiers attempted suicide. Overall, the in-theater suicide attempt rate among RC soldiers was 81/100,000 person-years. Risk was highest in the fifth month of deployment (13.8 per 100,000 person-months). Suicide attempts were more likely among soldiers who were women (adjusted odds ratio, aOR = 2.5 [95% CI: 1.8-3.5]), less than high school educated (aOR = 1.8 [95% CI: 1.3-2.5]), in their first 2 years of service (aOR = 2.0 [95% CI: 1.2-3.4]), were currently married (aOR = 2.0 [95% CI: 1.5-2.7]), and had received a mental health diagnosis in the previous month (aOR = 24.7 [95% CI: 17.4-35.0]). Conclusions: Being female, early in service and currently married are associated with increased odds of suicide attempt in RC soldiers. Risk of suicide attempt was greatest at mid deployment. These predictors and the timing of suicide attempt for RC soldiers in-theater are largely consistent with those of deployed Active Component (Regular) soldiers. Results also reinforce and replicate the findings among Active Component soldiers related to the importance of a recent mental health diagnosis and the mid-deployment as a period of enhanced risk.
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Affiliation(s)
- Cara M. Stokes
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - James A. Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115
| | - Murray B. Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California San Diego, 8939 Villa La Jolla Drive, Suite 200, La Jolla, California 92037,VA San Diego Healthcare System, 8810 Rio San Diego Drive, San Diego, CA 92108
| | - Carol S. Fullerton
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Holly B. Herberman Mash
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Charlotte A. Riggs-Donovan
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Tsz Hin Hinz Ng
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Pablo A. Aliaga
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Gary H. Wynn
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Hieu M. Dinh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Tzu-Cheg Kao
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Oscar I. Gonzalez
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
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Hoopsick RA, Homish DL, Vest BM, Homish GG. Alcohol Use Among Never-Deployed U.S. Army Reserve and National Guard Soldiers: The Effects of Nondeployment Emotions and Sex. Alcohol Clin Exp Res 2018; 42:2413-2422. [PMID: 30381833 PMCID: PMC6286239 DOI: 10.1111/acer.13901] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limited research shows that mental health problems are prevalent among never-deployed soldiers and many experience negative emotions related to their nondeployment. U.S. Army Reserve/National Guard (USAR/NG) soldiers are also at high risk for alcohol misuse. However, it is not known if nondeployment emotions contribute to an increased risk of alcohol misuse among never-deployed USAR/NG soldiers. METHODS Data are from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing study of USAR/NG soldiers. We used regression models to examine the relations between nondeployment emotions, assessed by the Non-Deployment Emotions (NDE) Questionnaire, and a range of alcohol use outcomes, assessed by the Alcohol Use Disorders Identification Test and standard quantity and frequency questions, among a sample of never-deployed soldiers who were partnered at baseline (N = 174). Final models controlled for years of military service, current number of close military friends in the social network, marital satisfaction, and depression. We also tested for potential differences in these associations by sex. RESULTS Nondeployment emotions were associated with frequency of getting drunk (adjusted risk ratio [aRR] = 1.02, 95% CI: 1.01, 1.04; p < 0.05) and typical number of drinks consumed during a drinking episode (aRR = 1.03, 95% CI: 1.01, 1.04; p < 0.01). Nondeployment emotions had a trend-level association with percent of days drinking (adjusted odds ratio = 1.05, 95% CI: 1.00, 1.11; p = 0.055). Nondeployment emotions had a significant interaction with sex (p < 0.05) on the likelihood of alcohol problems, such that only male soldiers experienced a greater likelihood of alcohol problems when they had highly negative nondeployment emotions. There was no relation between nondeployment emotions and alcohol problems among female soldiers. CONCLUSIONS Findings demonstrate that greater nondeployment emotions are associated with increased alcohol use among never-deployed USAR/NG soldiers. The NDE Questionnaire may assist in identifying those at highest risk for alcohol problems.
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Affiliation(s)
- Rachel A. Hoopsick
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York
| | - Bonnie M. Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York
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Waitzkin H, Cruz M, Shuey B, Smithers D, Muncy L, Noble M. Military Personnel Who Seek Health and Mental Health Services Outside the Military. Mil Med 2018; 183:e232-e240. [DOI: 10.1093/milmed/usx051] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Howard Waitzkin
- Health Sciences Center and Department of Sociology, University of New Mexico, 801 Encino Place NE, Suite C-14, Albuquerque, NM 87102
| | - Mario Cruz
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, MSC09 5030, 1 University of New Mexico, Albuquerque, NM 87131
| | - Bryant Shuey
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, MSC09 5030, 1 University of New Mexico, Albuquerque, NM 87131
| | - Daniel Smithers
- Boston University School of Medicine, 72 East Concord St, Boston, MA 02118
| | - Laura Muncy
- Civilian Medical Resources Network, P.O. Box 2965, Taos, NM 87571
| | - Marylou Noble
- Civilian Medical Resources Network, P.O. Box 2965, Taos, NM 87571
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13
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Hoopsick RA, Fillo J, Vest BM, Homish DL, Homish GG. Substance use and dependence among current reserve and former military members: Cross-sectional findings from the National Survey on Drug Use and Health, 2010-2014. J Addict Dis 2017; 36:243-251. [PMID: 28813208 DOI: 10.1080/10550887.2017.1366735] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Maladjustment after leaving the military may contribute to poor health outcomes, including increased risk for substance use and dependence. The authors examined differences in substance use and dependence on the basis of military involvement in a large nationally representative sample. Data are from a subset of the 2010-2014 waves of the National Survey on Drug Use and Health (n = 5,608). The sample included men (81.9%) and women (18.1%) aged 20-49 years who had either separated/retired from the military (n = 4,862) or were a current reserve service member (n = 746). The sample was 70.8% Non-Hispanic White with a median family income between $50,000 and $74,999. Those who were separated/retired from the military had a higher odds of past month smoking (adjusted odds ratio [AOR] = 1.73, 95% confidence interval [CI]: 1.27, 2.36; p = 0.001), nonmedical use of prescription painkillers (AOR = 4.07, 95% CI: 1.88, 8.83; p < 0.001), illicit drug use (AOR = 2.75, 95% CI: 1.79, 4.24; p < 0.001), alcohol dependence (AOR = 2.17, 95% CI: 1.20, 3.93; p = 0.011), nicotine dependence (AOR = 2.03, 95% CI: 1.25, 3.28; p = 0.004), and illicit drug dependence (AOR = 5.89; 95% CI: 2.19, 15.85; p = 0.001), compared to current reserve service members, controlling for sex, age, race, and income. Service members are leaving the military at an increasing rate and substance use may increase after separation. Across a range of substances, those who are separated/retired from the military have a higher likelihood of substance use/dependence than current reserve service members. Care models that assist in the transition from discharge to civilian life should be considered.
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Affiliation(s)
- Rachel A Hoopsick
- a Department of Community Health and Health Behavior , State University of New York at Buffalo , Buffalo , New York , USA
| | - Jennifer Fillo
- b Research Institute on Addictions, State University of New York at Buffalo , Buffalo , New York , USA
| | - Bonnie M Vest
- c Department of Family Medicine , State University of New York at Buffalo , Buffalo , New York , USA
| | - D Lynn Homish
- a Department of Community Health and Health Behavior , State University of New York at Buffalo , Buffalo , New York , USA
| | - Gregory G Homish
- a Department of Community Health and Health Behavior , State University of New York at Buffalo , Buffalo , New York , USA.,b Research Institute on Addictions, State University of New York at Buffalo , Buffalo , New York , USA.,c Department of Family Medicine , State University of New York at Buffalo , Buffalo , New York , USA
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