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Liu RT, Bettis AH, Lawrence HR, Walsh RFL, Sheehan AE, Pollak OH, Stephenson AR, Kautz MM, Marlowe RM. Measures of Suicidal Thoughts and Behaviors in Children and Adolescents: A Systematic Review and Recommendations for Use in Clinical and Research Settings. Assessment 2024:10731911241249438. [PMID: 38742801 DOI: 10.1177/10731911241249438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Empirically supported measures of suicidal thoughts and behaviors (STBs) are needed to serve as reference outcomes for suicide risk screening tools and to monitor severity and treatment progress in children and adolescents with STBs. The present paper systematically reviewed existing measures of STBs in youth and studies evaluating their psychometric properties and clinical utility. Measures were then evaluated on reliability, validity, and clinical utility. Sixteen articles (20 independent samples) were found with psychometric data with youth samples for eight measures. Interview-based measures were found to have the strongest psychometric support and clinical utility. Significant limitations exist for all self-report measures due to inherent characteristics of these measures that cannot be remedied through additional psychometric study. There is an urgent need for the development and validation of new self-report measures of STBs, particularly for preadolescent children, sexual and gender minority youth, and racial/ethnic minority youth.
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Affiliation(s)
- Richard T Liu
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
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2
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Deng H, Zhang X, Zhang Y, Yan J, Zhuang Y, Liu H, Li J, Xue X, Wang C. The pooled prevalence and influential factors of non-suicidal self-injury in non-clinical samples during the COVID-19 outbreak: A meta-analysis. J Affect Disord 2023; 343:109-118. [PMID: 37802326 DOI: 10.1016/j.jad.2023.09.036] [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: 04/21/2023] [Revised: 09/22/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND COVID-19 has had an enormous impact on the mental health of people around the world, particularly adolescents. Non-suicidal self-injury (NSSI) is one of the most prominent and dangerous behaviors associated with suicide. However, few meta-analyses of the NSSI prevalence have ever been conducted since the COVID-19 outbreak. Here, we conducted a meta-analysis to estimate the pooled prevalence and elucidate the influencing factors for NSSI. METHODS We searched PubMed, Web of Science, Embase, APA PsycINFO, CNKI and Wanfang Database for relevant literature published before April 2022. Pooled prevalence and 95 % confidence interval (CI) were used to assess NSSI prevalence. Subgroup and meta-regression analyses were performed to clarify the potential influencing factors. RESULTS A total of 15 studies with 24,055 participants were eventually included. The results showed that the pooled overall prevalence of NSSI among overall samples during the COVID-19 pandemic was 22.5 % (95 % CI: 17.2 % to 28.9 %). Subgroup and meta-regression analyses revealed that the crucial influencing factors for NSSI included gender, age, regional distribution, and suicidal ideation. Specifically, the NSSI prevalence among adolescents and adults during the pandemic was 32.40 % and 15.70 %, respectively. Most importantly, gender is a significant influencing factor for NSSI among adolescents. CONCLUSIONS The pooled prevalence of NSSI during the COVID-19 outbreak has surged to alarming heights, especially among adolescents. The prevalence of NSSI may be influenced by complex factors such as gender and age. Therefore, it is critical to pay attention to NSSI behaviors in the adolescent population, particularly male adolescents who appear to be susceptible.
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Affiliation(s)
- Hu Deng
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China.
| | - Xueqian Zhang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China; Department of Psychology, Chengde Medical University, Chengde, China
| | - Yiyue Zhang
- Department of Psychology, School of Humanities and Social Sciences, Beihang University, Beijing, China
| | - Jingyi Yan
- Department of Psychology, Chengde Medical University, Chengde, China
| | - Yunyue Zhuang
- Department of Psychology, Chengde Medical University, Chengde, China
| | - Huaqing Liu
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Jiuju Li
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Xiao Xue
- Department of Psychiatry, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Chundi Wang
- Department of Psychology, School of Humanities and Social Sciences, Beihang University, Beijing, China.
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3
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Cheng F, Shi L, Wang S, Jin Q, Xie H, Wang B, Zhang W. The relationship between childhood traumatic experience and suicidal tendency in non-suicidal self-injury behavior patients. BMC Psychiatry 2023; 23:401. [PMID: 37277735 DOI: 10.1186/s12888-023-04863-0] [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: 02/22/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Individuals with non-suicidal self-injury (NSSI) behavior are usually prone to repeated, intentional, direct harm to their own bodies that is not allowed by society without suicidal ideation. Under this behavior guidance, childhood traumatic experience may easily cause a series of psychological comorbidity symptoms, such as anxiety and depression, finally leading to a suicidal tendency. METHODS A total of 311 adolescent NSSI behavioral patients were recruited at the Ningbo Kangning hospital, Zhejiang Province according to the DSM-5 diagnostic criteria. Demographic data, childhood abuse and neglect, internet addiction, self-esteem, anxiety, and suicidal tendency were evaluated. A structural equation model with a path induction mechanism was constructed to evaluate the relationship between distal and proximal factors related to suicidal tendencies due to childhood traumatic experiences in NSSI behavioral individuals. RESULTS Among the 311 subjects included in the survey, 250 (80.39%) suffered traumatic experiences, such as emotional abuse/physical abuse/sexual abuse/emotional neglect or physical neglect in their childhood, 303 (97.43%) had suicidal ideation, 271 (87.14%) showed the total score of self-esteem, 148 (47.59%) had different degrees of Internet addiction tendency, and 286 (91.96%) showed obvious anxiety. The established path model fit well (GFI = 0.996, RMSEA = 0.03), and the model showed that self-esteem, anxiety, and childhood traumatic experience had standardized coefficients of -0.235 (z = -4.742, p < 0.01), 0.322 (z = 6.296, p < 0.01), 0.205 (z = 4.047, p < 0.01), respectively, with suicidal ideation path, suggesting that self-esteem, Internet addiction, and anxiety showed significant mediating effects in the process of childhood traumatic experience affecting suicidal ideation. CONCLUSION In the context of childhood traumatic experience, it is often accompanied by a series of regulatory behaviors such as Internet addiction, self-esteem, and so on, which finally leads to anxiety, mental symptoms, and even suicidal tendencies. The results provide effective support for the structural equation modeling to evaluate the multi-level influence of NSSI behavior individuals and emphasize that childhood familial factors may lead to psychiatric comorbidity symptoms and suicidal behavior.
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Affiliation(s)
- Fang Cheng
- Department of Pediatric Psychology, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China
| | - Linwei Shi
- School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, 350116, China
| | - Shujun Wang
- Department of Pediatric Psychology, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China
| | - Qiong Jin
- Department of Pediatric Psychology, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China
| | - Huabing Xie
- Department of General Medicine, People's Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Beini Wang
- Department of Pediatric Psychology, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China.
| | - Wenwu Zhang
- Department of Pediatric Psychology, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, China.
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Walker LE, Poltavskiy E, Howard JT, Janak JC, Watrous J, Alcover K, Pettey WBP, Ambardar S, Meyer E, Gundlapalli AV, Stewart IJ. Suicide attempts and mental health diagnoses in combat-injured service members: A retrospective cohort study. Suicide Life Threat Behav 2022; 53:227-240. [PMID: 36576267 DOI: 10.1111/sltb.12938] [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: 04/15/2022] [Revised: 08/19/2022] [Accepted: 12/05/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Examinations of risk factors for suicide attempt in United States service members at high risk of mental health diagnoses, such as those with combat injuries, are essential to guiding prevention and intervention efforts. METHODS Retrospective cohort study of 8727 combat-injured patients matched to deployed, non-injured patients utilizing Department of Defense and Veterans Affairs administrative records. RESULTS Combat injury was positively associated with suicide attempt in the univariate model (HR = 1.75, 95% CI 1.5-2.1), but lost significance after adjustment for mental health diagnoses. Utilizing Latent Transition Analysis in the combat-injured group, we identified five mental/behavioral health profiles: (1) Few mental health diagnoses, (2) PTSD and depressive disorders, (3) Adjustment disorder, (4) Multiple mental health comorbidities, and (5) Multiple mental health comorbidities with alcohol use disorder (AUD). Multiple mental health comorbidities with AUD had the highest suicide attempt rate throughout the study and more than four times that of Multiple mental health comorbidities in the first study year (23.4 vs. 5.1 per 1000 person years, respectively). CONCLUSION Findings indicate that (1) combat injury's impact on suicide attempt is attenuated by mental health and (2) AUD with multiple mental health comorbidities confers heightened suicide attempt risk in combat-injured service members.
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Affiliation(s)
- Lauren E Walker
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Eduard Poltavskiy
- David Grant USAF Medical Center, Travis AFB, Fairfield, California, USA
| | | | | | - Jessica Watrous
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Leidos Inc., San Diego, California, USA
| | - Karl Alcover
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Warren B P Pettey
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Shiva Ambardar
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Eric Meyer
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Adi V Gundlapalli
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ian J Stewart
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Military Cardiovascular Outcomes Research (MiCOR), Bethesda, Maryland, USA
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Taillieu TL, Sareen J, Afifi TO. Associations among child abuse history, deployment-related traumatic events, mental disorders, and suicidal behaviors in Canadian Regular Force personnel. J Trauma Stress 2022; 35:1060-1071. [PMID: 35727709 PMCID: PMC9545891 DOI: 10.1002/jts.22814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 11/17/2021] [Accepted: 12/16/2021] [Indexed: 11/11/2022]
Abstract
Increasing attention has been focused on suicidal behavior among military personnel. Exposure to deployment-related traumatic events (DRTEs) and child abuse (CA) both have been associated with mental disorders and suicidal behaviors among military personnel. Thus, the primary objectives of this study were to examine (a) sex differences in CA history and DRTEs, past-year mental disorders, and past-year suicide-related outcomes and (b) independent, cumulative, and interactive effects of CA history and DRTEs on past-year mental disorders and suicide outcomes among Canadian military personnel. Data were from the representative Canadian Forces Mental Health Survey collected in 2013 (N = 8,161; response rate = 79.8%). The results indicated a high prevalence of trauma exposure, with sex differences noted for specific trauma types. Both CA history and DRTEs were strongly associated with mental disorders, CA history: aORs = 1.60-2.44; DRTEs; aORs = 1.67-3.88. Cumulative, but not interactive, effects were noted for the effects of CA history and DRTEs on most mental disorders. Associations between CA history and DRTEs on suicide outcomes were largely indirect via their impact on mental disorders. Information regarding the role of specific types of predeployment trauma on mental disorders and suicidal behavior can be used to develop more targeted prevention and intervention strategies aimed at improving the mental health of military personnel.
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Affiliation(s)
- Tamara L. Taillieu
- Department of Community Health SciencesUniversity of ManitobaWinnipegManitobaCanada
| | - Jitender Sareen
- Department of PsychiatryUniversity of ManitobaWinnipegManitobaCanada
| | - Tracie O. Afifi
- Departments of Community Health Sciences and PsychiatryUniversity of ManitobaWinnipegManitobaCanada
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6
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Cacace S, Smith EJ, Cramer RJ, Meca A, Desmarais SL. Military self-stigma as a mediator of the link between military identity and suicide risk. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1994329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sam Cacace
- Department of Public Health Sciences, University of North Carolina, Charlotte, North Carolina, USA
| | - Emily J. Smith
- Center for Family and Community Engagement, NC State University, Raleigh, North Carolina, USA
| | - Robert J. Cramer
- Department of Public Health Sciences, University of North Carolina, Charlotte, North Carolina, USA
| | - Alan Meca
- Department of Psychology, University of Texas, San Antonio, Texas, USA
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Shelef L, Rabbany JM, Gutierrez PM, Kedem R, Ben Yehuda A, Mann JJ, Yacobi A. The Role of Past Suicidal Behavior on Current Suicidality: A Retrospective Study in the Israeli Military. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E649. [PMID: 33466594 PMCID: PMC7828732 DOI: 10.3390/ijerph18020649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/06/2021] [Accepted: 01/09/2021] [Indexed: 11/16/2022]
Abstract
Past suicide attempts are a significant risk factor for future suicidality. Therefore, the present military-based study examined the past suicidal behavior of soldiers who recently made a severe suicide attempt. Our sample consisted of 65 active-duty soldiers (61.5% males), between the ages of 18 and 28 years old (M = 20.4, SD ± 1.3). The inclusion criterion was a recent severe suicide attempt, requiring at least a 24 h hospitalization. This sample was divided into two groups, according to previous suicidal behavior, namely whether their first suicide attempt was before or after enlistment (n = 25; 38.5% and n = 40; 61.5%, respectively). We then examined the lethality and intent of the recent event in regard to this division. Four measures were used to assess the subjects' suicidal characteristics: the Columbia Suicide Severity Rating Scale, the Self-Harm Behavior Questionnaire, the Suicidal Behaviors Questionnaire-Revised, and the Beck Scale for Suicide Ideation. No significant difference in the severity of the suicide attempts (either actual or potential severity) were found between those who had suicide attempts before enlistment and those who had their first attempt in the service. As a matter of fact, most of the suicide attempts that occurred for the first time during military service had used a violent method (58.3%, n = 21). Finally, using multivariate analyses, we found that current thoughts and behavior, rather than past suicidality, was the strongest predictor for the lethality of suicide attempts.
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Affiliation(s)
- Leah Shelef
- Department of Health and Well-Being, IDF’s Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel;
| | | | - Peter M Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO 80045, USA;
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Ron Kedem
- Statistican, Medical Corps-Israel Defense Forces, Ramat Gan 5262000, Israel;
| | - Ariel Ben Yehuda
- Department of Health and Well-Being, IDF’s Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel;
| | - J. John Mann
- Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY 10032, USA;
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Assaf Yacobi
- Beer Ya’akov-Ness Ziona Mental Health Medical Center, Beer Yaakov 70350, Israel;
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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8
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Liu Y, Xiao Y, Ran H, He X, Jiang L, Wang T, Yang RX, Xu X, Yang G, Lu J. Association between parenting and non-suicidal self-injury among adolescents in Yunnan, China: a cross-sectional survey. PeerJ 2020; 8:e10493. [PMID: 33354431 PMCID: PMC7727394 DOI: 10.7717/peerj.10493] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/13/2020] [Indexed: 12/16/2022] Open
Abstract
Background Non-suicidal self-injury (NSSI) among adolescents is prevalent and its rate has increased in recent years worldwide. Previous studies had investigated the association between parenting and childhood NSSI, but little is known about the relationship between parental rearing and repetition and severity of NSSI. The aim of this study was to investigate associations of parenting with NSSI and its repetition and severity in a representative adolescent sample from southwestern China. Methods In this cross-sectional study, a sample of 2,705 adolescents (F/M: 1,245/1,460; mean age: 13.4 ± 2.2 years) was recruited from 14 randomly selected schools in Lincang municipality, Yunnan province, China. A self-report questionnaire was used to collect data. The Adolescent Non-Suicidal Self-Injury Function Assessment Scale and the short Chinese Egna Minnen av Barndoms Uppfostran (s-EMBU-C) were used to evaluate NSSI behaviors and parenting style, respectively. Univariate and multivariate logistic regression models were adopted to examine association between parenting and NSSI. Results Overall lifetime prevalence of NSSI was 47.1% (95% CI [36.2–58.0]), with self-cutting being the most common form (23.5% (95% CI [19.3–27.7])), followed by hitting hard objects (23.4% (95% CI [20.2–26.7])) and pulling hairs (20.9% (95% CI [18.8–22.6])). In multiple logistic regression analyses, NSSI was positively associated with high level of father’s rejection (OR: 1.32 (95% CI [1.01–1.72])), high level of mother’s rejection (OR: 1.76 (95% CI [1.46–2.13])), low level of mother’s emotional warmth (OR: 1.42 (95% CI [1.15–1.75])), and high level of mother’s overprotection (OR: 1.74 (95% CI [1.49–2.03])), repeated NSSI was positively associated with low level of father’s emotional warmth (OR: 1.39 (95% CI [1.10–1.75])) and high level of mother’s overprotection (OR: 1.79 (95% CI [1.33–2.41])), and severe NSSI was positively associated with low level of father’s emotional warmth (OR: 1.64 (95% CI [1.11–2.43])) and high level of mother’s rejection (OR: 2.16 (95% CI [1.71–2.71])). Conclusion NSSI is common among adolescents in southwestern China. Negative parenting styles are associated with NSSI, repeated NSSI, and severe NSSI. The development of intervention measures for preventing or reducing NSSI among Chinese adolescents in school settings should consider parenting styles.
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Affiliation(s)
- Yi Liu
- National Health Commission Key Laboratory of Drug Addiction Medicine, Psychiatric Department, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuanyuan Xiao
- Department of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, China
| | - Hailiang Ran
- Department of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, China
| | - Xingting He
- Lincang Psychiatric Hospital, Lincang, China
| | - Linling Jiang
- National Health Commission Key Laboratory of Drug Addiction Medicine, Psychiatric Department, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | | | - Run-Xu Yang
- National Health Commission Key Laboratory of Drug Addiction Medicine, Psychiatric Department, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiufeng Xu
- National Health Commission Key Laboratory of Drug Addiction Medicine, Psychiatric Department, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | | | - Jin Lu
- National Health Commission Key Laboratory of Drug Addiction Medicine, Psychiatric Department, First Affiliated Hospital of Kunming Medical University, Kunming, China
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Monteith LL, Holliday R, Miller C, Schneider AL, Hoffmire CA, Bahraini NH, Forster JE. Suicidal ideation, suicide attempt, and non-suicidal self-injury among female veterans: Prevalence, timing, and onset. J Affect Disord 2020; 273:350-357. [PMID: 32560928 DOI: 10.1016/j.jad.2020.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/19/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Suicide rates among female veterans have continued to increase, particularly among those not using Veterans Health Administration (VHA) care. Nonetheless, suicide research has rarely focused on female veterans, particularly non-VHA users. The present study examined the prevalence and onset of suicidal ideation (SI), suicide attempt (SA), and non-suicidal self-injury (NSSI) in relation to military service among female veterans. Additionally, current, past, and never VHA users were compared in regard to SI, SA, and NSSI prevalence. METHODS Female veterans (n = 439) participated in a national, cross-sectional survey. RESULTS Lifetime prevalence of SI (47.9%), SA (17.7%), and NSSI (13.2%) were high. Participants were more likely to report experiencing SI and SA following separation, compared to preceding (SI, SA) or during (SI only) military service, controlling for time at risk. However, onset was more likely to occur prior to military service, compared to after separation, for SI, SA, and NSSI. In age-adjusted analyses, current and past users of VHA care were more likely to report experiencing lifetime SI, compared to those who never used VHA care. However, when adjusting for service era, past and never VHA users did not significantly differ. LIMITATIONS Cross-sectional design, retrospective recall, and convenience sample. CONCLUSIONS For female veterans, onset of SI, SA, and NSSI appears to most commonly occur before military service. However, SI and SA prevalence are highest following separation, suggesting a period warranting additional support and intervention. Results underscore the need for continued suicide surveillance, prevention, and intervention efforts for female veterans, especially current VHA users.
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Affiliation(s)
- Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States.
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States
| | - Christin Miller
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, United States
| | - Alexandra L Schneider
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, United States
| | - Claire A Hoffmire
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, United States; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, United States
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, United States
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, United States; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, United States; Department of Biostatistics and Informatics, Colorado School of Public Health, United States
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10
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Ghosh A, Santana MC, Fox TD. The Role of Military Culture in Therapy and Prevention:Training Recommendations for University and College Counseling Centers. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2020. [DOI: 10.1080/87568225.2020.1753608] [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)
- Arpita Ghosh
- Department of Educational Psychology, The University of Kansas, Lawrence, Kansas, USA
| | - Mercedes C. Santana
- Student Counseling Services, Metropolitan State University, Saint Paul, Minnesota, USA
| | - Troy D. Fox
- Department of Educational Psychology, The University of Kansas, Lawrence, Kansas, USA
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11
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Papazoglou K, Blumberg DM, Chiongbian VB, Tuttle BM, Kamkar K, Chopko B, Milliard B, Aukhojee P, Koskelainen M. The Role of Moral Injury in PTSD Among Law Enforcement Officers: A Brief Report. Front Psychol 2020; 11:310. [PMID: 32194477 PMCID: PMC7064734 DOI: 10.3389/fpsyg.2020.00310] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/10/2020] [Indexed: 02/05/2023] Open
Abstract
Exposure to critical incidents and hence potentially traumatic events is endemic in law enforcement. The study of law enforcement officers’ experience of moral injury and their exposure to potentially morally injurious incidents, and research on moral injury’s relationship with different forms of traumatization (e.g. compassion fatigue, post-traumatic stress disorder) are in their infancy. The present study aims to build on prior research and explores the role of moral injury in predicting post-traumatic stress disorder (PTSD) and its clusters thereof. To this end, a sample of law enforcement officers (N = 370) from the National Police of Finland was recruited to participate in the current study. Results showed that moral injury significantly predicted PTSD as well as its diagnostic clusters (i.e., avoidance, hyperarousal, re-experiencing). The aforementioned role of moral injury to significantly predict PTSD and its clusters were unequivocal even when compassion fatigue was incorporated into the path model. Clinical, research, and law enforcement practice implications are discussed.
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Affiliation(s)
| | - Daniel M Blumberg
- California School of Professional Psychology, Alliant International University, San Diego, CA, United States
| | | | | | - Katy Kamkar
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Brian Chopko
- Department of Sociology, Kent State University, North Canton, OH, United States
| | | | - Prashant Aukhojee
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Mari Koskelainen
- National Bureau of Investigation, Intelligence Division, Threat Assessment Team, Vantaa, Finland
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12
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Hom MA, Duffy ME, Rogers ML, Hanson JE, Gutierrez PM, Joiner TE. Examining the link between prior suicidality and subsequent suicidal ideation among high-risk US military service members. Psychol Med 2019; 49:2237-2246. [PMID: 30355371 DOI: 10.1017/s0033291718003124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Research is needed to identify the factors that explain the link between prior and future suicidality. This study evaluated possible mediators of the relationship between: (1) the severity of prior suicidality and (2) suicidal ideation severity at 3-month follow-up among a sample of high-risk military personnel. METHODS US military service members referred to or seeking care for suicide risk (N = 624) completed self-report psychiatric domain measures and a clinician interview assessing prior suicidality severity at baseline. Three months later, participants completed a self-report measure of suicidal ideation severity. Three separate percentile bootstrap mediation models were used to examine psychiatric factors (i.e. alcohol abuse, anxiety sensitivity, hopelessness, insomnia, posttraumatic stress symptoms, suicidal ideation, and thwarted belongingness) as parallel mediators of the relationship between prior suicidality severity (specifically, suicidal ideation, suicide attempt, and overall suicidality - i.e. ideation/attempt severity combined) at baseline and suicidal ideation severity at follow-up. RESULTS Hopelessness, specifically, and the total effect of all mediators, each significantly accounted for the relationship between prior suicidality severity and subsequent ideation severity across models. In the models with attempt severity and overall suicidality severity as predictors, thwarted belongingness was also a significant mediator. CONCLUSIONS Hopelessness, thwarted belongingness, and overall severity of psychiatric indices may explain the relationship between prior suicidality severity and future suicidal ideation severity among service members at elevated suicide risk. Research is needed to replicate these findings and examine other possible mediators.
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Affiliation(s)
- Melanie A Hom
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Mary E Duffy
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Megan L Rogers
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Jetta E Hanson
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, USA
| | - Peter M Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, USA
- Denver Veterans Affairs Medical Center, Aurora, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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13
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Matarazzo BB, Brown GK, Stanley B, Forster JE, Billera M, Currier GW, Ghahramanlou-Holloway M, Brenner LA. Predictive Validity of the Columbia-Suicide Severity Rating Scale among a Cohort of At-risk Veterans. Suicide Life Threat Behav 2019; 49:1255-1265. [PMID: 30368871 DOI: 10.1111/sltb.12515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/16/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To examine the psychometric properties of the Columbia- Suicide Severity Rating Scale (C-SSRS) among a cohort of veterans identified to be at risk for suicide. METHOD Convergent, divergent, and predictive validity of the C-SSRS were examined using secondary data from a study of veterans who presented to the psychiatric emergency room (n = 237). Data were collected 1 week, 1 month, 3 months, and 6 months following emergency room discharge. RESULTS Results demonstrated good evidence for convergent and divergent validity. Baseline intensity subscale scores predicted actual and interrupted attempts, and any behavior for all available data and for the subsample who had 6-month follow-up data, and also predicted preparatory behavior in the full sample. Baseline severity subscale scores predicted preparatory behavior and any behavior for the full sample and for those with 6 months of follow-up, and actual attempts for the full sample. Severity of ideation cutoff scores was significantly associated with actual attempts and any behavior in both samples. Adding a prior behavior criterion demonstrated similar results. CONCLUSIONS Findings suggest that the C-SSRS is a psychometrically sound measure that can be used to augment suicide risk assessment with veterans who are already identified to be at risk for suicide.
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Affiliation(s)
- Bridget B Matarazzo
- Research, Education and Clinical Center (MIRECC), VA Rocky Mountain Mental Illness, Denver, CO, USA.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gregory K Brown
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Veterans Integrated Service Network (VISN) 4 MIRECC, Philadelphia, PA, USA.,Department of Veterans Affairs, Philadelphia, PA, USA
| | - Barbara Stanley
- Department of Psychiatry, Columbia University, New York, NY, USA.,New York State Psychiatric Institute, New York, NY, USA
| | - Jeri E Forster
- Rocky Mountain MIRECC, US Department of Veterans Affairs, Denver, CO, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado, School of Medicine, Aurora, CO, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Melodi Billera
- Rocky Mountain MIRECC, US Department of Veterans Affairs, Aurora, CO, USA
| | - Glenn W Currier
- Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Marjan Ghahramanlou-Holloway
- Departments of Medical & Clinical Psychology and Psychiatry, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Lisa A Brenner
- Rocky Mountain MIRECC, US Department of Veterans Affairs, Denver, CO, USA.,Departments of Psychiatry, Neurology, and Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, Aurora, CO, USA
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14
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Monteith LL, Holliday R, Schneider AL, Forster JE, Bahraini NH. Identifying factors associated with suicidal ideation and suicide attempts following military sexual trauma. J Affect Disord 2019; 252:300-309. [PMID: 30991258 DOI: 10.1016/j.jad.2019.04.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/12/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND As increasing research demonstrates that military sexual trauma (MST) is associated with suicidal ideation and attempts, discerning factors that place MST survivors at risk for these outcomes is critical. The present study aimed to: (1) characterize suicidal ideation and attempts among MST survivors; (2) identify factors associated with post-MST suicide attempts, post-MST suicidal ideation, and past-week suicidal ideation. METHODS A convenience sample of 108 veterans (66 women, 42 men) who reported a history of MST participated in this cross-sectional study. Pre-MST suicidal ideation and attempt, childhood physical and sexual abuse, military sexual assault, institutional betrayal, and posttraumatic cognitions about self, world, and self-blame were examined, with age and gender as covariates. RESULTS Seventy-five percent of participants reported experiencing post-MST suicidal ideation, and 40.7% reported attempting suicide following MST. Pre-MST suicide attempt and posttraumatic cognitions about self were associated with post-MST suicide attempt. Pre-MST suicidal ideation, military sexual assault, childhood physical abuse, and posttraumatic cognitions about self were associated with post-MST suicidal ideation. Lastly, pre-MST suicidal ideation and posttraumatic cognitions about self were associated with past-week suicidal ideation; results were unchanged when accounting for recent PTSD or depressive symptoms. LIMITATIONS The cross-sectional design, retrospective self-report, and small sample are limitations. CONCLUSIONS Addressing negative posttraumatic beliefs about self may be important for managing suicide risk among MST survivors. Assessing for pre-MST suicidal ideation and attempt is likely also warranted. Further understanding of the longitudinal impact of posttraumatic beliefs about self on subsequent risk for suicidal ideation and attempt is warranted.
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Affiliation(s)
- Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, 1700 North Wheeling, Aurora, CO 80045, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States.
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, 1700 North Wheeling, Aurora, CO 80045, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States
| | - Alexandra L Schneider
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, 1700 North Wheeling, Aurora, CO 80045, United States
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, 1700 North Wheeling, Aurora, CO 80045, United States; Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, United States; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, United States
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, 1700 North Wheeling, Aurora, CO 80045, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, United States
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15
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Liu RT. The psychological scars of suicide: Accounting for how risk for suicidal behavior is heightened by its past occurrence. Neurosci Biobehav Rev 2019; 99:42-48. [PMID: 30685485 PMCID: PMC6410722 DOI: 10.1016/j.neubiorev.2019.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/08/2019] [Accepted: 01/21/2019] [Indexed: 11/28/2022]
Abstract
Not only is suicidal behavior strongly predicted by its past occurrence, but the risk for recurrence appears to increase with each subsequent attempt. The current paper discusses a potential explanation for this phenomenon, that suicide attempts may leave a residual psychological scar that heightens risk for future attempts. This possibility is evaluated against two alternatives: (i) risk for first and subsequent suicide attempts is accounted for by a shared diathesis pre-existing the first lifetime attempt, and (ii) different rates of developmental decline in risk factors account for differences in prospective number of attempts. In this discussion, a formalized conceptual framework of psychological scarring is presented, along with considerations of particular relevance to its study. Finally, the clinical implications of determining the processes underlying the association between suicide attempts and heightened risk for recurrence are discussed.
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Affiliation(s)
- Richard T Liu
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI, 02915, United States.
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16
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Abstract
Recent studies have revealed a high rate of nonsuicidal self-injury (NSSI) behavior in Chinese students, but quantitative syntheses of pooled prevalence are sparse. There have been several NSSI prevalence meta-analyses in other populations. However, given the existence of cultural diversity, racial difference, educational system difference and so on, these results may not be ideal for Chinese populations. Furthermore, the above-mentioned meta-analyses did not include Chinese database which may have led to unintentional bias. Thus, we conducted this meta-analysis to estimate the prevalence of NSSI in Chinese middle-school students.The databases searched included PubMed, Embase, Web of Science, CBM (Chinese database), Chinese National Knowledge Infrastructure (CNKI), Wanfang Data (Chinese database) and the Weipu database (Chinese database). The search terms included: self-injury/self-harm/self-abuse/nonsuicidal self-injury/deliberate self-harm, adolescen*/youth/teen/students, and China/Chinese. All relevant articles published between January 2000 to November 2017, in either Chinese or English, were included. Two investigators were engaged in this process, and any disagreements were settled by a third investigator. A random effects model was then used to calculate the pooled prevalence.A total of 420 studies with 160,348 participants were retrieved. The pooled prevalence was 22.37% (95% CI: 18.84%-25.70%). Substantial heterogeneity in prevalence estimates was revealed. Subgroup analyses showed that the pooled estimate of prevalence of life time NSSI was 14.5% (95%CI: 0.06%-22.7%), and 6-24 months NSSI was23.3% (95%CI: 20.5%-26.1%). The prevalence for males was 20.6% (95% CI: 16.1%-25.0%), and for females was 21.9% (95% CI: 17.6%-26.2%).The prevalence of NSSI in Chinese middle-school students is relatively high. More attention should be paid to the current situation.
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17
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Hourani LL, Williams J, Lattimore PK, Morgan JK, Hopkinson SG, Jenkins L, Cartwright J. Workplace victimization risk and protective factors for suicidal behavior among active duty military personnel. J Affect Disord 2018; 236:45-51. [PMID: 29715608 DOI: 10.1016/j.jad.2018.04.095] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/26/2018] [Accepted: 04/08/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Workplace victimization is a potential risk factor for suicidal behaviors (SB) among military personnel that has been largely overlooked. This paper examines both the impact of workplace victimization on reported SB and several potential protective factors associated with such suicidal behaviors in a large sample of active duty soldiers. METHODS A case-control study was conducted with 71 soldiers who reported SB in the past 12 months, each matched on sociodemographic characteristics to two others without reported suicidal behaviors. A multiple regression model was estimated to assess the effects of risk and protective factors while controlling for other variables. RESULTS SB was associated with several aspects of victimization, mental health and substance abuse conditions, pain, impulsivity, stressors, negative life events, work-family conflict, active coping behaviors and positive military-related factors. Controlling for other variables, those with SB were more likely to have sought mental health or substance abuse services, to be depressed, anxious, impulsive, and less resilient than non-SB personnel. LIMITATIONS Study limitations included the use of retrospective self-report data, absence of some known SB predictors, and a population restricted to active duty Army personnel. CONCLUSIONS SB among active duty personnel is associated with victimization since joining the military and is protected by resiliency. These findings suggest that in addition to the usual mental health factors, these additional predictors should be accounted for in SB intervention and prevention planning for active duty personnel.
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Affiliation(s)
- Laurel L Hourani
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC 27709, USA.
| | - Jason Williams
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC 27709, USA
| | - Pamela K Lattimore
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC 27709, USA
| | - Jessica K Morgan
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC 27709, USA; Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310, USA
| | - Susan G Hopkinson
- Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310, USA
| | - Linda Jenkins
- Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310, USA
| | - Joel Cartwright
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC 27709, USA; Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310, USA
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18
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Gomes DAR, de Araújo RMF, Gomes MS. Incidence of suicide among military police officers in South Brazil: An 11-year retrospective cohort study. Compr Psychiatry 2018; 85:61-66. [PMID: 29981945 DOI: 10.1016/j.comppsych.2018.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/31/2018] [Accepted: 06/16/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Suicide is known to be the leading cause of death among police officers (PO) worldwide. However, most studies were conducted in developed countries, with no data from Brazil. The present study aimed to evaluate the incidence and the sociodemographic profile of suicide among a military PO subpopulation in South Brazil. METHODS This retrospective cohort evaluated 31,110 military PO with available data on cause of death from 2006 to 2016. Participants were monitored for an average of 18.8 ± 9.6 years following the date of entry into the military police. RESULTS Mean age at the end of the follow up time was 41.4 ± 9.1 years, with 90.7% males. A total of 650 participants died (2.1%), with 43 suicides (6.6% of all deaths) - cumulative incidence of 138/100,000. Bivariate analysis revealed a significant association (p < 0.05) between suicide and age (HR = 0.70, 95%CI = 0.66-0.74), females (HR = 1.67, 95%CI = 1.08-2.60) and enlisted military rank (HR = 14.9, 95%CI = 2.05-108.5). Multivariate models showed an independent association between suicide and age (HR = 0.71, 95%CI = 0.67-0.74) and enlisted military rank (HR = 9.96, 95%CI = 1.30-76.3). CONCLUSIONS The incidence of suicide among military PO in South Brazil was high, compared to the national suicide rate. Younger age and lower military rank were independent predictors of suicide in this subpopulation.
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Affiliation(s)
- Denise Alves Riambau Gomes
- Department of Health of the Military Brigade of Rio Grande do sul, Brazil, Rua Castro de Menezes, 275, CEP 90010-190 Porto Alegre, RS, Brazil
| | - Rafael Moreno Ferro de Araújo
- Vale do Taquari University - Univates, Lajeado, Brazil, Rua Avelino Talini, 171, CEP 95914-014 Lajeado, RS, Brazil; Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil, Av. Ipiranga, 6681, prédio 6, CEP 90619900 Porto Alegre, RS, Brazil.
| | - Maximiliano Schünke Gomes
- Department of Health of the Military Brigade of Rio Grande do sul, Brazil, Rua Castro de Menezes, 275, CEP 90010-190 Porto Alegre, RS, Brazil; Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil, Av. Ipiranga, 6681, prédio 6, CEP 90619900 Porto Alegre, RS, Brazil.
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19
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Bryan CJ, Rudd MD. Nonlinear Change Processes During Psychotherapy Characterize Patients Who Have Made Multiple Suicide Attempts. Suicide Life Threat Behav 2018; 48:386-400. [PMID: 28597959 DOI: 10.1111/sltb.12361] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/20/2017] [Indexed: 12/01/2022]
Abstract
Research suggests that multiple suicide attempters experience considerable variability in suicide ideation and longer-duration suicidal crises, which suggests the possibility of two states of stability (one low risk and one high risk). To date, however, few studies have examined nonlinear change processes in suicide ideation among patients. In a sample of 76 active duty U.S. Army soldiers receiving brief cognitive behavioral therapy for acute suicide risk, we examined differences in the ebb and flow of suicide ideation among multiple attempters, first-time attempters, and ideators. Results indicated that multiple attempters were characterized by two states of stability corresponding to low and high intensity suicide ideation; these states were separated by a region of instability corresponding to moderate intensity suicide ideation. In contrast, ideators and first-time attempters were characterized by only a single state of stability corresponding to low intensity suicide ideation. Among patients who have made multiple suicide attempts, suicide ideation may function as a bimodal rather than a continuous construct.
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Affiliation(s)
- Craig J Bryan
- National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA
| | - M David Rudd
- National Center for Veterans Studies, The University of Memphis, Memphis, TN, USA
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20
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Lee DJ, Kearns JC, Wisco BE, Green JD, Gradus JL, Sloan DM, Nock MK, Rosen RC, Keane TM, Marx BP. A longitudinal study of risk factors for suicide attempts among Operation Enduring Freedom and Operation Iraqi Freedom veterans. Depress Anxiety 2018; 35:609-618. [PMID: 29637667 DOI: 10.1002/da.22736] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/21/2017] [Accepted: 01/25/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Suicide rates among veterans have increased markedly since the onset of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF; LeardMann et al., 2013). Identification of factors with the greatest contribution to suicide risk among veterans is needed to inform risk assessment and to identify intervention targets. METHODS This study examined predictors of suicide attempts among participants in the Veterans After-Discharge Longitudinal Registry; a nationwide cohort of OEF/OIF veterans enrolled in Department of Veterans Affairs (VA) services. Veterans with and without probable posttraumatic stress disorder (PTSD) were sampled at a 3:1 ratio, and male and female veterans were sampled at a 1:1 ratio. Participants (N = 1,649) were assessed at two time points, roughly 2 years apart (M = 28.74 months, SD = 8.72). RESULTS Seventy-four participants (4.49%) attempted suicide during the follow-up period. The strongest predictors of suicide attempts among the full sample were suicidal intent, attempt history, suicide ideation, PTSD symptoms, alcohol use disorder (AUD) symptoms, and depression. Veterans with multiple risk factors were particularly vulnerable; of veterans with 0, ≥1, ≥2, ≥3, or ≥ 4 of these risk factors, 0%, 7.81%, 10.31%, 18.45%, and 20.51% made a suicide attempt, respectively. CONCLUSIONS This prospective study identified several strong predictors of suicide attempts among OEF/OIF veterans which may be important targets for suicide prevention efforts. Further, co-occurrence of multiple risk factors was associated with markedly greater risk for suicide attempts; veterans with multiple risk factors appear to be at the highest risk among OEF/OIF veterans enrolled in VA care.
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Affiliation(s)
- Daniel J Lee
- National Center for PTSD, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Jaclyn C Kearns
- VA Boston Healthcare System, Boston, MA, USA.,Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, NY, USA
| | - Blair E Wisco
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Jonathan D Green
- VA Boston Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Jaimie L Gradus
- National Center for PTSD, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA
| | - Denise M Sloan
- National Center for PTSD, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | | | - Terence M Keane
- National Center for PTSD, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Brian P Marx
- National Center for PTSD, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
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21
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Fox KR, Ribeiro JD, Kleiman EM, Hooley JM, Nock MK, Franklin JC. Affect toward the self and self-injury stimuli as potential risk factors for nonsuicidal self-injury. Psychiatry Res 2018; 260:279-285. [PMID: 29223043 DOI: 10.1016/j.psychres.2017.11.083] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 11/27/2017] [Accepted: 11/27/2017] [Indexed: 11/19/2022]
Abstract
Few risk factors for nonsuicidal self-injury (NSSI) have been identified. This study investigated diminished aversion toward self-injury (i.e., NSSI, suicide/death stimuli) and self-criticism as unique NSSI risk factors. After terminating a treatment study, 154 adults with a recent and frequent NSSI history completed self-report and computer-based measures of psychopathology, implicit and explicit self-criticism, and implicit aversion to NSSI and suicide/death. Participants were then contacted 4 weeks later to test factors predicting NSSI frequency over this follow-up period. Diminished aversion toward NSSI stimuli and self-criticism significantly predicted NSSI 4 weeks later. These effects were unique from other theoretically important predictors, such as past week NSSI frequency and total number of NSSI methods used. Findings provide support that erosion of barriers to NSSI (e.g., aversion to self-injurious stimuli, decreased self-worth) may facilitate continued engagement in these dangerous behaviors. Results shed light on potential treatment targets for NSSI.
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Affiliation(s)
- Kathryn R Fox
- Department of Psychology, Harvard University, Cambridge, MA, USA.
| | - Jessica D Ribeiro
- Department of Psychology, Florida State University, Tallahassee, FL, USA; Military Suicide Research Consortium, USA
| | - Evan M Kleiman
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Jill M Hooley
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Joseph C Franklin
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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22
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Stanley IH, Hom MA, Spencer-Thomas S, Joiner TE. Suicidal thoughts and behaviors among women firefighters: An examination of associated features and comparison of pre-career and career prevalence rates. J Affect Disord 2017. [PMID: 28641147 DOI: 10.1016/j.jad.2017.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Women protective service workers die by suicide at a higher rate than women workers in other occupational groups. However, no study has examined rates and correlates of suicidal thoughts and behaviors among women firefighters, despite the potential for these data to inform suicide screening, prevention, and intervention initiatives. The purpose of this study is to describe and compare pre-career and career rates of suicidal thoughts and behaviors and identify their sociodemographic and occupational correlates among women firefighters. METHODS Data were obtained from 313 current U.S. women firefighters who completed a web-based survey (mean age = 37.30y, SD = 9.70y, 92.7% White). RESULTS Pre-career rates of suicide ideation, plans, attempts, and non-suicidal self-injury (NSSI) were found to be 28.4%, 10.2%, 5.8%, and 11.2%, respectively. Career rates of suicide ideation, plans, attempts, and NSSI were found to be 37.7%, 10.9%, 3.5%, and 9.3%, respectively. Pre-career rates of suicide ideation (OR = 4.760, 95% CI = 2.820-8.034, p < 0.001), plans (OR = 4.867, 95% CI = 2.067-11.463, p < 0.001), attempts (OR = 7.175, 95% CI = 1.726-29.828, p = 0.007), and NSSI (OR = 9.676, 95% CI = 4.130-22.670, p < 0.001) were significantly associated with career suicidality. With few exceptions, neither sociodemographic characteristics nor firefighter experiences were associated with career suicidal symptoms. LIMITATIONS Study limitations include a cross-sectional design and convenience sample recruitment strategy. CONCLUSIONS Women firefighters report elevated rates of suicidal thoughts and behaviors. Suicidal symptoms occurring prior to one's tenure as a firefighter-and not solely an aspect of firefighter career experiences-should be considered in suicide risk screening, prevention, and intervention initiatives. Studies examining modifiable suicide risk factors and correlates (e.g., psychiatric symptoms, workplace harassment) are needed.
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Affiliation(s)
- Ian H Stanley
- Department of Psychology, Florida State University, Tallahassee, FL, USA.
| | - Melanie A Hom
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | | | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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23
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Ursano RJ, Kessler RC, Stein MB, Naifeh JA, Nock MK, Aliaga PA, Fullerton CS, Wynn GH, Ng THH, Dinh HM, Sampson NA, Kao TC, Schoenbaum M, McCarroll JE, Cox KL, Heeringa SG. Medically Documented Suicide Ideation Among U.S. Army Soldiers. Suicide Life Threat Behav 2017; 47:612-628. [PMID: 27897318 PMCID: PMC5447500 DOI: 10.1111/sltb.12316] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/11/2016] [Indexed: 11/27/2022]
Abstract
We used administrative data to examine predictors of medically documented suicide ideation (SI) among Regular Army soldiers from 2006 through 2009 (N = 10,466 ideators, 124,959 control person-months). Enlisted ideators (97.8% of all cases) were more likely than controls to be female, younger, older when entering service, less educated, never or previously deployed, and have a recent mental health diagnosis. Officer ideators were more likely than controls to be female, younger, younger when entering service, never married, and have a recent mental health diagnosis. Risk among enlisted soldiers peaked in the second month of service and declined steadily, whereas risk among officers remained relatively stable over time. Risk of SI is highest among enlisted soldiers early in Army service, females, and those with a recent mental health diagnosis.
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Affiliation(s)
- Robert J. Ursano
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Ronald C. Kessler
- Department of Health Care Policy; Harvard Medical School; Boston MA USA
| | - Murray B. Stein
- Department of Psychiatry and Department of Family Medicine and Public Health; University of California San Diego; La Jolla CA USA
- VA San Diego Healthcare System; San Diego CA USA
| | - James A. Naifeh
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Matthew K. Nock
- Department of Psychology; Harvard University; Cambridge MA USA
| | - Pablo A. Aliaga
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Carol S. Fullerton
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Gary H. Wynn
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Tsz Hin Hinz Ng
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Hieu M. Dinh
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Nancy A. Sampson
- Department of Health Care Policy; Harvard Medical School; Boston MA USA
| | - Tzu-Cheg Kao
- Department of Preventive Medicine and Biometrics; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | | | - James E. McCarroll
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Kenneth L. Cox
- U.S. Army Public Health Center (Provisional); Aberdeen Proving Ground MD USA
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Suicide in Illinois, 2005-2010: A reflection of patterns and risks by age groups and opportunities for targeted prevention. J Trauma Acute Care Surg 2017; 81:S30-5. [PMID: 27244579 DOI: 10.1097/ta.0000000000001141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Suicide accounts for two thirds of all deaths from intentional or violence-related injury and is a leading cause of death in the United States. Patterns of suicide have been well described among high-risk groups, but few studies have compared the circumstances related to suicides across all age groups. We sought to understand the epidemiology of suicide cases in Illinois and to characterize the risks and patterns for suicide among different age groups. METHODS We used suicide data collected from the Illinois Violent Death Reporting System to assess demographics, method of suicide, circumstances, and mental health status among different age groups. RESULTS Between 2005 and 2010, 3,016 suicides were reported; 692 (23%) were female, and the median age (n = 3,013) was 45 years (range, 10-98 years). The most common method/weapon types were hanging/strangulation (33%), firearm (32%) and poisoning (21%). Hanging was more common (74%) among young people aged 10 to 19 years, while firearm use was more common among elderly persons age 65 years and older (55%). The percentage of victims within an age group experiencing a crisis within two weeks before committing suicide was highest among 10- to 14-year-olds, while the risk factor of having a family member or friend die in the past 5 years was highest among older victims. CONCLUSION The final analysis demonstrated age-related trends in suicide in Illinois, suggesting prevention programs should tailor services by age. LEVEL OF EVIDENCE Epidemiologic study, level IV.
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The influence of gender on suicidal ideation following military sexual trauma among Veterans in the Veterans Health Administration. Psychiatry Res 2016; 244:257-65. [PMID: 27504921 DOI: 10.1016/j.psychres.2016.07.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/20/2016] [Indexed: 11/23/2022]
Abstract
No studies have examined whether military sexual trauma, as measured and defined within the Veterans Health Administration (VHA), is associated with suicidal ideation among Veterans in VHA care, when taking prior suicide attempts into account. Research regarding the role of gender in this association is also limited. The present study examined: (1) whether military sexual trauma was associated with the presence of past-week suicidal ideation among 354 Veterans in VHA (310 men, 44 women); (2) whether gender moderated the association between military sexual trauma and suicidal ideation. Information regarding military sexual trauma, suicidal ideation, suicide attempt, and psychiatric diagnoses was obtained from self-report instruments and medical records. Adjusting for age, gender, combat, posttraumatic stress disorder, depressive disorders, negative affect, and lifetime suicide attempt, Veterans with military sexual trauma were significantly more likely to report suicidal ideation, compared to Veterans without military sexual trauma. Furthermore, the association between military sexual trauma and suicidal ideation was stronger for men compared to women. These results contribute to a growing literature identifying military sexual trauma as a risk factor for suicidal thoughts and behaviors among Veterans in VHA care and emphasize the importance of screening for suicidal ideation among survivors of military sexual trauma.
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26
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Bryan CJ, Rudd MD, Wertenberger E. Individual and environmental contingencies associated with multiple suicide attempts among U.S. military personnel. Psychiatry Res 2016; 242:88-93. [PMID: 27262267 DOI: 10.1016/j.psychres.2016.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 05/12/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
Suicidal behavior among U.S. military personnel persists as a significant public health issue. Previous research indicates the primary motive for suicide attempts among military personnel is the desire to reduce or alleviate emotional distress, a finding that converges with studies in nonmilitary samples. Much less is understood about the consequences of a first suicide attempt that could influence the occurrence of additional suicide attempts. In order to identify these contingencies, 134 active duty Soldiers who had attempted suicide (n=69 first-time attempters, n=65 multiple attempters) participated in structured interviews focused on their experiences immediately following their first attempt. Soldiers were more likely to have made multiple suicide attempts if they were younger at the time of their first attempt, were not admitted to a hospital or treatment program after their first attempt, or experienced emotional and psychological relief immediately afterwards. Results suggest that Soldiers who experience emotional and/or psychological relief immediately after their first suicide attempt or do not receive treatment are more likely to make additional suicide attempts.
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Affiliation(s)
- Craig J Bryan
- National Center for Veterans Studies, Salt Lake City, UT, USA; The University of Utah, Department of Psychology, Salt Lake City, UT, USA.
| | - M David Rudd
- National Center for Veterans Studies, Salt Lake City, UT, USA; The University of Memphis, Office of the President, Memphis, TN, USA
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27
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Servatius RJ, Marx CE, Sinha S, Avcu P, Kilts JD, Naylor JC, Pang KCH. Brain and Serum Androsterone Is Elevated in Response to Stress in Rats with Mild Traumatic Brain Injury. Front Neurosci 2016; 10:379. [PMID: 27616978 PMCID: PMC4999428 DOI: 10.3389/fnins.2016.00379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/03/2016] [Indexed: 12/03/2022] Open
Abstract
Exposure to lateral fluid percussion (LFP) injury consistent with mild traumatic brain injury (mTBI) persistently attenuates acoustic startle responses (ASRs) in rats. Here, we examined whether the experience of head trauma affects stress reactivity. Male Sprague-Dawley rats were matched for ASRs and randomly assigned to receive mTBI through LFP or experience a sham surgery (SHAM). ASRs were measured post injury days (PIDs) 1, 3, 7, 14, 21, and 28. To assess neurosteroids, rats received a single 2.0 mA, 0.5 s foot shock on PID 34 (S34), PID 35 (S35), on both days (2S), or the experimental context (CON). Levels of the neurosteroids pregnenolone (PREG), allopregnanolone (ALLO), and androsterone (ANDRO) were determined for the prefrontal cortex, hippocampus, and cerebellum. For 2S rats, repeated blood samples were obtained at 15, 30, and 60 min post-stressor for determination of corticosterone (CORT) levels after stress or context on PID 34. Similar to earlier work, ASRs were severely attenuated in mTBI rats without remission for 28 days after injury. No differences were observed between mTBI and SHAM rats in basal CORT, peak CORT levels or its recovery. In serum and brain, ANDRO levels were the most stress-sensitive. Stress-induced ANDRO elevations were greater than those in mTBI rats. As a positive allosteric modulator of gamma-aminobutyric acid (GABAA) receptors, increased brain ANDRO levels are expected to be anxiolytic. The impact of brain ANDRO elevations in the aftermath of mTBI on coping warrants further elaboration.
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Affiliation(s)
- Richard J Servatius
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical CenterSyracuse, NY, USA; Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers UniversityNewark, NJ, USA; Graduate School of Biomedical Sciences, Rutgers UniversityNewark, NJ, USA
| | - Christine E Marx
- Veterans Affairs Mid-Atlantic Mental Illness, Research Education and Clinical Center, Durham Veterans Affairs Medical CenterDurham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, USA
| | - Swamini Sinha
- Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers UniversityNewark, NJ, USA; Graduate School of Biomedical Sciences, Rutgers UniversityNewark, NJ, USA
| | - Pelin Avcu
- Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers UniversityNewark, NJ, USA; Graduate School of Biomedical Sciences, Rutgers UniversityNewark, NJ, USA
| | - Jason D Kilts
- Veterans Affairs Mid-Atlantic Mental Illness, Research Education and Clinical Center, Durham Veterans Affairs Medical CenterDurham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, USA
| | - Jennifer C Naylor
- Veterans Affairs Mid-Atlantic Mental Illness, Research Education and Clinical Center, Durham Veterans Affairs Medical CenterDurham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, USA
| | - Kevin C H Pang
- Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers UniversityNewark, NJ, USA; Graduate School of Biomedical Sciences, Rutgers UniversityNewark, NJ, USA; Department of Veterans Affairs, New Jersey Health Care SystemEast Orange, NJ, USA
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28
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Silva C, Hagan CR, Rogers ML, Chiurliza B, Podlogar MC, Hom MA, Tzoneva M, Lim IC, Joiner TE. Evidence for the Propositions of the Interpersonal Theory of Suicide Among a Military Sample. J Clin Psychol 2016; 73:669-680. [PMID: 27478932 DOI: 10.1002/jclp.22347] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 03/01/2016] [Accepted: 05/31/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Although the interpersonal theory of suicide may explain the elevated suicide risk among military service members, past explorations have been equivocal. This study aimed to investigate the propositions of the interpersonal theory in a sample of U.S. Army recruiters. METHOD Participants (N = 3,428) completed self-report measures assessing the interpersonal theory's constructs (i.e., thwarted belongingness (TB), perceived burdensomeness (PB), acquired capability for suicide), current suicidal ideation, agitation, and insomnia. History of depression was obtained from medical records. RESULTS Hierarchical multiple regression analyses revealed that the interaction between TB and PB was associated with current suicidal ideation, controlling for depression, agitation, and insomnia. This effect was especially notable among those with high capability for suicide. CONCLUSION Findings provide support for the interpersonal theory in a large, diverse military sample. It may be advantageous to assess and therapeutically address TB and PB among at-risk service members.
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29
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Male suspected suicide decedents in Utah: A comparison of Veterans and nonveterans. Compr Psychiatry 2016; 69:1-10. [PMID: 27423339 DOI: 10.1016/j.comppsych.2016.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 04/11/2016] [Accepted: 04/23/2016] [Indexed: 12/29/2022] Open
Abstract
UNLABELLED There has been significant debate regarding suicide risk in Veterans compared to nonveterans. However, few studies have examined similarities and differences between Veteran and nonveteran suicide decedents using a combination of next of kin psychological autopsy and data from a state Office of the Medical Examiner (OME). For the current study, next of kin of a one-year cohort of male suspected suicide decedents in Utah completed psychological autopsy interviews with trained research staff. Next of kin of 70 Veterans and 356 nonveterans completed the interviews, which included demographic, behavioral, psychosocial, and clinical variables. The psychological autopsy data then were combined with OME data for the presented analyses. Results showed that Veteran and nonveteran suicide decedents differed on multiple factors, including age at death. Specifically, male nonveteran suicide decedents were younger at age of death compared to Utah Veterans and to a national sample. Veteran decedents also were more likely to have a history of suicide attempts and more likely to have access to firearms compared to nonveterans. Other between-group differences, including Veterans being more likely to have lived alone and method of death (e.g., gunshot, hanging, etc.), were no longer statistically significant after adjustment for age at death. CONCLUSIONS these findings have significant clinical and practical importance, as they highlight the risk for suicide in younger nonveterans and older Veterans in Utah.
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Hazlett EA, Blair NJ, Fernandez N, Mascitelli K, Perez-Rodriguez MM, New AS, Goetz RR, Goodman M. Startle amplitude during unpleasant pictures is greater in veterans with a history of multiple-suicide attempts and predicts a future suicide attempt. Psychophysiology 2016; 53:1524-34. [PMID: 27378071 DOI: 10.1111/psyp.12698] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/30/2016] [Indexed: 12/26/2022]
Abstract
UNLABELLED Recent studies demonstrate that veterans exhibit higher suicide risk compared with the general U.S. POPULATION A prior suicide attempt is a well-documented predictor of suicide death. Despite increased attention to clinical risk factors of suicide and efforts to develop psychosocial interventions to reduce suicide risk, the underlying biological factors that confer this risk are not well understood. This study examined affect-modulated startle (AMS) during a series of intermixed unpleasant, neutral, and pleasant pictures in a sample of 108 demographically-matched veterans at low (passive ideators: n = 26) and high risk (active ideators: n = 29; single attempters: n = 28; and multiple attempters: n = 25) for suicide based on the Columbia Suicide Severity Rating Scale. An exploratory aim involved a longitudinal component in a subset of the high-risk sample that went on to participate in a randomized 6-month clinical trial. We investigated whether baseline AMS predicts a subsequent suicide attempt at 12-month follow-up. Compared with the other three groups, multiple attempters showed greater startle potentiation during unpleasant pictures and deficient overall startle habituation from early to later trials. The groups did not differ in startle during neutral or pleasant pictures, or self-reported picture valence. Greater startle during unpleasant pictures was associated with greater emotion dysregulation as measured by the Difficulties in Emotion Regulation Scale and a future suicide attempt assessed prospectively at 12-month follow-up. These findings suggest that startle potentiation during unpleasant pictures in multiple-suicide attempters is a promising psychophysiological biomarker of suicide risk and underscore the clinical importance of targeting emotion dysregulation in the treatment of patients at-risk for suicide.
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Affiliation(s)
- Erin A Hazlett
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA. .,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA. .,Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2 South), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA. .,Research and Development, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.
| | - Nicholas J Blair
- Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2 South), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.,Research and Development, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Nicolas Fernandez
- Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2 South), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.,Research and Development, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Kathryn Mascitelli
- Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2 South), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.,Research and Development, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | | | - Antonia S New
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raymond R Goetz
- Division of Clinical Phenomenology, New York State Psychiatric Institute, New York, New York, USA.,Columbia University, College of Physicians and Surgeons, New York, New York, USA
| | - Marianne Goodman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2 South), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
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31
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Fox KR, Franklin JC, Ribeiro JD, Kleiman EM, Bentley KH, Nock MK. Meta-analysis of risk factors for nonsuicidal self-injury. Clin Psychol Rev 2015; 42:156-67. [PMID: 26416295 PMCID: PMC4772426 DOI: 10.1016/j.cpr.2015.09.002] [Citation(s) in RCA: 249] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 08/25/2015] [Accepted: 09/10/2015] [Indexed: 11/19/2022]
Abstract
Nonsuicidal self-injury (NSSI) is a prevalent and dangerous phenomenon associated with many negative outcomes, including future suicidal behaviors. Research on these behaviors has primarily focused on correlates; however, an emerging body of research has focused on NSSI risk factors. To provide a summary of current knowledge about NSSI risk factors, we conducted a meta-analysis of published, prospective studies longitudinally predicting NSSI. This included 20 published reports across 5078 unique participants. Results from a random-effects model demonstrated significant, albeit weak, overall prediction of NSSI (OR=1.59; 95% CI: 1.50 to 1.69). Among specific NSSI risk factors, prior history of NSSI, cluster b, and hopelessness yielded the strongest effects (ORs>3.0); all remaining risk factor categories produced ORs near or below 2.0. NSSI measurement, sample type, sample age, and prediction case measurement type (i.e., binary versus continuous) moderated these effects. Additionally, results highlighted several limitations of the existing literature, including idiosyncratic NSSI measurement and few studies among samples with NSSI histories. These findings indicate that few strong NSSI risk factors have been identified, and suggest a need for examination of novel risk factors, standardized NSSI measurement, and study samples with a history of NSSI.
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Affiliation(s)
- Kathryn R Fox
- Department of Psychology, Harvard University, United States.
| | | | - Jessica D Ribeiro
- Department of Psychology, Harvard University, United States; Military Suicide Research Consortium, United States
| | - Evan M Kleiman
- Department of Psychology, Harvard University, United States
| | - Kate H Bentley
- Center for Anxiety and Related Disorders, Boston University, United States
| | - Matthew K Nock
- Department of Psychology, Harvard University, United States
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32
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Villatte JL, O'Connor SS, Leitner R, Kerbrat AH, Johnson LL, Gutierrez PM. Suicide Attempt Characteristics Among Veterans and Active-Duty Service Members Receiving Mental Health Services: A Pooled Data Analysis. MILITARY BEHAVIORAL HEALTH 2015; 3:316-327. [PMID: 26740909 PMCID: PMC4699574 DOI: 10.1080/21635781.2015.1093981] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Past suicidal behaviors are among the strongest and most consistent predictors of eventual suicide and may be particularly salient in military suicide. The current study compared characteristics of suicide attempts in veterans (N = 746) and active-duty service members (N = 1,013) receiving treatment for acute suicide risk. Baseline data from six randomized controlled trials were pooled and analyzed using robust regression. Service members had greater odds of having attempted suicide relative to veterans, though there were no differences in number of attempts made. Service members also had higher rates of premilitary suicide attempts and nonsuicidal self-injury (NSSI). Veterans disproportionately attempted suicide by means of overdose. In veterans, combat deployment was associated with lower odds of lifetime suicide attempt, while history of NSSI was associated with greater attempt odds. Neither was significantly associated with lifetime suicide attempt in service members. Implications for suicide assessment and treatment are discussed.
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Affiliation(s)
| | | | - Rebecca Leitner
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver VA Medical Center, Denver, Colorado
| | | | | | - Peter M Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver VA Medical Center, and University of Colorado School of Medicine, Denver, Colorado
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33
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The association between nonsuicidal self-injury and the emotional disorders: A meta-analytic review. Clin Psychol Rev 2015; 37:72-88. [DOI: 10.1016/j.cpr.2015.02.006] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 12/27/2022]
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34
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Maguen S, Skopp NA, Zhang Y, Smolenski DJ. Gender differences in suicide and suicide attempts among US Army soldiers. Psychiatry Res 2015; 225:545-9. [PMID: 25530416 DOI: 10.1016/j.psychres.2014.11.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/19/2014] [Accepted: 11/25/2014] [Indexed: 10/24/2022]
Abstract
In order to best tailor suicide prevention initiatives and programs, it is critical to gain an understanding of how service members׳ suicide risk factors may differ by gender. We aimed to better understand gender differences in suicide and suicide attempts among soldiers, including demographic, military, mental health, and other risk factors. We also examined risk factors uniquely associated with suicide and suicide attempts. We conducted a retrospective study of 1857 US Army soldiers who died by suicide or attempted suicide between 2008 and 2010 and had a Department of Defense Suicide Event Report. Female and male soldiers had more similarities than differences when examining risk factors associated with suicide. The only gender difference approaching significance was workplace difficulties, which was more strongly associated with suicide for female soldiers, compared to their male counterparts. Among suicide decedents, the most common risk factor was having a failed intimate relationship in the 90 days prior to suicide. Among those who attempted suicide, the most common risk factor was a major psychiatric diagnosis. Better understanding both gender differences and risk factors uniquely associated with suicide has critical prevention and public health implications as we work to better understand preventable mortality in our youngest generation of service members.
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Affiliation(s)
- Shira Maguen
- San Francisco VA Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
| | - Nancy A Skopp
- National Center for Telehealth & Technology, Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury, Joint Base Lewis-McChord, Tacoma, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Ying Zhang
- National Center for Telehealth & Technology, Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury, Joint Base Lewis-McChord, Tacoma, WA, USA
| | - Derek J Smolenski
- National Center for Telehealth & Technology, Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury, Joint Base Lewis-McChord, Tacoma, WA, USA
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