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de Grandpré É, Suurd Ralph C, Hiller E. Thwarted belongingness and empathy's relation with organizational culture change. Front Psychol 2024; 15:1287769. [PMID: 38638514 PMCID: PMC11024451 DOI: 10.3389/fpsyg.2024.1287769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 03/13/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction In response to several high-profile cases of senior leaders in the Canadian Armed Forces (CAF) being accused of various forms of sexual and professional misconduct, the organization has committed to culture change. Drawing on the group engagement model and empirical evidence, we propose that CAF members' experience of thwarted belongingness reduces their capacity to show empathy, which in turn affects their support for culture change. Method Participants were 139 Naval and Officer Cadets from the Royal Military College of Canada who were predominantly male (61%), between 18 and 21 years old (80%), and not members of a visible minority group (68%). Data was collected via an online self-report survey assessing thwarted belongingness, empathy, and attitudes toward culture change. Results Whether participants experienced thwarted belongingness was not directly related to their level of support for culture change. Individuals' thwarted belongingness was indirectly and negatively associated with support for culture change, through its impact on empathy. Discussion Taken together, the results demonstrate that cadets' experience of belongingness contributed to their level of empathy, which together predicted their support for culture change initiatives. Efforts to change the culture of the CAF may need to consider improving members' levels of belongingness and, by extension, their levels of empathy. Implications for inclusion efforts are discussed.
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Affiliation(s)
| | - Cindy Suurd Ralph
- Department of Military Psychology and Leadership, Royal Military College of Canada, Kingston, ON, Canada
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Shelef L, Nir I, Tatsa-Laur L, Yavnai N, Gold N, Cohen G, Ben Yehuda A. Factors associated with self-harm behaviors during military service in the Israel Defense Forces, rates of such behaviors and their outcomes. MILITARY PSYCHOLOGY 2024; 36:158-167. [PMID: 38377251 PMCID: PMC10880502 DOI: 10.1080/08995605.2022.2151815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
The military environment involves stressful situations that may trigger or aggravate suicidal behaviors, such as suicide attempts (SAs), which significantly increase the likelihood of future suicide. This cross-sectional study aims to assess risk factors for severe SAs and non-suicidal self-injury (NSSI) among Israel Defense Forces (IDF) soldiers. Data were retrieved from an IDF computerized self-harm surveillance database and were based on the criteria of the Columbia Suicide Severity Rating Scale (C-SSRS) and the Suicide Attempt Self-Injury Interview (SASII). The cohort included all 1,238 occurrences of self-harm behavior, during 2017-2021. Other investigated variables included adjustment difficulty (AD, as per IDF definition) and psychiatric diagnosis (PD) as reported by mental health officers (MHOs) during recruitment. Higher rates of adjustment difficulties were found among soldiers who had conducted NSSIs. Higher rates of previous psychiatric diagnoses were found among individuals with SAs, and their risk of dying by suicide during military service was twice as high (OR = 2.356; p < .001). If the latter also served in a combat unit, the risk was almost fourfold (OR = .3.860; p < .001). The current study demonstrates a clear difference between IDF soldiers who conduct NSSI vs. those conducting SA with regard to adjustment difficulty (as per IDF definition) and PD.
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Affiliation(s)
- Leah Shelef
- Department of Health and Well-Being, Medical Corps, Israeli Defense Forces, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- The School of Social Work, Sapir Academic College, D.N. Hof Ashkelon, Israel
| | - Ishai Nir
- Department of Health and Well-Being, Medical Corps, Israeli Defense Forces, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lucian Tatsa-Laur
- Department of Health and Well-Being, Medical Corps, Israeli Defense Forces, Ramat Gan, Israel
| | - Nirit Yavnai
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Niv Gold
- Department of Health and Well-Being, Medical Corps, Israeli Defense Forces, Ramat Gan, Israel
| | - Gadi Cohen
- Department of Health and Well-Being, Medical Corps, Israeli Defense Forces, Ramat Gan, Israel
| | - Ariel Ben Yehuda
- Department of Health and Well-Being, Medical Corps, Israeli Defense Forces, Ramat Gan, Israel
- Shalvata Mental Health Center, Clalit Health Services, Hod Hasharon, Israel
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Zhou J, Hu T, Xue S, Dong Z, Tang W. The association of childhood trauma with suicidality in adult psychiatric patients: The mediating role of NSSI and the moderating role of self-esteem. J Clin Psychol 2024; 80:664-677. [PMID: 38265412 DOI: 10.1002/jclp.23646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND The contribution of specific childhood trauma subtypes to suicidal thoughts and the associated mechanisms remains unclear, particularly in psychiatric patients. METHODS Face-to-face interviews were conducted with 449 psychiatric patients aged 18-73. Childhood trauma, self-esteem, nonsuicidal self-injury (NSSI), and suicidality were assessed retrospectively. Regression and moderated mediation model were employed to examine these relationships. RESULTS Emotional and sexual abuse were independently associated with suicidality. Female patients reported higher levels of emotional and sexual abuse, lower self-esteem, and a heightened risk of suicide. Self-esteem moderated the links between childhood trauma and NSSI, as well as between NSSI and suicidality. NSSI served as a mediator between childhood trauma and suicidality. CONCLUSIONS Suicide prevention in mentally ill patients should involve targeted programs addressing specific childhood trauma. Additionally, psychological interventions to enhance self-esteem and assist individuals engaging in NSSI behavior are crucial.
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Affiliation(s)
- Jing Zhou
- Department of Psychosomatic Medicine, Leshan People's Hospital, Leshan, Sichuan, China
- Department of Psychiatry, Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Hu
- School of Education and Psychology, Chengdu Normal University, Chengdu, China
- Business School, Sichuan University, Chengdu, China
| | - Shuang Xue
- Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, China
| | - Zaiquan Dong
- Department of Psychiatry, Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Wanjie Tang
- Department of Psychiatry, Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Zhong W, Liang Q, Yang A, Yan R. Why emotional neglect brings suicidal ideation? The mediating effect of meaning in life and the moderating effect of post-stress growth. CHILD ABUSE & NEGLECT 2024; 149:106700. [PMID: 38382400 DOI: 10.1016/j.chiabu.2024.106700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Emotional neglect during childhood has long-lasting negative effects on individuals, and it is often hidden and unrecognized. Previous research has not fully understood its unique effects on mental health outcomes, especially when considering the co-occurrence with other forms of maltreatment. The meaning-making coping and growth model suggests that individuals achieve positive psychological outcomes by constructively integrating negative experiences into their self-concept, which may be a protective mechanism against the detrimental effects of emotional neglect. OBJECTIVE This study aimed to examine the relationship between emotional neglect and suicidal ideation among undergraduates, accounting for the presence of emotional abuse and physical neglect, and to investigate the mediating role of meaning in life and the moderating role of post-stress growth in this relationship. METHODS A self-reported survey was conducted with 3132 undergraduate students from a university in South China. The survey assessed emotional neglect, emotional abuse, physical neglect, suicidal ideation, post-stress growth, and meaning in life. RESULTS Meaning in life partially mediated the relationship between emotional neglect and suicidal ideation. Post-stress growth moderated the association between emotional neglect and the sense of meaning in life, in particular the moderation effect was stronger when emotional abuse was weaker. CONCLUSIONS Meaning in life mediated the relationship between emotional neglect and suicide ideation. Post-stress growth moderated the mediation effect such that it was weakened among individual with a higher level of post-stress growth. This study contributes to the understanding of the psychopathological processes following emotional neglect and the development of positive personal changes thereafter.
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Affiliation(s)
- Weiwei Zhong
- Mental Health Education and Consultation Center, Guangdong University of Foreign Studies, Guangzhou, Guangdong 510420, China
| | - Qianrong Liang
- School of Finance, Guangdong University of Foreign Studies, Guangzhou, Guangdong 510420, China; Institute of Analytical Psychology, Faculty of Humanities and Social Sciences, City University of Macau, Macau 999078, China
| | - An Yang
- Department of Applied Psychology, Guangdong University of Foreign Studies, Guangzhou, Guangdong 510420, China.
| | - Ru Yan
- Mental Health Education and Consultation Center, Guangdong University of Foreign Studies, Guangzhou, Guangdong 510420, China.
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Pardue-Bourgeois S, Goldberg SB, Wyman MF, Abbas M, Flynn AWP, Domínguez S, Tucker RP. The Link between Deployment-Related Injuries and Suicidal Thinking in the Army National Guard: Examining the Role of Perceived Burdensomeness and Hopelessness. Arch Suicide Res 2023:1-12. [PMID: 37881842 PMCID: PMC11045658 DOI: 10.1080/13811118.2023.2270667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
OBJECTIVE In 2020, Army National Guard members demonstrated greater risk of suicide than their military and civilian counterparts. Though literature on deployment-related experiences and suicidal ideation (SI) is mixed, investigations of specific deployment-related experiences (e.g., injuries) may further elucidate the relationship between deployment and suicide risk. Deployment-related injuries, including pain severity and functional impairment, have been linked to increased risk of SI, and correlates like perceived burdensomeness (PB) and hopelessness. The current study sought to examine the cross-sectional relationship between deployment-related injuries, including pain severity and functional impairment, and severity of SI through PB and hopelessness. METHOD Immediately post-deployment, Army National Guard members (N = 2,261) completed validated self-report measures on past-week SI, PB, hopelessness, and single items regarding injury sustained during deployment and associated functional impairment and pain severity. RESULTS Indirect effect analyses revealed that experience of deployment-related injury was related to SI through PB and hopelessness (R2 = .1993), functional impairment was related to SI through PB, and pain severity was related to SI through PB. Contrary to hypotheses, hopelessness was not associated with SI when PB was simultaneously considered. CONCLUSIONS Army National Guard members who develop a sense of PB related to their injury and functional impairment of that injury may be at increased risk for suicidal ideation. Military suicide-prevention efforts may be potentiated through targeting distorted cognitions such as PB and hopelessness, especially in service members who have been injured.
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History of suicide attempt associated with amygdala and hippocampus changes among individuals with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01554-5. [PMID: 36788147 DOI: 10.1007/s00406-023-01554-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/09/2023] [Indexed: 02/16/2023]
Abstract
Abnormalities in subcortical brain structures may reflect higher suicide risk in mood disorders, but less is known about its associations for schizophrenia. This cross-sectional imaging study aimed to explore whether the history of suicide attempts was associated with subcortical changes among individuals with schizophrenia. We recruited 44 individuals with schizophrenia and a history of suicide attempts (SZ-SA) and 44 individuals with schizophrenia but without a history of suicide attempts (SZ-NSA) and 44 healthy controls. Linear regression showed that SZ-SA had smaller volumes of the hippocampus (Cohen's d = -0.72), the amygdala (Cohen's d = -0.69), and some nuclei of the amygdala (Cohen's d, -0.57 to -0.72) than SZ-NSA after adjusting for age, sex, illness phase, and intracranial volume. There was no difference in the volume of the subfields of the hippocampus. It suggests the history of suicide attempts is associated with subcortical volume alterations in schizophrenia.
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Hinkson KD, Drake-Brooks MM, Christensen KL, Chatterley MD, Robinson AK, Crowell SE, Williams PG, Bryan CJ. An examination of the mental health and academic performance of student veterans. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:2334-2341. [PMID: 33400638 DOI: 10.1080/07448481.2020.1858837] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 09/14/2020] [Accepted: 10/30/2020] [Indexed: 05/27/2023]
Abstract
Objective: The purpose of this study was to provide a more comprehensive look into the demographics of the veteran student subpopulation while exploring the relationship between the mental health of student veterans and their academic performance. Methods: A nationwide anonymous survey was distributed to student veterans who were enrolled in postsecondary institutions. Results: A large number of participants reported distress with symptoms of PTSD, depression, sleep disturbances, and/or suicidal ideation and attempts, and screened likely for mental health problems in these areas. Participants also endorsed academic problems ranging from the ability to stay focused to failing tests and quizzes. Additional findings demonstrated a positive association between GPA and both PTSD and depression. Conclusion: These findings can be used as a platform upon which to begin the discussion on the implications for mental health professionals, administrators, and educators.
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Affiliation(s)
- Kent D Hinkson
- National Center for Veterans Studies, University of Utah, Salt Lake City, Utah, USA
| | | | | | | | | | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Paula G Williams
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Craig J Bryan
- National Center for Veterans Studies, University of Utah, Salt Lake City, Utah, USA
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Vélez-Grau C, Romanelli M, Lindsey MA. Adolescent suicide attempts in the United States: When suicide ideation and suicide capability interact. Suicide Life Threat Behav 2022; 52:549-566. [PMID: 35156223 DOI: 10.1111/sltb.12845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Guided by the interpersonal theory of suicide, this study examined whether the relationship between level of suicide ideation and attempted suicide varies as a function of suicide capability. METHODS Cross-sectional data were obtained from the 2017 and 2019 Youth Risk Behavior Survey in which 28,442 respondents were sampled. Confirmatory factor analysis was conducted to create a latent suicide capability variable. Structural equation modeling was used to test the moderating effects of suicide capability on the relationship between level of suicide ideation and attempted suicide, adjusting for sociodemographic characteristics, sadness/hopelessness, and the sampling design. RESULTS Compared to adolescent with no reported ideation, those reporting single and dual ideation experienced increased odds of attempted suicide. The relationship between level of suicide ideation and attempted suicide significantly varied as a function of capability. While adolescents with dual suicide ideation experienced higher rates of attempted suicide at increasing levels of capability, faster rates of change of attempted suicide at increasing levels of capability were observed among those with single and no reported ideation. CONCLUSION Capability may heighten the risk of suicide attempts among youth, suggesting that treatment efforts could be directed at reducing exposure to painful and provocative experiences associated with suicide behaviors.
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Affiliation(s)
- Carolina Vélez-Grau
- New York University, NYU McSilver Institute for Poverty Policy and Research, New York, New York, USA
| | - Meghan Romanelli
- University of Washington, NYU McSilver Institute for Poverty Policy and Research, Seattle, Washington, USA
| | - Michael A Lindsey
- New York University Silver School of Social Work, NYU McSilver Institute for Poverty Policy and Research, New York, New York, USA
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Naifeh JA, Nock MK, Dempsey CL, Georg MW, Aliaga PA, Dinh HM, Fullerton CS, Mash HBH, Kao TC, Sampson NA, Wynn GH, Zaslavsky AM, Stein MB, Kessler RC, Ursano RJ. Association of emotion reactivity and distress intolerance with suicide attempts in U.S. Army soldiers. Suicide Life Threat Behav 2022; 52:289-302. [PMID: 34866228 PMCID: PMC10370465 DOI: 10.1111/sltb.12821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/30/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Emotion reactivity (ER) and distress intolerance (DI) may be associated with increased suicide attempt (SA) risk among U.S. Army soldiers. METHOD In this case-control study, 74 soldiers recently hospitalized for SA (cases) were compared with 133 control soldiers from the same Army installations selected based on either propensity score matching (n = 103) or reported 12-month suicide ideation (SI) (n = 30). Controls were weighted to represent the total Army population at the study sites and the subpopulation of 12-month ideators. Participants completed questionnaires assessing ER, DI, and other psychosocial variables. Logistic regression analyses examined whether ER and DI differentiated SA cases from the general population and from 12-month ideators before and after controlling for additional important risk factors (sociodemographic characteristics, stressors, mental disorders). RESULTS In univariate analyses, ER differentiated SA cases from both the general population (OR = 2.5[95%CI = 1.7-3.6]) and soldiers with 12-month SI (OR = 2.5[95%CI = 1.3-4.6]). DI also differentiated cases from the general population (OR = 2.9[95%CI = 2.0-4.1]) and 12-month ideators (OR = 1.9[95%CI = 1.1-3.5]). These associations persisted after controlling for sociodemographic variables, stressors, and mental disorders. CONCLUSION Findings provide evidence that higher ER and DI are associated with increased risk of SA among soldiers, even after adjusting for known risk factors. Prospective research with larger samples is needed.
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Affiliation(s)
- James A Naifeh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Catherine L Dempsey
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Matthew W Georg
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Pablo A Aliaga
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Hieu M Dinh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Carol S Fullerton
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Holly B Herberman Mash
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Tzu-Cheg Kao
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Gary H Wynn
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA.,VA San Diego Healthcare System, La Jolla, California, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Kumar SA, Hein CL, DiLillo D, Pietrzak RH. Resilience to Suicidal Ideation Among U.S. Military Veterans with Posttraumatic Stress: Results from the National Health and Resilience in Veterans Study. MILITARY BEHAVIORAL HEALTH 2022; 10:328-337. [PMID: 36393818 PMCID: PMC9642972 DOI: 10.1080/21635781.2021.2015019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Veterans with combat exposure experience high rates of posttraumatic stress symptoms (PTSS) and associated suicidal ideation. The current study examined whether social support (i.e., social connectedness and social engagement) and protective psychological factors (i.e., resilience and altruism) moderated the relation between PTSS and suicidal ideation severity in a sample of 149 U.S. military combat veterans who served in the Vietnam War or Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND). Consistent with expectations, initial PTSS were positively associated with concurrent and three-year follow-up severity of suicidal ideation. Moderation analyses revealed the relation between initial PTSS and concurrent suicidal ideation severity was no longer significant at above average levels of social connectedness, social engagement, and psychological resilience. Further, the relation between initial PTSS and suicidal ideation severity three years later continued to be buffered by above average levels of social engagement. Results suggest social connectedness, psychological resilience, and social engagement help moderate initial severe thoughts of suicide linked to PTSS, while social engagement might be the strongest protective factor against severe suicidal ideation over time. Empirically-supported prevention and treatment efforts enhancing social engagement may help promote resilience to severe PTSS-related suicidal ideation among veterans from Vietnam and OEF/OIF/OND combat eras.
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Affiliation(s)
| | - Christina L. Hein
- U.S. Department of the Army, 25th Combat Aviation Brigade, Wheeler Army Airfield, Hawaii
| | - David DiLillo
- University of Nebraska-Lincoln, Department of Psychology
| | - Robert H. Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System,Department of Psychiatry, Yale School of Medicine,Department of Social and Behavioral Sciences, Yale School of Public Health
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Blain RC, Pukay-Martin ND, Martin CE, Dutton-Cox CE, Chard KM. Residential Cognitive Processing Therapy Decreases Suicidality by Reducing Perceived Burdensomeness in Veterans with Posttraumatic Stress Disorder. J Trauma Stress 2021; 34:1199-1208. [PMID: 33128808 DOI: 10.1002/jts.22618] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/15/2020] [Accepted: 09/13/2020] [Indexed: 12/21/2022]
Abstract
The interpersonal theory of suicide (Joiner, 2005) may help explain high suicide rates among veterans with posttraumatic stress disorder (PTSD). It suggests that suicidal ideation results from believing that one is a burden on others (i.e., perceived burdensomeness) and does not belong among family, friends, or other social groups (i.e., thwarted belongingness). Evidence-based PTSD treatments, including cognitive processing therapy (CPT), decrease suicidal ideation, potentially through changes in these two theory constructs. The current study examined whether (a) changes in PTSD severity and suicidal ideation and (b) changes in negative cognitions about self and suicidal ideation were indirectly associated through changes in perceived burdensomeness and thwarted belongingness across PTSD treatment. Participants (N = 107) were veterans in a residential treatment program who were diagnosed with full or subthreshold PTSD and received CPT. Changes in PTSD symptom severity and negative cognitions about self predicted changes in suicidal ideation, B = 0.18, p < .001 and B = 0.50, p < .001, respectively. Changes in PTSD symptom severity and negative cognitions about self were indirectly associated with suicidal ideation through changes in perceived burdensomeness, B = 0.16, 95% CI [0.07, 0.25]; B = 0.27, 95% CI [0.05, 0.50], but not thwarted belongingness, B = -0.002; 95% CI [-0.06, 0.06]; B = 0.06, 95% CI [-0.12, 0.21] in separate models. These findings suggest that residential CPT may be uniquely equipped to decrease suicidality by restructuring negative beliefs, including perceptions of being a burden on others, and/or by alleviating the objective burden of PTSD.
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Affiliation(s)
- Rachel C Blain
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA
| | | | - Colleen E Martin
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA
| | | | - Kathleen M Chard
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Wirth JH, Sacco DF, Brown M, Okdie BM. “I hate to be a burden!”: Experiencing feelings associated with ostracism due to one's poor performance burdening the group. EUROPEAN JOURNAL OF SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/ejsp.2738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- James H. Wirth
- Department of Psychology The Ohio State University at Newark Newark OH USA
| | - Donald F. Sacco
- School of Psychology The University of Southern Mississippi Hattiesburg MS USA
| | - Mitch Brown
- Department of Psychological Science University of Arkansas Fayetteville AR USA
| | - Bradley M. Okdie
- Department of Psychology The Ohio State University at Newark Newark OH USA
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13
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Heath PJ, Vogel DL, Vidales C, Abraham WT. Measurement invariance of suicide screening measures across military branch. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1962186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Patrick J. Heath
- Department of Psychological Science, Gustavus Adolphus College, Saint Peter, Minnesota, USA
| | - David L. Vogel
- Department of Psychology, Iowa State University, Ames, Iowa, USA
| | - Carlos Vidales
- Department of Psychology, Iowa State University, Ames, Iowa, USA
| | - W. Todd Abraham
- Department of Human Development and Family Studies, Iowa State University, Ames, Iowa, USA
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14
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Sokol Y, Gromatsky M, Edwards ER, Greene AL, Geraci JC, Harris RE, Goodman M. The deadly gap: Understanding suicide among veterans transitioning out of the military. Psychiatry Res 2021; 300:113875. [PMID: 33901974 DOI: 10.1016/j.psychres.2021.113875] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/13/2021] [Indexed: 11/26/2022]
Abstract
In the period following separation from the military, service members face the challenge of transitioning to a post-military civilian life. Some evidence suggests these transitioning Veterans are at higher risk for suicide compared with both the broader Veteran population and the United States public, yet they often do not receive adequate support and resources. In this review, we use the Three-Step Theory of suicide to outline characteristics of transitioning Veterans and the transition process that may affect suicide risk. We then highlight relevant services available to this specific subgroup of Veterans and make recommendations that address barriers to care. Cumulatively, this literature suggests transitioning Veterans fall within a "deadly gap" between the end of their military service and transition into civilian life. This "deadly gap" consists of limited psychiatric services and increased suicide risk factors which together may explain the increase in suicide during this transition period.
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Affiliation(s)
- Yosef Sokol
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States.
| | - Molly Gromatsky
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States
| | - Emily R Edwards
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States
| | - Ashley L Greene
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States
| | - Joseph C Geraci
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Resilience Center for Veterans & Families, Teachers College, Columbia University, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States; Columbia University, United States; Syracuse University, Institute for Veterans and Military Families, United States
| | - Rachel E Harris
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; William Paterson University, United States
| | - Marianne Goodman
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States
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15
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Batterham PJ, Calear AL. Incorporating psychopathology into the interpersonal-psychological theory of suicidal behavior (IPTS). Suicide Life Threat Behav 2021; 51:482-491. [PMID: 33378114 DOI: 10.1111/sltb.12727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 02/03/2020] [Accepted: 09/11/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The interpersonal-psychological theory of suicidal behavior (IPTS) posits that the joint presence of perceived burdensomeness (PB), thwarted belongingness (TB), and capability for suicide (CS) is necessary for suicide attempt. Emerging evidence demonstrates these effects are not consistently observed. Psychopathology may independently impact on the explanatory power of the IPTS constructs. AIMS The aims of the current study were to assess whether the inclusion of psychopathology indicators into the IPTS explains additional variance in recent suicide attempt and to assess the relative influence of interpersonal-psychological constructs versus mental illness on suicide attempt. METHOD Australian adults (N = 1,323; 77% female) who reported suicidal ideation in the past year were recruited using social media advertising to complete an online cross-sectional survey. RESULTS None of the predicted IPTS interactions was significantly associated with recent suicide attempt, although PB and CS had significant independent associations. The addition of psychopathology indicators to the IPTS model explained significant additional variation in suicide attempt (18% vs. 14%). CONCLUSIONS The influence of psychopathology on suicide attempt may be insufficiently explained by interpersonal-psychological constructs. The IPTS may have greater explanatory power to identify transitions from suicidal ideation to suicide attempt after accounting for mental illness.
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Affiliation(s)
- Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
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16
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Ray TN, Hunsanger JA, Nagy SM, Pickett SM. Potentially morally injurious events and depression symptoms among a trauma-exposed sample: Examining the roles of interpersonal needs and emotion dysregulation. Stress Health 2021; 37:151-161. [PMID: 32918366 DOI: 10.1002/smi.2981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 11/09/2022]
Abstract
The current study examined a conceptual model of the association between potentially morally injurious events (PMIEs) and depression symptoms. It was hypothesized that interpersonal needs (i.e., perceived burdensomeness and thwarted belongingness) would independently mediate the relationship between PMIEs and depression symptoms, while emotion dysregulation would moderate the associations. Individuals who experienced a traumatic event and were residing in the United States (N = 147) completed a cross-sectional questionnaire containing measures of PMIEs, interpersonal needs, emotion dysregulation and depression symptoms. Results indicated that the indirect effect through perceived burdensomeness was significant at high levels of emotion dysregulation, whereas the indirect effect through thwarted belongingness was non-significant. Additionally, emotion dysregulation moderated each pathway, with the exception of the direct effects from PMIEs to depression symptoms. The proposed model may be informative for researchers and clinicians interested in the association between PMIEs and depression symptoms. The results may encourage the use of emotion regulation strategies to assist patients suffering from depression symptoms, especially when exposure to a PMIE has occurred.
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Affiliation(s)
- Travis N Ray
- Department of Psychology, Oakland University, Rochester, Michigan, USA
| | | | - Samantha M Nagy
- Department of Psychology, Oakland University, Rochester, Michigan, USA
| | - Scott M Pickett
- Department of Psychology, Oakland University, Rochester, Michigan, USA.,Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida, USA
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17
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Chu C, Zuromski KL, Bernecker SL, Gutierrez PM, Joiner TE, Liu H, Naifeh JA, Stein MB, Ursano RJ, Nock MK. A test of the interpersonal theory of suicide in a large, representative, retrospective and prospective study: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Behav Res Ther 2020; 132:103688. [PMID: 32731055 PMCID: PMC10351027 DOI: 10.1016/j.brat.2020.103688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/28/2020] [Accepted: 06/19/2020] [Indexed: 11/28/2022]
Abstract
The interpersonal theory of suicide hypothesizes that perceived burdensomeness, thwarted belongingness, and hopelessness lead to active suicidal thoughts and individuals with active suicidal thoughts and elevated capability for suicide are most likely to attempt suicide. We retrospectively and prospectively tested this theory in a large sample of 7677 U.S. Army soldiers followed post-deployment for up to nine months. The interaction of perceived burdensomeness and hopelessness (OR = 2.59) was significantly associated with lifetime suicidal thoughts; however, the interactions of thwarted belongingness and perceived burdensomeness and of thwarted belongingness and hopelessness were not. Consistent with the theory, capability for suicide prospectively predicted suicide attempts during and following deployment (OR = 1.22); however, among soldiers reporting lifetime suicidal thoughts, capability did not predict attempts, only perceived burdensomeness did (OR = 1.36). Results supported some, but not all, theory hypotheses, suggesting that additional constructs may be needed to better identify the psychological factors that lead soldiers to attempt suicide.
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Affiliation(s)
- Carol Chu
- Department of Psychology, Harvard University, Cambridge, MA, USA.
| | - Kelly L Zuromski
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | | | - Peter M Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA; University of Colorado School of Medicine, Department of Psychiatry, Aurora, CO, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Howard Liu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - James A Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine in Bethesda, MD, USA
| | - Murray B Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine in Bethesda, MD, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
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Abstract
Abstract. We examined the negative outcomes, particularly social costs that result when a person harms their group by performing poorly, and whether self-compassion could buffer against these negative outcomes. In Studies 1 and 2, participants performed poorly and harmed their group or performed equal to their group. Harmful poor-performing participants felt more burdensome, experienced more negative affect, felt more ostracized, anticipated more exclusion, and felt lowered self-esteem than equal-performing participants. Studies 3 and 4 disentangled poor performance from harming a group. Poor-performing participants either harmed the group or caused no harm. Harmful poor-performing participants felt more burdensome and anticipated more exclusion, indicating the additional social consequences of a harmful poor performance over a non-harmful performance. Across studies, trait self-compassion was associated with reduced negative effects.
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Affiliation(s)
- James H. Wirth
- Department of Psychology, Ohio State University at Newark, OH, USA
| | - Ashley Batts Allen
- Department of Psychology, University of North Carolina at Pembroke, NC, USA
| | - Emily M. Zitek
- School of Industrial and Labor Relations, Cornell University, Ithaca, NY, USA
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Kramer EB, Gaeddert LA, Jackson CL, Harnke B, Nazem S. Use of the acquired capability for suicide scale (ACSS) among United States military and Veteran samples: A systematic review. J Affect Disord 2020; 267:229-242. [PMID: 32217223 DOI: 10.1016/j.jad.2020.01.153] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/26/2019] [Accepted: 01/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Military personnel and Veterans are at increased risk for suicide. Theoretical and conceptual arguments have suggested that elevated levels of acquired capability (AC) could be an explanatory factor accounting for this increased risk. However, empirical research utilizing the Acquired Capability for Suicide Scale (ACSS) in military populations has yielded mixed findings. METHODS To better ascertain what factors are associated with AC, and whether methodological limitations may be contributing to mixed findings, a systematic review was conducted. RESULTS A total of 31 articles utilized the ACSS to examine factors associated with AC, including combat history, in United States (U.S.) military personnel and Veterans. Nearly all studies (96.8%) were rated high risk of bias. Use of the ACSS varied, with seven different iterations utilized. Nearly all studies examined correlations between the ACSS and sample characteristics, mental health and clinical factors, Interpersonal Theory of Suicide constructs, and/or suicide-specific variables. Results of higher-level analyses, dominated by cross-sectional designs, often contradicted correlational findings, with inconsistent findings across studies. LIMITATIONS Included studies were non-representative of all U.S. military and Veteran populations and may only generalize to these populations. CONCLUSIONS Due to the high risk of bias, inconsistent use of the ACSS, lack of sample heterogeneity, and variability in factors examined, interpretation of current ACSS empirical data is cautioned. Suggestions for future research, contextualized by these limitations, are discussed.
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Affiliation(s)
- Emily B Kramer
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Building G3, Room 189, Aurora, CO 80045, USA
| | - Laurel A Gaeddert
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Building G3, Room 189, Aurora, CO 80045, USA
| | - Christine L Jackson
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Building G3, Room 189, Aurora, CO 80045, USA
| | - Ben Harnke
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, 12950 E. Montview Blvd., MS A003, Aurora, CO 80045, USA
| | - Sarra Nazem
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Building G3, Room 189, Aurora, CO 80045, USA; Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado Anschutz School of Medicine, 13001 E. 17th Place, Room C2000C, Aurora, CO 80045, USA.
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20
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Shelef L, Fruchter E, Mann J, Yacobi A. Correlations between interpersonal and cognitive difficulties: Relationship to suicidal ideation in military suicide attempters. Eur Psychiatry 2020; 29:498-502. [DOI: 10.1016/j.eurpsy.2014.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 12/28/2013] [Accepted: 01/19/2014] [Indexed: 11/28/2022] Open
Abstract
AbstractBackgroundUnderstanding suicidal ideation may help develop more effective suicide screening and intervention programs. The interpersonal and the cognitive-deficit theories seek to describe the factors leading to suicidal behavior. In the military setting it is common to find over- and under-reporting of suicidal ideation. This study sought to determine the relationship between these two models and determine to what degree their components can indirectly predict suicidal ideation.MethodsSuicide attempters (n = 32) were compared with non-suicidal psychologically treated peers (n = 38) and controls (n = 33), matched for sex and age (mean 19.7 years). Pearson's analysis was used to quantify the relationship between the variables from the two models and hierarchal regression analysis was used to determine the explanation of suicidal ideation variance by these variables.ResultsSuicide attempters have more difficulties in problem-solving, negative emotion regulation and burdensomeness compared with their peers (P < .001). These variables are all closely correlated with each other and to suicide ideation (r > ± 0.5; P < .001). Prior suicide attempt, loneliness and burdensomeness together explain 65% (P < .001) of the variance in suicidal ideation.ConclusionsSuicidal ideation is strongly correlated with components of interpersonal and cognitive difficulties. In addition to assessing current suicidal ideation, clinicians should assess past suicide attempt, loneliness and burdensomeness.
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Hill RM, Katusic M. Examining suicide risk in individuals with autism spectrum disorder via the interpersonal theory of suicide: clinical insights and recommendations. CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2020.1741360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ryan M. Hill
- Department of Pediatrics, Baylor College of Medicine & Texas Children’s Hospital, Houston, TX, USA
| | - Maja Katusic
- Department of Pediatrics, Baylor College of Medicine & Texas Children’s Hospital, Houston, TX, USA
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Blow AJ, Farero A, Ganoczy D, Walters H, Valenstein M. Intimate Relationships Buffer Suicidality in National Guard Service Members: A Longitudinal Study. Suicide Life Threat Behav 2019; 49:1523-1540. [PMID: 30507054 DOI: 10.1111/sltb.12537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/29/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Members of the U.S. military are at a high suicide risk. While studies have examined predictors of suicide in the U.S. military, more studies are needed which examine protective factors for suicide. Informed by the interpersonal theory of suicide, this study examined the strength of the intimate relationship and its role as a buffer of suicidality in National Guard service members. METHOD A total of 712 National Guard residing in a Midwestern state, who had all recently returned home from a deployment, took part in this study and completed surveys at 6 and 12 months postdeployment. They were assessed on suicide risk, mental health (depression, post-traumatic stress disorder, anxiety), and relationship satisfaction. RESULTS Lower relationship satisfaction and more depressive symptoms at the 6-month assessment were significantly related to greater suicide risk at 12 months. Each interaction between couple satisfaction and three mental health variables (PTSD, depression, and anxiety) at the 6-month assessment was significantly associated with suicide risk at 12 months. CONCLUSIONS The strength of the intimate relationship serves as a buffer for suicide in National Guard service members who have PTSD, anxiety, or depression. Interventions that strengthen these intimate relationships could reduce suicide in service members.
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Affiliation(s)
- Adrian J Blow
- Department of Human Development and Family Studies, Michigan State University, East Lansing, MI, USA
| | - Adam Farero
- Department of Human Development and Family Studies, Michigan State University, East Lansing, MI, USA
| | - Dara Ganoczy
- Veterans Health Administration, Ann Arbor, MI, USA
| | | | - Marcia Valenstein
- Department of Psychiatry University of Michigan and VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI, USA
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23
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Crowell-Williamson GA, Fruhbauerova M, DeCou CR, Comtois KA. Perceived burdensomeness, bullying, and suicidal ideation in suicidal military personnel. J Clin Psychol 2019; 75:2147-2159. [PMID: 31332803 PMCID: PMC11000627 DOI: 10.1002/jclp.22836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Suicide is a major public health concern among military servicemembers and previous research has demonstrated an association between bullying and suicide. This study evaluated the association between workplace bullying and suicidal ideation via perceived burdensomeness and thwarted belongingness which were hypothesized to mediate this association. METHOD Four hundred and seventy-one suicidal Army Soldiers and U.S. Marines completed self-report measures of suicidal ideation, thwarted belongingness, perceived burdensomeness, and bullying. A series of regressions were used to test the hypothesized mediation model using the baseline data from a larger clinical trial. RESULTS Perceived burdensomeness was a significant mediator of the association between bullying and the level of suicidal ideation, but thwarted belongingness was not a significant mediator. CONCLUSIONS Perceived burdensomeness may represent a malleable target for intervention to prevent suicide among military service members, and should be evaluated further as an intervening variable with regard to suicidality in the setting of bullying victimization.
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Affiliation(s)
- Gavin A Crowell-Williamson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Martina Fruhbauerova
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Christopher R DeCou
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Katherine A Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
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24
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Baer MM, LaCroix JM, Browne JC, Hassen HO, Perera KU, Weaver J, Soumoff A, Ghahramanlou-Holloway M. Lack of Emotional Awareness is Associated with Thwarted Belongingness and Acquired Capability for Suicide in a Military Psychiatric Inpatient Sample. Suicide Life Threat Behav 2019; 49:1395-1411. [PMID: 30457162 DOI: 10.1111/sltb.12530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 09/17/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To examine potential links between facets of impulsivity and emotion dysregulation to components of the Interpersonal-Psychological Theory of Suicide (thwarted belongingness, perceived burdensomeness, and acquired capability) among U.S. military personnel. METHOD The current study performed secondary data analysis from a randomized control trial testing the efficacy of a cognitive therapy for 134 service members (71.64% male, 68.66% Caucasian; mean age: 30.14) admitted to a psychiatric inpatient unit for a suicide-related crisis. We utilized the Difficulties in Emotion Regulation Scale, the Barratt Impulsivity Scale, the Acquired Capability for Suicide Scale, and the Interpersonal Needs Questionnaire. RESULTS All emotion dysregulation dimensions and one impulsivity facet (attentional) were positively correlated with perceived burdensomeness and thwarted belongingness. Lack of emotional awareness was positively associated with acquired capability. After controlling for depression, hopelessness, and demographic covariates, lack of emotional awareness was significantly associated with both thwarted belongingness and acquired capability, but not perceived burdensomeness, and impulsivity dimensions did not link to any variable of interest. CONCLUSIONS Findings imply that individuals with reduced emotional awareness may have difficulty cultivating interpersonal bonds and be more vulnerable to elevated acquired capability. Lack of emotional awareness may be a potential contributor to both suicidal desire and capability.
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Affiliation(s)
- Margaret M Baer
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jessica M LaCroix
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Joy C Browne
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Helena O Hassen
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Kanchana U Perera
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Alyssa Soumoff
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Marjan Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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25
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Dempsey CL, Benedek DM, Zuromski KL, Riggs-Donovan C, Ng THH, Nock MK, Kessler RC, Ursano RJ. Association of Firearm Ownership, Use, Accessibility, and Storage Practices With Suicide Risk Among US Army Soldiers. JAMA Netw Open 2019; 2:e195383. [PMID: 31173124 PMCID: PMC6563574 DOI: 10.1001/jamanetworkopen.2019.5383] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/23/2019] [Indexed: 11/14/2022] Open
Abstract
Importance Since 2004, the suicide rate among US Army soldiers has exceeded the rate of death from combat injury. It is critical to establish factors that increase the risk of acting on suicidal thoughts to guide early intervention and suicide prevention. Objective To assess whether firearm ownership, use, storage practices, and accessibility are associated with increased risk of suicide. Design, Setting, and Participants In this case-control study, suicide cases (n = 135) were defined as US Army soldiers who died by suicide while on active duty between August 1, 2011, and November 1, 2013. Next-of-kin and Army supervisors of soldiers who died by suicide (n = 168) were compared with propensity-matched controls (n = 137); those soldiers with a suicidal ideation in the past year (n = 118) provided structured interview data. Data were analyzed from April 5, 2018, to April 2, 2019. Main Outcomes and Measures Firearm ownership, storage, and accessibility were assessed by using items from the World Health Organization Composite International Diagnostic Interview screening scales along with items created for the purpose of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) study. Results Among the 135 suicide decedents, next-of-kin reported that they had greater accessibility to firearms compared with propensity-matched controls. Specifically, suicide decedents were more likely to own 1 or more handguns compared with propensity-matched controls (odds ratio [OR], 1.9; 95% CI, 1.0-3.7; χ21 = 4.2; false discovery rate [FDR] P = .08), store a loaded gun at home (OR, 4.1; 95% CI, 1.9-9.1; χ21 = 12.2; FDR P = .003), and publicly carry a gun when not required for military duty (OR, 3.2; 95% CI, 1.4-7.3; χ21 = 7.4; FDR P = .02). The combination of these 3 items was associated with a 3-fold increase in the odds of suicide death (OR, 3.4; 95% CI, 1.2-9.4; χ21 = 5.4; FDR P = .05). Storing a loaded gun with ammunition at home or publicly carrying a gun when not on duty was associated with a 4-fold increase in the odds of suicide death (OR, 3.9; 95% CI, 1.9-7.9; χ21 = 14.1; FDR P = .002). Conclusions and Relevance In this study, in addition to gun ownership, ease and immediacy of firearm access were associated with increased suicide risk. Discussion with family members and supervisors about limiting firearm accessibility should be evaluated for potential intervention.
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Affiliation(s)
- Catherine L. Dempsey
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - David M. Benedek
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kelly L. Zuromski
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Charlotte Riggs-Donovan
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Tsz Hin H. Ng
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Ronald C. Kessler
- Department of Healthcare Policy, Harvard Medical School, Boston, Massachusetts
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Schuman DL, Cerel J, Praetorius RT. Suicide in U.S. Women Veterans: An Interpersonal Theory Perspective on Suicide Prevention Policies. SOCIAL WORK IN PUBLIC HEALTH 2019; 34:418-429. [PMID: 31140383 DOI: 10.1080/19371918.2019.1616028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Increases in suicide rates for U.S. women Service Members and Veterans have emerged as a public health issue of great concern. Women Veterans are more likely than their civilian counterparts to die by suicide, and rates of suicide for women Veterans are rising faster than rates for male Veterans. Given higher rates of suicide in combat-exposed males and increased rates of suicide associated with military deployment for women, the expansion of women into direct combat roles may further escalate their rates of suicide. The interpersonal theory of suicide provides a framework for the examination of women Veterans' risk factors and how implementation of policy provisions can more effectively ameliorate suicide risk. Recent suicide prevention policy initiatives that target women Veterans' unique needs are important steps; however, suicide prevention efforts should address specific risk factors contributing to thwarted belongingness, perceived burdensomeness, and the acquired capability for suicide in Veteran women.
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Affiliation(s)
- Donna L Schuman
- a College of Social Work , University of Kentucky , Lexington , Kentucky , USA
| | - Julie Cerel
- a College of Social Work , University of Kentucky , Lexington , Kentucky , USA
| | - Regina T Praetorius
- b School of Social Work , University of Texas at Arlington , Arlington, TX , USA
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27
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Naifeh JA, Ursano RJ, Kessler RC, Zaslavsky AM, Nock MK, Dempsey CL, Bartolanzo D, Ng THH, Aliaga PA, Zuromski KL, Dinh HM, Fullerton CS, Kao TC, Mash HBH, Sampson NA, Wynn GH, Stein MB. Transition to suicide attempt from recent suicide ideation in U.S. Army soldiers: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Depress Anxiety 2019; 36:412-422. [PMID: 30549394 PMCID: PMC6488405 DOI: 10.1002/da.22870] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/20/2018] [Accepted: 12/01/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Most people with suicide ideation (SI) do not attempt suicide (SA). Understanding the transition from current/recent SI to SA is important for mental health care. Our objective was to identify characteristics that differentiate SA from 30-day SI among representative U.S. Army soldiers. METHODS Using a unique case-control design, soldiers recently hospitalized for SA (n = 132) and representative soldiers from the same four communities (n = 10,193) were administered the same questionnaire. We systematically identified variables that differentiated suicide attempters from the total population, then examined whether those same variables differentiated all 30-day ideators (n = 257) from the total population and attempters from nonattempting 30-day ideators. RESULTS In univariable analyses, 20 of 23 predictors were associated with SA in the total population (0.05 level). The best multivariable model included eight significant predictors: interpersonal violence, relationship problems, major depressive disorder, posttraumatic stress disorder (PTSD), and substance use disorder (all having positive associations), as well as past 12-month combat trauma, intermittent explosive disorder (IED), and any college education (all having negative associations). Six of these differentiated 30-day ideators from the population. Three differentiated attempters from ideators: past 30-day PTSD (OR = 6.7 [95% CI = 1.1-39.4]), past 30-day IED (OR = 0.2 [95% CI = 0.1-0.5]), and any college education (OR = 0.1 [95% CI = 0.0-0.6]). The 5% of ideators with highest predicted risk in this final model included 20.9% of attempters, a four-fold concentration of risk. CONCLUSIONS Prospective army research examining transition from SI to SA should consider PTSD, IED, and education. Combat exposure did not differentiate attempters from ideators. Many SA risk factors in the Army population are actually risk factors for SI.
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Affiliation(s)
- James A Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Catherine L Dempsey
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Danielle Bartolanzo
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Tsz Hin Hinz Ng
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Pablo A Aliaga
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Kelly L Zuromski
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Hieu M Dinh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Carol S Fullerton
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Tzu-Cheg Kao
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Holly B Herberman Mash
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Gary H Wynn
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Murray B Stein
- Department of Psychiatry and Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, La Jolla, CA, USA
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Wadhawan A, Stiller JW, Potocki E, Okusaga O, Dagdag A, Lowry CA, Benros ME, Postolache TT. Traumatic Brain Injury and Suicidal Behavior: A Review. J Alzheimers Dis 2019; 68:1339-1370. [DOI: 10.3233/jad-181055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Abhishek Wadhawan
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Saint Elizabeths Hospital, Psychiatry Residency Training Program, Washington, DC, USA
| | - John W. Stiller
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Saint Elizabeths Hospital, Neurology Consultation Service, Washington, DC, USA
- Maryland State Athletic Commission, Baltimore, MD, USA
| | - Eileen Potocki
- VA Maryland Healthcare System, Baltimore VA Medical Center, Baltimore, MD, USA
| | - Olaoluwa Okusaga
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Michael E DeBakey VA Medical Center, Houston, TX, USA
| | - Aline Dagdag
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Psychiatry, University of Maryland Medical Center, Baltimore, MD, USA
| | - Christopher A. Lowry
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA
- Department of Physical Medicine and Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA
| | - Michael E. Benros
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Teodor T. Postolache
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA
- Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, MD, USA
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Wang Z, Yu G, Tian X. Exploring Behavior of People with Suicidal Ideation in a Chinese Online Suicidal Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010054. [PMID: 30587805 PMCID: PMC6339245 DOI: 10.3390/ijerph16010054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/23/2018] [Accepted: 12/24/2018] [Indexed: 12/19/2022]
Abstract
People with suicidal ideation (PSI) are increasingly using social media to express suicidal feelings. Researchers have found that their internet-based communication may lead to the spread of suicidal ideation, which presents a set of challenges for suicide prevention. To develop effective prevention and intervention strategies that can be efficiently applied in online communities, we need to understand the behavior of PSI in internet-based communities. However, to date there have been no studies that specifically focus on the behavior of PSI in Chinese online communities. A total of 4489 postings in which users explicitly expressed their suicidal ideation were labeled from 560,000 postings in an internet-based suicidal community on Weibo (one of the biggest social media platforms in China) to explore their behavior. The results reveal that PSI are significantly more active than other users in the community. With the use of social network analysis, we also found that the more frequently users communicate with PSI, the more likely that users would become suicidal. In addition, Chinese women may be more likely to be at risk of suicide than men in the community. This study enriches our knowledge of PSI’s behavior in online communities, which may contribute to detecting and assisting PSI on social media.
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Affiliation(s)
- Zheng Wang
- School of Management, Harbin Institute of Technology, Harbin 150001, China.
| | - Guang Yu
- School of Management, Harbin Institute of Technology, Harbin 150001, China.
| | - Xianyun Tian
- School of Management, Harbin Institute of Technology, Harbin 150001, China.
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30
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Reger MA, Tucker RP, Carter SP, Ammerman BA. Military Deployments and Suicide: A Critical Examination. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2018; 13:688-699. [PMID: 30286298 DOI: 10.1177/1745691618785366] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Deployment to a combat zone is a fundamental mission for most military forces, but prior research suggests that there is a complex and nuanced association between deployment and related risk factors for suicide. Deployment and combat experiences vary greatly among military personnel and can affect a variety of protective and risk factors for suicide. This article offers a critical examination of the association among modern U.S. military deployments, suicide attempts, and death while considering the context of a prominent theory of suicide. Although previous work has demonstrated that deployment is not associated with suicide overall in this population, there is growing evidence that risk may be elevated shortly after deployment, and for some subgroups. Specific aspects of combat exposure, including the experience of killing or witnessing death in combat, may be important contributing factors. An analysis of the literature illustrates that deployment-related risk factors for suicide are complex. The limitations of the literature are discussed, and future directions are suggested.
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Affiliation(s)
- Mark A Reger
- 1 VA Puget Sound Health Care System, Seattle, Washington.,2 Department of Psychiatry & Behavioral Sciences, University of Washington
| | | | - Sarah P Carter
- 1 VA Puget Sound Health Care System, Seattle, Washington
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Dillon KH, Cunningham KC, Neal JM, Wilson SM, Dedert EA, Elbogen EB, Calhoun PS, Beckham JC, Kimbrel NA. Examination of the indirect effects of combat exposure on suicidal behavior in veterans. J Affect Disord 2018; 235:407-413. [PMID: 29677605 PMCID: PMC8954689 DOI: 10.1016/j.jad.2018.04.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/06/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Researchers have theorized that increased rates of suicide in the military are associated with combat exposure; however, this hypothesis has received inconsistent support in the literature, potentially because combat exposure may be indirectly related to suicide risk through its influence on posttraumatic stress disorder (PTSD) and depressive symptoms. The current study tested the hypothesis that combat exposure has a significant indirect effect on suicidal behavior among Iraq/Afghanistan-era veterans through its effects on PTSD-depressive symptomatology. METHODS Iraq/Afghanistan-era veterans (N = 3,238) participated in a cross-sectional, multi-site study of post-deployment mental health consisting of clinical interviews and self-report questionnaires. Structural equation modeling (SEM) was used to examine direct and indirect relationships between three latent variables: combat exposure, PTSD-depression, and suicidal behavior (past attempts and current ideation, intent, and preparation). RESULTS A partial mediation model was the best-fitting model for the data. Combat exposure was significantly associated with PTSD-depression (β = 0.50, p < .001), which was in turn associated with suicidal behavior (β = 0.62, p < .001). As expected, the indirect effect between combat exposure and suicidal behavior was statistically significant, β = 0.31, p < .001. LIMITATIONS Data were cross-sectional, and suicidal behavior was measured via self-report. CONCLUSIONS Results indicated that combat exposure was indirectly related to suicidal behavior via PTSD-depressive symptomatology. Findings lend support for a higher-order combined PTSD-depression latent factor and suggest that Iraq/Afghanistan-era veterans with high levels of PTSD-depressive symptoms are at increased risk for suicidal behavior.
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Affiliation(s)
- Kirsten H. Dillon
- Duke University Medical Center, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Katherine C. Cunningham
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Julia M. Neal
- Duke University Medical Center, Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Sarah M. Wilson
- Duke University Medical Center, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA,VA Center for Health Services Research in Primary Care, Durham, NC, USA
| | - Eric A. Dedert
- Duke University Medical Center, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Eric B. Elbogen
- Duke University Medical Center, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Patrick S. Calhoun
- Duke University Medical Center, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA,VA Center for Health Services Research in Primary Care, Durham, NC, USA
| | - Jean C. Beckham
- Duke University Medical Center, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | | | - Nathan A. Kimbrel
- Duke University Medical Center, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Durham Veterans Affairs Medical Center, Durham, NC, USA,Correspondence concerning this article should be sent to: Dr. Nathan A. Kimbrel, VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, 3022 Croasdaile Drive, Durham, NC, 27705,
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32
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Sher L, Flory J, Bierer L, Makotkine I, Yehuda R. Dehydroepiandrosterone and dehydroepiandrosterone sulfate levels in combat veterans with or without a history of suicide attempt. Acta Psychiatr Scand 2018; 138:55-61. [PMID: 29790155 DOI: 10.1111/acps.12897] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The goal of this study was to determine whether combat veterans who have made a suicide attempt postdeployment can be distinguished from combat veterans who have never made a suicide attempt based on differences in psychological and biological variables. METHODS Demographic and clinical parameters of suicide attempters and non-attempters were assessed. Blood samples were assayed for dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS). RESULTS Suicide attempters had higher Scale for Suicidal Ideation and Montgomery-Åsberg Depression Rating Scale (MADRS)-suicidal thoughts item scores in comparison with non-attempters. There was a trend toward higher MADRS scores in the suicide attempter group compared with non-attempters. Suicide attempters had significantly lower levels of DHEA and DHEAS compared with non-attempters. Scale for Suicidal Ideation scores in all study participants combined negatively correlate with DHEA and DHEAS levels. DHEAS levels negatively correlate with Scale for Suicidal Ideation scores in suicide non-attempters but not in suicide attempters. DHEA/DHEAS ratios positively correlate with total adolescence aggression scores, total adulthood aggression scores, and total aggression scale scores in suicide attempters but not in suicide non-attempters. CONCLUSION There are psychobiological differences between combat veterans with or without a history of suicidal behaviour.
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Affiliation(s)
- L Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Flory
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - L Bierer
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - I Makotkine
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R Yehuda
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
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33
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Baer MM, LaCroix JM, Browne JC, Hassen HO, Perera KU, Weaver J, Soumoff A, Ghahramanlou-Holloway M. Non-Suicidal Self-Injury Elevates Suicide Risk among United States Military Personnel with Lifetime Attempted Suicide. Arch Suicide Res 2018; 22:453-464. [PMID: 28885089 DOI: 10.1080/13811118.2017.1358225] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Military psychiatric inpatients with and without a lifetime history of non-suicidal self-injury (NSSI), combined with a history of at least one suicide attempt, were compared on suicide ideation severity, number of suicide attempts, and Interpersonal-Psychological Theory of Suicide variables. Data were derived from baseline assessments performed in a psychotherapy randomized controlled trial. Lifetime history of NSSI and lifetime number of suicide attempts were assessed using the Columbia Suicide Severity Rating Scale (C-SSRS; Posner et al., 2011 ). Individuals with versus without a combined lifetime history of attempted suicide and NSSI showed significant elevations on thwarted belongingness and acquired capability for suicide. No significant between-group differences were found on perceived burdensomeness, frequency, duration, and controllability of suicide ideation, or number of lifetime suicide attempts. A history of NSSI, above and beyond attempted suicide, appears to increase service members' social alienation and acquired capability for suicide.
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Ursano RJ, Stein MB, Mash HBH, Naifeh JA, Fullerton CS, Zaslavsky AM, Ng THH, Aliaga PA, Wynn GH, Dinh HM, McCarroll JE, Sampson NA, Kao TC, Schoenbaum M, Heeringa SG, Kessler RC. Documented family violence and risk of suicide attempt among U.S. Army soldiers. Psychiatry Res 2018; 262:575-582. [PMID: 28965813 PMCID: PMC6444361 DOI: 10.1016/j.psychres.2017.09.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/11/2017] [Accepted: 09/17/2017] [Indexed: 01/16/2023]
Abstract
Suicide attempt (SA) rates in the U.S. Army increased substantially during the wars in Afghanistan and Iraq. This study examined associations of family violence (FV) history with SA risk among soldiers. Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), we identified person-month records of active duty, Regular Army, enlisted soldiers with medically documented SAs from 2004 to 2009 (n = 9650) and a sample of control person-months (n = 153,528). Logistic regression analyses examined associations of FV with SA, adjusting for socio-demographics, service-related characteristics, and prior mental health diagnosis. Odds of SA were higher in soldiers with a FV history and increased as the number of FV events increased. Soldiers experiencing past-month FV were almost five times as likely to attempt suicide as those with no FV history. Odds of SA were elevated for both perpetrators and those who were exclusively victims. Male perpetrators had higher odds of SA than male victims, whereas female perpetrators and female victims did not differ in SA risk. A discrete-time hazard function indicated that SA risk was highest in the initial months following the first FV event. FV is an important consideration in understanding risk of SA among soldiers.
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Affiliation(s)
- Robert J. Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA,Corresponding Author: Robert J. Ursano M.D., , Address: Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, Phone: 301-295-9797
| | - Murray B. Stein
- Department of Psychiatry and Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California and VA San Diego Healthcare System, San Diego, California, USA
| | - Holly B. Herberman Mash
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - James A. Naifeh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Carol S. Fullerton
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Tsz Hin Hinz Ng
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Pablo A. Aliaga
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Gary H. Wynn
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Hieu M. Dinh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - James E. McCarroll
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Tzu-Cheg Kao
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | - Steven G. Heeringa
- University of Michigan, Institute for Social Research, Ann Arbor, Michigan, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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35
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Love HA, Durtschi JA, Ruhlmann LM, Nelson Goff BS. Army Soldiers and Suicidal Thoughts: The Impact of Negative Relationship Dynamics Moderated by the Dissolution of Romantic Relationships. JOURNAL OF MARITAL AND FAMILY THERAPY 2018; 44:265-276. [PMID: 28718931 DOI: 10.1111/jmft.12252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Suicide among United States active-duty Army soldiers rapidly increased over the past two decades. Using a sample of 322 soldiers from the Army STARRS study, the researchers examined if romantic relationship factors (i.e., hostile disagreements and relationship distress) were linked with suicidal thoughts in Army soldiers, and if these associations were moderated by a recent separation or divorce. Hostile disagreements and relational distress were both significantly associated with higher rates of suicidal ideation. These associations were significantly amplified in magnitude when in the context of a recent separation or divorce. Implications include novel assessment, prevention, and treatment efforts focused on romantic relationships that may reduce the likelihood of soldiers experiencing thoughts of suicide.
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Bryan CJ, Wood DS, May A, Peterson AL, Wertenberger E, Rudd MD. Mechanisms of Action Contributing to Reductions in Suicide Attempts Following Brief Cognitive Behavioral Therapy for Military Personnel: A Test of the Interpersonal-Psychological Theory of Suicide. Arch Suicide Res 2018; 22:241-253. [PMID: 28422576 DOI: 10.1080/13811118.2017.1319313] [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] [Indexed: 10/19/2022]
Abstract
Brief cognitive behavioral therapy (BCBT) is associated with significant reductions in suicide attempts among military personnel. However, the underlying mechanisms of action contributing to reductions in suicide attempts in effective psychological treatments remain largely unknown. The present study conducted a secondary analysis of a randomized controlled trial of BCBT versus treatment as usual (TAU) to examine the mechanisms of action hypothesized by the interpersonal-psychological theory of suicide (IPT): perceived burdensomeness, thwarted belongingness, and fearlessness about death. In a sample of 152 active duty U.S. Army personnel with recent suicide ideation or attempts, there were significantly fewer suicide attempts in BCBT, but there were no differences between treatment groups from baseline to 6 months postbaseline on any of the 3 IPT constructs or their interactions. Tests of the moderated mediation failed to support an indirect effect for the IPT model, regardless of which IPT variables were specified as mediators or moderators. Results suggest that the IPT's hypothesized mechanisms of action do not account for reductions in suicide attempts in BCBT. Implications for clinical practice and research are discussed.
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Assavedo BL, Green BA, Anestis MD. Military personnel compared to multiple suicide attempters: Interpersonal theory of suicide constructs. DEATH STUDIES 2018; 42:123-129. [PMID: 28557621 DOI: 10.1080/07481187.2017.1334013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The current study aimed to address the discrepancy between suicide rates in the military and general population by comparing facets of the interpersonal theory of suicide between civilians with multiple suicide attempts and U.S. military personnel. Military personnel exhibited higher levels of capability for suicide but lower levels of perceived burdensomeness and thwarted belongingness than civilian multiple attempters. When comparing only personnel endorsing ideation and civilian multiple attempters, the significant difference for capability remained, but the differences for perceived burdensomeness and thwarted belongingness became nonsignificant. Results suggest the emergence of ideation places personnel at a greater risk for suicide than many civilian multiple attempters.
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Affiliation(s)
- Brittney L Assavedo
- a Department of Clinical Psychology , The University of Southern Mississippi , Hattiesburg , Mississippi , USA
| | - Bradley A Green
- a Department of Clinical Psychology , The University of Southern Mississippi , Hattiesburg , Mississippi , USA
| | - Michael D Anestis
- a Department of Clinical Psychology , The University of Southern Mississippi , Hattiesburg , Mississippi , USA
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Blais RK, Monteith LL, Kugler J. Sexual dysfunction is associated with suicidal ideation in female service members and veterans. J Affect Disord 2018; 226:52-57. [PMID: 28961442 DOI: 10.1016/j.jad.2017.08.079] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 08/15/2017] [Accepted: 08/27/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Suicide is a leading cause of premature death among military service members/veterans (SM/Vs). The Interpersonal Theory of Suicide (Joiner, 2007) proposes that higher thwarted belonging, perceived burdensomeness, and acquired capability confer increased risk for suicide. However, no studies have examined the association of sexual dysfunction, a possible component of thwarted belonging and perceived burdensomeness, with suicidal ideation. The present study explored whether sexual dysfunction was associated with suicidal ideation when accounting for mental health, demographic, and military characteristics among female SM/Vs. METHOD Female SM/Vs (n = 710) completed an anonymous online survey assessing demographics, mental health, military characteristics, sexual dysfunction, and suicidal ideation. RESULTS One hundred fifty-nine participants (22.39%) reported suicidal ideation during the preceding two weeks. A multivariable ordinal regression adjusted for age, marital status, probable posttraumatic stress disorder (PTSD), probable depression, race/ethnicity, Army service, and deployment history. Lower sexual functioning (adjusted odds ratio [AOR] = 0.98, 95% confidence interval[CI] = 0.95-0.99), probable PTSD (AOR = 2.54, 95% CI = 1.61-4.01), and probable depression (AOR = 5.28, 95% CI = 3.34-8.34) were associated with suicidal ideation. Post-hoc analyses examined the association of suicidal ideation with specific components of sexual functioning: difficulties with sexual arousal (AOR = 0.87, 95% CI = 0.79-0.97) and sexual satisfaction (AOR = 0.85, 95% CI = 0.75-0.96) were associated with suicidal ideation. LIMITATIONS Data were cross-sectional and limited to self-report. DISCUSSION Sexual dysfunction is associated with suicidal ideation, accounting for established mental health, military, and demographic characteristics among female SM/Vs. Efforts to prevent suicidal ideation in female SM/Vs may be enhanced by screening for and treating sexual dysfunction, particularly sexual arousal and satisfaction.
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Affiliation(s)
- Rebecca K Blais
- Department of Psychology, Utah State University, United States.
| | - Lindsey L Monteith
- Denver Veterans Affairs Medical Center, Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States
| | - Jordan Kugler
- Department of Psychology, Utah State University, United States
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Aronson KR, Kyler SJ, Morgan NR, Perkins DF, Love L. Spouse and Family Functioning Before and After a Marine’s Suicide: Comparisons to Deaths by Accident and in Combat. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Keith R. Aronson
- Clearinghouse for Military Family Readiness, Pennsylvania State University
| | - Sandee J. Kyler
- Clearinghouse for Military Family Readiness, Pennsylvania State University
| | - Nicole R. Morgan
- Clearinghouse for Military Family Readiness, Pennsylvania State University
| | - Daniel F. Perkins
- Clearinghouse for Military Family Readiness, Pennsylvania State University
| | - Linda Love
- U.S. Marine Corps, Philadelphia, Pennsylvania
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40
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Huang KC, Tzeng DS, Lin CH, Chung WC. Interpersonal-Psychological Theory, Alexithymia, and Personality Predict Suicide Ideation among Maladjusted Soldiers in Taiwan. Suicide Life Threat Behav 2017; 47:603-611. [PMID: 27883207 DOI: 10.1111/sltb.12315] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/29/2016] [Indexed: 11/29/2022]
Abstract
This case-control study enrolled 226 maladjusted soldiers and 229 controls to investigate the impact of the interpersonal-psychological theory of suicide, alexithymia, personality, and childhood trauma on suicide risk among Taiwanese soldiers. Assessments included the Toronto Alexithymia Scale, Eysenck Personality Inventory, Mini-International Neuropsychiatric Interview, and Brief Symptom Rating Scale. In addition to thwarted belongingness and perceived burdensomeness, other risks included less extraversion with higher neuroticism, higher alexithymia, poor academic performance, domestic violence, and life-threatening events. Our study demonstrates the interaction of the interpersonal-psychological theory and other suicide risk factors in Taiwanese soldiers.
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Affiliation(s)
- Kai-Cheng Huang
- Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Lingya District, Kaohsiung City, Taiwan
| | - Dong-Sheng Tzeng
- Tri-Service General Hospital Beitou Branch, Beitou, Taipei, Taiwan.,College of Pharmacy and Biotechnology, Tajen University, Pingtung, Taiwan.,Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hung Lin
- Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Lingya District, Kaohsiung City, Taiwan
| | - Wei-Ching Chung
- School of Nursing, Fooyin University, Kaohsiung City, Taiwan
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41
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Pennings SM, Finn J, Houtsma C, Green BA, Anestis MD. Posttraumatic Stress Disorder Symptom Clusters and the Interpersonal Theory of Suicide in a Large Military Sample. Suicide Life Threat Behav 2017; 47:538-550. [PMID: 27982459 DOI: 10.1111/sltb.12317] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 07/06/2016] [Indexed: 11/30/2022]
Abstract
Prior studies examining posttraumatic stress disorder (PTSD) symptom clusters and the components of the interpersonal theory of suicide (ITS) have yielded mixed results, likely stemming in part from the use of divergent samples and measurement techniques. This study aimed to expand on these findings by utilizing a large military sample, gold standard ITS measures, and multiple PTSD factor structures. Utilizing a sample of 935 military personnel, hierarchical multiple regression analyses were used to test the association between PTSD symptom clusters and the ITS variables. Additionally, we tested for indirect effects of PTSD symptom clusters on suicidal ideation through thwarted belongingness, conditional on levels of perceived burdensomeness. Results indicated that numbing symptoms are positively associated with both perceived burdensomeness and thwarted belongingness and hyperarousal symptoms (dysphoric arousal in the 5-factor model) are positively associated with thwarted belongingness. Results also indicated that hyperarousal symptoms (anxious arousal in the 5-factor model) were positively associated with fearlessness about death. The positive association between PTSD symptom clusters and suicidal ideation was inconsistent and modest, with mixed support for the ITS model. Overall, these results provide further clarity regarding the association between specific PTSD symptom clusters and suicide risk factors.
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Affiliation(s)
| | - Joseph Finn
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Claire Houtsma
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Bradley A Green
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Michael D Anestis
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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42
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Allbaugh LJ, Florez IA, Turmaud DR, Quyyum N, Dunn SE, Kim J, Kaslow NJ. Child Abuse - Suicide Resilience Link in African American Women: Interpersonal Psychological Mediators. JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 2017; 26:1055-1071. [PMID: 31105423 PMCID: PMC6519949 DOI: 10.1080/10926771.2017.1350773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The interpersonal-psychological theory of suicidal behavior (IPTS) is an exemplary model for understanding the desire for suicidal behavior. As such, it is important to explore its applicability in ethnoracial minority groups at increasing risk for suicidal behavior, such as low-income African American women. Guided by the IPTS, the current study used five parallel mediation models to examine if there are links between individual types of childhood abuse (physical, sexual, emotional) and suicide resilience and between cumulative abuse (higher levels of abuse inclusive of all three types, more types of severe levels of abuse) and suicide resilience, and whether the three components of the model (thwarted belongingness, perceived burdensomeness, acquired capability for suicide) mediate these associations. In a sample of low-income, African American women (n = 179), higher levels of each of the three types of childhood abuse and cumulative abuse correlated with lower levels of suicide resilience. Parallel mediation analyses using bootstrapping techniques revealed that increased acquired capability for suicide mediated all five associations and perceived burdensomeness mediated three of the links (emotional abuse, cumulative abuse, and cumulative abuse-severe with suicide resilience). Attention is paid to the clinical implications of the findings in terms of attending to the acquired capability for suicide and suicide resilience in the assessment and treatment of low-income, suicidal, African American women.
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Affiliation(s)
- Lucy J. Allbaugh
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ivonne Andrea Florez
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Nadia Quyyum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sarah E. Dunn
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jungjin Kim
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Nadine J. Kaslow
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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43
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Bryan CJ, Grove JL, Kimbrel NA. Theory-driven models of self-directed violence among individuals with PTSD. Curr Opin Psychol 2017; 14:12-17. [DOI: 10.1016/j.copsyc.2016.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/26/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
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44
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Podlogar MC, Houtsma C, Khazem LR, Ringer F, Mofield T, Green BA, Anestis MD, Lim IC, Joiner TE. The Associations Between Army National Guard Versus Active Duty Soldier Status and Perceived Burdensomeness, Thwarted Belongingness, and Acquired Capability. J Clin Psychol 2017; 73:1682-1691. [DOI: 10.1002/jclp.22473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/17/2016] [Accepted: 02/10/2017] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Ingrid C. Lim
- Office of the Surgeon General Defense Health Headquarters
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45
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Huang KC, Tzeng DS, Lin CH, Chung WC. Interpersonal-psychological theory and parental bonding predict suicidal ideation among soldiers in Taiwan. Asia Pac Psychiatry 2017; 9. [PMID: 26932826 DOI: 10.1111/appy.12236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 12/30/2015] [Accepted: 01/28/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Suicide is an important issue among military personnel, who have higher suicide rates compared with the general population. The interpersonal-psychological theory of suicide (IPTS) might provide an empirical explanation of this phenomenon, and parental bonding influences social adjustment and suicide. To investigate the relevance of IPTS and parental bonding for suicide among Taiwanese soldiers, a case-control study was conducted. METHODS Using a suicide-reporting system in a teaching general hospital in Southern Taiwan, 226 at-risk maladjusted soldiers and 229 well-adjusted controls were enrolled. We collected basic information, and participants answered four IPTS-based questions. Suicide risk was assessed using the Brief Symptom Rating Scale item 6. A four-factor model of the Parental Bonding Instrument assessed parental bonding. All participants were interviewed using the Mini International Neuropsychiatric Interview for primary screening and to recheck the accuracy of the Brief Symptom Rating Scale item 6 score. RESULTS A parsimonious model obtained by regression analysis of risk factors indicated that poor academic performance, conduct-related issues in childhood, and exposure to life-threatening situations are risk factors for suicide intention. Maladjusted suicidal soldiers showed a sense of thwarted belongingness (β = 0.145; P < 0.001), higher perceived burdensomeness (β = 0.311; P < 0.001), less fear of death (β = 0.124; P < 0.05), lower paternal autonomy (β = -0.122; P < 0.05), and higher maternal indifference (β = 0.162; P < 0.0001). DISCUSSION Interpersonal-psychological theory of suicide, accompanied by an assessment of parental bonding, could be used for assessing suicide risk and preventing suicide attempts.
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Affiliation(s)
- Kai-Cheng Huang
- Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Lingya District, Kaohsiung City, Taiwan
| | - Dong-Sheng Tzeng
- Tri-Service General Hospital Beitou Branch, Beitou, Taipei, Taiwan.,College of Pharmacy and Biotechnology, Tajen University, Pingtung, Taiwan.,Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hung Lin
- Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Lingya District, Kaohsiung City, Taiwan
| | - Wei-Ching Chung
- School of Nursing, Fooyin University, Kaohsiung City, Taiwan
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46
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Ludwig B, Roy B, Wang Q, Birur B, Dwivedi Y. The Life Span Model of Suicide and Its Neurobiological Foundation. Front Neurosci 2017; 11:74. [PMID: 28261051 PMCID: PMC5306400 DOI: 10.3389/fnins.2017.00074] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/31/2017] [Indexed: 01/19/2023] Open
Abstract
The very incomprehensibility of the suicidal act has been occupying the minds of researchers and health professionals for a long time. Several theories of suicide have been proposed since the beginning of the past century, and a myriad of neurobiological studies have been conducted over the past two decades in order to elucidate its pathophysiology. Both neurobiology and psychological theories tend to work in parallel lines that need behavioral and empirical data respectively, to confirm their hypotheses. In this review, we are proposing a "Life Span Model of Suicide" with an attempt to integrate the "Stress-Diathesis Model" and the "Interpersonal Model of Suicide" into a neurobiological narrative and support it by providing a thorough compilation of related genetic, epigenetic, and gene expression findings. This proposed model comprises three layers, forming the capability of suicide: genetic factors as the predisposing Diathesis on one side and Stress, characterized by epigenetic marks on the other side, and in between gene expression and gene function which are thought to be influenced by Diathesis and Stress components. The empirical evidence of this model is yet to be confirmed and further research, specifically epigenetic studies in particular, are needed to support the presence of a life-long, evolving capability of suicide and identify its neurobiological correlates.
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Affiliation(s)
| | | | | | | | - Yogesh Dwivedi
- UAB Mood Disorder Program, Department of Psychiatry and Behavioral Neurobiology, University of Alabama at BirminghamBirmingham, AL, USA
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47
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Monteith LL, Bahraini NH, Menefee DS. Perceived Burdensomeness, Thwarted Belongingness, and Fearlessness about Death: Associations With Suicidal Ideation among Female Veterans Exposed to Military Sexual Trauma. J Clin Psychol 2017; 73:1655-1669. [DOI: 10.1002/jclp.22462] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 11/10/2016] [Accepted: 01/03/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Lindsey L. Monteith
- Rocky Mountain Mental Illness Research; Education and Clinical Center and University of Colorado Anschutz Medical Campus
| | - Nazanin H. Bahraini
- Rocky Mountain Mental Illness Research; Education and Clinical Center and University of Colorado Anschutz Medical Campus
| | - Deleene S. Menefee
- Michael E. DeBakey Veterans Affairs Medical Center; South Central Mental Illness Research; Education and Clinical Center, and Baylor College of Medicine
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48
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Du J, Zhu M, Bao H, Li B, Dong Y, Xiao C, Zhang GY, Henter I, Rudorfer M, Vitiello B. The Role of Nutrients in Protecting Mitochondrial Function and Neurotransmitter Signaling: Implications for the Treatment of Depression, PTSD, and Suicidal Behaviors. Crit Rev Food Sci Nutr 2017; 56:2560-2578. [PMID: 25365455 DOI: 10.1080/10408398.2013.876960] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Numerous studies have linked severe stress to the development of major depressive disorder (MDD) and suicidal behaviors. Furthermore, recent preclinical studies from our laboratory and others have demonstrated that in rodents, chronic stress and the stress hormone cortisol cause oxidative damage to mitochondrial function and membrane lipids in the brain. Mitochondria play a key role in synaptic neurotransmitter signaling by providing adenosine triphosphate (ATP), mediating lipid and protein synthesis, buffering intracellular calcium, and regulating apoptotic and resilience pathways. Membrane lipids are similarly essential to central nervous system (CNS) function because cholesterol, polyunsaturated fatty acids, and sphingolipids form a lipid raft region, a special lipid region on the membrane that mediates neurotransmitter signaling through G-protein-coupled receptors and ion channels. Low serum cholesterol levels, low antioxidant capacity, and abnormal early morning cortisol levels are biomarkers consistently associated with both depression and suicidal behaviors. In this review, we summarize the manner in which nutrients can protect against oxidative damage to mitochondria and lipids in the neuronal circuits associated with cognitive and affective behaviors. These nutrients include ω3 fatty acids, antioxidants (vitamin C and zinc), members of the vitamin B family (Vitamin B12 and folic acid), and magnesium. Accumulating data have shown that these nutrients can enhance neurocognitive function, and may have therapeutic benefits for depression and suicidal behaviors. A growing body of studies suggests the intriguing possibility that regular consumption of these nutrients may help prevent the onset of mood disorders and suicidal behaviors in vulnerable individuals, or significantly augment the therapeutic effect of available antidepressants. These findings have important implications for the health of both military and civilian populations.
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Affiliation(s)
- Jing Du
- a School of Medicine, Yunnan University , Kunming , Yunnan , China.,c Laboratory of Molecular Pathophysiology, Intramural Research Program, NIMH, NIH , Bethesda , Maryland , USA
| | - Ming Zhu
- a School of Medicine, Yunnan University , Kunming , Yunnan , China
| | - Hongkun Bao
- a School of Medicine, Yunnan University , Kunming , Yunnan , China
| | - Bai Li
- a School of Medicine, Yunnan University , Kunming , Yunnan , China
| | - Yilong Dong
- a School of Medicine, Yunnan University , Kunming , Yunnan , China
| | - Chunjie Xiao
- a School of Medicine, Yunnan University , Kunming , Yunnan , China
| | - Grace Y Zhang
- c Laboratory of Molecular Pathophysiology, Intramural Research Program, NIMH, NIH , Bethesda , Maryland , USA
| | - Ioline Henter
- d Molecular Imaging Branch, Intramural Research Program, NIMH, NIH , Bethesda , Maryland , USA
| | - Matthew Rudorfer
- b Division of Service and Intervention Research, NIMH, NIH , Rockville , Maryland , USA
| | - Benedetto Vitiello
- b Division of Service and Intervention Research, NIMH, NIH , Rockville , Maryland , USA
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49
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McLean CP, Zang Y, Zandberg L, Bryan CJ, Gay N, Yarvis JS, Foa EB. Predictors of suicidal ideation among active duty military personnel with posttraumatic stress disorder. J Affect Disord 2017; 208:392-398. [PMID: 27810723 DOI: 10.1016/j.jad.2016.08.061] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/24/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Given the alarming rate of military suicides, it is critical to identify the factors that increase risk of suicidal thoughts and behaviors among active duty military personnel. METHODS This study examined a predictive model of suicidal ideation among 366 treatment-seeking active duty military personnel with posttraumatic stress disorder (PTSD) following deployments to or near Iraq or Afghanistan. Structural equation modeling was employed to examine the relative contribution of combat exposure, social support, PTSD severity, depressive symptoms, guilt, and trauma-related cognitions on suicidal ideation. RESULTS The final structural equation model had a highly satisfactory fit [χ2 (2) =2.023, p=.364; RMSEA =.006; CFI =1; GFI =.998]. PTSD severity had an indirect effect on suicidal ideation via trauma-related cognitions. Depression had a direct positive effect on suicidal ideation; it also had an indirect effect via trauma-related cognitions and interpersonal support. Among participants who had made a previous suicide attempt, only depression symptom severity was significantly linked to suicidal ideation. LIMITATIONS Data are cross-sectional, precluding causal interpretations. Findings may only generalize to treatment seeking active duty military personnel with PTSD reporting no more than moderate suicidal ideation. CONCLUSIONS These findings suggest that depression and trauma-related cognitions, particularly negative thoughts about the self, play an important role in suicidal ideation among active duty military personnel with PTSD. Negative cognitions about the self and interpersonal support may be important targets for intervention to decrease suicidal ideation.
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Affiliation(s)
- Carmen P McLean
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Yinyin Zang
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States.
| | - Laurie Zandberg
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Craig J Bryan
- National Center for Veterans Studies, Salt Lake City, UT, United States; Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Natalie Gay
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeffrey S Yarvis
- Headquarters, Carl R. Darnall Army Medical Center, Fort Hood, TX, United States
| | - Edna B Foa
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
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Rogers ML, Kelliher-Rabon J, Hagan CR, Hirsch JK, Joiner TE. Negative emotions in veterans relate to suicide risk through feelings of perceived burdensomeness and thwarted belongingness. J Affect Disord 2017; 208:15-21. [PMID: 27741431 DOI: 10.1016/j.jad.2016.09.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/27/2016] [Accepted: 09/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Suicide rates among veterans are disproportionately high compared to rates among the general population. Veterans may experience a number of negative emotions (e.g., anger, self-directed hostility, shame, guilt) during periods of postwar adjustment and reintegration into civilian life that may uniquely confer risk for suicide. Mechanisms of these associations, however, are less well studied. The purpose of the present study was to examine the relationship between negative emotions and suicide risk in veterans through the theoretical framework of the interpersonal theory of suicide. METHODS A large sample of veterans (N = 541) completed measures assessing their negative emotions, perceived burdensomeness, thwarted belongingness, and suicide risk. RESULTS Self-directed hostility and shame related indirectly to suicide risk through both perceived burdensomeness and thwarted belongingness. Thwarted belongingness accounted for the association between anger and suicide risk, whereas perceived burdensomeness accounted for the relationship between guilt and suicide risk. LIMITATIONS This study had a cross-sectional design and relied solely on self-report measures. CONCLUSIONS These findings provide evidence for the role of negative emotions in conferring risk for suicide in veterans. Clinical implications, limitations, and future research directions are discussed.
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