1
|
Hoffmire CA, Kittel JA, Brenner LA, Schneider AL, Katon J, Miller C, Monteith LL. Suicidal Ideation and Suicide Attempts Among Women Veterans Using VA Reproductive Health Care: Prevalence and Associations With Fertility-, Pregnancy- and Parenting-related Factors. Womens Health Issues 2024; 34:528-539. [PMID: 39107152 DOI: 10.1016/j.whi.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 06/21/2024] [Accepted: 06/26/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION Women veterans are at elevated risk for suicide and experience a high prevalence of suicidal ideation (SI) and suicide attempt (SA) history. Knowledge regarding SI/SA correlates among women veterans who use reproductive health care services is limited, inhibiting development of evidence-based, gender-sensitive suicide prevention programming tailored to meet women veterans' needs and preferences. This study aimed to 1) describe the prevalence and characteristics of SI and SA among women veterans using Veterans Health Administration (VHA) reproductive health care services and 2) provide an initial exploration of associations between fertility-, pregnancy-, and parenting-related factors with SI and SA to guide future research. METHODS Post-9/11 women veterans (n = 352) who used VHA reproductive health care in fiscal year 2018 completed a cross-sectional survey on reproductive health, mental health, and parenting. RESULTS Approximately 30% and 12% experienced SI and SA(s), respectively, after military service; 10% reported past-month SI. Infertility, pregnancy loss, age at first pregnancy, and parental status were not significantly associated with SI or SA history, although notable effect sizes were observed for infertility and age at first pregnancy; further research is warranted. Among parents, parental functioning was not associated with SI/SA, but lower parental satisfaction was significantly associated with past-month SI (prevalence ratio, 3.36; 95% confidence interval, 1.19-9.46; adjusting for demographics, military characteristics, mental health symptoms). CONCLUSIONS Postmilitary SI and SA(s) are common among women veterans accessing VHA reproductive health care services. Those with low parental satisfaction may be at particularly high risk. Findings can guide future research and inform clinical care to facilitate suicide prevention.
Collapse
Affiliation(s)
- Claire A Hoffmire
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Julie A Kittel
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lisa A Brenner
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Alexandra L Schneider
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
| | - Jodie Katon
- Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Christin Miller
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
| | - Lindsey L Monteith
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| |
Collapse
|
2
|
Denneson LM, Smolenski DJ, McDonald KL, Shull S, Hoffmire CA, Britton PC, Carlson KF, Dobscha SK. Gender differences in risk and resilience for suicidal thoughts and behaviors: A national longitudinal survey study of United States veterans with a recent suicide attempt. J Affect Disord 2024; 360:412-420. [PMID: 38815763 DOI: 10.1016/j.jad.2024.05.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND This study reports on gender differences in psychosocial symptoms and suicidal thoughts and behaviors from the first longitudinal, national survey of veterans with a recent nonfatal suicide attempt to inform women-tailored suicide prevention. METHODS We recruited all female veterans with a documented nonfatal suicide attempt between October 2018 and September 2019 and a stratified matched sample of males. Surveys were administered at baseline, month 6, and month 12; 968 veterans completed the baseline survey with valid gender data. Surveys assessed psychosocial constructs, suicidal ideation severity, and suicidal behavior. Administrative datasets provided healthcare and suicide attempt data during the one year follow up. RESULTS Women retained higher social rejection and institutional betrayal, and lower self-compassion and autonomy than men over follow up. Higher overall self-compassion was associated with lower baseline suicide ideation for both women and men; however, this association was stronger for women (Δ = -0.19; 95 % CI = -0.31, -0.07; d = -0.15). Individuals with higher overall psychological distress had greater odds of a subsequent suicide attempt (AOR = 2.20, 95 % CI = 1.56, 3.11). Social rejection had the strongest association with worsening psychological distress, both within individuals (b = 0.18; 95 % CI = 0.14, 0.23; d = 0.23) and between individuals (b = 0.07; 95 % CI = 0.04, 0.10; d = 0.09). LIMITATIONS Results may not generalize beyond a VHA-utilizing veteran population. CONCLUSIONS Findings from this study inform potential therapeutic targets and topics for future research on tailoring suicide prevention for women veterans. While all veterans may need support reducing distress, women may need additional support in multiple other areas.
Collapse
Affiliation(s)
- Lauren M Denneson
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
| | - Derek J Smolenski
- Defense Health Agency, Department of Defense, Silver Spring, MD, USA
| | - Katie L McDonald
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA
| | - Sarah Shull
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA
| | - Claire A Hoffmire
- Rocky Mountain MIRECC, VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Peter C Britton
- VISN 2 Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, NY, USA
| | - Kathleen F Carlson
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA; School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Steven K Dobscha
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
3
|
Monteith LL, Holder N, Iglesias CD, Holliday R. Institutional Betrayal and Closeness Among Women Veteran Survivors of Military Sexual Trauma: Associations with Self-Directed Violence and Mental Health Symptoms. J Trauma Dissociation 2024; 25:315-333. [PMID: 36069509 DOI: 10.1080/15299732.2022.2120152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
Institutional betrayal is defined as harm caused by an institution to an individual in the context of trust and dependence. High institutional betrayal is associated with poorer health outcomes, and high levels of trust, dependence, or identification with the institution (institutional closeness) may exacerbate the negative effects of institutional betrayal. While military sexual trauma is prevalent among women Veterans and associated with high rates of institutional betrayal, studies of the impact of military sexual trauma-related institutional betrayal have been limited in size and scope and have not examined the potential role of institutional closeness. We conducted a secondary analysis of national survey data collected from women Veterans who screened positive for military sexual trauma (n = 229). Hierarchical logistic and linear regression were used to examine associations between predictor variables (institutional betrayal, institutional closeness, and their interaction) and outcomes of interest and adjusted for age, education, and military sexual assault history. Institutional betrayal was associated with increased odds of suicidal ideation and suicide attempt during or following military service, as well as more severe symptoms of depression and posttraumatic stress disorder (PTSD). Institutional betrayal was not associated with non-suicidal self-injury or lifetime substance misuse. Counter to hypotheses, institutional closeness did not moderate relationships between institutional betrayal and mental health symptoms or self-directed violence. Results underscore the necessity of preventing and addressing institutional betrayal among women Veterans who experience military sexual trauma.
Collapse
Affiliation(s)
- Lindsey L Monteith
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, USA
| | - Nicholas Holder
- Mental Health, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, School of Medicine, San Francisco, California, USA
| | - Christe'An D Iglesias
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Ryan Holliday
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
4
|
Barnette BH, O'Loughlin CM, Park Y, Vogel K, Burke TA, Law KC, Ammerman BA. Nonsuicidal self-injury characteristics: A mixed methods analysis of differences between veterans and civilians. J Psychiatr Res 2023; 168:318-324. [PMID: 37949043 DOI: 10.1016/j.jpsychires.2023.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/31/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
Nonsuicidal self-injury (NSSI) is a well-established risk factor for suicidal behavior, with certain NSSI characteristics being associated with increased risk. In the United States (U.S.), the veteran suicide rate is elevated, though lifetime prevalence rates of NSSI appear similar between veterans and civilians. There is limited research that directly compares veterans and civilians across multiple NSSI characteristics to examine between-group differences in NSSI behavior and provide important context for the application of NSSI research with the veteran population. This study examined differences between U.S. veterans and civilians with a history of suicidal ideation across several NSSI characteristics, including method, severity, age of onset, shame, distress, and reason for initial NSSI engagement. A sample of 527 veterans and civilians completed measures of direct and indirect NSSI behaviors along with supplemental questions designed to further assess endorsed NSSI behaviors. Additionally, respondents provided written responses to an open-ended question about their reasons for initial engagement in NSSI, which were coded for post-hoc analysis. Chi-square difference tests and t-tests were conducted, revealing significant group differences between veterans and civilians in NSSI method, lifetime versatility, age of onset, age at last occurrence, and reasons for initial engagement. No significant differences were found in NSSI frequency, severity, shame, or distress. These findings provide valuable information on similarities and differences in NSSI behavior characteristics between U.S. veterans and civilians with lifetime suicidal ideation to inform future research and the assessment of NSSI in these populations.
Collapse
Affiliation(s)
- Benjamin H Barnette
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA.
| | | | - Yeonsoo Park
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Katrina Vogel
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Taylor A Burke
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Keyne C Law
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA
| | - Brooke A Ammerman
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| |
Collapse
|
5
|
Stanley IH, Marx BP, Fina BA, Young-McCaughan S, Tyler HC, Sloan DM, Blankenship AE, Dondanville KA, Walker JL, Boffa JW, Bryan CJ, Brown LA, Straud CL, Mintz J, Abdallah CG, Back SE, Blount TH, DeBeer BB, Flanagan J, Foa EB, Fox PT, Fredman SJ, Krystal J, McDevitt-Murphy ME, McGeary DD, Pruiksma KE, Resick PA, Roache JD, Shiroma P, Taylor DJ, Wachen JS, Kaplan AM, López-Roca AL, Nicholson KL, Schobitz RP, Schrader CC, Sharrieff AFM, Yarvis JS, Litz BT, Keane TM, Peterson AL. Psychometric Properties of the Self-Injurious Thoughts and Behaviors Interview-Short Form Among U.S. Active Duty Military Service Members and Veterans. Assessment 2023; 30:2332-2346. [PMID: 36644835 DOI: 10.1177/10731911221143979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We assessed the interrater reliability, convergent validity, and discriminant validity of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF) in a sample of 1,944 active duty service members and veterans seeking services for posttraumatic stress disorder (PTSD) and related conditions. The SITBI-SF demonstrated high interrater reliability and good convergent and discriminant validity. The measurement properties of the SITBI-SF were comparable across service members and veterans. Approximately 8% of participants who denied a history of suicidal ideation on the SITBI-SF reported suicidal ideation on a separate self-report questionnaire (i.e., discordant responders). Discordant responders reported significantly higher levels of PTSD symptoms than those who denied suicidal ideation on both response formats. Findings suggest that the SITBI-SF is a reliable and valid interview-based measure of suicide-related thoughts and behaviors for use with military service members and veterans. Suicide risk assessment might be optimized if the SITBI-SF interview is combined with a self-report measure of related constructs.
Collapse
Affiliation(s)
- Ian H Stanley
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
- University of Colorado, School of Medicine, Aurora, USA
| | - Brian P Marx
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
| | - Brooke A Fina
- University of Texas Health Science Center at San Antonio, USA
| | - Stacey Young-McCaughan
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | - Hannah C Tyler
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | - Denise M Sloan
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
| | | | | | - James L Walker
- University of Texas Health Science Center at San Antonio, USA
| | - Joseph W Boffa
- Southeast Louisiana Veterans Health Care System, New Orleans, USA
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Craig J Bryan
- The Ohio State University Wexner Medical Center, Columbus, USA
| | | | - Casey L Straud
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
- University of Texas at San Antonio, USA
| | - Jim Mintz
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | - Chadi G Abdallah
- Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Sudie E Back
- Medical University of South Carolina, Charleston, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | | | - Bryann B DeBeer
- University of Colorado, School of Medicine, Aurora, USA
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Julianne Flanagan
- Medical University of South Carolina, Charleston, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Edna B Foa
- University of Pennsylvania, Philadelphia, USA
| | - Peter T Fox
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | | | - John Krystal
- VA Connecticut Healthcare System, West Haven, USA
- Yale University, New Haven, CT, USA
| | | | - Donald D McGeary
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
- University of Texas at San Antonio, USA
| | - Kristi E Pruiksma
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | | | - John D Roache
- University of Texas Health Science Center at San Antonio, USA
| | - Paulo Shiroma
- Minneapolis VA Medical Center, MN, USA
- University of Minnesota, Minneapolis, USA
| | | | | | | | | | - Karin L Nicholson
- Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
- Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, CA, USA
| | | | | | - Allah-Fard M Sharrieff
- Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
- U.S. Department of Homeland Security, Miami, FL, USA
| | - Jeffrey S Yarvis
- Tulane University School of Medicine, New Orleans, LA, USA
- Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
| | - Brett T Litz
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
- Boston University, MA, USA
| | - Terence M Keane
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
| | - Alan L Peterson
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
- University of Texas at San Antonio, USA
| |
Collapse
|
6
|
Livingston WS, Tannahill HS, Meter DJ, Fargo JD, Blais RK. The Association of Military Sexual Harassment/Assault With Suicide Ideation, Plans, Attempts, and Mortality Among US Service Members/Veterans: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:2616-2629. [PMID: 35763372 DOI: 10.1177/15248380221109790] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Suicide rates continue to increase among service members/veterans. Military sexual harassment/assault (MSH/A) may increase risk of suicide, but little is known about the collective magnitude of associations between MSH/A and suicide outcomes, including ideation, plan, attempt, and mortality. The current meta-analysis addressed this literature gap while testing potential moderators of gender, marital status, discharge status, and military branch. PsycINFO, PubMed, Dissertations/Theses, relevant citation lists, and conference brochures were reviewed for papers that included quantitative analyses in English, U.S. military samples, and measures of MSH/A and suicide ideation/plan/attempt/mortality. The search resulted in 22 studies (N = 10,898,875) measuring the association of MSH/A with suicide ideation (k = 15), plans (k = 1), attempts (k = 14), and mortality (k = 2), with papers published from 2007-2021. MSH/A was associated with suicide ideation (r ¯ = .14) and attempts (r ¯ = .11, ps < .05). The association of MSH/A and suicide ideation and attempts was higher among women relative to men, those identifying as married versus not married, those actively serving compared to discharged, and those reporting service in the Air Force relative to all other branches. The association of MSH/A with suicide plans and mortality was not calculated due to the small number of studies reporting those effect sizes (ks = 1-2). The effect sizes observed suggest MSH/A is part of a larger network of risk factors for suicide. Moderators indicate that suicide risk is higher among specific groups, and prevention strategies would be most effective if they targeted these individuals. This research area would be strengthened by additional studies of plans and mortality.
Collapse
Affiliation(s)
| | | | - Diana J Meter
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Jamison D Fargo
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Rebecca K Blais
- Department of Psychology, Utah State University, Logan, UT, USA
- Psychology Department, Arizona State University,Tempe, AZ, USA
| |
Collapse
|
7
|
Lim E, Kim BJ, Lee CS, Cha B, Lee SJ, Seo JY, Choi JW, Lee YJ, Kang N, Kim SC, Lee D. Dietary Carotene Intake and Suicidal Ideation in Korean Females: Analysis of Data From the Korea National Health and Nutrition Examination Survey (2012, 2013, and 2015). Psychiatry Investig 2023; 20:897-903. [PMID: 37899212 PMCID: PMC10620338 DOI: 10.30773/pi.2022.0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/06/2022] [Accepted: 11/16/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE The suicide rate in Korea was the highest among countries in the Organisation for Economic Co-operation and Development in 2019. In a previous study, higher intake of vegetables and fruits was associated with a lower risk of suicidal ideation, and carotene-rich fruits and vegetables lowered the risk of depression. This study aimed to examine the direct relationship between carotene intake and suicidal ideation, adjusting for the effect on depression. METHODS This study used data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted in 2012, 2013, and 2015. Carotene intake was assessed through a food intake frequency survey with a 24-hour recall. Suicidal ideation and depression were assessed using the mental health section of the KNHANES. We applied logistic regression to assess the relationship between carotene intake and suicidal ideation, adjusting for potential confounders. RESULTS A total of 5,480 females aged 19-64 years were included in this study. Carotene intake was significantly lower in the suicidal ideation group (3,034.5±1,756.4 μg/day) than in the nonsuicidal ideation group (3,225.4±1,795.1 μg/day) (p=0.015). We found a significant inverse association between carotene intake and the risk of suicidal ideation after adjusting for potential confounders (odds ratio=0.934, 95% confidence interval=0.873-0.999). CONCLUSION These results suggest that carotene intake may be inversely associated with the risk of suicidal ideation. Our findings may inform the development of new nutritional interventions to prevent increases in the risk of suicide worldwide.
Collapse
Affiliation(s)
- Eunji Lim
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Psychiatry, Gyeongsang National University, College of Medicine, Jinju, Republic of Korea
| | - Bong-Jo Kim
- Department of Psychiatry, Gyeongsang National University, College of Medicine, Jinju, Republic of Korea
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Cheol-Soon Lee
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Psychiatry, Gyeongsang National University, College of Medicine, Jinju, Republic of Korea
| | - Boseok Cha
- Department of Psychiatry, Gyeongsang National University, College of Medicine, Jinju, Republic of Korea
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - So-Jin Lee
- Department of Psychiatry, Gyeongsang National University, College of Medicine, Jinju, Republic of Korea
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ji-Yeong Seo
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jae-Won Choi
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Young-Ji Lee
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Psychiatry, Gyeongsang National University, College of Medicine, Jinju, Republic of Korea
| | - Nuree Kang
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Seung Chan Kim
- Biostatistics Cooperation Center, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Dongyun Lee
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Psychiatry, Gyeongsang National University, College of Medicine, Jinju, Republic of Korea
| |
Collapse
|
8
|
Monteith LL, Miller CN, Polzer E, Holliday R, Hoffmire CA, Iglesias CD, Schneider AL, Brenner LA, Simonetti JA. "Feel the need to prepare for Armageddon even though I do not believe it will happen": Women Veterans' Firearm Beliefs and Behaviors during the COVID-19 Pandemic, Associations with Military Sexual Assault and Posttraumatic Stress Disorder Symptoms. PLoS One 2023; 18:e0280431. [PMID: 36763646 PMCID: PMC9917279 DOI: 10.1371/journal.pone.0280431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 01/01/2023] [Indexed: 02/12/2023] Open
Abstract
AIMS Firearm purchasing increased within the U.S. during the coronavirus disease 2019 pandemic. While rates of firearm ownership and suicide are elevated among women Veterans compared to women non-Veterans, no studies have examined if and how firearm beliefs and behaviors changed among women Veterans during the pandemic. We examined women Veterans' changes in firearm beliefs and engagement in firearm behaviors during the early pandemic era. METHOD 3,000 post-9/11 era women Veterans were invited to participate in a survey. 501 respondents (May-December 2020) comprised the sample for this concurrent nested mixed-method analysis. Thematic analysis and log-binomial regression were used. RESULTS 13.88% (n = 69) of women Veterans in our sample reported changes in their firearm beliefs; 22.15% (n = 109) reported engaging in firearm behaviors. The most prevalent reported behaviors were making household firearms more accessible (16.13%) and purchasing ammunition (11.97%). Smaller percentages reported carrying a firearm more frequently (6.71%), loading previously unloaded firearms (5.69%), or purchasing a firearm (4.24%). Thematic analysis suggested firearm behaviors were likely driven by a perceived increased need to protect oneself, family, and property due to: (1) uncertainties brought on by the pandemic; (2) pandemic-related threats necessitating self-defense, preparedness, and self-sufficiency; (3) political, social, and racial unrest and protests. PTSD symptom severity and military sexual assault history were associated with higher prevalence of changes in firearm beliefs and engagement in firearm behaviors during the pandemic. DISCUSSION Consideration of women Veterans' prior experiences and pandemic-related factors may be necessary to contextualize firearm discussions and inform future research. Given associations of military sexual assault and PTSD symptoms with firearm beliefs and behaviors, it may be crucial to ensure that such discussion are trauma-informed.
Collapse
Affiliation(s)
- Lindsey L. Monteith
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado, United States of America
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- * E-mail:
| | - Christin N. Miller
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado, United States of America
| | - Evan Polzer
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado, United States of America
| | - Ryan Holliday
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado, United States of America
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Claire A. Hoffmire
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado, United States of America
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Christe’An D. Iglesias
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado, United States of America
| | - Alexandra L. Schneider
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado, United States of America
| | - Lisa A. Brenner
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado, United States of America
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Joseph A. Simonetti
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado, United States of America
- Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| |
Collapse
|
9
|
Monteith LL, Kinney AR, Holliday R, Miller C, Schneider AL, Hoffmire CA, Simonetti JA, Brenner LA, Forster JE. Associations between deployment experiences, safety-related beliefs, and firearm ownership among women Veterans. J Psychiatr Res 2023; 157:72-81. [PMID: 36442409 DOI: 10.1016/j.jpsychires.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/15/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Among women Veterans, firearms are the leading suicide means. This has prompted efforts to elucidate factors associated with women Veterans' firearm ownership. This cross-sectional study examined if deployment experiences were associated with firearm ownership among women Veterans and if safety-related beliefs mediated these associations. METHODS 492 previously deployed post-9/11 women Veterans participated in a national survey that included the Deployment Risk and Resilience Inventory-2, subscales of the Posttraumatic Cognitions Inventory and Posttraumatic Maladaptive Beliefs Scale, and firearm ownership questions. Path analysis was used. RESULTS Perceived threat during deployment was associated with firearm ownership, irrespective of safety-related beliefs. Indirect effects did not support that safety-related beliefs mediated relations between deployment experiences and firearm ownership. The other deployment experiences (sexual harassment, sexual assault, general harassment, combat experiences) were not indirectly associated with firearm ownership, nor were safety-related beliefs (negative cognitions about the world, threat of harm, beliefs about others' reliability and trustworthiness) directly associated with firearm ownership. In an exploratory serial mediation analysis, perceived threat during deployment mediated the association between combat experiences and firearm ownership. In a sensitivity analysis examining firearm acquisition following military service, results were similar, except the indirect effect of combat experiences upon firearm acquisition through perceived threat was not significant. CONCLUSION Post-9/11 women Veterans' firearm acquisition and ownership may relate to specific deployment experiences, such as perceived threat; however, longitudinal studies are needed to fully ascertain this. Efforts to address firearm access among post-9/11 women Veterans may benefit from assessing heightened sense of danger during deployment.
Collapse
Affiliation(s)
- Lindsey L Monteith
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, 1700 North Wheeling St., Aurora, CO, 80045, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO, 80045, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Rm 1201G, Aurora, CO, 80045, USA.
| | - Adam R Kinney
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, 1700 North Wheeling St., Aurora, CO, 80045, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Rm 1201G, Aurora, CO, 80045, USA.
| | - Ryan Holliday
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, 1700 North Wheeling St., Aurora, CO, 80045, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO, 80045, USA.
| | - Christin Miller
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, 1700 North Wheeling St., Aurora, CO, 80045, USA.
| | - Alexandra L Schneider
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, 1700 North Wheeling St., Aurora, CO, 80045, USA.
| | - Claire A Hoffmire
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, 1700 North Wheeling St., Aurora, CO, 80045, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Rm 1201G, Aurora, CO, 80045, USA.
| | - Joseph A Simonetti
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, 1700 North Wheeling St., Aurora, CO, 80045, USA; Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, 12401 East 17th Avenue, 4th Floor, Aurora, CO, 80045, USA.
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, 1700 North Wheeling St., Aurora, CO, 80045, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO, 80045, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Rm 1201G, Aurora, CO, 80045, USA.
| | - Jeri E Forster
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, 1700 North Wheeling St., Aurora, CO, 80045, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Rm 1201G, Aurora, CO, 80045, USA; Department of Biostatistics and Informatics, Colorado School of Public Health, 13001 East 17th Place, 3rd Floor, Mail Stop B119, Aurora, CO, 80045, USA.
| |
Collapse
|
10
|
Halverson TF, Patel TA, Mann AJD, Evans MK, Gratz KL, Beckham JC, Calhoun PS, Kimbrel NA. The Screen for Nonsuicidal Self-Injury: Development and initial validation among veterans with psychiatric disorders. Suicide Life Threat Behav 2022; 52:615-630. [PMID: 35257418 PMCID: PMC9378472 DOI: 10.1111/sltb.12847] [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: 05/27/2021] [Revised: 12/13/2021] [Accepted: 01/16/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Nonsuicidal self-injury (NSSI) is associated with significant impairment and is a robust predictor of suicidal ideation, attempts, and death by suicide; however, the present lack of a brief screening instrument for NSSI coupled with consistent underidentification of NSSI in male adults has led to concerning rates of missed identification of NSSI. METHODS The Screen for Nonsuicidal Self-Injury (SNSI) is a brief, 10-item screen designed to identify individuals currently engaging in NSSI with an emphasis on behaviors more frequently endorsed by male adults. The present study examined the development and validation of the SNSI. RESULTS In a sample of veterans (N = 124) with complex psychiatric presentations, SNSI scores demonstrated good internal consistency and strong construct validity with area under the curve (AUC) estimates of 0.85-0.93 for the identification of NSSI disorder. SNSI scores also demonstrated good convergent (rs 0.59-0.90) and external validity (rs = 0.25-0.42), and excellent predictive validity identifying future NSSI Suicide and Life-Threatening Behavior disorder (AUC = 0.88) and NSSI behaviors (AUC = 0.90). Importantly, SNSI performance was not affected by participants' race, sex assigned at birth, or age. CONCLUSION The SNSI is an efficient screen to identify patients engaging in NSSI who are likely to benefit from more comprehensive assessment and treatment programs.
Collapse
Affiliation(s)
- Tate F. Halverson
- Durham Veterans Affairs Health Care System, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA
| | - Tapan A. Patel
- Durham Veterans Affairs Health Care System, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Adam J. D. Mann
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Mariah K. Evans
- Durham Veterans Affairs Health Care System, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kim L. Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Jean C. Beckham
- Durham Veterans Affairs Health Care System, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Patrick S. Calhoun
- Durham Veterans Affairs Health Care System, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Nathan A. Kimbrel
- Durham Veterans Affairs Health Care System, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| |
Collapse
|
11
|
Holliday R, Schneider AL, Miller C, Forster JE, Monteith LL. Factor Structure of the Suicide Cognitions Scale in a National Sample of Female Veterans. Arch Suicide Res 2022; 26:1349-1361. [PMID: 33689600 DOI: 10.1080/13811118.2021.1892003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The Suicide Cognitions Scale (SCS) may be beneficial for suicide risk assessment. However, research has identified diverging factor structures and focused primarily on samples composed of males. Given limited prior research with female veterans, who have experienced increased rates of suicide, we examined the factor structure of the SCS among a national sample of female veterans. METHOD Four-hundred thirty-one female veterans using and not using Veterans Health Administration care participated in an anonymous survey. RESULTS Exploratory factor analysis identified a three-factor solution, consistent with some prior research. This factor structure was not replicated in a confirmatory factor analysis. CONCLUSIONS Findings did not identify a consistent factor structure for the SCS among a sample of female veterans. Research is warranted to determine if suicide-specific cognitions differ among female veterans and to identify SCS items that should be added or removed to produce a more consistent factor structure among female veterans.HighlightsA consistent factor structure of the SCS among female Veterans was not identifiedSuicide-specific cognitions may differ among female VeteransAddition or removal of SCS items may be warranted in this population.
Collapse
|
12
|
Joseph JS, Smith-MacDonald L, Filice MC, Smith MS. Reculturation: A new perspective on military-civilian transition stress. MILITARY PSYCHOLOGY 2022; 35:193-203. [PMID: 37133548 DOI: 10.1080/08995605.2022.2094175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Various forms of assistance are offered to help US Veterans achieve success in their post-military lives in recognition of their service. Despite the many successes, a significant number of Veterans continue to remain at risk for negative mental health outcomes, including suicidality and low levels of life satisfaction. These findings may be due to challenges arising from cultural identity dissonance. Problematic strategies used by Veterans to reduce this dissonance can result in a lack of belongingness, a key component in Joiner's Interpersonal Theory of Suicide. The authors suggest that research on the immigrant experience of acculturation may provide a new perspective to better understand issues of identity and sense of belonging in Veterans. Given that most Veterans return to the culture in which they grew up, the authors offer the term "reculturation." The authors propose clinical psychology focus on exploring the reculturation process of Veterans to support program engagement and suicide prevention.
Collapse
Affiliation(s)
- Jeremy S. Joseph
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Lorraine Smith-MacDonald
- Heroes in Mind, Advocacy and Research Consortium Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Meg C. Filice
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA
| | - Matthew S. Smith
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA
| |
Collapse
|
13
|
Monteith LL, Holliday R, Dichter ME, Hoffmire CA. Preventing Suicide Among Women Veterans: Gender-Sensitive, Trauma-Informed Conceptualization. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2022; 9:186-201. [PMID: 35730002 PMCID: PMC9198614 DOI: 10.1007/s40501-022-00266-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review There is growing concern regarding suicide among women veterans, who have experienced an increase in suicide rates that has exceeded that reported for other US adult populations. Recent research has bolstered understanding of correlates of suicide risk specific to women veterans. Yet most existing suicide prevention initiatives take a gender-neutral, rather than gender-sensitive, approach. We offer clinical considerations and suggestions for suicide prevention tailored to the needs, preferences, and experiences of women veterans. Discussion is framed around the White House strategy for preventing suicide among military service members and veterans. Recent Findings Considering high rates of trauma exposure among women veterans, we propose that a trauma-informed lens is essential for taking a gender-sensitive approach to suicide prevention with this population. Nonetheless, research to inform evidence-based assessment and intervention remains largely focused on veteran men or gender-neutral. Integral next steps for research are posited. Summary Extant research provides an initial foundation for beginning to understand and address suicide among women veterans in a gender-sensitive, trauma-informed manner. Additional research that is specific to women veterans or that examines gender differences is critical to ensure women veterans receive optimal, evidence-based care to prevent suicide.
Collapse
Affiliation(s)
- Lindsey L. Monteith
- Rocky Mountain MIRECC for Veteran Suicide Prevention, Rocky Mountain Regional VA Medical Center, 1700 North Wheeling St, Aurora, CO 80045 USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Ryan Holliday
- Rocky Mountain MIRECC for Veteran Suicide Prevention, Rocky Mountain Regional VA Medical Center, 1700 North Wheeling St, Aurora, CO 80045 USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Melissa E. Dichter
- VA Center for Health Equity Research and Promotion, Philadelphia, PA USA
- Temple University School of Social Work, Philadelphia, PA USA
| | - Claire A. Hoffmire
- Rocky Mountain MIRECC for Veteran Suicide Prevention, Rocky Mountain Regional VA Medical Center, 1700 North Wheeling St, Aurora, CO 80045 USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, CO Aurora, USA
| |
Collapse
|
14
|
Monteith LL, Schneider AL, Holliday R, Bahraini NH. Assessing Institutional Betrayal Among Female Veterans Who Experienced Military Sexual Trauma: A Rasch Analysis of the Institutional Betrayal Questionnaire.2. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:10861-10883. [PMID: 33403916 DOI: 10.1177/0886260520983959] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Military sexual trauma (MST; i.e., sexual harassment and/or sexual assault during one's military service) is highly prevalent among female veterans and is associated with numerous adverse health and psychosocial sequelae. When institutions fail to prevent sexual trauma from happening or respond in an unsupportive manner (i.e., institutional betrayal [IB]), MST survivors typically report more severe health-related outcomes. Although the Institutional Betrayal Questionnaire.2 (IBQ.2) was developed to assess IB, no studies have examined the factor structure or dimensionality of the IBQ.2 among MST survivors. In addition, initial research has reported differing factor structures for this measure. The present study examined the dimensionality and factor structure of the IBQ.2, and tested for differential item functioning (DIF) based on whether military sexual assault was experienced. The sample comprised 235 female veterans who reported a history of MST in an anonymous national survey. Rasch analysis suggested multidimensionality and DIF based on history of military sexual assault. Exploratory factor analysis and parallel analysis suggested the IBQ.2 comprises three factors: (1) Environment Leading to MST, (2) Institutional Response to MST, and (3) Institutional Belongingness following MST. Although these results suggest that the IBQ.2 is multidimensional, the three-factor model had significant issues with respect to dimensionality, item fit, and person separation and reliability. Thus, using the full IBQ.2 may be more advantageous. Further examination of the IBQ.2 is warranted to ensure optimal assessment of IB in relation to MST, irrespective of whether the MST comprised sexual harassment or sexual assault, as well as to ensure that the IBQ.2 is culturally meaningful for MST survivors.
Collapse
Affiliation(s)
- Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alexandra L Schneider
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
15
|
Foynes MM, Singh RS, Landes SJ. A Functional Approach to the Assessment and Treatment of Non-Suicidal Self-Injury in Veterans: A Dialectical Behavior Therapy–Informed Perspective. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
16
|
Nichter B, Maguen S, Monteith LL, Kachadourian L, Norman SB, Hill ML, Herzog S, Pietrzak RH. Factors associated with multiple suicide attempts in a nationally representative study of U.S. military veterans. J Psychiatr Res 2021; 140:295-300. [PMID: 34126423 DOI: 10.1016/j.jpsychires.2021.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Veterans with a history of multiple suicide attempts are at increased risk for suicide mortality relative to those with a single attempt. However, little is known about factors that differentiate veterans who attempt suicide once compared to more than once. This study examined factors that distinguish single suicide attempters (SSA) from multiple suicide attempters (MSA) in a nationally representative sample of U.S. military veterans. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a representative sample of 4069 U.S. veterans. ANALYSES (a) estimated the lifetime prevalence of SSA and MSA; and (b) examined factors that differentiated veterans with a SSA from MSA. RESULTS The lifetime prevalences of SSA and MSA were 1.9% and 2.0%. The strongest correlates of MSA were history of lifetime depression (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.43-8.35), non-suicidal self-injury (OR, 3.28; 95% CI, 1.27-8.45), drug use disorder (OR, 4.0; 95% CI, 1.67-9.54), and marital status (OR, 0.40, 95% CI, 0.18-0.87), which accounted for 15.5%-41.4% of the total explained variance in MSA. DISCUSSION Half of military veterans who have attempted suicide in the United States report more than one attempt, suggesting that suicide attempts are not a one-time occurrence for a substantial proportion of veterans. Veterans who attempt suicide more than once show more deliberate self-harm behavior and have greater psychiatric comorbidities relative to single attempters. Implications for future research examining risk factors for suicide attempts among veterans are discussed.
Collapse
Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, University of California Sn Diego, La Jolla, CA, USA.
| | - Shira Maguen
- San Francisco VA Health Care System, San Francisco, CA, USA; University of California - San Francisco, San Francisco, USA
| | - Lindsey L Monteith
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lorig Kachadourian
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, New Haven, CT, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California Sn Diego, La Jolla, CA, USA; National Center for PTSD, White River Junction, VT, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Melanie L Hill
- Department of Psychiatry, University of California Sn Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Sarah Herzog
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - Robert H Pietrzak
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA; Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| |
Collapse
|
17
|
Hoffmire CA, Monteith LL, Forster JE, Bernhard PA, Blosnich JR, Vogt D, Maguen S, Smith AA, Schneiderman AI. Gender Differences in Lifetime Prevalence and Onset Timing of Suicidal Ideation and Suicide Attempt Among Post-9/11 Veterans and Nonveterans. Med Care 2021; 59:S84-S91. [PMID: 33438888 DOI: 10.1097/mlr.0000000000001431] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Rising US suicide rates are particularly notable among military veterans, especially women. It is unknown whether these differences extend to suicidal ideation (SI) and suicide attempts (SA), which are major predictors of suicide. Literature comparing SI and SA prevalence and timing of onset between veterans and nonveterans is limited. OBJECTIVE The objective of this study was to estimate and compare SI and SA prevalence and onset timing relative to age and military service between veterans and nonveterans, by gender. RESEARCH DESIGN Gender-stratified analysis of cross-sectional data from the Comparative Health Assessment Interview Study. Generalized estimating equations logistic regression was used to compare prevalence and onset of SI and SA between time periods and across groups, controlling for years at risk in each time period. SUBJECTS National sample of 15,082 post-9/11 veterans (36.7% women) and 4638 nonveterans (30.5% women). MEASURES Columbia-Suicide Severity Rating Scale adapted to assess SI and SA relative to age (less than 18 y, 18 y and above) and military service (pre-, during, and post-military). RESULTS Veteran men experienced significantly higher odds of lifetime SI compared with nonveteran men (odds ratio=1.13), whereas veteran women experienced significantly higher odds of lifetime SA compared with nonveteran women (odds ratio=1.35). SI and SA onset varied considerably for veterans and nonveterans and by gender within veteran groups. CONCLUSIONS Veterans and nonveterans appear to differ in periods of risk for SI and SA. Furthermore, gender differences in SI and SA onset for veterans highlight the need for gender-informed veteran suicide prevention strategies that target periods of highest risk.
Collapse
Affiliation(s)
- Claire A Hoffmire
- Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, VA Eastern Colorado Health Care System
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine
| | - Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, VA Eastern Colorado Health Care System
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, VA Eastern Colorado Health Care System
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine
| | - Paul A Bernhard
- Post Deployment Health Services Epidemiology Program, Office of Patient Care Services, Veterans Health Administration, Washington, DC
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Dawne Vogt
- Women's Health Sciences Division, National Center for PTSD (116B-3), VA Boston Healthcare System
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Shira Maguen
- San Francisco Veterans Affairs Health Care System
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA
| | - Alexandra A Smith
- Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, VA Eastern Colorado Health Care System
| | - Aaron I Schneiderman
- Post Deployment Health Services Epidemiology Program, Office of Patient Care Services, Veterans Health Administration, Washington, DC
| |
Collapse
|
18
|
Monteith LL, Holliday R, Hoffmire CA, Bahraini NH. Female Veterans' Willingness to Seek Veterans Health Administration and Non-Veterans Health Administration Services for Suicidal Thoughts and Mental Health Concerns. Med Care 2021; 59:S23-S30. [PMID: 33438879 DOI: 10.1097/mlr.0000000000001480] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The extent to which female veterans are willing to seek Veterans Health Administration (VHA) and non-VHA care when they are suicidal or experiencing mental health (MH) concerns is unknown. OBJECTIVES The objectives of this study were to: (1) examine whether current, past, and never VHA using female veterans' willingness to seek VHA care differs from their willingness to seek non-VHA care if suicidal or experiencing MH symptoms; (2) examine if VHA use, military sexual trauma, and suicidal ideation and attempt are associated with female veterans' willingness to use VHA and non-VHA care when experiencing suicidal thoughts or MH symptoms. RESEARCH DESIGN A cross-sectional anonymous survey. SUBJECTS Four hundred thirty nine female veterans, including current, past, and never VHA users were included. MEASURES General Help-Seeking Questionnaire, Self-Injurious Thoughts and Behaviors Interview, and the VA Military Sexual Trauma Screening Questions. RESULTS Current VHA users reported more willingness to use VHA than non-VHA care; conversely, past and never VHA users reported less willingness to use VHA care relative to non-VHA care. Military sexual assault and none or past VHA use were associated with lower willingness to use VHA care if suicidal or experiencing MH symptoms. In contrast, those with none or past VHA use reported greater willingness to use non-VHA care if suicidal or experiencing MH symptoms, while prior suicide attempt was associated with lower willingness. CONCLUSIONS Ensuring that acceptable and effective suicide prevention services are available to female veterans in both VHA and community settings is critical. Increasing help-seeking intentions among female veterans who have attempted suicide or experienced military sexual assault is also essential.
Collapse
Affiliation(s)
- Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
- Departments of Psychiatry
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
- Departments of Psychiatry
| | - Claire A Hoffmire
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
- Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
- Departments of Psychiatry
- Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO
| |
Collapse
|
19
|
Holliday R, Forster JE, Schneider AL, Miller C, Monteith LL. Interpersonal Violence Throughout the Lifespan: Associations With Suicidal Ideation and Suicide Attempt Among a National Sample of Female Veterans. Med Care 2021; 59:S77-S83. [PMID: 33438887 DOI: 10.1097/mlr.0000000000001447] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Female veterans experience interpersonal violence (ie, physical and sexual violence) more often than male veterans and nonveteran females. There is limited knowledge of types of interpersonal violence across the lifespan in relation to suicidal ideation and suicide attempt. Prior research has also focused on those accessing the Veterans Health Administration (VHA) care. OBJECTIVE This study examined if physical and sexual violence at differing time points (ie, premilitary, during military service) were associated with suicidal ideation and a suicide attempt at subsequent time points. We anticipated that violence would be associated with an increased risk of suicidal ideation and attempt; however, given limited prior research, we were uncertain which types of violence and time points would be associated with risk. RESEARCH DESIGN Data from a cross-sectional national survey. SUBJECTS A total of 407 female veterans using, formerly using, or who never used VHA care. MEASURES Suicidal ideation, suicide attempt, physical violence, and sexual violence were assessed. RESULTS Premilitary sexual, but not physical, violence was associated with military suicidal ideation. Both premilitary and military sexual and physical violence were associated with postmilitary suicidal ideation. Premilitary and military sexual, but not physical, violence were associated with a postmilitary suicide attempt. These results were maintained after accounting for VHA use. A significant model for military suicide attempt was not generated. CONCLUSIONS Assessment of premilitary and military sexual violence among female veterans is warranted within the context of suicide risk assessment and prevention. Preventing sexual violence among female veterans may be important for preventing suicidal ideation and attempt.
Collapse
Affiliation(s)
- Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
- Departments of Psychiatry
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
- Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Alexandra L Schneider
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
| | - Christin Miller
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
| | - Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
- Departments of Psychiatry
| |
Collapse
|
20
|
Affiliation(s)
- Robert W O'Brien
- Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs, Washington, DC
| | | |
Collapse
|