1
|
Schafer KM, Melia R, Joiner T. Risk and protective correlates of suicidality in the military health and well-being project. J Affect Disord 2024; 363:258-268. [PMID: 39033824 DOI: 10.1016/j.jad.2024.07.141] [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: 10/31/2023] [Revised: 06/26/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024]
Abstract
Suicidality disproportionately affects Veterans, and in 2020 the Military Health and Well-Being Project was conducted in part to study the link between risk and protective constructs with suicidality among Veterans. In the present study, we investigate the relative contribution of risk (i.e., military self-stigma, daily stress, combat exposure, substance use, traumatic brain injury, and moral injury) and protective constructs (i.e., social integration, social contribution, public service motivation, purpose and meaning, and help-seeking) with suicidality. Using cross-sectional Pearson correlation and linear regression models, we studied the independent and relative contribution of risk and protective correlates in a sample of 1469 Veterans (male: n = 985, 67.1 %; female: n = 476, 32.4 %; transgender, non-binary, prefer not to say: n = 8, 0.5 %). When we investigated protective constructs individually as well as simultaneously, social contribution (β = -0.39, t = -15.59, p < 0.001) was the strongest protective construct against suicidality. Social integration (β = -0.13, t = -4.88, p < 0.001) additionally accounted for significant reduction in suicidality when all protective constructs were considered together. When we investigated the contribution of risk constructs towards suicidality, moral injury was most strongly associated with suicidality (r = 0.519, p < 0.001), yet when studied simultaneously for their relative contribution none of the constructs accounted for a significant amount of the variance in suicidality (|t|s ≤ 1.98, ps ≥ 0.07). These findings suggest that among Veterans it is possible that social contribution is protective against suicidality and could be a possible treatment target for the prevention or reduction of suicidality among Veterans.
Collapse
Affiliation(s)
- Katherine Musacchio Schafer
- Tennessee Valley Healthcare System, United States of America; Vanderbilt University Medical Center, United States of America.
| | - Ruth Melia
- Florida State University, United States of America; University of Limerick, United States of America
| | | |
Collapse
|
2
|
Sifat MS, Ehlke SJ, Ogunsanya M, Frank-Pearce SG, Boozary LK, Alexander AC, Businelle MS, Kendzor DE. Greater Discrimination Frequency and Lower Distress Tolerance Are Associated with Mental Health Problems Among Racially Privileged and Minoritized Adults Accessing an Urban Day Shelter. J Racial Ethn Health Disparities 2024; 11:45-61. [PMID: 36607564 PMCID: PMC10699794 DOI: 10.1007/s40615-022-01496-z] [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] [Received: 08/15/2022] [Revised: 11/29/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Discrimination experiences may be a contributing factor to the elevated prevalence of mental health problems among adults experiencing homelessness. METHODS Using survey data (N = 552) collected from adults seeking services at an urban day shelter, the relationships between everyday and major discrimination experiences, distress tolerance, and mental health problems (depression, anxiety, post-traumatic stress disorder, poor mental health days) were characterized. Distress tolerance was examined as a moderator of the relationship between discrimination and mental health problems. RESULTS Participants were predominantly from racially minoritized groups (59.6%), non-Hispanic (88.7%), and male (70.9%), with an average age of 45.7 years old (SD = 11.7). Descriptive analyses indicated that the main reason for discrimination differed between racially privileged (i.e., White participants) and racially minoritized participants (i.e., participants who identified as Black, American Indian/Alaska Native, Asian, Native Hawaiian/Pacific Islander, or multi-race), such that homelessness was most commonly endorsed among racially privileged participants while racial discrimination was most commonly reported among racially minoritized participants. Multivariate logistic regression analyses revealed associations between everyday discrimination, major discrimination, and distress tolerance with mental health problems. Distress tolerance did not moderate the relations between discrimination and mental health problems in most analyses. Notably, major discrimination was no longer associated with all mental health variables when both everyday and major discrimination were included in all models. CONCLUSION Findings suggest that reducing everyday discrimination and addressing the adverse impact of everyday discrimination experiences may have a beneficial impact on mental health.
Collapse
Affiliation(s)
- Munjireen S Sifat
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Sarah J Ehlke
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
| | - Motolani Ogunsanya
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Summer G Frank-Pearce
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Laili Kharazi Boozary
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Cellular and Behavioral Neurobiology, Psychology, University of Oklahoma, Norman, OK, USA
| | - Adam C Alexander
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Michael S Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Darla E Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
3
|
Novacek DM, Wynn JK, McCleery A, Reavis EA, Senturk D, Sugar CA, Tsai J, Green MF. Racial differences in the psychosocial response to the COVID-19 pandemic in veterans with psychosis or recent homelessness. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2022; 92:590-598. [PMID: 35737567 PMCID: PMC9958263 DOI: 10.1037/ort0000633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic continues to disproportionately impact people of color and individuals experiencing psychosis and homelessness. However, it is unclear whether there are differences by race in psychosocial responses to the pandemic in vulnerable populations. The double jeopardy hypothesis posits that multiply marginalized individuals would experience worse psychosocial outcomes. The present study investigated the clinical and functional initial responses to the pandemic in both Black (n = 103) and White veterans (n = 98) with psychosis (PSY), recent homelessness (RHV), and in a control group (CTL) enrolled in Department of Veterans Affairs (VA) healthcare services. Clinical interviews were administered via phone at two time points: baseline (mid-May through mid-August 2020) and follow-up (mid-August through September 2020). The baseline interview also included retrospective measures of pre-COVID status from January 2020. There were no significant differences between Black and White veterans in depression, anxiety, or loneliness. However, Black veterans did endorse more fears of contamination, F(1, 196.29) = 9.48, p = .002. Across all groups, Black veterans had better family integration compared to White veterans, F(1, 199.98) = 7.62, p = .006. There were no significant differences by race in social integration, work/role productivity, or independent living. In sum, there were few significant differences between Black and White veterans in initial psychosocial response to the pandemic. The lack of racial disparities might reflect the presence of VA's wrap-around services. The findings also highlight the robust nature of social support in Black veterans, even in the context of a global pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
Affiliation(s)
- Derek M. Novacek
- Center on Enhancing Community Integration in Homeless Veterans, VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Jonathan K. Wynn
- Center on Enhancing Community Integration in Homeless Veterans, VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Amanda McCleery
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA
| | - Eric A. Reavis
- Center on Enhancing Community Integration in Homeless Veterans, VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Damla Senturk
- Department of Biostatistics, University of California, Los Angeles, CA
| | - Catherine A. Sugar
- Center on Enhancing Community Integration in Homeless Veterans, VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
- Department of Biostatistics, University of California, Los Angeles, CA
| | - Jack Tsai
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
- National Center on Homelessness Among Veterans, US Department of Veterans Affairs, Tampa, FL
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Michael F. Green
- Center on Enhancing Community Integration in Homeless Veterans, VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| |
Collapse
|