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Jamieson SK, Cerel J, Maple M. Impacts of exposure to suicide of a military colleague from the lived experience of veterans: Informing postvention responses from a military cultural perspective. DEATH STUDIES 2024; 48:688-697. [PMID: 38212987 DOI: 10.1080/07481187.2023.2261408] [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: 01/13/2024]
Abstract
Although exposure to the suicide death of a military colleague has been shown quantitatively to increase suicide risk factors among veterans, there are very few studies where veterans have been asked about this experience. This article presents a qualitative analysis of 38 interviews with U.S. veterans with exposure to the suicide death of a military colleague in past war operations. Participants described the impact of exposure in relation to the military context and official response to the death, which had long-term ramifications. Our findings suggest suicide prevention and postvention responses for veterans should be informed by the lived experience of veterans, including those for whom this experience occurred significantly in the past, as the impacts of different military policies and practices in response to suicide deaths over time are relevant to the impact of exposure to death of a military colleague in the short and long term.
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Affiliation(s)
- Sacha Kendall Jamieson
- Sydney School of Education and Social Work, The University of Sydney, Sydney, Australia
- School of Health, University of New England, Armidale, Australia
| | - Julie Cerel
- Suicide Prevention & Exposure Lab (SPEL), College of Social Work, University of Kentucky, Lexington, KY, USA
| | - Myfanwy Maple
- School of Health, University of New England, Armidale, Australia
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Fox H, Preston TJ, Morabito D, Schmidt NB, Albanese BJ. The interactive effects of AS and trauma exposure on suicide capability and suicide risk. J Psychiatr Res 2023; 167:100-107. [PMID: 37862905 DOI: 10.1016/j.jpsychires.2023.10.011] [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: 11/07/2022] [Revised: 09/04/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Trauma exposure has been linked with heightened suicide risk purportedly through habituation to threatening stimuli, thereby reducing fear of suicide. However, no research has examined variables that may influence this process. Anxiety sensitivity (AS) is one cognitive-affective factor that may strengthen the relationship between trauma exposure and reduced fear of suicide by amplifying traumatic reactivity. The present study evaluated this by examining the interaction of AS and trauma exposure type (e.g., direct vs. witnessed) predicting fear of suicide and self-reported suicide risk. METHODS Participants (n = 124) were recruited for a long-term (∼3-4 years) follow-up after participation in a clinical trial targeting suicide risk factors and were asked to complete self-report measures of trauma history, AS, fear of suicide, and suicide risk. RESULTS Significant interactions emerged such that a greater number of direct traumasexperienced predicted lower fear of suicide and greater suicide risk among those with greater AS. The interactive effect of witnessed traumas and AS predicting suicidality was insignificant. Results remained even after including relevant covariates. DISCUSSION The current findings suggest that AS augments the effects of repeated trauma exposure on fear of suicide and suicide risk. It is plausible these painful and provocative events are more potent among those with high AS due to the amplification of traumatic affective responses, though future research examining the longitudinal relations is needed to confirm this process.
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Affiliation(s)
- Hailey Fox
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Thomas J Preston
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Danielle Morabito
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Brian J Albanese
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA.
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Gomes DAR, de Araújo RMF, Gomes MS. Incidence of suicide among military police officers in South Brazil: An 11-year retrospective cohort study. Compr Psychiatry 2018; 85:61-66. [PMID: 29981945 DOI: 10.1016/j.comppsych.2018.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/31/2018] [Accepted: 06/16/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Suicide is known to be the leading cause of death among police officers (PO) worldwide. However, most studies were conducted in developed countries, with no data from Brazil. The present study aimed to evaluate the incidence and the sociodemographic profile of suicide among a military PO subpopulation in South Brazil. METHODS This retrospective cohort evaluated 31,110 military PO with available data on cause of death from 2006 to 2016. Participants were monitored for an average of 18.8 ± 9.6 years following the date of entry into the military police. RESULTS Mean age at the end of the follow up time was 41.4 ± 9.1 years, with 90.7% males. A total of 650 participants died (2.1%), with 43 suicides (6.6% of all deaths) - cumulative incidence of 138/100,000. Bivariate analysis revealed a significant association (p < 0.05) between suicide and age (HR = 0.70, 95%CI = 0.66-0.74), females (HR = 1.67, 95%CI = 1.08-2.60) and enlisted military rank (HR = 14.9, 95%CI = 2.05-108.5). Multivariate models showed an independent association between suicide and age (HR = 0.71, 95%CI = 0.67-0.74) and enlisted military rank (HR = 9.96, 95%CI = 1.30-76.3). CONCLUSIONS The incidence of suicide among military PO in South Brazil was high, compared to the national suicide rate. Younger age and lower military rank were independent predictors of suicide in this subpopulation.
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Affiliation(s)
- Denise Alves Riambau Gomes
- Department of Health of the Military Brigade of Rio Grande do sul, Brazil, Rua Castro de Menezes, 275, CEP 90010-190 Porto Alegre, RS, Brazil
| | - Rafael Moreno Ferro de Araújo
- Vale do Taquari University - Univates, Lajeado, Brazil, Rua Avelino Talini, 171, CEP 95914-014 Lajeado, RS, Brazil; Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil, Av. Ipiranga, 6681, prédio 6, CEP 90619900 Porto Alegre, RS, Brazil.
| | - Maximiliano Schünke Gomes
- Department of Health of the Military Brigade of Rio Grande do sul, Brazil, Rua Castro de Menezes, 275, CEP 90010-190 Porto Alegre, RS, Brazil; Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil, Av. Ipiranga, 6681, prédio 6, CEP 90619900 Porto Alegre, RS, Brazil.
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Bryan CJ, Cukrowicz KC. Associations between types of combat violence and the acquired capability for suicide. Suicide Life Threat Behav 2011; 41:126-36. [PMID: 21470292 DOI: 10.1111/j.1943-278x.2011.00023.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Research suggests that combat exposure might increase risk for suicide. The interpersonal-psychological theory of suicide (IPTS) proposes that exposure to painful and provocative experiences such as combat contribute to fearlessness about death and increased pain tolerance, which serve to enhance the individual's capability to attempt suicide. Violent and aggressive combat experiences, in particular, should demonstrate relatively stronger associations to this capability. The current study tests this proposition in a sample of deployed active duty combatants. Results indicate that all types of combat exposure independently contribute to capability for suicide. Consistent with the IPTS, when considering all types of combat simultaneously, combat characterized by violence and high levels of injury and death are associated with relatively stronger associations to this capability.
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Affiliation(s)
- Craig J Bryan
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, TX 78229, USA.
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Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, Joiner TE. The interpersonal theory of suicide. Psychol Rev 2010; 117:575-600. [PMID: 20438238 PMCID: PMC3130348 DOI: 10.1037/a0018697] [Citation(s) in RCA: 2648] [Impact Index Per Article: 189.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Suicidal behavior is a major problem worldwide and, at the same time, has received relatively little empirical attention. This relative lack of empirical attention may be due in part to a relative absence of theory development regarding suicidal behavior. The current article presents the interpersonal theory of suicidal behavior. We propose that the most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs-thwarted belongingness and perceived burdensomeness (and hopelessness about these states)-and further that the capability to engage in suicidal behavior is separate from the desire to engage in suicidal behavior. According to the theory, the capability for suicidal behavior emerges, via habituation and opponent processes, in response to repeated exposure to physically painful and/or fear-inducing experiences. In the current article, the theory's hypotheses are more precisely delineated than in previous presentations (Joiner, 2005), with the aim of inviting scientific inquiry and potential falsification of the theory's hypotheses.
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Affiliation(s)
- Kimberly A Van Orden
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA.
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Selby EA, Anestis MD, Bender TW, Ribeiro JD, Nock MK, Rudd MD, Bryan CJ, Lim IC, Baker MT, Gutierrez PM, Joiner TE. Overcoming the fear of lethal injury: evaluating suicidal behavior in the military through the lens of the Interpersonal-Psychological Theory of Suicide. Clin Psychol Rev 2009; 30:298-307. [PMID: 20051309 DOI: 10.1016/j.cpr.2009.12.004] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 12/02/2009] [Accepted: 12/03/2009] [Indexed: 12/25/2022]
Abstract
Suicide rates have been increasing in military personnel since the start of Operation Enduring Freedom and Operation Iraqi Freedom, and it is vital that efforts be made to advance suicide risk assessment techniques and treatment for members of the military who may be experiencing suicidal symptoms. One potential way to advance the understanding of suicide in the military is through the use of the Interpersonal-Psychological Theory of Suicide. This theory proposes that three necessary factors are needed to complete suicide: feelings that one does not belong with other people, feelings that one is a burden on others or society, and an acquired capability to overcome the fear and pain associated with suicide. This review analyzes the various ways that military service may influence suicidal behavior and integrates these findings into an overall framework with relevant practical implications. Findings suggest that although there are many important factors in military suicide, the acquired capability may be the most impacted by military experience because combat exposure and training may cause habituation to fear of painful experiences, including suicide. Future research directions, ways to enhance risk assessment, and treatment implications are also discussed.
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Affiliation(s)
- Edward A Selby
- Florida State University, Tallahassee, Florida 32306-1270, United States
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Henderson R, Stark C, Humphry RW, Selvaraj S. Changes in Scottish suicide rates during the Second World War. BMC Public Health 2006; 6:167. [PMID: 16796751 PMCID: PMC1526726 DOI: 10.1186/1471-2458-6-167] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 06/23/2006] [Indexed: 11/24/2022] Open
Abstract
Background It is believed that total reported suicide rates tend to decrease during wartime. However, analysis of suicide rates during recent conflicts suggests a more complex picture, with increases in some age groups and changes in method choice. As few age and gender specific analyses of more distant conflicts have been conducted, it is not clear if these findings reflect a change in the epidemiology of suicide in wartime. Therefore, we examined suicide rates in Scotland before, during and after the Second World War to see if similar features were present. Methods Data on deaths in Scotland recorded as suicide during the period 1931 – 1952, and population estimates for each of these years, were obtained from the General Register Office for Scotland. Using computer spreadsheets, suicide rates by gender, age and method were calculated. Forward stepwise logistic regression was used to assess the effect of gender, war and year on suicide rates using SAS V8.2. Results The all-age suicide rate among both men and women declined during the period studied. However, when this long-term decline is taken into account, the likelihood of suicide during the Second World War was higher than during both the pre-War and post-War periods. Suicide rates among men aged 15–24 years rose during the Second World War, peaking at 148 per million (41 deaths) during 1942 before declining to 39 per million (10 deaths) by 1945, while the rate among men aged 25–34 years reached 199 per million (43 deaths) during 1943 before falling to 66 per million (23 deaths) by 1946. This was accompanied by an increase in male suicides attributable to firearms and explosives during the War years which decreased following its conclusion. Conclusion All age male and female suicide rates decreased in Scotland during World War II. However, once the general background decrease in suicide rates over the whole period is accounted for, the likelihood of suicide among the entire Scottish population during the Second World War was elevated. The overall decrease in suicide rates concealed large increases in younger male age groups during the War years, and an increase in male suicides recorded as due to the use of firearms. We conclude that the effects of war on younger people, reported in recent conflicts in Central Europe, were also seen in Scotland during the Second World War. The results support the findings of studies of recent conflicts which have found a heterogeneous picture with respect to age specific suicide rates during wartime.
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Affiliation(s)
- Rob Henderson
- NHS Highland, Department of Public Health, Assynt House, Beechwood Park, Inverness, IV2 3HG, Scotland, UK
| | - Cameron Stark
- NHS Highland, Department of Public Health, Assynt House, Beechwood Park, Inverness, IV2 3HG, Scotland, UK
- Centre for Rural Health, University of Aberdeen, The Green House, Beechwood Business Park North, Inverness, IV2 3ED, Scotland, UK
| | - Roger W Humphry
- Centre for Rural Health, University of Aberdeen, The Green House, Beechwood Business Park North, Inverness, IV2 3ED, Scotland, UK
- Epidemiological Research Unit, Scottish Agricultural College, Drummond Hill, Inverness, IV2 4JZ, Scotland, UK
| | - Sivasubramaniam Selvaraj
- Centre for Rural Health, University of Aberdeen, The Green House, Beechwood Business Park North, Inverness, IV2 3ED, Scotland, UK
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