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Sher L, Bierer LM, Flory J, Makotkine I, Yehuda R. Brain-derived neurotrophic factor in war veterans with or without a history of suicide attempt. J Affect Disord 2022; 308:160-165. [PMID: 35427710 DOI: 10.1016/j.jad.2022.04.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/23/2022] [Accepted: 04/09/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) plays a central role in brain development and plasticity and has been demonstrated to be altered in neuropsychiatric diseases and suicidal behavior. We examined whether there is a difference with regard to plasma BDNF levels between veterans who made or did not make a suicide attempt post-deployment. METHODS Combat veterans who made or did not make post-deployment suicide attempts were interviewed using Mini-International Neuropsychiatric Interview, the Montgomery-Åsberg Depression Rating Scale, the Barratt Impulsivity Scale (BIS) and the Scale for Suicidal Ideation (SSI). Reaction to the most recent suicide attempt was evaluated using item 16 of the Suicide Intent Scale. Plasma BDNF levels were determined by the BDNF ELISA kit. RESULTS Controlling for age and body-mass index (BMI), BDNF levels were higher among suicide attempters than non-attempters. We observed a positive correlation between BDNF levels and SSI scores among non-attempters but not among attempters. BDNF levels positively correlated with BIS scores among suicide attempters but not among non-attempters. Suicide attempters who regretted that they made a suicide attempt had significantly higher BDNF levels in comparison to attempters who did not regret their attempts, controlling or not controlling for age and BMI. LIMITATIONS A modest sample size is a shortcoming of our study. CONCLUSIONS Our study demonstrates that BDNF may be involved in the pathophysiology of suicidal behavior in combat veterans. Given the relative ease of measuring plasma BDNF levels, it may be appropriate to consider adding such assessments to studies of suicidal behavior.
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Affiliation(s)
- Leo Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Linda M Bierer
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Janine Flory
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Iouri Makotkine
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Yehuda
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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2
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Roche R, Manzi J, Bard K. A Patient-Centered Study Examining Self-Identification of Mental Health Challenges Among Female Military Officers. J Patient Cent Res Rev 2021; 8:134-139. [PMID: 33898646 PMCID: PMC8060039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Due to the expansion of leadership roles in the military for women, female military personnel now face stressors equal to, and yet unique from, their male counterparts. This pilot study surveyed 73 female U.S. Army officers regarding their experiences of leadership and mental wellness within the military. A mixed-methods survey was distributed via 2 private Facebook groups for female Army officers following an anonymized convenience sampling. This anonymous, patient-centered protocol was used to protect against known stigma surrounding disclosing mental health concerns in the military. Respondents were asked a series of questions including perceived mental health status and access to behavioral health services. Most respondents reported feelings of stress related to their roles as officers (86.6%). Self-reported feelings of anxiety (83.6%) and depression (65.7%) were high. In contrast, only 30.1% had ever received a formal diagnosis of anxiety or depression by a mental health professional. Our survey confirmed a large percentage, 65.7% of respondents, reported avoiding mental/behavioral health services. Female military officers are able to recognize their feelings as symptoms of anxiety and depression; however, many take active steps to hide these symptoms from their family members and senior officers and avoid seeking professional care.
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Affiliation(s)
- Rosellen Roche
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
| | - Joel Manzi
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
| | - Katelyn Bard
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
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3
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Naifeh JA, Mash HBH, Stein MB, Vance MC, Aliaga PA, Fullerton CS, Dinh HM, Wynn GH, Kao TC, Sampson NA, Kessler RC, Ursano RJ. Sex Differences in US Army Suicide Attempts During the Wars in Iraq and Afghanistan. Med Care 2021; 59:S42-S50. [PMID: 33438882 PMCID: PMC7810153 DOI: 10.1097/mlr.0000000000001425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine sex differences in risk for administratively documented suicide attempt (SA) among US Army soldiers during the Iraq/Afghanistan wars. METHOD Using administrative person-month records of Regular Army enlisted soldiers from 2004 to 2009, we identified 9650 person-months with a first documented SA and an equal-probability control sample (n=153,528 person-months). Person-months were weighted to the population and pooled over time. After examining the association of sex with SA in a logistic regression analysis, predictors were examined separately among women and men. RESULTS Women (an estimated 13.7% of the population) accounted for 25.2% of SAs and were more likely than men to attempt suicide after adjusting for sociodemographic, service-related, and mental health diagnosis (MHDx) variables (odds ratio=1.6; 95% confidence interval, 1.5-1.7). Women with increased odds of SA in a given person-month were younger, non-Hispanic White, less educated, in their first term of enlistment, never or previously deployed (vs. currently deployed), and previously received a MHDx. The same variables predicted SA among men. Interactions indicated significant but generally small differences between women and men on 6 of the 8 predictors, the most pronounced being time in service, deployment status, and MHDx. Discrete-time survival models examining risk by time in service demonstrated that patterns for women and men were similar, and that women's initially higher risk diminished as time in service increased. CONCLUSIONS Predictors of documented SAs are similar for US Army women and men. Differences associated with time in service, deployment status, and MHDx require additional research. Future research should consider stressors that disproportionately affect women.
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Affiliation(s)
- James A. Naifeh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Holly B. Herberman Mash
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Murray B. Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California San Diego, La Jolla
- VA San Diego Healthcare System, San Diego, CA
| | - Mary C. Vance
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Pablo A. Aliaga
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Carol S. Fullerton
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
| | - Hieu M. Dinh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Gary H. Wynn
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
| | - Tzu-Cheg Kao
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Robert J. Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences
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McIntire KL, Crawford KM, Perrin PB, Sestak JL, Aman K, Walter LA, Page DB, Wen H, Randolph BO, Brunner RC, Novack TL, Niemeier JP. Factors Increasing Risk of Suicide after Traumatic Brain Injury: A State-of-the-Science Review of Military and Civilian Studies. Brain Inj 2021; 35:151-163. [PMID: 33460350 DOI: 10.1080/02699052.2020.1861656] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Primary Objective: Survey TBI literature to identify evidence of risk for post-injury suicide.Literature Selection: Search terms ((traumatic brain injury OR TBI) AND (suicidality OR suicidal behaviour OR suicidal ideation)) entered in PubMed, OVID Medline, PsychInfo, and Web of Science for papers published in print 01/01/1997 to 06/30/2019.Analysis of Literature: Authors screened abstracts, excluding duplicates and articles not meeting inclusion/exclusion criteria. Full papers were reviewed to make final exclusions. Data were extracted from 40 papers included co- and premorbid disorders, demographics, injury-related and psychological factors.Results: Persons with TBI have a higher risk for suicide than the general population. Reviewed articles reported comorbid depression and/or PTSD as risk factors for post-TBI suicide. Co- or premorbid substance misuse, sex, and sleep disturbance moderate risk. Quality of the literature was limited by sample size, the predominance of male participants, and inconsistency in reporting of findings.Conclusions: Comorbid depression and PTSD are significant post-TBI risk factors for suicide. Several variables combine to moderate or mediate TBI's connection with suicide. Civilian and military clinician cross-talk and consistent reporting of results from reproducible studies of post-TBI suicide risk factors could improve prevention and treatment efforts in veterans and civilians.
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Affiliation(s)
- Kayla L McIntire
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Kelly M Crawford
- Department of Physical Medicine and Rehabilitation, Carolinas Medical Center (Atrium Health System), Charlotte, North Carolina, USA
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jordan L Sestak
- Department of Physical Medicine and Rehabilitation, Carolinas Medical Center (Atrium Health System), Charlotte, North Carolina, USA
| | - Kyle Aman
- Department of Physical Medicine and Rehabilitation, Emory University, Atlanta, Georgia, USA
| | - Lauren A Walter
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - David B Page
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Huacong Wen
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Brittney O Randolph
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Robert C Brunner
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Tom L Novack
- Department of Physical Therapy, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Janet P Niemeier
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
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5
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Neuropeptide Y plasma levels and suicidal behavior in combat veterans. Eur Neuropsychopharmacol 2020; 40:31-37. [PMID: 32593562 DOI: 10.1016/j.euroneuro.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/01/2020] [Accepted: 06/09/2020] [Indexed: 01/27/2023]
Abstract
War veterans are at increased risk of suicide that may be related to deployment and/or post-deployment stressors and to adjustment-related factors. The aim of this study was to examine whether levels of plasma neuropeptide Y (NPY) might distinguish combat veterans who have made a post-deployment suicide attempt from those who have never made a suicide attempt. We focused on NPY because of prior findings linking NPY with the neurobiology of resilience, stress-related and other disorders, and suicidal behavior. Demographic and clinical parameters of suicide attempters and non-attempters were assessed and plasma NPY was determined by radioimmunoassay. NPY levels were higher among attempters in comparison to non-attempters, controlling for sex and body-mass index. Suicide attempters had higher Scale for Suicidal Ideation (SSI) scores than non-attempters. There was a positive correlation between NPY levels and SSI scores among non-attempters but not among attempters. Likewise, NPY levels positively correlated with Brown-Goodwin Aggression Scale scores among suicide attempters but not among non-attempters. This is the first demonstration of altered plasma NPY levels in association with suicide attempt history and suicidal ideation in veterans. Our findings suggest that clinical differences between combat veterans with or without a history of suicide attempt may have a neurobiological origin.
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6
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Sher L, Bierer LM, Flory J, Hill MN, Makotkine I, Yehuda R. Endogenous cannabinoid levels and suicidality in combat veterans. Psychiatry Res 2020; 287:112495. [PMID: 31375282 DOI: 10.1016/j.psychres.2019.112495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 12/29/2022]
Abstract
Combat veterans are at elevated suicide risk. The goal of this study was to test the hypothesis that combat veterans who have made a suicide attempt post-deployment can be distinguished from combat veterans who have never made a suicide attempt based on differences in psychological and biological variables. For the latter, we focused on endogenous cannabinoids, neuroendocrine markers that are associated with stress. Demographic and clinical parameters of suicide attempters and non-attempters were assessed. Blood samples were assayed for anandamide (AEA), 2-arachidonoylglycerol (2-AG), and cortisol. Suicide attempters had higher Scale for Suicidal Ideation (SSI) scores in comparison to non-attempters. Controlling for gender, 2-AG levels were higher among suicide attempters in comparison to non-attempters. Cortisol levels positively correlated with 2-AG levels and negatively correlated with SSI scores among non-attempters but not among attempters. AEA levels negatively correlated with SSI scores among attempters but not among non-attempters. Our results indicate that there are psychological and biological differences between combat veterans with or without a history of suicidal attempt. Our findings also suggest that clinically observed differences between the groups may have a neurobiological basis.
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Affiliation(s)
- Leo Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Linda M Bierer
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Janine Flory
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Iouri Makotkine
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Yehuda
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
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7
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Gross GM, Ronzitti S, Combellick JL, Decker SE, Mattocks KM, Hoff RA, Haskell SG, Brandt CA, Goulet JL. Sex Differences in Military Sexual Trauma and Severe Self-Directed Violence. Am J Prev Med 2020; 58:675-682. [PMID: 32037020 DOI: 10.1016/j.amepre.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Previous research has demonstrated an association between military sexual trauma and risk for suicide; however, risk for self-directed violence such as suicide attempt or nonsuicidal self-injury following military sexual trauma is understudied. This study examines the relationship between military sexual trauma and serious self-directed violence resulting in hospitalization, as well as whether this relationship differs by sex. METHODS Participants were 750,176 Operations Enduring Freedom/Iraqi Freedom/New Dawn veterans who were enrolled in Veterans Health Administration care during the period of October 1, 2001-September 30, 2014 and who were screened for military sexual trauma. Data were analyzed in 2019. Bivariate analyses and Cox proportional hazards regression models were employed. RESULTS Women veterans were more likely to screen positive for military sexual trauma (21.33% vs 1.63%), and women and men were equally likely to experience serious self-directed violence (1.19% women vs 1.18% men). Controlling for demographic variables and psychiatric morbidity, military sexual trauma predicted serious self-directed violence for both men and women. Further, men with military sexual trauma were 15% less likely to experience self-directed violence compared with women with military sexual trauma (hazard ratio=0.85, 95% CI=0.74, 0.98). CONCLUSIONS Military sexual trauma is associated with risk for serious self-directed violence for both men and women veterans, and the relationship may be pronounced among women. Results underscore the importance of incorporating military sexual trauma into treatment and preventative efforts for self-directed violence.
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Affiliation(s)
- Georgina M Gross
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut.
| | - Silvia Ronzitti
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Joan L Combellick
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Suzanne E Decker
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Kristin M Mattocks
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts
| | - Rani A Hoff
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Joseph L Goulet
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
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8
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Zuromski KL, Bernecker SL, Chu C, Wilks CR, Gutierrez PM, Joiner TE, Liu H, Naifeh JA, Nock MK, Sampson NA, Zaslavsky AM, Stein MB, Ursano RJ, Kessler RC. Pre-deployment predictors of suicide attempt during and after combat deployment: Results from the Army Study to Assess Risk and Resilience in Servicemembers. J Psychiatr Res 2020; 121:214-221. [PMID: 31865211 PMCID: PMC6953717 DOI: 10.1016/j.jpsychires.2019.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/04/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Deployment-related experiences might be risk factors for soldier suicides, in which case identification of vulnerable soldiers before deployment could inform preventive efforts. We investigated this possibility by using pre-deployment survey and administrative data in a sample of US Army soldiers to develop a risk model for suicide attempt (SA) during and shortly after deployment. METHODS Data came from the Army Study to Assess Risk and Resilience in Servicemembers Pre-Post Deployment Survey (PPDS). Soldiers completed a baseline survey shortly before deploying to Afghanistan in 2011-2012. Survey measures were used to predict SAs, defined using administrative and subsequent survey data, through 30 months after deployment. Models were built using penalized regression and ensemble machine learning methods. RESULTS Significant pre-deployment risk factors were history of traumatic brain injury, 9 + mental health treatment visits in the 12 months before deployment, young age, female, previously married, and low relationship quality. Cross-validated AUC of the best penalized and ensemble models were .75-.77. 21.3-40.4% of SAs occurred among the 5-10% of soldiers with highest predicted risk and positive predictive value (PPV) among these high-risk soldiers was 4.4-5.7%. CONCLUSIONS SA can be predicted significantly from pre-deployment data, but intervention planning needs to take PPV into consideration.
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Affiliation(s)
- Kelly L. Zuromski
- Department of Psychology, Harvard University, Cambridge, MA, USA,Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Samantha L. Bernecker
- Department of Psychology, Harvard University, Cambridge, MA, USA,Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Carol Chu
- Department of Psychology, Harvard University, Cambridge, MA, USA,Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Chelsey R. Wilks
- Department of Psychology, Harvard University, Cambridge, MA, USA,Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Peter M. Gutierrez
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA,Rocky Mountain Mental Illness Research, Education, and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Thomas E. Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Howard Liu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - James A. Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Murray B. Stein
- Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Willmund GD, Heß J, Helms C, Wertenauer F, Seiffert A, Nolte A, Wesemann U, Zimmermann PL. Suicides between 2010 and 2014 in the German Armed Forces-Comparison of Suicide Registry Data and a German Armed Forces Survey. Suicide Life Threat Behav 2019; 49:1497-1509. [PMID: 30556592 DOI: 10.1111/sltb.12534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 10/26/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The last 10 years have seen an increase in the number of suicides in the US Armed Forces. Accordingly, the topic of suicides in the German military has received a lot of attention in media and science alike. METHODS This study retrospectively examined all suicides (N = 107) committed by active, nonretired German military personnel from 2010 to the end of 2014, analyzing archived medical records. In a second step, these data were compared to a representative German Armed Forces survey conducted in 2012 (N = 1,549). RESULTS The following risk groups for suicide were identified: male (OR = 9.6), single (OR = 7.8), aged over 45 years (OR = 4.0), short period of service (<2 years; OR = 2.7), and low level of education (OR = 2.2). Surprisingly, military personnel with little experience in deployments abroad (<2 missions) showed double the risk (OR = 2.0) compared to those who had been deployed more than once. DISCUSSION Multiple robustness checks show that being single, aged over 45 years, and having obtained a low level of education exhibit the most robust effects on suicide risk. CONCLUSION Efforts should be made to develop and evaluate risk group-focused prevention programs. We conclude, that further studies should be initiated to show differences of risk groups between lethal and nonlethal suicidal behavior.
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Affiliation(s)
- Gerd-Dieter Willmund
- Bundeswehr Centre for Military Mental Health, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Julius Heß
- Bundeswehr Centre for Military History and Social Sciences, Potsdam, Germany
| | - Christian Helms
- Bundeswehr Centre for Military Mental Health, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Florian Wertenauer
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Woden, ACT, Australia.,Psychiatrische Abteilung, Sozialmedizinisches Zentrum Baumgartner Höhe und Otto-Wagner-Spital, Wien, Austria
| | - Anja Seiffert
- Bundeswehr Centre for Military History and Social Sciences, Potsdam, Germany
| | - Almut Nolte
- Bundeswehr, Bundeswehr Central Hospital, Koblenz, Germany
| | - Ulrich Wesemann
- Bundeswehr Centre for Military Mental Health, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Peter L Zimmermann
- Bundeswehr Centre for Military Mental Health, Bundeswehr Hospital Berlin, Berlin, Germany
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10
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Reimann CA, Mazuchowski EL. Suicide Rates Among Active Duty Service Members Compared with Civilian Counterparts, 2005-2014. Mil Med 2019; 183:396-402. [PMID: 29635600 DOI: 10.1093/milmed/usx209] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 01/07/2018] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to compare military suicide rates with civilian suicide rates, adjusting for age and sex differences that exist between the two populations. The number of active component (AC) service members whose manner of death was certified as suicide was determined for specific age and sex groups for each year from 2005 to 2014. Indirect standardization was then used to determine the expected number of suicides for each age/sex group, based on the U.S. suicide rates for the corresponding age/sex groups obtained from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System. Although suicide rates among U.S. active duty Service Members were found to increase between 2005 and 2009, overall age- and sex-adjusted AC suicide rates were lower than or comparable to civilian rates every year of the study period. When suicide numbers were analyzed within specific age and sex categories, there was a significant association between higher suicide incidence and AC military status for 17-29-yr-old females in 2010, 2012, and 2014, and a significant association between lower suicide incidence and AC military status for 25-49 -yr-old males in some years.
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Affiliation(s)
- Carolyn A Reimann
- Armed Forces Medical Examiner System, Dover Air Force Base, Delaware, 115 Purple Heart Drive, Dover Air Force Base, DE 19902
| | - Edward L Mazuchowski
- Armed Forces Medical Examiner System, Dover Air Force Base, Delaware, 115 Purple Heart Drive, Dover Air Force Base, DE 19902
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11
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Stokes CM, Naifeh JA, Kessler RC, Stein MB, Fullerton CS, Mash HBH, Riggs-Donovan CA, Ng THH, Aliaga PA, Wynn GH, Dinh HM, Kao TC, Gonzalez OI, Sampson NA, Ursano RJ. Risk factors and timing of suicide attempts among US Army Reserve Component soldiers during deployment to the Afghanistan and Iraq wars: Results from the Army Study to Assess Risk and Resilience in Servicemembers. Psychiatry 2019; 82:240-255. [PMID: 31566520 PMCID: PMC7446572 DOI: 10.1080/00332747.2019.1653056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Objective: During the wars in Afghanistan and Iraq, suicidal behaviors increased among U.S. Army soldiers. Although Reserve Component (RC) soldiers (National Guard and Army Reserve) comprise approximately one third of those deployed in support of the wars, few studies have examined suicidal behaviors among these "citizen-soldiers". The objective of this study is to examine suicide attempt risk factors and timing among RC enlisted soldiers. Methods: This longitudinal, retrospective cohort study used individual-level person-month records from Army and Department of Defense administrative data systems to examine socio-demographic, service-related, and mental health predictors of medically documented suicide attempts among enlisted RC soldiers during deployment from 2004-2009. Data were analyzed using discrete-time survival models. Results: A total of 230 enlisted RC soldiers attempted suicide. Overall, the in-theater suicide attempt rate among RC soldiers was 81/100,000 person-years. Risk was highest in the fifth month of deployment (13.8 per 100,000 person-months). Suicide attempts were more likely among soldiers who were women (adjusted odds ratio, aOR = 2.5 [95% CI: 1.8-3.5]), less than high school educated (aOR = 1.8 [95% CI: 1.3-2.5]), in their first 2 years of service (aOR = 2.0 [95% CI: 1.2-3.4]), were currently married (aOR = 2.0 [95% CI: 1.5-2.7]), and had received a mental health diagnosis in the previous month (aOR = 24.7 [95% CI: 17.4-35.0]). Conclusions: Being female, early in service and currently married are associated with increased odds of suicide attempt in RC soldiers. Risk of suicide attempt was greatest at mid deployment. These predictors and the timing of suicide attempt for RC soldiers in-theater are largely consistent with those of deployed Active Component (Regular) soldiers. Results also reinforce and replicate the findings among Active Component soldiers related to the importance of a recent mental health diagnosis and the mid-deployment as a period of enhanced risk.
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Affiliation(s)
- Cara M. Stokes
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - James A. Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115
| | - Murray B. Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California San Diego, 8939 Villa La Jolla Drive, Suite 200, La Jolla, California 92037,VA San Diego Healthcare System, 8810 Rio San Diego Drive, San Diego, CA 92108
| | - Carol S. Fullerton
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Holly B. Herberman Mash
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Charlotte A. Riggs-Donovan
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Tsz Hin Hinz Ng
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Pablo A. Aliaga
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Gary H. Wynn
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Hieu M. Dinh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Tzu-Cheg Kao
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Oscar I. Gonzalez
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
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Naifeh JA, Mash HBH, Stein MB, Fullerton CS, Kessler RC, Ursano RJ. The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS): progress toward understanding suicide among soldiers. Mol Psychiatry 2019; 24:34-48. [PMID: 30104726 PMCID: PMC6756108 DOI: 10.1038/s41380-018-0197-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 06/22/2018] [Accepted: 07/02/2018] [Indexed: 01/11/2023]
Abstract
Responding to an unprecedented increase in the suicide rate among soldiers, in 2008 the US Army and US National Institute of Mental Health funded the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), a multicomponent epidemiological and neurobiological study of risk and resilience factors for suicidal thoughts and behaviors, and their psychopathological correlates among Army personnel. Using a combination of administrative records, representative surveys, computerized neurocognitive tests, and blood samples, Army STARRS and its longitudinal follow-up study (STARRS-LS) are designed to identify potentially actionable findings to inform the Army's suicide prevention efforts. The current report presents a broad overview of Army STARRS and its findings to date on suicide deaths, attempts, and ideation, as well as other important outcomes that may increase suicide risk (e.g., mental disorders, sexual assault victimization). The findings highlight the complexity of environmental and genetic risk and protective factors in different settings and contexts, and the importance of life and career history in understanding suicidal thoughts and behaviors.
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Affiliation(s)
- James A. Naifeh
- 0000 0001 0421 5525grid.265436.0Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Holly B. Herberman Mash
- 0000 0001 0421 5525grid.265436.0Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Murray B. Stein
- 0000 0001 2107 4242grid.266100.3Department of Psychiatry and Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA USA ,0000 0004 0419 2708grid.410371.0VA San Diego Healthcare System, San Diego, CA USA
| | - Carol S. Fullerton
- 0000 0001 0421 5525grid.265436.0Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Ronald C. Kessler
- 000000041936754Xgrid.38142.3cDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Robert J. Ursano
- 0000 0001 0421 5525grid.265436.0Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD USA
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Sher L, Flory J, Bierer L, Makotkine I, Yehuda R. Dehydroepiandrosterone and dehydroepiandrosterone sulfate levels in combat veterans with or without a history of suicide attempt. Acta Psychiatr Scand 2018; 138:55-61. [PMID: 29790155 DOI: 10.1111/acps.12897] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The goal of this study was to determine whether combat veterans who have made a suicide attempt postdeployment can be distinguished from combat veterans who have never made a suicide attempt based on differences in psychological and biological variables. METHODS Demographic and clinical parameters of suicide attempters and non-attempters were assessed. Blood samples were assayed for dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS). RESULTS Suicide attempters had higher Scale for Suicidal Ideation and Montgomery-Åsberg Depression Rating Scale (MADRS)-suicidal thoughts item scores in comparison with non-attempters. There was a trend toward higher MADRS scores in the suicide attempter group compared with non-attempters. Suicide attempters had significantly lower levels of DHEA and DHEAS compared with non-attempters. Scale for Suicidal Ideation scores in all study participants combined negatively correlate with DHEA and DHEAS levels. DHEAS levels negatively correlate with Scale for Suicidal Ideation scores in suicide non-attempters but not in suicide attempters. DHEA/DHEAS ratios positively correlate with total adolescence aggression scores, total adulthood aggression scores, and total aggression scale scores in suicide attempters but not in suicide non-attempters. CONCLUSION There are psychobiological differences between combat veterans with or without a history of suicidal behaviour.
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Affiliation(s)
- L Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Flory
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - L Bierer
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - I Makotkine
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R Yehuda
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Mantua J, Helms SM, Weymann KB, Capaldi VF, Lim MM. Sleep Quality and Emotion Regulation Interact to Predict Anxiety in Veterans with PTSD. Behav Neurol 2018; 2018:7940832. [PMID: 29971139 PMCID: PMC6008674 DOI: 10.1155/2018/7940832] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/23/2018] [Accepted: 05/13/2018] [Indexed: 11/17/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating and common consequence of military service. PTSD is associated with increased incidence of mood disturbances (e.g., anxiety). Additionally, veterans with PTSD often have poor-quality sleep and poor emotion regulation ability. We sought to assess whether such sleep and emotion regulation deficits contribute to mood disturbances. In 144 veterans, using a double moderation model, we tested the relationship between PTSD and anxiety and examined whether sleep quality and emotion regulation interact to moderate this relationship. We found that PTSD predicts higher anxiety in veterans with poor and average sleep quality who utilize maladaptive emotion regulation strategies. However, there was no relationship between PTSD and anxiety in individuals with good sleep quality, regardless of emotion regulation. Similarly, there was no relationship between PTSD and anxiety in individuals with better emotion regulation, regardless of sleep quality. Results were unchanged when controlling for history of traumatic brain injury (TBI), despite the fact that those with both PTSD and TBI had the poorest emotion regulation overall. Taken together, these results suggest that good-quality sleep may be protective against poor emotion regulation in veterans with PTSD. Sleep may therefore be a target for therapeutic intervention in veterans with PTSD and heightened anxiety.
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Affiliation(s)
- Janna Mantua
- Neuroscience & Behavior Program, University of Massachusetts, Amherst, Amherst, MA 01003, USA
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Steven M. Helms
- VA Portland Health Care System, Portland, OR 97239, USA
- Oregon Health & Science University, Portland, OR 97239, USA
| | - Kris B. Weymann
- VA Portland Health Care System, Portland, OR 97239, USA
- Oregon Health & Science University, Portland, OR 97239, USA
| | - Vincent F. Capaldi
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Miranda M. Lim
- VA Portland Health Care System, Portland, OR 97239, USA
- Oregon Health & Science University, Portland, OR 97239, USA
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Reger MA, Smolenski DJ, Skopp NA, Metzger-Abamukang MJ, Kang HK, Bullman TA, Gahm GA. Suicides, homicides, accidents, and undetermined deaths in the U.S. military: comparisons to the U.S. population and by military separation status. Ann Epidemiol 2018; 28:139-146.e1. [DOI: 10.1016/j.annepidem.2017.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/02/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
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Sareen J, Afifi TO, Taillieu T, Cheung K, Turner S, Stein MB, Zamorski MA. Deployment-Related Traumatic Events and Suicidal Behaviours in a Nationally Representative Sample of Canadian Armed Forces Personnel. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:795-804. [PMID: 28490190 PMCID: PMC5697623 DOI: 10.1177/0706743717699174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Worldwide, there has been substantial controversy with respect to whether military deployment is a risk factor for suicidal behaviour. The present study examined the relationship between lifetime exposure to deployment and deployment-related traumatic events (DRTEs) and past-year suicidal ideation (SI), suicidal plans (SP), and suicidal attempts (SA). METHOD Data were analysed from the 2013 Canadian Forces Mental Health Survey (8161 respondents; response rate, 79.8%; aged 18-60 years). A total of 12 individual items assessed exposure to DRTEs (e.g., combat, witnessing human atrocities, feeling responsible for the death of Canadian or ally personnel, knowing someone who was injured or killed). We examined each individual DRTE type as well as the number of types of DRTEs in relation to suicidal behaviour. RESULTS Lifetime deployment was not significantly associated with suicidal behaviour. In models adjusted for sociodemographic variables, most of the individual DRTE items and the DRTE count variable were significantly associated with suicidal behaviours (adjusted odds ratio ranged between 1.10 and 5.32). When further adjusting for child abuse exposure, these associations were minimally attenuated, and some became nonsignificant. In models adjusting for mental disorders and child abuse, most DRTEs and number of types of DRTEs became nonsignificant in relation to SI, SP, and SA. CONCLUSIONS Active military personnel exposed to increasing number of DRTEs are at increased risk for SI, SP, and SA. However, most of the association between DRTEs and suicidal behaviour is accounted for by child abuse exposure and mental disorders.
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Affiliation(s)
- Jitender Sareen
- Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Tracie O. Afifi
- Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Tamara Taillieu
- Applied Health Sciences Program, University of Manitoba, Winnipeg, Manitoba
| | - Kristene Cheung
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba
| | - Sarah Turner
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Murray B. Stein
- University of California San Diego, San Diego, California, USA
- VA San Diego Healthcare System, San Diego, California, USA
| | - Mark A. Zamorski
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group HQ, Ottawa, Ontario
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario
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Naifeh JA, Nock MK, Ursano RJ, Vegella PL, Aliaga PA, Fullerton CS, Kessler RC, Wryter CL, Heeringa SG, Stein MB. Neurocognitive Function and Suicide in U.S. Army Soldiers. Suicide Life Threat Behav 2017; 47:589-602. [PMID: 27801502 PMCID: PMC5411316 DOI: 10.1111/sltb.12307] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 08/18/2016] [Indexed: 11/29/2022]
Abstract
This prospective cohort study used administrative data from the Army Study to Assess Risk and Resilience in Servicemembers to examine associations between neurocognitive functioning and subsequent suicidal events among Regular Army enlisted soldiers during the years 2004-2009. Cases were all soldiers who completed the Army's Automated Neuropsychological Assessment Metrics (ANAM) computerized testing battery prior to documented suicide attempt (n = 607), ideation (n = 955), or death (n = 57). Controls were an equal-probability sample of 9,893 person-months from other soldiers. Exploratory factor analysis of five ANAM tests identified a general neurocognitive factor that excluded the mathematic processing test (MTH). When examined separately in logistic regression analyses that controlled for sociodemographics and prior mental health diagnosis, both the general neurocognitive factor (logit [β] = -.197 to -.521; p < .01) and MTH (β = -.024 to -.064; p < .05) were associated with all outcomes. When both predictors were examined simultaneously, the general neurocognitive factor continued to be associated with all outcomes (β = -.164 to -.417; p < .05) and MTH continued to be associated with suicide attempt (β = -.015; p = .046) and ideation (β = -.014; p = .018). These small but robust associations suggest that future research must continue to examine the extent to which objective neurocognitive tests may enhance understanding and prediction of suicide risk.
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Affiliation(s)
- James A. Naifeh
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Matthew K. Nock
- Department of Psychology; Harvard University; Cambridge MA USA
| | - Robert J. Ursano
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Patti L. Vegella
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Pablo A. Aliaga
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Carol S. Fullerton
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Ronald C. Kessler
- Department of Health Care Policy; Harvard Medical School; Boston MA USA
| | - Christina L. Wryter
- Department of Psychiatry; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | | | - Murray B. Stein
- Department of Psychiatry; University of California San Diego; La Jolla CA USA
- Department of Family Medicine and Public Health; University of California San Diego; La Jolla CA USA
- VA San Diego Healthcare System; La Jolla CA USA
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Rogers ML, Ringer FB, Michaels MS, Chiurliza B, Hagan CR, Chu C, Schneider ME, Lim IC, Joiner TE. Sex Differences in Suicide-Related Symptoms in a Large Military Sample. ACTA ACUST UNITED AC 2017; 5:73-80. [PMID: 28944102 DOI: 10.1080/21635781.2016.1243496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Little research has focused on suicide-related symptoms in female servicemembers, despite high rates of suicidal behaviors. This study examined sex differences in suicide-related risk factors in 3,374 U.S. Army Recruiters (91.9% male). Female servicemembers had a greater number of past major depressive and suicidal ideation episodes than males; there were no differences in suicide attempt histories or mental health visits. Females reported significantly fewer symptoms of current suicidal ideation, perceived burdensomeness, and acquired capability. No significant sex differences emerged for thwarted belongingness, insomnia, or agitation. Our findings provide evidence for sex differences in rates of suicide-related symptoms among military personnel.
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Suicide in Illinois, 2005-2010: A reflection of patterns and risks by age groups and opportunities for targeted prevention. J Trauma Acute Care Surg 2017; 81:S30-5. [PMID: 27244579 DOI: 10.1097/ta.0000000000001141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Suicide accounts for two thirds of all deaths from intentional or violence-related injury and is a leading cause of death in the United States. Patterns of suicide have been well described among high-risk groups, but few studies have compared the circumstances related to suicides across all age groups. We sought to understand the epidemiology of suicide cases in Illinois and to characterize the risks and patterns for suicide among different age groups. METHODS We used suicide data collected from the Illinois Violent Death Reporting System to assess demographics, method of suicide, circumstances, and mental health status among different age groups. RESULTS Between 2005 and 2010, 3,016 suicides were reported; 692 (23%) were female, and the median age (n = 3,013) was 45 years (range, 10-98 years). The most common method/weapon types were hanging/strangulation (33%), firearm (32%) and poisoning (21%). Hanging was more common (74%) among young people aged 10 to 19 years, while firearm use was more common among elderly persons age 65 years and older (55%). The percentage of victims within an age group experiencing a crisis within two weeks before committing suicide was highest among 10- to 14-year-olds, while the risk factor of having a family member or friend die in the past 5 years was highest among older victims. CONCLUSION The final analysis demonstrated age-related trends in suicide in Illinois, suggesting prevention programs should tailor services by age. LEVEL OF EVIDENCE Epidemiologic study, level IV.
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Kessler RC, Stein MB, Petukhova MV, Bliese P, Bossarte RM, Bromet EJ, Fullerton CS, Gilman SE, Ivany C, Lewandowski-Romps L, Bell AM, Naifeh JA, Nock MK, Reis BY, Rosellini AJ, Sampson NA, Zaslavsky AM, Ursano RJ. Predicting suicides after outpatient mental health visits in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Mol Psychiatry 2017; 22:544-551. [PMID: 27431294 PMCID: PMC5247428 DOI: 10.1038/mp.2016.110] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/27/2016] [Accepted: 06/01/2016] [Indexed: 12/03/2022]
Abstract
The 2013 US Veterans Administration/Department of Defense Clinical Practice Guidelines (VA/DoD CPG) require comprehensive suicide risk assessments for VA/DoD patients with mental disorders but provide minimal guidance on how to carry out these assessments. Given that clinician-based assessments are not known to be strong predictors of suicide, we investigated whether a precision medicine model using administrative data after outpatient mental health specialty visits could be developed to predict suicides among outpatients. We focused on male nondeployed Regular US Army soldiers because they account for the vast majority of such suicides. Four machine learning classifiers (naive Bayes, random forests, support vector regression and elastic net penalized regression) were explored. Of the Army suicides in 2004-2009, 41.5% occurred among 12.0% of soldiers seen as outpatient by mental health specialists, with risk especially high within 26 weeks of visits. An elastic net classifier with 10-14 predictors optimized sensitivity (45.6% of suicide deaths occurring after the 15% of visits with highest predicted risk). Good model stability was found for a model using 2004-2007 data to predict 2008-2009 suicides, although stability decreased in a model using 2008-2009 data to predict 2010-2012 suicides. The 5% of visits with highest risk included only 0.1% of soldiers (1047.1 suicides/100 000 person-years in the 5 weeks after the visit). This is a high enough concentration of risk to have implications for targeting preventive interventions. An even better model might be developed in the future by including the enriched information on clinician-evaluated suicide risk mandated by the VA/DoD CPG to be recorded.
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Affiliation(s)
- Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Murray B. Stein
- Departments of Psychiatry and Family and Preventive Medicine, University of California San Diego, La Jolla, California and VA San Diego Healthcare System, San Diego, California
| | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Paul Bliese
- Darla Moore School of Business, University of South Carolina, Columbia, South Carolina
| | - Robert M. Bossarte
- Post Deployment Health Service, Department of Veterans Affairs, Washington DC
| | - Evelyn J. Bromet
- Department of Psychiatry & Behavioral Science, Stony Brook School of Medicine, Stony Brook, New York
| | - Carol S. Fullerton
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, Maryland
| | - Stephen E. Gilman
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; Department of Epidemiology, Harvard T.H. Chan School of Public Health, and Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christopher Ivany
- U.S Army Medical Command, Behavioral Health Service Line, Bethesda, Maryland
| | | | | | - James A. Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, Maryland
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Benjamin Y. Reis
- Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
| | | | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, Maryland
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Mendoza C, Barreto GE, Ávila-Rodriguez M, Echeverria V. Role of neuroinflammation and sex hormones in war-related PTSD. Mol Cell Endocrinol 2016; 434:266-77. [PMID: 27216917 DOI: 10.1016/j.mce.2016.05.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/16/2016] [Accepted: 05/19/2016] [Indexed: 11/17/2022]
Abstract
The susceptibility to develop posttraumatic stress disorder (PTSD) is greatly influenced by both innate and environmental risk factors. One of these factors is gender, with women showing higher incidence of trauma-related mental health disorders than their male counterparts. The evidence so far links these differences in susceptibility or resilience to trauma to the neuroprotective actions of sex hormones in reducing neuroinflammation after severe stress exposure. In this review, we discuss the impact of war-related trauma on the incidence of PTSD in civilian and military populations as well as differences associated to gender in the incidence and recovery from PTSD. In addition, the mutually influencing role of inflammation, genetic, and sex hormones in modulating the consequences derived from exposure to traumatic events are discussed in light of current evidence.
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Affiliation(s)
- Cristhian Mendoza
- Neurobiology Laboratory, Facultad Ciencias de la Salud, Universidad San Sebastian, Lientur 1457, Concepción, 4080871, Chile
| | - George E Barreto
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C., Colombia; Center for Biomedical Research, Universidad Autónoma de Chile, Carlos Antúnez 1920, Providencia, Santiago, Chile
| | | | - Valentina Echeverria
- Neurobiology Laboratory, Facultad Ciencias de la Salud, Universidad San Sebastian, Lientur 1457, Concepción, 4080871, Chile; Research and Development, Bay Pines VA Healthcare System, Bay Pines, FL, USA.
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Ursano RJ, Kessler RC, Stein MB, Naifeh JA, Aliaga PA, Fullerton CS, Wynn GH, Vegella PL, Ng THH, Zhang BG, Wryter CL, Sampson NA, Kao TC, Colpe LJ, Schoenbaum M, McCarroll JE, Cox KL, Heeringa SG. Risk Factors, Methods, and Timing of Suicide Attempts Among US Army Soldiers. JAMA Psychiatry 2016; 73:741-9. [PMID: 27224848 PMCID: PMC4937827 DOI: 10.1001/jamapsychiatry.2016.0600] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Suicide attempts in the US Army have risen in the past decade. Understanding the association between suicide attempts and deployment, as well as method and timing of suicide attempts, can assist in developing interventions. OBJECTIVE To examine suicide attempt risk factors, methods, and timing among soldiers currently deployed, previously deployed, and never deployed at the time this study was conducted. DESIGN, SETTING, AND PARTICIPANTS This longitudinal, retrospective cohort study of Regular Army-enlisted soldiers on active duty from 2004 through 2009 used individual-level person-month records to examine risk factors (sociodemographic, service related, and mental health), method, and time of suicide attempt by deployment status (never, currently, and previously deployed). Administrative data for the month before each of 9650 incident suicide attempts and an equal-probability sample of 153 528 control person-months for other soldiers were analyzed using a discrete-time survival framework. MAIN OUTCOMES AND MEASURES Suicide attempts and career, mental health, and demographic predictors were obtained from administrative and medical records. RESULTS Of the 9650 enlisted soldiers who attempted suicide, 86.3% were male, 68.4% were younger than 30 years, 59.8% were non-Hispanic white, 76.5% were high school educated, and 54.7% were currently married. The 40.4% of enlisted soldiers who had never been deployed (n = 12 421 294 person-months) accounted for 61.1% of enlisted soldiers who attempted suicide (n = 5894 cases). Risk among those never deployed was highest in the second month of service (103 per 100 000 person-months). Risk among soldiers on their first deployment was highest in the sixth month of deployment (25 per 100 000 person-months). For those previously deployed, risk was highest at 5 months after return (40 per 100 000 person-months). Currently and previously deployed soldiers were more likely to attempt suicide with a firearm than those never deployed (currently deployed: OR, 4.0; 95% CI, 2.9-5.6; previously deployed: OR, 2.7; 95% CI, 1.8-3.9). Across deployment status, suicide attempts were more likely among soldiers who were women (currently deployed: OR, 3.4; 95% CI, 3.0-4.0; previously deployed: OR, 1.5; 95% CI, 1.4-1.7; and never deployed: OR, 2.4; 95% CI, 2.3-2.6), in their first 2 years of service (currently deployed: OR, 1.9; 95% CI, 1.5-2.3; previously deployed: OR, 2.2; 95% CI, 1.9-2.7; and never deployed: OR, 3.1; 95% CI, 2.7-3.6), and had a recently received a mental health diagnosis in the previous month (currently deployed: OR, 29.8; 95% CI, 25.0-35.5; previously deployed: OR, 22.2; 95% CI, 20.1-24.4; and never deployed: OR, 15.0; 95% CI, 14.2-16.0). Among soldiers with 1 previous deployment, odds of a suicide attempt were higher for those who screened positive for depression or posttraumatic stress disorder after return from deployment and particularly at follow-up screening, about 4 to 6 months after deployment (depression: OR, 1.4; 95% CI, 1.1-1.9; posttraumatic stress disorder: OR, 2.4; 95% CI, 2.1-2.8). CONCLUSIONS AND RELEVANCE Identifying the timing and risk factors for suicide attempt in soldiers requires consideration of environmental context, individual characteristics, and mental health. These factors can inform prevention efforts.
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Affiliation(s)
- Robert J Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Murray B Stein
- Department of Psychiatry, University of California-San Diego, La Jolla4Department of Family Medicine and Public Health, University of California-San Diego, La Jolla
| | - James A Naifeh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Pablo A Aliaga
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Carol S Fullerton
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Gary H Wynn
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Patti L Vegella
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Tsz Hin Hinz Ng
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Bailey G Zhang
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Christina L Wryter
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Tzu-Cheg Kao
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Lisa J Colpe
- University of California-San Diego, La Jolla7Veterans Affairs San Diego Healthcare System, La Jolla, California8National Institute of Mental Health, Bethesda, Maryland
| | - Michael Schoenbaum
- University of California-San Diego, La Jolla7Veterans Affairs San Diego Healthcare System, La Jolla, California8National Institute of Mental Health, Bethesda, Maryland
| | - James E McCarroll
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kenneth L Cox
- US Army Public Health Command, Aberdeen Proving Ground, Maryland
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Kimerling R, Makin-Byrd K, Louzon S, Ignacio RV, McCarthy JF. Military Sexual Trauma and Suicide Mortality. Am J Prev Med 2016; 50:684-691. [PMID: 26699249 DOI: 10.1016/j.amepre.2015.10.019] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/22/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The Veterans Health Administration health system uses a clinical reminder in the medical record to screen for military sexual trauma. For more than 6 million Veterans, this study assessed associations between military sexual trauma screen results and subsequent suicide mortality. METHODS For Veterans who received Veterans Health Administration services in fiscal years 2007-2011 and were screened for military sexual trauma (5,991,080 men; 360,774 women), proportional hazards regressions evaluated associations between military sexually trauma and suicide risk. Models were adjusted for age, rural residence, medical morbidity, and psychiatric conditions, obtained from medical records at the year military sexual trauma screening occurred. Analyses were conducted in 2014. RESULTS Military sexual trauma was reported by 1.1% of men and 21.2% of women. A total of 9,017 Veterans completed suicide during the follow-up period. Hazard ratios for military sexual trauma were 1.69 (95% CI=1.45, 1.97) among men and 2.27 (95% CI=1.76, 2.94) among women. Suicide risk associated with military sexual trauma remained significantly elevated in adjusted models. CONCLUSIONS Study results are among the first population-based investigations to document sexual trauma as a risk factor for suicide mortality. Military sexual trauma represents a clinical indicator for suicide prevention in the Veterans Health Administration. Results suggest the importance of continued assessments regarding military sexual trauma and suicide risks and of collaboration between military sexual trauma-related programs and suicide prevention efforts. Moreover, military sexual trauma should be considered in suicide prevention strategies even among individuals without documented psychiatric morbidity.
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Affiliation(s)
- Rachel Kimerling
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California; Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California; National MST Support Team, VA Mental Health Services, Department of Veterans Affairs, Menlo Park, California.
| | - Kerry Makin-Byrd
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California; National MST Support Team, VA Mental Health Services, Department of Veterans Affairs, Menlo Park, California
| | - Samantha Louzon
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Ann Arbor, Michigan
| | - Rosalinda V Ignacio
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Ann Arbor, Michigan
| | - John F McCarthy
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Ann Arbor, Michigan; VA Center for Clinical Management Research, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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Kessler RC, Stein MB, Bliese PD, Bromet EJ, Chiu WT, Cox KL, Colpe LJ, Fullerton CS, Gilman SE, Gruber MJ, Heeringa SG, Lewandowski-Romps L, Millikan-Bell A, Naifeh JA, Nock MK, Petukhova MV, Rosellini AJ, Sampson NA, Schoenbaum M, Zaslavsky AM, Ursano RJ. Occupational differences in US Army suicide rates. Psychol Med 2015; 45:3293-3304. [PMID: 26190760 PMCID: PMC4860903 DOI: 10.1017/s0033291715001294] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Civilian suicide rates vary by occupation in ways related to occupational stress exposure. Comparable military research finds suicide rates elevated in combat arms occupations. However, no research has evaluated variation in this pattern by deployment history, the indicator of occupation stress widely considered responsible for the recent rise in the military suicide rate. METHOD The joint associations of Army occupation and deployment history in predicting suicides were analysed in an administrative dataset for the 729 337 male enlisted Regular Army soldiers in the US Army between 2004 and 2009. RESULTS There were 496 suicides over the study period (22.4/100 000 person-years). Only two occupational categories, both in combat arms, had significantly elevated suicide rates: infantrymen (37.2/100 000 person-years) and combat engineers (38.2/100 000 person-years). However, the suicide rates in these two categories were significantly lower when currently deployed (30.6/100 000 person-years) than never deployed or previously deployed (41.2-39.1/100 000 person-years), whereas the suicide rate of other soldiers was significantly higher when currently deployed and previously deployed (20.2-22.4/100 000 person-years) than never deployed (14.5/100 000 person-years), resulting in the adjusted suicide rate of infantrymen and combat engineers being most elevated when never deployed [odds ratio (OR) 2.9, 95% confidence interval (CI) 2.1-4.1], less so when previously deployed (OR 1.6, 95% CI 1.1-2.1), and not at all when currently deployed (OR 1.2, 95% CI 0.8-1.8). Adjustment for a differential 'healthy warrior effect' cannot explain this variation in the relative suicide rates of never-deployed infantrymen and combat engineers by deployment status. CONCLUSIONS Efforts are needed to elucidate the causal mechanisms underlying this interaction to guide preventive interventions for soldiers at high suicide risk.
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Affiliation(s)
- R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - M. B. Stein
- Departments of Psychiatry and Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - P. D. Bliese
- Darla Moore School of Business, University of South Carolina, Columbia, SC, USA
| | - E. J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - W. T. Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - K. L. Cox
- US Army Public Health Command, Aberdeen Proving Ground, MD, USA
| | - L. J. Colpe
- Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD, USA
| | - C. S. Fullerton
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - S. E. Gilman
- Departments of Social and Behavioral Sciences, and Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - M. J. Gruber
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - S. G. Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | | | | | - J. A. Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - M. K. Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - M. V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - A. J. Rosellini
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - N. A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - M. Schoenbaum
- Office of Science Policy, Planning and Communications, National Institute of Mental Health, Bethesda, MD, USA
| | - A. M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - R. J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
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The Interactive Effects of the Capability for Suicide and Major Depressive Episodes on Suicidal Behavior in a Military Sample. COGNITIVE THERAPY AND RESEARCH 2015; 40:22-30. [PMID: 26834299 DOI: 10.1007/s10608-015-9727-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Major depressive symptoms represent a significant risk for suicidal ideation and behavior. Given that suicide is fearsome, the interpersonal theory of suicide proposes that individuals who engage in suicidal behavior possess not only the desire to die, but also the acquired capability (AC) for suicide. This study examined whether major depressive episodes (MDEs) may be particularly relevant to suicidal behavior when considered in the context of AC. History of MDEs, AC, and suicide attempt history were examined in a large (n=3,377) sample of military members. Data were analyzed using hierarchical multiple regression. Results indicated that among individuals with high AC, the number of MDEs was significantly, positively associated with number of previous suicide attempts; MDEs were not significantly related to suicide attempt history among individuals with low AC. Findings held in the presence of robust covariates associated with suicidal behavior. Findings suggest that a history of MDEs alone may not indicate severe suicide risk - increased AC for suicide appears necessary for increased suicide risk. Implications for suicide treatment and prevention in military personnel are discussed.
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Zimmerman L, Villatte JL, Kerbrat AH, Atkins DC, Flaster A, Comtois KA. Current Suicidal Ideation among Treatment-Engaged Active Duty Soldiers and Marines. MILITARY BEHAVIORAL HEALTH 2015; 3:296-305. [PMID: 27170848 PMCID: PMC4861158 DOI: 10.1080/21635781.2015.1093980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We examined suicidal ideation among 399 active duty Soldiers and Marines engaged in mental health treatment. Using a generalized linear model controlling for demographic and military factors, depression, and positive traumatic brain injury screen, we confirmed our hypothesis that self-report measures of current PTSD symptoms uniquely predicted suicidal ideation. The association between PTSD severity and suicidal ideation was moderated by gender with women at higher risk as PTSD severity increased. Female Soldiers and Marines with high levels of PTSD should receive additional monitoring and intervention. Self-report measures may aid with risk assessment and identify symptom-related distress associated with suicide risk.
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Affiliation(s)
- Lindsey Zimmerman
- Implementation Science, National Center for PTSD, Dissemination and Training Division, Veteran Affairs Palo Alto Health Care System
| | - Jennifer L. Villatte
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington 98104 Phone: (206) 543-2640 Fax: (206) 685-3157
| | - Amanda H. Kerbrat
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington 98104 Phone: (206) 543-2640 Fax: (206) 685-3157
| | - David C. Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington 98104 Phone: (206) 543-2640 Fax: (206) 685-3157
| | - Aaron Flaster
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington 98104 Phone: (206) 543-2640 Fax: (206) 685-3157
| | - Kate A. Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington 98104 Phone: (206) 543-2640 Fax: (206) 685-3157
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