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Zuromski KL, Wilks C, Al-Suwaidi M, Wittler E, Scherban L, Hite B, Raymond L, Dempsey CL, Stein MB, Ursano RJ, Benedek D, Nock MK. Perspectives of suicide loss survivors: Qualitative analysis of data from a psychological autopsy study of U.S. Army soldiers. Suicide Life Threat Behav 2024; 54:437-449. [PMID: 38353139 PMCID: PMC11164635 DOI: 10.1111/sltb.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Suicide loss survivors can provide information not otherwise available about the circumstances preceding a suicide. In this study, we analyzed interview data from suicide loss survivors collected as part of a psychological autopsy study of U.S. Army soldiers. METHODS Next-of-kin (NOK) (n = 61) and Army supervisors (SUP) (n = 107) of suicide decedents (n = 135) who had died in the last 2-3 months answered open-ended questions about suicide risk factors, ideas for improving suicide prevention, and the impact of the suicide. Responses were coded using conventional content analysis methods to identify common themes. RESULTS Many NOK (30%) and SUP (50%) did not observe any signs of risk preceding the soldier's suicide. The most common idea regarding suicide prevention from SUP was that the suicide was inevitable, whereas NOK were more likely to emphasize the importance of increasing mental health treatment and reducing stigma. Both NOK and SUP reported negative effects of the suicide, but SUP reported some positive effects (e.g., increased unit connectedness). CONCLUSIONS Results underscore the challenges of using informants to identify soldiers at high risk of suicide, given many respondents did not observe any warning signs. Findings also highlight attitudinal barriers present in the military that, if targeted, may increase soldiers' help-seeking and willingness to disclose their risk.
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Affiliation(s)
| | | | | | | | | | - Blake Hite
- Department of Psychology, Harvard University
| | | | - Catherine L. Dempsey
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | - Murray B. Stein
- Department of Psychiatry and Family Medicine & Public Health, University of California, San Diego
- Veterans Affairs San Diego Healthcare System
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | - David Benedek
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
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Sheridan N, Kennedy A, Gray C, Dunn L, Stewart J, Elliott H, Carnrite K, Adeponle A, Cloutier P. Building Resilience and Attachment in Vulnerable Adolescents: The Feasibility of a Virtually Delivered Group Intervention for Adolescents with Suicidal Ideation and Their Caregivers. TELEMEDICINE REPORTS 2024; 5:36-45. [PMID: 38469169 PMCID: PMC10927228 DOI: 10.1089/tmr.2023.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 03/13/2024]
Abstract
Background The COVID-19 pandemic required many interventions to be conducted virtually. Building Resilience and Attachment in Vulnerable Adolescents (BRAVA) is a group intervention designed for adolescents and their caregivers to reduce adolescent suicidal ideation (SI). Objective We aimed to adapt BRAVA for virtual delivery and evaluate its acceptability and feasibility. Methods We conducted an 8-week pre-post trial between October and December 2020. Six adolescents and six primary caregivers were recruited from a pediatric hospital in Ontario, Canada. Families completed a virtual intake and exit assessment together and 6 weekly BRAVA group sessions separately. Satisfaction feedback was collected after each group session and during their exit, and clinical outcomes were collected at intake and exit. Weekly team meetings were conducted to gather clinician feedback. Results The study uptake rate was 42.9% of eligible participants. There were no dropouts. Adolescent and caregiver attendance rates for group sessions were high (median = 6). Most youth (83.4%) and caregivers (66.7%) reported that the virtual process worked well. All caregivers (100%) agreed they would participate in a virtual group session again, compared with youth (50%). Providers approved of the virtual adaptation but identified potential improvements (e.g., manual content, safety procedures). Adolescent SI decreased significantly post-treatment (Mpre = 50.7, Mpost = 29.7, p = 0.002). Conclusions Virtual delivery of BRAVA is acceptable and feasible and may help reduce SI in adolescents. Uptake, retention, and satisfaction were high for adolescents and caregivers. Feedback collected will improve BRAVA for future evaluations, including a randomized controlled trial.
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Affiliation(s)
- Nicole Sheridan
- Psychiatry and Mental Health Research, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Allison Kennedy
- Mental Health, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Clare Gray
- Mental Health, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Leigh Dunn
- Psychiatry and Mental Health Research, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jayme Stewart
- Psychiatry and Mental Health Research, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Hannah Elliott
- Psychiatry and Mental Health Research, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Kendra Carnrite
- Psychiatry and Mental Health Research, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ademola Adeponle
- Mental Health, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Paula Cloutier
- Psychiatry and Mental Health Research, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Mental Health, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Tsai KZ, Liu PY, Lin YP, Chu CC, Huang WC, Sui X, Lavie CJ, Lin GM. Do the American guideline-based leisure time physical activity levels for civilians benefit the mental health of military personnel? Front Psychiatry 2023; 14:1255516. [PMID: 38034917 PMCID: PMC10682789 DOI: 10.3389/fpsyt.2023.1255516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Backgrounds This study aimed to clarify the association of American guideline-based leisure time physical activity (PA) level with mental health in 4,080 military personnel in Taiwan. Methods The moderate intensity PA level was assessed according to the total running time per week (wk) reported in a self-administered questionnaire over the previous 6 months and was categorized into PA level <150, 150-299, and ≥300 min/wk. Mental stress was assessed by the Brief Symptom Rating Scale (BSRS)-5 for which ≥15 points were classified as great mental stress. Suicide ideation (SI) was graded as 1 for mild, 2 for moderate, and 3 or 4 for severe. Multivariable logistic regression analysis was employed to determine the association between PA and mental health while adjusting for demographics, smoking, alcohol intake, betel nut chewing, and obesity. Results As compared to participants with a PA level of <150 min/wk., those with PA levels 150-299 min/wk. and ≥ 300 min/wk. had a lower possibility of SI ≥1 [odds ratios (ORs) and 95% confidence intervals (CIs): 0.58 (0.40-0.83) and 0.23 (0.14-0.36), respectively] and SI ≥1 and/or BSRS-5 ≥ 15 [ORs: 0.55 (0.39-0.79) and 0.21 (0.13-0.34), respectively]. The possibilities were more significantly lower for SI ≥2 [ORs: 0.37 (0.20-0.68) and 0.10 (0.04-0.26), respectively] and SI ≥2 and/or BSRS-5 ≥ 15 [ORs: 0.35 (0.20-0.62) and 0.10 (0.04-0.25), respectively]. Conclusion Our findings indicate that participating in moderate-intensity leisure time PA level for ≥150 min/wk. may have a positive effect on mental health among military personnel. The impact appears to be even more significant when engaging in a higher PA level of ≥300 min/wk.
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Affiliation(s)
- Kun-Zhe Tsai
- Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan
- Department of Stomatology of Periodontology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Pang-Yen Liu
- Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yen-Po Lin
- Department of Critical Care Medicine, Taipei Tzu Chi Hospital, New Taipei City, Taiwan
| | - Chen-Chih Chu
- Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Carl J. Lavie
- Ochsner Clinical School, John Ochsner Heart and Vascular Institute, The University of Queensland School of Medicine, New Orleans, LA, United States
| | - Gen-Min Lin
- Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan
- Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Ripperger MA, Kolli J, Wilimitis D, Robinson K, Reale C, Novak LL, Cunningham CA, Kasuske LM, Grover SG, Ribeiro JD, Walsh CG. External Validation and Updating of a Statistical Civilian-Based Suicide Risk Model in US Naval Primary Care. JAMA Netw Open 2023; 6:e2342750. [PMID: 37938841 PMCID: PMC10632956 DOI: 10.1001/jamanetworkopen.2023.42750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/29/2023] [Indexed: 11/10/2023] Open
Abstract
Importance Suicide remains an ongoing concern in the US military. Statistical models have not been broadly disseminated for US Navy service members. Objective To externally validate and update a statistical suicide risk model initially developed in a civilian setting with an emphasis on primary care. Design, Setting, and Participants This retrospective cohort study used data collected from 2007 through 2017 among active-duty US Navy service members. The external civilian model was applied to every visit at Naval Medical Center Portsmouth (NMCP), its NMCP Naval Branch Health Clinics (NBHCs), and TRICARE Prime Clinics (TPCs) that fall within the NMCP area. The model was retrained and recalibrated using visits to NBHCs and TPCs and updated using Department of Defense (DoD)-specific billing codes and demographic characteristics, including expanded race and ethnicity categories. Domain and temporal analyses were performed with bootstrap validation. Data analysis was performed from September 2020 to December 2022. Exposure Visit to US NMCP. Main Outcomes and Measures Recorded suicidal behavior on the day of or within 30 days of a visit. Performance was assessed using area under the receiver operating curve (AUROC), area under the precision recall curve (AUPRC), Brier score, and Spiegelhalter z-test statistic. Results Of the 260 583 service members, 6529 (2.5%) had a recorded suicidal behavior, 206 412 (79.2%) were male; 104 835 (40.2%) were aged 20 to 24 years; and 9458 (3.6%) were Asian, 56 715 (21.8%) were Black or African American, and 158 277 (60.7%) were White. Applying the civilian-trained model resulted in an AUROC of 0.77 (95% CI, 0.74-0.79) and an AUPRC of 0.004 (95% CI, 0.003-0.005) at NBHCs with poor calibration (Spiegelhalter P < .001). Retraining the algorithm improved AUROC to 0.92 (95% CI, 0.91-0.93) and AUPRC to 0.66 (95% CI, 0.63-0.68). Number needed to screen in the top risk tiers was 366 for the external model and 200 for the retrained model; the lower number indicates better performance. Domain validation showed AUROC of 0.90 (95% CI, 0.90-0.91) and AUPRC of 0.01 (95% CI, 0.01-0.01), and temporal validation showed AUROC of 0.75 (95% CI, 0.72-0.78) and AUPRC of 0.003 (95% CI, 0.003-0.005). Conclusions and Relevance In this cohort study of active-duty Navy service members, a civilian suicide attempt risk model was externally validated. Retraining and updating with DoD-specific variables improved performance. Domain and temporal validation results were similar to external validation, suggesting that implementing an external model in US Navy primary care clinics may bypass the need for costly internal development and expedite the automation of suicide prevention in these clinics.
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Affiliation(s)
- Michael A. Ripperger
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jhansi Kolli
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Drew Wilimitis
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katelyn Robinson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carrie Reale
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laurie L. Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Lalon M. Kasuske
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | | | - Colin G. Walsh
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee
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Stecker T, Allan NP, Hoge C, Ashrafioun L, Conner KR. Efficacy of CBT for Treatment Seeking (CBT-TS) in Untreated Veterans and Service Members at Risk for Suicidal Behavior. J Gen Intern Med 2023; 38:2639-2646. [PMID: 36964422 PMCID: PMC10506992 DOI: 10.1007/s11606-023-08129-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 03/01/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE Military members and Veterans at-risk for suicide are often unlikely to seek behavioral health treatment. The primary aim of this study was to test the efficacy of brief CBT for Treatment Seeking (CBT-TS) to improve behavioral health treatment utilization among U.S. military service members and Veterans at-risk for suicide. METHODS A total of 841 participants who served in the U.S. military since 9/11 and who reported suicidality but were not in behavioral health treatment were recruited to participate in this trial. Participants were randomly assigned to either brief CBT-TS delivered by phone or an assessment-only control condition. Follow-up assessments were conducted at baseline and months 1, 3, 6, and 12 to track treatment utilization and symptoms. RESULTS CBT-TS resulted in significantly greater behavioral health treatment initiation within 1 month compared to the control condition (B = .93, p < .001); and the higher treatment initiation persisted for 12 months post intervention. CONCLUSIONS This study employed a low-cost, easily implementable one-session intervention administered by phone. The study provides evidence that CBT-TS is efficacious in promoting behavioral health treatment initiation in an adult population at risk for suicidal behavior and showed enduring benefits for 6-12 months. CBT-TS provides a unique strategy for treatment engagement for at-risk adults unlikely to seek treatment. TRIAL REGISTRATION Clinicaltrials.gov NCT05077514.
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Affiliation(s)
- Tracy Stecker
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA.
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA.
| | - Nicholas P Allan
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | - Charles Hoge
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Lisham Ashrafioun
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA
- Departments of Emergency Medicine and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Kenneth R Conner
- Departments of Emergency Medicine and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Luu A, Campbell-Sills L, Sun X, Kessler RC, Ursano RJ, Jain S, Stein MB. Prospective Association of Unmet Mental Health Treatment Needs With Suicidal Behavior Among Combat-Deployed Soldiers. Psychiatr Serv 2023:appips20220248. [PMID: 36872895 DOI: 10.1176/appi.ps.20220248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Military personnel frequently report discontinuing or not pursuing psychiatric treatment despite perceiving a need for services. This study aimed to examine how unmet need for treatment or support among U.S. Army soldiers relates to future suicidal ideation (SI) or suicide attempt (SA). METHODS Mental health treatment need and help seeking in the past 12 months were evaluated for soldiers (N=4,645) who subsequently deployed to Afghanistan. Weighted logistic regression models were used to examine the prospective association of predeployment treatment needs with SI and SA during and after deployment, with adjustment for potential confounders. RESULTS Compared with soldiers without predeployment treatment needs, those who reported not seeking help despite needing it had increased risk for SI during deployment (adjusted OR [AOR]=1.73), past-30-day SI at 2-3 months postdeployment (AOR=2.08), past-30-day SI at 8-9 months postdeployment (AOR=2.01), and SA through 8-9 months postdeployment (AOR=3.65). Soldiers who sought help and stopped treatment without improvement had elevated SI risk at 2-3 months postdeployment (AOR=2.35). Those who sought help and stopped after improving did not have increased SI risk during or 2-3 months after deployment but had elevated risks for SI (AOR=1.71) and SA (AOR=3.43) by 8-9 months postdeployment. Risks for all suicidality outcomes were also elevated among soldiers who reported receiving ongoing treatment before deployment. CONCLUSIONS Unmet or ongoing needs for mental health treatment or support before deployment are associated with increased risk for suicidal behavior during and after deployment. Detecting and addressing treatment needs among soldiers before deployment may help prevent suicidality during deployment and reintegration periods.
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Affiliation(s)
- Andrew Luu
- Department of Psychiatry (Luu, Campbell-Sills, Stein) and Herbert Wertheim School of Public Health and Human Longevity Science (Sun, Jain, Stein), University of California San Diego, La Jolla; Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Psychiatry, Uniformed Services University, Bethesda (Ursano)
| | - Laura Campbell-Sills
- Department of Psychiatry (Luu, Campbell-Sills, Stein) and Herbert Wertheim School of Public Health and Human Longevity Science (Sun, Jain, Stein), University of California San Diego, La Jolla; Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Psychiatry, Uniformed Services University, Bethesda (Ursano)
| | - Xiaoying Sun
- Department of Psychiatry (Luu, Campbell-Sills, Stein) and Herbert Wertheim School of Public Health and Human Longevity Science (Sun, Jain, Stein), University of California San Diego, La Jolla; Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Psychiatry, Uniformed Services University, Bethesda (Ursano)
| | - Ronald C Kessler
- Department of Psychiatry (Luu, Campbell-Sills, Stein) and Herbert Wertheim School of Public Health and Human Longevity Science (Sun, Jain, Stein), University of California San Diego, La Jolla; Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Psychiatry, Uniformed Services University, Bethesda (Ursano)
| | - Robert J Ursano
- Department of Psychiatry (Luu, Campbell-Sills, Stein) and Herbert Wertheim School of Public Health and Human Longevity Science (Sun, Jain, Stein), University of California San Diego, La Jolla; Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Psychiatry, Uniformed Services University, Bethesda (Ursano)
| | - Sonia Jain
- Department of Psychiatry (Luu, Campbell-Sills, Stein) and Herbert Wertheim School of Public Health and Human Longevity Science (Sun, Jain, Stein), University of California San Diego, La Jolla; Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Psychiatry, Uniformed Services University, Bethesda (Ursano)
| | - Murray B Stein
- Department of Psychiatry (Luu, Campbell-Sills, Stein) and Herbert Wertheim School of Public Health and Human Longevity Science (Sun, Jain, Stein), University of California San Diego, La Jolla; Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Psychiatry, Uniformed Services University, Bethesda (Ursano)
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Sullivan SR, Myhre K, Mitchell EL, Monahan M, Khazanov G, Spears AP, Gromatsky M, Walsh S, Goodman A, Jager-Hyman S, Green KL, Brown GK, Stanley B, Goodman M. Suicide and Telehealth Treatments: A PRISMA Scoping Review. Arch Suicide Res 2022; 26:1794-1814. [PMID: 35137677 DOI: 10.1080/13811118.2022.2028207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND This PRISMA scoping review explored worldwide research on the delivery of suicide-specific interventions through an exclusive telehealth modality. Research over telehealth modalities with suicidal individuals highlights the importance of facilitating participants' access to treatments despite location and circumstances (e.g., rural, expenses related to appointments, etc.). AIM The review sought evidence of outcomes of trials or projects in which both the patient and therapist attended sessions conjointly and openly discussed suicide over a telehealth modality (e.g., phone, zoom). METHOD To explore this topic the authors searched for research trials and quality improvement projects using Ovid Medline, Ovid Embase, Ovid PsycINFO, EBSCO Social Services Abstracts, and Web of Science on 3/3/2021. RESULTS Nine different articles were included that each spanned distinct treatments, with eight being research studies and one being a quality improvement project. LIMITATIONS Publications featuring ongoing or upcoming research in which complete study results were not available did not meet inclusion criteria for this review. CONCLUSION Several important research gaps were identified. While this approach has been largely understudied, exclusive telehealth delivery of suicide-specific interventions has great potential for the prevention of suicidality, especially in the era of COVID-19 and beyond.
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Bond AE, Bandel SL, Rodriguez TR, Anestis JC, Anestis MD. Mental Health Treatment Seeking and History of Suicidal Thoughts Among Suicide Decedents by Mechanism, 2003-2018. JAMA Netw Open 2022; 5:e222101. [PMID: 35285919 PMCID: PMC9907334 DOI: 10.1001/jamanetworkopen.2022.2101] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Understanding mental health and substance use treatment seeking and suicidality among suicide decedents is important to determine prevention efforts. OBJECTIVE To evaluate differences in treatment seeking and suicidality between suicide decedents who died by firearms and those who died by other methods. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional data were collected on 234 652 suicide decedents from 2003 to 2018. Participant information was reported by their state of residence to the National Violent Death Reporting System. Statistical analysis was performed from July 1, 2021, to January 21, 2022. MAIN OUTCOMES AND MEASURES Main outcomes were treatment for mental health and substance use at time of death, previous treatment for mental health and substance use, history of suicidal ideation or plans, history of suicide attempts, and disclosure of suicidal ideation or plans. RESULTS A total of 234 652 participants (182 520 male [77.8%]; 205 966 White [87.8%]; mean [SD] age, 46.3 [18.2] years [range, 3-112 years]) were included in this study. Compared with suicide decedents who died by another method (n = 117 526 [50.1%]), those who died by firearm (n = 117 126 [49.9%]) were more likely to have disclosed thoughts or plans of suicide within the month prior to death (odds ratio [OR], 1.16 [95% CI, 1.13-1.18]) and were less likely to have previously attempted suicide (OR, 0.44 [95% CI, 0.43-0.46]). Compared with those who died by poisoning, those who used a firearm were more likely to have had a history of suicidal thoughts or plans (OR, 1.19 [95% CI, 1.15-1.23]) and to have disclosed their thoughts or plans of suicide within the month prior to death (OR, 1.06 [95% CI, 1.03-1.10]). Compared with those who died by hanging, those who used a firearm were more likely to have disclosed their thoughts or plans of suicide to another person within the month prior to their death (OR, 1.14 [95% CI, 1.11-1.17]). CONCLUSIONS AND RELEVANCE These findings provide information that suggests who is at risk to die by firearm suicide. Community-based interventions in suicide prevention could help reduce access to firearms during a time of crisis. The finding that firearm suicide decedents were more likely to disclose their suicidal thoughts or plans provides an important avenue for prevention.
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Affiliation(s)
- Allison E. Bond
- The New Jersey Gun Violence Research Center, Piscataway
- Department of Psychology, Rutgers University, The State University of New Jersey, New Brunswick
| | - Shelby L. Bandel
- The New Jersey Gun Violence Research Center, Piscataway
- Department of Psychology, Rutgers University, The State University of New Jersey, New Brunswick
| | - Taylor R. Rodriguez
- The New Jersey Gun Violence Research Center, Piscataway
- Department of Psychology, Rutgers University, The State University of New Jersey, New Brunswick
| | - Joye C. Anestis
- School of Public Health, Rutgers University, The State University of New Jersey, New Brunswick
| | - Michael D. Anestis
- The New Jersey Gun Violence Research Center, Piscataway
- School of Public Health, Rutgers University, The State University of New Jersey, New Brunswick
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9
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Fikretoglu D, Sharp ML, Adler AB, Bélanger S, Benassi H, Bennett C, Bryant R, Busuttil W, Cramm H, Fear N, Greenberg N, Heber A, Hosseiny F, Hoge CW, Jetly R, McFarlane A, Morganstein J, Murphy D, O'Donnell M, Phelps A, Richardson DJ, Sadler N, Schnurr PP, Smith P, Ursano R, Hooff MV, Wessely S, Forbes D, Pedlar D. Pathways to mental health care in active military populations across the Five-Eyes nations: An integrated perspective. Clin Psychol Rev 2021; 91:102100. [PMID: 34871868 DOI: 10.1016/j.cpr.2021.102100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/29/2021] [Accepted: 11/05/2021] [Indexed: 12/19/2022]
Abstract
Military service is associated with increased risk of mental health problems. Previous reviews have pointed to under-utilization of mental health services in military populations. Building on the most recent systematic review, our narrative, critical review takes a complementary approach and considers research across the Five-Eyes nations from the past six years to update and broaden the discussion on pathways to mental healthcare in military populations. We find that at a broad population level, there is improvement in several indicators of mental health care access, with greater gains in initial engagement, time to first treatment contact, and subjective satisfaction with care, and smaller gains in objective indicators of adequacy of care. Among individual-level barriers to care-seeking, there is progress in improving recognition of need for care and reducing stigma concerns. Among organizational-level barriers, there are advances in availability of services and cultural acceptance of care-seeking. Other barriers, such as concerns around confidentiality, career impact, and deployability persist, however, and may account for some remaining unmet need. To address these barriers, new initiatives that are more evidence-based, theoretically-driven, and culturally-sensitive, are therefore needed, and must be rigorously evaluated to ensure they bring about additional improvements in pathways to care.
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Affiliation(s)
- Deniz Fikretoglu
- Defence Research and Development Canada, 1133 Sheppard Ave. West, Toronto, ON, Canada.
| | | | - Amy B Adler
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | | | | | | | | | | - Heidi Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | | | | | | | - Fardous Hosseiny
- Centre of Excellence on Post-Traumatic Stress Disorder (PTSD), Ottawa, ON, Canada
| | - Charles W Hoge
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Rakesh Jetly
- Department of National Defence, Ottawa, ON, Canada
| | | | | | - Dominic Murphy
- Combat Stress, Leatherhead, Surrey, UK; King's College London, London, UK
| | - Meaghan O'Donnell
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - Andrea Phelps
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - Don J Richardson
- Parkwood Institute- St. Joseph's Health Care London, London, ON, Canada
| | - Nicole Sadler
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | | | - Patrick Smith
- Centre of Excellence on Post-Traumatic Stress Disorder (PTSD), Ottawa, ON, Canada
| | | | - Miranda Van Hooff
- Military and Emergency Services Health Australia (MESHA), Woodville, SA, Australia
| | | | - David Forbes
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - David Pedlar
- Canadian Institute for Military and Veteran Health Research, Queen's University, Kingston, ON, Canada
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10
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Lane R, Robles P, Brondolo E, Jansson A, Diduk-Smith RM. Antecedents of Suicide Among Active Military, Veteran, and Nonmilitary Residents of the Commonwealth of Virginia: The Role of Intimate Partner Problems. Arch Suicide Res 2021; 25:790-809. [PMID: 32476621 DOI: 10.1080/13811118.2020.1765927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Intimate partner problems increase suicide risk, particularly among active service members and veterans. Age, marital status and military service status may modify the role of intimate partner problems in suicide. Methods: Participants included 6255 men who died by suicide at 18 years of age and older and who actively, previously, or never served in the military. Reports of intimate partner problems prior to suicide were documented by the Virginia Department of Health. Results: Unmarried active service members, above middle age, were more likely than veterans and individuals without prior military service to have associated reports of intimate partner problems. Conclusion: Life stages and relationship context may influence the role of intimate partner problems as a risk factor for suicide.
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11
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Dempsey CL, Benedek DM, Nock MK, Zuromski KL, Brent DA, Ao J, Aliaga PA, Heeringa SG, Kessler RC, Stein MB, Ursano RJ. Social closeness and support are associated with lower risk of suicide among U.S. Army soldiers. Suicide Life Threat Behav 2021; 51:940-954. [PMID: 34196966 PMCID: PMC10615249 DOI: 10.1111/sltb.12778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/18/2021] [Accepted: 04/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We tested the aspects of social support, unit cohesion, and religiosity hypothesized to be protective factors for suicide among U.S. service members. METHODS This case-control study compared U.S. Army soldiers who died by suicide while on active duty (n = 135) to controls of two types: those propensity score-matched on known sociodemographic risk factors (n = 128); and those controls who had thought about, but not died by, suicide in the past year (n = 108). Data included structured interviews of next of kin (NOK) and Army supervisors (SUP) for each case and control soldier. Logistic regression analyses were used to examine predictors of suicide. RESULTS Perceived social closeness and seeking help from others were associated with decreased odds of suicide, as reported by SUP (OR = 0.2 [95% CI = 0.1, 0.5]) and NOK (OR = 0.4 [95% CI = 0.2, 0.8]). Novel reports by SUP informants of high levels of unit cohesion/morale decreased odds of suicide (OR = 0.1 [95% CI = 0.0, 0.2]). Contrary to study hypotheses, no religious affiliation was associated with lower odds of suicide (OR = 0.3 [95% CI = 0.2, 0.6]). CONCLUSIONS Perceived social closeness and unit/group cohesion are associated with lower odds of suicide. These results point toward social intervention strategies as testable components of suicide prevention programs.
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Affiliation(s)
- Catherine L Dempsey
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - David M Benedek
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Kelly L Zuromski
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - David A Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jingning Ao
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Pablo A Aliaga
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Steven G Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Cambridge, MA, USA
| | - Murray B Stein
- Department of Psychiatry and Family Medicine & Public Health, University of California San Diego, La Jolla, CA, USA
- VA San Diego Health Care System, San Diego, CA, USA
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA
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12
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Chu C, Zuromski KL, Bernecker SL, Gutierrez PM, Joiner TE, Liu H, Naifeh JA, Stein MB, Ursano RJ, Nock MK. A test of the interpersonal theory of suicide in a large, representative, retrospective and prospective study: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Behav Res Ther 2020; 132:103688. [PMID: 32731055 PMCID: PMC10351027 DOI: 10.1016/j.brat.2020.103688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/28/2020] [Accepted: 06/19/2020] [Indexed: 11/28/2022]
Abstract
The interpersonal theory of suicide hypothesizes that perceived burdensomeness, thwarted belongingness, and hopelessness lead to active suicidal thoughts and individuals with active suicidal thoughts and elevated capability for suicide are most likely to attempt suicide. We retrospectively and prospectively tested this theory in a large sample of 7677 U.S. Army soldiers followed post-deployment for up to nine months. The interaction of perceived burdensomeness and hopelessness (OR = 2.59) was significantly associated with lifetime suicidal thoughts; however, the interactions of thwarted belongingness and perceived burdensomeness and of thwarted belongingness and hopelessness were not. Consistent with the theory, capability for suicide prospectively predicted suicide attempts during and following deployment (OR = 1.22); however, among soldiers reporting lifetime suicidal thoughts, capability did not predict attempts, only perceived burdensomeness did (OR = 1.36). Results supported some, but not all, theory hypotheses, suggesting that additional constructs may be needed to better identify the psychological factors that lead soldiers to attempt suicide.
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Affiliation(s)
- Carol Chu
- Department of Psychology, Harvard University, Cambridge, MA, USA.
| | - Kelly L Zuromski
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | | | - Peter M Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA; University of Colorado School of Medicine, Department of Psychiatry, Aurora, CO, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Howard Liu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - James A Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine in Bethesda, MD, USA
| | - Murray B Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine in Bethesda, MD, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
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