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Kuehn KS, Foster KT, Czyz EK, King CA. Identifying person-specific coping responses to suicidal urges: A case series analysis and illustration of the idiographic method. Suicide Life Threat Behav 2022; 52:490-499. [PMID: 35141956 PMCID: PMC9232880 DOI: 10.1111/sltb.12841] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Suicide is a leading cause of death. One challenge to prevention efforts is the wide phenomenological heterogeneity in suicidal urges, thoughts, and behaviors across individuals at risk. Despite this heterogeneity, most suicide research estimates group-level effects by averaging across people as if they were the same, preventing detection of person-specific factors that may modulate risk and be key to effective prevention. The goal of the present study is to illustrate the idiographic (i.e., person-specific) approach and highlight its utility for suicide research. METHODS We implemented a case series approach using three cases from a subset of psychiatrically hospitalized adolescents who provided intensive longitudinal data on daily urges and coping behavior after discharge following a suicide attempt. For illustration, person-specific, bidirectional links between suicidal urges and coping behavior were modeled across a series of cases using a vector autoregression approach. RESULTS The relationship between suicidal urges and coping differed across the three individuals, who were presented to exhibit the range of this variability in the presence/absence and magnitude of effects. CONCLUSIONS Individuals who report similar suicidal risk levels likely respond in individualized ways to suicidal urges (e.g., use different coping strategies), necessitating personalized assessment and treatment. We discuss implications for future suicide research.
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Affiliation(s)
- Kevin S. Kuehn
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Ewa K. Czyz
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Cheryl A. King
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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Nichter B, Monteith LL, Norman SB, Maguen S, Hill ML, Herzog S, Pietrzak RH. Differentiating U.S. military veterans who think about suicide from those who attempt suicide: A population-based study. Gen Hosp Psychiatry 2021; 72:117-123. [PMID: 34450447 DOI: 10.1016/j.genhosppsych.2021.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Several vulnerability factors for suicidal behavior in U.S. veterans have been identified. However, little is known about factors that differentiate veterans who contemplate suicide from those who attempt suicide. This study examined sociodemographic and clinical characteristics that distinguish veterans who think about suicide from those who attempt suicide. METHOD Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a population-based sample of 4069 veterans. Analyses estimated the lifetime prevalence of suicide ideation (SI) and suicide attempts (SA); and examined differences between veterans with a history of attempt(s), and SI without a history of attempt(s). RESULTS A total 25.9% of U.S. veterans reported lifetime SI and 3.9% reported a SA. Several factors distinguished veterans with a history of SA from those with SI only: the strongest were younger age (odds ratio [OR] = 0.97, 95% CI = 0.95-0.98), nonsuicidal self-injury (OR = 1.81, 95% CI = 1.11-3.03), adverse childhood experiences (OR = 1.14; 95% CI = 1.06-1.23), alcohol use disorder (OR = 1.99; 95% CI = 1.28-3.12), lower household income (OR = 0.62; 95% CI = 0.40-0.95), and physical disability (OR = 1.69; 95% CI = 1.07-2.70). CONCLUSIONS Although a quarter of U.S. veterans contemplate suicide in their lifetimes, the majority do not attempt suicide. Specific sociodemographic and clinical features may differentiate veterans who contemplate versus attempt suicide.
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Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
| | - Lindsey L Monteith
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; National Center for PTSD, White River Junction, VT, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Shira Maguen
- San Francisco VA Health Care System, San Francisco, CA, USA; University of California - San Francisco, San Francisco, USA
| | - Melanie L Hill
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Sarah Herzog
- Department of Psychiatry, Columbia University, Irving Medical Center, New York, NY, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - Robert H Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Nichter B, Maguen S, Monteith LL, Kachadourian L, Norman SB, Hill ML, Herzog S, Pietrzak RH. Factors associated with multiple suicide attempts in a nationally representative study of U.S. military veterans. J Psychiatr Res 2021; 140:295-300. [PMID: 34126423 DOI: 10.1016/j.jpsychires.2021.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Veterans with a history of multiple suicide attempts are at increased risk for suicide mortality relative to those with a single attempt. However, little is known about factors that differentiate veterans who attempt suicide once compared to more than once. This study examined factors that distinguish single suicide attempters (SSA) from multiple suicide attempters (MSA) in a nationally representative sample of U.S. military veterans. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a representative sample of 4069 U.S. veterans. ANALYSES (a) estimated the lifetime prevalence of SSA and MSA; and (b) examined factors that differentiated veterans with a SSA from MSA. RESULTS The lifetime prevalences of SSA and MSA were 1.9% and 2.0%. The strongest correlates of MSA were history of lifetime depression (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.43-8.35), non-suicidal self-injury (OR, 3.28; 95% CI, 1.27-8.45), drug use disorder (OR, 4.0; 95% CI, 1.67-9.54), and marital status (OR, 0.40, 95% CI, 0.18-0.87), which accounted for 15.5%-41.4% of the total explained variance in MSA. DISCUSSION Half of military veterans who have attempted suicide in the United States report more than one attempt, suggesting that suicide attempts are not a one-time occurrence for a substantial proportion of veterans. Veterans who attempt suicide more than once show more deliberate self-harm behavior and have greater psychiatric comorbidities relative to single attempters. Implications for future research examining risk factors for suicide attempts among veterans are discussed.
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Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, University of California Sn Diego, La Jolla, CA, USA.
| | - Shira Maguen
- San Francisco VA Health Care System, San Francisco, CA, USA; University of California - San Francisco, San Francisco, USA
| | - Lindsey L Monteith
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lorig Kachadourian
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, New Haven, CT, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California Sn Diego, La Jolla, CA, USA; National Center for PTSD, White River Junction, VT, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Melanie L Hill
- Department of Psychiatry, University of California Sn Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Sarah Herzog
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - Robert H Pietrzak
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA; Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Bryan CJ, Rozek DC, Butner J, Rudd MD. Patterns of change in suicide ideation signal the recurrence of suicide attempts among high-risk psychiatric outpatients. Behav Res Ther 2019; 120:103392. [PMID: 31104763 PMCID: PMC7155814 DOI: 10.1016/j.brat.2019.04.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 01/28/2019] [Accepted: 04/02/2019] [Indexed: 11/17/2022]
Abstract
Suicide ideation is an inherently dynamic construct. Previous research implicates different temporal patterns in suicide ideation among individuals who have made multiple suicide attempts as compared to individuals who have not. Temporal patterns among first-time attempters might therefore distinguish those who eventually make a second suicide attempt. To test this possibility, the present study used a dynamical systems approach to model change patterns in suicide ideation over the course of brief cognitive behavioral therapy for suicide prevention (12 sessions total) among 33 treatment-seeking active duty Soldiers with one prior suicide attempt. Variable-centered models were constructed to determine if change patterns differed between those with and without a follow-up suicide whereas person-centered models were constructed to determine if within-person change patterns were associated with eventual suicide attempts. Severity of suicide ideation was not associated with the occurrence of suicide attempts during follow-up, but person-centered temporal patterns were. Among those who made an attempt during follow-up, suicide ideation demonstrated greater within-person variability across treatment. Results suggest certain change processes in suicide ideation may characterize vulnerability to recurrent suicide attempt among first-time attempters receiving outpatient behavioral treatment. Nonlinear dynamic models may provide advantages for suicide risk assessment and treatment monitoring in clinical settings.
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Affiliation(s)
- Craig J Bryan
- National Center for Veterans Studies, The University of Utah,USA.
| | - David C Rozek
- National Center for Veterans Studies, The University of Utah,USA
| | | | - M David Rudd
- National Center for Veterans Studies, The University of Utah,USA
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Bryan CJ, Rudd MD. Nonlinear Change Processes During Psychotherapy Characterize Patients Who Have Made Multiple Suicide Attempts. Suicide Life Threat Behav 2018; 48:386-400. [PMID: 28597959 DOI: 10.1111/sltb.12361] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/20/2017] [Indexed: 12/01/2022]
Abstract
Research suggests that multiple suicide attempters experience considerable variability in suicide ideation and longer-duration suicidal crises, which suggests the possibility of two states of stability (one low risk and one high risk). To date, however, few studies have examined nonlinear change processes in suicide ideation among patients. In a sample of 76 active duty U.S. Army soldiers receiving brief cognitive behavioral therapy for acute suicide risk, we examined differences in the ebb and flow of suicide ideation among multiple attempters, first-time attempters, and ideators. Results indicated that multiple attempters were characterized by two states of stability corresponding to low and high intensity suicide ideation; these states were separated by a region of instability corresponding to moderate intensity suicide ideation. In contrast, ideators and first-time attempters were characterized by only a single state of stability corresponding to low intensity suicide ideation. Among patients who have made multiple suicide attempts, suicide ideation may function as a bimodal rather than a continuous construct.
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Affiliation(s)
- Craig J Bryan
- National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA
| | - M David Rudd
- National Center for Veterans Studies, The University of Memphis, Memphis, TN, USA
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Bryan CJ, Rudd MD, Wertenberger E. Individual and environmental contingencies associated with multiple suicide attempts among U.S. military personnel. Psychiatry Res 2016; 242:88-93. [PMID: 27262267 DOI: 10.1016/j.psychres.2016.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 05/12/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
Suicidal behavior among U.S. military personnel persists as a significant public health issue. Previous research indicates the primary motive for suicide attempts among military personnel is the desire to reduce or alleviate emotional distress, a finding that converges with studies in nonmilitary samples. Much less is understood about the consequences of a first suicide attempt that could influence the occurrence of additional suicide attempts. In order to identify these contingencies, 134 active duty Soldiers who had attempted suicide (n=69 first-time attempters, n=65 multiple attempters) participated in structured interviews focused on their experiences immediately following their first attempt. Soldiers were more likely to have made multiple suicide attempts if they were younger at the time of their first attempt, were not admitted to a hospital or treatment program after their first attempt, or experienced emotional and psychological relief immediately afterwards. Results suggest that Soldiers who experience emotional and/or psychological relief immediately after their first suicide attempt or do not receive treatment are more likely to make additional suicide attempts.
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Affiliation(s)
- Craig J Bryan
- National Center for Veterans Studies, Salt Lake City, UT, USA; The University of Utah, Department of Psychology, Salt Lake City, UT, USA.
| | - M David Rudd
- National Center for Veterans Studies, Salt Lake City, UT, USA; The University of Memphis, Office of the President, Memphis, TN, USA
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