1
|
Arenson M, Bernat E, De Los Reyes A, Neylan TC, Cohen BE. Social support, social network size, and suicidal ideation: A nine-year longitudinal analysis from the Mind Your Heart Study. J Psychiatr Res 2021; 135:318-324. [PMID: 33545566 DOI: 10.1016/j.jpsychires.2021.01.017] [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: 09/18/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
Substantial research has investigated the impact of social support on the development and course of suicidal thoughts and behaviors. However, its measurement has been inconsistent, and different facets of social support may have differential effects on suicidal ideation (SI). The present study used data from 743 veterans recruited between 2008 and 2010 as part of the Mind Your Heart Study to investigate the relationship between two aspects of social support (social network size and perceived social support) and SI over 9 years. Using the 9th item of the PHQ-9, we created two composite scores: (1, chronicity) the proportion of years the participant endorsed SI and (2, severity) the severity of SI across the follow-up period. We found that, when modeled individually, both larger social network size and greater perceived social support predicted lower SI chronicity (β=-.16, β = -0.19 respectively; ps < .001) and lower SI severity (β=-0.15 and β = -0.19, respectively; ps < .001). However, when modeled together and controlling for PTSD and depression symptoms, increased social network size but not perceived social support predicted lower SI chronicity (β=-0.09, p = .01 and β = 0.02, p = .48, respectively) and SI severity (β=-0.07, p = .045 and β = 0.01, p = .71, respectively). These findings suggest that social network size may be an important target for intervention, and that future work is needed to better delineate the effect of different features of social support on risk for suicide.
Collapse
Affiliation(s)
- Melanie Arenson
- University of Maryland, College Park, 4094 Campus Drive, Campus Park, MD, 20742, USA; San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA, 94121, USA.
| | - Edward Bernat
- University of Maryland, College Park, 4094 Campus Drive, Campus Park, MD, 20742, USA
| | - Andres De Los Reyes
- University of Maryland, College Park, 4094 Campus Drive, Campus Park, MD, 20742, USA
| | - Thomas C Neylan
- San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA, 94121, USA; University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Beth E Cohen
- San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA, 94121, USA; University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| |
Collapse
|
2
|
Rugo KF, Tabares JV, Crowell SE, Baucom BR, Rudd MD, Bryan CJ. The role of depression and suicidal cognitions as contributors to suicide risk among active duty soldiers reporting symptoms of posttraumatic stress disorder. J Affect Disord 2020; 265:333-341. [PMID: 32090757 DOI: 10.1016/j.jad.2020.01.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/12/2019] [Accepted: 01/20/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Military suicide rates have risen across all service branches, with the overall rate surpassing that of the general population for the first time in history in 2008. Service members with posttraumatic stress disorder (PTSD) are at a substantially higher risk for suicidal ideation, suicide attempts, and death by suicide than their peers without PTSD. While the link between PTSD and suicide is well established in the literature, less is known about the precise nature of that connection. Several constructs have been implicated as potential mediators of this relation, such as depression, alcohol use, suicidal cognitions, and sleep disturbance. Yet, to our knowledge, these constructs have never been examined simultaneously in a single model to determine mediational influence for suicide risk among soldiers with PTSD. METHODS A sample of 172 active duty Army soldiers completed a series of measures targeting the aforementioned constructs. Data were analyzed using mediation model analyses. RESULTS Suicidal cognitions fully mediated the relation between PTSD symptoms and current suicide risk severity. The indirect effect for suicidal cognitions was significantly larger than indirect effects for alcohol use, depression, and sleep disturbance. Exploratory analyses suggest serial mediation of the relation between PTSD and current suicide risk by depression and suicidal cognitions. LIMITATIONS These results should be interpreted within the context of study limitations, to include use of self-report data and inability to firmly establish temporal sequencing assumed in mediation. CONCLUSIONS Implications of this study include the improvement of suicide risk assessment and individualized treatment planning for suicidal military personnel with PTSD.
Collapse
Affiliation(s)
- Kelsi F Rugo
- National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA; Department of Psychology, The University of Utah, Salt Lake City, UT, USA.
| | - Jeffrey V Tabares
- National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA; Department of Psychology, The University of Utah, Salt Lake City, UT, USA
| | - Sheila E Crowell
- Department of Psychology, The University of Utah, Salt Lake City, UT, USA
| | - Brian R Baucom
- Department of Psychology, The University of Utah, Salt Lake City, UT, USA
| | - M David Rudd
- National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA; Department of Psychology, University of Memphis, Memphis, TN, USA
| | - Craig J Bryan
- National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA; Department of Psychology, The University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
3
|
Zuromski KL, Dempsey CL, Ng THH, Riggs-Donovan CA, Brent DA, Heeringa SG, Kessler RC, Stein MB, Ursano RJ, Benedek D, Nock MK. Utilization of and barriers to treatment among suicide decedents: Results from the Army Study to Assess Risk and Resilience Among Servicemembers (Army STARRS). J Consult Clin Psychol 2019; 87:671-683. [PMID: 31008631 DOI: 10.1037/ccp0000400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine suicide decedents' use of mental health treatment and perceived barriers to initiating and maintaining treatment. METHOD We used a psychological autopsy study conducted as part of the Army Study to Assess Risk and Resilience Among Servicemembers (Army STARRS) that compared suicide decedents (n = 135) to soldiers in two control conditions: those propensity-score-matched on known sociodemographic and Army history variables (n = 137) and those with a history of suicidal thoughts in the past 12 months (n = 118). Informants were next of kin and Army supervisors. RESULTS Results revealed that suicide decedents were significantly more likely to be referred to services and to use more intensive treatments (e.g., medication, overnight stay in hospital) than propensity-matched controls. However, decedents also were more likely to perceive significant barriers to treatment-seeking. All differences observed in the current study were between propensity-matched controls and decedents, with no observed differences between suicide ideators and decedents. CONCLUSIONS Many suicide decedents used some form of mental health care at some point in their lives; however, they also were more likely than propensity-matched controls to perceive barriers that may have prevented service use. The lack of differences between suicide ideators and decedents suggests that more information is needed, beyond knowledge of treatment utilization or perceived barriers, to identify and intervene on those at highest risk for suicide. These findings underscore the importance of reducing attitudinal barriers that may deter suicidal soldiers from seeking treatment, and also improving risk detection among those who are attending treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Catherine L Dempsey
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | - Tsz Hin Hinz Ng
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | - Charlotte A Riggs-Donovan
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | - David A Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | | | - Murray B Stein
- Department of Psychiatry and Family Medicine & Public Health, University of California, San Diego
| | - 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
| | | |
Collapse
|
4
|
Reger MA, Tucker RP, Carter SP, Ammerman BA. Military Deployments and Suicide: A Critical Examination. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2018; 13:688-699. [PMID: 30286298 DOI: 10.1177/1745691618785366] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Deployment to a combat zone is a fundamental mission for most military forces, but prior research suggests that there is a complex and nuanced association between deployment and related risk factors for suicide. Deployment and combat experiences vary greatly among military personnel and can affect a variety of protective and risk factors for suicide. This article offers a critical examination of the association among modern U.S. military deployments, suicide attempts, and death while considering the context of a prominent theory of suicide. Although previous work has demonstrated that deployment is not associated with suicide overall in this population, there is growing evidence that risk may be elevated shortly after deployment, and for some subgroups. Specific aspects of combat exposure, including the experience of killing or witnessing death in combat, may be important contributing factors. An analysis of the literature illustrates that deployment-related risk factors for suicide are complex. The limitations of the literature are discussed, and future directions are suggested.
Collapse
Affiliation(s)
- Mark A Reger
- 1 VA Puget Sound Health Care System, Seattle, Washington.,2 Department of Psychiatry & Behavioral Sciences, University of Washington
| | | | - Sarah P Carter
- 1 VA Puget Sound Health Care System, Seattle, Washington
| | | |
Collapse
|
5
|
Arenson MB, Whooley MA, Neylan TC, Maguen S, Metzler TJ, Cohen BE. Posttraumatic stress disorder, depression, and suicidal ideation in veterans: Results from the mind your heart study. Psychiatry Res 2018; 265:224-230. [PMID: 29753254 DOI: 10.1016/j.psychres.2018.04.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 04/12/2018] [Accepted: 04/12/2018] [Indexed: 01/14/2023]
Abstract
Veterans with PTSD or depression are at increased risk for suicidal ideation. However, few studies have examined that risk in those with comorbid PTSD and depression, instead focusing on these disorders individually. This study investigates the association of suicidal ideation with comorbid PTSD and depression and examines the role of military and psychosocial covariates. We evaluated 746 veterans using the CAPS to assess PTSD and the PHQ-9 to measure depression and suicidal ideation. Covariates were assessed via validated self-report measures. 49% of veterans with comorbid PTSD and depression endorsed suicidal ideation, making them more likely to do so than those with depression alone (34%), PTSD alone (11%), or neither (2%). In multivariate logistic regression models, this association remained significant after controlling for demographics and symptom severity. Anger, hostility, anxiety, alcohol use, optimism and social support did not explain the elevated risk of suicidal ideation in the comorbid group in fully adjusted models. As suicidal ideation is a known risk factor for suicide attempts and completions, veterans with comorbid PTSD and depression represent a vulnerable group who may need more intensive monitoring and treatment to reduce risk of suicide.
Collapse
Affiliation(s)
- Melanie B Arenson
- San Francisco VA Medical Center, San Francisco, CA, USA; University of California, San Francisco, San Francisco, CA, USA.
| | - Mary A Whooley
- San Francisco VA Medical Center, San Francisco, CA, USA; University of California, San Francisco, San Francisco, CA, USA
| | - Thomas C Neylan
- San Francisco VA Medical Center, San Francisco, CA, USA; University of California, San Francisco, San Francisco, CA, USA
| | - Shira Maguen
- San Francisco VA Medical Center, San Francisco, CA, USA; University of California, San Francisco, San Francisco, CA, USA
| | - Thomas J Metzler
- San Francisco VA Medical Center, San Francisco, CA, USA; University of California, San Francisco, San Francisco, CA, USA
| | - Beth E Cohen
- San Francisco VA Medical Center, San Francisco, CA, USA; University of California, San Francisco, San Francisco, CA, USA.
| |
Collapse
|
6
|
Athey A, Overholser J. A Systematic Review of Suicide Risk in Veterans: Depression is a More Powerful Predictor than Comorbid Psychiatric Disorders. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/21635781.2018.1442757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Alison Athey
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - James Overholser
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
7
|
Nock MK, Dempsey CL, Aliaga PA, Brent DA, Heeringa SG, Kessler RC, Stein MB, Ursano RJ, Benedek D. Psychological autopsy study comparing suicide decedents, suicide ideators, and propensity score matched controls: results from the study to assess risk and resilience in service members (Army STARRS). Psychol Med 2017; 47:2663-2674. [PMID: 28502265 PMCID: PMC5674992 DOI: 10.1017/s0033291717001179] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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 The suicide rate has increased significantly among US Army soldiers over the past decade. Here we report the first results from a large psychological autopsy study using two control groups designed to reveal risk factors for suicide death among soldiers beyond known sociodemographic factors and the presence of suicide ideation. METHODS Informants were next-of-kin and Army supervisors for: 135 suicide cases, 137 control soldiers propensity-score-matched on known sociodemographic risk factors for suicide and Army history variables, and 118 control soldiers who reported suicide ideation in the past year. RESULTS Results revealed that most (79.3%) soldiers who died by suicide have a prior mental disorder; mental disorders in the prior 30-days were especially strong risk factors for suicide death. Approximately half of suicide decedents tell someone that they are considering suicide. Virtually all of the risk factors identified in this study differed between suicide cases and propensity-score-matched controls, but did not significantly differ between suicide cases and suicide ideators. The most striking difference between suicides and ideators was the presence in the former of an internalizing disorder (especially depression) and multi-morbidity (i.e. 3+ disorders) in the past 30 days. CONCLUSIONS Most soldiers who die by suicide have identifiable mental disorders shortly before their death and tell others about their suicidal thinking, suggesting that there are opportunities for prevention and intervention. However, few risk factors distinguish between suicide ideators and decedents, pointing to an important direction for future research.
Collapse
Affiliation(s)
| | - Catherine L. Dempsey
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services, University of Health Sciences
| | - Pablo A. Aliaga
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services, University of Health Sciences
| | | | | | | | - Murray B. Stein
- University of California, San Diego and VA 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
| |
Collapse
|
8
|
Guilt is more strongly associated with suicidal ideation among military personnel with direct combat exposure. J Affect Disord 2013; 148:37-41. [PMID: 23232420 DOI: 10.1016/j.jad.2012.11.044] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 11/07/2012] [Accepted: 11/20/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Suicide rates in the U.S. military have been rising rapidly in the past decade. Research suggests guilt is a significant predictor of suicidal ideation among military personnel, and may be especially pronounced among those who have been exposure to combat-related traumas. The current study explored the interactive effect of direct combat exposure and guilt on suicidal ideation in a clinical sample of military personnel. METHODS Ninety-seven active duty U.S. Air Force personnel receiving outpatient mental health treatment at two military clinics completed self-report symptom measures of guilt, depression, hopelessness, perceived burdensomeness, posttraumatic stress disorder, and suicidal ideation. RESULTS Generalized multiple regression analyses indicated a significant interaction of guilt and direct combat exposure (B=.124, SE=.053, p=.020), suggesting a stronger relationship of guilt with suicidal ideation among participants who had direct combat exposure as compared to those who had not. The interactions of direct combat exposure with depression (B=.004, SE=.040, p=.926), PTSD symptoms (B=.016, SE=.018, p=.382), perceived burdensomeness (B=.159, SE=.152, p=.300) and hopelessness (B=.069, SE=.036, p=.057) were nonsignificant. CONCLUSIONS Although guilt is associated with more severe suicidal ideation in general among military personnel, it is especially pronounced among those who have had direct combat exposure.
Collapse
|
9
|
Bryan CJ, Morrow CE, Etienne N, Ray-Sannerud B. Guilt, shame, and suicidal ideation in a military outpatient clinical sample. Depress Anxiety 2013; 30:55-60. [PMID: 23077111 DOI: 10.1002/da.22002] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 08/30/2012] [Accepted: 08/30/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Increased suicide risk among US military personnel is a growing concern. Research has linked trauma exposure, including exposure to combat-related injuries, death, and atrocities to suicidal ideation among combat veterans. Guilt (feeling bad about what you did to another) and shame (feeling bad about who you are) have been proposed as potential contributors to suicidal ideation among military personnel, but have not yet received much empirical attention. METHODS Sixty-nine active duty military personnel receiving outpatient mental health treatment at a military clinic completed self-report symptom measures of guilt, shame, depression, posttraumatic stress disorder, and suicidal ideation while engaged in treatment. Generalized linear regression modeling was utilized to test the association of guilt and shame with suicidal ideation. RESULTS Mean levels of guilt and shame were significantly higher among military personnel with a history of suicidal ideation. Guilt (B = 0.203, SE = .046, P < .001) and shame (B = 0.111, SE = .037, P = .002) were independently associated with severity of current suicidal ideation above and beyond the effects of depression, PTSD symptoms, and the depression-by-PTSD interaction, and fully mediated the relationships of depression and PTSD symptom severity with suicidal ideation. When considered simultaneously, only guilt (B = 0.167, SE = .053, P = .001) was significantly associated with increased suicidal ideation. CONCLUSIONS Guilt and shame are associated with increased severity of suicidal ideation in military mental health outpatients. Guilt has a particularly strong relationship with suicidal ideation.
Collapse
Affiliation(s)
- Craig J Bryan
- National Center for Veterans Studies, The University of Utah, 260 S. Central Campus Dr., Salt Lake City, UT 84112, USA.
| | | | | | | |
Collapse
|
10
|
Bryan CJ, Hernandez AM, Allison S, Clemans T. Combat Exposure and Suicide Risk in Two Samples of Military Personnel. J Clin Psychol 2012; 69:64-77. [DOI: 10.1002/jclp.21932] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Sybil Allison
- University of Texas Health Science Center at San Antonio
| | - Tracy Clemans
- University of Texas Health Science Center at San Antonio
| |
Collapse
|
11
|
Panagioti M, Gooding PA, Tarrier N. A meta-analysis of the association between posttraumatic stress disorder and suicidality: the role of comorbid depression. Compr Psychiatry 2012; 53:915-30. [PMID: 22483367 DOI: 10.1016/j.comppsych.2012.02.009] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 02/20/2012] [Accepted: 02/21/2012] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE A considerable number of studies have reported an increased frequency of suicidal behaviors among individuals diagnosed with posttraumatic stress disorder (PTSD). This study aims, first, to provide a comprehensive systematic review and meta-analysis of the association between a PTSD diagnosis and frequency of suicidality and, second, to examine the role of comorbid depression in the association between suicidality and PTSD. METHODS Searches of Medline (June 2010), EMBASE (June 2010), PsycINFO (June 2010), PILOTS (June 2010), and Web of Science (June 2010) were conducted to identify studies that examined the association between PTSD and suicidality. The studies had to include an effect size of the association between PTSD and suicidality to be included in the meta-analysis. Sixty-three studies were eligible for inclusion in the meta-analysis. Overall and subgroup effect sizes were examined. RESULTS A highly significant positive association between a PTSD diagnosis and suicidality was found. The PTSD-suicidality association persisted across studies using different measures of suicidality, current and lifetime PTSD, psychiatric and nonpsychiatric samples, and PTSD populations exposed to different types of traumas. Comorbid major depression significantly compounded the risk for suicide in PTSD populations. CONCLUSION The current meta-analysis provides strong evidence that a PTSD diagnosis is associated with increased suicidality. The crucial role of comorbid major depression in the etiology of suicidality in PTSD is also supported.
Collapse
Affiliation(s)
- Maria Panagioti
- School of Psychological Sciences, University of Manchester, Manchester, United Kingdom
| | | | | |
Collapse
|
12
|
Bossarte RM. Bossarte Responds. Am J Public Health 2012; 102:e8. [DOI: 10.2105/ajph.2012.300923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Robert M. Bossarte
- Robert M. Bossarte is with the VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY, and the Department of Psychiatry, University of Rochester, Rochester, NY
| |
Collapse
|
13
|
Mihaljević S, Vuksan-Ćusa B, Marčinko D, Koić E, Kušević Z, Jakovljević M. Spiritual well-being, cortisol, and suicidality in Croatian war veterans suffering from PTSD. JOURNAL OF RELIGION AND HEALTH 2011; 50:464-473. [PMID: 20694578 DOI: 10.1007/s10943-010-9383-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We present our preliminary results of work that aims to observe the relationship between the cortisol level, the level of spiritual well-being, and suicidal tendencies in Croatian war veterans suffering from PTSD. The survey was conducted on 17 PTSD veterans who completed the Spiritual Well-Being Scale and the Beck Hopelessness Scale. The plasma cortisol level was obtained by venepuction at 8.00, 12.00, 13.00, 16.00, and 22.00 h. Results showed that veterans with higher spiritual well-being scores had lower cortisol levels, and evening cortisol levels showed significant correlation with suicidal risk. The results of the present study could be a stimulus for further investigation into spiritually based interventions, exploring their impact both on mental status and physical health.
Collapse
Affiliation(s)
- Sanea Mihaljević
- Psychiatry Department, General Hospital Virovitica, Gajeva 21, 33 000 Virovitica, Croatia.
| | | | | | | | | | | |
Collapse
|
14
|
|
15
|
Selby EA, Anestis MD, Bender TW, Ribeiro JD, Nock MK, Rudd MD, Bryan CJ, Lim IC, Baker MT, Gutierrez PM, Joiner TE. Overcoming the fear of lethal injury: evaluating suicidal behavior in the military through the lens of the Interpersonal-Psychological Theory of Suicide. Clin Psychol Rev 2009; 30:298-307. [PMID: 20051309 DOI: 10.1016/j.cpr.2009.12.004] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 12/02/2009] [Accepted: 12/03/2009] [Indexed: 12/25/2022]
Abstract
Suicide rates have been increasing in military personnel since the start of Operation Enduring Freedom and Operation Iraqi Freedom, and it is vital that efforts be made to advance suicide risk assessment techniques and treatment for members of the military who may be experiencing suicidal symptoms. One potential way to advance the understanding of suicide in the military is through the use of the Interpersonal-Psychological Theory of Suicide. This theory proposes that three necessary factors are needed to complete suicide: feelings that one does not belong with other people, feelings that one is a burden on others or society, and an acquired capability to overcome the fear and pain associated with suicide. This review analyzes the various ways that military service may influence suicidal behavior and integrates these findings into an overall framework with relevant practical implications. Findings suggest that although there are many important factors in military suicide, the acquired capability may be the most impacted by military experience because combat exposure and training may cause habituation to fear of painful experiences, including suicide. Future research directions, ways to enhance risk assessment, and treatment implications are also discussed.
Collapse
Affiliation(s)
- Edward A Selby
- Florida State University, Tallahassee, Florida 32306-1270, United States
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Panagioti M, Gooding P, Tarrier N. Post-traumatic stress disorder and suicidal behavior: A narrative review. Clin Psychol Rev 2009; 29:471-82. [DOI: 10.1016/j.cpr.2009.05.001] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 05/29/2009] [Accepted: 05/30/2009] [Indexed: 01/07/2023]
|
17
|
|
18
|
Batt A, Campeon A, Leguay D, Lecorps P. Épidémiologie du phénomène suicidaire : complexité, pluralité des approches et prévention. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s0246-1072(07)43505-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
19
|
Abstract
This paper reviews research based on the psychological autopsy (PA) method applied to the study of suicide. It evidences the presence of a number of methodological problems. Shortcomings concern sampling biases in the selection of control subjects, confounding influences of extraneous variables, and reliability of the assessment instruments. The absence of homogeneity among studies in the procedure employed, as well as the lack of defined guidelines for performing this type of inquiry are emphasized. Questions needing empirical investigation in the future are pointed out. It is concluded that the validity and reliability of findings emerging from the use of this method of investigation would benefit from a standardization of its application.
Collapse
Affiliation(s)
- Louise Pouliot
- University of Quebec at Montreal, Montreal, Quebec, Canada.
| | | |
Collapse
|
20
|
Abstract
To investigate risk factors for suicide in veterans of peacekeeping, 43 suicides and 41 fatal accidents in Norwegian peacekeepers (1978 to 1995) were compared in a psychological autopsy study. Mental health problems were the most important risk factor for suicide. Both living alone and the break-up of a love relationship contributed uniquely to suicide risk, even when controlling for mental health problems. No peacekeeping-related factor was associated with suicide. Preventive measures should focus on firearms control, improved detection systems for mental health problems in the military, and peer support through veterans' associations.
Collapse
Affiliation(s)
- Siri Thoresen
- Norwegian Centre for Studies on Violence and Traumatic Stress, Ltd, Kirkeveien 166, Bygning 48 (Z), 0407 Oslo, Norway.
| | | |
Collapse
|
21
|
Conner KR, Duberstein PR. Predisposing and Precipitating Factors for Suicide Among Alcoholics: Empirical Review and Conceptual Integration. Alcohol Clin Exp Res 2006; 28:6S-17S. [PMID: 15166632 DOI: 10.1097/01.alc.0000127410.84505.2a] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Alcohol dependence is a potent risk factor for suicide. Accordingly, alcoholics should be targeted in suicide prevention efforts. This article reviews the literature on suicide among alcoholics and provides a model that may inform research, clinical work, and prevention efforts. In this model, we propose that aggression/impulsivity, severe alcoholism, negative affect, and hopelessness are key predisposing factors for suicide among alcoholics. We propose that major depressive episodes and stressful life events, particularly interpersonal difficulties, are key precipitating factors. We also integrate these constructs in a model that proposes that many acts of suicide among alcoholics may be viewed as acts of reactive aggression executed in the midst of distress over a lost or threatened relationship. Empirical evidence for the model is discussed along with its limitations. The next generation of research on alcoholism and suicide should include a focus on the interpersonal anlage of suicide in this population.
Collapse
Affiliation(s)
- Kenneth R Conner
- Center for the Study and Prevention of Suicide and Laboratory of Personality and Development, Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
| | | |
Collapse
|
22
|
Goldney RD. The Farberow Award: the man. CRISIS 2006; 26:149-51. [PMID: 16276759 DOI: 10.1027/0227-5910.26.3.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
23
|
Thoresen S, Mehlum L, Røysamb E, Tønnessen A. Risk factors for completed suicide in veterans of peacekeeping: repatriation, negative life events, and marital status. Arch Suicide Res 2006; 10:353-63. [PMID: 16920686 DOI: 10.1080/13811110600791106] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This psychological autopsy study focused on suicide risk factors in veterans of peacekeeping, specifically, a representative sample of Norwegian peacekeepers. A multivariate analysis yielded three dimensions with a unique impact on suicide risk: Involuntary repatriation from peacekeeping service, negative life-events before peacekeeping and marital status. In accordance with previous research into suicidal processes, repatriation probably reflects an event causing severe damage to peacekeepers' self-esteem, which combined with vulnerability and lack of protection could increase suicide risk. Preventive measures should focus on careful personnel selection and follow-up of repatriated individuals.
Collapse
Affiliation(s)
- Siri Thoresen
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway.
| | | | | | | |
Collapse
|
24
|
Price RK, Risk NK, Haden AH, Lewis CE, Spitznagel EL. Post-traumatic stress disorder, drug dependence, and suicidality among male Vietnam veterans with a history of heavy drug use. Drug Alcohol Depend 2004; 76 Suppl:S31-43. [PMID: 15555815 DOI: 10.1016/j.drugalcdep.2004.08.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Accepted: 08/04/2004] [Indexed: 11/17/2022]
Abstract
This study examines the roles of post-traumatic stress disorder (PTSD) and drug dependence in non-fatal suicidality, i.e., suicidal ideation and suicide attempt, among Vietnam veterans in their adult years. The sample includes male veterans deployed to Vietnam, including an oversample of those who tested positive for opiates at their return (n = 642). PTSD, substance abuse, suicidality, and other psychopathology are analyzed using three waves of survey and military data covering the time period from early adolescence to middle adulthood. Measures include the onset and recency of each of the lifetime DSM-IV PTSD symptom criteria, and yearly symptom measures of DSM-IV dependence for alcohol and eight classes of psychoactive substances. Survival and hazard models are applied to assess the effects of drug dependence, PTSD, and other psychopathology on the duration of suicidality. Longitudinal models estimate the casual relationships among PTSD, drug dependence, and suicidality over a 25-year period. Results show evidence of strong continuity of PTSD, drug dependence, and suicidality over time. The causal role of drug dependence on PTSD and suicidality is limited to young adulthood. Evidence is stronger for self-medication in later adulthood. The results indicate that a life course perspective is needed for the combined treatment of PTSD and drug dependence for severely traumatized populations.
Collapse
Affiliation(s)
- Rumi Kato Price
- Department of Psychiatry, Washington University School of Medicine, 40 N. Kingshighway, Suite 2, St. Louis, MO 63108, USA.
| | | | | | | | | |
Collapse
|
25
|
Johnson DR, Fontana A, Lubin H, Corn B, Rosenheck R. Long-term course of treatment-seeking Vietnam veterans with posttraumatic stress disorder: mortality, clinical condition, and life satisfaction. J Nerv Ment Dis 2004; 192:35-41. [PMID: 14718774 DOI: 10.1097/01.nmd.0000105998.90425.6a] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study is a 6-year longitudinal study of 51 treatment-seeking male veterans with combat-related posttraumatic stress disorder. Measures of PTSD and psychiatric symptomatology, social functioning, and program impact were assessed at admission to an inpatient treatment program, at 18 months, and 6 years later. Previous studies had shown that the treatment program's impact on course of illness had been negligible. The sample showed an extremely high mortality rate of 17% over 6 years. The remaining veterans showed improvement in violence and alcohol and drug use, but an increase in hyperarousal symptoms and social isolation. Nearly three-fourths had had an inpatient hospitalization. Veterans' self-ratings, in contrast, indicated significant improvement in all areas of functioning except employment, as well as an overall positive view of the impact of the program on their lives. Results indicate that the majority of the veteran sample had experienced some improvement in their ability to cope with their chronic illness, decreasing their use of violence and substance abuse but still were experiencing high levels of symptomatology. The extremely high mortality rate, however, provides a somber reminder of the seriousness of this disorder.
Collapse
Affiliation(s)
- David Read Johnson
- Post Traumatic Stress Center, 19 Edwards Street, New Haven, CT 06511, USA
| | | | | | | | | |
Collapse
|
26
|
Conner KR, Duberstein PR, Conwell Y, Seidlitz L, Caine ED. Psychological vulnerability to completed suicide: a review of empirical studies. Suicide Life Threat Behav 2002; 31:367-85. [PMID: 11775713 DOI: 10.1521/suli.31.4.367.22048] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Retrospective research shows that close to 90 percent of suicides have a diagnosable psychiatric disorder; however, only a small proportion of individuals with psychopathology take their own lives. This article reviews the empirical literature on psychological vulnerability to completed suicide. A search of the MEDLINE and PsycINFO databases yielded 46 cohort or case-control studies that used standardized or structured assessments of psychological dimensions. Five constructs have been consistently associated with completed suicide: impulsivity/aggression, depression, anxiety, hopelessness, and self-consciousness/social disengagement. Current knowledge of psychological vulnerability to completed suicide could inform social and neurobiological research, and thereby deepen understanding of suicide while potentially bridging these areas of study.
Collapse
Affiliation(s)
- K R Conner
- Department of Psychiatry, Center for the Study and Prevention of Suicide, University of Rochester School of Medicine and Dentistry, NY 14642, USA.
| | | | | | | | | |
Collapse
|
27
|
Freeman TW, Roca V, Moore WM. A comparison of chronic combat-related posttraumatic stress disorder (PTSD) patients with and without a history of suicide attempt. J Nerv Ment Dis 2000; 188:460-3. [PMID: 10919706 DOI: 10.1097/00005053-200007000-00011] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- T W Freeman
- University of Arkansas Medical Sciences Department of Psychiatry, Little Rock 72205, USA
| | | | | |
Collapse
|
28
|
Abstract
Gender differences were examined in risk factors for suicidality among young adult friends of suicide victims. Data were derived from a follow-up community survey of 76 members of the social network of 23 consecutive adolescent suicide victims 6 years after the friend's death. The Beck-Kovacs Scale for Suicidal Ideation was the outcome measure. Multiple regression analyses revealed aggression to have the only significant effect on suicidality among men, whereas depression and posttraumatic stress disorder had significant independent effects on suicidality among women. Results suggest that young adult men who are aggressive and female subjects with elevated symptoms of depression and/or posttraumatic stress disorder may be at increased risk of suicidality.
Collapse
Affiliation(s)
- H G Prigerson
- Connecticut Mental Health Center, Yale University School of Medicine, New Haven 06519, USA
| | | |
Collapse
|
29
|
Adams DP, Barton C, Mitchell GL, Moore AL, Einagel V. Hearts and minds: suicide among United States combat troops in Vietnam, 1957-1973. Soc Sci Med 1998; 47:1687-94. [PMID: 9877339 DOI: 10.1016/s0277-9536(98)00253-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The literature on suicides among military personnel in a combat zone remains anecdotal. Although one finds literary and journalistic accounts of the problem, it has not been systematically analyzed. This paper will examine suicides among American combat troops during their tour of duty in Vietnam. Utilizing statistical data from the Southeast Asia Combat Area Casualties Database (SACACD), the authors will survey its epidemiology among U.S. ground troops in Vietnam from 1957 to 1973. The results suggest that certain types of combat troops were significantly more likely than others to commit suicide. These findings not only provide important predictors for military health professionals in the assessment of suicide risk, they also raise disturbing questions about the nature of organized armed conflict.
Collapse
|
30
|
Ferrada-Noli M, Asberg M, Ormstad K, Lundin T, Sundbom E. Suicidal behavior after severe trauma. Part 1: PTSD diagnoses, psychiatric comorbidity, and assessments of suicidal behavior. J Trauma Stress 1998; 11:103-12. [PMID: 9479679 DOI: 10.1023/a:1024461216994] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The study comprises 149 refugees from various countries, reporting exposure to severe traumata, who were referred for psychiatric diagnosis and assessment of suicide risk. The stressors reported comprised both personal experience of and/or forced witnessing of combat atrocities (including explosions or missile impacts in urban areas), imprisonment (including isolation), torture and inflicted pain, sexual violence, witnessing others' suicide, and of summary and/or mock executions. Posttraumatic stress disorder (PTSD) was diagnosed in 79% of all cases, other psychiatric illness in 16% and no mental pathology in 5%. The prevalence of suicidal behavior was significantly greater among refugees with principal PTSD diagnoses than among the remainder. PTSD patients with depression comorbidity reported higher frequency of suicidal thoughts; PTSD nondepressive patients manifested increased frequency of suicide attempts.
Collapse
Affiliation(s)
- M Ferrada-Noli
- Department of Social Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA
| | | | | | | | | |
Collapse
|
31
|
Duberstein PR, Conwell Y. Personality disorders and completed suicide: A methodological and conceptual review. ACTA ACUST UNITED AC 1997. [DOI: 10.1111/j.1468-2850.1997.tb00127.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
32
|
Watanabe KK, Kang HK. Military service in Vietnam and the risk of death from trauma and selected cancers. Ann Epidemiol 1995; 5:407-12. [PMID: 8653214 DOI: 10.1016/1047-2797(95)00039-a] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The postservice mortality of a cohort of 10,716 US Marine veterans who served in Vietnam was compared with that of 9,346 Marine veterans who did not serve in Vietnam. There was a significant excess of death for Vietnam Marines from all causes and all external causes. After adjustments for age and rank in military, overall mortality continued to be statistically significant, with a relative risk of 1.15 (95% confidence interval (CI) = 1.02 to 1.29) for Vietnam Marines compared to non-Vietnam Marines. All external causes was also significant, with a relative risk of 1.21 (95% CI = 1.00 to 1.47). The excess overall mortality was mainly due to excess deaths from external causes. The risks for several site-specific cancers were elevated but not statistically significant. Periodic follow-up of this Marine cohort should continue to determine whether there are statistically significant differences in the mortality patterns of Marine Vietnam and non-Vietnam veterans, especially for cancers.
Collapse
Affiliation(s)
- K K Watanabe
- Department of Veterans Affairs, Environmental Epidemiology Service, Washington, DC 20036-3406, USA
| | | |
Collapse
|