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Williamson C, Croak B, Simms A, Fear NT, Sharp ML, Stevelink SAM. Risk and protective factors for self-harm and suicide behaviours among serving and ex-serving personnel of the UK Armed Forces, Canadian Armed Forces, Australian Defence Force and New Zealand Defence Force: A systematic review. PLoS One 2024; 19:e0299239. [PMID: 38669252 PMCID: PMC11051630 DOI: 10.1371/journal.pone.0299239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/06/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Self-harm and suicide behaviours are a major public health concern. Several factors are associated with these behaviours among military communities. Identifying these factors may have important implications for policy and clinical services. The aim of this review was to identify the risk and protective factors associated with self-harm and suicide behaviours among serving and ex-serving personnel of the United Kingdom Armed Forces, Canadian Armed Forces, Australian Defence Force and New Zealand Defence Force. METHODS A systematic search of seven online databases (PubMed, Web of Science, Embase, Global Health, PsycINFO, PTSDpubs and CINAHL) was conducted alongside cross-referencing, in October 2022. Following an a priori PROSPERO approved protocol (CRD42022348867), papers were independently screened and assessed for quality. Data were synthesised using a narrative approach. RESULTS Overall, 28 papers were included: 13 from Canada, 10 from the United Kingdom, five from Australia and none from New Zealand. Identified risk factors included being single/ex-relationship, early service leavers, shorter length of service (but not necessarily early service leavers), junior ranks, exposure to deployment-related traumatic events, physical and mental health diagnoses, and experience of childhood adversity. Protective factors included being married/in a relationship, higher educational attainment, employment, senior ranks, and higher levels of perceived social support. CONCLUSION Adequate care and support are a necessity for the military community. Prevention and intervention strategies for self-harm and suicide behaviours may be introduced early and may promote social networks as a key source of support. This review found a paucity of peer-reviewed research within some populations. More peer-reviewed research is needed, particularly among these populations where current work is limited, and regarding modifiable risk and protective factors.
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Affiliation(s)
- Charlotte Williamson
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Bethany Croak
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Amos Simms
- Academic Department of Military Mental Health, King’s College London, London, United Kingdom
- British Army, London, United Kingdom
| | - Nicola T. Fear
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
- Academic Department of Military Mental Health, King’s College London, London, United Kingdom
| | - Marie-Louise Sharp
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Sharon A. M. Stevelink
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
- Department of Psychological Medicine, King’s College London, London, United Kingdom
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Campbell KA. Childhood trauma: a major risk factor in the military recruitment of young people. BMJ Mil Health 2024; 170:95-96. [PMID: 35649690 DOI: 10.1136/bmjmilitary-2022-002149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/04/2022]
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Gromatsky M, Halverson TF, Dillon KH, Wilson LC, LoSavio ST, Walsh S, Mellows C, Mann AJ, Goodman M, Kimbrel NA. The Prevalence of Nonsuicidal Self-Injury in Military Personnel: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:2936-2952. [PMID: 36062896 PMCID: PMC9985671 DOI: 10.1177/15248380221119513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Military service members and veterans (SMVs) are at risk for self-directed violence, including nonsuicidal self-injury (NSSI). While NSSI is an important construct worthy of independent study, it is understudied among SMVs and, when included in research, typically examined in the context of suicide risk. Consequently, lifetime prevalence rate estimates of NSSI among SMVs vary. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review and meta-analysis estimated the average lifetime NSSI prevalence among SMVs and explored demographic and methodological factors that may account for observed variability. Based on a search of Ovid MEDLINE, Embase, PsycINFO, and Web of Science, 47 samples from 42 articles across five countries met inclusion criteria. Results revealed an average NSSI lifetime prevalence rate of 15.76% among SMVs. Significantly higher prevalence rates were observed among clinical (28.14%) versus community (11.28%) samples and studies using interviews to assess NSSI (23.56%) versus self-report (13.44%) or chart review (7.84%). Lifetime prevalence increased as publication year increased and decreased as sample size increased. In contrast to prior literature, prevalence rates were comparable between active-duty SMVs, and studies collecting data anonymously versus those that did not. Lifetime prevalence was not moderated by age, gender, race, country, primary research focus, quality of NSSI operationalization, or whether NSSI methods were assessed. Findings suggest NSSI is a pervasive problem among military personnel, particularly within clinical settings, highlighting the need for systematic assessment of this important but understudied clinical phenomenon among SMVs. Further research is necessary to elucidate additional risk factors for NSSI among SMVs, including trauma exposure.
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Affiliation(s)
- Molly Gromatsky
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Tate F. Halverson
- Durham Veterans Affairs (VA) Health Care System, Durham, NC
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC
| | - Kirsten H. Dillon
- Durham Veterans Affairs (VA) Health Care System, Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Laura C. Wilson
- Department of Psychological Science, University of Mary Washington, Fredericksburg, VA
| | - Stefanie T. LoSavio
- Durham Veterans Affairs (VA) Health Care System, Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Samantha Walsh
- Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Clara Mellows
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill,Chapel Hill, NC
| | - Adam J. Mann
- Department of Psychology, University of Toledo, Toledo, OH
| | - Marianne Goodman
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nathan A. Kimbrel
- Durham Veterans Affairs (VA) Health Care System, Durham, NC
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC
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Chui Z, Leightley D, Jones M, Landau S, McCrone P, Hayes RD, Wessely S, Fear NT, Goodwin L. Mental health problems and admissions to hospital for accidents and injuries in the UK military: A data linkage study. PLoS One 2023; 18:e0280938. [PMID: 36693079 PMCID: PMC9873160 DOI: 10.1371/journal.pone.0280938] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Accidents are the most common cause of death among UK military personnel. It is a common misconception in the general public that accidental injuries are always the result of random events, however research suggests that mental health problems and the increased levels of risky behaviour in military personnel may play a role. The objective of this study was to further our understanding of injuries and deaths not related to deployment by examining the associations of mental health, alcohol misuse and smoking with inpatient admission to hospital for accidents and injuries, and attendance to accident and emergency (A&E) departments. METHODS Data on all hospital admissions for accidents and injuries and A&E attendance at NHS hospitals in England, Scotland and Wales were linked to data on self-reported mental health problems, alcohol misuse and smoking from a large, representative UK military cohort of serving and ex-serving personnel (n = 8,602). Logistic regression was used to examine the associations between having a hospital admission for an accident or injury with self-reported mental health problems, alcohol misuse and smoking. Cox proportional-hazards regression was then conducted to assess the associations of mental health problems, alcohol misuse and smoking with time to hospital admission for an accident or injury. Finally, negative binomial regression was used to examine associations between the number of A&E attendances with mental health problems, alcohol misuse and smoking. RESULTS Personnel reporting symptoms of common mental disorder (CMD) or probable post-traumatic stress disorder (PTSD) were more likely to have an admission to hospital for an accident or injury (fully adjusted odds ratio 1.39, 95% confidence interval [CI] 1.05-1.84), than those who did not report these symptoms, and also had more attendances to A&E (fully adjusted incidence rate ratio [IRR] 1.32, 95% CI 1.16-1.51). A&E attendances were also more common in personnel who were smokers (fully adjusted IRR 1.21, 95% CI 1.09-1.35) following adjustment for demographic, military and health characteristics. CONCLUSIONS The findings suggest that accidents and injuries among military personnel are not always random events and that there are health and behavioural factors, including poor mental health and smoking, which are associated (with small effect sizes) with an increased risk of being involved in an accident. Clinicians treating individuals attending hospital after an accident should consider their healthcare needs holistically, including issues related to mental health and health damaging behaviours.
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Affiliation(s)
- Zoe Chui
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- * E-mail:
| | - Daniel Leightley
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Margaret Jones
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Sabine Landau
- Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Paul McCrone
- Faculty of Education and Health, University of Greenwich, London, United Kingdom
| | - Richard D. Hayes
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Simon Wessely
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Nicola T. Fear
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Laura Goodwin
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
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Halverson TF, Mann AJD, Zelkowitz RL, Patel TA, Evans MK, Aho N, Beckham JC, Calhoun PS, Pugh MJ, Kimbrel NA. Nonsuicidal self-injury in veterans: Prevalence, clinical characteristics, and gender differences from a national cohort. Psychiatry Res 2022; 315:114708. [PMID: 35868073 PMCID: PMC9378466 DOI: 10.1016/j.psychres.2022.114708] [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: 04/20/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/28/2022]
Abstract
Nonsuicidal self-injury (NSSI) is a robust predictor of suicidal thoughts and behaviors; however, while there are typically only small differences observed in the prevalence of NSSI between men and women, this condition has been largely overlooked and underestimated among men. Assessing NSSI methods more common in men may address misidentification as well as allow for more precise NSSI prevalence estimates. Survey data from a national sample of Gulf War I-Era veterans (N = 1063) was used to estimate the prevalence of NSSI and compare prevalence of NSSI methods between men and women veterans. Demographic and clinical correlates of NSSI engagement were also examined. The national lifetime prevalence rate of NSSI among Gulf War I-Era veterans was 22.40%, whereas the past year prevalence rate was 8.10%. In both men and women, wall/object punching was the most common NSSI method endorsed across the lifetime. Men had slightly higher overall NSSI prevalence rates compared with women. This study highlights the need to systematically assess NSSI, particularly among veterans, to better identify, and consequently treat, NSSI in men. This is the first available prevalence estimate of NSSI to include the assessment of wall/object punching in a national sample of adult veterans.
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Affiliation(s)
- Tate F Halverson
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.
| | - Adam J D Mann
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Rachel L Zelkowitz
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston School of Medicine, Boston, MA, USA
| | - Tapan A Patel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Mariah K Evans
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Natalie Aho
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jean C Beckham
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Mary Jo Pugh
- VA Salt Lake City Healthcare System, Salt Lake City, UT, USA; School of Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
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6
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Hansen C, McFarlane A, Iannos M, Sadler N, Benassi H, Lawrence-Wood E, Hodson S, Searle A, Van Hooff M. Psychosocial factors associated with psychological distress and functional difficulties in recently transitioned and current serving regular Australian Defence Force members. Psychiatry Res 2020; 286:112860. [PMID: 32065981 DOI: 10.1016/j.psychres.2020.112860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 11/19/2022]
Abstract
The transition period from military-to-civilian life can be one of the most significant and stressful periods in the military life cycle. We explore the psychosocial factors associated with psychological distress and functional impairment among those who recently transitioned from the Australian Defence Force (ADF) and those currently serving in 2015. Using data from the Transition and Wellbeing Research Programme, multinomial logistic regression models were used to analyze the associations between a combined measure of psychological distress and functional impairment (K10/SDS) with various psychosocial, lifestyle, and physical health factors. There were 10,210 in the final analytic cohort (Transitioned=3,254; Regular 2015 ADF=6,956). Overall, the odds of belonging to the highly distressed/impaired group were greatest among those with insomnia (Odds Ratio 18.53), low resilience (OR 7.67), physical health symptoms (OR 7.16), and alcohol risk (OR 4.67). Other factors included pain (OR 3.36), financial issues (OR 2.38), and social strain (OR 1.98). The associations with insomnia and physical health symptoms were stronger among the Transitioned compared to the Regular 2015 ADF. Results of this research highlights the importance of taking a multi-dimensional perspective of symptoms in military populations, particularly in those recently transitioned from permanent service, as predictors of future risk of disorder.
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Affiliation(s)
- Craig Hansen
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia.
| | - Alexander McFarlane
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| | - Marie Iannos
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| | - Nicole Sadler
- Department of Defence, Canberra, Australia; Phoenix Australia, Centre for Posttraumatic Mental Health, Melbourne, Australia
| | - Helen Benassi
- Department of Defence, Canberra, Australia; Australian National University, Canberra, Australia
| | - Ellie Lawrence-Wood
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| | | | - Amelia Searle
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| | - Miranda Van Hooff
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
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Jones N, Sharp ML, Phillips A, Stevelink SAM. Suicidal Ideation, Suicidal Attempts, and Self-Harm in the UK Armed Forces. Suicide Life Threat Behav 2019; 49:1762-1779. [PMID: 31290563 DOI: 10.1111/sltb.12570] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/21/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In the UK military, suicide is infrequent and studies of self-harm behavior in this population are rare. OBJECTIVES To compare lifetime self-harm rates estimated on three occasions between 2004 and 2016 and to explore the associates of lifetime self-harm. METHOD Three phases of a UK AF cohort study (n = 10,272, 9,990, and 8,581, respectively) provided data. Telephone interviews assessed associates of self-harm among cohort members who reported subjective mental health problems in the past 3 years (n = 1,448). Validated measures of mental health and related stigmatization, social support, and help-seeking were obtained. RESULTS Lifetime self-harm increased significantly (p < .001) from 1.8% among serving personnel and 3.8% among veterans in 2004/06 to 1.9% and 4.5% in 2007/09 and to 4.2% and 6.6% in 2014/16 in the two groups, respectively. Veterans were consistently significantly more likely to report lifetime self-harm than serving personnel. Significant determinants of lifetime self-harm included current mental disorder symptoms, stigmatization, poor social support, suicidal ideation, and seeking help from formal medical sources. CONCLUSION Self-harm has increased over time in the UK serving and veteran community. Suicide prevention should focus on ameliorating mental disorder by encouraging engagement with health care, reducing negative views of mental illness, and fostering social support.
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Affiliation(s)
- Norman Jones
- Academic Department of Military Mental Health, Floor 3 Weston Education Centre, King's College London, London, UK
| | - Marie-Louise Sharp
- King's Centre for Military Mental Health Research, Weston Education Centre, King's College London, London, UK
| | - Ava Phillips
- Academic Department of Military Mental Health, Floor 3 Weston Education Centre, King's College London, London, UK
| | - Sharon A M Stevelink
- King's Centre for Military Mental Health Research, Weston Education Centre, King's College London, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Kip KE, Berumen J, Zeidan AR, Hernandez DF, Finnegan AP. The emergence of accelerated resolution therapy for treatment of post‐traumatic stress disorder: A review and new subgroup analyses. COUNSELLING & PSYCHOTHERAPY RESEARCH 2019. [DOI: 10.1002/capr.12210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kevin E. Kip
- College of Public HealthUniversity of South Florida Tampa Florida
| | - Jessica Berumen
- College of Public HealthUniversity of South Florida Tampa Florida
| | - Amina R. Zeidan
- University of Texas Health Sciences Center San Antonio Texas
| | | | - Alan P. Finnegan
- Westminster Centre for Research & Innovation in Veterans WellbeingUniversity of Chester Chester UK
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Sareen J, Afifi TO, Taillieu T, Cheung K, Turner S, Stein MB, Zamorski MA. Deployment-Related Traumatic Events and Suicidal Behaviours in a Nationally Representative Sample of Canadian Armed Forces Personnel. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:795-804. [PMID: 28490190 PMCID: PMC5697623 DOI: 10.1177/0706743717699174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Worldwide, there has been substantial controversy with respect to whether military deployment is a risk factor for suicidal behaviour. The present study examined the relationship between lifetime exposure to deployment and deployment-related traumatic events (DRTEs) and past-year suicidal ideation (SI), suicidal plans (SP), and suicidal attempts (SA). METHOD Data were analysed from the 2013 Canadian Forces Mental Health Survey (8161 respondents; response rate, 79.8%; aged 18-60 years). A total of 12 individual items assessed exposure to DRTEs (e.g., combat, witnessing human atrocities, feeling responsible for the death of Canadian or ally personnel, knowing someone who was injured or killed). We examined each individual DRTE type as well as the number of types of DRTEs in relation to suicidal behaviour. RESULTS Lifetime deployment was not significantly associated with suicidal behaviour. In models adjusted for sociodemographic variables, most of the individual DRTE items and the DRTE count variable were significantly associated with suicidal behaviours (adjusted odds ratio ranged between 1.10 and 5.32). When further adjusting for child abuse exposure, these associations were minimally attenuated, and some became nonsignificant. In models adjusting for mental disorders and child abuse, most DRTEs and number of types of DRTEs became nonsignificant in relation to SI, SP, and SA. CONCLUSIONS Active military personnel exposed to increasing number of DRTEs are at increased risk for SI, SP, and SA. However, most of the association between DRTEs and suicidal behaviour is accounted for by child abuse exposure and mental disorders.
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Affiliation(s)
- Jitender Sareen
- Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Tracie O. Afifi
- Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Tamara Taillieu
- Applied Health Sciences Program, University of Manitoba, Winnipeg, Manitoba
| | - Kristene Cheung
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba
| | - Sarah Turner
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Murray B. Stein
- University of California San Diego, San Diego, California, USA
- VA San Diego Healthcare System, San Diego, California, USA
| | - Mark A. Zamorski
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group HQ, Ottawa, Ontario
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario
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Cooper L, Andrew S, Fossey M. Educating nurses to care for military veterans in civilian hospitals: An integrated literature review. NURSE EDUCATION TODAY 2016; 47:68-73. [PMID: 27288266 DOI: 10.1016/j.nedt.2016.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 02/18/2016] [Accepted: 05/21/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND In the UK, military veterans will receive care by civilian nurses in civilian hospitals. We propose that the nurses providing this care require an understanding of the unique experiences and specific health needs of veterans to deliver evidence-based care. AIM To conduct an integrative review of published literature to explore how nursing programmes prepare nurses to care for the military veteran population in civilian hospitals. REVIEW METHODS A systematic search was undertaken of a range of electronic databases, Google Scholar and hand searching of Military and Veteran health journals. Papers that focused on education of civilian nurses about veteran health and included primary research or description of practice-based innovations were included in the review. RESULTS The search generated sixteen papers that were focused on nurse education in higher education institutions. Several papers focused on simulation as a teaching method for veteran-specific health issues or curriculum developments with educational innovations such as online courses. Six papers focusing in continuing professional education of nurses in the clinical setting were included as supplementary information. All papers reviewed were US focused and dated between January 2011 and September 2015. Our search concluded that there is a gap in knowledge in this subject area within a UK context, therefore our review includes UK background information to support the US findings. CONCLUSION Civilian nurses need educational preparation to understand the specific needs of veterans. Educational institutions in the US have responded to nationwide initiatives to undertake that preparation. More empirical studies need to be undertaken to develop, test and evaluate educational innovations for preparing students and nurses delivering care to military veteran in civilian healthcare settings.
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Affiliation(s)
- Linda Cooper
- Veterans and Families Institute, Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford CMI 1SQ, UK.
| | - Sharon Andrew
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford CMI 1SQ, UK.
| | - Matt Fossey
- Veterans and Families Institute, Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford CMI 1SQ, UK.
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Kimbrel NA, DeBeer BB, Meyer EC, Gulliver SB, Morissette SB. Nonsuicidal self-injury and suicide attempts in Iraq/Afghanistan war veterans. Psychiatry Res 2016; 243:232-7. [PMID: 27419652 PMCID: PMC5560029 DOI: 10.1016/j.psychres.2016.06.039] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/28/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
The present study examined the association between history of nonsuicidal self-injury (NSSI) and history of suicide attempts (SA) among 292 Iraq/Afghanistan veterans, half of whom carried a lifetime diagnosis of posttraumatic stress disorder (PTSD). Consistent with hypotheses, veterans who reported a history of NSSI were significantly more likely to report a history of SA than veterans without a history of NSSI. In addition, logistic regression demonstrated that NSSI remained a significant predictor of SA even after a wide range of covariates (i.e., combat exposure, traumatic brain injury, PTSD, depression, alcohol dependence) were considered. Taken together, these findings suggest that clinicians working with veterans should include NSSI history as part of their standard risk assessment battery.
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Affiliation(s)
- Nathan A. Kimbrel
- Durham Veterans Affairs Medical Center, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA,Duke University Medical Center, Durham, NC, USA,Correspondence concerning this article should be sent to: Dr. Nathan A. Kimbrel, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705. Phone: (919) 286-0411, ext. 6759.
| | - Bryann B. DeBeer
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA,Central Texas Veterans Health Care System, Temple, Texas, USA,Texas A&M University Health Science Center, College Station, Texas, USA
| | - Eric C. Meyer
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA,Central Texas Veterans Health Care System, Temple, Texas, USA,Texas A&M University Health Science Center, College Station, Texas, USA
| | - Suzy B. Gulliver
- Warriors Research Institute, Baylor, Scott & White Healthcare System, Waco, TX, USA
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Sareen J, Afifi TO, Taillieu T, Cheung K, Turner S, Bolton SL, Erickson J, Stein MB, Fikretoglu D, Zamorski MA. Trends in suicidal behaviour and use of mental health services in Canadian military and civilian populations. CMAJ 2016; 188:E261-E267. [PMID: 27221270 DOI: 10.1503/cmaj.151047] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 02/22/2016] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In the context of the Canadian mission in Afghanistan, substantial media attention has been placed on mental health and lack of access to treatment among Canadian Forces personnel. We compared trends in the prevalence of suicidal behaviour and the use of mental health services between Canadian military personnel and the general population from 2002 to 2012/13. METHODS We obtained data for respondents aged 18-60 years who participated in 4 nationally representative surveys by Statistics Canada designed to permit comparisons between populations and trends over time. Surveys of the general population were conducted in 2002 (n = 25 643) and 2012 (n = 15 981); those of military personnel were conducted in 2002 (n = 5153) and 2013 (n = 6700). We assessed the lifetime and past-year prevalence of suicidal ideation, plans and attempts, as well as use of mental health services. RESULTS In 2012/13, but not in 2002, military personnel had significantly higher odds of both lifetime and past-year suicidal ideation than the civilian population (lifetime: adjusted odds ratio [OR] 1.32, 95% confidence interval [CI] 1.17-1.50; past year: adjusted OR 1.34, 95% CI 1.09-1.66). The same was true for suicidal plans (lifetime: adjusted OR 1.64, 95% CI 1.35-1.99; past year: adjusted OR 1.66, 95% CI 1.18-2.33). Among respondents who reported past-year suicidal ideation, those in the military had a significantly higher past-year utilization rate of mental health services than those in the civilian population in both 2002 (adjusted OR 2.02, 95% CI 1.31-3.13) and 2012/13 (adjusted OR 3.14, 95% CI 1.86-5.28). INTERPRETATION Canadian Forces personnel had a higher prevalence of suicidal ideation and plans in 2012/13 and a higher use of mental health services in 2002 and 2012/13 than the civilian population.
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Affiliation(s)
- Jitender Sareen
- Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont.
| | - Tracie O Afifi
- Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont
| | - Tamara Taillieu
- Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont
| | - Kristene Cheung
- Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont
| | - Sarah Turner
- Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont
| | - Shay-Lee Bolton
- Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont
| | - Julie Erickson
- Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont
| | - Murray B Stein
- Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont
| | - Deniz Fikretoglu
- Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont
| | - Mark A Zamorski
- Departments of Psychiatry (Sareen, Afifi, Bolton), Psychology (Sareen, Cheung, Erickson) and Community Health Sciences (Sareen, Afifi, Turner, Bolton), University of Manitoba, Winnipeg, Man.; Applied Health Sciences Program (Taillieu), Department of Psychiatry (Stein), University of California San Diego; VA San Diego Healthcare System (Stein), San Diego, Calif.; Defence Research and Development Canada (Fikretoglu); Directorate of Mental Health (Zamorski), Canadian Forces Health Services Group HQ; Department of Family Medicine, University of Ottawa, Ottawa, Ont
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Zheng WY, Kanesarajah J, Waller M, McGuire AC, Treloar SA, Dobson AJ. Childhood adversity and traumatic exposures during deployment as predictors of mental health in Australian military veterans. Aust N Z J Public Health 2015; 40:10-5. [DOI: 10.1111/1753-6405.12499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/01/2015] [Accepted: 10/01/2015] [Indexed: 12/01/2022] Open
Affiliation(s)
- Wu Yi Zheng
- Australian Institute of Health Innovation; Macquarie University; New South Wales
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Alexopoulos EC, Kavalidou K, Messolora F. Suicide Mortality Across Broad Occupational Groups in Greece: A Descriptive Study. Saf Health Work 2015; 7:1-5. [PMID: 27014484 PMCID: PMC4792908 DOI: 10.1016/j.shaw.2015.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 08/31/2015] [Accepted: 09/03/2015] [Indexed: 11/30/2022] Open
Abstract
Background Several studies have investigated the relationship between specific occupations and suicide mortality, as suicide rates differ by profession. The aim of this study was to investigate suicide mortality ratios across broad occupational groups in Greece for both sexes in the period 2000–2009. Methods Data of suicide deaths were retrieved from the Hellenic Statistical Authority and comparative mortality ratios were calculated. Occupational classification was based on the International Classification of Occupations (ISCO-88) and the coding for Intentional self-harm (X60–X84) was based on the international classification of diseases (ICD-10). Results Male dominant occupations, mainly armed forces, skilled farmers and elementary workers, and female high-skilled occupations were seen as high risk groups for suicide in a period of 10 years. The age-productive group of 30–39 years in Greek male elementary workers and the 50–59 age-productive group of Greek professional women proved to have the most elevated number of suicide deaths. Conclusion Further research is needed into the work-related stressors of occupations with high suicide mortality risk and focused suicide prevention strategies should be applied within vulnerable working age populations.
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Affiliation(s)
| | - Katerina Kavalidou
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Fani Messolora
- Peristeri's Regional Health Unit, Social Insurance Institute (IKA), Athens, Greece
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Goodwin L, Wessely S, Fear NT. The Future of "Big Data" in Suicide Behaviors Research: Can We Compare the Experiences of the U.S. and U.K. Armed Forces? Psychiatry 2015; 78:25-8. [PMID: 26168024 DOI: 10.1080/00332747.2015.1016783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The recent increased suicide rate in the U.S. military has received widespread academic and media attention (Nock et al., 2013). "Big data" has been defined as large, complex, and linkable information (Khoury & Ioannidis, 2014) that can be used to investigate such changes in incidence at a population level. "Big health data" can revolutionize the future of epidemiological research, and this commentary discusses a specific example of how it can be used to progress suicide research.
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Soltaninejad A, Fathi-Ashtiani A, Ahmadi K, Mirsharafoddini HS, Nikmorad A, Pilevarzadeh M. Personality factors underlying suicidal behavior among military youth. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e12686. [PMID: 24910793 PMCID: PMC4028766 DOI: 10.5812/ircmj.12686] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/06/2013] [Accepted: 07/24/2013] [Indexed: 11/16/2022]
Abstract
Background: Suicidal behavior is one the most significant mental health problems in the military. Militaries are closed systems that operate in particular situations. Military service is associated with certain stressful conditions. On this basis, there is likely of trauma in the military environment. Measures of suicidal behavior are pathologically complex. A range of biological, psychological, social, and institutional factors are involved in the incidence and prevalence of these behaviors. Objectives: One of the underlying factors in suicidal behavior is individuals' personality. Patients and Methods: The study population comprised of the Iranian Armed Forces. To recruit the sample of the research, 1659 soldiers were selected by multistage sampling. Data were collected using the Beck Scale for Suicide Ideation (BSSI) and NEO-Five Factor Inventory. Results: There was a significant positive correlation (r = 0.323) between neuroticism and suicide ideation; however, significant negative correlations existed between three other personality traits --extraversion [r = -0.306], agreeableness [r = -0.227], and conscientiousness [r = -0.271] and suicidal ideation. Unlike neuroticism, extraversion and conscientiousness personality factors could reduce significantly (as much 14% as are predicted) levels of suicidal ideation. Conclusions: Based on these results, neuroticism might increase suicide, but extraversion and conscientiousness personality traits are associated with a reduced risk of suicide.
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Affiliation(s)
- Abdollah Soltaninejad
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Abdollah Soltaninejad, Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-9126237032, E-mail:
| | - Ali Fathi-Ashtiani
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Khodabakhsh Ahmadi
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | | | - Alireza Nikmorad
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Motahare Pilevarzadeh
- Nursing and Midwifery Faculty, Jiroft University of Medical Sciences, Jiroft, IR Iran
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Bryan C, Bryan A. Nonsuicidal Self-Injury Among a Sample of United States Military Personnel and Veterans Enrolled in College Classes. J Clin Psychol 2014; 70:874-85. [DOI: 10.1002/jclp.22075] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Craig Bryan
- National Center for Veterans Studies-The University of Utah
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MacManus D, Jones N, Wessely S, Fear NT, Jones E, Greenberg N. The mental health of the UK Armed Forces in the 21st century: resilience in the face of adversity. J ROY ARMY MED CORPS 2014; 160:125-30. [DOI: 10.1136/jramc-2013-000213] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hunt EJF, Wessely S, Jones N, Rona RJ, Greenberg N. The mental health of the UK Armed Forces: where facts meet fiction. Eur J Psychotraumatol 2014; 5:23617. [PMID: 25206948 PMCID: PMC4138705 DOI: 10.3402/ejpt.v5.23617] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 04/05/2014] [Accepted: 05/21/2014] [Indexed: 11/14/2022] Open
Abstract
A substantial amount of research has been conducted into the mental health of the UK military in recent years. This article summarises the results of the various studies and offers possible explanations for differences in findings between the UK and other allied nations. Post-traumatic stress disorder (PTSD) rates are perhaps surprisingly low amongst British forces, with prevalence rates of around 4% in personnel who have deployed, rising to 6% in combat troops, despite the high tempo of operations in recent years. The rates in personnel currently on operations are consistently lower than these. Explanations for the lower PTSD prevalence in British troops include variations in combat exposures, demographic differences, higher leader to enlisted soldier ratios, shorter operational tour lengths and differences in access to long-term health care between countries. Delayed-onset PTSD was recently found to be more common than previously supposed, accounting for nearly half of all PTSD cases; however, many of these had sub-syndromal PTSD predating the onset of the full disorder. Rates of common mental health disorders in UK troops are similar or higher to those of the general population, and overall operational deployments are not associated with an increase in mental health problems in UK regular forces. However, there does appear to be a correlation between both deployment and increased alcohol misuse and post-deployment violence in combat troops. Unlike for regular forces, there is an overall association between deployment and mental health problems in Reservists. There have been growing concerns regarding mild traumatic brain injury, though this appears to be low in British troops with an overall prevalence of 4.4% in comparison with 15% in the US military. The current strategies for detection and treatment of mental health problems in British forces are also described. The stance of the UK military is that psychological welfare of troops is primarily a chain of command responsibility, aided by medical advice when necessary, and to this end uses third location decompression, stress briefings, and Trauma Risk Management approaches. Outpatient treatment is provided by Field Mental Health Teams and military Departments of Community Mental Health, whilst inpatient care is given in specific NHS hospitals.
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Affiliation(s)
- Elizabeth J F Hunt
- Academic Centre for Defence Mental Health (ACDMH), King's College London, Western Education Centre, London, UK
| | - Simon Wessely
- King's Centre for Military Health Research (KCMHR), King's College London, Western Education Centre, London, UK
| | - Norman Jones
- Academic Centre for Defence Mental Health (ACDMH), King's College London, Western Education Centre, London, UK
| | - Roberto J Rona
- King's Centre for Military Health Research (KCMHR), King's College London, Western Education Centre, London, UK
| | - Neil Greenberg
- Academic Centre for Defence Mental Health (ACDMH), King's College London, Western Education Centre, London, UK
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Rivlin A, Hawton K, Marzano L, Fazel S. Psychosocial characteristics and social networks of suicidal prisoners: towards a model of suicidal behaviour in detention. PLoS One 2013; 8:e68944. [PMID: 23922671 PMCID: PMC3726684 DOI: 10.1371/journal.pone.0068944] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 06/04/2013] [Indexed: 11/21/2022] Open
Abstract
Prisoners are at increased risk of suicide. Investigation of both individual and environmental risk factors may assist in developing suicide prevention policies for prisoners and other high-risk populations. We conducted a matched case-control interview study with 60 male prisoners who had made near-lethal suicide attempts in prison (cases) and 60 male prisoners who had not (controls). We compared levels of depression, hopelessness, self-esteem, impulsivity, aggression, hostility, childhood abuse, life events (including events occurring in prison), social support, and social networks in univariate and multivariate models. A range of psychosocial factors was associated with near-lethal self-harm in prisoners. Compared with controls, cases reported higher levels of depression, hopelessness, impulsivity, and aggression, and lower levels of self-esteem and social support (all p values <0.001). Adverse life events and criminal history factors were also associated with near-lethal self-harm, especially having a prior prison spell and having been bullied in prison, both of which remained significant in multivariate analyses. The findings support a model of suicidal behaviour in prisoners that incorporates imported vulnerability factors, clinical factors, and prison experiences, and underscores their interaction. Strategies to reduce self-harm and suicide in prisoners should include attention to such factors.
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Affiliation(s)
- Adrienne Rivlin
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, United Kingdom
| | - Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, United Kingdom
| | - Lisa Marzano
- Psychology Department, Middlesex University, The Burroughs, London, United Kingdom
| | - Seena Fazel
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, United Kingdom
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Hines LA, Jawahar K, Wessely S, Fear NT. Self-harm in the UK military. Occup Med (Lond) 2013; 63:354-7. [DOI: 10.1093/occmed/kqt065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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