Suicidal ideation in male UK military personnel who sustained a physical combat injury in Afghanistan and the mediating role of leaving service: The ADVANCE cohort study

BACKGROUND/AIMS

Suicidal Ideation (SI) is a risk factor for suicide, a leading cause of death amongst young men globally. In this study we assess whether sustaining a serious physical combat injury is associated with SI and whether leaving service mediates this association.

METHODS

We analysed data from male UK Armed Forces personnel who sustained a combat injury in Afghanistan and a frequency-matched comparison group who did not sustain such an injury (the ADVANCE cohort). SI was measured from the Patient Health Questionnaire-9 item 'thoughts that you would be better off dead or of hurting yourself in some way'.

RESULTS

Approximately, 11.9% (n = 61) of the uninjured group, 15.3% (n = 83) of the overall injured group, 8.5% (n = 13) of an Amputation injury (AI) subgroup and 17.6% (n = 70) of a Non-Amputation Injury (NAI) subgroup reported SI in the past 2 weeks. The NAI subgroup reported greater likelihood of SI (Relative Risk Ratio (RR) = 1.44, 95% confidence interval (CI) [1.04, 2.00]) compared to the comparison group, whereas the overall injured group (RR = 1.23, 95% CI [0.90, 1.68]) and AI subgroup (RR = 0.65, 95% CI [0.36, 1.18]) did not. Leaving service fully mediated the association between sustaining a NAI and SI (natural direct effect RR = 1.08, 95% CI [0.69, 1.69]).

CONCLUSIONS

UK military personnel with NAI reported significantly higher rates of SI compared to demographically similar uninjured personnel, while those who sustained AIs reported no significant difference. Leaving service was associated with greater rates of SI for both injured and uninjured personnel and fully mediated the association between sustaining a NAI and SI.

An empirical investigation of the distinction between passive and active ideation: Understanding the latent structure of suicidal thought content

INTRODUCTION

Although the distinction between passive and active suicidal ideation is well accepted by suicide researchers and clinicians, there has been very little empirical investigation into this distinction. The current study addressed this gap by examining the latent structure of suicidal ideation based on thought content.

METHOD

Participants from two distinct samples of U.S. adults (n1 = 6200; n2 = 10,625) completed a self-report assessment of eight commonly experienced suicidal thoughts using the Self-Injurious Thoughts and Behaviors Interview-Revised. Exploratory structural equation modeling was used to examine the latent structure of suicidal thoughts.

RESULTS

The two-factor model demonstrated significantly better fit than the one-factor solution across both samples. Thoughts typically classified as passive ideation strongly loaded onto one factor, whereas thoughts typically classified as active ideation loaded onto the second factor. The two factors were highly correlated and some suicidal thoughts exhibited meaningful cross-loading.

CONCLUSION

Our results suggest that passive and active ideation are two distinct constructs. Although they often co-occur, passive and active ideation are not nested constructs and should not be viewed as gradients of one underlying construct. Our findings suggest that at a minimum both passive and active ideation should be included in all suicide risk assessments and screenings.

Recent Stressful Life Events and Suicidal Ideation in Schizophrenia: A 1-Year Follow-up Study

ABSTRACT

Half of patients with schizophrenia experience suicidal ideation. Only few studies have examined the effects of recent stress on both current and emergent suicidal ideation.A cohort of 85 patients with schizophrenia spectrum disorders was assessed. The study was divided into a cross-sectional and longitudinal arms to test the effect of recent stress on suicidal ideation. Analysis was done using logistic regression models.After correcting for covariates, recent stress had no significant effect on current suicidal ideation. However, increased total stress (odds ratio [OR] = 1.099 [1.032-1.170], p = 0.003) and health-related stress (OR = 1.331 [1.074-1.650], p = 0.009) at follow-up were predictive of emergent suicidal ideation.With this sample size, we were unable to draw firm conclusions regarding the effect of specific life events on suicidal ideation. Further studies involving larger samples that investigate the interplay between several risk factors are needed.

Comorbid alcohol-related problems and suicidality disproportionately impact men and emerging adults among individuals with depressive symptoms

OBJECTIVE

Depressive disorders are common among adults with alcohol use disorder and with suicidality; however, demographic differences in comorbid alcohol use disorder, binge drinking, and suicidality are understudied. The objective of this study was to determine the extent to which comorbid suicidality and alcohol use disorders and comorbid suicidality and binge drinking differ by age and gender among adults with depressive symptoms.

METHOD

The sample included adults (unweighted N=29,460) in the United States who completed the 2015-2018 National Survey of Drug Use and Heath and screened positively for depression. Gender and age groups odds of alcohol use disorder only, suicidality only, and alcohol use disorder+suicidality were compared to neither problem. Similar analyses were conducted for binge drinking.

RESULTS

Men showed disproportional odds of alcohol use disorder only, all suicidality and alcohol use disorder comorbidities, and binge drinking+active suicidal ideation than women. Emerging adults showed higher odds of: passive and active suicidal ideation only and suicidality+alcohol use disorder than adults 35 and older; binge drinking only, binge drinking+passive suicidal ideation, and binge drinking+active suicidal ideation than all older adults; binge drinking+suicide planning and binge drinking+attempts than adults 50 and older.

LIMITATIONS

Because participants all reported depression symptoms either at the subclinical or clinical level, demographic differences in suicidality, alcohol use disorder, and binge drinking found in this study cannot be generalized to non-depressed samples.

CONCLUSIONS

Treatment providers should be aware of disproportionately higher odds of comorbid suicidality and alcohol use disorder, and suicidality and binge drinking among men and emerging adults.

Exposure to suicide in the family and suicidal ideation in Portugal during the Covid-19 pandemic: The mediating role of unbearable psychache

Objectives

This study tested the mediation effects of two facets of psychache – bearable and unbearable – in the relationship between exposure to suicide in the family and suicidal ideation in Portugal during the Covid‐19 pandemic.

Methods

Two hundred and forty‐four adults aged between 19 and 64 participated. Two groups were defined: one exposed to suicide in the family (n = 42) and a control group (n = 192).

Results

Path analysis using structural equation modelling tested a mediation model. Results demonstrated that unbearable psychache fully mediated the relationship between exposure to suicide and suicidal ideation, even when controlling for the mediation effects of depressive symptoms, the presence of a psychiatric diagnosis, and years of education.

Conclusions

These results suggest that rather than considering just the global experience of psychache in individuals exposed to suicide, researchers and clinicians should look to the presence of unbearable psychache given its contribution to suicidal ideation.

Practitioner points

Unbearable psychache fully mediated the relationship between exposure to suicide in the family and suicidal ideation

It is not the global experience of psychache that contributes to suicide ideation in individuals exposed to suicide in the family rather the presence of unbearable psychache

The Relationships Between Risk-Taking, Depression, and Alcohol Use in the Experience of Suicidal Ideation Among Adults in the General Population

Risk-taking is associated with suicide among depressed adolescents. In the United States, alcohol is among the most used substances resulting in need for treatment. While alcohol use relates to greater depression and suicidality, less is known about these relationships with risk-taking tendencies, particularly among adult populations. The current study examined suicidal ideation, alcohol use, depression, and risk-taking tendencies among adults 18-65 years old who participated in the 2017 National Survey on Drug Use and Health. Structural equation modeling was used to examine the specific aims in Mplus8. A total of 1,740 (21.4%) participants endorsed suicidal ideation. The model demonstrated good fit and findings indicate increases in alcohol abuse or dependence (b = 0.094, SE = 0.01, p < .001), depression (b = 0.036, SE = 0.01, p < .001), and risk-taking (b = 0.044, SE = 0.01, p < .001) all independently related to increased odds of ideation. Increases in alcohol abuse or dependence (b = 0.210, SE = 0.02, p < .001) and depression (b = 0.026, SE = 0.01, p < .05) also related to elevated risk-taking. Based on the joint significance test, risk-taking tendencies served as a partial mediator, functioning as a mechanism in the relationships between alcohol use, depression, and ideation. Risk-taking thus serves as an important treatment target in the prevention of suicide. Implications for practice and future research are discussed.

Correctional Work: Reflections Regarding Suicide

The Public Health Agency of Canada declared suicide a public health problem in Canada (2016). Employees working in correctional services, researchers find, experience high rates of life-time suicidal ideation in comparison to other public safety professionals and the general population. Suicide behaviours (i.e., ideation, planning, attempts, death) are a multifactorial phenomenon, explained in part by the Interpersonal-Psychological Theory of Suicide that suggests attempted suicide is facilitated by perceived burdensomeness, a lost sense of belonging, a feeling of hopelessness, and a progressively reduced fear of death, as well as capacity and planning to engage a lethal attempt. In the current study, we unpack the factors that can influence suicide behaviours as reported by correctional workers. Our intent is to make explicit the experiences of a small sample (n = 25) of correctional workers in relation to suicidal behaviours, highlighting stories of recovery and acknowledging the importance of facilitating psychologically safe workplaces. Analysis entailed an inductive semi-grounded emergent theme approach. Participants identified certain risk factors as being able to induce suicidal ideation, such as marital or family problems as well as difficulties at work (i.e., bullying or difficult working conditions). Having children and a partner may act as factors preventing suicide for those with ideation. Participants sought help from professionals, such as their family doctor, a psychologist, or the Employee Assistance Program (EAP); however, the lack of perceived organisational supports and recognition of the issue of suicide by the employer are two elements that can hinder the search for help.

Assessing Suicidal Ideation Using a Brief Self-Report Measure

Accurate assessment of suicidal thoughts is a challenge for researchers and clinicians. There is evidence that self-report and clinical interview assessment methods can result in different endorsement numbers when used to assess suicidal ideation. This study investigates endorsement rates and psychometric properties of a two-item self-report measure of suicidal ideation that distinguishes active from passive suicidal ideation, when compared with a clinical interview. Individuals presenting at an outpatient psychiatry clinic completed a measure of depression severity containing two items assessing passive and active suicidal ideation before undergoing a structured clinical interview. Self-report and clinical interview items demonstrated a low level of agreement. Self-report items were more strongly correlated with same-domain clinical interviewer ratings than different-domain ratings. These items demonstrated high negative predictive value and moderate-to-low positive predictive value for interviewer ratings. A two-item measure of suicidal ideation did not highly align with corresponding interviewer ratings, though such a measure may be useful in determining the absence of suicidal ideation, as well as distinguishing between passive and active suicidal ideation.

Retracted: The Three-Step Theory of Suicide: An Independent Replication and Conceptual Extension

Retraction: Christopher R. Hagan PhD, Jennifer J. Muehlenkamp PhD, "The Three-Step Theory of Suicide: An Independent Replication and Conceptual Extension," Suicide and Life-Threatening Behavior, Wiley, © American Association of Suicidology The above article, published online on 30 September 2019 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors, the journal Editor in Chief, Thomas Joiner, PhD, and John Wiley and Sons Ltd. The retraction has been agreed due to errors in variable calculation and a post-publication reviewer's concerns that some analyses did not accurately test the theoretical model. An updated version of this article will soon undergo review for publication at Suicide and Life-Threatening Behavior, and if accepted for publication, will be accompanied by an editorial from the Editor-in-Chief.

Characterizing the phenomenology of passive suicidal ideation: a systematic review and meta-analysis of its prevalence, psychiatric comorbidity, correlates, and comparisons with active suicidal ideation

BACKGROUND

Compared to active ideation, passive ideation remains relatively understudied and its clinical importance poorly defined. The weight that should be accorded passive ideation in clinical risk assessment is therefore unclear.

METHODS

We conducted a systematic review and meta-analysis of the prevalence of passive ideation, its psychiatric comorbidity, associated sociodemographic characteristics, as well as psychological and environmental correlates. For reference, pooled effects were also calculated for direct comparisons of passive and active ideation with respect to potential correlates. Relevant articles published since inception to 9 September 2019 were identified through a systematic search of MEDLINE and PsycINFO.

RESULTS

A total of 86 studies were included in this review. The prevalence of passive ideation was high across sample types, ranging from 5.8% for 1-year prevalence to 10.6% for lifetime prevalence in the general population. Passive ideation was strongly associated with sexual minority status, psychiatric comorbidity, psychological characteristics implicated in risk, and suicide attempts. Preliminary evidence exists for a large association with suicide deaths. The effect sizes for individual correlates of passive and active ideation were largely equivalent and mostly non-significant in head-to-head comparisons.

CONCLUSIONS

Passive ideation is a prevalent clinical phenomenon associated with significant psychiatric comorbidity. Current evidence also suggests notable similarities exist between passive and active ideation in terms of psychiatric comorbidity and psychological and other characteristics traditionally associated with risk.

Suicidal and Death Ideation in a Cohort of Psychiatric Outpatients

In Africa, data on the prevalence and predictors of death and suicidal ideation is lacking. In this study, a cross-sectional design was used to investigate the prevalence and risk factors for death and suicidal ideation in a cohort of 239 psychiatric patients receiving outpatient treatment at nine sites in the Durban area (South Africa) in 2015. Prevalence rates for death and suicidal ideation were high, with 35 (16%) patients reporting death ideation and 95 (40%) reporting suicidal ideation. Both death and suicidal ideation were significantly associated with unemployment (ORs = 2.61 and 2.34, respectively) and a primary diagnosis of depressive disorder (ORs = 4.72 and 6.54, respectively). Factors that uniquely predicted death ideation were: not being in an intimate relationship (OR = 6.45), ethnicity (being Indian South African: OR = 3.28) and a primary diagnosis of bipolar disorder (OR = 4.61), with suicidal ideation being uniquely predicted by a lower level of educational attainment (OR 2.86), ethnicity (being Black South African: OR = 3.36) and a primary diagnosis of borderline personality disorder (OR = 7.14). Study findings are discussed in terms of their implications for practice and future research.