1
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Sher L, Bierer LM, Flory J, Makotkine I, Yehuda R. Interplay of combat deployment harassment, testosterone concentrations and post-deployment suicide risk in male veterans. Acta Neuropsychiatr 2024; 36:167-171. [PMID: 38528804 DOI: 10.1017/neu.2024.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
OBJECTIVE Many combat veterans exhibit suicidal ideation and behaviour, but the relationships among experiences occurring during combat deployment and suicidality are still not fully understood. In this study, we tested the hypothesis that harassment during a combat deployment is associated with post-deployment suicidality and testosterone function. METHODS Male combat veterans who made post-deployment suicide attempts and demographically matched veterans without a history of suicide attempts were enrolled in the study. Demographic and clinical parameters of study participants were assessed and recorded. Study participants were interviewed by a trained clinician using the Mini-International Neuropsychiatric Interview (MINI), the Deployment Risk and Resilience Inventory (DRRI) – Relationships within unit scale, the Scale for Suicidal Ideation (SSI), and the Brown–Goodwin Aggression Scale. Free testosterone levels were assessed in morning blood samples. RESULTS DRRI harassment scores were higher and free testosterone levels were lower among suicide attempters in comparison with non-attempters. In the whole sample, DRRI harassment scores positively correlated with SSI scores and negatively correlated with free testosterone levels. Free testosterone levels negatively correlated with SSI scores. Aggression scale scores positively correlated with DRRI harassment scores among non-attempters but not among attempters. CONCLUSION Our observations that harassment scores are associated with suicidality and testosterone levels, and suicidality is associated with testosterone levels may indicate that there is a link between deployment harassment, testosterone function and suicidality.
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Affiliation(s)
- Leo Sher
- James J. Peters VA Medical Center, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Linda M Bierer
- James J. Peters VA Medical Center, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Janine Flory
- James J. Peters VA Medical Center, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Iouri Makotkine
- James J. Peters VA Medical Center, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rachel Yehuda
- James J. Peters VA Medical Center, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
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2
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Pardue-Bourgeois S, Goldberg SB, Wyman MF, Abbas M, Flynn AWP, Domínguez S, Tucker RP. The Link between Deployment-Related Injuries and Suicidal Thinking in the Army National Guard: Examining the Role of Perceived Burdensomeness and Hopelessness. Arch Suicide Res 2023:1-12. [PMID: 37881842 PMCID: PMC11045658 DOI: 10.1080/13811118.2023.2270667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
OBJECTIVE In 2020, Army National Guard members demonstrated greater risk of suicide than their military and civilian counterparts. Though literature on deployment-related experiences and suicidal ideation (SI) is mixed, investigations of specific deployment-related experiences (e.g., injuries) may further elucidate the relationship between deployment and suicide risk. Deployment-related injuries, including pain severity and functional impairment, have been linked to increased risk of SI, and correlates like perceived burdensomeness (PB) and hopelessness. The current study sought to examine the cross-sectional relationship between deployment-related injuries, including pain severity and functional impairment, and severity of SI through PB and hopelessness. METHOD Immediately post-deployment, Army National Guard members (N = 2,261) completed validated self-report measures on past-week SI, PB, hopelessness, and single items regarding injury sustained during deployment and associated functional impairment and pain severity. RESULTS Indirect effect analyses revealed that experience of deployment-related injury was related to SI through PB and hopelessness (R2 = .1993), functional impairment was related to SI through PB, and pain severity was related to SI through PB. Contrary to hypotheses, hopelessness was not associated with SI when PB was simultaneously considered. CONCLUSIONS Army National Guard members who develop a sense of PB related to their injury and functional impairment of that injury may be at increased risk for suicidal ideation. Military suicide-prevention efforts may be potentiated through targeting distorted cognitions such as PB and hopelessness, especially in service members who have been injured.
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3
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Ruiz F, Burgo-Black L, Hunt SC, Miller M, Spelman JF. A Practical Review of Suicide Among Veterans: Preventive and Proactive Measures for Health Care Institutions and Providers. Public Health Rep 2023; 138:223-231. [PMID: 35403486 PMCID: PMC10031829 DOI: 10.1177/00333549221085240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Suicide rates among veterans are higher than those of the general US population. Although veterans compose only 7.6% of the US population, nearly 14% of American adult suicides are among veterans. The rate of suicide is 1.5 times higher among all veterans and 2.1 times higher among female veterans compared with the general population. Only 47% of all veterans are enrolled in the US Department of Veterans Affairs (VA) Healthcare System, leaving a large number either not receiving health care or receiving it outside the VA. Recent legislation has improved access to care for veterans outside the VA, highlighting the need for a broad public health approach to address veteran suicide and the need for all health care institutions and clinicians to be familiar with the unique health concerns in this population. The purpose of this narrative review was to summarize the risk factors contributing to veteran suicide and to provide guidance on how to assess and mitigate these risks. Suicide is preventable through recognition of risk and prompt intervention. Health care providers both inside and outside the VA system are uniquely situated at the intersection of the many contributing factors to veteran suicide and should have a structured, proactive approach to address the problem.
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Affiliation(s)
- Frank Ruiz
- Frank H. Netter MD School of
Medicine–Quinnipiac University, North Haven, CT, USA
| | - Lucile Burgo-Black
- VA Connecticut Healthcare System, West
Haven, CT, USA
- Department of General Internal
Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Stephen C. Hunt
- VA Puget Sound Healthcare Systems,
Seattle, WA, USA
- University of Washington School of
Medicine, Seattle, WA, USA
| | - Matthew Miller
- Office of Mental Health and Suicide
Prevention, US Department of Veterans Affairs, Washington, DC, USA
- Suicide Prevention Program and Veterans
Crisis Line, Office of Mental Health and Suicide Prevention, US Department of
Veterans Affairs, Washington, DC, USA
| | - Juliette F. Spelman
- VA Connecticut Healthcare System, West
Haven, CT, USA
- Department of General Internal
Medicine, Yale School of Medicine, New Haven, CT, USA
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4
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Walker LE, Poltavskiy E, Howard JT, Janak JC, Watrous J, Alcover K, Pettey WBP, Ambardar S, Meyer E, Gundlapalli AV, Stewart IJ. Suicide attempts and mental health diagnoses in combat-injured service members: A retrospective cohort study. Suicide Life Threat Behav 2022; 53:227-240. [PMID: 36576267 DOI: 10.1111/sltb.12938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/19/2022] [Accepted: 12/05/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Examinations of risk factors for suicide attempt in United States service members at high risk of mental health diagnoses, such as those with combat injuries, are essential to guiding prevention and intervention efforts. METHODS Retrospective cohort study of 8727 combat-injured patients matched to deployed, non-injured patients utilizing Department of Defense and Veterans Affairs administrative records. RESULTS Combat injury was positively associated with suicide attempt in the univariate model (HR = 1.75, 95% CI 1.5-2.1), but lost significance after adjustment for mental health diagnoses. Utilizing Latent Transition Analysis in the combat-injured group, we identified five mental/behavioral health profiles: (1) Few mental health diagnoses, (2) PTSD and depressive disorders, (3) Adjustment disorder, (4) Multiple mental health comorbidities, and (5) Multiple mental health comorbidities with alcohol use disorder (AUD). Multiple mental health comorbidities with AUD had the highest suicide attempt rate throughout the study and more than four times that of Multiple mental health comorbidities in the first study year (23.4 vs. 5.1 per 1000 person years, respectively). CONCLUSION Findings indicate that (1) combat injury's impact on suicide attempt is attenuated by mental health and (2) AUD with multiple mental health comorbidities confers heightened suicide attempt risk in combat-injured service members.
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Affiliation(s)
- Lauren E Walker
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Eduard Poltavskiy
- David Grant USAF Medical Center, Travis AFB, Fairfield, California, USA
| | | | | | - Jessica Watrous
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Leidos Inc., San Diego, California, USA
| | - Karl Alcover
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Warren B P Pettey
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Shiva Ambardar
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Eric Meyer
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Adi V Gundlapalli
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ian J Stewart
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Military Cardiovascular Outcomes Research (MiCOR), Bethesda, Maryland, USA
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5
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Griffith J. Combat events and negative emotions associated with postdeployment illicit drug use among Army National Guard soldiers. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2148580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- James Griffith
- National Center for Veterans Studies, University of Utah
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6
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Wu C, Hou G, Lin Y, Sa Z, Yan J, Zhang X, Liang Y, Yang K, Zhang Y, Lang H. Exploring links between Chinese military recruits' psychological stress and coping style from the person-environment fit perspective: The chain mediating effect of self-efficacy and social support. Front Psychol 2022; 13:996865. [PMID: 36405197 PMCID: PMC9673819 DOI: 10.3389/fpsyg.2022.996865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
The choice of coping style of recruits under psychological stress in the process of military task execution has been an important topic in the promotion of military operations and cohesion of military forces. Taking a positive coping style under psychological stress can help recruits overcome the negative effects of stress and improve military morale and group combat effectiveness. Although soldiers' psychological stress in the process of military mission execution having an impact on coping style has been studied by a large body of literature, very little literature has focused on the mechanism of self-efficacy and social support between recruits' psychological stress and coping style from the person-environment fit perspective. Therefore, this study was conducted to analyze the impact of recruits' psychological stress on coping style through a chain mediation model and to discuss the role of self-efficacy and social support in this relationship. Two waves of survey data were utilized to test the research hypotheses on a sample of 1028 Chinese recruits performing military tasks. The results indicated that recruits' psychological stress negatively impacted positive coping styles and positively correlated with negative ones. In addition, self-efficacy and social support mediated the relationship between psychological stress and positive coping style, and self-efficacy mediated the relationship between psychological stress and negative coping style. More importantly, self-efficacy and social support play the chain mediating effect between psychological stress and positive coping style.
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Affiliation(s)
- Chao Wu
- Department of Nursing, Fourth Military Medical University, Xi'an, China
| | - Guangdong Hou
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yawei Lin
- Department of Nursing, Fourth Military Medical University, Xi'an, China
| | - Zhen Sa
- 69245 Troops of the Chinese People's Liberation Army, Xinjiang, China
| | - Jiaran Yan
- Department of Nursing, Fourth Military Medical University, Xi'an, China
| | - Xinyan Zhang
- Department of Engineer, Army 75 Group Military Hospital, Kunming, China
| | - Ying Liang
- 69243 Troops of the Chinese People's Liberation Army, Xinjiang, China
| | - Kejian Yang
- The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
- *Correspondence: Kejian Yang
| | - Yuhai Zhang
- Department of Health Statistics, School of Preventive Medicine, Fourth Military Medical University, Xi'an, China
- Yuhai Zhang
| | - Hongjuan Lang
- Department of Nursing, Fourth Military Medical University, Xi'an, China
- Hongjuan Lang
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7
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Carlson KF, Gilbert TA, DeFrancesco S, Wright DA, Shen X, Cook LJ. Accuracy of behavioral health variables in Oregon national violent death reporting system data: a linked cohort study. Inj Epidemiol 2022; 9:29. [PMID: 36100875 PMCID: PMC9469595 DOI: 10.1186/s40621-022-00393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background The National Violent Death Reporting System (NVDRS) collects data on the circumstances of violent deaths, and all firearm-related deaths, across states and territories in the USA. This surveillance system is critical to understanding patterns and risk factors for these fatalities, thereby informing targets for prevention. NVDRS variables include behavioral health conditions among decedents, but the validity of the reported behavioral health data is unknown. Using Department of Veterans Affairs (VA) healthcare records as a criterion standard, we examined the accuracy of NVDRS-reported behavioral health variables for veteran decedents in a sample state (Oregon) between 2003 and 2017.
Methods We linked Oregon NVDRS data to VA healthcare data to identify veteran decedents who used VA services within two years of death. Veterans’ VA diagnoses within this time frame, including depression, post-traumatic stress disorder (PTSD), anxiety, and substance use disorders, were compared to behavioral health variables identified in the Oregon NVDRS. Concordance, sensitivity, and correlates of sensitivity were examined over time and by decedent characteristics.
Results We identified 791 VA-using veterans with violent and/or firearm-related fatal injuries documented in the Oregon NVDRS between 2003 and 2017. In this cohort, the Oregon NVDRS accurately identified only 49% of decedents who were diagnosed with depression, 45% of those diagnosed with PTSD, and 17% of those diagnosed with anxiety by the VA. Among 211 veterans diagnosed by the VA with a substance use disorder, the Oregon NVDRS coded only 56% as having a substance use problem. In general, the sensitivity of behavioral health variables in the Oregon NVDRS remained the same or decreased over the study period; however, the sensitivity of PTSD diagnoses increased from 21% in 2003–2005 to 54% in 2015–2017. Sensitivity varied by some decedent characteristics, but not consistently across behavioral health variables.
Conclusions NVDRS data from one state missed more than half of behavioral health diagnoses among VA-using veterans who died from violence or from firearm injuries. This suggests that reports of behavioral health conditions among decedents nationally may be severely undercounted. Efforts to improve validity of these variables in state NVDRS data are needed.
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8
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Godby Vail S, Dierst-Davies R, Kogut D, Degiorgi Winslow L, Vargas J, Koeppl P, Marshall-Aiyelawo K. Behavioral health and treatment-seeking behaviors among deployed vs. non-deployed service members: How impactful is deployment on well-being? MILITARY PSYCHOLOGY 2022; 35:107-118. [PMID: 37133492 DOI: 10.1080/08995605.2022.2083468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Increasing attention has been dedicated to studying behavioral health of non-deployed military personnel. This investigation explored the impacts of a variety of sociodemographic and health factors on key behavioral health outcomes among active duty personnel. A secondary analysis was conducted using 2014 Defense Health Agency Health Related Behaviors Survey data (unweighted n = 45,762, weighted n = 1,251,606). Three logistic regression models investigated factors associated with reporting symptomatology consistent with depression, anxiety, and stress. We found that after adjusting for sociodemographic and other health variables (e.g., sleep), deployment was associated with stress but not anxiety or depression. Although deployed personnel were more likely to report increased levels of stress overall, few differences with respect to the sources of stressors were identified. While behavioral health screening and treatment needs may differ for non-deployed and deployed personnel, programs to support mental and physical well-being among all service members should be robustly promoted.
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9
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Hoffmire CA, Borowski S, Griffin BJ, Maguen S, Vogt D. Trajectories of suicidal ideation following separation from military service: Overall trends and group differences. Suicide Life Threat Behav 2022; 52:413-426. [PMID: 35067967 DOI: 10.1111/sltb.12831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although the transition out of military service is a high-risk time for suicidal ideation (SI), a paucity of research examines the development of SI during this transition process and veteran subgroups at risk for SI as they readjust to civilian life. METHODS A population-based, longitudinal post-9/11 veteran cohort reported SI frequency at 3, 9, 15, 21, and 27 months post-separation using the Patient Health Questionnaire-9. We identified distinct trajectories of SI over time (i.e., classes) using latent class growth analysis and examined demographic and military service predictors of class membership overall and by gender using multinomial logistic regression. RESULTS Four SI trajectories that were similar across genders were identified: resilient (90.1%), delayed onset (5.0%), remitting (2.7%), and chronic (2.2%). Younger age, minority race/ethnicity, medical and other (vs. honorable) separation types, and Veterans Health Administration service utilization were associated with increased odds of assignment to a higher-risk trajectory (delayed onset, remitting, and/or chronic vs. resilient), whereas continued service in the National Guard/Reserves and officer rank was associated with lower odds of assignment to a higher-risk trajectory. CONCLUSIONS Findings regarding veterans at greatest risk for SI following military separation can inform targeted assessment and early intervention efforts.
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Affiliation(s)
- Claire A Hoffmire
- Rocky Mountain MIRECC for Suicide Prevention, Department of Veterans Affairs, Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shelby Borowski
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Brandon J Griffin
- Central Arkansas VA Health Care System, Department of Veterans Affairs, Little Rock, Arkansas, USA.,Department of Psychiatry, University of Arkansas for Medical Services School of Medicine, Little Rock, Arkansas, USA
| | - Shira Maguen
- San Francisco VA Health Care System, Department of Veterans Affairs, San Francisco, California, USA.,Department of Psychiatry, University of California - San Francisco, San Francisco, California, USA
| | - Dawne Vogt
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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10
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Kinney AR, Stephenson RO, Cogan AM, Forster JE, Gerber HR, Brenner LA. Participation Mediates the Relationship Between Postconcussive Symptoms and Suicidal Ideation Among Veterans. Am J Occup Ther 2022; 76:23273. [PMID: 35486717 DOI: 10.5014/ajot.2022.048561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Veterans with mild traumatic brain injury (mTBI) and associated symptoms are at risk for suicide. Postconcussive symptoms (PCS) may heighten risk for suicidal thoughts by limiting veterans' participation. OBJECTIVE To investigate whether participation mediates the relationship between PCS and suicidal ideation. DESIGN Cross-sectional, exploratory design. Structural equation models were used to investigate whether participation mediated the relationship between PCS and suicidal ideation. SETTING Community. PARTICIPANTS Veterans with mTBI (N = 145). OUTCOMES AND MEASURES The Ohio State University TBI Identification Method was used to establish mTBI diagnosis. We identified latent variables for PCS and participation using the Neurobehavioral Symptom Inventory and select domains of the Medical Outcomes Study Short Form-36, respectively. We used the Beck Scale for Suicide Ideation to measure the presence of suicidal ideation. RESULTS Participation mediated the relationship between PCS and the presence of suicidal ideation (odds ratio [OR] = 1.09, p = .011). More severe PCS were associated with lesser participation (β = -.86, p < .001); greater participation was associated with lower odds of suicidal ideation (OR = 0.92, p = .007). CONCLUSIONS AND RELEVANCE PCS may heighten risk for suicidal thoughts among veterans by limiting successful participation, a primary target of occupational therapy intervention. Thus, the results suggest that occupational therapy practitioners can play a substantial role in suicide prevention services for veterans with mTBI. Preventive services could mitigate suicide risk among veterans with mTBI by enabling sustained engagement in meaningful and health-promoting activity (e.g., reasons for living) and targeting PCS. What This Article Adds: Researchers have proposed that occupational therapy practitioners can help prevent veteran suicide by supporting their engagement in meaningful, health-promoting activity and by targeting suicide risk factors within their scope of practice. To the best of our knowledge, this is the first study to offer empirical support for such proposed suicide prevention efforts. Although additional research is needed, these results are promising and highlight a distinct role for occupational therapy in suicide prevention.
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Affiliation(s)
- Adam R Kinney
- Adam R. Kinney, PhD, OTR/L, is Research Health Science Specialist, VA Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, CO, and Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora;
| | - Ryan O Stephenson
- Ryan O. Stephenson, DO, is Associate Professor, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, and Medical Director of Polytrauma and Traumatic Brain Injury, Eastern Colorado Health Care System, Denver VA Medical Center, Denver, CO
| | - Alison M Cogan
- Alison M. Cogan, PhD, OTR/L, is Health Science Specialist at the Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Jeri E Forster
- Jeri E. Forster, PhD, is Director of the Data and Statistical Core, VA Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, CO, and Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora
| | - Holly R Gerber
- Holly R. Gerber, MS, is Research Coordinator, VA Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, CO, and Doctoral Candidate, Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA
| | - Lisa A Brenner
- Lisa A. Brenner, PhD, is Director, VA Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, CO, and Professor, Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, University of Colorado Anschutz Medical Campus, Aurora
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11
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Trachik B, Oakey-Frost N, Ganulin ML, Adler AB, Dretsch MN, Cabrera OA, Tucker RP. Military suicide prevention: The importance of leadership behaviors as an upstream suicide prevention target. Suicide Life Threat Behav 2021; 51:316-324. [PMID: 33876487 DOI: 10.1111/sltb.12707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the longitudinal relationships between unit cohesion, Army leader behaviors, and subordinate suicidal/death ideation. Recent cross-sectional research indicates that subordinates who perceive that their leaders instill a sense of purpose regarding military service demonstrate less frequent suicidal ideation. METHOD Five hundred fifty-nine soldiers completed self-report measures of perceptions of leadership behaviors, unit cohesion, and suicidal/death ideation during deployment as well as one and three months following deployment. Latent change score modeling was conducted to evaluate the course and direction of study variables as well as the relationship between them. RESULTS Although lower levels of suicidal/death ideation were related to leader-provided purpose, leader-provided meaning, and unit cohesion at baseline, only leader-provided purpose and unit cohesion prospectively predicted changes in suicidal/death ideation. CONCLUSIONS Consistent with the goal of military leadership to augment effective clinical interventions that reduce suicide risk, prevention programs that reach a broader population of personnel should be considered. Enhanced leadership training may be an important primary prevention tool to reduce suicide risk that warrants further research.
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Affiliation(s)
- Benjamin Trachik
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA
| | | | - Michelle L Ganulin
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA
| | - Amy B Adler
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Michael N Dretsch
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA
| | - Oscar A Cabrera
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA
| | - Raymond P Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
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12
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LeardMann CA, Matsuno RK, Boyko EJ, Powell TM, Reger MA, Hoge CW. Association of Combat Experiences With Suicide Attempts Among Active-Duty US Service Members. JAMA Netw Open 2021; 4:e2036065. [PMID: 33528551 PMCID: PMC7856539 DOI: 10.1001/jamanetworkopen.2020.36065] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/14/2020] [Indexed: 12/02/2022] Open
Abstract
Importance There is uncertainty about the role that military deployment experiences play in suicide-related outcomes. Most previous research has defined combat experiences broadly, and a limited number of cross-sectional studies have examined the association between specific combat exposure (eg, killing) and suicide-related outcomes. Objective To prospectively examine combat exposures associated with suicide attempts among active-duty US service members while accounting for demographic, military-specific, and mental health factors. Design, Setting, and Participants This cohort study analyzed data from the Millennium Cohort Study, an ongoing prospective longitudinal study of US service members from all military branches. Participants were enrolled in 4 phases from July 1, 2001, to April 4, 2013, and completed a self-administered survey at enrollment and every 3 to 5 years thereafter. The population for the present study was restricted to active-duty service members from the first 4 enrollment phases who deployed in support of the wars in Iraq and Afghanistan. Questionnaire data were linked with medical encounter data through September 30, 2015. Data analyses were conducted from January 10, 2017, to December 14, 2020. Exposures Combat exposure was examined in 3 ways (any combat experience, overall combat severity, and 13 individual combat experiences) using a 13-item self-reported combat measure. Main Outcomes and Measures Suicide attempts were identified from military electronic hospitalization and ambulatory medical encounter data using the International Classification of Diseases, Ninth Revision codes. Results Among 57 841 participants, 44 062 were men (76.2%) and 42 095 were non-Hispanic White individuals (72.8%), and the mean (SD) age was 26.9 (5.3) years. During a mean (SD) follow-up period of 5.6 (4.0) years, 235 participants had a suicide attempt (0.4%). Combat exposure, defined broadly, was not associated with suicide attempts in Cox proportional hazards time-to-event regression models after adjustments for demographic and military-specific factors; high combat severity and certain individual combat experiences were associated with an increased risk for suicide attempts. However, these associations were mostly accounted for by mental disorders, especially posttraumatic stress disorder. After adjustment for mental disorders, combat experiences with significant association with suicide attempts included being attacked or ambushed (hazard ratio [HR], 1.55; 95% CI, 1.16-2.06), seeing dead bodies or human remains (HR, 1.34; 95% CI, 1.01-1.78), and being directly responsible for the death of a noncombatant (HR, 1.81; 95% CI, 1.04-3.16). Conclusions and Relevance This study suggests that deployed service members who experience high levels of combat or are exposed to certain types of combat experiences (involving unexpected events or those that challenge moral or ethical norms) may be at an increased risk of a suicide attempt, either directly or mediated through a mental disorder.
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Affiliation(s)
- Cynthia A. LeardMann
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, San Diego, California
| | - Rayna K. Matsuno
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, San Diego, California
| | - Edward J. Boyko
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Epidemiology, University of Washington School of Public Health, Seattle
- Department of Medicine, University of Washington School of Medicine, Seattle
| | - Teresa M. Powell
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, San Diego, California
| | - Mark A. Reger
- Veterans Affairs Puget Sound Healthcare System, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Charles W. Hoge
- Center for Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Psychiatry Division, Office of the Army Surgeon General, Falls Church, Virginia
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Glenn JJ, Dillon KH, Dennis PA, Patel TA, Mann AJ, Calhoun PS, Kimbrel NA, Beckham JC, Elbogen EB. Post-traumatic symptom severity mediates the association between combat exposure and suicidal ideation in veterans. Suicide Life Threat Behav 2020; 50:1167-1172. [PMID: 32770773 PMCID: PMC7746613 DOI: 10.1111/sltb.12678] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/08/2020] [Accepted: 05/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Previous studies of military veterans have produced mixed findings regarding whether combat exposure is directly related to suicidal ideation or is indirectly related to suicidal ideation via its influence on other factors. The present study used a longitudinal design to test the hypothesis that post-traumatic stress disorder (PTSD) symptom severity mediates the effect of combat exposure on suicidal ideation in veterans. METHOD Participants included 319 post-9/11 veterans (83.4% male; 42.1% White/52.1% Black; Mage = 39.7) assessed at baseline, 6, and 12 months. Structural equation modeling and bootstrapped confidence intervals were employed to examine the direct and indirect relationships between combat exposure, suicidal ideation, and PTSD symptom severity. RESULTS Results from the mediation model, in which demographic variables and non-combat trauma were included as covariates, revealed that the indirect effect of combat exposure on suicidal ideation via PTSD symptom severity was statistically significant, accounting for 64.1% of the covariance between combat exposure and suicidal ideation. CONCLUSIONS This study provides longitudinal evidence that the effects of combat exposure on suicidal ideation are mediated by PTSD symptom severity, suggesting the importance of targeting such symptoms in treatment to mitigate suicide risk among veterans with combat exposure.
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Affiliation(s)
- Jeffrey J. Glenn
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
| | - Kirsten H. Dillon
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Paul A. Dennis
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Tapan A. Patel
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
| | - Adam J. Mann
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
| | - Patrick S. Calhoun
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
- VA Center for Health Services Research in Primary Care, Durham, NC, USA
| | - Nathan A. Kimbrel
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
- VA Center for Health Services Research in Primary Care, Durham, NC, USA
| | - Jean C. Beckham
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Eric B. Elbogen
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
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Ravindran C, Morley SW, Stephens BM, Stanley IH, Reger MA. Association of Suicide Risk With Transition to Civilian Life Among US Military Service Members. JAMA Netw Open 2020; 3:e2016261. [PMID: 32915235 PMCID: PMC7489860 DOI: 10.1001/jamanetworkopen.2020.16261] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Although interest is high in addressing suicide mortality after the transition from military to civilian life, little is known about the risk factors associated with this transition. To support the ongoing suicide surveillance work of the US Department of Veterans Affairs (VA) Office of Mental Health and Suicide Prevention, examining these factors is important for targeting suicide prevention efforts. OBJECTIVE To examine the prevalence, patterns, and associated characteristics of suicide mortality among US service members after separation from military active status. DESIGN, SETTING, AND PARTICIPANTS This retrospective population-based cohort study obtained demographic and military service data from the VA/Department of Defense Identity Repository. Individuals who served on active duty in the US Army, Navy, Air Force, Marine Corps, or Coast Guard after September 11, 2001, and who separated from active status between January 1, 2010, and December 31, 2017, were included in the cohort. Data analyses were conducted from September 9, 2019, to April 1, 2020. MAIN OUTCOMES AND MEASURES Suicide mortality within 6 years after separation from military service. RESULTS A total of 1 868 970 service members (1 572 523 men [84.1%]; mean [SD] age at separation, 30.9 [9.9] years) separated from the military during the study period. Through the end of the study period (December 31, 2017), 3030 suicides (2860 men and 170 women) were identified as having occurred within 6 years of separation from the military. Statistically significant differences in suicide risk were found by demographic and military service characteristics. Suicide rates after separation were time dependent, generally peaking 6 to 12 months after separation and declining only modestly over the study period. Male service members had a statistically significantly higher hazard of suicide than their female counterparts (hazard ratio [HR], 3.13; 95% CI, 2.68-3.69). Younger individuals (aged 17-19 years; HR, 4.46 [95% CI, 3.71-5.36]) had suicide hazard rates that were approximately 4.5 times higher than those who transitioned at an older age (≥40 years). Service branch remained a risk factor for suicide even 6 years after separation; those who separated from the Marine Corps (HR, 1.55; 95% CI, 1.36-1.78) and the Army (HR, 1.48; 95% CI, 1.31-1.67) had a higher hazard than those who transitioned from the Air Force. The hazard for those who separated from the active component was higher than for those who separated from the reserve component (HR, 1.29; 95% CI, 1.18-1.42). Service members with a shorter length of service had a higher hazard (HR, 1.26; 95% CI, 1.11-1.42) than those with a longer service history. CONCLUSIONS AND RELEVANCE Results of this study show that not all service members who recently transitioned from military life had the same risk of suicide. The data suggest that awareness of military service and demographic characteristics can help identify those most at risk for suicide to target prevention efforts.
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Affiliation(s)
- Chandru Ravindran
- Veterans Integrated Service Network (VISN) 2, Center of Excellence for Suicide Prevention, Canandaigua, New York
| | - Sybil W. Morley
- Veterans Integrated Service Network (VISN) 2, Center of Excellence for Suicide Prevention, Canandaigua, New York
| | - Brady M. Stephens
- Veterans Integrated Service Network (VISN) 2, Center of Excellence for Suicide Prevention, Canandaigua, New York
| | - Ian H. Stanley
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Mark A. Reger
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
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15
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Ammerman BA, Gebhardt HM, Lee JM, Tucker RP, Matarazzo BB, Reger MA. Differential Preferences for the Caring Contacts Suicide Prevention Intervention Based on Patient Characteristics. Arch Suicide Res 2020; 24:301-312. [PMID: 31213148 DOI: 10.1080/13811118.2019.1632231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The Caring Contacts suicide prevention intervention has been promoted by the Joint Commission, given its effectiveness, high reach, and cost effectiveness. Despite its increased application, no study has examined whether patient characteristics influence perceptions of the intervention, which may inform implementation efforts and ultimately impact effectiveness. One hundred fifty-four veterans were recruited from a Veterans Affairs psychiatric inpatient unit. Participants completed a survey to provide feedback on preferences, including the message correspondent, format (e.g., postcard, email), the importance of handwriting (vs. typed), visual presentation, and schedule for mailings. Results demonstrated that Caring Contacts preferences did not differ by most variables, including military rank, combat deployment history, or most personal technology use characteristics. Some demographic differences were identified, especially by age. More older veterans preferred messages to be sent in a physical letter compared to younger veterans, but if messages were sent via postal mail, younger veterans had a stronger preference for messages to be handwritten and sent using real stamps and colorful envelopes. Overall, findings suggest that few Caring Contacts adaptations are needed based on patient characteristics. Programs targeting older cohorts should consider postal mail formats for Caring Contacts.
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16
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Zuromski KL, Bernecker SL, Chu C, Wilks CR, Gutierrez PM, Joiner TE, Liu H, Naifeh JA, Nock MK, Sampson NA, Zaslavsky AM, Stein MB, Ursano RJ, Kessler RC. Pre-deployment predictors of suicide attempt during and after combat deployment: Results from the Army Study to Assess Risk and Resilience in Servicemembers. J Psychiatr Res 2020; 121:214-221. [PMID: 31865211 PMCID: PMC6953717 DOI: 10.1016/j.jpsychires.2019.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/04/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Deployment-related experiences might be risk factors for soldier suicides, in which case identification of vulnerable soldiers before deployment could inform preventive efforts. We investigated this possibility by using pre-deployment survey and administrative data in a sample of US Army soldiers to develop a risk model for suicide attempt (SA) during and shortly after deployment. METHODS Data came from the Army Study to Assess Risk and Resilience in Servicemembers Pre-Post Deployment Survey (PPDS). Soldiers completed a baseline survey shortly before deploying to Afghanistan in 2011-2012. Survey measures were used to predict SAs, defined using administrative and subsequent survey data, through 30 months after deployment. Models were built using penalized regression and ensemble machine learning methods. RESULTS Significant pre-deployment risk factors were history of traumatic brain injury, 9 + mental health treatment visits in the 12 months before deployment, young age, female, previously married, and low relationship quality. Cross-validated AUC of the best penalized and ensemble models were .75-.77. 21.3-40.4% of SAs occurred among the 5-10% of soldiers with highest predicted risk and positive predictive value (PPV) among these high-risk soldiers was 4.4-5.7%. CONCLUSIONS SA can be predicted significantly from pre-deployment data, but intervention planning needs to take PPV into consideration.
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Affiliation(s)
- Kelly L. Zuromski
- Department of Psychology, Harvard University, Cambridge, MA, USA,Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Samantha L. Bernecker
- Department of Psychology, Harvard University, Cambridge, MA, USA,Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Carol Chu
- Department of Psychology, Harvard University, Cambridge, MA, USA,Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Chelsey R. Wilks
- Department of Psychology, Harvard University, Cambridge, MA, USA,Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Peter M. Gutierrez
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA,Rocky Mountain Mental Illness Research, Education, and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Thomas E. Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Howard Liu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - James A. Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Murray B. Stein
- Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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17
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Bossarte R, Riggs-Donovan CA. Risk of Suicide and Other Adverse Outcomes among Servicemembers: Looking beyond the Military Experience. Psychiatry 2020; 83:259-261. [PMID: 32960165 DOI: 10.1080/00332747.2020.1804787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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