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Carey FR, Harbertson J, Sharifian N, Boyko EJ, Rull RP. All-cause mortality among United States military personnel: Findings from the Millennium Cohort Study, 2001-2021. Ann Epidemiol 2024; 99:1-8. [PMID: 39214485 DOI: 10.1016/j.annepidem.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 08/02/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE The goal of this study was to estimate all-cause mortality among Operations Enduring Freedom, Iraqi Freedom, and New Dawn era service members and veterans and to identify protective and risk factors for mortality. METHODS Using 20 years of longitudinal data from the Millennium Cohort Study (2001-2021), sequential Cox proportional hazard models were conducted to examine demographic, military, and health-related characteristics associated with all-cause mortality among service members and veterans. RESULTS Among 201,619 participants, 3806 (1.9 %) were deceased by the end of the observation period, with an age- and sex-adjusted incidence of 37.6 deaths per 100,000 person-years. Deployed service members had lower all-cause mortality risk than those who did not deploy. Personnel who experienced combat had higher mortality risk compared with those who did not in unadjusted models; this association was nonsignificant after accounting for health-related factors. Enlisted and Army personnel both had a higher mortality risk, while women and Hispanic individuals had a lower risk. Stressful life events, lower physical health related quality of life, problem drinking, and smoking were also associated with greater mortality risk. CONCLUSION These profiles may be useful for developing preventive education and intervention efforts in military and veteran populations to reduce premature mortality.
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Affiliation(s)
- Felicia R Carey
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA.
| | - Judith Harbertson
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA
| | - Neika Sharifian
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA
| | | | - Rudolph P Rull
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
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Gil A, Schuman D, Chang KY, Liu Z, Hwang CL. Implications of Physical Activity in Reducing Alcohol Use for Women Veterans: A Narrative Review. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:554-564. [PMID: 39035145 PMCID: PMC11257116 DOI: 10.1089/whr.2023.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 07/23/2024]
Abstract
Women veterans (WV) are a fast-growing population in the United States with concerning health disparities. Reports of increased risks of cardiovascular disease (CVD) and poorer health are evident in WV compared with their civilian counterparts. The transition from active duty to veteran poses additional life stressors, causing changes in health behaviors such as unhealthy alcohol consumption and decreased physical activity, which may explain health disparities in WV. The changes in these two health risk behaviors may be influenced by each other, and emerging evidence suggests that physical activity aids in managing alcohol consumption during alcohol use treatment. In this general narrative review, we summarized findings from studies involving WV on (1) the associations between alcohol consumption and physical activity and (2) the effect of physical activity on reducing alcohol use. We also discussed the clinical consideration of adding physical activity to alcohol use interventions for WV. Most of the literature included in this review has been based on predominantly veteran men populations. This knowledge gap highlights the importance of continued efforts and research studies targeting WV to eliminate health disparities among them.
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Affiliation(s)
- Alfredo Gil
- Department of Kinesiology, The University of Texas at Arlington, Arlington, Texas, USA
| | - Donna Schuman
- School of Social Work, The University of Texas at Arlington, Arlington, Texas, USA
| | - Keng-Yu Chang
- Department of Kinesiology, The University of Texas at Arlington, Arlington, Texas, USA
| | - Zhaoli Liu
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas, USA
| | - Chueh-Lung Hwang
- Department of Kinesiology, The University of Texas at Arlington, Arlington, Texas, USA
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Castro Moreno LS, Fuertes Valencia LF, Pacheco García OE, Muñoz Lozada CM. Risk factors associated with suicide attempt as predictors of suicide, Colombia, 2016-2017. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2023; 52:176-184. [PMID: 37863768 DOI: 10.1016/j.rcpeng.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/23/2021] [Indexed: 10/22/2023]
Abstract
BACKGROUND Suicidal behaviour is the cause of half of all violent deaths. It is considered to be a public health problem with one million victims a year. Suicide attempt is the most important risk factor. In Colombia, in 2017 the suicide attempt rate was 51.8/100,000 inhabitants, and the fatality rate reached 10.0/100,000. The objective is to identify suicide attempt factors associated with death and determine survival after the attempt for 2 years. MATERIAL AND METHODS Retrospective cohort study and survival analysis. A total of 42,594 records of the suicide attempt surveillance system databases and 325 records of death by suicide in 2016 and 2017 were analysed. The risk factors were examined and a χ2-test and multivariate analysis and logistic regression were performed. Cumulative survival probability was calculated using the Kaplan-Meier method. A Cox regression model was applied to determine the proportional relationship of the suicide attempt variables that are related to suicide. RESULTS Men die by suicide 4.5 times more often than women. One in four suicide victims had made at least one prior suicide attempt. The attempt factors related with death by suicide were: male gender (HR = 2.99; 95% CI, 2.27-3.92), adulthood (over 29 years, HR = 2.38; 95% CI, 1.90-2.99), living in a rural area (HR = 2.56; 95% CI, 2.04-3.20), chronic disease history (HR = 2.43; 95% CI, 1.66-3.57) and depression disorder (HR = 1.94; 95% CI, 1.55-2.41). Some 50% of suicide deaths occur up to 560 days after the suicide attempt. CONCLUSIONS The risk of suicide is highest in male patients, with a history of depression, chronic illness and exposure to heavy workloads.
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Affiliation(s)
- Luz Stella Castro Moreno
- Entrenamiento Programa de Epidemiología de Campo (FETP), Instituto Nacional de Salud, Bogotá, Colombia.
| | | | - Oscar Eduardo Pacheco García
- Grupo de Formación de Talento Humano para la Vigilancia en Salud Pública, Dirección de Vigilancia y Análisis del Riesgo en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Claudia Marcela Muñoz Lozada
- Grupo de Formación de Talento Humano para la Vigilancia en Salud Pública, Dirección de Vigilancia y Análisis del Riesgo en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
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Rusé J, Clenet A, Vaiva G, Debien C, Arbus C, Salles J. The association between reattempted suicide and incoming calls to the brief contact intervention service, VigilanS: a study of the clinical profile of callers. BMC Psychiatry 2023; 23:21. [PMID: 36624409 PMCID: PMC9829445 DOI: 10.1186/s12888-022-04503-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Suicide is a major health problem globally. As attempted suicide is a major risk factor for suicide, specific prevention strategies have been designed for use thereafter. An example is the brief contact intervention (BCI). In this regard, France employs a composite BCI, VigilanS, which utilizes three types of contact: phone calls, postcards and a 'who to contact in a crisis' card. Previous studies have found that this system is effective at preventing suicide. Nevertheless, VigilanS was not effective in the same way for all the patients included. This observation raises the question of specific adaptation during follow-up for populations that were less receptive to the service. In consideration of this issue, we identified one study which found that incoming calls to the service were linked with a higher risk of suicide reattempts. However, this study did not document the profiles of the patients who made these calls. Better understanding of why this population is more at risk is important in terms of identifying factors that could be targeted to improve follow-up. This research therefore aims to bring together such data. METHODS We performed a retrospective analysis of 579 patients referred to VigilanS by Toulouse University Hospital (France). We examined the sociodemographics, clinical characteristics, and follow-ups in place and compared the patients who made incoming calls to the service versus those who did not. Subsequently, we conducted a regression analysis using the significantly associated element of patients calling VigilanS. Then, in order to better understand this association, we analyzed the factors, including such calls, that were linked to the risk of suicide reattempts. RESULTS We found that 22% of the patients in our sample called the VigilanS service. These individuals: were older, at 41.4 years versus 37.9 years for the non-callers; were more likely to have a borderline personality disorder (BPD) diagnosis (28.9% versus 19.3%); and had a history of suicide attempts (71.9% versus 54.6%). Our analysis confirmed that incoming calls to VigilanS (OR = 2.9) were associated with reattempted suicide, as were BPD (OR = 1.8) and a history of suicide attempts (OR = 1.7). CONCLUSION There was a high risk that the patients calling VigilanS would make another suicide attempt. However, this association was present regardless of the clinical profile. We postulate that this link between incoming calls and reattempted suicide may arise because this form of contact is, in fact, a way in which patients signal that a further attempt will be made.
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Affiliation(s)
- Jeanne Rusé
- grid.411175.70000 0001 1457 2980Department of Psychiatry, University Hospital of Toulouse, CHU Toulouse, Toulouse, France
| | - Adeline Clenet
- grid.411175.70000 0001 1457 2980Department of Psychiatry, University Hospital of Toulouse, CHU Toulouse, Toulouse, France
| | - Guillaume Vaiva
- Centre National de Ressources et de Résilience Lille-Paris, Lille, France ,grid.410463.40000 0004 0471 8845Department of Psychiatry, Centre Hospitalier Universitaire de Lille, Inserm, U1172-LilNCog-Lille Neuroscience and Cognition, Lille, France
| | - Christophe Debien
- Centre National de Ressources et de Résilience Lille-Paris, Lille, France ,grid.410463.40000 0004 0471 8845Department of Psychiatry, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Christophe Arbus
- grid.411175.70000 0001 1457 2980University Hospital of Toulouse, CHU Toulouse, Department of Psychiatry, Toulouse NeuroImaging Center, ToNIC, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Juliette Salles
- University Hospital of Toulouse, CHU Toulouse, Department of Psychiatry, Infinity (Toulouse Institute for Infectious and Inflammatory Diseases), INSERM UMR1291, CNRS UMR5051, Université Toulouse III, Toulouse, France.
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Unemployment, homelessness, and other societal outcomes in patients with schizophrenia: a real-world retrospective cohort study of the United States Veterans Health Administration database : Societal burden of schizophrenia among US veterans. BMC Psychiatry 2022; 22:458. [PMID: 35804314 PMCID: PMC9264584 DOI: 10.1186/s12888-022-04022-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden associated with schizophrenia is substantial. Impacts on the individual, healthcare system, and society may be particularly striking within the veteran population due to the presence of physical and mental health comorbidities. Disease burden is also influenced by a complex interplay between social determinants of health and health disparities. The objective of the current study was to compare non-healthcare societal outcomes between veterans with and without schizophrenia in the United States Veterans Health Administration (VHA). METHODS A retrospective cohort study was conducted using the VHA database (01/2013-09/2019; study period). Veterans with schizophrenia (≥2 diagnoses of ICD-9295.xx, ICD-10 F20.x, F21, and/or F25.x during the study period) were identified; the index date was the earliest observed schizophrenia diagnosis. Veterans with schizophrenia were propensity score-matched to those without schizophrenia using baseline characteristics. A 12-month baseline and variable follow-up period were applied. The frequency of unemployment, divorce, incarceration, premature death, and homelessness were compared between the matched cohorts using standardized mean difference (SMD). Risk of unemployment and homelessness were estimated using logistic regression models. RESULTS A total of 102,207 veterans remained in each cohort after matching (91% male; 61% White [per AMA]; median age, 59 years). Among veterans with schizophrenia, 42% had a substance use disorder and 30% had mental health-related comorbidities, compared with 25 and 15%, respectively, of veterans without schizophrenia. Veterans with schizophrenia were more likely to experience unemployment (69% vs. 41%; SMD: 0.81), divorce (35% vs. 28%; SMD: 0.67), homelessness (28% vs. 7%; SMD: 0.57), incarceration (0.4% vs. 0.1%; SMD: 0.47), and premature death (14% vs. 12%; SMD < 0.1) than veterans without schizophrenia. After further adjustments, the risk of unemployment and of homelessness were 5.4 and 4.5 times higher among veterans with versus without schizophrenia. Other predictors of unemployment included Black [per AMA] race and history of substance use disorder; for homelessness, younger age (18-34 years) and history of mental health-related comorbidities were additional predictors. CONCLUSION A greater likelihood of adverse societal outcomes was observed among veterans with versus without schizophrenia. Given their elevated risk for unemployment and homelessness, veterans with schizophrenia should be a focus of targeted, multifactorial interventions to reduce disease burden.
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Demesmaeker A, Chazard E, Hoang A, Vaiva G, Amad A. Suicide mortality after a nonfatal suicide attempt: A systematic review and meta-analysis. Aust N Z J Psychiatry 2022; 56:603-616. [PMID: 34465221 DOI: 10.1177/00048674211043455] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Deliberate self-harm and suicide attempts share common risk factors but are associated with different epidemiological features. While the rate of suicide after deliberate self-harm has been evaluated in meta-analyses, the specific rate of death by suicide after a previous suicide attempt has never been assessed. The aim of our study was to estimate the incidence of death by suicide after a nonfatal suicide attempt. METHOD We developed and followed a standard meta-analysis protocol (systematic review registration-PROSPERO 2021: CRD42021221111). Randomized controlled trials and cohort studies published between 1970 and 2020 focusing on the rate of suicide after suicide attempt were identified in PubMed, PsycInfo and Scopus and qualitatively described. The rates of deaths by suicide at 1, 5 and 10 years after a nonfatal suicide attempt were pooled in a meta-analysis using a random-effects model. Subgroup analysis and meta-regressions were also performed. RESULTS Our meta-analysis is based on 41 studies. The suicide rate after a nonfatal suicide attempt was 2.8% (2.2-3.5) at 1 year, 5.6% (3.9-7.9) at 5 years and 7.4% (5.2-10.4) at 10 years. Estimates of the suicide rate vary widely depending on the psychiatric diagnosis, the method used for the suicide attempt, the type of study and the age group considered. CONCLUSION The evidence of a high rate of suicide deaths in the year following nonfatal suicide attempts should prompt prevention systems to be particularly vigilant during this period.
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Affiliation(s)
- Alice Demesmaeker
- U1172-LilNCog-Lille Neuroscience & Cognition, Inserm, CHU Lille, Université de Lille, Lille, France.,Hôpital Fontan, CHU de Lille, Lille, France
| | - Emmanuel Chazard
- ULR 2694 Metrics, CERIM, Public Health Department, CHU Lille, Université de Lille, Lille, France
| | - Aline Hoang
- U1172-LilNCog-Lille Neuroscience & Cognition, Inserm, CHU Lille, Université de Lille, Lille, France
| | - Guillaume Vaiva
- U1172-LilNCog-Lille Neuroscience & Cognition, Inserm, CHU Lille, Université de Lille, Lille, France.,Hôpital Fontan, CHU de Lille, Lille, France.,Centre National de Ressources et de Résilience (CN2R), Lille, France
| | - Ali Amad
- U1172-LilNCog-Lille Neuroscience & Cognition, Inserm, CHU Lille, Université de Lille, Lille, France.,Hôpital Fontan, CHU de Lille, Lille, France
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Hein TC, Cooper SA, McCarthy JF. Mortality following non-fatal suicide attempts by Veterans in Veterans Health Administration care. Suicide Life Threat Behav 2022; 52:222-230. [PMID: 34816474 DOI: 10.1111/sltb.12811] [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: 02/23/2021] [Revised: 05/28/2021] [Accepted: 09/30/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Little is known regarding long-term mortality outcomes after non-fatal suicide attempts among Veterans Health Administration (VHA) patients, which may inform services delivery and program evaluation. METHODS For 4,601,081 Veterans with 2005 VHA encounters, we assessed unadjusted and age-adjusted all-cause and cause-specific mortality through 2017, overall and for Veterans with (N = 8243) versus without (N = 4,592,838) 2005 VHA suicide attempt documentation. Standardized mortality ratios compared mortality rates by suicide attempt status. Multivariable proportional hazards regression models assessed age- and gender-adjusted mortality risk. RESULTS Among Veteran VHA users with non-fatal suicide attempt diagnoses, 1.6% died of suicide, 4.6% of non-suicide external causes, and 30.7% of any cause. In age- and gender-adjusted analyses, Veterans who attempted suicide had increased suicide (hazard ratio [HR] = 4.52, 95% confidence interval [CI] = 3.82-5.36), non-suicide external cause (HR = 3.75, 95% CI = 3.38-4.17), and all-cause (separate due to non-proportional hazards: 2006, HR = 2.05, 95% CI = 1.81-2.31; 2007-2017, HR = 1.72, 95% CI = 1.65-1.80) mortality through 2017. CONCLUSION Over 12 years, Veteran VHA patients with non-fatal suicide attempt diagnoses had increased risk of suicide, non-suicide external cause, and all-cause mortality. Over 98% of Veteran VHA users who had a diagnosed non-fatal attempt did not die by suicide, highlighting additional program evaluation outcomes and opportunities to support physical and mental health.
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Affiliation(s)
- Tyler C Hein
- Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Ann Arbor, Michigan, USA
| | - Samantha A Cooper
- Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Ann Arbor, Michigan, USA
| | - John F McCarthy
- Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Ann Arbor, Michigan, USA
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Nichter B, Hill ML, Na PJ, Kline AC, Norman SB, Krystal JH, Southwick SM, Pietrzak RH. Prevalence and Trends in Suicidal Behavior Among US Military Veterans During the COVID-19 Pandemic. JAMA Psychiatry 2021; 78:1218-1227. [PMID: 34431973 PMCID: PMC8387942 DOI: 10.1001/jamapsychiatry.2021.2332] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
IMPORTANCE The COVID-19 pandemic has raised considerable concerns about increased risk for suicidal behavior among US military veterans, who already had elevated rates of suicide before the pandemic. OBJECTIVE To examine longitudinal changes in suicidal behavior from before the COVID-19 pandemic to nearly 10 months into the pandemic and identify risk factors and COVID-related variables associated with new-onset suicide ideation (SI). DESIGN, SETTING, AND PARTICIPANTS This population-based prospective cohort study used data from the first and second wave of the National Health and Resilience in Veterans Study, conducted from November 18, 2019, to December 19, 2020. Median dates of data collection for the prepandemic and peripandemic assessments were November 21, 2019, and November 14, 2020, nearly 10 months after the start of the COVID-19 public health emergency in the US. A total of 3078 US military veterans aged 22 to 99 years were included in the study. MAIN OUTCOMES AND MEASURES Past-year SI and suicide attempts. RESULTS In this cohort study of 3078 US veterans (mean [SD] age, 63.2 [14.7] years; 91.6% men; 79.3% non-Hispanic White veterans, 10.3% non-Hispanic Black veterans, and 6.0% Hispanic veterans), 233 (7.8%) reported past-year SI, and 8 (0.3%) reported suicide attempts at the peripandemic assessment. Past-year SI decreased from 10.6% prepandemic (95% CI, 9.6%-11.8%) to 7.8% peripandemic (95% CI, 6.9%-8.8%). A total of 82 veterans (2.6%) developed new-onset SI over the follow-up period. After adjusting for sociodemographic and military characteristics, the strongest risk factors and COVID-19-related variables for new-onset SI were low social support (odds ratio [OR], 2.77; 95% CI, 1.46-5.28), suicide attempt history (OR, 6.31; 95% CI, 2.71-14.67), lifetime posttraumatic stress disorder and/or depression (OR, 2.25; 95% CI, 1.16-4.35), past-year alcohol use disorder severity (OR, 1.06; 95% CI, 1.01-1.12), COVID-19 infection (OR, 2.41; 95% CI, 1.41-5.01), and worsening of social relationships during the pandemic (OR, 1.47; 95% CI, 1.16-1.88). CONCLUSIONS AND RELEVANCE The results of this cohort study suggest that despite grim forecasts that the COVID-19 pandemic would exacerbate suicidality among US military veterans, the rate of SI decreased at the population level nearly 10 months into the pandemic. Veterans who were infected with COVID-19 were more than twice as likely to report SI, which suggests the need for future research to examine the potential link between COVID-19 infection and suicidal behavior.
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Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, University of California San Diego, La Jolla
| | - Melanie L. Hill
- Department of Psychiatry, University of California San Diego, La Jolla,VA San Diego Healthcare System, San Diego, California
| | - Peter J. Na
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Alexander C. Kline
- Department of Psychiatry, University of California San Diego, La Jolla,VA San Diego Healthcare System, San Diego, California
| | - Sonya B. Norman
- Department of Psychiatry, University of California San Diego, La Jolla,National Center for PTSD, White River Junction, Vermont,VA Center of Excellence for Stress and Mental Health, San Diego, California
| | - John H. Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Steven M. Southwick
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Robert H. Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut,National Center for PTSD, VA Connecticut Healthcare System, West Haven,Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
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Substance use and suicide outcomes among self-injured trauma patients. Drug Alcohol Depend 2021; 226:108906. [PMID: 34315104 DOI: 10.1016/j.drugalcdep.2021.108906] [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] [Received: 03/15/2021] [Revised: 05/26/2021] [Accepted: 05/30/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Research indicates alcohol (AUD) or substance (SUD) use disorders and acute alcohol or drug use serve as risk factors for suicidal behaviors and death both distally and proximally to a suicidal event. However, limited research has investigated these relationships among medically serious suicide attempters at the time of injury without relying on cohorts of substance users only or by examining suicide decedent characteristics. METHODS Data were collected from the National Trauma Data Bank (NTDB) for 2017. The sample comprised patients who engaged in suicidal and self-injurious acts that were medically serious enough to require trauma admission and were tested for alcohol (N = 9,196) or drug (N = 8,121) exposure upon admission. Logistic regression determined relationships between acute alcohol/substance use, presence of AUDs and SUDs and suicide mortality risk, while linear regression evaluated substance conditions and injury severity and length of stay (LOS). RESULTS AUDs (OR = 0.59[0.42-0.83]) and SUDs (OR = 0.66[0.48-0.90]) had reduced odds of death but increased LOS (β = 1.7, p < .001; β = 0.82, p = .024). Blood alcohol concentration (BAC) was positively associated with reduced odds of death (OR = 0.20[0.06-0.61]), injury severity (β = -5.3, p < .001), and LOS (β = -7.5, p < .001). Presence of cocaine (β = -0.80, p = .044) and opioids (β = -1.4, p < .001) were associated lower injury severity, while MDMA (β = 3.6, p = .016) and methamphetamine (β = 1.5, p = .025) were associated with increased injury severity. CONCLUSIONS While higher BAC may be associated with lower odds of mortality during a single high-risk suicide event, substance users may be at increased risk for worse outcomes over time. Targeted interventions should be considered to interrupt and develop healthy alternatives for survivors with substance use conditions.
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Nichter B, Maguen S, Monteith LL, Kachadourian L, Norman SB, Hill ML, Herzog S, Pietrzak RH. Factors associated with multiple suicide attempts in a nationally representative study of U.S. military veterans. J Psychiatr Res 2021; 140:295-300. [PMID: 34126423 DOI: 10.1016/j.jpsychires.2021.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Veterans with a history of multiple suicide attempts are at increased risk for suicide mortality relative to those with a single attempt. However, little is known about factors that differentiate veterans who attempt suicide once compared to more than once. This study examined factors that distinguish single suicide attempters (SSA) from multiple suicide attempters (MSA) in a nationally representative sample of U.S. military veterans. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a representative sample of 4069 U.S. veterans. ANALYSES (a) estimated the lifetime prevalence of SSA and MSA; and (b) examined factors that differentiated veterans with a SSA from MSA. RESULTS The lifetime prevalences of SSA and MSA were 1.9% and 2.0%. The strongest correlates of MSA were history of lifetime depression (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.43-8.35), non-suicidal self-injury (OR, 3.28; 95% CI, 1.27-8.45), drug use disorder (OR, 4.0; 95% CI, 1.67-9.54), and marital status (OR, 0.40, 95% CI, 0.18-0.87), which accounted for 15.5%-41.4% of the total explained variance in MSA. DISCUSSION Half of military veterans who have attempted suicide in the United States report more than one attempt, suggesting that suicide attempts are not a one-time occurrence for a substantial proportion of veterans. Veterans who attempt suicide more than once show more deliberate self-harm behavior and have greater psychiatric comorbidities relative to single attempters. Implications for future research examining risk factors for suicide attempts among veterans are discussed.
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Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, University of California Sn Diego, La Jolla, CA, USA.
| | - Shira Maguen
- San Francisco VA Health Care System, San Francisco, CA, USA; University of California - San Francisco, San Francisco, USA
| | - Lindsey L Monteith
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lorig Kachadourian
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, New Haven, CT, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California Sn Diego, La Jolla, CA, USA; National Center for PTSD, White River Junction, VT, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Melanie L Hill
- Department of Psychiatry, University of California Sn Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Sarah Herzog
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - Robert H Pietrzak
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA; Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Djembi Fossi L, Debien C, Demarty AL, Vaiva G, Messiah A. SUICIDE REATTEMPT IN A POPULATION-WIDE BRIEF CONTACT INTERVENTION TO PREVENT SUICIDE ATTEMPTS - THE VIGILANS PROGRAM, FRANCE. Eur Psychiatry 2021; 64:e57. [PMID: 34266505 PMCID: PMC8516749 DOI: 10.1192/j.eurpsy.2021.2221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Among the postcrisis suicide prevention programmes, brief contact interventions (BCIs) have been proven to be efficient. VigilanS generalizes to a whole French region a BCI combining resource cards, telephone calls, and sending postcards, according to a predefined algorithm. However, a major problem in suicide prevention is the suicide reattempt, which can lead to final suicide. Here, we analyze the suicide reattempt in VigilanS. Methods The study concerned patients included in VigilanS over the period from January 1, 2015 to December 31, 2018, with an end of follow-up on July 1, 2019. We performed a series of descriptive analyses, survival curves, and regressions. The outcome was the suicide reattempt, and the predictive variables were the characteristics of the patient at entry and during follow-up in VigilanS. Age and sex were considered as adjustment variables. Results A total of 11,879 inclusions occurred during the study period, corresponding to 10,666 different patients, among which 905 reattempted suicide. More than half were primary suicide attempters (53.4%). A significant relationship with suicide reattempt was identified for the following characteristics: being a non-primary suicide attempter, having attempted suicide by voluntary drug intoxication and phlebotomy, alcohol consumption among primary suicide attempters, and having no companion at the emergency room visit among non-primary suicide attempters. Hanging (as suicide method), having made no call to VigilanS were protective factors. Conclusion This study provides us with a valuable insight into the profiles of patients repeating a suicide attempts, which is important for suicide prevention in general.
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Affiliation(s)
- Larissa Djembi Fossi
- INSERM, MOODS Research unit "Depression, Anxiety, Psychotraumatism and Suicide", Centre de recherche en Epidémiologie et santé des populations (CESP), Université Paris-Saclay, Hôpital Paul-Brousse, Villejuif, France.,INSERM, Sorbonne University, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Social Epidemiology Team, Paris, France
| | - Christophe Debien
- Department of Psychiatry, University Hospital of Lille.,Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog (JPARC) - Lille Neurosciences & Cognition, F-59000Lille, France.,Centre National de Ressources et Résilience pour les psychotraumas (Cn2r Lille Paris), Lille, France Department of Psychiatry, University Hospital of Lille
| | | | - Guillaume Vaiva
- Department of Psychiatry, University Hospital of Lille.,Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog (JPARC) - Lille Neurosciences & Cognition, F-59000Lille, France.,Centre National de Ressources et Résilience pour les psychotraumas (Cn2r Lille Paris), Lille, France Department of Psychiatry, University Hospital of Lille
| | - Antoine Messiah
- INSERM, MOODS Research unit "Depression, Anxiety, Psychotraumatism and Suicide", Centre de recherche en Epidémiologie et santé des populations (CESP), Université Paris-Saclay, Hôpital Paul-Brousse, Villejuif, France
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Castro Moreno LS, Fuertes Valencia LF, Pacheco García OE, Muñoz Lozada CM. Risk Factors Associated with Suicide Attempt as Predictors of Suicide, Colombia, 2016-2017. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 52:S0034-7450(21)00070-6. [PMID: 34090686 DOI: 10.1016/j.rcp.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/11/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Suicidal behaviour is the cause of half of all violent deaths. It is considered to be a public health problem with one million victims a year. Suicide attempt is the most important risk factor. In Colombia, in 2017 the suicide attempt rate was 51.8/100,000 inhabitants, and the fatality rate reached 10.0/100,000. The objective is to identify suicide attempt factors associated with death and determine survival after the attempt for 2 years. MATERIAL AND METHODS Retrospective cohort study and survival analysis. A total of 42,594 records of the suicide attempt surveillance system databases and 325 records of death by suicide in 2016 and 2017 were analysed. The risk factors were examined and a χ2-test and multivariate analysis and logistic regression were performed. Cumulative survival probability was calculated using the Kaplan-Meier method. A Cox regression model was applied to determine the proportional relationship of the suicide attempt variables that are related to suicide. RESULTS Men die by suicide 4.5 times more often than women. One in four suicide victims had made at least one prior suicide attempt. The attempt factors related with death by suicide were: male gender (HR=2.99; 95% CI, 2.27-3.92), adulthood (over 29 years, HR=2.38; 95% CI, 1.90-2.99), living in a rural area (HR=2.56; 95% CI, 2.04-3.20), chronic disease history (HR=2.43; 95% CI, 1.66-3.57) and depression disorder (HR=1.94; 95% CI, 1.55-2.41). Some 50% of suicide deaths occur up to 560 days after the suicide attempt. CONCLUSIONS The risk of suicide is highest in male patients, with a history of depression, chronic illness and exposure to heavy workloads.
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Affiliation(s)
- Luz Stella Castro Moreno
- Entrenamiento Programa de Epidemiología de Campo (FETP), Instituto Nacional de Salud, Bogotá, Colombia.
| | | | - Oscar Eduardo Pacheco García
- Grupo de Formación de Talento Humano para la Vigilancia en Salud Pública, Dirección de Vigilancia y Análisis del Riesgo en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Claudia Marcela Muñoz Lozada
- Grupo de Formación de Talento Humano para la Vigilancia en Salud Pública, Dirección de Vigilancia y Análisis del Riesgo en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
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13
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Huber RS, McGlade EC, Legarreta M, Subramaniam P, Renshaw PF, Yurgelun-Todd DA. Cingulate white matter volume and associated cognitive and behavioral impulsivity in Veterans with a history of suicide behavior. J Affect Disord 2021; 281:117-124. [PMID: 33316716 DOI: 10.1016/j.jad.2020.11.126] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Suicide is one of the leading causes of death for military personnel and Veterans. Neuroimaging studies have revealed abnormalities in white matter tracts and brain connectivity in suicide behavior (SB); however, reports of alterations in white matter volume and its association with related behaviors are limited. The current study examined the relationship between cingulate white matter volume (WMV), impulsivity, and SB in Veterans. METHODS Fifty-two Veterans, ages 18 to 65, underwent magnetic resonance imaging on a 3T Siemens Verio scanner. Morphometric analysis of brain images was performed to evaluate differences in WMV in cingulate regions of interest. Participants completed the Columbia Suicide Severity Rating Scale to assess lifetime suicide behavior and the Barratt Impulsivity Scale (BIS) and the Continuous Performance Test (CPT) to assess impulsivity. RESULTS Twenty-nine Veterans had a history of suicidal ideation (SI) and 23 had a history of suicide attempts (SA). Controlling for age, sex, handedness and total white matter volume, reduced WMV was observed in the left rostral anterior cingulate cortex (rACC) in Veterans with SA relative to Veterans with SI, p = .008. Additionally, non-planning on the BIS was negatively correlated with left rACC WMV for Veterans with a history of SA, p = .04. Other subregions of the ACC WMV were negatively correlated with planning and attention impulsivity (BIS) and omission and commission errors (CPT) for attempters. CONCLUSIONS Reduction in rACC WMV in Veterans with SA was negatively correlated with nonplanning measures. These findings are consistent with ACC involvement in inhibitory processes and build on evidence that SB is associated with neurobiological abnormalities and suggest that white matter changes may be related to actual attempts.
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Affiliation(s)
- Rebekah S Huber
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging Laboratory, University of Utah, Salt Lake City, UT, USA.
| | - Erin C McGlade
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging Laboratory, University of Utah, Salt Lake City, UT, USA; Veterans Affairs VISN 19 Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, UT, USA
| | - Margaret Legarreta
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging Laboratory, University of Utah, Salt Lake City, UT, USA; Sheridan Veterans Affairs Health Care System, Sheridan, WY, USA
| | - Punitha Subramaniam
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Perry F Renshaw
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging Laboratory, University of Utah, Salt Lake City, UT, USA; Veterans Affairs VISN 19 Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, UT, USA
| | - Deborah A Yurgelun-Todd
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging Laboratory, University of Utah, Salt Lake City, UT, USA; Veterans Affairs VISN 19 Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, UT, USA
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14
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Factors associated with single versus multiple suicide attempts in depressive disorders. J Affect Disord 2020; 277:306-312. [PMID: 32858311 DOI: 10.1016/j.jad.2020.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/12/2020] [Accepted: 08/09/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Many risk factors for suicidal behavior have been identified. Much less has been done to associate risk factors with recurrence of suicidal behavior. METHODS We compared prevalence of 30 potential risk factors among 8496 depressive patient-subjects from the BRIDGE consortium with no (NSA, n = 6267), one (1SA, n = 1123), or repeated (≥2) suicide attempts (RSA, n = 1106). RESULTS Prevalence of most factors ranked: RSA ≥ 1SA > NSA, with a notable opposite trend for the diagnosis of type II bipolar disorder (BD). Factors independently and significantly more present among RSA than 1SA subjects were: borderline personality, substance abuse, mood-switching with antidepressant treatment, female sex, and unsatisfactory response to antidepressant treatment. There also were notably strong associations of RSA with type I or probable BD and associated factors, including family history of BD, young onset, mixed and psychotic features. LIMITATIONS Potential effects of treatment on risk of suicidal acts could not be evaluated adequately, as well as associations between levels of suicidal behavior and eventual death by suicide. CONCLUSIONS In a large cohort of depressive patients, there were significant associations not only with suicidal behavior generally, but also with the intensity of suicide attempts.
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15
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Chen X, Ramanan B, Tsai S, Jeon‐Slaughter H. Differential Impact of Aging on Cardiovascular Risk in Women Military Service Members. J Am Heart Assoc 2020; 9:e015087. [PMID: 32515249 PMCID: PMC7429070 DOI: 10.1161/jaha.120.015087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/30/2020] [Indexed: 01/08/2023]
Abstract
Background Atherosclerotic cardiovascular disease (ASCVD) is the third leading cause of death in women service members and veterans. This study assessed 10-year ASCVD risk in women service members and veterans using their own electronic health record data extracted from Veterans Affairs (VA) national Corporate Data Warehouse database. Methods and Results We retrospectively followed 69 574 VA women, aged 30 to 79 years, from 2007 to 2017. Of these, 52% were whites (n=36 172), 42% were blacks (n=29 232), and 6% were Hispanics (n=4171). Risk factors and ASCVD events (nonfatal myocardial infarction, nonfatal stroke, and cardiac deaths) were identified using diagnostic and procedural codes from electronic health records. Then, within the same construct of the current American College of Cardiology/American Heart Association 10-year ASCVD risk assessment models for women, coefficients for risks factors were recalculated using the VA national electronic health record data, stratified by race (hereafter, VA women model). Our study found a curvilinear association of aging with increased risk of 10-year ASCVD event in VA women starting at ages as young as 30 years across all race groups. The VA women model performance in predicting ASCVD events at 10 years was mixed-moderate in discrimination (C statistics, 0.61-0.64) but good in accuracy, as demonstrated by calibration plots approximating a 45° line. Conclusions The study finding, a curvilinear association of aging with increased ASCVD risk in VA women across all races, demonstrates the need for cardiovascular risk screening of younger VA women, aged <45 years.
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Affiliation(s)
- Xiaofei Chen
- Veterans Affairs North Texas Health Care SystemDallasTX
- Southern Methodist UniversityDallasTX
| | - Bala Ramanan
- Veterans Affairs North Texas Health Care SystemDallasTX
- Department of SurgeryUniversity of Texas Southwestern Medical CenterDallasTX
| | - Shirling Tsai
- Veterans Affairs North Texas Health Care SystemDallasTX
- Department of SurgeryUniversity of Texas Southwestern Medical CenterDallasTX
| | - Haekyung Jeon‐Slaughter
- Veterans Affairs North Texas Health Care SystemDallasTX
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTX
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16
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Do N, Grossman R, Feldman T, Fillmore N, Elbers D, Tuck D, Dhond R, Selva L, Meng F, Fitzsimons M, Ajjarapu S, Ayandeh S, Hall R, Do S, Brophy M. The Veterans Precision Oncology Data Commons: Transforming VA data into a national resource for research in precision oncology. Semin Oncol 2019; 46:314-320. [PMID: 31629530 DOI: 10.1053/j.seminoncol.2019.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/17/2019] [Indexed: 01/14/2023]
Abstract
The Department of Veterans Affairs (VA) has a strong track record providing high-quality, evidence-based care to cancer patients. In order to accelerate discoveries that will further improve care for Veterans with cancer, the VA has partnered with the Center for Translational Data Science at the University of Chicago and the Open Commons Consortium to establish a data sharing platform, the Veterans Precision Oncology Data Commons (VPODC). The VPODC makes clinical, genomic, and imaging data from the VA available to the research community at large. In this paper, we detail our motivation for data sharing, describe the VPODC, and outline our collaboration model. By transforming VA data into a national resource for research in precision oncology, the VPODC seeks to foster innovation through collaboration and resource sharing that will ultimately lead to improved care for Veterans with cancer.
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Affiliation(s)
- Nhan Do
- VA Boston Healthcare System, Boston University School of Medicine, Boston, Massachusetts.
| | | | - Theodore Feldman
- VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts
| | - Nathanael Fillmore
- VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts
| | - Danne Elbers
- VA Boston Healthcare System, University of Vermont, Burlington, Vermont
| | - David Tuck
- VA Boston Healthcare System, Boston University School of Medicine, Boston, Massachusetts
| | - Rupali Dhond
- VA Boston Healthcare System, Boston, Massachusetts
| | - Luis Selva
- VA Boston Healthcare System, Boston University School of Medicine, Boston, Massachusetts
| | - Frank Meng
- VA Boston Healthcare System, Boston University School of Medicine, Boston, Massachusetts
| | | | - Samuel Ajjarapu
- VA Boston Healthcare System, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Robert Hall
- VA Boston Healthcare System, Boston, Massachusetts
| | - Stephanie Do
- VA Boston Healthcare System, College of William and Mary, Williamsburg, Virginia
| | - Mary Brophy
- VA Boston Healthcare System, Boston University School of Medicine, Boston, Massachusetts
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17
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Soberay KA, Hanson JE, Dwyer M, Plant EA, Gutierrez PM. The Relationship between Suicidal Responses and Traumatic Brain Injury and Severe Insomnia in Active Duty, Veteran, and Civilian Populations. Arch Suicide Res 2019; 23:391-410. [PMID: 29792569 DOI: 10.1080/13811118.2018.1479322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
This study examined how a positive traumatic brain injury (TBI) screening and insomnia severity relate to suicidal outcomes across active duty, veteran, and civilian samples. Data were used from 3,993 participants from 19 studies. We conducted a series of analyses by group to identify which significantly differed on the variables of interest. TBI and insomnia each had independent relationships with outcomes over and above the impact of the other factor. Veterans presented as clinically worse across the outcomes. However, the relationship between insomnia and suicidal responses was stronger for active duty military compared to veterans. Continued research on TBIs and insomnia severity across groups will improve quality of care for those at risk of suicide.
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Affiliation(s)
- Kelly A Soberay
- a Military Suicide Research Consortium , Denver , CO , USA.,b Department of Veterans Affairs , Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) , Denver , CO 80206 , USA
| | - Jetta E Hanson
- a Military Suicide Research Consortium , Denver , CO , USA.,b Department of Veterans Affairs , Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) , Denver , CO 80206 , USA
| | - Megan Dwyer
- a Military Suicide Research Consortium , Denver , CO , USA.,b Department of Veterans Affairs , Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) , Denver , CO 80206 , USA
| | - E Ashby Plant
- a Military Suicide Research Consortium , Denver , CO , USA.,c Florida State University , Tallahassee , FL , USA
| | - Peter M Gutierrez
- a Military Suicide Research Consortium , Denver , CO , USA.,b Department of Veterans Affairs , Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) , Denver , CO 80206 , USA.,d University of Colorado School of Medicine , Denver , CO , USA
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18
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Tate JP, Sterne JAC, Justice AC. Albumin, white blood cell count, and body mass index improve discrimination of mortality in HIV-positive individuals. AIDS 2019; 33:903-912. [PMID: 30649058 PMCID: PMC6749990 DOI: 10.1097/qad.0000000000002140] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Despite viral suppression and immune response on antiretroviral therapy, people with HIV infection experience excess mortality compared with uninfected individuals. The Veterans Aging Cohort Study (VACS) Index incorporates clinical biomarkers of general health with age, CD4 cell count, and HIV-1 RNA to discriminate mortality risk in a variety of HIV-positive populations. We asked whether additional biomarkers further enhance discrimination. DESIGN AND METHODS Using patients from VACS for development and from the Antiretroviral Therapy Cohort Collaboration (ART-CC) for validation, we obtained laboratory values from a randomly selected visit from 2000 to 2014, at least 1 year after antiretroviral therapy initiation. Patients were followed for 5-year, all-cause mortality through September 2016. We fitted Cox models with established predictors and added new predictors based on model fit and Harrell's c-statistic. We converted all variables to continuous functional forms and selected the best model (VACS Index 2.0) for validation in ART-CC patients. We compared discrimination using c-statistics and Kaplan-Meier plots. RESULTS Among 28 390 VACS patients and 12 109 ART-CC patients, 7293 and 722 died, respectively. Nadir CD4, CD8, and CD4 : CD8 ratio did not improve discrimination. Addition of albumin, white blood count, and BMI, improved c-statistics in VACS from 0.776 to 0.805 and in ART-CC from 0.800 to 0.831. Results were robust in all nine ART-CC cohorts, all lengths of follow-up and all subgroups. CONCLUSION VACS Index 2.0, adding albumin, white blood count, and BMI to version 1.0 and using continuous variables, provides improved discrimination and is highly transportable to external settings.
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Affiliation(s)
- Janet P Tate
- VA Connecticut Health Systems, West Haven, Connecticut, USA
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19
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Iovine-Wong PE, Nichols-Hadeed C, Thompson Stone J, Gamble S, Cross W, Cerulli C, Levandowski BA. Intimate Partner Violence, Suicide, and Their Overlapping Risk in Women Veterans: A Review of the Literature. Mil Med 2019; 184:e201-e210. [DOI: 10.1093/milmed/usy355] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/17/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Paige E Iovine-Wong
- Department of Community Health and Health Behavior, University of Buffalo School of Public Health and Health Professions, 401 Goodyear Road, Buffalo, NY
| | - Corey Nichols-Hadeed
- Laboratory of Interpersonal Violence and Victimization, Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY
| | - Jennifer Thompson Stone
- Laboratory of Interpersonal Violence and Victimization, Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY
| | - Stephanie Gamble
- Laboratory of Interpersonal Violence and Victimization, Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, 400 Fort Hill Ave, Canandaigua, NY
| | - Wendi Cross
- Laboratory of Interpersonal Violence and Victimization, Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, 400 Fort Hill Ave, Canandaigua, NY
| | - Catherine Cerulli
- Laboratory of Interpersonal Violence and Victimization, Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY
| | - Brooke A Levandowski
- Department of Obstetrics and Gynecology, Clinical and Translational Science Institute, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY
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20
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Single Versus Multiple Suicide Attempts: A Prospective Examination of Psychiatric Factors and Wish to Die/Wish to Live Index Among Military and Civilian Psychiatrically Admitted Patients. J Nerv Ment Dis 2018; 206:657-661. [PMID: 30020209 DOI: 10.1097/nmd.0000000000000851] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Individuals with multiple suicide attempts have a greater risk for eventual suicide death. We investigated clinical differences in participants with single versus multiple suicide attempts. Individuals with multiple attempts were more likely to have severe depressive symptoms, drug use disorder, and a higher wish to die. Borderline personality disorder traits and drug use disorder were significant predictors of multiple attempts when adjusting for other psychiatric disorders. Participants with multiple attempts sustained higher suicidal ideation-worst and wish to die/wish to live-worst scores during the 3-month assessment period. Clinical differences between individuals with multiple versus single attempts point to the need of tailored suicide prevention efforts.
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21
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Mortality Among Veterans and Non-veterans: Does Type of Health Care Coverage Matter? POPULATION RESEARCH AND POLICY REVIEW 2018. [DOI: 10.1007/s11113-018-9468-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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22
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Danan ER, Krebs EE, Ensrud K, Koeller E, MacDonald R, Velasquez T, Greer N, Wilt TJ. An Evidence Map of the Women Veterans' Health Research Literature (2008-2015). J Gen Intern Med 2017; 32:1359-1376. [PMID: 28913683 PMCID: PMC5698220 DOI: 10.1007/s11606-017-4152-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/08/2017] [Accepted: 07/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Women comprise a growing proportion of Veterans seeking care at Veterans Affairs (VA) healthcare facilities. VA initiatives have accelerated changes in services for female Veterans, yet the corresponding literature has not been systematically reviewed since 2008. In 2015, VA Women's Health Services and the VA Women's Health Research Network requested an updated literature review to facilitate policy and research planning. METHODS The Minneapolis VA Evidence-based Synthesis Program performed a systematic search of research related to female Veterans' health published from 2008 through 2015. We extracted study characteristics including healthcare topic, design, sample size and proportion female, research setting, and funding source. We created an evidence map by organizing and presenting results within and across healthcare topics, and describing patterns, strengths, and gaps. RESULTS We identified 2276 abstracts and assessed each for relevance. We excluded 1092 abstracts and reviewed 1184 full-text articles; 750 were excluded. Of 440 included articles, 208 (47%) were related to mental health, particularly post-traumatic stress disorder (71 articles), military sexual trauma (37 articles), and substance abuse (20 articles). The number of articles addressing VA priority topic areas increased over time, including reproductive health, healthcare organization and delivery, access and utilization, and post-deployment health. Three or fewer articles addressed each of the common chronic diseases: diabetes, hypertension, depression, or anxiety. Nearly 400 articles (90%) used an observational design. Eight articles (2%) described randomized trials. CONCLUSIONS Our evidence map summarizes patterns, progress, and growth in the female Veterans' health and healthcare literature. Observational studies in mental health make up the majority of research. A focus on primary care delivery over clinical topics in primary care and a lack of sex-specific results for studies that include men and women have contributed to research gaps in addressing common chronic diseases. Interventional research using randomized trials is needed.
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Affiliation(s)
- Elisheva R Danan
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA. .,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Erin E Krebs
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kristine Ensrud
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eva Koeller
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Roderick MacDonald
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Tina Velasquez
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Nancy Greer
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Timothy J Wilt
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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Kochanski-Ruscio K, Nademin E, Perera K, LaCroix JM, Baer M, Hassen HO, Englert MD, Ghahramanlou-Holloway M. An Examination of United States Air Force Suicide Decedents Based on Documented Suicide Attempt Histories. Arch Suicide Res 2017; 21:556-567. [PMID: 27668347 DOI: 10.1080/13811118.2016.1240635] [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] [Indexed: 10/20/2022]
Abstract
In this study, we compared United States military decedents who died by suicide on their first attempt with decedents who had made multiple attempts. Death investigation files for 217 United States Air Force (USAF) personnel who died by suicide between 1996 and 2006 were coded for demographic, psychosocial, and psychiatric characteristics. Among USAF suicide decedents, 77% died by suicide on their first attempt and 23% had a documented history of at least one prior attempt. Decedents with a history of prior attempts were more likely to have an interpersonal stressor within 3 months of death and were twice as likely to have a documented Axis I diagnosis. There were few differences between military suicide decedents based on history of prior attempts. Further research is needed to inform military suicide prevention endeavors.
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Roberts LW, Louie AK, Guerrero APS, Balon R, Beresin EV, Brenner A, Coverdale J. Premature Mortality Among People with Mental Illness: Advocacy in Academic Psychiatry. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:441-446. [PMID: 28585124 DOI: 10.1007/s40596-017-0738-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/17/2017] [Indexed: 06/07/2023]
Affiliation(s)
| | | | | | | | | | - Adam Brenner
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Kopacz MS, Kane CP, Pigeon WR, Nieuwsma JA. Chaplaincy Encounters Following a Suicide Attempt. J Health Care Chaplain 2017; 23:167-173. [PMID: 28426335 DOI: 10.1080/08854726.2017.1312813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This descriptive study examines the provision of chaplaincy services to veterans who sought health care at a Department of Veterans Affairs (VA) Medical Center following a suicide attempt. A system-wide VA database of suicidal behavior was used to identify a cohort of n = 22,701 veterans who survived a suicide attempt. Next, an electronic review of VA clinical records found that n = 7,447 (32.8%) received chaplaincy services in the 30 days following their attempt. Of this group, the overwhelming majority of first chaplaincy encounters took place in in-patient settings: n = 6890 (92.5%). First chaplaincy encounters most often occurred 1-7 days following the attempt: n = 5,033 (67.6%). Most chaplaincy service users had only one chaplaincy encounter: n = 3,514 (47.2%). The findings suggest that, at VA Medical Centers, a relatively sizeable percentage of suicide attempt survivors have contact with chaplaincy services. Additional research is needed to ascertain if chaplaincy services yield any therapeutic benefit for this group.
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Affiliation(s)
- Marek S Kopacz
- a VISN 2 Center of Excellence for Suicide Prevention , Canandaigua , New York , USA
| | - Cathleen P Kane
- a VISN 2 Center of Excellence for Suicide Prevention , Canandaigua , New York , USA
| | - Wilfred R Pigeon
- a VISN 2 Center of Excellence for Suicide Prevention , Canandaigua , New York , USA.,b University of Rochester Medical Center , Rochester , New York , USA
| | - Jason A Nieuwsma
- c Mid-Atlantic Mental Illness Research, Education and Clinical Center, Mental Health and Chaplaincy , Durham , North Carolina , USA.,d Duke University Medical Center , Durham , North Carolina , USA
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Logan J, Bohnert A, Spies E, Jannausch M. Suicidal ideation among young Afghanistan/Iraq War Veterans and civilians: Individual, social, and environmental risk factors and perception of unmet mental healthcare needs, United States, 2013. Psychiatry Res 2016; 245:398-405. [PMID: 27611069 PMCID: PMC5808402 DOI: 10.1016/j.psychres.2016.08.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 11/20/2022]
Abstract
Suicidal Ideation among Afghanistan/Iraq War Veterans remains a health concern. As young Veterans adjust to civilian life, new risk factors might emerge and manifest differently in this group versus those in the general population. We explored these differences. With 2013 National Survey on Drug Use and Health data, we examined differences in risk of past-year suicidal ideation between Veterans of the Afghanistan/Iraq War periods aged 18-34 years (N=328) and age-comparable civilians (N=23,222). We compared groups based on individual and socio-environmental risk factors as well as perceptions of unmet mental healthcare needs. We report adjusted rate ratios (aRRs); interaction terms tested for between-group differences. PY suicidal ideation rates for Veterans and civilians did not differ (52 versus 59 per 1,000, p=0.60) and both groups shared many risk factors. However, drug problems and perceived unmet mental health care needs were vastly stronger risk factors among Veterans versus civilians (interaction terms indicated that the aRRs were 3.8-8.0 times higher for Veterans versus civilians). Other differences were discovered as well. Past-year suicidal ideation rates did not differ by Veteran status among young adults. However, different risk factors per group were detected, which can inform Veteran suicide prevention efforts.
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Affiliation(s)
- Joseph Logan
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, 4770 Buford Highway, MS-F63, Atlanta, GA 30341-3724, USA.
| | - Amy Bohnert
- University of Michigan and US Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Erica Spies
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, 4770 Buford Highway, MS-F63, Atlanta, GA 30341-3724, USA
| | - Mary Jannausch
- University of Michigan and US Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
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Chen HM, Hung TH, Chou SY, Tsai CS, Su JA. Three-year mortality rate of suicide attempters in consultation-liaison service. Int J Psychiatry Clin Pract 2016; 20:254-9. [PMID: 27541986 DOI: 10.1080/13651501.2016.1213853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Suicide attempters might be sent to the emergency room for urgent medical intervention. Some with more severe physical morbidity may be hospitalised, and psychiatrists might be consulted for suicide evaluation. The aim of our study was to investigate the three-year all-cause mortality rate of hospitalised suicide attempters with regard to the effect of consultation-liaison services, and to identify any risk factors associated with mortality. METHODS Between 2002 and 2006, 196 inpatients from medical or surgical wards in a general hospital who had consulted psychiatrists because of suicide attempts were collected consecutively. We traced their mortality incidence during a three-year period, and calculated the mortality rate and time (days) to death. RESULTS Three-year all-cause mortality was 20.4%, and there was a higher risk of mortality in the first two years after the index suicide attempt. In the adjusted Cox regression model, associated risks included male gender, older age, diagnosis of depressive disorders and lack of psychiatric follow-up. CONCLUSIONS We found that hospitalised suicide attempters had higher all-cause mortality after discharge, and determined that psychiatric follow-up is helpful. More attention should be paid to those with potential risk factors, and timely intervention is suggested in order to reduce mortality.
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Affiliation(s)
- Hong-Ming Chen
- a Department of Psychiatry , Chang Gung Memorial Hospital , Chiayi , Taiwan ;,b Graduate Institute of Clinical Medical Sciences , Chang Gung University , Taoyuan , Taiwan ;,c Department of Nursing , Chang Gung Institute of Technology , Taoyuan , Taiwan
| | - Tai-Hsin Hung
- a Department of Psychiatry , Chang Gung Memorial Hospital , Chiayi , Taiwan ;,b Graduate Institute of Clinical Medical Sciences , Chang Gung University , Taoyuan , Taiwan ;,c Department of Nursing , Chang Gung Institute of Technology , Taoyuan , Taiwan
| | - Shih-Yong Chou
- a Department of Psychiatry , Chang Gung Memorial Hospital , Chiayi , Taiwan ;,b Graduate Institute of Clinical Medical Sciences , Chang Gung University , Taoyuan , Taiwan ;,c Department of Nursing , Chang Gung Institute of Technology , Taoyuan , Taiwan
| | - Ching-Shu Tsai
- a Department of Psychiatry , Chang Gung Memorial Hospital , Chiayi , Taiwan ;,b Graduate Institute of Clinical Medical Sciences , Chang Gung University , Taoyuan , Taiwan ;,c Department of Nursing , Chang Gung Institute of Technology , Taoyuan , Taiwan
| | - Jian-An Su
- a Department of Psychiatry , Chang Gung Memorial Hospital , Chiayi , Taiwan ;,b Graduate Institute of Clinical Medical Sciences , Chang Gung University , Taoyuan , Taiwan ;,c Department of Nursing , Chang Gung Institute of Technology , Taoyuan , Taiwan
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Britton PC, Stephens B, Wu J, Kane C, Gallegos A, Ashrafioun L, Tu X, Conner KR. Comorbid depression and alcohol use disorders and prospective risk for suicide attempt in the year following inpatient hospitalization. J Affect Disord 2015; 187:151-5. [PMID: 26339924 DOI: 10.1016/j.jad.2015.08.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study is to identify predictors of nonfatal suicide attempts in veterans discharged from acute hospitalization with depression and/or alcohol use disorder (AUD) diagnoses. We hypothesized that primary depression confers similar risk for attempt whether or not it is accompanied by secondary AUD, and that a suicide attempt in the prior year would confer greatest risk of the variables studied. METHOD Veteran Health Administration (VHA) patients discharged from acute inpatient hospitalization in 2011 with AUD and/or non-bipolar depression diagnoses (N=22,319) were analyzed using information from the computerized record system and national database on suicidal behavior. Proportional hazard regression models estimated unadjusted and adjusted hazard ratios (AHR) and confidence intervals (95% CI) for risk of a nonfatal attempt within one year following discharge. RESULTS As hypothesized, primary depression with secondary AUD [AHR (95% CI)=1.41 (1.04, 1.92)] and without secondary AUD [AHR (95% CI)=1.30 (1.00, 1.71)] conferred similar prospective risk for attempt (AUD without depression, reference). Although prior suicide attempt was associated with increased risk, acute care in "general psychiatry" during hospitalization [AHR (95% CI)=6.35 (3.48, 13.00)] conferred the greatest risk among the variables studied. Transfer to another inpatient setting reduced risk [AHR (95% CI=0.53 (0.34, 0.79). LIMITATIONS Analyses were based on administrative data and did not include information on mortality. CONCLUSION When primary depression is severe enough to warrant inpatient hospitalization, a secondary diagnosis of AUD may not contribute additional prospective risk for nonfatal attempt. Within VHA, acute psychiatric care during hospitalization is a potential marker for increased risk for nonfatal attempt. Transfer to an additional inpatient setting may reduce risk for nonfatal attempt.
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Affiliation(s)
- Peter C Britton
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Brady Stephens
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, USA
| | - Jing Wu
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, USA
| | - Cathleen Kane
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, USA
| | - Autumn Gallegos
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Lisham Ashrafioun
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Xin Tu
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Kenneth R Conner
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Stanley B, Brown GK, Currier GW, Lyons C, Chesin M, Knox KL. Brief Intervention and Follow-Up for Suicidal Patients With Repeat Emergency Department Visits Enhances Treatment Engagement. Am J Public Health 2015; 105:1570-2. [PMID: 26066951 DOI: 10.2105/ajph.2015.302656] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We implemented an innovative, brief, easy-to-administer 2-part intervention to enhance coping and treatment engagement. The intervention consisted of safety planning and structured telephone follow-up postdischarge with 95 veterans who had 2 or more emergency department (ED) visits within 6 months for suicide-related concerns (i.e., suicide ideation or behavior). The intervention significantly increased behavioral health treatment attendance 3 months after intervention, compared with treatment attendance in the 3 months after a previous ED visit without intervention. The trend was for a decreasing hospitalization rate.
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Affiliation(s)
- Barbara Stanley
- Barbara Stanley and Megan Chesin are with the Department of Psychiatry, Columbia University, New York, NY, and the New York State Psychiatric Institute, New York. Gregory K. Brown is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Glenn W. Currier and Kerry L. Knox are with the Department of Psychiatry, University of Rochester, Rochester, NY. Chelsea Lyons is with Health Services Research and Policy, University of Rochester
| | - Gregory K Brown
- Barbara Stanley and Megan Chesin are with the Department of Psychiatry, Columbia University, New York, NY, and the New York State Psychiatric Institute, New York. Gregory K. Brown is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Glenn W. Currier and Kerry L. Knox are with the Department of Psychiatry, University of Rochester, Rochester, NY. Chelsea Lyons is with Health Services Research and Policy, University of Rochester
| | - Glenn W Currier
- Barbara Stanley and Megan Chesin are with the Department of Psychiatry, Columbia University, New York, NY, and the New York State Psychiatric Institute, New York. Gregory K. Brown is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Glenn W. Currier and Kerry L. Knox are with the Department of Psychiatry, University of Rochester, Rochester, NY. Chelsea Lyons is with Health Services Research and Policy, University of Rochester
| | - Chelsea Lyons
- Barbara Stanley and Megan Chesin are with the Department of Psychiatry, Columbia University, New York, NY, and the New York State Psychiatric Institute, New York. Gregory K. Brown is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Glenn W. Currier and Kerry L. Knox are with the Department of Psychiatry, University of Rochester, Rochester, NY. Chelsea Lyons is with Health Services Research and Policy, University of Rochester
| | - Megan Chesin
- Barbara Stanley and Megan Chesin are with the Department of Psychiatry, Columbia University, New York, NY, and the New York State Psychiatric Institute, New York. Gregory K. Brown is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Glenn W. Currier and Kerry L. Knox are with the Department of Psychiatry, University of Rochester, Rochester, NY. Chelsea Lyons is with Health Services Research and Policy, University of Rochester
| | - Kerry L Knox
- Barbara Stanley and Megan Chesin are with the Department of Psychiatry, Columbia University, New York, NY, and the New York State Psychiatric Institute, New York. Gregory K. Brown is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Glenn W. Currier and Kerry L. Knox are with the Department of Psychiatry, University of Rochester, Rochester, NY. Chelsea Lyons is with Health Services Research and Policy, University of Rochester
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Finley EP, Bollinger M, Noël PH, Amuan ME, Copeland LA, Pugh JA, Dassori A, Palmer R, Bryan C, Pugh MJV. A national cohort study of the association between the polytrauma clinical triad and suicide-related behavior among US Veterans who served in Iraq and Afghanistan. Am J Public Health 2015; 105:380-7. [PMID: 25033126 DOI: 10.2105/ajph.2014.301957] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES We examined the association of posttraumatic stress disorder (PTSD), traumatic brain injury, and chronic pain-the polytrauma clinical triad (PCT)-independently and with other conditions, with suicide-related behavior (SRB) risk among Operation Enduring Freedom (OEF; Afghanistan) and Operation Iraqi Freedom (OIF) veterans. METHODS We used Department of Veterans Affairs (VA) administrative data to identify OEF and OIF veterans receiving VA care in fiscal years 2009-2011; we used International Classification of Diseases, Ninth Revision, Clinical Modification codes to characterize 211652 cohort members. Descriptive statistics were followed by multinomial logistic regression analyses predicting SRB. RESULTS Co-occurrence of PCT conditions was associated with significant increase in suicide ideation risk (odds ratio [OR] = 1.9; 95% confidence interval [CI]=1.5, 2.4) or attempt and ideation (OR=2.6; 95% CI=1.5, 4.6), but did not exceed increased risk with PTSD alone (ideation: OR=2.3; 95% CI=2.0, 2.6; attempt: OR=2.0; 95% CI=1.4, 2.9; ideation and attempt: OR=1.8; 95% CI=1.2, 2.8). Ideation risk was significantly elevated when PTSD was comorbid with depression (OR=4.2; 95% CI=3.6, 4.8) or substance abuse (OR=4.7; 95% CI = 3.9, 5.6). CONCLUSIONS Although PCT was a moderate SRB predictor, interactions among PCT conditions, particularly PTSD, and depression or substance abuse had larger risk increases.
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Affiliation(s)
- Erin P Finley
- Erin P. Finley, Mary Bollinger, Polly H. Noël, Jacqueline A. Pugh, Albana Dassori, and Mary Jo V. Pugh are with South Texas Veterans Health Care System, San Antonio. Raymond Palmer is with Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio. Megan E. Amuan is with Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA. Laurel A. Copeland is with Center for Applied Health Research, jointly sponsored by Central Texas Veterans, Health Care System and Scott and White Healthcare System, Temple, TX. Craig Bryan is with National Center for Veterans Studies and Department of Psychology, The University of Utah, Salt Lake City, UT
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Al-Sayegh H, Lowry J, Polur RN, Hines RB, Liu F, Zhang J. Suicide history and mortality: a follow-up of a national cohort in the United States. Arch Suicide Res 2015; 19:35-47. [PMID: 25674703 DOI: 10.1080/13811118.2013.855154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Little is known about the cause-specific deaths among young suicide attempters from the general population, and the time window for intervention to reduce the elevated rate of death was unclear. We analyzed a nationally representative sample of young adults (17-39 years old) who participated in the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) and were followed up with vital status through December 31, 2006. The history of attempted suicide was associated with an increased rate for all-cause death (HR = 1.52 [95% CI = 0.92-2.52]) with borderline statistical significance. Previous suicide attempters experienced a 3-fold (HR = 2.68[=1.01-7.09]) increased rate for cardiovascular diseases (CVD), and a 7-fold (HR = 7.10 [95% CI = 1.37-36.9]) increased rate of death due to completed suicide compared with non-attempters. The survival curves of the attempters declined rapidly for the first 3 years of follow-up, and the distance between curves remained consistent starting from the third year to the end of the follow-up. Prevention services should be tailored not only for suicide, but also for cardiovascular diseases among populations with suicidal tendency, and the service should be intensified within first 3 years after suicidal behaviors occur.
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Affiliation(s)
- Hasan Al-Sayegh
- a College of Public Health , Georgia Southern University , Statesboro , Georgia , USA
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Phillips SB. The dangerous role of silence in the relationship between trauma and violence: a group response. Int J Group Psychother 2014; 65:65-87. [PMID: 25513940 DOI: 10.1521/ijgp.2015.65.1.64] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article considers that somewhere in the space between violence and trauma is dangerous silence. Silence intensifies the impact of trauma, and trauma that goes unspoken, un-witnessed, and unclaimed too often "outs itself" as more violence to self or others. Relevant empirical evidence on the impact of civilian interpersonal violence, combat trauma, school shootings, bullying, and domestic violence confirms this tragic cycle. Crucial to addressing the danger of silence in this cycle, the article examines the centrality of silence existentially, neuropsychologically, psychologically, developmentally, interpersonally, and culturally in relation to violence. The bridge to voicing and assimilating the unspeakable is empathic connection with others. Drawing upon two different types of group programs, the article demonstrates that group can serve as that bridge. Group process has the potential to undo the dangerous role of silence in the relationship of trauma and violence.
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Ghahramanlou-Holloway M, Tucker J, Neely LL, Carreno-Ponce JT, Ryan K, Holloway K, George B. Suicide Risk among Military Women. Psychiatr Ann 2014. [DOI: 10.3928/00485713-20140403-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chapman SLC, Wu LT. Suicide and substance use among female veterans: a need for research. Drug Alcohol Depend 2014; 136:1-10. [PMID: 24315571 PMCID: PMC3945024 DOI: 10.1016/j.drugalcdep.2013.11.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The number of female veterans is increasing. Veterans Administration (VA) enrollment increased over 40% from past eras. However, little research has focused on their mental health. We reviewed literature to examine associations of substance use with suicide in female veterans, identify research gaps, and inform future studies. METHODS Google Scholar, Pub Med, and PsychINFO were searched using: substance use, female veteran, and suicide. Exclusion criteria (e.g., not discussing U.S. veterans) left 17 articles. RESULTS Nine studies examined completed suicide among veterans. In most recent years, rates of deaths were greater for veterans than nonveterans, including females. Completed suicide was associated with past trauma, young age, and a mental disorder. Studies have often not addressed substance use. Three studies examined completed suicide among VA treated veterans without examining substance use as an associated factor. Rates of completed suicides were also higher among veterans than nonveterans, including females. A large proportion of females also had a mental diagnosis. Five studies examined substance use and attempted or completed suicide among VA treated veterans. Veterans in poor mental health had increased odds of suicide mortality; women with a substance use disorder (SUD) had a higher hazard ratio for completed suicide than men with a SUD. Engagement in substance abuse treatment decreased odds of suicide attempt among veterans. CONCLUSION Available data suggest that suicide rates are higher among female veterans than women in the general population. Substance use may increase the likelihood of suicidal behaviors among female veterans, particularly those with a mental diagnosis.
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Affiliation(s)
- Shawna L. Carroll Chapman
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA,Address for correspondence: Shawna L. Carroll Chapman, Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC 27710, USA; tel.: 785-840-6632; fax: 919-681-8400;
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
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Cesur R, Sabia JJ, Tekin E. The psychological costs of war: military combat and mental health. JOURNAL OF HEALTH ECONOMICS 2013; 32:51-65. [PMID: 23220456 DOI: 10.1016/j.jhealeco.2012.09.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 09/01/2012] [Accepted: 09/14/2012] [Indexed: 06/01/2023]
Abstract
We exploit plausibly exogenous variation in overseas deployment assignment to estimate the effect of combat exposure on psychological well-being. Controlling for pre-deployment mental health, we find that active-duty soldiers deployed to combat zones are more likely to suffer from post-traumatic stress disorder (PTSD) than their counterparts deployed outside the United States in non-combat zones. Among those deployed to combat zones, those deployed to locales where they engage in enemy firefight or witness allied or civilian deaths are at an increased risk for suicidal ideation and PTSD relative to their active-duty counterparts deployed to combat zones without enemy firefight.
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Affiliation(s)
- Resul Cesur
- University of Connecticut, Finance Department, 2100 Hillside Road Unit 1041, Storrs, CT 06269-1041, USA.
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Abstract
Military veterans represent a unique, heterogeneous population with suicide prevalence rates, risk factors and preventative management needs that differ from those of the rest of community. Veterans worldwide receive high proportions of their healthcare from community providers, and sensitivity to these distinct needs is required for optimized care. An overview of the recent prevalence-study literature, with a focus upon statistical design, is presented in order to provide a critical orientation within this field with high levels of popular media attention. Attention to psychiatric comorbidity, subthreshold symptomology, select signature disorders of contemporary conflicts (namely, post-traumatic stress disorder and traumatic brain injury), and veteran life narratives before, within and beyond military service will guide our review of risk factor assessment and management strategies. This critical review of the literature provides an overview of this active field of neuropsychiatric research with a select focus upon these topics of special interest.
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Affiliation(s)
- Timothy R Rice
- Department of Psychiatry, The Mount Sinai School of Medicine, 1425 Madison Avenue, Box 1230, New York, NY 10029, USA.
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Suicide among war veterans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:2504-19. [PMID: 22851956 PMCID: PMC3407917 DOI: 10.3390/ijerph9072504] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 07/08/2012] [Accepted: 07/11/2012] [Indexed: 11/25/2022]
Abstract
Studies aiming to identify if war veterans are at higher risk of suicide have often produced inconsistent results; this could be due to the complexity of comparisons and different methodological approaches. It should be noted that this contingent has many risk factors, such as stressful exposures, wounds, brain trauma and pain syndrome. Most recent observations confirm that veterans are really more likely to die of suicide as compared to the general population; they are also more likely to experience suicidal ideation and suffer from mental health problems. Suicides are more frequent in those who develop PTSD, depression and comorbid states due to war exposure. Combat stress and its’ frequency may be an important factor leading to suicide within the frame of the stress-vulnerability model. According to this model, the effects of stress may interact with social factors, interpersonal relations and psychological variables producing suicidal tendencies. Modern understanding of stress-vulnerability mechanisms based on genetic predispositions, early life development, level of exposure to stress and stress-reactivity together with interpersonal aspects may help to build more effective suicide prevention programs based on universal/selective/indicated prevention principles.
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