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Pease JL, Martin CE, Rowe C, Chard KM. Impact of residential PTSD treatment on suicide risk in veterans. Suicide Life Threat Behav 2022; 53:250-261. [PMID: 36541183 DOI: 10.1111/sltb.12939] [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: 02/24/2022] [Revised: 10/27/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION In 2019, 17 veterans died by suicide every day. Various suicide prevention treatments have emerged, yet limited research has explored the impact of Post Traumatic Stress Disorder (PTSD) treatment on suicidal ideation and behaviors. METHODS This study examines the impact of Cognitive Processing Therapy (CPT) on suicidal ideation among veterans in three residential PTSD programs (women's, men's, and PTSD/Traumatic Brain Injury). Interview and self-report data were collected from veterans (n = 446) throughout treatment. RESULTS Over 50% of veterans reported current suicidal ideation and a history of suicide attempts prior to treatment. Variables that predicted change in suicidal ideation included prior suicide attempt (β = 0.21, p = 0.022), change in CAPS-5 total score (β = 0.28, p = 0.038), employment status (β = -0.20, p = 0.035) and history of suicide attempt (β = 0.25, p = 0.009). Those without a previous suicide attempt made greater gains in CPT treatment than those with a previous suicide attempt. CONCLUSION Following 7 weeks of CPT residential treatment, a decrease in PTSD symptoms was significantly associated with a reduction in suicidal ideation. Implications are that CPT can reduce suicide risk in a variety of Veteran cohorts with differing trauma types.
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Affiliation(s)
- James L Pease
- College of Allied Health Sciences, School of Social Work, University of Cincinnati, Cincinnati, Ohio, USA
| | - Colleen E Martin
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA
| | - Claire Rowe
- College of Allied Health Sciences, School of Social Work, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kathleen M Chard
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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2
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Ingram PB, Morris CS, Golden B, Youngren WA, Fulton JA, Sharpnack J. The Influence of Service Era: Comparing Personality Assessment Inventory (PAI) Scale Scores Within a Posttraumatic Stress Disorder Treatment Clinic (PCT). J Clin Psychol Med Settings 2022; 29:624-635. [PMID: 34427816 DOI: 10.1007/s10880-021-09812-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
Research is mixed on the role of service era in symptom endorsement among Veterans, with differences emerging depending on the instrument evaluated. This study compares Personality Assessment Inventory (PAI) scale scores of VA test-takers who served during the Vietnam, Desert Storm, or Post-9/11 service eras. The sample was collected at a VA Posttraumatic Stress Disorder Clinical Team. Associations between gender and combat exposure were also examined as covariates. Results suggest that Veterans' self-report on the PAI is influenced by service era, even after accounting for gender and combat exposure during deployment. The largest differences were between Vietnam or Post-9/11 Veterans and those from the Gulf War era. Symptom differences typically varied across scales commonly associated with symptoms of trauma exposure/posttraumatic stress disorder. Implications for the clinical use of, and research with, the PAI and other broadband personality assessments within the VA healthcare system and trauma treatment settings are discussed.
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Affiliation(s)
- Paul B Ingram
- Department of Psychological Sciences, Texas Tech University, 2810 18th Street, Lubbock, TX, 79424, USA.
- Eastern Kansas Veteran Healthcare System, Topeka, KS, USA.
| | - Cole S Morris
- Department of Psychological Sciences, Texas Tech University, 2810 18th Street, Lubbock, TX, 79424, USA
| | - Brittney Golden
- Department of Psychological Sciences, Texas Tech University, 2810 18th Street, Lubbock, TX, 79424, USA
| | | | - Joe A Fulton
- Department of Psychology, University of Kansas, Lawrence, KS, USA
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3
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Brown EM, Salat DH, Milberg WP, Fortier CB, McGlinchey RE. Accelerated longitudinal cortical atrophy in
OEF
/
OIF
/
OND
veterans with severe
PTSD
and the impact of comorbid
TBI. Hum Brain Mapp 2022; 43:3694-3705. [PMID: 35426972 PMCID: PMC9294300 DOI: 10.1002/hbm.25877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/04/2022] [Accepted: 04/05/2022] [Indexed: 12/02/2022] Open
Abstract
Veterans who deployed in support of Operation Enduring Freedom (OEF), Iraqi Freedom (OIF), and New Dawn (OND) commonly experience severe psychological trauma, often accompanied by physical brain trauma resulting in mild traumatic brain injury (mTBI). Prior studies of individuals with posttraumatic stress disorder (PTSD) have revealed alterations in brain structure, accelerated cellular aging, and impacts on cognition following exposure to severe psychological trauma and potential interactive effects of military‐related mTBI. To date, however, little is known how such deployment‐related trauma changes with time and age of injury of the affected veteran. In this study, we explored changes in cortical thickness, volume, and surface area after an average interval of approximately 2 years in a cohort of 254 OEF/OIF/OND Veterans ranging in age from 19 to 67 years. Whole‐brain vertex‐wise analyses revealed that veterans who met criteria for severe PTSD (Clinician‐Administered PTSD Scale ≥60) at baseline showed greater negative longitudinal changes in cortical thickness, volume, and area over time. Analyses also revealed a significant severe‐PTSD by age interaction on cortical measures with severe‐PTSD individuals exhibiting accelerated cortical degeneration with increasing age. Interaction effects of comorbid military‐related mTBI within the severe‐PTSD group were also observed in several cortical regions. These results suggest that those exhibiting severe PTSD symptomatology have accelerated atrophy that is exacerbated with increasing age and history of mTBI.
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Affiliation(s)
- Emma M. Brown
- Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston Massachusetts USA
- Translational Research Center for TBI and Stress Disorders (TRACTS) VA Boston Healthcare System Boston Massachusetts USA
| | - David H. Salat
- Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston Massachusetts USA
- Translational Research Center for TBI and Stress Disorders (TRACTS) VA Boston Healthcare System Boston Massachusetts USA
- Brain Aging and Dementia (BAnD) Laboratory, A. A. Martinos Center for Biomedical Imaging, Department of Radiology Massachusetts General Hospital Charlestown Massachusetts USA
| | - William P. Milberg
- Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston Massachusetts USA
- Translational Research Center for TBI and Stress Disorders (TRACTS) VA Boston Healthcare System Boston Massachusetts USA
- Department of Psychiatry Harvard Medical School Boston Massachusetts USA
- Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston Massachusetts USA
| | - Catherine B. Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) VA Boston Healthcare System Boston Massachusetts USA
- Department of Psychiatry Harvard Medical School Boston Massachusetts USA
- Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston Massachusetts USA
| | - Regina E. McGlinchey
- Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston Massachusetts USA
- Translational Research Center for TBI and Stress Disorders (TRACTS) VA Boston Healthcare System Boston Massachusetts USA
- Department of Psychiatry Harvard Medical School Boston Massachusetts USA
- Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston Massachusetts USA
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Ahuja M, Awasthi M, Records K, Lamichhane RR. Early Age of Alcohol Initiation and its Association with Suicidal Behaviors. Subst Use Misuse 2021; 56:1332-1338. [PMID: 34057030 DOI: 10.1080/10826084.2021.1922452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The relationship between alcohol use and suicidal behaviors is well-accepted, but less is known about the contribution of its early initiation. This study was designed to test the association of early alcohol initiation versus later initiation with suicidal ideation and attempt in an ethnically diverse sample. METHODS The Collaborative Psychiatric Epidemiology Surveys (CPES), 2001-2003 (n = 20,013), database was used. A total of 13,867 participants were selected included 56.9% females and 43.1% males. Race and ethnicity were reported as 28.8% non-Hispanic White, 39.1% Black, 20.3% Latino, and 11.9% Asian. Logistic regression analyses tested the associations between early (< =14 years) and later (> =15) age alcohol initiation with suicide ideation and attempts. Alcohol initiation was indexed by self-report of the first time that any alcohol product was consumed. Potential confounders were controlled. RESULTS Early alcohol initiation was associated with higher odds (AOR = 3.64, 95% CI [2.51, 5.28]) of suicide ideation as compared with adults who had initiated > = age 15 (AOR = 2.11, 95% CI [1.46, 3.04]). Early age initiation was also associated with higher odds (AOR = 3.81, 95% CI [2.02, 7.18]) of lifetime suicide attempt versus later age initiators (AOR = 2.03, 95% CI [1.08, 3.79]). Significant differences were found between early and later age of initiation. Conclusion: Early age of alcohol initiation has profoundly increased odds of suicide ideation or attempt. It is critical that effective prevention programs for children and their caregivers be implemented to prevent or delay alcohol initiation and lessen the risk for future suicidal behaviors.
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Affiliation(s)
- Manik Ahuja
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee, USA
| | - Manul Awasthi
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee, USA
| | - Kathie Records
- School of Nursing, College of Natural and Health Sciences, University of Northern Colorado, Greeley, Colorado, USA
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5
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Wilchek-Aviad Y, Cohen-Louck K. Testing the Effectiveness of a Salutogenic Model for Reducing Suicidal Tendencies in a Population of Elderly and Young Adults. OMEGA-JOURNAL OF DEATH AND DYING 2020; 84:1081-1099. [PMID: 32460669 DOI: 10.1177/0030222820919186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Suicide is a leading cause of mortality worldwide, with the elderly having the highest suicide rates. This study tests the effectiveness of a salutogenic model in normative elderly people compared with young adults in protecting against risk behaviors and suicidal tendencies, based on two variables: locus of control and meaning in life (mediating variable between locus of control and suicidal tendency). Participants were 191 people aged 65 to 100 years and 200 young adults aged 18 to 28 years old. Participants completed questionnaires on locus of control and purpose in life and were assessed for suicidal tendencies. Findings reveal a negative effect of age on locus of control, purpose in life, and a negative correlation between purpose in life and internal locus of control and suicidal tendency. Purpose in life mediates between internal locus of control and suicidal tendency in both populations. The salutogenic model has significant implications and can be used to reduce suicidal tendencies.
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Martin RL, Bauer BW, Ramsey KL, Green BA, Capron DW, Anestis MD. How Distress Tolerance Mediates the Relationship Between Posttraumatic Stress Disorder and the Interpersonal Theory of Suicide Constructs in a U.S. Military Sample. Suicide Life Threat Behav 2019; 49:1318-1331. [PMID: 30368865 DOI: 10.1111/sltb.12523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/26/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Despite the general suicide rate within the military being comparable to the general population when comparing peers, there are certain branches of the military that have elevated risk. Specifically, the U.S. National Guard has suicide rates that are constantly higher than other military branches and civilian peers. The National Guard are a unique military population in which they frequently transition between military and civilian life. With these unique experiences and heightened risk, military suicide prevention efforts may benefit from further research within this population. Posttraumatic stress disorder (PTSD) is another concern amongst military personnel and has been linked to suicidal behavior. METHODS The current study examined the indirect effects that distress tolerance, a protective factor against suicide, has on the relationship between PTSD and constructs within a well-validated theory for suicide (the Interpersonal-Psychological Theory for suicidal behaviors) in a sample of U.S. Army National Guard personnel. RESULTS Results indicated that distress tolerance had a significant indirect effect on the relationship between PTSD and thwarted belongingness, perceived burdensomeness, and capability for suicide. CONCLUSIONS These findings are consistent with previous literature examining the relationship between distress tolerance and our outcome variables. These results could have important clinical implications, mainly that intervention strategies targeting distress tolerance could have significant impacts on suicide-relate thoughts.
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Affiliation(s)
- Rachel L Martin
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Brian W Bauer
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Kathleen L Ramsey
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Bradley A Green
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Daniel W Capron
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Michael D Anestis
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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Burke TA, Ammerman BA, Jacobucci R. The use of machine learning in the study of suicidal and non-suicidal self-injurious thoughts and behaviors: A systematic review. J Affect Disord 2019; 245:869-884. [PMID: 30699872 DOI: 10.1016/j.jad.2018.11.073] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/20/2018] [Accepted: 11/11/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Machine learning techniques offer promise to improve suicide risk prediction. In the current systematic review, we aimed to review the existing literature on the application of machine learning techniques to predict self-injurious thoughts and behaviors (SITBs). METHOD We systematically searched PsycINFO, PsycARTICLES, ERIC, CINAHL, and MEDLINE for articles published through February 2018. RESULTS Thirty-five articles met criteria to be included in the review. Included articles were reviewed by outcome: suicide death, suicide attempt, suicide plan, suicidal ideation, suicide risk, and non-suicidal self-injury. We observed three general aims in the use of SITB-focused machine learning analyses: (1) improving prediction accuracy, (2) identifying important model indicators (i.e., variable selection) and indicator interactions, and (3) modeling underlying subgroups. For studies with the aim of boosting predictive accuracy, we observed greater prediction accuracy of SITBs than in previous studies using traditional statistical methods. Studies using machine learning for variable selection purposes have both replicated findings of well-known SITB risk factors and identified novel variables that may augment model performance. Finally, some of these studies have allowed for subgroup identification, which in turn has helped to inform clinical cutoffs. LIMITATIONS Limitations of the current review include relatively low paper sample size, inconsistent reporting procedures resulting in an inability to compare model accuracy across studies, and lack of model validation on external samples. CONCLUSIONS We concluded that leveraging machine learning techniques to further predictive accuracy and identify novel indicators will aid in the prediction and prevention of suicide.
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Affiliation(s)
- Taylor A Burke
- Temple University, Department of Psychology, Philadelphia, PA, USA.
| | - Brooke A Ammerman
- University of Notre Dame, Department of Psychology, Notre Dame, IN, USA
| | - Ross Jacobucci
- University of Notre Dame, Department of Psychology, Notre Dame, IN, USA
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8
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Steele IH, Thrower N, Noroian P, Saleh FM. Understanding Suicide Across the Lifespan: A United States Perspective of Suicide Risk Factors, Assessment & Management. J Forensic Sci 2017. [PMID: 28639299 DOI: 10.1111/1556-4029.13519] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Suicide is a troubling, preventable phenomenon. Prior to attempts, individuals often seek help, prompting practitioners to perform risk assessments that ideally use evidence-based risk management strategies. A literature review was performed using Harvard Countway Library of Medicine, Google Scholar, PubMed. Key words used were "Forensic Science," "Suicide Risk Management," "Pediatric Suicide Risk Factors," "Adult Suicide Risk Factors," "Geriatric Suicide Risk Factors," "Suicide Risk Assessment." Parameters limited articles to studies/reviews completed in the past twenty years in the United States. Results indicated predictors of suicide in juveniles were insomnia, burdensomeness, and recent conflicts with family or a romantic partner. Adults had greater risk if male, substance abusing, with marital/job loss. Elderly individuals with multiple medical comorbidities, hopelessness, and isolation were at higher risk. Everyone evaluated should be screened for access to firearms. Management of suicide risk involves providing the least restrictive form of treatment which maintains an individual's safety.
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Affiliation(s)
- Ian H Steele
- Harvard Longwood Psychiatry Resident Training Program Beth Israel Deaconess Medical Center, Department of Psychiatry, 330 Brookline Ave, Rabb-2, Boston, MA 02215
| | - Natasha Thrower
- Harvard Longwood Psychiatry Resident Training Program Brigham and Women's Hospital, Department of Psychiatry 221 Longwood Ave, Boston, MA 02115
| | - Paul Noroian
- Forensic Psychiatry Fellowship, Law and Psychiatry Program, Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655
| | - Fabian M Saleh
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115.,Sexual Violence Prevention and Risk Management Program, Department of Psychiatry, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Rabb-2, Boston, MA 02215
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Turner HA, Finkelhor D, Hamby S, Henly M. Victimization and adversity among children experiencing war-related parental absence or deployment in a nationally representative US sample. CHILD ABUSE & NEGLECT 2017; 67:271-279. [PMID: 28292704 DOI: 10.1016/j.chiabu.2017.02.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/14/2017] [Accepted: 02/27/2017] [Indexed: 06/06/2023]
Abstract
This study compares children and youth who have experienced lifetime war-related parental absence or deployment with those having no such history on a variety of victimization types, non-victimization adversity, trauma symptoms, and delinquency; and assesses whether cumulative adversity and victimization help to explain elevated emotional and behavioral problems among children of parents who have experienced war-related absence or deployment. The National Surveys of Children's Exposure to Violence (NatSCEV) are comprised of three cross-sectional telephone surveys conducted in 2008, 2011, and 2014. Data were collected on the experiences of children aged one month to seventeen years. In each survey, interviews were conducted with youth 10-17 years old and with caregivers of children 0-9 years old. The analyses use pooled data from all three U.S. nationally-representative samples (total sample size of 13,052). Lifetime parental war-related absence or deployment was a marker for elevated childhood exposure to a wide array of victimization and adversity types. Cumulative past year exposure to multiple forms of victimization and adversity fully explained elevated trauma symptoms and delinquency in this population of children. Given the breadth of victimization and adversity risk, children with histories of parental war-related absence or deployment, as well as their families, represent important target groups for broad-based prevention and interventions to reduce exposure and ameliorate consequences when it does occur.
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Affiliation(s)
- Heather A Turner
- Crimes against Children Research Center, University of New Hampshire, Durham, NH, United States.
| | - David Finkelhor
- Crimes against Children Research Center, University of New Hampshire, Durham, NH, United States
| | - Sherry Hamby
- Life Paths Appalachian Research Center and University of the South, Sewanee, TN, USA
| | - Megan Henly
- Crimes against Children Research Center, University of New Hampshire, Durham, NH, United States
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Knox KL, Bossarte RM. Suicide prevention for veterans and active duty personnel. Am J Public Health 2012; 102 Suppl 1:S8-9. [PMID: 22390608 DOI: 10.2105/ajph.2011.300593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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