Suicide Risk by Unit Component among Veterans Who Served in Iraq or Afghanistan

This study assessed the risk of suicide by time since separation from the military for US veterans who served in Iraq or Afghanistan. Suicide risk was assessed by comparing the number of suicides among veterans, when stratified by active vs. reserve/National Guard status to the expected number based on rates of suicide in the US general population. Hazard rates were used to assess suicide risk since the time each veteran separated/deactivated from active duty service. Compared to the US general population, active duty veterans had a 56% increased risk of suicide and reserve/National Guard veterans had a 29% increased risk. Suicide risk decreased as time since separation/deactivation increased for both groups. The risk of suicide for both groups was greatest during the first year of follow-up.     

Suicide in Vietnam Veterans: The Suicide Wall

ABSTRACT

Although official data have reported an average number of suicides in the veterans of the Vietnam War, the veterans themselves estimate that the death toll from suicide may be 8 to 10 times the official toll. Attention is drawn to a website honoring those veterans of the war who have committed suicide: www.suicidewall.com     

Clinical Features Associated with Suicide Attempts versus Suicide Gestures in an Inpatient Sample

The objective of this study was to test whether suicide attempters and suicide gesturers can be clinically differentiated. A total of 150 subjects who had attempted suicide at least once, had made a suicide gesture, had suicidal ideation, and/or had engaged in non-suicidal self-injury were recruited from the inpatient service of the Jiménez Díaz Foundation (Madrid, Spain). A multinomial regression analysis was conducted. Histrionic and antisocial personality disorders were risk factors specific to suicide gestures. Narcissistic personality disorder was specifically associated with suicide attempts. Borderline personality disorder was associated with both suicide gestures and attempts. A high level of impulsiveness was a risk factor specific to suicide attempts. Conclusion: Suicide attempters and suicide gesturers are two distinct, although partially overlapping, populations.     

Suicide Attempts in 107 Adolescents and Adults with Kleptomania

Suicide attempts in kleptomania have received little investigation. This study examined rates, correlates, and predictors of suicide attempts in kleptomania. A total of 107 adolescent and adult subjects (n = 32 [29.9%] males) with DSM-IV kleptomania were assessed with standard measures of symptom severity, psychiatric comorbidity, and functional impairment. Subjects had high rates of suicide attempts (24.3%). The suicide attempt in 92.3% of those who attempted suicide was attributed specifically to kleptomania. Suicide attempts were associated with current and life-time bipolar disorder (p = .047) and lifetime personality disorder (p = .049). Individuals with kleptomania have high rates of suicide attempts. Bipolar disorder is associated with suicide attempts in individuals with kleptomania and underscores the importance of carefully assessing and monitoring suicidality in patients with kleptomania.     

Religious Coping and Suicide Risk in a Sample of Recently Returned Veterans

The aim of the present study is to examine religious coping and depression as predictors of suicide risk in a large U.S. veteran sample from recent conflicts. Demographic, military history, depressive symptomatology, positive and negative religious coping and self-reported suicidal behavior were analyzed in a sample of 772 recently returned veterans. Suicide risk was computed as a continuum of risk across 4 separate categories. Negative religious coping was significantly associated with suicide risk, even after statistically controlling for depressive symptomatology and other variables. The present analysis did not find any significant relationships for positive religious coping. No significant gender interaction effects were found. The present findings support the importance of understanding veteran experiences of religious coping, particularly negative religious coping, in the context of suicide prevention efforts.     

Correlates of Nonsuicidal Self-Injury and Suicide Attempts Among Tertiary Care,Emergency Department Patients

Objective:

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the distinction between nonsuicidal self-injury (NSSI) and suicidal behaviour disorder is highlighted in the section Conditions for Further Study. Diagnostic criteria classify NSSI and suicidal behaviour disorder as distinct disorders, with the latter including suicide attempt (SA). This study examined the prevalence and correlates of NSSI in emergency department (ED) settings and compared them to SA.

Methods:

Data came from adult referrals to psychiatric services in 2 EDs between January 2009 and June 2011 (n = 5336). NSSI was compared with SA, as well as no suicidal behaviour, across a broad range of demographic and diagnostic correlates.

Results:

NSSI was more highly associated with female sex, childhood abuse, anxiety disorders, major depressive disorder (MDD), aggression and impulsivity, age under 45, and substance use disorders (SUDs), compared with presentations without suicidal behaviour. Comparing NSSI and SA, no differences were observed on sex, age, history of child abuse, or presence of anxiety or SUDs. Recent life stressors (OR 1.44; 95% CI 1.05 to 1.99), active suicidal ideation (OR 8.84; 95% CI 5.26 to 14.85), MDD (OR 3.05; 95% CI 2.23 to 4.17), previous psychiatric care or SA (OR 1.89; 95% CI 1.36 to 2.64), and single marital status (OR 1.63; 95% CI 1.20 to 2.22) contributed to a higher SA rate. Among people with NSSI, 83.7% presented only once to an ED. Among people who presented multiple times, only 18.2% re-presented with NSSI.

Conclusions:

NSSI is associated with early life adversity and psychiatric comorbidity. Most people present only once to ED services, and self-harm presentations seemed to change over time. Future studies should continue to clarify whether NSSI and SA have distinct risk profiles.     

One-Year Incidence of Suicide Attempts and Associated Risk and Protective Factors Among Adolescents

The goal of this study was to estimate incidence of adolescent suicide attempts and predictors of attempts. Data were collected using diagnostic interviews and questionnaires with a sample of 4,175 youths 11–17 and 3,134 followed-up a year later. Total incidence was 0.95% and first incidence 0.84% for attempts. We found few significant independent predictors of attempts. Multivariate analyses identified only 2 independent predictors of first incidence (marijuana use and caregiver attempts). We did find evidence for cumulative effects of risk factors, with increased odds of attempts with increasing number of risk factors. The difficulty in identifying a common set of modifiable risk factors continues to make development of effective interventions difficult. However, based on our results and those of other researchers, the impact of the cumulative risk conferred by multiple factors would seem to offer a viable strategy for reducing risk of suicide attempts as well as other mental health outcomes among adolescents.     

Characteristics of Recent Suicide Attempts by Inmates in Maximum Security Correctional Centers

The research examined inmates' subjective perceptions of the reasons for suicide attempts and the psychological, sociological and criminological factors associated with such attempts. The sample comprised 60 male inmates who had made a recent suicide attempt. The methods of examination were semi-structured interviews with the inmates and analysis of their psychological and criminological files. The results showed that the examined group was not totally homogeneous. Methods of suicidal attempts divided the sample into two groups: those who had made a non-life-threatening (NLT) suicide attempt (58%) and those who made a life-threatening (LT) attempt (42%). Several factors significantly differentiated NLT and LT groups. Four of these factors were combined in regression models to clarify the relationships between the variables and to predict, in retrospect, whether an inmate had made a NLT or LT suicide attempt. The results are discussed in relation to previous findings on suicidology and to practical implications in correctional settings.     

Characteristics of Recent Suicide Attempters with and without Borderline Personality Disorder

The present research compared recent suicide attempters with and without a diagnosis of Borderline Personality Disorder (BPD). One hundred and eighty recent suicide attempters, recruited in the Emergency Department, participated in extensive research interviews. Results showed that suicide attempters with BPD displayed greater severity of overall psychopathology, depression, hopelessness, suicidal ideation, past suicide attempts, and had poorer social problem solving skills than those without a BPD diagnosis. No differences were found between the groups regarding the intent to die or lethality associated with the index suicide attempt. These findings highlight the seriousness of BPD and the risk that individuals diagnosed with this disorder will attempt suicide.     

Veterans Crisis Line Callers With and Without Prior VHA Service Use

This study examines differences between Veterans with and without prior Veterans Health Administration service use who received a clinical referral from the Veterans’ Crisis Line. Differences between groups were identified using data taken from 13,444 calls and medical records. Approximately 91% of Veterans had a history of service use and 9% did not. Callers with prior service use were older, had more mental health disorders, made in-person contact more quickly, and used more outpatient mental healthcare. Those without prior service use were younger, had more mental health problems, and presented for care later. Callers with suicide-related diagnoses had high rates of service contact. These groups represent different subpopulations with unique healthcare needs and practices.     

Longitudinal Prediction of Suicide Attempts for a Diverse Adolescent Sample of Native Hawaiians,Pacific Peoples,and Asian Americans

The objective of this study was to determine the longitudinal predictors of past-6-month suicide attempts for a diverse adolescent sample of Native Hawaiians, Pacific peoples, and Asian Americans. The study used longitudinal data from the Hawaiian High Schools Health Survey (N?=?2,083, 9th to 11th graders, 1992–1993 and 1993–1994 school years). A stepwise multiple logistic regression was conducted. The final model consisted of three statistically significant predictors: (1) Time 1 suicide attempt, odds ratio?=?30.6; (2) state anxiety, odds ratio?=?4.9; and (3) parent expectations, odds ratio?=?1.9. Past suicide attempt was by far the strongest predictor of future suicide attempts. Implications are discussed, including the need for screening of prior suicide attempts and focused interventions after suicide attempts.     

Brooding,Reflection, and Distraction: Relation to Non-Suicidal Self-Injury versus Suicide Attempts

The present study examined the relation between cognitive response styles (i.e., brooding, reflection, distraction) and cognitive inflexibility in differentially predicting history of non-suicidal self-injury (NSSI) only, suicide attempt (SA) only, or both (NSSI + SA). College students (N = 352) completed self-report measures of rumination, distraction, and self-harm history, a diagnostic interview, and a computerized task measuring cognitive flexibility. Brooding uniquely predicted SA-only history, while reflection uniquely predicted history of NSSI-only and NSSI + SA. Distraction was associated with lower odds of NSSI-only and NSSI + SA. Cognitive inflexibility was not significantly associated with self-harm history. Cognitive vulnerabilities may help identify individuals who are at risk for self-harm and may differentiate between NSSI and SA.     

Attachment Representation and Suicidal Ideation in Vietnam Combat Veterans With Posttraumatic Stress Disorder

Attachment representation has been linked to psychopathology and suicidality. Possible links between attachment representations and suicidal ideation in a PTSD sample were examined. Vietnam combat veterans in treatment for PTSD (N = 48) were assessed for PTSD severity, attachment representation and current and lifetime suicidality. Contrary to expectation individuals with secure attachment representations had higher levels of current suicidal ideation than those with insecure attachment representations, and unresolved/disorganized attachment was associated with lower levels of current suicidal ideation. Secure attachment may not provide protection against high levels of distress and suicidal ideation among combat veterans with PTSD.     

Pathways to High-Lethality Suicide Attempts in Individuals with Borderline Personality Disorder

The purpose of this study was to develop and test a model of high-lethality suicide attempts (HLSA) in individuals with Borderline Personality Disorder (BPD). An increased number of prior suicide attempts, substance use immediately prior to the attempt, and objective planning were proposed to lead directly to a HLSA, while aggression and impulsivity were hypothesized to lead indirectly to a HLSA through their associations with prior attempts. Path analysis revealed a revised model in which impulsivity was found to be significantly associated with both the lethality of the most recent attempt and the number of prior attempts. These results are discussed in terms of trait and crescendo models of suicidal behavior and their implications for suicide risk assessment among individuals with BPD.     

Rurality as a Risk Factor for Attempted Suicide and Death by Suicide in Ontario,Canada

ObjectiveThis study aims to examine rural and urban differences in attempted suicide and death by suicide in Ontario, Canada.MethodThis is a population-based nested case-control study. Data were obtained from administrative databases held at ICES, which capture all hospital and emergency department visits across Ontario between 2007 and 2017. All adults living in Ontario who attempted suicide or died by suicide are included in the study, and controls were matched by sex and age. Suicides were captured using vital statistics. Suicide attempts were determined using emergency department service codes.ResultsRurality is a risk factor for attempted suicide and death by suicide. Rural males are more likely to die by suicide compared with urban males (adjusted odds ratio(AOR) = 1.70, 95% confidence interval (CI), 1.49 to 1.95), and the odds of death by suicide increase with increasing levels of rurality. Rural males and females have an increased risk of attempted suicide compared with their urban counterparts (males: AOR = 1.37, 95% CI, 1.24 to 1.50) (females: AOR = 1.26, 95% CI,  1.14 to 1.39), with a pattern of increasing risk of suicide attempts with increasing rurality. Rural females are not at increased risk of suicide compared with urban females (AOR = 1.08, 95% CI, 0.80 to 1.45). Sensitivity analyses corroborated the results.ConclusionsRural males are almost two times more likely to die by suicide compared with urban males, and both rural males and females have an elevated risk of suicide attempts compared with urban residents. Future research should examine potential mediators of the relationship between rurality and suicide.     

Suicide attempts and impulsivity

Impulsivity in suicidal behavior can describe the attempt (state) or the attempter (trait). There are no studies simultaneously measuring attempt impulsivity and attempter impulsivity in representative samples of suicide attempts. A one–year study of 278 suicide attempts in a general hospital tested the continuous versus dichotomous relationship between attempter impulsivity (Barratt Impulsiveness Scale) and attempt impulsivity (low scores in the planning subscale of Becks Suicidal Intent Scale). Attempter impulsivity was not a good predictor of attempt impulsivity independently of how both dimensions were measured (continuous or dichotomous ways). Impulsive attempts were associated with low lethality and lack of depression. Opportunities for prevention of suicide attempts in major depression and some personality traits may exist but require attentive monitoring of suicidal ideation and intent.