Cannabis use disorder and suicide attempts in Iraq/Afghanistan-era veterans

The objective of the present research was to examine the association between lifetime cannabis use disorder (CUD), current suicidal ideation, and lifetime history of suicide attempts in a large and diverse sample of Iraq/Afghanistan-era veterans (N = 3233) using a battery of well-validated instruments. As expected, CUD was associated with both current suicidal ideation (OR = 1.683, p = 0.008) and lifetime suicide attempts (OR = 2.306, p < 0.0001), even after accounting for the effects of sex, posttraumatic stress disorder, depression, alcohol use disorder, non-cannabis drug use disorder, history of childhood sexual abuse, and combat exposure. Thus, the findings from the present study suggest that CUD may be a unique predictor of suicide attempts among Iraq/Afghanistan-era veterans; however, a significant limitation of the present study was its cross-sectional design. Prospective research aimed at understanding the complex relationship between CUD, mental health problems, and suicidal behavior among veterans is clearly needed at the present time.     

Does cannabis use lead to depression and suicidal behaviours? A population‐based longitudinal study

Objective: This study investigates the relationship between cannabis use and later depression, suicidal ideation and suicide attempts in a cohort of young Norwegians. Method: Data were gathered through the Young in Norway longitudinal study, in which a population‐based sample of 2033 Norwegians were followed up over a 13‐year period, from their early teens to their late twenties. Data were gathered on: (a) exposure to cannabis use; and (b) depression, suicide ideation and suicide attempts. In addition, information about possible confounding factors was included. Results: In early adolescence, no associations with later depression or suicidal behaviours were observed. In the sample’s twenties, we observed highly significant associations with suicide ideation and suicide attempts. When adjusting for confounders, the OR was 2.9 (95% CI 1.3–6.1) for later suicide attempts in the group who had used cannabis 11+ times during the past 12 months. Conclusion: The findings suggest that exposure to cannabis by itself does not lead to depression but that it may be associated with later suicidal thoughts and attempts.     

The Prevalence and Psychosocial Correlates of Suicide Attempts Among Inpatient Adolescent Offspring of Croatian PTSD Male War Veterans

Despite evidence that children of male war veterans with combat-related posttraumatic stress disorder (PTSD) are at particularly high risk for behavior problems, very little is currently known about suicidal behaviors in this population of youth. This study aimed to examine the prevalence and psychosocial correlates of suicide attempts among psychiatrically hospitalized adolescent offspring of Croatian male PTSD veterans. Participants were psychiatric inpatients, ages 12–18 years. Self-report questionnaires assessed demographics, suicide attempts, psychopathology, parenting style, and family functioning. The prevalence of suicide attempts was 61.5 % (65.2 % for girls and 58.0 % for boys). Internalizing symptoms, family dysfunction, lower levels of maternal and paternal care, and paternal overcontrol were significantly associated with suicide attempts. Our findings suggest that suicide attempts are common among inpatient adolescent offspring of male PTSD veterans and that interventions targeting both adolescent psychopathology and family relationships are needed for adolescents who have attempted suicide.     

The relationship between anxiety disorders and suicide attempts: findings from the National Epidemiologic Survey on Alcohol and Related Conditions

Background: Previous work has suggested that anxiety disorders are associated with suicide attempts. However, many studies have been limited by lack of accounting for factors that could influence this relationship, notably personality disorders. This study aims to examine the relationship between anxiety disorders and suicide attempts, accounting for important comorbidities, in a large nationally representative sample. Methods: Data came from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2. Face‐to‐face interviews were conducted with 34,653 adults between 2004 and 2005 in the United States. The relationship between suicide attempts and anxiety disorders (panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety disorder, posttraumatic stress disorder (PTSD)) was explored using multivariate regression models controlling for sociodemographics, Axis I and Axis II disorders. Results: Among individuals reporting a lifetime history of suicide attempt, over 70% had an anxiety disorder. Even after adjusting for sociodemographic factors, Axis I and Axis II disorders, the presence of an anxiety disorder was significantly associated with having made a suicide attempt (AOR=1.70, 95% confidence interval (CI): 1.40–2.08). Panic disorder (AOR=1.31, 95% CI: 1.06–1.61) and PTSD (AOR=1.81, 95% CI: 1.45–2.26) were independently associated with suicide attempts in multivariate models. Comorbidity of personality disorders with panic disorder (AOR=5.76, 95% CI: 4.58–7.25) and with PTSD (AOR=6.90, 95% CI: 5.41–8.79) demonstrated much stronger associations with suicide attempts over either disorder alone. Conclusion: Anxiety disorders, especially panic disorder and PTSD, are independently associated with suicide attempts. Clinicians need to assess suicidal behavior among patients presenting with anxiety problems. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Major depressive disorder, suicidal ideation, and suicide attempt in twins discordant for cannabis dependence and early-onset cannabis use

BACKGROUND: Previous research has reported both a moderate degree of comorbidity between cannabis dependence and major depressive disorder (MDD) and that early-onset cannabis use is associated with increased risks for MDD. OBJECTIVE: To examine whether associations between both lifetime cannabis dependence and early cannabis use and measures of MDD, suicidal ideation, and suicide attempt persist after controlling for genetic and/or shared environmental influences. DESIGN: Cross-sectional survey of twin pairs discordant for lifetime cannabis dependence and those discordant for early cannabis use. SETTING: General population sample of twins (median age, 30 years). PARTICIPANTS: Two hundred seventy-seven same-sex twin pairs discordant for cannabis dependence and 311 pairs discordant for early-onset cannabis use (before age 17 years). MAIN OUTCOME MEASURES: Self-report measures of DSM-IV-defined lifetime MDD, suicidal ideation, and suicide attempt. RESULTS: Individuals who were cannabis dependent had odds of suicidal ideation and suicide attempt that were 2.5 to 2.9 times higher than those of their non-cannabis-dependent co-twin. Additionally, cannabis dependence was associated with elevated risks of MDD in dizygotic but not in monozygotic twins. Those who initiated cannabis use before age 17 years had elevated rates of subsequent suicide attempt (odds ratio, 3.5 [95% confidence interval, 1.4-8.6]) but not of MDD or suicidal ideation. Early MDD and suicidal ideation were significantly associated with subsequent risks of cannabis dependence in discordant dizygotic pairs but not in discordant monozygotic pairs. CONCLUSIONS: Comorbidity between cannabis dependence and MDD likely arises through shared genetic and environmental vulnerabilities predisposing to both outcomes. In contrast, associations between cannabis dependence and suicidal behaviors cannot be entirely explained by common predisposing genetic and/or shared environmental predispositions. Previously reported associations between early-onset cannabis use and subsequent MDD likely reflect shared genetic and environmental vulnerabilities, although it remains possible that early-onset cannabis use may predispose to suicide attempt.     

Combined PTSD and depressive symptoms interact with post-deployment social support to predict suicidal ideation in Operation Enduring Freedom and Operation Iraqi Freedom veterans

Rates of suicide are alarmingly high in military and veteran samples. Suicide rates are particularly elevated among those with post-traumatic stress disorder (PTSD) and depression, which share overlapping symptoms and frequently co-occur. Identifying and confirming factors that reduce, suicide risk among veterans with PTSD and depression is imperative. The proposed study evaluated, whether post-deployment social support moderated the influence of PTSD–depression symptoms on, suicidal ideation among Veterans returning from Iraq and Afghanistan using state of the art clinical, diagnostic interviews and self-report measures. Operations Enduring and Iraqi Freedom (OEF/OIF) Veterans (n=145) were invited to, participate in a study evaluating returning Veterans? experiences. As predicted, PTSD–depression, symptoms had almost no effect on suicidal ideation (SI) when post-deployment social support was high; however, when, post-deployment social support was low, PTSD–depression symptoms were positively associated with, SI. Thus, social support may be an important factor for clinicians to assess in the context of PTSD and, depressive symptoms. Future research is needed to prospectively examine the inter-relationship, between PTSD/depression and social support on suicidal risk, as well as whether interventions to, improve social support result in decreased suicidality.     

Psychiatric and substance-use comorbidities associated with lifetime crack cocaine use in young adults in the general population

Objective

To assess the association between lifetime crack cocaine use and psychiatric (post-traumatic stress disorder, current depression, current dysthymia, generalized anxiety disorder, panic disorder with agoraphobia, social phobia, as well as SRQ scores and suicide risk) and substance-use disorders (tobacco, alcohol, cannabis, cocaine, amphetamine, inhalants, sedatives, hallucinogens and opioids) in youth in the general population of the city of Pelotas, RS.

Method

This was a cross-sectional population-based study, involving 1560 participants between 18 and 24 years old. Lifetime substance use and abuse were investigated using the ASSIST inventory. Psychiatric comorbidities were assessed using the Mini-International Neuropsychiatric Interview and symptoms of common mental disorders were evaluated with the Self-Reported Questionnaire (SRQ).

Results

The prevalence of lifetime crack cocaine use in the sample was 2.5%. Its use was associated with total SRW scores and the presence of post-traumatic stress disorder, antisocial personality disorder and suicide risk in the final regression model. Tobacco, alcohol, cannabis, cocaine, amphetamine and cocaine dependence were also associated with lifetime use of crack cocaine.

Discussion

Youth with a history of crack cocaine use had a higher prevalence of psychiatric conditions such as post-traumatic stress disorder, as well as an increased risk of tobacco, alcohol, cannabis, cocaine, amphetamine and inhalant use and dependence.     

Sleep,suicide behaviors,and the protective role of sleep medicine

Objective/BackgroundSleep disturbance is associated with suicidal thoughts and behaviors. The relationship of specific sleep disorders to suicide attempts is less well established. Whether treating sleep disorders reduces suicide attempts remains controversial.MethodsSuicide attempts, treatment utilization, and psychiatric diagnoses were extracted from electronic medical records and a suicide attempt database from the U.S. Department of Veterans Affairs. The sample (N = 60,102) consisted of patients with any record of suicide attempt in FY13-14 and a 1:1 case-control of patients with no record of attempt, who were propensity score-matched based on age, gender, and prior year mental health treatment utilization. Associations among sleep disorders and suicide attempt were examined via logistic regression. Covariates included depression, anxiety, posttraumatic stress disorder (PTSD), bipolar, schizophrenia, substance use disorder (SUD), medical comorbidity, and obesity.ResultsInsomnia (OR = 5.62; 95% CI, 5.39–5.86), nightmares (odds ratio, OR = 2.49; 95% confidence interval, CI, 2.23–2.77), and sleep-related breathing disorders (OR = 1.37; 95% CI, 1.27–1.48) were positively associated with suicide attempt after accounting for age, gender, treatment utilization, and comorbid sleep disorders. Furthermore, when controlling for depression, anxiety, PTSD, bipolar, schizophrenia, substance use disorder (SUD), medical comorbidity, and obesity, insomnia (OR = 1.51, 95% CI, 1.43–1.59) remained positively associated with suicide attempt nightmares (OR = 0.96; 95% CI, 0.85–1.09) nor sleep-related breathing disorders (OR = 0.87, 95% CI = 0.79–0.94). Additionally, sleep medicine visits 180 days prior to index date were associated with decreased likelihood of suicide attempt for individuals with sleep disorders (OR = 0.86; 95% CI, 0.79–0.94).ConclusionInsomnia is associated with suicide attempt among veterans. Sleep medicine visits were associated with a reduced risk of suicide attempt in sleep disordered patients. The assessment and treatment of sleep disorders should be considered in context of strategies to augment suicide prevention efforts.     

The loss of a fellow service member: Complicated grief in post‐9/11 service members and veterans with combat‐related posttraumatic stress disorder

Bereavement is a potent and highly prevalent stressor among service members and veterans. However, the psychological consequences of bereavement, including complicated grief (CG), have been minimally examined. Loss was assessed in 204 post‐9/11, when service members and veterans with combat‐related posttraumatic stress disorder (PTSD) took part in a multicenter treatment study. Those who reported the loss of an important person completed the inventory of complicated grief (ICG; n = 160). Over three quarters (79.41%) of the sample reported an important lifetime loss, with close to half (47.06%) reporting the loss of a fellow service member (FSM). The prevalence of CG was 24.75% overall, and nearly one third (31.25%) among the bereaved. CG was more prevalent among veterans who lost a fellow service member (FSM) (41.05%, n = 39) compared to those bereaved who did not (16.92%, n = 11; OR = 3.41, 95% CI: 1.59, 7.36). CG was associated with significantly greater PTSD severity, functional impairment, trauma‐related guilt, and lifetime suicide attempts. Complicated grief was prevalent and associated with adverse psychosocial outcomes in veterans and service members with combat‐related PTSD. Clinicians working with this population should inquire about bereavement, including loss of a FSM, and screen for CG. Additional research examining CG in this population is needed.     

Suicidal ideation and suicide attempts in body dysmorphic disorder

OBJECTIVE: Because suicidality in body dys-morphic disorder (BDD) has received little investigation, this study examined rates, correlates, predictors, and other aspects of suicidal ideation and suicide attempts in this disorder. METHOD: From January 2001 to June 2003, 200 subjects with DSM-IV BDD recruited from diverse sources were assessed with standard measures. RESULTS: Subjects had high rates of lifetime suicidal ideation (78.0%) and suicide attempts (27.5%). Body dysmorphic disorder was the primary reason for suicidal ideation in 70.5% of those with a history of ideation and nearly half of subjects with a past attempt. Suicidal subjects often did not reveal their BDD symptoms to their clinician. In univariate analyses, both suicidal ideation and suicide attempts were associated with lifetime functional impairment due to BDD (p < .001), current functional impairment (p < .001 to < .05), lifetime bipolar disorder (p < .05), any personality disorder (p < .05 to .001), and comorbid borderline personality disorder (p < .01 to < .001). A history of suicidal ideation (but not suicide attempts) was additionally associated with comorbid lifetime major depression (p = .001). A history of suicide attempts (but not suicidal ideation) was additionally associated with delusional appearance beliefs (p = .01) and lifetime posttraumatic stress disorder (PTSD), an eating disorder, or a substance use disorder (p < .001 to < .05). In logistic regression analyses, suicidal ideation was significantly predicted by comorbid major depression (p = .010) and greater lifetime impairment due to BDD (p = .003); suicide attempts were significantly predicted by PTSD (p = .011), a substance use disorder (p = .011), and greater lifetime impairment due to BDD (p = .005). CONCLUSION: Individuals with BDD have high rates of suicidal ideation and suicide attempts. Lifetime impairment due to BDD and certain comorbid disorders are associated with suicidality.     

Suicide risk in bipolar patients: the role of co-morbid substance use disorders

Objective:  Bipolar disorder is associated with a high frequency of both completed suicides and suicide attempts. The primary aim of this study was to identify clinical predictors of suicide attempts in subjects with bipolar disorder.
Methods:  We studied 336 subjects with a diagnosis of bipolar I, bipolar II, or schizoaffective disorder (bipolar type). The Structured Clinical Interview for DSM-IV (SCID-I) was administered and subsequently two expert psychiatrists established a diagnosis. Predictors of suicide attempts were examined in attempters and non-attempters.
Results:  The lifetime rate of suicide attempts for the entire sample was 25.6%. A lifetime co-morbid substance use disorder was a significant predictor of suicide attempts: bipolar subjects with co-morbid substance use disorders (SUD) had a 39.5% lifetime rate of attempted suicide, while those without had a 23.8% rate (odds ratio=2.09, 95% CI=1.03–4.21, χ²=4.33, df=1, p=0.037).
Conclusions:  Lifetime co-morbid SUD were associated with a higher rate of suicide attempts in patients with bipolar disorder. This relationship may have a genetic origin and/or be explained by severity of illness and trait impulsivity.     

The role of alcohol use disorder and alcohol consumption in suicide attempts–A secondary analysis of 1921 suicide attempts

BackgroundIt is not known how characteristics of suicide attempts vary with different forms of alcohol involvement. The aim of this study is to clarify the role of alcohol use disorder and acute alcohol consumption in suicide attempts.MethodsData on 1921 suicide attempts was gathered in a major German city over a 5-year period. Suicide attempts were categorised according to a diagnosis of alcohol use disorder and acute alcohol consumption at the time of the attempt. Group comparisons and multinomial logistic regression were used for statistical analysis.ResultsIn 331 suicide attempts (17%) an alcohol use disorder was diagnosed. Six hundred and twenty-two suicide attempts (32%) were committed with acute alcohol consumption. Suicide attempts by individuals with alcohol use disorder were more often committed by men, older individuals and as a recurrent attempt, independently of alcohol consumption at the time of the attempt. When alcohol was consumed in suicide attempts by individuals with alcohol use disorder, low-risk methods were used most often.ConclusionsIndividuals with a diagnosis of alcohol use disorder are a high-risk group for multiple suicide attempts and should be a target group for suicide prevention. Screening for suicidality should be a regular part of the clinical assessment in individuals with alcohol use disorder.     

Neuroactive steroids and suicidality in posttraumatic stress disorder

OBJECTIVE: Recent studies suggest that neuroactive steroids may be altered in posttraumatic stress disorder (PTSD). Since high rates of suicidality accompany PTSD, the authors investigated neuroactive steroid levels and correlations to suicide attempts in veterans with this disorder. METHOD: Male veterans with PTSD enrolled in a larger study during inpatient hospitalization (N=130) were assessed for suicidal ideation or suicide attempt in the last 6 months. Serum levels of dehydroepiandrosterone (DHEA), androstenedione, testosterone, and estradiol were determined. The authors investigated associations between neuroactive steroids and suicidality. RESULTS: High rates of suicidality were observed. Close to 70% of these patients had suicidal thoughts, and 25% had attempted suicide in the last 6 months. Patients who had attempted suicide demonstrated significantly higher median DHEA levels than those who had not attempted suicide (15.6 versus 8.3 ng/ml), an association that persisted after adjustment for age. CONCLUSIONS: These findings suggest that higher DHEA levels may be linked to suicidality in veterans with PTSD and may be associated with the risk of self-harm.     

Comorbid panic disorder as an independent risk factor for suicide attempts in depressed outpatients

ObjectiveAlthough comorbid panic disorder is associated with more severe symptoms and poorer therapeutic response in depressive patients, the relationship between panic disorder and risk of suicide attempt has not been confirmed. This study aimed to examine the relationship between comorbid panic disorder and clinical characteristics associated with suicidal risk as well as the likelihood of suicide attempt.MethodA total of 223 outpatients with current major depressive disorder participated in the study. Both subjects with panic disorder (33%) and those without panic disorder (67%) were compared based on history of suicide attempts, current psychopathologies, and traits of impulsivity and anger.ResultsSubjects with panic disorder had higher levels of impulsivity, depression, and hopelessness and were more likely to report a history of suicide attempts. Subjects with panic disorder were younger at the time of first suicide attempt than those without panic disorder. Logistic regression analyses indicated that comorbid panic disorder was significantly associated with a history of suicide attempts after adjusting for other clinical correlates (odds ratio = 2.8; p < 0.01).ConclusionsThese findings suggest that comorbid panic disorder in patients with major depressive disorder may be associated with a more severe burden of illness and may independently increase the likelihood of suicide attempt.     

Impulsivity and aggression as predictors of suicide attempts in alcoholics

Introduction: The aim of this study was to assess the potential role of impulsive and aggressive behavior in the pathogenesis of suicide attempts in alcoholics. Impulsive and aggressive behavior as well as a psychiatric comorbidity with depressive conditions and personality disorders have been reported to be significant risk factors for suicide attempts in alcoholics. We hypothesized that alcoholics with a history of violent suicide attempts show an increased level of impulsive and aggressive behavior. Furthermore, the potential influence of concurrent personality disorders and depressive conditions were assessed. Material and methods: 182 detoxified alcohol-dependent subjects were enrolled into the study. Impulsive and aggressive traits were assessed using the Buss-Durkee Hostility Inventory and the Brown-Goodwin Assessment for Lifetime History of Aggression, personality disorders using the SCID II. Characteristics of alcohol dependence and suicide attempts were evaluated using the Semi-Structured Assessment on Genetics in Alcoholism (SSAGA). Results: Alcohol-dependent subjects with a history of suicidal behavior show a profile with higher impulsive and aggressive behavior. No significant association between these traits and concurrent borderline and antisocial personality disorder was found. Subjects with suicide attempts tended to have a significantly higher rate of depressive disorders. Discussion: These results suggest that impulsive and aggressive traits might contribute significantly to the risk of suicide attempts in alcoholics. Received: 14 December 2001 / Accepted: 3 April 2002     

A population-based longitudinal study of risk factors for suicide attempts in major depressive disorder

No longitudinal study has examined risk factors for future suicide attempts in major depressive disorder in a nationally representative sample. The objective of this study was to investigate baseline sociodemographic characteristics, comorbid mental disorders, specific depressive symptoms, and previous suicidal behavior as potential risk factors for suicide attempts at 3 years follow-up. Data came from the national epidemiologic survey on alcohol and related conditions (NESARC), a large nationally representative longitudinal survey of mental illness in adults [Wave 1 (2001-2002); Wave 2 (2004-2005) n = 34,653]. Logistic regression examined associations between risk factors present at Wave 1 and suicide attempts at Wave 2 (n = 169) among individuals with major depressive disorder at baseline assessment (n = 6004). Risk factors for incident suicide attempts at Wave 2 (n = 63) were identified among those with major depressive disorder at Wave 1 and no lifetime history of suicide attempts (n = 5170). Results revealed specific comorbid anxiety, personality, and substance use disorders to be associated with incident suicide attempts at Wave 2. Comorbid borderline personality disorder was strongly associated with suicide attempts in all models. Several comorbid disorders were strongly associated with suicide attempts at Wave 2 even after adjusting for previous suicidal behavior, notably posttraumatic stress disorder (adjusted odds ratio (AOR) = 2.20; 95% confidence interval (95% CI) 1.27-3.83) and dependent personality disorder (AOR = 4.43; 95% CI 1.93-10.18). These findings suggest that mental illness comorbidity confers an increased risk of future suicide attempts in major depressive disorder that is not solely accounted for by past suicidal behavior.     

Suicide risk in civilian PTSD patients

Abstract Background There appears to be a strong connection between suicidality and the experience of trauma. The study investigated suicidality in chronic civilian post–traumatic stress disorder (PTSD). Method Ninety–four participants suffering from chronic PTSD were assessed for suicidal ideation, plans and attempts since the index trauma as part of a comprehensive assessment. The prevalence of these was assessed and characteristics of those reporting suicide–related thoughts and behaviour were investigated through logistic and multinominal regression analyses. Results Over half of the sample (56.4%) reported some aspect of suicidality with 38.3% reporting ideation, 8.5% reporting suicide plans and 9.6% having made suicide attempts since the trauma. Of the nine participants who reported suicide attempts, six had made more than one attempt. The proportions of participants who reported suicidality in this sample were significantly greater than reported within the general population, when comparisons were made with an epidemiological study. Logistic regression analysis indicated that a unit increase in life impairment (OR = 3.1) and depression (OR = 1.14) scores were independently and significantly associated with suicidality. Multinominal regression indicated that life impairment (OR = 2.71) and depression (OR = 1.13) scores were associated with the presence of suicidal ideation compared to no ideation, and life impairment (OR = 5.75), depression (OR = 1.2) scores and receiving psychotropic medication (OR = 10.6) were associated with the presence of plans and attempts compared to no suicidal behaviour. Conclusions Suicide risk is elevated in those suffering from chronic PTSD and is associated with impaired functioning in combination with depression.     

Military sexual trauma and suicidal behavior among National Guard personnel

BackgroundPreliminary evidence suggests military sexual trauma (MST) may be associated with increased risk for suicidal behaviors among active duty military personnel and veterans. Among National Guard personnel, a high-risk subgroup, MST and suicide risk have not received much empirical attention.PurposeTo examine the association of MST with suicide ideation and suicide attempts among National Guard personnel.ProceduresN = 997 National Guard personnel from Idaho and Utah participated in an anonymous online survey. Weighted analyses were conducted to minimize sampling bias.Main findings9% of participants had a history of MST (6% of men, 28% of women). Among participants reporting MST, 68% reported a service member perpetrator and 44% reported a civilian perpetrator (12% reported both). A history of MST was associated with significantly increased risk for lifetime suicide attempt. MST remained a significant predictor of lifetime suicide attempt even when restricting the sample to the subgroup with a history of suicidal thoughts (n = 257, 27% of full sample). When adjusting for premilitary sexual victimization, MST was no longer significantly associated with lifetime suicide attempts, but premilitary sexual victimization was.ConclusionsThe rate of MST among National Guard personnel is comparable to rates among active duty military personnel, although the perpetrators of MST are less likely to be service members. MST is a risk factor for suicide attempts, but premilitary sexual victimization is a relatively stronger risk factor.     

Norwegian male military veterans show low levels of mental health problems four years after deployment in Afghanistan

Background: Deployment of soldiers is associated with considerable rates of mental disorders after redeployment. Aims: The aim of this study was to identity prevalence of probable mental disorders and associated factors among male Norwegian soldiers at a mean of 4 years following deployment to Afghanistan in 2001–2011.

Methods: The retrospective questionnaire-based study invited all Norwegian veterans deployed to Afghanistan from 2001–2011 to participate. The response rate was 59%, but only the 3403 men (47.5%) who completed all items of the four different screening instruments were used to define cases with mental health problems were included. Independent variables covered deployment and post-deployment issues.

Results: The prevalence of subjects with mental health problems was 5.1% (95% CI?=?4.4–5.9%) of the sample. Among deployment-related factors, physical and mental problems during deployment were most strongly associated with mental health problems after deployment. Among post-deployment factors high neuroticism and limitations in work, social, and family functions showed the strongest associations. In multivariable analysis, younger age at first deployment (OR?=?0.95), neuroticism (OR?=?6.40), increased current alcohol intake (OR?=?3.08), impaired family function (OR?=?1.91), more sleep problems (OR =1.13), and increased negative civilian life events (OR?=?1.39) remained significantly associated with probable mental disorders.

Conclusions: Among male Norwegian veterans from Afghanistan, the prevalence of mental health problems was low, and mainly associated with post-deployment factors. Veterans complaining of mental symptoms should be diagnosed, treated, and examined for other problems of life.     

Anxiety disorders associated with suicidal ideation and suicide attempts in the National Comorbidity Survey

This study examined the relationship between anxiety disorders and suicidal ideation or suicide attempts in a nationally representative sample (N = 5877; age, 15-54; response rate, 82.4%). A modified version of the Composite International Diagnostic Interview was used to make DSM-III-R mental disorder diagnoses. Two multivariate logistic regression analyses were performed with suicidal ideation (N = 754) and suicide attempts (N = 259) as dependent variables. In each regression, the independent variables entered were lifetime social phobia, panic disorder, agoraphobia, generalized anxiety disorder, simple phobia, and posttraumatic stress disorder (PTSD). Covariates in the analyses were sociodemographics, lifetime mood disorders, substance use disorders, nonaffective psychosis, antisocial personality disorder, and presence of three or more lifetime DSM-III-R diagnoses. PTSD was significantly associated with suicidal ideation (adjusted odds ratio = 2.79; p < 0.01) and suicide attempts (adjusted odds ratio = 2.67; p < 0.01). None of the other anxiety disorders were significantly associated with suicidal ideation or attempts. The robust association between PTSD and suicide attempts has important implications for psychiatric assessment of suicidal behavior. Future research is required to investigate the mechanisms underlying the relationship between PTSD and suicidal behavior.