Support Systems: How Post-Deployment Support Impacts Suicide Risk Factors in the United States Army National Guard

Suicide rates within the military have continued to rise in recent years, resulting in re-doubled efforts to understand and remedy this trend. In an attempt to clarify unique pathways to suicide risk in this population, the current study examined the relationship between length of time since most recent deployment and several suicide risk factors (hopelessness, suicidal ideation, and resolved plans and preparations). Furthermore, this study examined the moderating influence of post-deployment social support in the prediction of suicide risk. Results indicated that the interaction of time since deployment and post-deployment support predicted both hopelessness and resolved plans and preparations, but did not predict suicidal ideation. These findings suggest that the negative effects of time spent away from recognized military support may be compounded by the isolating effect of decreased access to alternative supports at home, resulting in increased hopelessness and/or resolved plans and preparations. Implications for the necessity of improved post-deployment programs are discussed.     

Dispositional Optimism as a Moderator of the Relationship Between Negative Life Events and Suicide Ideation and Attempts

Relatively little research has focused on the role that positive psychological characteristics, such as optimism, might play in the mitigation of stressors and reduction of psychopathology. Dispositional optimism is a trait-like characteristic reflecting a positive attitude or mood regarding the future. This study examined the moderating effect of dispositional optimism on the relationship between negative life experiences and suicide ideation and attempts in a college student sample. Negative life events were associated with current suicide ideation and previous suicide attempts, and dispositional optimism moderated these relationships, after controlling for hopelessness and severity of depression. Individuals with greater optimism have reduced risk for suicide ideation and attempts in the face of low to moderate negative life events; however, this association is changed at the highest levels of negative life events. Implications for treatment include strengthening active and future-focused coping in patients who have experienced negative or potentially traumatic life events to protect against suicidal thoughts and behaviors.     

Posttraumatic stress disorder, depression, and suicide in veterans

Suicidal behavior is a critical problem in war veterans. Combat veterans are not only more likely to have suicidal ideation, often associated with posttraumatic stress disorder (PTSD) and depression, but they are more likely to act on a suicidal plan. Especially since veterans may be less likely to seek help from a mental health professional, non-mental-health physicians are in a key position to screen for PTSD, depression, and suicidal ideation in these patients. The authors discuss the association of PTSD, depression, and suicide in veterans, keys to assessment of suicide risk, and interventions.     

The Interactive Effects of the Capability for Suicide and Major Depressive Episodes on Suicidal Behavior in a Military Sample

Major depressive symptoms are associated with increased risk for suicidal ideation and behavior. Suicide is fearsome; as such, the interpersonal theory of suicide proposes that individuals who engage in suicidal behavior possess not only the desire to die, but also the acquired capability (AC) for suicide. This study examined whether major depressive episodes (MDEs) may be particularly relevant to suicidal behavior when considered in the context of AC. History of MDEs, AC, and suicide attempt history were examined in a large (n = 3377) sample of military members. Data were analyzed using hierarchical multiple regression. Results indicated that among individuals with high AC, the number of MDEs was significantly, positively associated with number of previous suicide attempts; MDEs were not significantly related to suicide attempt history among individuals with low AC. Findings held in the presence of robust covariates associated with suicidal behavior. Findings suggest that a history of MDEs alone may not indicate severe suicide risk—increased AC for suicide appears necessary for increased suicide risk. Implications for suicide treatment and prevention in military personnel are discussed.     

PREDICTORS OF SUICIDAL BEHAVIOR IN A SAMPLE OF TURKISH SUICIDE ATTEMPTERS

In a Turkish sample, 100 suicide attempters, were compared with 60 healthy controls on measures of hopelessness, depression, and suicidal ideation. Suicide attempters were more depressive, more hopeless, and displayed greater suicidal ideation than healthy controls. Depression severity rather than hopelessness correlated with suicidal intent. Suicide lethality was independent of depression severity, hopelessness, and suicidal ideation and intent, suggesting that lethality is likely due to chance.     

Predictors of suicidal behavior in a sample of Turkish suicide attempters

In a Turkish sample, 100 suicide attempters, were compared with 60 healthy controls on measures of hopelessness, depression, and suicidal ideation. Suicide attempters were more depressive, more hopeless, and displayed greater suicidal ideation than healthy controls. Depression severity rather than hopelessness correlated with suicidal intent. Suicide lethality was independent of depression severity, hopelessness, and suicidal ideation and intent, suggesting that lethality is likely due to chance.     

Spirituality Moderates Hopelessness,and Suicidal Ideation among Iranian Depressed Adolescents

To examine the moderating role of spirituality between hopelessness, spirituality, and suicidal ideation, 202 Iranian depressed adolescent inpatients completed measures of patient health, suicidal ideation, hopelessness, and core spiritual experience. Structural equation modelling indicated that depressed inpatients high in hopelessness, but also high in spirituality, had less suicidal ideation than others. These findings reinforce the importance of spirituality as a protective factor against hopelessness and suicidal ideation.     

Chronic Pain,TBI, and PTSD in Military Veterans: A Link to Suicidal Ideation and Violent Impulses?

The polytrauma clinical triad refers to the co-occurrence of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD). Despite research implicating dyadic relationships between these conditions and adverse outcomes, scant research has examined the polytrauma clinical triad's relation to suicide or violence. The present cross-sectional study was designed to examine whether this complex clinical presentation increases risk of suicidal ideation and violent impulses after accounting for other established risk factors. Veterans who served in the military since September 11, 2001 (N?=?667) who reported chronic pain completed an interview and self-report battery. Bivariate analyses showed that suicidal ideation and violent impulses both correlated with PTSD, TBI+PTSD, pain intensity and interference, drug abuse, and major depressive disorder (MDD). Multiple regression analyses showed that: 1) race, chronic pain with PTSD, alcohol abuse, and MDD significantly predicted suicidal ideation, 2) pain interference, chronic pain with TBI, chronic pain with PTSD, chronic pain with TBI+PTSD, drug abuse, and MDD significantly predicted violent impulses, and 3) pain interference was a more critical predictor of suicidal and violent ideation than pain intensity. Implications for risk assessment and treatment are discussed.

Assessing suicide risk in stroke patients: review of two cases

Poststroke depression can be accompanied by suicidal ideation, yet reports of suicide among stroke patients are rare. When untreated, depression can become prolonged and severe. Risk factors for suicide include depression, severe insomnia, chronic illness, and organic brain syndrome. Early clinical assessment of suicide risk factors is essential in the rehabilitation setting. Two patients who developed mood disturbances in the acute poststroke period and eventually committed suicide are presented. Neither patient openly expressed suicidal thoughts to staff or family members. Retrospective analysis of medical records was compared to established suicide risk factors reported in the medical literature. Indirect verbal cues and nonverbal behavior patterns indicating potential suicide risk may have been present. Strategies for evaluation and management of suicidal behavior are discussed. These cases emphasize the need for early assessment of suicide risk by the entire rehabilitation team.     

Testing the Escape Theory of Suicide in an Outpatient Clinical Population

To test the Baumeister's Escape Theory ofSuicide, 132 clinical outpatients at two different sitescompleted measures of life events, multidimensionalperfectionism, depression, hopelessness, reasons for living, and suicide ideation. A structuralequation model yielded significant paths from sociallyprescribed perfectionism to depression, depression tohopelessness, hopelessness to both reasons for living and suicide ideation, and reasons for living tosuicide ideation. A path analysis showed that theproposed model had a strong overall Goodness ofFitindex. Results strongly support the escape theory of suicide in outpatients who might beparticularly vulnerable to suicidal thoughts, mostlybecause of the expected relationships of depression,hopelessness, reasons for living, and suicideideation.     

Emotion Dysregulation and Vulnerability to Suicidal Ideation and Attempts

This study investigated the predictive utility of a six-dimensional conceptualization of emotion dysregulation for suicidal ideation, as well as its ability to distinguish among individuals with differing histories of suicidality. Young adults (N = 96) with current suicidal ideation but no suicide attempt history (n = 17), a history of a single (n = 20) or multiple attempts (n = 17), or no current ideation/no past attempts (n = 42) completed measures of emotion dysregulation, suicidal ideation, depression, hopelessness, and a diagnostic interview. Multiple suicide attempters differed from participants with no suicidal ideation/no past attempts on two emotion dysregulation dimensions—nonacceptance of emotional responses and perceived limited access to emotion regulation strategies. After adjusting for depression symptoms and the presence of a mood or anxiety diagnosis, limited access to emotion regulation strategies significantly predicted current suicidal ideation, a relation that was found to be statistically mediated by hopelessness.     

Reasons for Living Among U.S. Army Personnel Thinking About Suicide

Reasons for living are associated with reduced suicide risk, but have not received much empirical attention among U.S. military personnel, a population with elevated suicide risk. The present study examined the factor structure, reliability, and validity of the Brief Reasons for Living Inventory (BRFLI) in a clinical sample of 97 treatment-seeking Army personnel with recent suicide ideation and/or a history of suicide attempts. Results supported a five-factor structure for the BRFLI. Each factor had good internal consistency (ω’s?> 0.94) and demonstrated convergent and divergent validity. Survival and coping beliefs and responsibility to family subscale scores were negatively correlated with recent suicidal thinking. Responsibility to family subscale scores were associated with significantly reduced risk of suicide attempts during follow-up. BRFLI subscale scores showed little to no clinical responsivity following intervention. Results suggest survival and coping beliefs and responsibility to family may be protective for high-risk military personnel.     

Suicidal ideation in outpatients with chronic musculoskeletal pain: an exploratory study of the role of sleep onset insomnia and pain intensity

OBJECTIVES: Sleep disturbance, depression, and heightened risk of suicide are among the most clinically significant sequelae of chronic pain. While sleep disturbance is associated with suicidality in patients with major depression and is a significant independent predictor of completed suicide in psychiatric patients, it is not known whether sleep disturbance is associated with suicidal behavior in chronic pain. This exploratory study evaluates the importance of insomnia in discriminating suicidal ideation in chronic pain relative to depression severity and other pain-related factors. METHODS: Fifty-one outpatients with non-cancer chronic pain were recruited. Subjects completed a pain and sleep survey, the Pittsburgh Sleep Quality Index, the Beck Depression Inventory, and the Multidimensional Pain Inventory. Subjects were classified as "suicidal ideators" or "non-ideators" based on their responses to BDI-Item 9 (Suicide). Bivariate analyses and multivariate discriminant function analyses were conducted. RESULTS: Twenty-four percent reported suicidal ideation (without intent). Suicidal ideators endorsed higher levels of: sleep onset insomnia, pain intensity, medication usage, pain-related interference, affective distress, and depressive symptoms (P < 0.03). These 6 variables were entered into stepwise discriminant function analyses. Two variables predicted group membership: Sleep Onset Insomnia Severity and Pain Intensity, respectively. The discriminant function correctly classified 84.3% of the cases (P < 0.0001). DISCUSSION: Chronic pain patients who self-reported severe and frequent initial insomnia with concomitant daytime dysfunction and high pain intensity were more likely to report passive suicidal ideation, independent from the effects of depression severity. Future research aimed at determining whether sleep disturbance is a modifiable risk factor for suicidal ideation in chronic pain is warranted.     

Effectiveness of a community-based program for suicide prevention among elders with early-stage dementia: A controlled observational study

The purpose of this study was to develop a small-group-focused suicide prevention program for elders with early-stage dementia and to assess its effects. This was a quasi-experimental study with a control group pretest–posttest design. A total of 62 elders diagnosed with early-stage dementia who were receiving care services at nine daycare centers in J City Korea participated in this study. The experimental group participated in the suicide prevention program twice a week for 5 weeks with a pretest and two posttests The developed suicide prevention program had a significant effect on the perceived health status, social support, depression, and suicidal ideation of elders with early-stage dementia. Nurses should integrate risk factors such as depression and protective factors such as health status and social support into a suicide prevention program. This community-based program in geriatric nursing practice can be effective in preventing suicide among elders with early-stage dementia.     

Does optimism weaken the negative effects of being lonely on suicide risk?

ABSTRACT

The present study investigated loneliness and optimism as predictors of suicide risk, specifically, depressive symptoms and suicidal ideation, in 457 Hungarian college students. Beyond the expected role of loneliness in suicide risk, being optimistic buffered the positive association between loneliness and suicide. The findings implicate the importance of fostering optimism for potentially lowering suicide risk among lonely college students.     

Posttraumatic Cognitions and Suicidal Ideation Among Veterans Receiving PTSD Treatment

With approximately 20 veteran suicide deaths per day, suicidal ideation (SI) among veterans is an important concern. Posttraumatic stress disorder (PTSD) is associated with SI among veterans, yet mechanisms of this relationship remain unclear. Negative posttraumatic cognitions contribute to the development and maintenance of PTSD, yet no studies have prospectively examined the relationship between posttraumatic cognitions and SI. Veterans (N?=?177; 66% Male) participating in a 3-week intensive outpatient program for PTSD completed assessments of PTSD severity, depressive symptoms, SI, and posttraumatic cognitions. Negative posttraumatic cognitions about the self significantly predicted SI at posttreatment, controlling for pretreatment levels of SI, depression, and PTSD symptom severity. Self-blame and negative posttraumatic cognitions about others/world did not predict SI prospectively. Negative posttraumatic cognitions about the self appear to be an important factor in the manifestation of SI among veterans with PTSD and should be monitored as a potential indicator of suicide risk.     

Psychopathy,Depression, and Anxiety as Predictors of Suicidal Ideation in Offenders

Compared to nonoffenders, offenders are at increased risk for suicidal ideation and psychopathy. However, literature currently lacks sufficient understanding of moderating pathways linking psychopathy to suicidal ideation among offenders. This study investigated anxiety and depressive symptoms as potential moderators using a sample of 162 male offenders in the New Jersey correctional system. Results supported a significant positive correlation between secondary psychopathy and suicidal ideation. In addition, depression and physiological anxiety moderated the association between secondary psychopathy and suicidal ideation. Present findings may assist in determining relevant suicide risk factors (i.e., depression, physiological anxiety, secondary psychopathy) to assess for in offenders.     

Rumination and Hopelessness as Mediators of the Relation Between Perceived Emotion Dysregulation and Suicidal Ideation

The present study examined whether particular emotion dysregulation dimensions were associated with suicidal ideation through their effects on ruminative thinking and hopelessness. Emerging adults (ages 18–25) with (n = 32) and without (n = 111) a suicide attempt history completed an emotion dysregulation measure at baseline and measures of rumination, hopelessness, depressive symptoms, and suicidal ideation 2–3 years later. Multiple suicide attempters (n = 15) were distinguished by elevated scores on emotion dysregulation dimensions involving impulse control difficulties and inability to access effective emotion regulation strategies. The Strategies dimension, assessed at baseline, was significantly associated with both rumination and hopelessness at follow-up, and with higher ideation at follow-up. Rumination and hopelessness mediated the relation between Strategies and ideation, even when adjusting for depressive symptoms. Perceived inability to access emotion regulation strategies may increase vulnerability to suicidal ideation through its effects on rumination and hopelessness.     

Identifying suicide risk among college students: A systematic review

Abstract

Mental health research highlights the need to focus on suicide risk in college students. However, evidence for associated risk and protective factors in this cohort is mixed. This review synthesizes data from 29 independent studies (N?=?11,557 participants). Self-reported depression, cumulative stressful life events, sleep difficulties, a disconnection from others, and a sense of hopelessness demonstrated significant associations with heightened suicide risk. Reasons to live and hope provided significant protective effects. The findings highlight key intervention targets, pointing to the importance of cognitive-behavioral interventions to ameliorate suicidal thoughts but also build dispositional hope and goal-directed thinking.     

Religiousness and non-hopeless suicide ideation

Individuals who think about suicide but do not feel suicidally hopeless tend to be less religious and can therefore entertain thoughts of suicide unabated by religiousness. Religiousness, suicide ideation, and hopelessness were surveyed among 279 Idaho college students, 37 (13%) of whom were non-hopeless suicide ideators. A total of only 21 (7%) qualified as ideator/hopeless or non-ideator/hopeless with the remaining 221 (79%) qualifying as non-ideator/non-hopeless. Lower religiousness coinciding with greater ideation supports Durkheim's position that religious social affiliation protects against suicide. The fact that non-hopeless ideators were less religious than all others suggests that religion may provide hope that buffers against suicidal ideas.