Military personnel compared to multiple suicide attempters: Interpersonal theory of suicide constructs.

The current study aimed to address the discrepancy between suicide rates in the military and general population by comparing facets of the interpersonal theory of suicide between civilians with multiple suicide attempts and U.S. military personnel. Military personnel exhibited higher levels of capability for suicide but lower levels of perceived burdensomeness and thwarted belongingness than civilian multiple attempters. When comparing only personnel endorsing ideation and civilian multiple attempters, the significant difference for capability remained, but the differences for perceived burdensomeness and thwarted belongingness became nonsignificant. Results suggest the emergence of ideation places personnel at a greater risk for suicide than many civilian multiple attempters.

The association between specific combat experiences and aspects of the Interpersonal Theory of Suicide.

BACKGROUND: Studies examining the relationship between combat exposure and suicide risk typically focus on combat exposure overall, combining numerous different combat experiences. Our study expands upon prior research by examining the association between specific combat experiences and components of both suicidal desire and the capability for suicide. METHOD: We hypothesized that most combat experiences would be associated with capability for suicide. Furthermore, we hypothesized that experiences that involved direct exposure to death and injury (e.g. personally witnessing the death or injury of other soldiers) would be associated with higher levels of thwarted belongingness, perceived burdensomeness, and suicidal ideation. Participants were 400 service members drawn largely from the Army National Guard who had been deployed at least once and endorsed having experienced combat. RESULTS: Consistent with hypotheses, combat experiences involving direct exposure to injury or death exhibited a more pronounced pattern of associations with suicide risk factors than did other experiences. However, only a minority of combat experiences were associated with the capability for suicide. DISCUSSION: These results, while preliminary, indicate that different combat experiences are associated with different outcomes and that, in this sense, not all combat experiences are created equal with respect to suicide risk.

The Associations Between Army National Guard Versus Active Duty Soldier Status and Perceived Burdensomeness, Thwarted Belongingness, and Acquired Capability.

OBJECTIVE: This study aimed to examine if levels of thwarted belongingness, perceived burdensomeness, and acquired capability significantly differed between guardsmen and active duty soldiers. METHOD: Multivariate analysis of covariance was used to test for differences between active duty Army (n = 1,393) and Army National Guard (n = 623) groups, before and after controlling for the effects of age, gender, race, marital status, level of education, and deployment history. RESULTS: Guardsmen reported significantly higher mean levels of thwarted belongingness and perceived burdensomeness than did active duty soldiers, even after adjusting for demographic differences. Guardsmen also reported slightly lower levels of acquired capability, though this effect was accounted for by demographic differences. CONCLUSION: These findings support the notion that National Guard and active duty soldiers differ on perceived burdensomeness and thwarted belongingness. Additional research investigating sources of perceived burdensomeness and thwarted belongingness among guardsmen is needed.

Homosexuality as a Discrete Class.

Previous research on the latent structure of sexual orientation has returned conflicting results, with some studies finding a dimensional structure (i.e., ranging quantitatively along a spectrum) and others a taxonic structure (i.e., categories of individuals with distinct orientations). The current study used a sample (N = 33,525) from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). A series of taxometric analyses were conducted using three indicators of sexual orientation: identity, behavior, and attraction. These analyses, performed separately for women and men, revealed low-base-rate same-sex-oriented taxa for men (base rate = 3.0%) and women (base rate = 2.7%). Generally, taxon membership conferred an increased risk for psychiatric and substance-use disorders. Although taxa were present for men and women, women demonstrated greater sexual fluidity, such that any level of same-sex sexuality conferred taxon membership for men but not for women.

Testing the main hypotheses of the interpersonal-psychological theory of suicidal behavior in a large diverse sample of United States military personnel.

BACKGROUND: Preliminary data indicate the suicide rate in the United States military decreased in 2013, but the National Guard saw a continued increase. METHOD: We examined the utility of the interpersonal-psychological theory of suicidal behavior (IPTS) in a sample of US military personnel drawn largely from the National Guard (n=934; 77.7% male; 59.5% white). RESULTS: Results indicated the interaction of thwarted belongingness and perceived burdensomeness predicted suicidal ideation and resolved plans and preparations for suicide. In each case, risk was greatest at higher levels of both predictors. Furthermore, results indicated the interaction of thwarted belongingness, perceived burdensomeness, and acquired capability for suicide predicted prior suicide attempts. In this interaction term, the relationship between suicidal desire (thwarted belongingness and perceived burdensomeness) and suicide attempts was significant and positive only at high levels of acquired capability. All analyses were cross-sectional. CONCLUSIONS: Results indicate the IPTS may be useful for conceptualizing suicide risk in the National Guard.

Examining the relationship between coping strategies and suicidal desire in a sample of United States military personnel.

Suicidal desire in the military has been previously examined through the lens of the Interpersonal-Psychological Theory of Suicide (IPTS). However, no research has examined the impact of specific coping strategies on perceived burdensomeness, thwarted belongingness, and suicidal ideation in a large population of individuals serving in the US military. Furthermore, the factor structure of previously utilized coping clusters did not apply to our sample of military personnel. Therefore, we found a three-factor solution to be tested in this sample. We hypothesized that specific types of coping behavior clusters (Adaptive and Maladaptive) would predict both IPTS constructs and suicidal ideation. Results indicated that Adaptive and Maladaptive coping clusters predicted the IPTS constructs in the hypothesized directions. However, only the Maladaptive cluster predicted suicidal ideation. These findings implicate the need for further research and suicide prevention efforts focusing on coping strategies, specifically those that are maladaptive in nature, in relation to suicidal ideation in military members.

The Impact of Varying Levels of Confidentiality on Disclosure of Suicidal Thoughts in a Sample of United States National Guard Personnel.

OBJECTIVES: Increasing rates of suicide in the military indicate current assessment approaches are not yielding accurate determinations of risk. Concern that endorsement of suicidal ideation may result in obstacles to career advancement may be resulting in nondisclosure. METHOD: To test this, we recruited a sample of US National Guard personnel (n = 789; 81.7% male; 63.2% white) and administered two measures of current thoughts of suicide. One measure was integrated into our risk assessment protocol and soldiers were thus aware that answers could result in referral to on site military mental health professionals. The other measure was not integrated into the risk assessment protocol and soldiers were thus aware that results would not be reported to on site military mental health professionals. RESULTS: As hypothesized, a higher proportion of individuals reported current thoughts of suicide on the measure not integrated into the risk protocol (9.4%) than on the measure that was (6.0%). Also as hypothesized, a higher proportion of those willing to endorse current thoughts of suicide on the measure not integrated into the risk protocol denied current thoughts of suicide on the one that was (61.5%) than vice versa (39.0%). Limitations include cross-sectional self-report data and a lack of counter-balancing of measures. CONCLUSIONS: The results indicate that increasing the confidentiality of risk assessments within the National Guard increases the likelihood of reporting of current thoughts of suicide.

Locus of control as a contributing factor in the relation between self-perception and adolescent aggression.

Researchers continue to debate the role of self-esteem in aggression, but research has shown a consistent association between narcissism and aggression in adults and adolescents [e.g., Barry et al., 2007; Bushman and Baumeister, 1998; Stucke, 2007]. The primary aim of the current study was to examine whether locus of control (LOC) moderated the relation between self-perception variables (i.e., self-esteem and narcissism) and aggression in adolescents. Participants were 174 youth (145 males, 26 females) between the ages of 16 and 19 who were enrolled in a voluntary residential program for youth who have dropped out of school. The results showed that LOC moderated the association between self-esteem and aggression such that low self-esteem was associated with higher levels of aggression for individuals with an external LOC. Contrary to expectations, LOC failed to moderate the narcissism-aggression relation. The implications of this study for understanding how self-perception is related to adolescent aggression are discussed.

Latent structure of unipolar and bipolar mood symptoms.

OBJECTIVES: The taxonic versus dimensional status of mood symptoms has been the subject of debate among mental health professionals. Conventional diagnostic models suggest that mood disorders are categorical; however, the inability of categorical models to adequately account for subthreshold unipolar and bipolar presentations and the heterotypic continuity of symptoms in unipolar and bipolar cases has resulted in growing support for dimensional views. The current study sought to evaluate the relative viabilities of categorical and dimensional models of mood symptoms within a taxometric framework. METHODS: We examined the latent structure of mood symptoms in an epidemiological sample drawn from the Collaborative Psychiatric Epidemiological Surveys. Using three taxometric procedures (MAMBAC, MAXEIG, and L-Mode), we analyzed indicators of mania and depression created from the mood symptoms section of the survey. RESULTS: The taxometric analyses supported a taxonic rather than dimensional structure for mania and depression. Membership in the mania and depressive taxa was associated with meeting criteria for DSM-IV lifetime manic episode and major depressive disorder, respectively. We identified a subset of 700 individuals falling into both taxa; membership in this subset was associated with lifetime bipolar disorder status. Group membership predicted designated external variables including help-seeking, family history, and duration of impairment. Within taxon and/or complement groups, severity scores still appeared to predict external variables. CONCLUSION: Our findings suggest that although taxonic, mood disorders possess meaningful dimensional variation.

Quantifying groundwater flow variability in a poorly cemented fractured sandstone aquifer to inform in situ remediation.

This study applies innovative methods to characterize and quantify the magnitude of groundwater flow in a fractured and variably cemented sandstone aquifer to inform an in-situ remediation strategy for trichloroethene (TCE) contamination. A modified active-distributed temperature sensing (A-DTS) approach in which fiber optic cables were permanently grouted in the borehole was used to quantify groundwater flow rates. Two additional tracer tests were conducted: 1) fluorescein tracer injection followed by rock coring and sampling for visual mapping and porewater analysis, and 2) deployment of passive flux meters in conventional monitoring wells to evaluate groundwater velocity and mass flux distributions. Forced gradient injection of fluorescein tracer suggests a dual porosity flow system wherein higher rates of groundwater flow occur within discrete features including highly permeable bedding planes and fractures, with slower flow occurring within the rock matrix. Tracer was observed and detected in the unfractured matrix porewater >1.5 m away from the injection well. Beyond this distance, >6 m radially away from the injection hole, tracer was primarily detected within and adjacent to high transmissivity fractures serving as preferential flow paths. The Darcy flux calculated using active distributed temperature sensing (A-DTS) shows depth-discrete values ranging from 7 to 60 cm/day, with average and median values of 23 and 17 cm/day, respectively. Passive Flux Meters (PFMs) deployed in three conventional monitoring wells with slotted screens and sand filter packs showed groundwater flux values ranging from 2 to 11 cm/day, with an overall average of 4 cm/day and are likely biased low due to spreading in the sand pack. The study results were used to inform an in-situ remediation system design including the proposed injection well spacing and the amendment delivery approach. In addition, the results were used to build confidence in the viability of delivering an oxidant to the rock matrix via advective processes. This is important because 1) the matrix is where the majority of the TCE mass occurs, and 2) it provides insights on processes that directly affect remedial performance expectations given advective delivery to preferential pathways and the matrix overcomes diffusion only conditions.

Internal Battles: Examining How Anger/Hostility Moderate the Association Between Negative Urgency and Suicidal Desire Variables in Military and Civilian Samples.

OBJECTIVE: Suicide is consistently within the top ten leading causes of death in the United States. The suicide rate of National Guard personnel is elevated relative to the general population; however, research suggests that many of the suicide risk factors for military personnel are similar to the suicide risk factors for civilians. We examined whether negative urgency moderated the relationships between anger/hostility and perceived burdensomeness/thwarted belongingness in both a military and civilian samples. METHOD: There were two samples in the current study: (1) military personnel (majority national guard) and (2) community members oversampled for suicide attempt history. RESULTS: Our hypotheses were partially supported with the interaction of hostility and negative urgency predicting perceived burdensomeness in the military sample. Within civilians, anger interacted with negative urgency to predict perceived burdensomeness. There were nonsignificant findings for analyses predicting thwarted belongingness. Exploratory analyses indicated that in both samples, anger and hostility interacted with negative urgency to predict suicidal ideation. CONCLUSIONS: Results suggest that aggressive attributes may contribute to individuals feeling as though they are a burden on others when moderate to high levels of negative urgency are present. Additionally, this study provides foundational support for the differences between suicidal desire and ideation.

The Relationship between Post-Battle Experiences and Thwarted Belongingness and Perceived Burdensomeness in Three United States Military Samples.

Suicide rates within the military are elevated relative to the general population; however, research suggests that many of the suicide risk factors for military personnel are similar to the suicide risk factors for civilians. Given that many military specific experiences (e.g., number of deployments) are not considered robust predictors of either suicidal ideation or behavior, it has been posited that deployment specific experiences (e.g., post-battle experiences) may be better able to explain the increased rates of suicide among military personnel. Therefore, the current study aimed to examine the relationship between post-battle experiences and perceived burdensomeness (PB), thwarted belongingness (TB), and suicidal ideation within 3 different military samples: a non-clinical sample of Army National Guard personnel, a non-clinical sample of active duty U.S. Air Force Security Forces personnel, and a clinical sample of U.S. Army personnel receiving outpatient treatment. Post-battle experiences were found to be significantly associated with TB in both non-clinical samples; however, the association between post-battle experiences and TB was non-significant within the clinical sample. Furthermore, results indicated that post-battle experiences were not significantly associated with either PB or suicidal ideation in any of the samples. These findings suggest that in non-clinical samples, post-battle experiences impact a soldier's ability to feel connected to others. Within clinical samples, results indicate that post-battle experiences may not be a direct contributor to either PB or TB. These results indicate a need for universal intervention promoting interpersonal support of military personnel and their families prior to development of further need for psychological interventions. This upstream approach may decrease further development of TB and potentially prevent suicidal desire.

The latent structure of posttraumatic stress disorder among adolescents.

Debate has arisen over whether posttraumatic stress disorder (PTSD) is most accurately conceptualized as representing a discrete clinical syndrome or an extreme reaction to traumatic life events. Recent taxometric research using predominantly adult samples appears to support a dimensional model of PTSD, raising questions about the utility of current psychiatric nosology which depicts PTSD as a distinct entity. The present study sought to use taxometric procedures to examine the latent structure of posttraumatic stress reactions among a national epidemiologic sample of 2,885 adolescents. Results were consistent with previous taxometric studies in supporting a dimensional model of posttraumatic stress reactions. The implications of these findings for public policy, as well as the etiology and assessment of posttraumatic stress reactions, are discussed.

The Anxiety Sensitivity Index--Revised: confirmatory factor analyses, structural invariance in Caucasian and African American samples, and score reliability and validity.

The most commonly used measure of anxiety sensitivity is the 36-item Anxiety Sensitivity Index-Revised (ASI-R). Exploratory factor analyses have produced several different factors structures for the ASI-R, but an acceptable fit using confirmatory factor analytic approaches has only been found for a 21-item version of the instrument. We evaluated the fit of all published factor models for the 36- and 21-item ASI-R, modified the hierarchical model using an approach that does not eliminate items, evaluated the invariance of the modified model across Caucasian and African-American subsamples, and compared the reliability and validity of the 36-item and 21-item versions. The 21-item version of the ASI-R fit a four factor model, as did the 36-item version after several meaningful model modifications. The modified 36-item model was replicable in independent cases and its structural properties were generally invariant across race. Scores from the 36-item version exhibited superior reliability and criterion-related validity.

Detecting Potential Underreporting of Suicide Ideation Among U.S. Military Personnel.

Using a military sample comprised largely of National Guard personnel, zero-inflation negative binomial regression was applied to estimate the effects of indirect, nonface valid indicators of suicide ideation [Thwarted Belongingness (TB), Perceived Burdensomeness (PB), and Hopelessness], in predicting suicide ideation. Data from a sample of 497 military personnel (82.1% male; mage  = 27.24; range = 18-59) were analyzed. TB and the interaction of TB with Hopelessness were significant predictors in the logistic regression, and in the negative binomial regression, the main effects of TB and hopelessness, and the interactions of TB with hopelessness and PB with hopelessness were significant. The findings further indicated that approximately 10% of those not reporting ideation would be predicted to be ideators. Clinically, these results indicate that, in samples reluctant to report ideation, the assessment of suicide risk may improve through the use of relevant measures that do not explicitly reference suicide thoughts.

Psychopathic Personality Traits in the Military: An Examination of the Levenson Self-Report Psychopathy Scales in a Novel Sample.

The Levenson Self-Report Psychopathy Scale is a short, self-report measure initially developed to assess psychopathic traits in noninstitutionalized samples. The present study aimed to explore factor structure and convergent and discriminant validity of the Levenson Self-Report Psychopathy Scale in a large U.S. military sample (90.7% Army National Guard). Factor analytic data, regression, and correlational analyses point to the superiority of Brinkley, Diamond, Magaletta, and Heigel's three-factor model in this sample. Implications for theory and the study of psychopathic personality traits in a military sample are discussed.

How Distress Tolerance Mediates the Relationship Between Posttraumatic Stress Disorder and the Interpersonal Theory of Suicide Constructs in a U.S. Military Sample.

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.

Taxometric analysis of biceps femoris EMG following electrocutaneous stimulation over the sural nerve: determining the latent structure of the nociceptive flexion reflex (NFR).

The nociceptive flexion reflex (NFR) is a polysynaptic withdrawal reflex typically assessed from biceps femoris electromyogram (EMG) following noxious stimulation of the ipsilateral sural nerve. Electrophysiological evidence suggests the reflex is elicited following the activation of small diameter A-delta afferents. As a result, the NFR is assumed to be a categorically distinct construct that emerges from EMG activity only following nociceptor activation. Despite the widespread use of the NFR in pain research, there has been little attempt to verify the latent structure of the NFR. The present study used "coherent cut kinetics" taxometric analyses to examine whether the latent structure of biceps femoris EMG reflects the taxonic structure that would be predicted from electrophysiological evidence. To achieve this end, preliminary analyses first compared different methods of scoring NFR magnitude. Results suggested the presence of a taxon in the covariance of biceps femoris EMG and stimulus intensity that is likely to be the NFR. Furthermore, preliminary analyses suggested the best method of scoring NFR magnitude was using Cohen's d. Implications of these results are discussed.

Is perfectionism categorical or dimensional? A taxometric analysis.

Considerable debate exists within the perfectionism literature regarding whether perfectionism is most accurately conceptualized as a dimensional or categorical construct. Specifically, some researchers have viewed perfectionism as a continuous construct, with extreme scores being associated with negative psychological outcomes (e.g., obsessive-compulsive disorder, eating disorders, etc.). In contrast, others have argued that two distinct forms of perfectionism exist (i.e., adaptive vs. maladaptive perfectionism) that are associated with both positive and negative outcomes. The purpose of this study was to examine the latent structure of perfectionism using taxometric procedures to determine whether perfectionism is most accurately conceptualized as taxonic (categorical) or dimensional (continuous). We applied four taxometric procedures (maximum eigenvalue [Waller & Meehl, 1998], maximum covariance [Meehl & Yonce, 1996], mean above minus below a cut [Meehl & Yonce, 1994], and latent-mode factor analysis [Waller & Meehl, 1998]) to perfectionism data collected from 2 large nonclinical samples. Results provided convergent evidence for a dimensional conceptualization of perfectionism across samples, perfectionism measures, and statistical procedures. We discuss the implications of these findings for the theory, assessment, and investigation of perfectionism are discussed.

The latent structure of anxiety sensitivity--revisited.

Anxiety sensitivity has been implicated as a risk factor for the development and maintenance of panic and other anxiety disorders. Although researchers have generally assumed that anxiety sensitivity is a dimensional, rather than categorical, variable, recent taxometric research has raised questions concerning the accuracy of this assumption. The present study examined the latent structure of anxiety sensitivity by applying four taxometric procedures (MAXEIG, MAXCOV, MAMBAC, and L-Mode) to data collected from two large nonclinical samples (n = 1,025 and n = 744) using two distinct measures of anxiety sensitivity (Anxiety Sensitivity Profile and Anxiety Sensitivity Index-Revised). In contrast to previous taxometric analyses of anxiety sensitivity, results of the present research provided convergent evidence for a latent anxiety sensitivity dimension. Several potential explanations for the discrepancy between these findings and those of previous research are discussed, as well as the implications of these findings for the conceptualization and measurement of anxiety sensitivity.