Feasibility and acceptability of caring contacts texts for suicide prevention among veterans recently separated from military service.

The primary purpose of this single-arm mixed-methods pilot trial was to examine the feasibility, acceptability, and preliminary effects of a text message-based version of Caring Contacts, Caring Contacts texts (CC-t), among veterans recently separated from military service. Twenty-four veterans (Mage = 32.92, SD = 8.16; 75% male; 50% Black; 91.7% non-Hispanic/Latinx) were recruited through the Department of Veterans Affairs (VA) and enrolled in CC-t, which involved approximately five text messages sent by the study team expressing care and concern over the course of 3 months. Participants completed pre- and postintervention assessments and an interview, during which self-reported feasibility and acceptability of CC-t, and preliminary effects of CC-t on health care engagement and suicide risk were assessed. Self-reported feasibility and acceptability of CC-t were also assessed among VA staff involved in the study. Among veterans and VA staff, scores on the Feasibility of Intervention Measure (M = 17.91 and M = 15.67, respectively) and Acceptability of Intervention Measure (M = 18.19; M = 19.33, respectively) were above the mean, suggesting that CC-t was easy to engage in or implement and was well-tolerated. These findings were reinforced in the qualitative feedback, which suggested that veterans found the text messages to be comfortable, convenient, and had a positive impact on their mood. Quantitative results provided preliminary evidence for improved veteran health care engagement following CC-t. CC-t appears to be feasible and acceptable among veterans and VA staff and holds promise as a primary suicide prevention for veterans making the transition from military service to civilian life. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Comparing the interactions of risk factors by method of suicide among veterans: A moderated network analysis approach.

Despite the well-established link between firearm access and suicide, less is known about other variables that may influence the risk for death by self-inflicted gunshot versus other methods of suicide. As individual factors have demonstrated limited predictive ability, scholars have called for studies that consider the multifaceted relations between myriad variables. One alternative to the typical cause-and-effect approach for investigating various forms of psychopathology is network analysis. However, few studies have applied this method to suicidal outcomes, particularly in the context of a veteran population. Data from 19,234 male veteran suicide decedents (89.1% White; Mage = 57.16, SD = 18.64) acquired from the National Violent Death Reporting System were used to investigate characteristics of veteran suicide decedents who died by self-inflicted gunshot (gun; 66.4%) versus alternative methods (nongun, e.g., poisoning, hanging; 33.5%). Results of the overall moderated network model indicated that veterans in the gun group were more likely to have a physical health problem that contributed to the suicide than veterans in the nongun group. Additionally, results of the moderated network model revealed several pairs of associated circumstances whose relationships were significantly moderated by method of suicide, the three strongest of which included having a physical health problem that contributed to the suicide. Overall, results suggest that public health prevention and intervention efforts aimed at reducing the overall burden of physical health problems among male veterans may mitigate the risk of firearm suicides. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Self-Reported Likelihood of a Future Suicide Attempt: The Role of Plans for Suicide.

OBJECTIVE: The present study seeks to add to the existing literature by determining if having a plan for suicide, is associated with an individual's self-reported likelihood of attempting suicide in the future. METHOD: Data came from a sample of 97 United States Army personnel with past week ideation or lifetime attempt history. Assessments were collected at baseline, 1-month, 3-month, and 6-months. RESULTS: Self-reported likelihood of attempting suicide in the future was not associated with the presence of a plan for suicide overall or a plan with a specific method (i.e., firearm, cutting/scratching, and medication). DISCUSSION: Although a plan for suicide is commonly thought to indicate elevated risk our findings suggest that presence or absence of suicide plans is not associated with more self-reported likelihood of a future suicide attempt.

The self-reported likelihood of attempting suicide in the future was not associated with the presence of a plan for suicide among service members.Findings suggest that presence or absence of suicide plans is not associated with self-reported likelihood of suicidal behavior among service members.Clinicians and researchers working with a military population may benefit from a broader approach to risk assessment and safety planning that does not rely too heavily on an individual's self-reported plans for suicide.

The armory project: Partnering with firearm retailers to promote and provide voluntary out-of-home firearm storage.

INTRODUCTION: In this article, we describe the development of a regional firearm storage network organized by investigators affiliated with the Department of Veterans Affairs and run by small business, firearm retailers who were also U.S. Veterans. METHODS: Three firearm retailers participated as collaborators in the development of a temporary out-of-home storage program and as test sites in a 4-month, uncontrolled pilot. Both quantitative and qualitative measures were collected to assess feasibility, acceptability, fidelity, and program effectiveness. RESULTS: Data indicated the out-of-home storage program was feasible and acceptable to firearm retailers and their staff. The program led to changes in staff beliefs regarding the role of secure firearm storage in suicide prevention, dispersal of materials about the out-of-home storage program to customers, conversations about secure storage and availability of out-of-home storage, and actual storage of customers' firearms. CONCLUSIONS: We discuss the potential benefits and limitations of a voluntary out-of-home storage network organized by public health professionals but run by firearm retailers.

When safe firearm storage isn't enough: Examining risk profiles among firearm suicide decedents.

INTRODUCTION: Suicide is a leading cause of death in the United States, and firearms are the most frequently used suicide method. Research suggests risk for firearm suicide increases with greater access to firearms (e.g., storing loaded or unlocked). Although safe firearm storage is promoted as a means of risk reduction, no studies have explored factors differentiating firearm suicide decedents who stored firearms safely vs. those who stored unsafely prior to death. METHODS: Utilizing data from the National Violent Death Reporting System, the current study aimed to determine which factors distinguish firearm suicide decedents who stored firearms safely vs. those who stored unsafely. The current sample included decedents for whom data were available on whether the firearm used in the suicide was stored loaded or unloaded (n = 4269) and unlocked or locked (n = 6273) prior to their death. RESULTS: Results revealed using a long gun in the suicide (as opposed to a handgun) was associated with five times greater odds of storing unloaded prior to death, suggesting this safe firearm storage practice alone does not mitigate risk among all long gun owners. CONCLUSION: These findings indicate a need to increase suicide prevention efforts within the long gun owning community.

Engaging stakeholders to develop a suicide prevention learning module for Louisiana firearm training courses.

BACKGROUND: Firearm suicide is a significant public health problem in the United States of America among the general and veteran populations. Broad-based preventive strategies, including lethal means safety, have been emphasized as a key approach to suicide prevention. Prior research has identified ways to improve the reach and uptake of lethal means safety messages. However, few resources have been created with these lessons in mind. METHODS: Louisiana firearm owners and instructors were recruited through a larger project, Veteran-Informed Safety Intervention and Outreach Network, as well as a publicly available database of firearm instructors to participate in focus groups to provide feedback on an existing suicide prevention learning module (developed in Utah) for use by firearm instructors. Their feedback was used to adapt the module, which included a brief video and PowerPoint presentation. Firearm owners and instructors were then invited back for another round of focus groups to provide feedback on this adapted learning module. Team-based rapid qualitative analysis was conducted to identify themes across transcripts from these four focus groups. RESULTS: Firearm owners and instructors agreed on several key themes, including the importance of messenger relatability and aligning the lethal means safety message with firearm owner values. Feedback suggested these themes were adequately addressed in the adapted learning module and contributed to overall module acceptability. The final theme, present across the original and adapted learning modules (i.e., Utah and Louisiana), was openness to further information and training on firearm suicide prevention. CONCLUSION: Consistent with a public health approach to suicide prevention, the current study used stakeholder engagement to develop a suicide prevention learning module perceived as representative, accurate, and acceptable to Louisiana firearm owners and instructors. These findings can be used to inform firearm suicide prevention efforts in other states.

The Firearm Implicit Association Test: A Validation Study.

Firearm violence causes significant public health burden, but there is a lack of research concerning motivations for firearm access despite clear epidemiological risk. Developing robust tools to measure attitudes toward firearms and firearm-related behaviors can improve our ability to conduct firearm violence research. We aimed to develop a feasible and effective tool that could indirectly measure firearm beliefs. A total of 274 undergraduates were recruited from two southern universities and completed an implicit association test (IAT) designed to indirectly assess attitudes toward firearms (Firearm IAT). Participants also completed self-report measures, including Attitude Toward Guns Scale (ATGS) and Gun Beliefs and Behavior Scale (GBBS) to examine explicit attitudes toward firearms. Demographic and firearm-related data were also assessed. The Firearm IAT revealed an association between firearms and negatively valenced words. The Firearm IAT had a good internal consistency and construct validity with a D score that is significantly different from 0 and a reliability score of 0.84. The Firearm IAT showed significant positive correlations with ATGS and GBBS suggesting this measure could serve as an indirect assessment of firearm attitudes.

Firearm Suicide Prevention in the U.S. Military: Recommendations From a National Summit.

The U.S. DoD has identified firearm suicide prevention as a key operational priority. One vital approach to addressing firearm suicides is through promoting lethal means safety, which involves the voluntary use of secure storage for personally owned firearms and/or temporarily moving firearms out of the home during risk periods. Despite promising approaches to lethal means safety, critical gaps remain in research, programming, and communication among and across scientists, DoD programmatic leaders, front-line commanders, and service members. To address these gaps, the first-ever national "Firearm Suicide Prevention in the Military: Messaging and Interventions Summit" was convened in June 2022, bringing together DoD personnel and researchers with expertise in firearm suicide prevention and lethal means safety. The Summit identified 10 recommendations to enhance firearm suicide prevention messaging and interventions in the U.S. military, including (1) repeal or amend prohibitions on questioning service members about personal firearms; (2) develop, examine, and use common language for firearm injury prevention; (3) implement a universal approach to training on comprehensive firearm injury prevention; (4) encourage leadership across disciplines and levels; (5) aim for broad culture change; (6) support innovative research; (7) consider various outcome measures; (8) promote "cultural competence" for better communication; (9) reduce territorialism; and (10) develop creative partnerships. Ultimately, these recommendations can facilitate productive partnerships with a shared goal: to develop, test, and implement strategies that standardize lethal means safety and reduce firearm suicides and other firearm injuries or harm among service members.

Practical Capability Among Veterinarians: Preliminary Evidence of the Importance of Access to Lethal Medications in the Workplace.

OBJECTIVE: Veterinarians die by suicide at elevated rates. Higher levels of capability for suicide among veterinarians, including access to lethal medications, may account for this discrepancy. This study aimed to determine the importance of accessibility of lethal medications in veterinary workplaces in the relationship between recent suicidal ideation and perceived likelihood of making a future suicide attempt. METHOD: Participants identifying with one or more groups at high-risk for suicide (e.g., veterinarians, firearm owners) were recruited via social media to complete online self-report questionnaires examining demographic, work-related, and suicide-related risk factors. The sample of veterinarians (n = 310) was primarily female, White, and worked in small animal practices. RESULTS: Method of lethal medication storage in the workplace moderated the relationship between past week ideation and perceived likelihood of a future suicide attempt such that the relationship became stronger among those storing medications unlocked during business hours and weaker among those storing medications locked during business hours. CONCLUSION: Secure storage of lethal medications in the workplace may protect against suicide risk. Barriers to lethal medications, when not actively in use, may reduce both physical and cognitive accessibility. Future research should determine the impact of workplace lethal medication storage on suicidal behavior among veterinarians.HIGHLIGHTSLethal med storage moderates link between suicidal thoughts and belief suicide is likelyStoring unlocked may increase physical and cognitive accessibility of this methodWorking with vets to develop and implement means safety strategies will be important.

Coping in crisis: The role of psychologists in response to a pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has had a major impact on the world. In the United States, healthcare systems have been taxed, medical supplies depleted, and healthcare providers overburdened by the increased need. Although psychologists cannot provide medical services, we possess a unique skillset that can alleviate some of the stress placed on healthcare providers, answer important questions about how this disease impacts patients, and support the growing mental health needs of providers and patients alike. The following commentary outlines the ways in which psychologists and mental health workers at one facility, the Southeast Louisiana Veterans Health Care System, supported the medical system and cared for patient and staff mental health in response to the COVID-19 pandemic. Lessons learned from this experience as well as important future steps are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Development and Initial Validation of a Scale Assessing Suicide-Specific Rumination: The Suicide Rumination Scale.

Suicide-specific rumination, a repetitive mental fixation on one's suicidal thoughts and intentions, may influence the transition from suicidal thoughts to behaviors. Research on suicide-specific rumination has been hindered by the lack of an independent measurement tool. This article presents the development and validation of a self-report measure of suicide-specific rumination across several samples with lifetime suicidal ideation (Sample 1: N = 494 students; Sample 2: N = 219 community members; Sample 3: N = 128 adults at high risk for suicide). The Suicide Rumination Scale (SRS) item pool was reduced from a pool of 41 items to 8 items that are highly discriminant and of varying levels of difficulty. The SRS demonstrated measurement invariance, convergent validity, and nonredundancy with related measures. Importantly, the SRS differentiated suicide attempters from ideators, suggesting its potential clinical relevance. Overall, these findings suggest that the SRS is a valid and incrementally useful measure of suicide-specific rumination.

Masculinity's association with the interpersonal theory of suicide among military personnel.

OBJECTIVE: Given that the majority of those who die by suicide are male, masculine traits have been examined as a potential link to the development of capability for suicide. However, research has not examined if such traits influence suicidal desire (i.e., thwarted belongingness, perceived burdensomeness). This study examined the influence of stereotypically masculine traits of stoicism, sensation seeking, physical aggression, verbal aggression, and self-reliance on all three components of the Interpersonal Theory of Suicide within a sample of male and female service members. METHODS: A total of 953 service members were recruited as part of a larger study. RESULTS: Sensation seeking and stoicism were positively associated with capability for suicide. With regard to suicidal desire, self-reliance and verbal aggression were positively associated with both perceived burdensomeness and thwarted belongingness. Stoicism was positively associated with thwarted belongingness. CONCLUSIONS: Findings suggest that different masculine traits are associated with the three components of the Interpersonal Theory of Suicide in various ways. Stoicism may be an especially important masculine trait that influences a component of suicidal desire and capability for suicide.

Correlates of death among SARS-CoV-2 positive veterans: The contribution of lifetime tobacco use.

Despite a growing body of research examining correlates and consequences of COVID-19, few findings have been published among military veterans. This limitation is particularly concerning as preliminary data indicate that veterans may experience a higher rate of mortality compared to their civilian counterparts. One factor that may contribute to increased rates of death among veterans with COVID-19 is tobacco use. Indeed, findings from a recent meta-analysis highlight the association between lifetime smoking status and COVID-19 progression to more severe or critical conditions including death. Notably, prevalence rates of tobacco use are higher among veterans than civilians. Thus, the purpose of the current study was to examine demographic and medical variables that may contribute to likelihood of death among veterans testing positive for SARS-CoV-2. Additionally, we examined the unique influence of lifetime tobacco use on veteran mortality when added to the complete model. Retrospective chart reviews were conducted on 440 veterans (80.5% African American/Black) who tested positive for SARS-CoV-2 (7.3% deceased) at a large, southeastern Veterans Affairs (VA) hospital between March 11, 2020 and April 23, 2020, with data analysis occurring from May 26, 2020 to June 5, 2020. Older age, male gender, immunodeficiency, endocrine, and pulmonary diseases were positively related to the relative risk of death among SARS-CoV-2 positive veterans, with lifetime tobacco use predicting veteran mortality above and beyond these variables. Findings highlight the importance of assessing for lifetime tobacco use among SARS-CoV-2 positive patients and the relative importance of lifetime tobacco use as a risk factor for increased mortality.

What I have is what I am: Differences in demographics, suicidal thoughts and behaviors, and firearm behavior and beliefs between firearm owners who do and do not primarily identify as firearm owners.

Non-legislative forms of means safety (i.e., safe firearm storage practices) have been promoted as a way to reduce elevated suicide risk found among firearm owners. However, evidence suggests that some firearm owners are less willing than others to engage in these practices. The current study aimed to understand factors that differentiate firearm owners' beliefs and behaviors that are relevant to suicide risk by examining differences between individuals for whom firearm ownership represents a central aspect of identity (i.e., primary firearm owners) versus firearm owners who primarily identify with some other demographic or occupational characteristic. Results of main analyses revealed that primary firearm owners were more likely to be male, were less likely to have experienced suicidal ideation, were less likely to store their firearms safely across a number of storage methods, and were less open to means safety across all storage methods. These findings highlight demographically which firearm owners may be more likely to view firearm ownership as central to their identity and also suggest that this identification may be associated with beliefs and behaviors that increase suicide risk. Future firearm suicide prevention efforts should focus on culturally competent discussions and messaging to find common ground with firearm owners and to increase the salience of suicide among firearm owners.

Firearm legislation and statewide suicide rates: The moderating role of household firearm ownership levels.

Firearm legislation is associated with statewide suicide rates; however, prior research has often relied upon older data and categorical legislative grades while also failing to consider the nuanced role of firearm ownership. Therefore, the robust literature base on legislation and suicide has not directly examined regarding the extent to which the value of legislation hinges upon the rate of firearm ownership in a given state. The current study examined 2015 US statewide firearm legislation strength scores from Giffords Law Center to Prevent Gun Violence and 2016 statewide suicide rates from the Centers for Disease Control and Prevention. Firearm legislation strength was inversely associated with statewide overall and firearm suicide rates, but not with non-firearm suicide rates. Firearm ownership rates moderated the association between firearm legislation strength and statewide overall suicide rates. Specifically, firearm legislation strength was inversely associated with statewide overall suicide rates at mean and high levels of firearm ownership. Findings support the potential utility of firearm legislation as part of a national effort to decrease US suicide deaths, particularly in areas with higher firearm ownership rates.

The Role of Opioid Use in Distinguishing between Suicidal Ideation and Attempts.

OBJECTIVE: Opioid use disorders are associated with heightened suicidal ideation, suicide attempts, and suicide death. This study aimed to examine the extent to which opioid differentiates between those with suicide attempts from those with lifetime suicidal ideation but no history of attempt. METHODS: Participants were drawn from the US National Guard and a residential substance use treatment facility. Multinomial logistic regression was utilized to determine the extent to which a lifetime history of nonmedical opioid use differentiated between (1) individuals with no lifetime history of suicidal ideation or attempt, (2) individuals with a history of suicidal ideation but no attempt, and (3) individuals with a history of at least one suicide attempt. RESULTS: History of opioid use among National Guard personnel and opioid use disorders among substance-dependent patients were associated with an increased likelihood of having at least one suicide attempt relative to both a history of suicidal ideation but no attempts and no history of ideation or attempts. Findings held when accounting for lifetime nonmedical use of other substances and the presence of other lifetime substance use disorders. CONCLUSIONS: Results highlight the importance of assessing for suicide risk among opioid users.

Help-seeking Behavior in Socially Conservative and Christian Suicide Decedents.

OBJECTIVE: The purpose of this study was to examine the relationship between religious affiliation, political beliefs, and lifetime mental health help-seeking behavior in a sample of suicide decedents. We hypothesized that Christian decedents would be less likely to have sought help than non-Christians, and socially conservative individuals would be less likely to have sought help than socially liberal or moderate individuals. METHOD: Smaller samples (N = 147 for political analyses, N = 218 for religion analyses) were drawn from a larger sample of 267 suicide decedents, for whom data were collected from loss survivors. RESULTS: Logistic regression analyses showed that Christian and non-Christian individuals did not differ significantly in help-seeking behavior prior to death by suicide. Individuals who identified as socially liberal were significantly more likely to have sought mental health care than were individuals who identified as socially conservative. CONCLUSIONS: This is the first study to examine the association between social conservatism and a lack of help-seeking behavior. These findings show the importance of implementing interventions to increase help-seeking behavior for suicidality within demographic groups that stigmatize help-seeking behavior, specifically socially conservative individuals. They also stress the importance of suicide prevention tactics that do not require disclosing suicidal intent within these groups.

Firearm suicide: pathways to risk and methods of prevention.

Firearms are utilized in approximately half of all US suicides, making them a serious public health concern and a target of suicide prevention efforts. Practical capability influences the transition from suicidal ideation to action and is particularly relevant to firearm suicide. Firearm ownership, experience using firearms, unsafe firearm storage, and high cultural acceptability of firearms increase risk for death by firearm suicide. Means safety strategies, which emphasize the reduction of practical capability for suicide through the limitation of access to and safe storage of firearms, are effective in preventing suicide and include interventions such as lethal means counseling, firearm legislation, and promoting safe storage practices. Public health interventions aimed at reducing firearm suicide are critical topics for continued research.