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ABSTRACT: The associations between social support and stress with internalizing symptoms (depressive symptoms and hopelessness) and hazardous drinking were tested in an inpatient sample of suicidal military personnel. Baseline data from a randomized clinical trial were analyzed. Different sources of support and stressors in the social context of military personnel were differentially linked to internalizing symptoms and hazardous drinking. In the full sample ( n = 192), family and nonfamily support were both inversely associated with internalizing symptoms but not hazardous drinking. Family stress was positively associated with internalizing symptoms. In a subsample of service members who had a history of deployment ( n = 98), postdeployment social support was protective against internalizing symptoms, whereas deployment harassment was associated with increased odds of hazardous drinking. Results underscore the need for assessment of various dimensions of social support and stress to guide case formulation and optimize strategies to support patients' mental well-being and adaptive coping.
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Personal Militar , Trastornos por Estrés Postraumático , Humanos , Ideación Suicida , Pacientes Internos , Salud Mental , Apoyo SocialRESUMEN
BACKGROUND: Prior research has identified altered brain structure and function in individuals at risk for self-directed violence thoughts and behaviors. However, these studies have largely utilized healthy controls and findings have been inconsistent. Thus, this study examined differences in resting-state functional network connectivity among individuals with lifetime suicide attempt(s) v. lifetime self-directed violence thoughts alone. METHODS: Using data from the UK Biobank, this study utilized a series of linear regressions to compare individuals with lifetime suicide attempt(s) (n = 566) v. lifetime self-directed violence thoughts alone (n = 3447) on within- and between- network resting-state functional connectivity subnetworks. RESULTS: There were no significant between-group differences for between-network, within-network, or whole-brain functional connectivity after adjusting for age, sex, ethnicity, and body mass index and performing statistical corrections for multiple comparisons. Resting-state network measures may not differentiate between individuals with lifetime suicide attempt(s) and lifetime self-directed violence thoughts alone. CONCLUSIONS: Null findings diverge from results reported in smaller neuroimaging studies of suicide risk, but are consistent with null findings in other large-scale studies and meta-analyses. Strengths of the study include its large sample size and stringent control group. Future research on a wider array of imaging, genetic, and psychosocial risk factors can clarify relative contributions of individual and combined variables to suicide risk and inform scientific understanding of ideation-to-action framework.
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Trastornos Mentales , Intento de Suicidio , Humanos , Intento de Suicidio/psicología , Ideación Suicida , Biobanco del Reino Unido , Bancos de Muestras BiológicasRESUMEN
INTRODUCTION: Promoting help-seeking is a key suicide prevention strategy. Yet, research on help-seeking patterns by high-risk individuals is limited. This study examined help-seeking among United States military Service members admitted for psychiatric inpatient care. METHODS: Participants were active duty Service members (N = 111) psychiatrically hospitalized for a suicide-related event. Data were collected as part of a larger randomized controlled trial. Reported types and perceived helpfulness of resources sought 30 days before hospitalization were examined. Hierarchical binary logistic regressions were used to examine associations among types of helping resources, mental health treatment stigma, and perceived social support. RESULTS: Approximately 90% of participants sought help prior to hospitalization, most frequently from behavioral health providers and friends. Accessed resources were generally considered helpful. Adjusting for covariates, mental health treatment stigma was not associated with seeking help from any resource type. Higher perceived social support was associated with greater likelihood of help-seeking from a friend (OR = 1.08, p = 0.013 [95% CI = 1.02, 1.14]). Marital status, education level, and organizational barriers were associated with specific types of resources, and/or not seeking help. CONCLUSION: Help-seeking is a complex human behavior. Promoting help-seeking among vulnerable subgroups requires further understanding of multiple interconnected factors.
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Servicios de Salud Mental , Personal Militar , Suicidio , Humanos , Estados Unidos , Personal Militar/psicología , Prevención del Suicidio , Apoyo Social , Estigma Social , Aceptación de la Atención de Salud/psicologíaRESUMEN
Cognitive flexibility has been linked with positive psychological health outcomes, whereas cognitive rigidity has been linked with suicide risk. We examined associations among cognitive flexibility and certain suicide risk indicators among a sample of patients psychiatrically hospitalized for suicide risk (n = 40). Data were collected during two pilot randomized controlled trials. At baseline, cognitive flexibility was not associated with depressive symptoms, hopelessness, or severity of lifetime worst point suicide ideation. At 3-months post psychiatric discharge, higher baseline cognitive flexibility predicted significantly lower depressive symptoms and worst point suicide ideation in the past month, but did not predict lower hopelessness.
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Pacientes Internos , Ideación Suicida , Cognición , Hospitalización , Humanos , Pacientes Internos/psicología , Factores de RiesgoRESUMEN
BACKGROUND: Limited knowledge exists regarding targets for suicide-focused care among high-risk United States (U.S.) civilian and military sexual minorities. PURPOSE: This study aimed to understand the demographic and clinical characteristics of a suicidal sexual minority sample, psychiatrically hospitalized in military treatment facilities, to advance future targeted care for this vulnerable subgroup. METHODS: Secondary analysis of baseline data from a multisite psychotherapy randomized controlled trial was performed comparing those who self-identified as lesbian, gay, or bisexual (LGB; n = 39) to heterosexual participants (n = 170). RESULTS: LGB participants were more likely than heterosexual participants to be younger, female, never married, and enlisted rank. LGB participants reported significantly lower family support, higher perceived burdensomeness, lower acquired capability for suicide, and were twice as likely to report that they could not control their suicidal thoughts. LGB and heterosexual participants reported similar levels of other suicide risk indicators and similar lifetime suicidal ideation and attempt histories. CONCLUSIONS: Compared to heterosexual participants, LGB participants reported increased risk indicators for suicide yet similar lifetime suicidal ideation and attempt histories. Suicide prevention programs should address the unique needs of this vulnerable subgroup. Interventions targeting family support, perceived burdensomeness, and controllability of suicidal thoughts may be promising.
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Personal Militar , Minorías Sexuales y de Género , Adulto , Bisexualidad/psicología , Femenino , Humanos , Pacientes Internos , Ideación Suicida , Estados Unidos/epidemiologíaRESUMEN
Introduction Changes in social interactions following psychiatric hospitalization, a period characterized by heightened suicide risk, are important to understand. OBJECTIVE: We qualitatively explored perceived changes in social interactions one month after inpatient psychiatric discharge following a suicidal crisis. METHODS: A total of 113 United States Service members, recruited in the context of a psychotherapy randomized controlled trial, described the extent to which social interactions with family members, peers, and military commanders had changed. RESULTS: Most participants (82.3%) reported at least some change in social interactions, conveying six common themes. Showing more care and checking in more were frequently reported for family (24.8%, 20.4%), commanders (23.0%, 16.8%), and by peers (12.4%, 10.6%). Showing more concern was most frequently reported for family (13.3%) followed by peers (6.2%) and commanders (6.2%). Participants reported showing more caution from peers (14.2%), commanders (13.3%) and family (6.2%). Acting more distant was reported from commanders (7.1%), peers (7.1%), and family (5.3%). Showing negative reaction(s) was reported from commanders (8.0%), family (3.5%) and rarely for peers (0.9%). CONCLUSION: Inpatient providers are encouraged to prepare patients for potential changes in social interactions following psychiatric discharge and how to best respond to these changes.
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OBJECTIVE: Physical, emotional, and sexual abuse are subtypes of childhood abuse that may persist into adulthood. This study applied latent class analysis to describe the pattern of co-occurrence of these three abuse subtypes during childhood and adulthood and examined latent class differences in psychosocial characteristics and three types of suicide attempt history (aborted, interrupted, and actual). METHODS: Data were drawn from a high-risk sample of 115 military service members and adult beneficiaries who were psychiatrically hospitalized following a suicide-related crisis. RESULTS: Three latent classes were identified: Multiple and Persistent Abuse (Class One: 29.6%), Childhood Physical and Persistent Emotional Abuse (Class Two: 27.0%), and Minimal Abuse (Class Three: 43.5%). Females were more likely than males to report a history of Multiple and Persistent Abuse. After controlling for gender, the Multiple and Persistent Abuse Class had higher scores of depressive symptoms and hazardous drinking, poorer sleep quality, and increased social stress than the Minimal Abuse Class. Moreover, the Multiple and Persistent Abuse Class was associated with increased likelihood of lifetime interrupted suicide attempt (Odds Ratio [OR] = 3.81, 95% CI = 1.20, 12.07) and actual suicide attempt (OR = 3.65, 95% CI = 1.23, 10.85), and had the greatest number of total actual suicide attempt (1.82 times on average). CONCLUSION: Co-occurrence of multiple subtypes of abuse across development is associated with higher psychosocial risk and history of suicide attempt. The assessment of specific subtypes of abuse and their timing may inform case conceptualization and the management of suicide risk among psychiatric inpatients.
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Maltrato a los Niños , Delitos Sexuales , Adulto , Niño , Femenino , Humanos , Pacientes Internos , Análisis de Clases Latentes , Masculino , Factores de Riesgo , Ideación Suicida , Intento de SuicidioRESUMEN
The present study aimed to explore reasons for dying (RFD) and reasons for living (RFL) among suicidal inpatients, conceptualize the RFD-RFL index, and examine whether suicide risk indicators were associated with the RFD-RFL index scores. Participants were military personnel (N = 167) psychiatrically hospitalized following a suicide-related crisis who provided baseline data as part of a randomized controlled trial. Family was the most commonly reported RFL (39.7%) and was the top ranked RFL for 65.9% of participants. The most frequently endorsed RFD categories included general descriptors of self (26.9%), general statements about escape (19.7%), and others/relationships (19.1%). Greater RFD-RFL index scores were associated with a greater wish to die relative to wish to live, greater hopelessness, and with a history of lifetime multiple suicide attempts. Endorsing more RFD relative to RFL may indicate heightened suicide risk. Results of this study identify the characteristics of RFD and RFL among a high-risk, military sample, and provide preliminary support for the clinical utility of evaluating the quantities of RFD and RFL. Clinicians are encouraged to explore RFD and RFL when working with suicidal patients. Future research may explore military-specific RFD and evaluate the validity of the proposed RFD-RFL index.
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Personal Militar/psicología , Psicometría/estadística & datos numéricos , Medición de Riesgo/métodos , Prevención del Suicidio , Suicidio/psicología , Encuestas y Cuestionarios/normas , Adulto , Actitud Frente a la Muerte , Femenino , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Teoría Psicológica , Psicometría/instrumentación , Psicometría/métodos , Factores de Riesgo , Ideación Suicida , Intento de Suicidio/psicologíaRESUMEN
Suicide attempts and psychiatric hospitalization represent the final outcomes of a complex dynamical system of interacting factors that influence a particular individual's likelihood of engaging in suicidal behavior, as well as their ability to seek help prior to acting upon suicidal impulses. This study examined the association between different types of lifetime trauma exposure and the likelihood of psychiatric hospitalization following a suicide attempt (SA) rather than suicidal ideation (SI) alone. Electronic medical records for 1100 U.S. military service members and their dependents admitted to a military psychiatric inpatient setting for SA or SI were reviewed for documented lifetime trauma exposure history. Findings indicated that exposure to at least one childhood trauma of any type, and childhood neglect in particular, increased the likelihood that an individual would be hospitalized for SA rather than SI. Exploratory gender-stratified analyses demonstrated that childhood neglect, childhood sexual abuse, and adulthood traumatic loss may be linked with the likelihood of being hospitalized for SA. These findings demonstrate the importance of developing more detailed and nuanced conception of factors known to be associated with suicide as their effects may depend on details of their timing and nature, as well as their interactions with other systems.
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Personal Militar , Delitos Sexuales , Ideación Suicida , Heridas y Lesiones , Adulto , Femenino , Hospitalización , Humanos , Masculino , Personal Militar/psicología , Factores de Riesgo , Intento de Suicidio , Heridas y Lesiones/psicología , Adulto JovenRESUMEN
BACKGROUND: To describe prevalence and identify clinical correlates of hazardous drinking among suicidal inpatients at military medical settings. METHOD: Data were drawn from the baseline assessment of a multisite randomized controlled trial of Post-Admission Cognitive Therapy (PACT). Participants were military Service members or adult beneficiaries (Nâ¯=â¯218) who were admitted to inpatient care following a suicide-related crisis. Hazardous alcohol use in the past year was assessed using the Alcohol Use Disorder Identification Test (AUDIT). RESULTS: The average AUDIT score was 6.78 (SDâ¯=â¯7.87), with 28.9% reporting hazardous drinking (scored ≥8 on the AUDIT). Hazardous drinkers were more likely than nonhazardous drinkers to meet diagnosis of Substance Use Disorder (SUD; Odds Ratio [OR]â¯=â¯5.96, 95% confidence intervals [CI]â¯=â¯2.13, 16.71). Hazardous drinking was neither associated with measures of suicide ideation nor aborted or interrupted suicide attempt. However, hazardous drinkers had greater risk of having both single (RRR [Relative Risk Ratio]â¯=â¯2.55, 95% CIâ¯=â¯1.18, 5.50) and multiple actual suicide attempts (RRRâ¯=â¯2.38, 95% CIâ¯=â¯1.06, 5.32) than nonhazardous drinkers. The association between hazardous drinking and single (but not multiple) actual suicide attempt remained significant after controlling for gender, depressive symptoms, hopelessness, Post-Traumatic Stress Disorder, and SUD (adjusted RRRâ¯=â¯2.48, 95% CIâ¯=â¯1.09, 5.65). CONCLUSIONS: A history of actual suicide attempt is associated with hazardous alcohol use among suicidal psychiatric inpatients. Assessment of drinking and drug use may inform case conceptualization and treatment of suicide-related behaviors in psychiatric inpatient settings.
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Trastornos Relacionados con Alcohol/psicología , Trastornos de Ansiedad/psicología , Conducta Peligrosa , Trastorno Depresivo Mayor/psicología , Personal Militar/psicología , Trastornos por Estrés Postraumático/psicología , Ideación Suicida , Intento de Suicidio/psicología , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Trastornos Relacionados con Alcohol/epidemiología , Trastornos de Ansiedad/epidemiología , Trastorno Depresivo Mayor/epidemiología , Femenino , Hospitalización , Hospitales Militares , Humanos , Masculino , Personal Militar/estadística & datos numéricos , Servicio de Psiquiatría en Hospital , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Intento de Suicidio/estadística & datos numéricos , Adulto JovenRESUMEN
OBJECTIVE: Individuals with a recent suicidal crisis are typically admitted for inpatient psychiatric care. However, targeted inpatient interventions for suicide prevention remain sparse. Thus, this pilot randomized controlled trial evaluated a brief inpatient cognitive behavioral protocol, Post-Admission Cognitive Therapy (PACT) for the prevention of suicide. METHODS: United States service members and beneficiaries (Nâ¯=â¯24) psychiatrically hospitalized at a military medical center due to a recent suicidal crisis were randomized to receive either PACT plus Enhanced Usual Care (PACTâ¯+â¯EUC) or EUC alone. Blinded follow-up assessments were conducted at one-, two-, and three-months post discharge. The degree of change and variability of response to PACT for repeat suicide attempt(s) (primary outcome), as well as depression, hopelessness, and suicide ideation (secondary outcomes) were examined. RESULTS: Significant between-group differences in re-attempt status were not found. Reliable Change Index analyses indicated that among the most clinically severe participants, a greater proportion of PACTâ¯+â¯EUC participants compared with EUC participants met criteria for clinically significant reductions on depression (40% versus 25%), hopelessness (67% versus 50%), suicide ideation (45% versus 33%), and posttraumatic stress symptomatology (40% versus 25%). CONCLUSIONS: PACT is a promising inpatient cognitive behavioral intervention for suicide risk reduction. The efficacy of PACT is currently being evaluated in a well-powered multi-site randomized controlled trial.
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Terapia Cognitivo-Conductual , Hospitalización , Hospitales Militares , Pacientes Internos , Evaluación de Resultado en la Atención de Salud , Ideación Suicida , Intento de Suicidio/prevención & control , Adolescente , Adulto , Terapia Cognitivo-Conductual/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Familia Militar , Personal Militar , Proyectos Piloto , Psicoterapia Breve , Método Simple Ciego , Adulto JovenRESUMEN
Psychiatric hospitalization for a suicide attempt (SA), rather than suicide ideation (SI) alone, is a stronger risk indicator for eventual suicide death. Yet, little is known about demographic and clinical characteristics differentiating those admitted for SA versus SI. Understanding these differences has implications for assessment and treatment. A retrospective review of electronic medical records (EMRs) was performed on service members (n = 955) admitted for SA or SI at the Walter Reed Army Medical Center between 2001-2006. Service members hospitalized for SA were younger compared to those hospitalized for SI. The proportion of women admitted for SA was significantly higher than those admitted for SI whereas their male counterparts showed the opposite pattern. Patients admitted for SA, versus SI, had significantly higher prevalence of adjustment disorder with mixed disturbance of emotion and conduct (MDEC), personality disorder not otherwise specified (PDNOS), and borderline personality disorder (BPD). Patients admitted for SI had significantly higher prevalence of adjustment disorder with depressed mood and deferred Axis II diagnosis, compared to those admitted for SA. There were no significant between-group differences in the average or median number of documented prior suicide attempts. Findings highlight the need for more standardized assessment, diagnostic decision-making, and documentation practices for all patients.
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Hospitalización , Personal Militar/psicología , Ideación Suicida , Intento de Suicidio/psicología , Adolescente , Adulto , Femenino , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , Trastornos de la Personalidad , Prevalencia , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: To examine potential links between facets of impulsivity and emotion dysregulation to components of the Interpersonal-Psychological Theory of Suicide (thwarted belongingness, perceived burdensomeness, and acquired capability) among U.S. military personnel. METHOD: The current study performed secondary data analysis from a randomized control trial testing the efficacy of a cognitive therapy for 134 service members (71.64% male, 68.66% Caucasian; mean age: 30.14) admitted to a psychiatric inpatient unit for a suicide-related crisis. We utilized the Difficulties in Emotion Regulation Scale, the Barratt Impulsivity Scale, the Acquired Capability for Suicide Scale, and the Interpersonal Needs Questionnaire. RESULTS: All emotion dysregulation dimensions and one impulsivity facet (attentional) were positively correlated with perceived burdensomeness and thwarted belongingness. Lack of emotional awareness was positively associated with acquired capability. After controlling for depression, hopelessness, and demographic covariates, lack of emotional awareness was significantly associated with both thwarted belongingness and acquired capability, but not perceived burdensomeness, and impulsivity dimensions did not link to any variable of interest. CONCLUSIONS: Findings imply that individuals with reduced emotional awareness may have difficulty cultivating interpersonal bonds and be more vulnerable to elevated acquired capability. Lack of emotional awareness may be a potential contributor to both suicidal desire and capability.
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Regulación Emocional , Emociones , Personal Militar/psicología , Prevención del Suicidio , Suicidio , Adulto , Femenino , Humanos , Conducta Impulsiva , Pacientes Internos/psicología , Relaciones Interpersonales , Masculino , Teoría Psicológica , Autoimagen , Ideación Suicida , Suicidio/psicología , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Individuals with suicide ideation require self-efficacy to avoid engagement in suicidal behaviors. Low self-efficacy has been examined as a risk indicator for suicidal behaviors. The Self-Efficacy to Avoid Suicidal Action (SEASA) scale assesses self-efficacy to resist suicidal urges and was originally evaluated in a sample of adults receiving treatment for substance use disorders. The goal of this study was to explore the link between suicide ideation and self-efficacy to avoid suicidal action among a high-risk group of psychiatric inpatients. Military personnel psychiatrically hospitalized following a suicide-related event (Nâ¯=â¯139) completed a modified version of the SEASA and provided a full history of suicidal behaviors. Data were analyzed using multiple linear regression. Severity of worst time point suicide ideation, endorsement of any current suicide ideation, and history of multiple lifetime suicide attempts were associated with lower self-efficacy to avoid suicidal action. Self-efficacy to avoid engagement in suicidal action is a belief that can be strengthened and practiced within evidence-based treatments such as cognitive behavior therapy for suicide prevention. Thus, providers are encouraged to target this type of self-efficacy in case conceptualization and treatment planning. Future research on how self-efficacy to avoid suicidal action can be effectively measured are needed.
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Pacientes Internos/psicología , Personal Militar/psicología , Autoeficacia , Trastornos Relacionados con Sustancias/psicología , Ideación Suicida , Prevención del Suicidio , Adulto , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Factores de Riesgo , Centros de Tratamiento de Abuso de Sustancias , Intento de Suicidio/psicologíaRESUMEN
Links between emotion dysregulation, suicide ideation, and suicidal versus non-suicidal self-injury (NSSI) are poorly understood within military samples. United States service members and beneficiaries (Nâ¯=â¯186), psychiatrically hospitalized following a suicidal crisis, completed the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), and reported lifetime suicide ideation, attempts, and NSSI. We expected that emotion dysregulation would positively associate with worst lifetime suicide ideation, multiple suicide attempt status, and lifetime NSSI. Suicide ideation severity and multiple suicide attempts did not associate with DERS components. Notably, difficulties with impulse control (feeling out of control while distressed) was positively associated with NSSI history. Theoretical models that clearly describe the role of emotion dysregulation in suicidal thoughts, its progression to suicidal actions, and NSSI are needed to advance clinical care for this highly vulnerable group. Longitudinal and micro-longitudinal study designs require further investigation.
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Síntomas Afectivos/psicología , Conducta Impulsiva , Pacientes Internos/psicología , Personal Militar/psicología , Conducta Autodestructiva/psicología , Adolescente , Adulto , Emociones , Femenino , Hospitales Psiquiátricos , Humanos , Masculino , Persona de Mediana Edad , Suicidio/psicología , Estados Unidos , Adulto JovenRESUMEN
Posttraumatic stress disorder (PTSD) is one of the most commonly diagnosed psychiatric disorders in the United States and has been linked to suicidal thoughts and behaviors, yet the role of a PTSD diagnosis on functional impairment among suicidal individuals remains unknown. This study examined the association between PTSD status and functional impairment among military psychiatric inpatients admitted for acute suicide risk (N = 166) with a lifetime history of at least one suicide attempt. Measures of functionality included: (1) alcohol use; (2) sleep quality; (3) social problem-solving; and (4) work and social adjustment. Thirty-eight percent of the sample met criteria for PTSD. Women were more likely than men to meet criteria for PTSD (p = 0.007), and participants who met PTSD criteria had significantly more psychiatric diagnoses (p < 0.001). Service members who met PTSD criteria reported more disturbed sleep (p = 0.003) and greater difficulties with work and social adjustment (p = 0.004) than those who did not meet PTSD criteria. However, functionality measures were not significantly associated with PTSD status after controlling for gender and psychiatric comorbidity. Gender and number of psychiatric comorbidities other than PTSD were significant predictors of PTSD in logistic regression models across four functionality measures. Future studies should assess the additive or mediating effect of psychiatric comorbidities in the association between impaired functioning and PTSD. Clinicians are encouraged to assess and address functionality during treatment with suicidal individuals, paying particular attention to individuals with multiple psychiatric diagnoses.
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Suicide remains a significant public health problem for the United States military. Trauma-related diagnoses such as acute stress disorder (ASD) or posttraumatic stress disorder (PTSD) may exacerbate suicide risk, particularly among service members psychiatrically hospitalized following suicide-related events. To date, treatments to address suicide risk and trauma symptomatology among service members within inpatient milieus have been nonexistent. To address this gap, a randomized controlled pilot trial of Post-Admission Cognitive Therapy (PACT) was conducted to evaluate a targeted cognitive-behavioral program among traumatized military personnel (N = 36) hospitalized following a recent suicide attempt. All participants met criteria for ASD or PTSD and were randomly assigned to receive either PACT and enhanced usual care (PACT + EUC) or EUC alone. PACT consisted of six 60- to 90-min individual psychotherapy sessions, adapted from Brown et al.'s (2005) cognitive therapy protocol for suicide prevention. Blinded follow-up assessments were conducted at 1-, 2-, and 3-months postpsychiatric discharge. The primary outcome was days until repeat suicide attempt. Secondary outcomes included depression, hopelessness, suicide ideation, and PTSD symptoms. Participants did not significantly differ in reattempt status. However, based on reliable change index analyses, a greater proportion of PACT + EUC versus EUC participants met criteria for clinically significant change on measures of depression (100% vs. 78%), hopelessness (83% vs. 57%), and PTSD symptom severity (100% vs. 38%), but not for suicide ideation (60% vs. 67%). PACT is an innovative inpatient protocol, currently under evaluation in a well-powered multisite RCT for its efficacy in reducing subsequent suicidal behaviors. (PsycINFO Database Record
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Terapia Cognitivo-Conductual , Pacientes Internos/psicología , Personal Militar/psicología , Prevención del Suicidio , Adulto , Femenino , Humanos , Masculino , Proyectos Piloto , Ideación Suicida , Suicidio/psicología , Intento de Suicidio/psicología , Resultado del Tratamiento , Adulto JovenRESUMEN
Individuals with multiple suicide attempts have a greater risk for eventual suicide death. We investigated clinical differences in participants with single versus multiple suicide attempts. Individuals with multiple attempts were more likely to have severe depressive symptoms, drug use disorder, and a higher wish to die. Borderline personality disorder traits and drug use disorder were significant predictors of multiple attempts when adjusting for other psychiatric disorders. Participants with multiple attempts sustained higher suicidal ideation-worst and wish to die/wish to live-worst scores during the 3-month assessment period. Clinical differences between individuals with multiple versus single attempts point to the need of tailored suicide prevention efforts.
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Terapia Cognitivo-Conductual , Trastornos Mentales/terapia , Personal Militar/psicología , Intento de Suicidio/psicología , Femenino , Humanos , Masculino , Trastornos Mentales/psicología , Resultado del TratamientoRESUMEN
OBJECTIVE: Suicide among United States service members is a significant public health concern. Intimate partner relationship stress may contribute to suicide risk, as a failed or failing relationship is the most commonly documented stressor preceding military suicide attempts and deaths. However, little is known about the manner by which relationship stressors are associated with the experience of military suicidality. METHODS: A sample of 190 psychiatrically hospitalized military personnel and adult dependents enrolled in an ongoing randomized controlled trial evaluating the efficacy of an inpatient cognitive behavioral treatment for suicidality were included in this study. Analyses examined depression, hopelessness, and suicidality among participants with (nâ¯=â¯105) and without (nâ¯=â¯85) self-reported romantic relationship stress. RESULTS: Over half (55%) of the sample reported current romantic relationship stress. Compared to participants without current romantic relationship stress, results indicated that individuals reporting current romantic relationship stress were more hopeless (AORâ¯=â¯1.07 (95% CI: 1.01-1.12), pâ¯=â¯0.020), more likely to endorse multiple suicide attempts (AORâ¯=â¯1.96 (95% CI: 1.01-3.79), pâ¯=â¯0.046), had higher overall suicide risk (AORâ¯=â¯2.49, (95% CI: 1.03-6.06), pâ¯=â¯0.044), and were more likely to report that the reason for their suicidality was at least in part to get a reaction from others. CONCLUSIONS: Findings suggest romantic relationship stress is associated with greater suicide risk, and have clinical implications for suicide prevention and intervention. Future research may examine mechanisms and pathways between romantic relationship stress, suicidality, and prevention and intervention strategies.
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Hospitales Psiquiátricos , Relaciones Interpersonales , Personal Militar/psicología , Parejas Sexuales/psicología , Estrés Psicológico/psicología , Intento de Suicidio/psicología , Adulto , Terapia Cognitivo-Conductual/métodos , Femenino , Hospitales Psiquiátricos/tendencias , Humanos , Pacientes Internos/psicología , Masculino , Persona de Mediana Edad , Autoinforme , Estrés Psicológico/epidemiología , Estrés Psicológico/prevención & control , Suicidio/psicología , Suicidio/tendencias , Intento de Suicidio/prevención & control , Intento de Suicidio/tendencias , Estados Unidos/epidemiología , Violencia/psicología , Prevención del SuicidioRESUMEN
Service members (SM) are at increased risk of psychiatric conditions, including suicide, yet research indicates SMs believe seeking mental health treatment may negatively impact their military careers, despite a paucity of research examining actual career impacts. This study examined the link between seeking outpatient mental health (MH) treatment and military career impacts within the United States Marine Corps. In Phase 1, a retrospective medical record review of outpatient MH treatment-seeking Marines (N = 38) was conducted. In Phase 2, a sample of outpatient MH treatment-seeking Marines (N = 40) was matched to a non-treatment-seeking sample of Marines (N = 138) to compare career-progression. In Phase 1, there were no significant links between demographic, military, and clinical characteristics and referral source or receipt of career-affecting treatment recommendations. In Phase 2, MH treatment-seeking Marines in outpatient settings were more likely than matched controls to be separated from the military (95.0% versus 63.0%, p = 0.002), but no more likely to experience involuntary separation. MH treatment-seeking Marines were more likely to have documented legal action (45.0% versus 23.9%, p = 0.008) and had a shorter time of military service following the index MH encounter than matched controls (p < 0.001). Clinical, anti-stigma, and suicide prevention policy implications are discussed.