Predictors of Suicide Attempt Within 30 Days After First Medically Documented Suicidal Ideation in U.S. Army Soldiers.

OBJECTIVE: The authors sought to identify predictors of imminent suicide attempt (within 30 days) among U.S. Army soldiers following their first documented suicidal ideation. METHODS: Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers, the authors identified 11,178 active-duty Regular Army enlisted soldiers (2006-2009) with medically documented suicidal ideation and no prior medically documented suicide attempts. The authors examined risk factors for suicide attempt within 30 days of first suicidal ideation using logistic regression analyses, including sociodemographic and service-related characteristics, psychiatric diagnoses, physical health care visits, injuries, and history of family violence or crime perpetration or victimization. RESULTS: Among soldiers with first documented suicidal ideation, 830 (7.4%) attempted suicide, 46.3% of whom (N=387) attempted suicide within 30 days (rate, 35.4 per 1,000 soldiers). Following a series of multivariate analyses, the final model identified females (odds ratio=1.3, 95% CI=1.0, 1.8), combat medics (odds ratio=1.6, 95% CI=1.1, 2.2), individuals with an anxiety disorder diagnosis prior to suicidal ideation (odds ratio=1.3, 95% CI=1.0, 1.6), and those who received a sleep disorder diagnosis on the same day as the recorded suicidal ideation (odds ratio=2.3, 95% CI=1.1, 4.6) as being more likely to attempt suicide within 30 days. Black soldiers (odds ratio=0.6, 95% CI=0.4, 0.9) and those who received an anxiety disorder diagnosis on the same day as suicidal ideation (odds ratio=0.7, 95% CI=0.5, 0.9) were less likely. CONCLUSIONS: Suicide attempt risk is highest in the first 30 days following ideation diagnosis and is more likely among women, combat medics, and soldiers with an anxiety disorder diagnosis before suicidal ideation and a same-day sleep disorder diagnosis. Black soldiers and those with a same-day anxiety disorder diagnosis were at decreased risk. These factors may help identify soldiers at imminent risk of suicide attempt.

Development of a Tool to Predict Risk of Behavioral Health Evacuation From Combat.

In the present study, we examined administrative data on 667,437 deployments of at least 30 days duration to Iraq and Afghanistan from 2011 through the end of 2016 to determine risk factors for evacuation from the combat zone for behavioral health reasons. Demographic data, military-specific data, responses on predeployment mental health assessments, and presence of previous treatment for psychiatric conditions were entered into a logistic regression based on expert determination, distinguishing the 2,133 behavioral health evacuations from those deployments that either did not end in evacuation or included evacuations for reasons other than behavioral health. The model, derived from a random half of the sample (training set), was verified on the other half (validation set). Predictor variables used in the model were calendar year; gender; age; rank; marital status; parental status; number of prior war zone deployments; branch of service; screens for symptoms of posttraumatic stress disorder, depression, and hazardous alcohol use on the predeployment mental health assessment; and prior substance- and non-substance-related behavioral health diagnoses. Odds ratios (range: 1.05-3.85) for selected variables that contributed to the model were used to assign risk scores in the Behavioral Health Evacuation Risk Tool, which can aid predicting which service members are more likely to be evacuated from combat for behavioral health reasons, thus indicating where resources can be allocated for behavioral health referrals and war zone care.

The diathesis-stress model in the emergence of major psychiatric disorders during military service.

Existing evidence and the diathesis-stress model hypothesis suggest that stress as an environmental factor may trigger the onset of psychiatric disorders, such as psychosis spectrum disorders, mood disorders, anxiety disorders, in people with an underlying vulnerability. The purpose of this study was to determine the period of time during military service at which symptomatology of clinical significance is more often developed, considering that stress of service and adaptation to its requirements is common to all army recruits. A retrospective file study for the years 2017-2018 was conducted in order to identify male soldiers who were hospitalized in the psychiatric clinic of 414 Athens Military hospital and diagnosed as F20-29, F30-39 and F40-48 according to ICD-10. The number of hospitalizations per clinical diagnosis and the time of onset relatively to the month of military service were examined. A total of 139 cases were screened, 119 of which had disorders falling into the diagnostic categories F20-29, F30-39 and F40-48. 53% of total hospitalizations took place within the first two months of a nine-month military service. It was found that the risk of disorder onset within the first two months of military service was statistically higher (OR=0.210, p=0.001) for a schizophrenic spectrum disorder (F20-29) compared to F30-39 and F40-48 disorders. After adjusting for potential confounders, such as heritability for psychiatric disorders, urbanicity, history of substance use or age, the risk for hospitalization within the first two months continued to be significantly predicted by F20-29 disorder (OR=0.255, p=0.022) compared to other diagnoses. Individuals vulnerable in developing a psychotic disorder appear to have lower stress tolerance and may manifest an earlier disease onset, when exposed to the stress of military service compared to subjects predisposed to develop mood or anxiety disorders. Stress during military service is of major importance for the emergence of the whole psychopathology spectrum, particularly in vulnerable individuals. The development of prevention and early intervention strategies is considered to be of particular importance to conscripts. The findings of the present study are in agreement with the diathesis-stress model and moreover suggest that people who subsequently develop a psychotic spectrum disorder have greater vulnerability to stress exposure.

Hippocampal gray matter increases following multimodal psychological treatment for combat-related post-traumatic stress disorder.

Introduction: Smaller hippocampal volumes are one of the most consistent findings in neuroimaging studies of post-traumatic stress disorder (PTSD). However, very few prospective studies have assessed changes in hippocampal gray matter prior to and following therapy for PTSD, and no neuroimaging studies to date have longitudinally assessed military populations. Methods: A pilot study was conducted, assessing patients with combat-related PTSD with structural MRI. Participants were then assigned either to a treatment group or waiting-list control group. After the treatment group received multimodal psychological therapy for approximately 6 weeks, both groups completed a second neuroimaging assessment. Results: Region-of-interest analysis was used to measure gray matter volume in the hippocampus and amygdala. There was a group by time interaction; the therapy group (n = 6) showed a significant increase in hippocampal volume and a nonsignificant trend toward an increase in amygdala volume following therapy, while no change was observed in the waiting-list group (n = 9). Conclusions: This study provides initial evidence for increases in gray matter volume in the hippocampus in response to therapy for combat-related PTSD.

What's Changed? A Comparison of Army Suicide Surveillance Data to Cases from 1975 to 1982.

US Army suicide rates increased significantly in the last decade and have remained high. To inform future research hypotheses, Army suicide surveillance data (2012-2014) were compared to similar Army data for suicides from 1975 to 1982. Preliminary data suggest that suicide rates increased across most demographic groups, but may have decreased among divorced soldiers. Mental health utilization increased over time. Legal problems and physical health problems were identified in a higher percentage of cases in the recent data relative to the 1975-1982 era. Potential implications for suicide prevention are discussed.

[Modern state and prospects of development of medical-and-psychological support of military servicemen of the Armed Forces of the Russian Federation].

The authors analysed state and prospects of medical-and-psychological support of military servicemen, which is supposed to consider as a complex of measures aimed at monitoring of professional psychological health, professional-and-psychological expertise, psychophysiological and pharmacological, correction, and medical-and-psychological rehabilitation. Organisation and maintaince of the above mentioned measures should be carried out by specialists of medical--and-psychological support groups and medical-and-psychological correction.

Components and Characteristics of a Psychiatric Partial Hospital Military Program.

This article describes the components of a psychiatric partial hospital military program and the characteristics of referrals received over the 5-year period from 2009 to 2013. The 5-year study period included ongoing combat operations in Iraq and Afghanistan along with their subsequent troop withdrawals and change in mission. A total of 1,194 service members were referred for this level of care, and even with the changing battlefield conditions, the number of psychiatric referrals remained steady throughout the 5-year period, with a significant spike in admissions in 2013. The principal diagnoses were major depressive disorder and post-traumatic stress disorder. One-third of the admissions came from service members with 4 to 8 years' time in service and slightly more than one-third were employed in direct combat roles or medical support. In terms of gender, females accounted for one-quarter of the admissions.

Accelerated resolution therapy: an innovative mental health intervention to treat post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is a disabling trauma and stress-related disorder that may occur after a person experiences a traumatic event, and evokes a combination of intrusion and avoidance symptoms, negative alterations in cognitions and mood, and alterations in arousal and reactivity. Accelerated resolution therapy (ART) is an emerging psychotherapy that provides fast and lasting resolution for mental health problems such as PTSD. ART has been shown to achieve a positive result in one to five sessions, typically over a 2-week period, and requires no homework, skills practice or repeated exposure to targeted events. Initial research, including one randomised control trial, has demonstrated that ART interventions can significantly reduce symptoms of psychological trauma in both civilians and US service members and veterans. These results suggest that ART be considered as either a primary treatment option or for refractory PTSD in those with a suboptimal response to endorsed first-line therapies. Conservative estimates indicate substantial potential cost savings in PTSD treatment. Despite the need for more definitive clinical trials, there is increasing interest in ART in the USA, including in the US Army. The growing positive empirical evidence is compelling, and there appears to be sufficient evidence to warrant UK researchers undertaking ART research. The armed forces offer the potential for comparative international trials. However, equally important are veterans, emergency services personnel and those subjected to violence. ART appears to also have application in other conditions, including depression, anxiety disorders, and alcohol or drug misuse. ART can potentially help personnel traumatised by the unique challenges of war and conflict zones by providing brief psychotherapy in a readily accessible and culturally competent manner. ART facilitates the provision of interventions and resolutions in theatre, thus enhancing forces' fighting capability.

"The role of different stigma perceptions in treatment seeking and dropout among active duty military personnel": Correction to Britt et al. (2015).

UNLABELLED: Reports an error in "The role of different stigma perceptions in treatment seeking and dropout among active duty military personnel" by Thomas W. Britt, Kristen S. Jennings, Janelle H. Cheung, Cynthia L. S. Pury and Heidi M. Zinzow (Psychiatric Rehabilitation Journal, 2015[Jun], Vol 38[2], 142-149). Six participants were included in the sample for the treatment-seeking analyses who scored 50 or above on the PTSD Checklist, but did not meet the specific criteria on the three PTSD subscales. Of these six participants, four screened positive for another problem. Removing the two participants who did not screen positive for another problem did not affect the significance of any of the predictors in the analyses. (The following abstract of the original article appeared in record 2015-12033-001.) OBJECTIVE: Many military personnel with mental health problems do not seek treatment from mental health professionals, and if they do seek treatment, they drop out of treatment before receiving the recommended number of sessions. The present study examined the role of 4 different stigma perceptions on these outcomes: perceived stigma to career, perceived stigma of differential treatment, self-stigma from seeking treatment, and stigmatizing perceptions of soldiers who seek treatment. METHOD: One thousand three hundred twenty-four active duty soldiers completed a self-report survey assessment that included measures of the 4 different stigma perceptions, indices of mental health symptoms, receipt of mental health treatment, and whether they had dropped out of treatment before it was completed. RESULTS: Participants screening positive for a mental health problem reported higher scores on all 4 stigma perceptions. All 4 stigma perceptions were each associated with a reduced likelihood of treatment seeking when considered individually, but only stigmatizing beliefs about those who seek treatment were uniquely associated with treatment seeking. Perceived stigma for one's career and differential treatment from others, along with self-stigma from treatment seeking, were associated with an increased probability of dropping out of mental health treatment. Self-stigma from treatment seeking was the only unique predictor of dropout. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Different stigma perceptions were associated with treatment seeking and dropout. Further longitudinal research is needed to examine how stigma perceptions influence these important outcomes. Practitioners need to be aware of how different stigma perceptions can influence treatment seeking and potentially target stigma perceptions during treatment to prevent dropout.

[Prospects of IT usage in the field of military psychiatry].

Development of effective information support for monitoring of internal health, based on the principles of complex diagnostics, provides the necessary tools objektive evaluation and prediction of mental health in servicemen. Effectiveness of psychiatric prophylaxys technologies depends on compliance with a number of fundamental principles, the main of which should be considered as a multidimensional assessment of mental health in servicemen and real cooperation of different specialists (commanders, specialists of medical and psychological service) for its implementation. In this case, an introduction of information and communication technologies on the basis of the district (fleet) and the Central Military Hospital, as well as other bodies of military control will be almost justified only when creating a full-fledged "information field of military psychiatry" that implements the basic principles of the monitoring system of mental health and includes necessary infrastructure. The practical implementation of this system will allow to personjfyfy medical and psychological assistance to military personnel, to improve early diagnosis of mental disorders, addictive .and suicidal behaviour, and thus increase the effectiveness throughout psychiatric prophylaxis in the army.

The Psychiatrist as Leader-Teacher: Promoting Learning Beyond Residency.

In today's fast-paced, data-saturated, zero-tolerance practice environment, psychiatrists and other health care providers are expected to maintain clinical, fiscal, and administrative competence. The authors present a unique type of psychiatric leader­the leader-teacher­who incorporates teaching of these elements into day-to-day practice, enhancing lifelong learning for credentialed staff and increasing their confidence in managing complex clinical and administrative issues. Particular emphasis is placed on leader-teachers working in military environments. The article discusses the primary characteristics of this type of leader, including their tendency to (1) seek clarification, (2) distill information, (3) communicate guidance, and (4) catalogue products. The authors also address the advantages and disadvantages of being a leader-teacher and present several illustrative cases.

Characteristics of soldiers with self-harm in the israeli defense forces.

Suicide is the leading cause of soldier death in the Israeli Defense Forces (IDF) in peace time. Suicide attempt (SA) and non-suicidal self-injury (NSSI) are risk factors for death by suicide in civilian studies and therefore their predictive value needs to be determined in the military. All army screening, psychometric and demographic data on consecutive cases of IDF soldier self-harm during the years 2010-2011 were analyzed. The Columbia Suicide Severity Rating Scale was used retrospectively to classify self-harm as suicidal or NSSI. The Suicide Ideation Scale and the Suicide Intent Scale were scored retrospectively by trained clinical psychologists. A total of 107 soldiers reported self-harm during the study period, comprising 70 SA and 37 with NSSI. The most prevalent diagnosis was personality disorder (n = 48). Soldiers with any mood/anxiety disorders comprised the smallest group (n = 21) and included major depression, dysthymia, anxiety, and posttraumatic stress disorder. Soldiers with NSSI (n = 37) did not differ in any of the characteristics from those who attempted suicide (n = 70). Unlike the well-known female dominance in both SA and NSSI patients in other settings, males dominated this army sample in both groups. Soldiers with self-harm (both SA and NSSI) cannot be easily distinguished by any demographics or specific psychological attributes detectable at induction, and the scales used in suicide research cannot predict an attempt or NSSI. Unlike civilian samples, males dominated attempter and NSSI groups and the reason for this may be multifactorial. These retrospective findings, if replicated, indicate the need for different screening strategies at induction into the military.

[Psychology and psychopathology of information warfare].

Tension of information warfare as a form of modern war has a global character nowadays. Topicality of research of psychological reaction peculiarities and psychopathology phenomena developing during information warfare is determined by necessity of scientific development of the effective means of diagnosis and prophylaxis of these phenomena. The article is devoted to analytical review of modern articles about aim, goals and methods of information warfare, covering some signs of manipulative influence on people's mind. Authors set forward opinion about possible psychological peculiarities and psychopathological consequences of targeted aggressive information influence and also suggest some methods against this influence.

Timing of mental health treatment and PTSD Symptom improvement among Iraq and Afghanistan veterans.

OBJECTIVE: This study examined demographic, military, temporal, and logistic variables associated with improvement of posttraumatic stress disorder (PTSD) among Iraq and Afghanistan veterans who received mental health outpatient treatment from the U.S. Department of Veterans Affairs (VA) health care system. The authors sought to determine whether time between last deployment and initiating mental health treatment was associated with a lack of improvement in PTSD symptoms. METHODS: The authors conducted a retrospective analysis of existing medical records of Iraq and Afghanistan veterans who enrolled in VA health care, received a postdeployment PTSD diagnosis, and initiated treatment for one or more mental health problems between October 1, 2007, and December 31, 2011, and whose records contained results of PTSD screening at the start of treatment and approximately one year later (N=39,690). RESULTS: At the start of treatment, 75% of veterans diagnosed as having PTSD had a positive PTSD screen. At follow-up, 27% of those with a positive screen at baseline had improved, and 43% of those with a negative screen at baseline remained negative. A negative PTSD screen at follow-up was associated with female gender, older age, white race, having never married, officer rank, non-Army service, closer proximity to the nearest VA facility, and earlier initiation of treatment after the end of the last deployment. CONCLUSIONS: Interventions to reduce delays in initiating mental health treatment may improve veterans' treatment response. Further studies are needed to test interventions for particular veteran subgroups who were less likely than others to improve with treatment.

Telebehavioral health in Afghanistan.

Providing behavioral health care to numerous beneficiaries spread over a large and dangerous area is a unique and challenging responsibility faced by the U.S. Army in the deployed environment. We describe the use of telebehavioral health as one tool available to behavioral health officers in Afghanistan to reach remote service members when face-to-face encounters are not possible or practical. Finally, challenges to the current telebehavioral system established during Operation Enduring Freedom are discussed, with recommendations made for implementation in future deployed settings.

La formación del psiquiatra militar en el contexto de la guerra contemporánea / Training of military psychiatrists for contemporary warfare

Se opina acerca de las características de las acciones del psiquiatra militar en casos de desastres y guerras. Teniendo en cuenta las características y preparación que demandan estas situaciones excepcionales, el psiquiatra militar debe estar dotado de una preparación, que le permita atender en breve tiempo, gran cantidad de pacientes. Esta base, no está en los currículos de preparación de tiempo de paz, lo cual establece una necesidad, de forma que se empleen los escenarios de desastres, naturales o no, a fin de obtener el entrenamiento necesario para alcanzar las habilidades(AU)

An analysis is provided of the characteristics of military psychiatry actions in disaster and war situations. Considering the features of these exceptional situations and the preparation they require, the military psychiatrist should be trained to attend to a large number of patients in a short time. Since such training is not included in peace time curricula, it is necessary to take advantage of disaster scenarios, either natural or not, to develop those abilities(AU)

La formación del psiquiatra militar en el contexto de la guerra contemporánea / Training of military psychiatrists for contemporary warfare

Se opina acerca de las características de las acciones del psiquiatra militar en casos de desastres y guerras. Teniendo en cuenta las características y preparación que demandan estas situaciones excepcionales, el psiquiatra militar debe estar dotado de una preparación, que le permita atender en breve tiempo, gran cantidad de pacientes. Esta base, no está en los currículos de preparación de tiempo de paz, lo cual establece una necesidad, de forma que se empleen los escenarios de desastres, naturales o no, a fin de obtener el entrenamiento necesario para alcanzar las habilidades.

An analysis is provided of the characteristics of military psychiatry actions in disaster and war situations. Considering the features of these exceptional situations and the preparation they require, the military psychiatrist should be trained to attend to a large number of patients in a short time. Since such training is not included in peace time curricula, it is necessary to take advantage of disaster scenarios, either natural or not, to develop those abilities.

A pilot study of an enhanced mental health assessment during routine and discharge medicals in the British Armed Forces.

OBJECTIVES: A pilot study to assess the practicality of introducing an enhanced mental health assessment (EMHA) into all routine and discharge medicals of the UK Armed Forces in order to facilitate treatment prior to and on return to civilian life. METHODS: A pilot study was conducted using an EMHA questionnaire with questions about depression, anxiety, post-traumatic stress disorder, alcohol use, sleep and anger/irritability. At pilot sites, the EMHA was completed during all routine and discharge medicals between May 2011 and July 2011. At the end of the study period, qualitative data were collected from participating medical officers and practice managers regarding their opinions about the pilot study. RESULTS: The quantitative data revealed an average pick-up rate for mental health (MH) problems. Out of the four military medical centres who participated and the 325 questionnaires collected, one referral to a Department of Community Mental Health was made. 26 (8%) patients were categorised as 'some concern and patient offered advice and/or reassurance'. The vast majority of patients were found to have no evidence of MH problems. However, using a validated alcohol screening tool, 64% of service personnel were found to have a score indicating 'higher risk drinking'. Analysis of the qualitative data suggests that the EMHA is an easy tool to implement with minimal additional time and resources needed. The interviewees pointed out a number of limitations and suggestions for possible further studies. CONCLUSIONS: The pilot study successfully demonstrated that the EMHA questionnaire is easy to administer, does not take up a large amount of additional resources or manpower and provides a useful check of MH status. The study picked up an average number of MH cases and the questions on alcohol consumption highlighted that military personnel may be at a 'higher risk of drinking'.