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Fijtman A, Clausen A, Kauer-Sant'Anna M, Morey R. Trauma history in veterans with bipolar disorder and its impact on suicidality. J Psychiatr Res 2023; 157:119-126. [PMID: 36463626 DOI: 10.1016/j.jpsychires.2022.10.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/22/2022] [Accepted: 10/28/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES Veterans are at increased risk for exposure to trauma, developing serious mental illnesses, and death by suicide. History of trauma correlates with worsening outcomes in patients with bipolar disorder. This study investigated associations between trauma exposure (type and timing) and suicide attempt in Veterans with bipolar disorder. METHODS One hundred six Veterans with a diagnosis of bipolar disorder and 815 Veterans with no psychiatric history (age rage = 20-72 years old) completed a clinical questionnaire, the Beck Scale for Suicide Ideation, and the Traumatic Live Events Questionnaire. Multinomial logistic regressions investigated correlations between diagnosis, time of trauma (before, during, or after the military), trauma type (attack, illness, accident, child violence, child sexual abuse, and adult sexual abuse), and suicide attempt. RESULTS Seventy-five Veterans with bipolar disorder had comorbid PTSD. Controlling for PTSD, Veterans with bipolar disorder had a higher prevalence of trauma including physical assault [odds ratio (OR) = 2.85; 95% confidence interval (CI) = 1.39-5.86] and child sexual trauma (OR = 2.89; CI = 1.38-6.05). Veterans with bipolar disorder who endorsed previous suicide attempts (n = 42) had significantly higher levels of exposure to childhood trauma (OR = 5.69; CI = 1.84-17.62). CONCLUSIONS Results support incorporating history of previous trauma exposure when assessing Veterans at risk for bipolar disorder. Especially, trauma characterized as attack and childhood sexual abuse. Particular attention should be given to Veterans with bipolar disorder and exposure to trauma during childhood, which may be associated with increased risk of suicidality.
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Affiliation(s)
- Adam Fijtman
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, 3643 N. Roxboro St, Durham, NC, 27704, USA.
| | - Ashley Clausen
- St. Vincent Hospital, Department of Behavioral Health, 2900 12th Ave N, Billings, MT, 59101, USA.
| | - Marcia Kauer-Sant'Anna
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-903, Brazil; Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-002, Brazil.
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- Durham VA Medical Center, 508 Fulton St. Durham, NC. 27705, USA
| | - Rajendra Morey
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, 3643 N. Roxboro St, Durham, NC, 27704, USA; Durham VA Medical Center, 508 Fulton St. Durham, NC. 27705, USA.
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2
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Insomnia and Post-traumatic Stress Disorder: A Meta-analysis on Interrelated Association (n=57,618) and Prevalence (n=573,665). Neurosci Biobehav Rev 2022; 141:104850. [DOI: 10.1016/j.neubiorev.2022.104850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/27/2022] [Accepted: 08/27/2022] [Indexed: 12/14/2022]
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Preskorn SH. Building a Comprehensive Biopsychosocial Database to Identify Underlying Causes of Suicide and Improve Suicide Prevention. J Psychiatr Pract 2022; 28:391-395. [PMID: 36074108 DOI: 10.1097/pra.0000000000000653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In June, 2022, the United States Department of Veterans Affairs (VA) announced an initiative to reduce death due to suicide in US Veterans. This column is based on a proposal written for that initiative, as well as on an earlier psychopharmacology column in this journal that reviewed the statistics and the genetics of suicide, and the US medicolegal death investigation system. This system is composed of 3137 county coroner or medical examiner offices across the country that are responsible under state and local law for investigating deaths that are not explained by natural causes and are suspicious and/or unattended. Thus, this system gathers data concerning all deaths due to suicide. Currently this death investigation system costs US taxpayers ∼$660 million per year, and it has determined that ∼45,000 Americans die from suicide each year. In the conduct of these investigations, a large amount of data is collected, including biological samples. While the demographic data are reported to the Centers for Disease Control (CDC), little-if anything-is done with the collected biological material beyond its use in determining the cause of death of the individual. The earlier column on this topic advocated for the establishment of a central database to retain and utilize this information to further understand the biopsychosocial causes of suicide, with the goal of preventing suicides. This column describes a proposal submitted to the VA system for how such a system could initially be piloted in a small group of VA medical centers and then expanded to the entire system. This initial effort could then, in turn, serve as a model for expanding such data gathering to the entire US medicolegal death investigation system.
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Joseph JS, Smith-MacDonald L, Filice MC, Smith MS. Reculturation: A new perspective on military-civilian transition stress. MILITARY PSYCHOLOGY 2022; 35:193-203. [PMID: 37133548 DOI: 10.1080/08995605.2022.2094175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Various forms of assistance are offered to help US Veterans achieve success in their post-military lives in recognition of their service. Despite the many successes, a significant number of Veterans continue to remain at risk for negative mental health outcomes, including suicidality and low levels of life satisfaction. These findings may be due to challenges arising from cultural identity dissonance. Problematic strategies used by Veterans to reduce this dissonance can result in a lack of belongingness, a key component in Joiner's Interpersonal Theory of Suicide. The authors suggest that research on the immigrant experience of acculturation may provide a new perspective to better understand issues of identity and sense of belonging in Veterans. Given that most Veterans return to the culture in which they grew up, the authors offer the term "reculturation." The authors propose clinical psychology focus on exploring the reculturation process of Veterans to support program engagement and suicide prevention.
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Affiliation(s)
- Jeremy S. Joseph
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Lorraine Smith-MacDonald
- Heroes in Mind, Advocacy and Research Consortium Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Meg C. Filice
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA
| | - Matthew S. Smith
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA
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Liu Y, Wang R, Chang R, Wang H, Xu L, Xu C, Yu X, Liu S, Chen H, Chen Y, Jin L, Wang Y, Cai Y. Perceived Burdensomeness, Thwarted Belongingness, and Social Exclusion in Transgender Women: Psychometric Properties of the Interpersonal Needs Questionnaire. Front Psychol 2022; 13:787809. [PMID: 35222188 PMCID: PMC8868044 DOI: 10.3389/fpsyg.2022.787809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022] Open
Abstract
Transgender women (TGW) experience serious psychiatric problems and high suicide rates. According to the interpersonal theory of suicide, thwarted belongingness and perceived burdensomeness play major roles in suicidality and can be measured by the Interpersonal Needs Questionnaire (INQ). However, no study has validated the use of the INQ in TGW. This study aimed to examine the psychometric properties of the INQ among TGW. We recruited 198 TGW (mean age 38.47 years) from Shenyang, China, using snowball sampling. The construct validity of the INQ was assessed through factor analysis, and convergent and divergent validity were examined through a structural equation model with other psychosocial factors. The construct validation analysis supported a three-factor model (perceived burdensomeness, thwarted belongingness, and social exclusion) with satisfactory fit indices: χ2/df = 1.54, RMSEA = 0.052, CFI = 0.931, TLI = 0.916, SRMR = 0.053. The thwarted belongingness was significantly associated with self-esteem and social support, and the social exclusion was significantly associated with loneliness, depression, entrapment, and defeat, suggesting satisfactory convergent and divergent validity for the three-factor model. The present findings indicate that for TGW, high social exclusion is important in assessing perceived interpersonal needs, while the notable deviation from previous two-factor model warrants further study.
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Affiliation(s)
- Yujie Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongxi Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruijie Chang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huwen Wang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong, China
| | - Lulu Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyue Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shangbin Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingjie Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lian Jin
- Ban Song Yuan Road Community Health Service Centre, Shanghai, China
| | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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6
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Martin CE, Pukay-Martin ND, Blain RC, Dutton-Cox C, Chard KM. Suicidal Ideation in a Veterans Affairs Residential Posttraumatic Stress Disorder Treatment Setting: The Roles of Thwarted Belongingness and Perceived Burdensomeness. J Trauma Stress 2021; 34:1188-1198. [PMID: 32598548 DOI: 10.1002/jts.22540] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 01/13/2020] [Accepted: 01/17/2020] [Indexed: 11/08/2022]
Abstract
Suicide is a significant public health concern, and, specifically, the veteran population has exhibited a 22% higher risk of death by suicide than the general population (Department of Veterans Affairs, 2017). The interpersonal psychological theory of suicide (IPTS; Joiner, 2005) appears to be the most widely researched theory to examine factors associated with suicidal ideation. The IPTS applies to veteran suicidal ideation in that veterans may feel they are burdensome to others or that they do not belong following their transition from active duty. The current study sought to (a) identify the prevalence and correlates of the IPTS constructs perceived burdensomeness and thwarted belongingness; (b) examine the main and interactive effects of these constructs on suicidal ideation; and (c) examine their indirect effects in the associations between posttraumatic stress disorder (PTSD) symptomatology, depressive symptomatology, and substance use with suicidal ideation in a sample of veterans in PTSD residential treatment (N = 125). Regression results demonstrated that perceived burdensomeness was significantly associated with suicidal ideation, β = .50, p < .001; however, thwarted belongingness and the interaction of the two were not. In the models of indirect effects, perceived burdensomeness emerged as the only significant indirect effect in the association between PTSD symptomatology and suicidal ideation, β = .01 (SE = .00), 95% CI [.0050, .0149], as well as between depressive symptomatology and suicidal ideation, β = .02 (SE = .01), 95% CI [.0109, .0311]. Study limitations and future directions are also discussed.
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Affiliation(s)
- Colleen E Martin
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA
| | | | - Rachel C Blain
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA
| | | | - Kathleen M Chard
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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7
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Blain RC, Pukay-Martin ND, Martin CE, Dutton-Cox CE, Chard KM. Residential Cognitive Processing Therapy Decreases Suicidality by Reducing Perceived Burdensomeness in Veterans with Posttraumatic Stress Disorder. J Trauma Stress 2021; 34:1199-1208. [PMID: 33128808 DOI: 10.1002/jts.22618] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/15/2020] [Accepted: 09/13/2020] [Indexed: 12/21/2022]
Abstract
The interpersonal theory of suicide (Joiner, 2005) may help explain high suicide rates among veterans with posttraumatic stress disorder (PTSD). It suggests that suicidal ideation results from believing that one is a burden on others (i.e., perceived burdensomeness) and does not belong among family, friends, or other social groups (i.e., thwarted belongingness). Evidence-based PTSD treatments, including cognitive processing therapy (CPT), decrease suicidal ideation, potentially through changes in these two theory constructs. The current study examined whether (a) changes in PTSD severity and suicidal ideation and (b) changes in negative cognitions about self and suicidal ideation were indirectly associated through changes in perceived burdensomeness and thwarted belongingness across PTSD treatment. Participants (N = 107) were veterans in a residential treatment program who were diagnosed with full or subthreshold PTSD and received CPT. Changes in PTSD symptom severity and negative cognitions about self predicted changes in suicidal ideation, B = 0.18, p < .001 and B = 0.50, p < .001, respectively. Changes in PTSD symptom severity and negative cognitions about self were indirectly associated with suicidal ideation through changes in perceived burdensomeness, B = 0.16, 95% CI [0.07, 0.25]; B = 0.27, 95% CI [0.05, 0.50], but not thwarted belongingness, B = -0.002; 95% CI [-0.06, 0.06]; B = 0.06, 95% CI [-0.12, 0.21] in separate models. These findings suggest that residential CPT may be uniquely equipped to decrease suicidality by restructuring negative beliefs, including perceptions of being a burden on others, and/or by alleviating the objective burden of PTSD.
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Affiliation(s)
- Rachel C Blain
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA
| | | | - Colleen E Martin
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA
| | | | - Kathleen M Chard
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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8
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Crasta D, Spears AP, Sullivan SR, Britton PC, Goodman M. Better off with you: Exploring congruity between caregivers’ and Veterans’ experience of efforts to cope with suicide. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1959222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Dev Crasta
- Department of Veterans Affairs, VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Angela Page Spears
- Department of Veterans Affairs, VISN 2 Mental Illness Research, Education, & Clinical Center, Bronx, New York, USA
| | - Sarah R. Sullivan
- Department of Veterans Affairs, VISN 2 Mental Illness Research, Education, & Clinical Center, Bronx, New York, USA
| | - Peter C. Britton
- Department of Veterans Affairs, VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Marianne Goodman
- Department of Veterans Affairs, VISN 2 Mental Illness Research, Education, & Clinical Center, Bronx, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
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9
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O'Connor SS, McClay MM, Powers J, Rotterman E, Comtois KA, Ellen Wilson J, Nicolson SE. Measuring the impact of suicide attempt posttraumatic stress. Suicide Life Threat Behav 2021; 51:641-645. [PMID: 33870540 DOI: 10.1111/sltb.12733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the associations between posttraumatic stress symptoms (PTS) following a medically serious suicide attempt with suicidal ideation, related interpersonal constructs, and outpatient mental health service utilization. METHODS The study utilized an existing data set from a clinical trial consisting of 66 patients recruited at a level 1 trauma center following medical admission for a suicide attempt. Measures of suicide attempt-related PTS (SA-PTS), suicidal ideation, perceived burdensomeness, thwarted belongingness, and outpatient medical and mental health utilization were completed at 1 and 3 months. A series of mixed-effects regression models were used to analyze the data. RESULTS Greater SA-PTS at 1 month was associated with significantly greater suicidal ideation, thwarted belongingness, and perceived burdensomeness across 1 and 3 months. CONCLUSIONS Addressing PTS following a medically serious suicide attempt may aid in addressing suicide-specific constructs and improve the recovery trajectory following hospitalization.
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10
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Foster A, Alderman M, Safin D, Aponte X, McCoy K, Caughey M, Galynker I. Teaching Suicide Risk Assessment: Spotlight on the Therapeutic Relationship. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:257-261. [PMID: 33786778 DOI: 10.1007/s40596-021-01421-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
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Martin RL, Bauer BW, Smith NS, Daruwala SE, Green BA, Anestis MD, Capron DW. Internal Battles: Examining How Anger/Hostility Moderate the Association Between Negative Urgency and Suicidal Desire Variables in Military and Civilian Samples. Suicide Life Threat Behav 2020; 50:805-822. [PMID: 32026518 DOI: 10.1111/sltb.12616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 01/07/2020] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Rachel L Martin
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Brian W Bauer
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Nicole S Smith
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Samantha E Daruwala
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Bradley A Green
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Michael D Anestis
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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Martin RL, Bauer BW, Ramsey KL, Green BA, Capron DW, Anestis MD. How Distress Tolerance Mediates the Relationship Between Posttraumatic Stress Disorder and the Interpersonal Theory of Suicide Constructs in a U.S. Military Sample. Suicide Life Threat Behav 2019; 49:1318-1331. [PMID: 30368865 DOI: 10.1111/sltb.12523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/26/2018] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Rachel L Martin
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Brian W Bauer
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Kathleen L Ramsey
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Bradley A Green
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Daniel W Capron
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Michael D Anestis
- Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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13
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Morales S, Barros J, Echávarri O, García F, Osses A, Moya C, Maino MP, Fischman R, Núñez C, Szmulewicz T, Tomicic A. Acute Mental Discomfort Associated with Suicide Behavior in a Clinical Sample of Patients with Affective Disorders: Ascertaining Critical Variables Using Artificial Intelligence Tools. Front Psychiatry 2017; 8:7. [PMID: 28210230 PMCID: PMC5289061 DOI: 10.3389/fpsyt.2017.00007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/11/2017] [Indexed: 12/30/2022] Open
Abstract
AIM In efforts to develop reliable methods to detect the likelihood of impending suicidal behaviors, we have proposed the following. OBJECTIVE To gain a deeper understanding of the state of suicide risk by determining the combination of variables that distinguishes between groups with and without suicide risk. METHOD A study involving 707 patients consulting for mental health issues in three health centers in Greater Santiago, Chile. Using 345 variables, an analysis was carried out with artificial intelligence tools, Cross Industry Standard Process for Data Mining processes, and decision tree techniques. The basic algorithm was top-down, and the most suitable division produced by the tree was selected by using the lowest Gini index as a criterion and by looping it until the condition of belonging to the group with suicidal behavior was fulfilled. RESULTS Four trees distinguishing the groups were obtained, of which the elements of one were analyzed in greater detail, since this tree included both clinical and personality variables. This specific tree consists of six nodes without suicide risk and eight nodes with suicide risk (tree decision 01, accuracy 0.674, precision 0.652, recall 0.678, specificity 0.670, F measure 0.665, receiver operating characteristic (ROC) area under the curve (AUC) 73.35%; tree decision 02, accuracy 0.669, precision 0.642, recall 0.694, specificity 0.647, F measure 0.667, ROC AUC 68.91%; tree decision 03, accuracy 0.681, precision 0.675, recall 0.638, specificity 0.721, F measure, 0.656, ROC AUC 65.86%; tree decision 04, accuracy 0.714, precision 0.734, recall 0.628, specificity 0.792, F measure 0.677, ROC AUC 58.85%). CONCLUSION This study defines the interactions among a group of variables associated with suicidal ideation and behavior. By using these variables, it may be possible to create a quick and easy-to-use tool. As such, psychotherapeutic interventions could be designed to mitigate the impact of these variables on the emotional state of individuals, thereby reducing eventual risk of suicide. Such interventions may reinforce psychological well-being, feelings of self-worth, and reasons for living, for each individual in certain groups of patients.
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Affiliation(s)
- Susana Morales
- Facultad de Medicina, Departamento de Psiquiatría, Depression and Suicidality Research Group, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Jorge Barros
- Facultad de Medicina, Departamento de Psiquiatría, Depression and Suicidality Research Group, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Orietta Echávarri
- Facultad de Medicina, Departamento de Psiquiatría, Depression and Suicidality Research Group, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Fabián García
- Independent researcher, Avenida José Manso de Velasco 6968, Santiago, Chile
| | - Alex Osses
- Independent researcher, Isla Darwin 8726, Santiago, Chile
| | - Claudia Moya
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
- School of Nursery, Universidad San Sebastián, Santiago, Chile
| | - María Paz Maino
- Facultad de Medicina, Departamento de Psiquiatría, Depression and Suicidality Research Group, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Ronit Fischman
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Catalina Núñez
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Tita Szmulewicz
- Facultad de Medicina, Departamento de Psiquiatría, Depression and Suicidality Research Group, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Alemka Tomicic
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
- School of Psychology, Universidad Diego Portales, Santiago, Chile
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