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Moceri-Brooks J, Garand L, Sekula LK, Joiner TE. Exploring the use of the Interpersonal Needs Questionnaire to examine suicidal thoughts and behaviors among Post-9/11 U.S. Combat Veterans: An integrative review. MILITARY PSYCHOLOGY 2024; 36:340-352. [PMID: 38661461 PMCID: PMC11057638 DOI: 10.1080/08995605.2023.2178223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 02/01/2023] [Indexed: 03/05/2023]
Abstract
This integrative review expands on the work of Kramer et al. (2020), by reviewing studies that utilized the Interpersonal Needs Questionnaire (INQ) to examine the interpersonal constructs (thwarted belongingness and perceived burdensomeness) of the Interpersonal Theory of Suicide (ITS) to understand suicidal thoughts and behaviors among service members and Veterans with combat experience. Very few studies (n = 9) in the literature were identified, however important relationships were revealed between combat exposure/experiences, thwarted belongingness, perceived burdensomeness, and suicidal thoughts and behaviors among military samples. Studies also reported risk factors for high levels of thwarted belongingness or perceived burdensomeness in military samples, such as moral injuries, betrayal, and aggression. This review highlights the utility of the INQ to measure ITS constructs among Post-9/11 U.S. Combat Veterans.
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Affiliation(s)
| | - Linda Garand
- Duquesne University School of Nursing, Pittsburgh, Pennsylvania
| | | | - Thomas E. Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida
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Primack JM, Thompson MF, Peters A, Quinn M, Kelsey M, Miller IW, Bozzay M. Suicide Characteristics of Veterans Hospitalized for Suicide Ideation or Attempt. Mil Med 2023; 188:e3371-e3376. [PMID: 37294816 DOI: 10.1093/milmed/usad196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/09/2023] [Accepted: 05/17/2023] [Indexed: 06/11/2023] Open
Abstract
INTRODUCTION Veteran suicide rates continue to be unacceptably high, with the most common risk factor being a past suicide attempt (SA). However, some characteristics of suicidal ideation (SI) and behavior among Veterans hospitalized for suicide risk remain under-reported. MATERIALS AND METHODS One hundred and eighty-three Veterans hospitalized for either an SA or SI with intent were screened for enrollment in a treatment study to prevent suicide. Veterans completed a demographic form, the Columbia-Suicide Severity Rating Scale, and the McLean borderline personality disorder screening measure shortly after inpatient psychiatric admission. Chi-squared and t-tests were used to compare suicide characteristics (e.g., intensity, duration, deterrents, and controllability) between Veterans with and without a lifetime history of SA. Thematic analyses of the reported method of SI were conducted. RESULTS Sixty-seven percent of participants were hospitalized for SI and 33% were hospitalized for SA. Twenty-one percent of Veterans hospitalized for SI also endorsed a recent SA in the weeks preceding hospitalization. Most participants reported at least one lifetime SA (71%). Veterans with a lifetime history of SA reported greater frequency and duration of ideation in the week before hospitalization (t[169] = -2.56, P = .01; t[168] = -2.04, P = .04) while also reporting that deterrents were less likely to prevent an SA (t[107.09] = -3.58, P = .001) compared to those with no lifetime SA. CONCLUSION Overall, Veterans hospitalized for SI/SA demonstrated markers of chronic suicide risk, as most participants endorsed a past attempt in their lifetime. Some Veterans admitted for SI also reported a past month's attempt, suggesting that in certain cases, hospitalization does not immediately follow an acute suicidal crisis. A past SA differentiated Veterans on average frequency and duration of SI as well as the perception of deterrents preventing suicidal behavior. Therefore, a thorough evaluation of suicide methods and intensity may be informative in treatment planning for Veterans at greatest risk of suicide.
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Affiliation(s)
- Jennifer M Primack
- Research service, Providence VA Medical Center, Providence, RI 02908, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - Matthew F Thompson
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Aileen Peters
- Research service, Providence VA Medical Center, Providence, RI 02908, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - McKenzie Quinn
- Research service, Providence VA Medical Center, Providence, RI 02908, USA
| | - Madeline Kelsey
- Research service, Providence VA Medical Center, Providence, RI 02908, USA
| | - Ivan W Miller
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - Melanie Bozzay
- Research service, Providence VA Medical Center, Providence, RI 02908, USA
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Wang S, Kennedy SH, Salomons TV, Ceniti AK, McInerney SJ, Bergmans Y, Pizzagalli DA, Farb N, Turecki G, Schweizer TA, Churchill N, Sinyor M, Rizvi SJ. Resting-state neural mechanisms of capability for suicide and their interaction with pain - A CAN-BIND-05 Study. J Affect Disord 2023; 330:139-147. [PMID: 36878406 DOI: 10.1016/j.jad.2023.02.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/13/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Suicidal ideation is highly prevalent in Major Depressive Disorder (MDD). However, the factors determining who will transition from ideation to attempt are not established. Emerging research points to suicide capability (SC), which reflects fearlessness of death and increased pain tolerance, as a construct mediating this transition. This Canadian Biomarker Integration Network in Depression study (CANBIND-5) aimed to identify the neural basis of SC and its interaction with pain as a marker of suicide attempt. METHODS MDD patients (n = 20) with suicide risk and healthy controls (n = 21) completed a self-report SC scale and a cold pressor task measuring pain threshold, tolerance, endurance, and intensity at threshold and tolerance. All participants underwent a resting-state brain scan and functional connectivity was examined for 4 regions: anterior insula (aIC), posterior insula (pIC), anterior mid-cingulate cortex (aMCC) and subgenual anterior cingulate cortex (sgACC). RESULTS In MDD, SC correlated positively with pain endurance and negatively with threshold intensity. Furthermore, SC correlated with the connectivity of aIC to the supramarginal gyrus, pIC to the paracingulate gyrus, aMCC to the paracingulate gyrus, and sgACC to the dorsolateral prefrontal cortex. These correlations were stronger in MDD compared to controls. Only threshold intensity mediated the correlation between SC and connectivity strength. LIMITATIONS Resting-state scans provided an indirect assessment of SC and the pain network. CONCLUSIONS These findings highlight point to a neural network underlying SC that is associated with pain processing. This supports the potential clinical utility of pain response measurement as a method to investigate markers of suicide risk.
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Affiliation(s)
- Shijing Wang
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Sidney H Kennedy
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Tim V Salomons
- Department of Psychology, Queen's University, Kingston, Canada
| | - Amanda K Ceniti
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Shane J McInerney
- Department of Psychiatry, National University of Ireland, Galway, Ireland
| | - Yvonne Bergmans
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Norman Farb
- Department of Psychology, University of Toronto Mississauga, Mississauga, Canada
| | - Gustavo Turecki
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Tom A Schweizer
- Institute of Medical Science, University of Toronto, Toronto, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Nathan Churchill
- Neuroscience Research Program, St. Michael's Hospital, Toronto, Canada
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sakina J Rizvi
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
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Tull MT, DeMoss ZT, Anestis MD, Lavender JM, McDermott MJ, Gratz KL. Examining associations between suicidal desire, implicit fearlessness about death, and lifetime frequency of suicide attempts. Suicide Life Threat Behav 2022; 52:1110-1120. [PMID: 35899809 PMCID: PMC10087538 DOI: 10.1111/sltb.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/01/2022] [Accepted: 07/11/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Suicide models propose that the capability for suicide, such as fearlessness about death (FAD), is necessary for the transition from suicidal desire to a suicide attempt. Most studies have relied on self-report methods to assess FAD. However, this research has produced equivocal results. As individuals may have limited awareness of learned or pre-existing associations between fearlessness and death, implicit measures of FAD hold promise. This study used a novel implicit association test (IAT), the IAT-FAD, to examine associations between suicidal desire, implicit FAD, and lifetime suicide attempt frequency. METHODS Patients in residential substance use treatment (N = 75), a population with increased suicide risk and exposure to painful and provocative events, completed the IAT-FAD and assessments of suicidal desire and past suicide attempts. RESULTS Implicit FAD moderated the association between suicidal desire and lifetime frequency of suicide attempts associated with an intent to die and requiring medical attention (although not ambivalent suicide attempts). Suicidal desire related to medically attended suicide attempts only at high implicit FAD levels, and to suicide attempts with a clear intent to die only at high or mean implicit FAD levels. CONCLUSION Results provide initial support for the relevance of implicit measures of FAD for understanding suicide risk.
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Affiliation(s)
- Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Zachary T DeMoss
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Michael D Anestis
- New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA.,School of Public Health, Rutgers, the State University of New Jersey, Piscataway, New Jersey, USA
| | - Jason M Lavender
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, Maryland, USA.,The Metis Foundation, San Antonio, Texas, USA
| | - Michael J McDermott
- Department of Psychology, University of Louisiana at Lafayette, Lafayette, Louisiana, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
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Yang X, Krantz SM, Stewart SM. Examination of measurement invariance of the fearlessness about death scale in youth patients. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-04042-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bayliss LT, Christensen S, Lamont-Mills A, du Plessis C. Suicide capability within the ideation-to-action framework: A systematic scoping review. PLoS One 2022; 17:e0276070. [PMID: 36301944 PMCID: PMC9612581 DOI: 10.1371/journal.pone.0276070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/28/2022] [Indexed: 11/19/2022] Open
Abstract
Suicide capability is theorised to facilitate the movement from suicidal ideation to suicide attempt. Three types of contributors are posited to comprise suicide capability: acquired, dispositional, and practical. Despite suicide capability being critical in the movement from ideation-to-attempt, there has been no systematic synthesis of empirical evidence relating to suicide capability that would enable further development and refinement of the concept. This study sought to address this synthesis gap. A scoping review was conducted on suicide capability studies published January 2005 to January 2022. Eleven electronic databases and grey literature sources were searched returning 5,212 potential studies. After exclusion criteria application, 90 studies were included for final analysis. Results synthesis followed a textual narrative approach allocating studies based on contributors of suicide capability. Most studies focused on investigating only one factor within contributors. Painful and provocative events appear to contribute to acquired capability more so than fearlessness about death. Whilst emerging evidence for dispositional and practical contributors is promising, the small number of studies prevents further conclusions from being drawn. An unexpected additional cognitive contributor was identified. The focus of a single factor from most studies and the limited number of studies on contributors other than acquired capability limits the theoretical development and practical application of suicide capability knowledge. Given that suicide is a complex and multifaceted behaviour, future research that incorporates a combination of contributors is more likely to advance our understandings of suicide capability.
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Frazee KM, Shepler DK. Interpersonal Needs and Suicidality of Discharged Army Veterans. JOURNAL OF VETERANS STUDIES 2022. [DOI: 10.21061/jvs.v8i3.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Krantz SM, Heerschap J, Balzen KM, Sachs R, Kennard BD, Emslie GJ, Stewart SM. Fearlessness about death and suicide planning predict lethality of adolescent suicide attempts during and following treatment. J Clin Psychol 2022; 78:1540-1553. [PMID: 35118642 DOI: 10.1002/jclp.23324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/14/2021] [Accepted: 01/22/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The rate of adolescent suicide attempt has increased drastically over the past 10 years. However, little is known regarding what predicts a more versus less lethal attempt, which is of critical interest to clinicians managing this at-risk population. We sought to extend the study of lethality in adolescents by exploring its relationship with two recognized risk-factors for suicide attempt: fearlessness about death (FAD) and suicide planning. METHODS Participants (N = 254) were administered measures of FAD and depressive symptoms upon entering intensive outpatient treatment for adolescents exhibiting suicidal thoughts and behaviors. Attempts made between treatment entry and 6 months following discharge (n = 47) were scored on a 4-point ordinal scale of lethality. The resulting continuum ranged from no attempt to attempts of low to moderate levels of lethality. RESULTS FAD and suicide planning distinguished between levels of lethality of future attempt at the bivariate and multivariate level. FAD's predictive relationship with lethality while controlling for age, sex, depression, and prior attempt diminished when suicide planning was covaried. CONCLUSION FAD and suicide planning significantly predicted more versus less lethal future attempts in our sample of adolescents in a clinical setting. Our findings suggest that FAD influences the lethality of a future attempt by promoting planning for suicide. More studies are needed to assess whether the brief FAD scale might be a valuable adjunct in the clinical management of youth with suicidal thoughts and behaviors.
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Affiliation(s)
- Savannah M Krantz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jessica Heerschap
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Psychology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Psychiatry, Children's Health Children's Medical Center, Dallas, Texas, USA
| | - Kennedy M Balzen
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Raney Sachs
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Betsy D Kennard
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Psychology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Psychiatry, Children's Health Children's Medical Center, Dallas, Texas, USA
| | - Graham J Emslie
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Psychiatry, Children's Health Children's Medical Center, Dallas, Texas, USA
| | - Sunita M Stewart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Psychology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Psychiatry, Children's Health Children's Medical Center, Dallas, Texas, USA
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Arafat SMY, Hussain F, Zaman MS, Tabassum T, Islam MK, Shormi FR, Khan AR, Islam MR, Redwan ASM, Giasuddin NA, Mubashir A, Khan MAS. Thwarted belongingness, perceived burdensomeness, and acquired capability for suicide among university students of Bangladesh: Scales validation and status assessment. Front Psychiatry 2022; 13:1025976. [PMID: 36311516 PMCID: PMC9614224 DOI: 10.3389/fpsyt.2022.1025976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Identification of prior mental events of suicide attempts has immense importance in suicide prevention. However, it has not been studied in Bangladesh as there was no available psychometrically valid instrument measuring it. OBJECTIVES We aimed to test the psychometric properties of the interpersonal needs questionnaire (INQ-15) and acquired capability for suicide scale-fearlessness about death (ACSS-FAD) in Bangla along with the determination of the level of thwarted belongingness, perceived burdensomeness, and acquired capability for suicide. MATERIALS AND METHODS We collected data between 29 March and 14 April 2022 from 1,207 students of medical colleges and universities in Bangladesh by Google form. We assessed the psychometric properties of Bangla INQ and ACSS-FAD scales and examined factors associated with thwarted belongingness, perceived burdensomeness, and acquired capability for suicide. RESULTS The mean age of the participants was 22.82 ± 1.68 (range 18-29) years, 51% were females, 84% were graduate students, and 92% were unmarried. Both of the scales revealed acceptable levels of reliability. Confirmatory factor analysis revealed a two-factor structure of Bangla INQ after dropping three items from thwarted belongingness domain (item 9, 11, and 12) and a single factor structure for Bangla ACSS-FAD after dropping three items (item 1, 4, and 6). Perceived burdensomeness was significantly higher in females, students with a history of mental illness, family history of suicide, and the history of suicidal attempts. Fearlessness about death was significantly higher among females, non-Muslim participants, and history of suicidal attempts. CONCLUSION The current study revealed psychometric properties of two suicide scales (INQ and ACSS-FAD) in Bangla that can be used in subsequent studies. Prevention strategies targeting to females, persons with psychiatric disorder, history of previous attempt(s) should be prioritized specially among the young age group.
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Affiliation(s)
- S M Yasir Arafat
- Department of Psychiatry, Enam Medical College and Hospital, Dhaka, Bangladesh
| | - Fahad Hussain
- Department of Pharmacy, Noakhali Science and Technology University, Noakhali, Bangladesh
| | | | | | - Md Khayrul Islam
- Department of Psychiatry, Tairunnessa Memorial Medical College, Gazipur, Bangladesh
| | - Farzana Rabin Shormi
- Department of Psychiatry, Holy Family Red Crescent Medical College, Dhaka, Bangladesh
| | - Anisur Rahman Khan
- Faculty of Liberal Arts and Social Sciences, East West University, Dhaka, Bangladesh
| | - Md Rabiul Islam
- Department of Pharmacy, University of Asia Pacific, Dhaka, Bangladesh
| | - A S M Redwan
- Department of Psychiatry, Chattogram International Medical College, Chattogram, Bangladesh
| | - Noor Ahmed Giasuddin
- Department of Psychiatry, Shaheed Tajuddin Ahmad Medical College, Gazipur, Bangladesh
| | - Anila Mubashir
- Department of Applied Psychology, National University of Modern Languages, Rawalpindi, Pakistan
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Doran N, Bismark A, Khalifian C, Mishra J, De Peralta S, Martis B. Associations between veteran encounters with suicide prevention team and suicide-related outcomes. Suicide Life Threat Behav 2021; 51:729-735. [PMID: 33904613 DOI: 10.1111/sltb.12760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/29/2020] [Accepted: 12/10/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Suicide rates have been of increasing concern across the United States, particularly among military veterans. The Veterans Health Administration has initiated multiple suicide prevention initiatives, but little research has examined the impact of these programs. The purpose of this study was to test the hypothesis that more frequent contact with suicide prevention clinicians would predict lower odds of suicidal behavior. METHOD Retrospective medical record review was performed for 1364 veterans identified as high risk for suicide during 2012-2018. Logistic regression was used to test whether the number of suicide prevention contacts predicted the odds of suicide attempt, any self-directed violence, or reactivation of high-risk status in the next year, accounting for age, sex, length of high-risk episode, and other mental health contacts. RESULTS Each additional suicide prevention coordinator contact was associated with 4%-5% lower odds of suicide attempt, suicidal behavior, and reactivation of high-risk status in the next year (ps < 0.05). For suicide attempt and self-directed violence, associations were stronger when considering only initial high-risk episodes (8%-10% lower odds, ps < 0.05). CONCLUSIONS Findings suggest ongoing support from suicide prevention clinicians can have a significant protective effect. Additional research is needed to identify mechanisms by which this support reduces risk.
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Affiliation(s)
- Neal Doran
- Mental Health Care Line, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA
| | - Andrew Bismark
- Mental Health Care Line, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA
| | - Chandra Khalifian
- Mental Health Care Line, VA San Diego Healthcare System, San Diego, CA, USA
| | - Jyoti Mishra
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Sharon De Peralta
- Mental Health Care Line, VA San Diego Healthcare System, San Diego, CA, USA
| | - Brian Martis
- Mental Health Care Line, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA
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