Risk for suicide attempts among United States Air Force active duty members with suicide ideation: An ecological perspective

Reconnecting to Internal Sensations and Experiences (RISE): An online, multi-session intervention improves interoceptive sensibility for military personnel

OBJECTIVE

This preregistered randomized controlled trial tested the effects of a four-session, online interoceptive awareness intervention relative to an active comparator, matched for time and attention on interoception and suicidal ideation.

METHOD

Participants (N = 195; 69% male; mean age = 37) were active duty service members (62%) and veterans (38%) who completed measures of interoceptive sensibility, interoceptive accuracy, and suicidal ideation at baseline. They were randomized to either the interoceptive awareness intervention, Reconnecting to Internal Sensations and Experiences (RISE), or the comparator, Healthy Habits. Participants completed the assessment battery again at posttest as well as a 1 and 3-month follow-up.

RESULTS

RISE was rated as acceptable and demonstrated excellent feasibility per completion rates (85% completed all four modules). RISE improved the majority of interoceptive sensibility domains assessed (noticing body sensations, not worrying about sensations of pain or discomfort, emotional awareness, self-regulation, body listening, and body trust), and most of these gains remained at 1 and 3-month follow-ups. There were no differences between conditions on suicidal ideation, perhaps due to the low levels of ideation reported, or interoceptive accuracy.

CONCLUSIONS

RISE is a disseminable, cost-effective, and transdiagnostic intervention that improves interoceptive sensibility up to 3 months.

Love Is Not All You Need: Understanding the Association Between Relationship Status and Relationship Dysfunction With Self-Directed Violence in Veterans

INTRODUCTION

Research indicates that being married is associated with reduced risk of suicide and self-directed violence (SDV) relative to being divorced. Simultaneously, difficulties within relationships predict poorer health outcomes. However, research on relationship status rarely examines relationship functioning, obfuscating the joint contribution of these variables for SDV risk.

METHOD

Veterans (N = 1,049) completed a survey that included assessment of relationship status, relationship functioning, and SDV history. Logistic regression models tested how (a) relationship status, (b) relationship dysfunction, and (c) being divorced compared to being in a low- or high-dysfunction relationship were associated with SDV, controlling for several intrapersonal risk factors.

RESULTS

Veterans in a relationship did not differ in SDV history compared to divorced/separated veterans. However, more dysfunction within relationships was associated with greater odds of a history of SDV and suicidal cognitions. Finally, SDV histories were more likely among veterans endorsing high-dysfunction relationships compared with (a) low-dysfunction relationships and (b) divorced veterans.

CONCLUSION

It may be insufficient to only consider relationship status when evaluating interpersonal risk factors for SDV. A single item assessing relationship dysfunction was associated with enacted SDV and suicidal cognitions over and above intrapersonal risk factors. Integrating such single-item measures into clinical practice could improve identification and subsequent tailored intervention for veterans at greater risk for SDV.

Disrupted interoception in Military Service Members and Veterans with a history of suicidality

INTRODUCTION

This project tested whether Service Members (SM) and Veterans with current suicidal ideation or a history of suicide attempt had greater interoceptive dysfunction than SM and Veterans with past or no suicidal ideation.

METHOD

Participants (N = 195; 69% male) were SM (62%) and Veterans (38%) who completed measures of suicidal thoughts and behaviors and subjective and objective interoceptive dysfunction. Participants were split into the following suicide groups: no suicidality, lifetime ideation, current ideation, and past attempt. Planned orthogonal contrasts tested for differences.

RESULTS

The combined suicidality group (lifetime ideation, current ideation, or past attempt) had worse body trust relative to the no suicidality group, and the current ideation group had worse body trust relative to those with lifetime ideation. Those with a history of suicide attempt had worse body appreciation than the combined group of ideators, and those with current ideation had worse body appreciation relative to those with lifetime ideation. The groups did not differ on objective interoception.

CONCLUSION

Interoception is disrupted among individuals with suicidality histories within a predominantly male-identified military sample. Individuals with current suicidal ideation had both worse body trust and appreciation relative to those with past ideation. Suicide risk assessments may benefit from including questions related to body trust.

Nonfatal suicidal behaviors among former active duty servicemembers-United States, 2013-2019

Introduction

Examine characteristics associated with increased odds of nonfatal suicidal behaviors among former active-duty servicemembers (F-ADSM) using data from the 2013-2019 National Survey on Drug Use and Health (NSDUH).

Methods

F-ADSM were respondents who reported being separated/retired from the military and previously serving on active-duty. For each outcome of interest (suicidal ideation, made a suicide plan, made a suicide attempt), we used multivariable logistic regression with backwards elimination to identify characteristics with statistically significant associations.

Results

In the 12 months preceding the survey, 3.6% of F-ADSM reported suicidal ideation, 1.0% reported making a plan, and 0.3% reported making a suicide attempt. There were increased odds of self-reported suicide attempts among F-ADSM who were female; aged 18-49 years; non-Hispanic black; gay or bisexual; divorced/separated or widowed; not employed; in poverty; binged alcohol in the past month; or ever had a major depressive episode.

Conclusions

Suicide can be prevented through a comprehensive, upstream approach addressing veteran's holistic needs to prevent them from becoming suicidal in the first place, and support veterans at increased risk.

Association between Self-Stigma and Suicide Risk in Individuals with Schizophrenia: Moderating Effects of Self-Esteem and Perceived Support from Friends

This cross-sectional study assessed the moderating effects of self-esteem and perceived support from friends on the association between self-stigma and suicide risk in individuals with schizophrenia. We included 300 participants (267 with schizophrenia and 33 with schizoaffective disorder). Suicide risk was assessed using items adopted from the suicide module of the Mini-International Neuropsychiatric Interview; self-stigma was assessed using the Self-Stigma Scale-Short; perceived support from friends was assessed using the Friend Adaptation, Partnership, Growth, Affection, and Resolve Index; and self-esteem was assessed using the Rosenberg Self-Esteem Scale. A moderation analysis was performed to examine the moderating effects of self-esteem and perceived support from friends on the association between self-stigma and suicide risk. The results indicated that self-stigma was positively associated with suicide risk after the effects of other factors were controlled for. Both perceived support from friends and self-esteem significantly reduced the magnitude of suicide risk in participants with self-stigma. Our findings highlight the value of interventions geared toward ameliorating self-stigma and enhancing self-esteem in order to reduce suicide risk in individuals with schizophrenia.

Computerized intervention for reducing intimate partner victimization for perinatal women seeking mental health treatment: A multisite randomized clinical trial protocol

Intimate partner victimization (IPV) is a significant social and public health problem among perinatal women. Research suggests that 21% to 33% of perinatal women report IPV and there is an enormous amount of morbidity associated with IPV. Moreover, IPV places women at high risk for several psychiatric disorders, which transforms the perinatal period from an already challenging process into a potentially overwhelming one. Further, IPV and untreated mental illness during the perinatal period pose a dual risk of adverse physical and emotional outcomes for women and their developing fetus/infant. Given the high rates of IPV among women who seek mental health treatment, mental health clinics compared to other medical settings are more effective sites for focused case finding and intervention. Our team has successfully tested an innovative, computerized intervention, Strength for U in Relationship Empowerment (SURE). SURE is a brief, interactive program consistent with motivational interviewing and incorporates empowerment strategies. The proposed multisite randomized clinical trial (N = 186) will test whether SURE relative to control is associated with reduced IPV, greater positive affect and well-being, and greater perceived emotional support. We will also evaluate the role of theoretical mediators of empowerment and self-efficacy. Finally, we will estimate the resources needed and costs to deliver SURE, as well as the incremental cost effectiveness of SURE compared with treatment as usual. If SURE is found to be efficacious and cost effective, it can be easily integrated into clinical care and will fill a critical gap for a vulnerable, high-risk population.

Preferences in Information Processing, Marginalized Identity, and Non-Monogamy: Understanding Factors in Suicide-Related Behavior among Members of the Alternative Sexuality Community

Suicide-related behavior (SRB) is a mental health disparity experienced by the alternative sexuality community. We assessed mental health, relationship orientation, marginalized identities (i.e., sexual orientation minority, gender minority, racial minority, ethnic minority, and lower education), and preferences in information processing (PIP) as factors differentiating lifetime SRB groups. An online cross-sectional survey study was conducted in 2018. Members of the National Coalition for Sexual Freedom (NCSF; n = 334) took part. Bivariate analyses identified the following SRB risk factors: female and transgender/gender non-binary identity, sexual orientation minority identity, lower education, suicide attempt/death exposure, Need for Affect (NFA) Avoidance, depression, and anxiety. Monogamous relationship orientation was a protective factor. Multi-nomial regression revealed the following: (1) monogamous relationship orientation was a protective factor for suicidal ideation and attempt; (2) lower education was a risk factor for suicide attempt; (3) anxiety was a risk factor for suicide attempt; and (4) depression was a risk factor for suicidal ideation. A two-way interaction showed that elevated NFA Approach buffered the negative impacts of depression. Relationship orientation, several marginalized identities (i.e., based on gender, sexual orientation, and educational level), and PIP all contributed uniquely to SRB. Further study is necessary to understand the role of relationship orientation with suicide. Health education and suicide prevention efforts with NCSF should be tailored to account for marginalized identity, mental health, and NFA factors.