The Relationship Between Adult Attachment and Suicidal Thoughts and Behaviors: A Systematic Review

We aimed to (1) determine the extent of the relationship between attachment and suicidal thoughts and behaviors (STB), (2) investigate whether any gender differences exist, and (3) conduct a theoretical synthesis of the included studies. A systematic search of the databases Web of Science; EBSCO Host Medical and Psychology-related resources, which includes CINAHL, Health Source: Nursing/Academic Edition, Psychology and Behavioral Sciences Collection, and PsycINFO; and EMBASE was conducted, with 52 studies meeting the inclusion criteria. While secure attachment acts as protective factor, insecure attachment orientations appear to be vulnerability factors compromising an individual's capacity to cope with relationship issues, increasing suicide risk. There is insufficient evidence about gender differences. The theoretical synthesis suggests that attachment, interacting with other psychological traits in response to negative life events, acts as a vulnerability or protective factor for STB. Implications for treatment are also discussed.

Suicidal Self-Directed Violence Among Homeless US Veterans: A Systematic Review

A systematic review of the literature was conducted to investigate suicidal self-directed violence and homelessness among US military veterans, and identify existing suicide prevention strategies. In November 2015, MEDLINE, EMBASE, PsycInfo, CINAHL, Web of Science, Cochrane Library, Google, and Google Scholar were searched. Articles published since 1990 investigating self-directed violence among homeless veterans were identified. Data were extracted and synthesized qualitatively. Nineteen observational studies were included. Suicide ideation rates were 1.3% (current), 7.0% (past week), 12.1%-18% (past 30 days), and 74% (lifetime). Suicide attempt rates were 0%-6% (past 30 days), 30.7%-31.5% (past 5 years), and 15%-46.6% (lifetime). Death by suicide rate was 81.0 per 100,000. No interventional studies to prevent self-directed violence among homeless veterans were identified. Homeless veterans are at risk for self-directed violence, suggesting the need for research to examine preventive strategies. A comprehensive public health approach to suicide prevention needs to focus on vulnerable populations, including homeless veterans.

Suicide risk and precipitating circumstances among young, middle-aged, and older male veterans

OBJECTIVES

The purpose of this study was to evaluate the risk of suicide among veteran men relative to nonveteran men by age and to examine the prevalence of suicide circumstances among male veterans in different age groups (18-34, 35-44, 45-64, and ≥ 65 years).

METHODS

Data from the National Violent Death Reporting System (2003-2008) were used to calculate age-specific suicide rates for veterans (n = 8440) and nonveterans (n = 21,668) and to calculate the age-stratified mortality ratio for veterans. Multiple logistic regression was used to compare health status, stressful life events preceding suicide, and means of death among young, middle-aged, and older veterans.

RESULTS

Veterans were at higher risk for suicide compared with nonveterans in all age groups except the oldest. Mental health, substance abuse, and financial and relationship problems were more common in younger than in older veteran suicide decedents, whereas health problems were more prevalent in the older veterans. Most male veterans used firearms for suicide, and nearly all elderly veterans did so.

CONCLUSIONS

Our study highlighted heightened risk of suicide in male veterans compared with nonveterans. Within the veteran population, suicide might be influenced by different precipitating factors at various stages of life.

Resilience to suicidality: the buffering hypothesis

Recent years have seen a growing interest into resilience to suicidality, which has been described as a perception or set of beliefs which buffer individuals from suicidality in the face of stressors. The current review extends this research by introducing the buffering hypothesis, a framework for the investigation of resilience to suicidality. The key proposal of this is that psychological resilience factors should be viewed as existing on a separate dimension to risk which acts to moderate the impact of risk on suicidality. Furthermore, like risk factors, resilience factors are bipolar, with their positive pole conferring resilience and their negative pole acting to amplify suicidality. Seventy-seven studies were identified which investigated (a) whether psychological moderators of risk exist and (b) the particular psychological constructs which may act as moderators. The review found strong support for the existence of psychological moderators and indicated a moderating impact of attributional style, perfectionism, agency and hopelessness. These findings support the buffering hypothesis and suggest that a range of psychological factors may confer resilience to suicidality. These results suggest that the identification of moderators may improve estimates of suicide risk and that the development of buffering factors could be a key focus of suicide interventions.