Characteristics and Correlates of Cigarette Use Among Recent U.S. Veterans

Little is known about the smoking habits and cessation efforts of veterans returning from Iraq and Afghanistan, many of whom will seek health care services in the public sector. This project documents rates of smoking and quit attempts among veterans receiving Veteran's Health Administration (VHA) health care and describes the relationship between current smoking use/cessation and demographic characteristics, quality of life, and potential alcohol misuse.

A large representative sample of Iraq/Afghanistan era veterans was surveyed using the VA Survey of Healthcare Experiences of Patients (Wright, Craig, Campbell, Schafer, &; Humble, 2006 Wright, S. M., Craig, T., Campbell, S., Schaefer, J. and Humble, C. 2006. Patient satisfaction of female and male users of Veterans Health Administration services. Journal of General Internal Medicine, 21(Suppl. 3): S26–S32. [Crossref], [PubMed] , [Google Scholar]). One third of respondents reported smoking during the past year and 24% reported currently smoking. Current smoking status was more prevalent among those who reported less education and lower household income. Current smoking status was also related to lower mental and physical health quality of life and higher potential alcohol misuse scores. Quit attempts were significantly less common among reserve component veterans and quitters reported higher incomes and were slightly older. The frequency of cigarette smoking among recent veterans underscores the importance of addressing smoking cessation efforts within this population. Individual characteristics associated with current smoking, cessation efforts, and relapse may help tailor cessation treatment for this growing cohort of new veterans.     

Outpatient health care utilization of suicide decedents in their last year of life

The characteristics of health care utilization during the last year of life by Taiwanese who died by suicide were analyzed. The degree of health services utilization was evaluated by extracting the data of National Health Insurance (NHI) outpatient cohort records in 2006. A total of 4,406 fatal suicide cases were matched with the 17,587,901 subjects in the NHI beneficiary registry file. Rate of visit of the suicide decedents for all NHI outpatient services during their last year before death was 85%, and that for mental disorders service only was 30.2%. Average number of visits per person-year of the suicide decedents was 24.5 visits per year, two times higher than that of the survivors. The average numbers of visits (ANV) of male suicide decedents who used the mental disorders services was increased 6.8 times compared to that for all survivors. The increase in female decedents, in contrast, was 2.7 times. The increase in ANV for 15-24 age group was 14.6 times, significantly higher than that for the other age groups (<4 times). Effective prediction or prevention of potential suicides through increased awareness and surveillance of medical care resource utilization is possible, especially for male and young adult patients under mental disorder health care.     

Preventing suicide through improved training in suicide risk assessment and care: an American Association of Suicidology Task Force report addressing serious gaps in U.S. mental health training

There are twice as many suicides as homicides in the United States, and the suicide rate is rising. Suicides increased 12% between 1999 and 2009. Mental health professionals often treat suicidal patients, and suicide occurs even among patients who are seeking treatment or are currently in treatment. Despite these facts, training of most mental health professionals in the assessment and management of suicidal patients is surprisingly limited. The extant literature regarding the frequency with which mental health professionals encounter suicidal patients is reviewed, as is the prevalence of training in suicide risk assessment and management. Most importantly, six recommendations are made to address the longstanding insufficient training within the mental health professions regarding the assessment and management of suicidal patients.     

Tracking a movement: U.S. milestones in suicide prevention

Suicidology and suicide prevention are relatively new fields of study in the United States, but they have made significant progress since their beginnings. This study aimed to identify the most impactful theories in the history of science and suicidology and the most impactful events in the suicide prevention movement. These theories and events were identified through expert nomination. The most impactful theories were those of Shneidman, Durkheim, and Joiner. The most impactful events included the opening of the first suicide prevention center and hotline, the founding of the American Association of Suicidology, and national publications (e.g., National Strategy for Suicide Prevention).     

A demographic analysis of suicide among U.S. Navy personnel

Age-, sex-, race-, and employment-adjusted standardized mortality ratios (SMRs) were calculated for sailors committing suicide between 1990 and 1996 and compared with adjusted SMRs for civilians. Cluster analyses were conducted on annual rates from 1983 through 1995 to examine differences between comparison groups across time and location. Results showed fewer than expected suicides for Caucasian and African American males and a somewhat higher than expected suicide rate among other ethnic group males and among Caucasian women. The suicide rate showed an increase during the study period, with some evidence toward a clustering effect in time and space.     

Quality of care and cost containment in the U.S. and U.K.

Many activities of doctors in the acute hospital sector do not improve patient outcome because they are inappropriate. Curtailing interventions that are unnecessary (because the patient is not bad enough) or are unsuccessful (because the condition is too advanced) could both save resources and improve care. Rational rationing depends on knowledge about the expected benefits of various technologies when used in different clinical circumstances.     

Menninger's motives for suicide in the notes of completed and attempted suicides.

Brevard, Lester, and Yang in 1990, studying Menninger's motives for suicide, reported more evidence for the wish to be killed (i.e., self-blame or self-punishment) in suicide notes for completed suicides than in parasuicide notes for attempted suicide; however, they did not control for age and sex. A comparison of notes written by completed and attempted suicides that controlled for age and sex showed no differences in the presence of content which reflected Menninger's three motives for suicide, including the wish to be killed.     

Population size and suicide in U.S. cities: a static and dynamic exploration

The relationship between city population size and suicide rates rarely has been examined directly, though scholars often assume such a relationship exists based on studies of the association between suicide rates and urbanization (percent of the population living in cities) in various social contexts. In an effort to determine the basic association between suicide rates and city population size, we analyze data for four time points, 1960, 1970, 1980, and 1990, using a random sample of U.S. cities with 10,000 or more population in 1960. In addition, we conduct a time series analysis of change in population size and change in suicide rates over a two decade period. Results indicate that an association between population and suicide is atypical, and even when observed is highly sensitive to methodological specifications. The results call into question the notion that larger city population size is conducive to suicide as well as the assumption that studies of suicide and urbanization can substitute for studies of suicide and city population size.     

Association between serotonin transporter gene polymorphism and family history of attempted and completed suicide

The purpose of this study was to examine the association of the serotonin transporter gene to family history of suicidality. Forty-seven volunteers responded to questionnaires about family history of suicide, and provided buccal swabs for analysis of the polymorphism. Allelic homozygocity (the short variant) was associated with family history of suicidality. These data, to be interpreted with the study's limitations in mind, suggest a link between the serotonin transporter gene polymorphism and suicide-related variables, which should be the focus of future research.     

Suicidality in primary health care and national suicide rates

The incidence of suicidal symptoms for primary health care patients did not predict national suicide rates in a sample of 10 nations.     

Attitudes toward suicide: a comparison of Canadian and U.S. college students

The Suicide Opinion Questionnaire (SOQ) was administered to two samples (n = 100 each) of college students, one from Canada and one from the United States. A multivariate analysis of variance indicated substantial intergroup differences, but no sex differences. Univariate analyses indicated significant differences on 8 of the 15 SOQ factors, suggesting that Canadian college students perceive suicide as part of everyday life, not to be explained by recourse to religious, personality, or psychopathological constructs. The results are discussed in terms of six themes present in the suicide literature: motivation, acceptability, religion, impulsivity, recidivism, and misconceptions. Speculation is also provided regarding why such differences (despite considerable similarities) might exist.     

Suicide acceptability is related to suicide planning in U.S. adolescents and young adults

The association between adolescents' and young adults' attitudes toward suicide and their own suicidality across five racial-ethnic classifications was studied in a nationally representative sample of 3,301 youth ages 14 to 22 years from the National Annenberg Risk Survey of Youth. Results indicate that adolescents and young adults who most strongly believe that it is acceptable to end one's life are more than fourteen times more likely to make a plan to kill themselves as those who do not have such beliefs (p < .001). Future behavioral prevention and intervention research should take into consideration adolescents' and young adults' approval of suicide as a risk factor for taking their own lives.     

Psychological and Physical Characteristics of U.S. Marine Recruits

This study examined psychological and physical health factors in a cohort of U.S. Marine recruits with the goal of developing a comprehensive understanding of attributes recruits bring to training. 1,350 male recruits completed a multimeasure survey during the first week of training. A 2-way multivariate analysis of variance (MANOVA) was conducted to explore the relationship of hardiness dimensions on several psychological and physical factors. Compared with other military samples, this cohort reported similar levels on hardiness control and rigidity subscales. Recruits who reported higher scores on a measure of positive hardiness also reported higher scores on measures of grit, grit ambition, sensation seeking, training expectations, positive ways of coping, physical and mental health, fitness scores, and lower scores on a measure of depression. This study provides a more complete understanding of the complex array of attributes of Marine recruits and forms a foundation for predictive models of injury risk and/or attrition.     

Impact of emotional approach coping and hope on PTSD and depression symptoms in a trauma exposed sample of Veterans receiving outpatient VA mental health care services

The present investigation evaluates the relationship between coping style, dispositional hope, and posttraumatic stress disorder (PTSD) and depression symptom severity in a trauma-exposed Veteran sample. Specifically, we evaluated the adaptive value of emotional avoidant and approach coping strategies and perceptions of hope in a sample of 209 trauma-exposed Veterans receiving outpatient mental health care at a VA facility. Participants completed a life events questionnaire and inventories assessing coping, dispositional hope, and PTSD and depression symptom severity. Hierarchical regression analyses were conducted controlling for relevant demographic variables. Greater levels of emotional avoidance and lower levels of emotional expression were significantly associated with increased PTSD and depression symptom severity. Dispositional hope was positively associated with depression symptoms only and perceptions of hope moderated the association between emotional avoidance coping and depression symptoms. Findings highlight the value of emotional coping strategies and perceptions of hope in posttraumatic adjustment. Specifically, employing coping techniques that encourage emotional expression may promote improved adjustment among trauma-exposed individuals, while reduced perceptions of hope and the use of avoidant coping strategies may place individuals at greater risk for depression following exposure to traumatic events.     

Impact of emotional approach coping and hope on PTSD and depression symptoms in a trauma exposed sample of Veterans receiving outpatient VA mental health care services

Abstract

The present investigation evaluates the relationship between coping style, dispositional hope, and posttraumatic stress disorder (PTSD) and depression symptom severity in a trauma-exposed Veteran sample. Specifically, we evaluated the adaptive value of emotional avoidant and approach coping strategies and perceptions of hope in a sample of 209 trauma-exposed Veterans receiving outpatient mental health care at a VA facility. Participants completed a life events questionnaire and inventories assessing coping, dispositional hope, and PTSD and depression symptom severity. Hierarchical regression analyses were conducted controlling for relevant demographic variables. Greater levels of emotional avoidance and lower levels of emotional expression were significantly associated with increased PTSD and depression symptom severity. Dispositional hope was positively associated with depression symptoms only and perceptions of hope moderated the association between emotional avoidance coping and depression symptoms. Findings highlight the value of emotional coping strategies and perceptions of hope in posttraumatic adjustment. Specifically, employing coping techniques that encourage emotional expression may promote improved adjustment among trauma-exposed individuals, while reduced perceptions of hope and the use of avoidant coping strategies may place individuals at greater risk for depression following exposure to traumatic events.     

Examination of potential disparities in suicide risk identification and follow-up care within the Veterans Health Administration

To improve the identification and intervention of suicide risk, the Veterans Health Administration implemented the use of electronic patient record flags (PRF) to indicate when a veteran is identified as high risk for suicide and to increase the clinical contacts made with the veteran. The current study utilized an intersectional approach to assess potential disparities in the likelihood of receiving a PRF and the likelihood of receiving post-PRF follow-up care among veterans with substance use disorders (SUDs). Among 458,092 veterans who received a SUD diagnosis in 2012, Black veterans were less likely to receive a PRF, although Black-disabled veterans and Black-female veterans were more likely to receive a PRF. Homelessness was related to greater likelihood of receiving a PRF and post-PRF care. Hispanic/Latinx veterans who experienced homelessness were more likely to receive post-PRF care, while disabled veterans who experienced homelessness were less likely. Hispanic/Latinx, female veterans, and Black-disabled veterans were significantly less likely to receive post-PRF care. Overall, few marginalized or intersecting identities were associated with decreased PRF or decreased follow-up care. There are opportunities for specific strategies that promote engagement in VA follow-up services for veterans identifying as Hispanic/Latinx women, disabled Black veterans, and disabled homeless veterans.     

An analysis of U.S. parachuting fatalities: 2000-2004

Between 2000 and 2004, 125 recreational parachuting fatalities were reported in the USA. Each was categorized using a previously reported taxonomy. While patterns of skydiving fatality were largely unchanged since the last such analysis of fatalities from 1993-1999, some variations were noted. As in previous analyses, most of the recent skydiving fatalities were the direct result of human error. Some examples of commonplace human error fatalities were turning low to the ground resulting in a hard landing, accidentally colliding with other skydivers resulting in entangled parachutes, and failure to deploy the reserve parachute correctly in the event of malfunctioning main parachute.