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.     

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.     

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.     

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.     

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.     

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.     

Changing age patterns of U.S. male and female suicide rates, 1934-1983

Changes in the age patterns of U.S. male and female suicide rates from 1934 to 1983 are examined, using official suicide data. Among whites, the age patterns of male and female suicide rates have become less concordant since about 1960. In contrast, the age patterns of nonwhite male and female suicide rates have become more concordant since the mid-1950s. A review of sociological theories of suicide identifies problems in accounting for such changes--problems stemming in part from what has been a theoretical emphasis on cross-sectional relations.     

Worried and wired: effects of health anxiety on information-seeking and health care utilization behaviors.

Although online health information-seeking has been widely studied and findings suggest a variety of motivations behind an individual's health information-seeking behavior, little is known about how this information influences health utilization behaviors. Thus, the current study investigates the relationship between online health information seeking and health care utilization such as visiting a doctor. Additionally, this project expands the literature by examining the moderating role of health anxiety. Results suggest that an individual's level of health anxiety moderates the relationship between online health information seeking and health care utilization decisions.     

Motivational and Emotional Consequences of Self-Engagement: Voting in the 2000 U.S. Presidential Election

The role played by self-engagement in the prediction and consequences of goal-directed behavior was examined. Components of the Triangle Model of Responsibility were measured 4 days prior to the 2000 U.S. presidential election, and reported voting and reactions to the election were measured the day after the election. In support of the model, engagement in voting was highest when the guidelines for voting were perceived as clear, when the individual perceived personal control over voting, when the individual perceived voting as relevant to his or her role as a citizen, and when who won the election was important to the individual. Engagement in voting was strongly related to reports of actually voting in the election, and completely mediated the relationship between the other predictors and reported voting. Engagement was also related to a variety of behavioral activities (e.g., watching the presidential and vice-presidential debates, staying up late to watch the election results) indicative of investment in the election. Finally, being engaged in the act of voting prior to the election was strongly related to being in a heightened state of uncertainty and anxiety as a function of not knowing the outcome of the election. The importance of self-engagement in predicting behavior and emotional consequences to behavior is discussed.     

Associations of Stress Exposures and Social Support With Long-Term Mental Health Outcomes Among U.S. Iraq War Veterans

The long-term mental health effects of war-zone deployment in the Iraq and Afghanistan wars on military personnel are a significant public health concern. Using data collected prospectively at three distinct assessments during 2003–2014 as part of the Neurocognition Deployment Health Study and VA Cooperative Studies Program Study #566, we explored how stress exposures prior, during, and after return from deployment influence the long-term mental health outcomes of posttraumatic stress disorder (PTSD), depression, anxiety disorders, and problem drinking. Longer-term mental health outcomes were assessed in 375 service members and military veterans an average of 7.5 years (standard deviation = 1.0 year) after the initial (i.e., “index”) Iraq deployment following their predeployment assessment. Anxiety disorder was the most commonly observed long-term mental health outcome (36.0%), followed by depression (24.5%), PTSD (24.3%), and problem drinking (21.0%). Multivariable regression models showed that greater postdeployment stressors, as measured by the Post-Deployment Life Events scale, were associated with greater risk of depression, anxiety disorders, and problem drinking. Anxiety disorder was the only outcome affected by predeployment stress concerns. In addition, greater postdeployment social support was associated with lower risk of all outcomes except problem drinking. These findings highlight the importance of assessing postdeployment stress exposures, such as stressful or traumatic life events, given the potential impact of these stressors on long-term mental health outcomes. This study also highlights the importance of postdeployment social support as a modifiable protective factor that can be used to help mitigate risk of long-term adverse mental health outcomes following war-zone exposure.     

Predictors of Suicide‐Related Hospitalization among U.S. Veterans Receiving Treatment for Comorbid Depression and Substance Dependence

This study examined whether widely accepted suicide risk factors are useful in predicting suicide-related hospitalization, beyond history of a suicide attempt, in high-risk treatment-seeking veterans with depression and substance dependence. Negative mood regulation expectancies were the only significant predictor of hospitalization during 6-months of outpatient treatment. History of a suicide attempt was the only significant predictor of hospitalization during the one-year follow-up period. Results suggest that within high-risk populations, standard suicide risk factors may not identify individuals who will engage in suicidal behaviors resulting in hospitalization. Assessing negative mood regulation expectations may assist in identifying those most at risk.     

Relationship between gender and knowledge of U.S. state names and locations

Two experiments were conducted to assess gender differences in knowledge of U.S. state names and locations. Subjects for both experiments were drawn from a population that was approximately 95% Caucasian, 2% Native American, 1% Black, 1% Asian, and 1% Hispanic. Experiment 1 demonstrated superior male performance with respect to ability to correctly label state outlines on a blank map. Providing subjects with a list of state names (as a recall aid) resulted in performance deficits that were of equivalent magnitude for both males and females. It is suggested that this may have changed subjects' labeling strategy. Experiment 2, which assessed ability to list state names, showed no gender differences and no effect for providing a blank map (as a recall aid). Therefore, the performance differences obtained in Experiment 1 appear mediated by a gender difference in geographical knowledge and not by a gender difference in knowledge of state names. Implications of geographical knowledge deficits are briefly discussed.     

The Long-Term Effects of Operation Desert Storm on the Psychological Distress of U.S. Army Reserve and National Guard Veterans1

This study assessed factors related to the long-term psychological health of a sample of U.S. Army National Guard and Reserve Unit veterans who served during Operation Desert Storm (ODS). In the analysis, general distress symptom measures were obtained and comparisons made from soldiers who deployed to Germany, the Persian Gulf region, and throughout the United States, with soldiers who did not deploy. Elevated symptom levels were found for veterans of the Persian Gulf that could not be explained by variance attributed to demographics, or current life stress events. Reported exposure and the degree of current concern due to petrochemical fires in Kuwait were found to be significantly related to elevated symptom measures beyond the effect of combat-zone-related stresses. These findings suggest that a subset of Persian Gulf reserve veterans continue to have elevated levels of distress that are related to oil fire exposure.