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.     

Help‐Seeking for Suicidal Thoughts and Self‐Harm in Young People: A Systematic Review

There is a growing body of evidence to suggest that only a minority of young people experiencing suicidal thoughts or self‐harm present to any health services. This is of concern given that young people with suicidal thoughts or self‐harm often require treatment for mental illness as well as to reduce their risk of completed suicide. We reviewed previously published international community epidemiological studies examining help‐seeking for suicidal thoughts or self‐harm in young people up to the age of 26. The studies confirm that the majority of these young people do not seek professional help, and this includes seeking medical help after an overdose. The majority of young people studied do, however, seek help from social networks that most commonly are peers. Factors influencing and barriers to help‐seeking are discussed and highlight a need for further research into the role that peers and family play in the help‐seeking process for young people with suicidal thoughts or self‐harm.     

A Systematic Review of Suicide Prevention Programs for Military or Veterans

Military personnel and veterans have important suicide risk factors. After a systematic review of the literature on suicide prevention, seven (five in the U.S.) studies of military personnel were identified containing interventions that may reduce the risk of suicide. The effectiveness of the individual components was not assessed, and problems in methodology or reporting of data were common. Overall, multifaceted interventions for active duty military personnel are supported by consistent evidence, although of very mixed quality, and in some cases during intervals of declines in suicide rates in the general population. There were insufficient studies of U.S. Veterans to reach conclusions.     

Meta‐Analysis: A Systematic Method for Synthesizing Counseling Research

The authors provide a template for counseling researchers who are interested in quantitatively aggregating research findings. Meta‐analytic studies can provide relevant information to the counseling field by systematically synthesizing studies performed by researchers from diverse fields. Methodologically sound meta‐analyses require careful planning, diligent literature searches, detailed coding of study information, and knowledge of meta‐analytic approaches to statistical analyses. The authors provide steps to guide counseling researchers in conducting meta‐analytic reviews.     

Prevalence of Nonsuicidal Self‐Injury in Nonclinical Samples: Systematic Review,Meta‐Analysis and Meta‐Regression

Published prevalence estimates of nonsuicidal self‐injury (NSSI) among nonclinical samples are highly heterogeneous, raising concerns about their reliability and hindering attempts to explore the alleged increase in NSSI over time. Accordingly, the objectives of this study were to investigate the influence of methodological factors on heterogeneity in NSSI prevalence estimates, explore changes over time, and estimate overall international NSSI prevalence. Results showed that methodological factors contributed over half (51.6%) of the heterogeneity in prevalence estimates, and, after adjusting for these factors, NSSI prevalence did not increase over time. Overall, pooled NSSI prevalence was 17.2% among adolescents, 13.4% among young adults, and 5.5% among adults. Clearly, development of standardized methodology in NSSI research is crucial if accurate estimates are desired.     

Sleep Disturbances Among Combat Military Veterans: A Comparative Study Using Subjective and Objective Sleep Assessments

The sleep characteristics of 37 military veterans and active-duty service members (17 with PTSD and 20 without PTSD) of recent wars were analyzed to determine if combat deployment, with its associated sleep restriction, may be an alternative explanation for the sleep complaints found among combat veterans with PTSD (as determined by PTSD Checklist Military Version scores). Over a 1-week period, sleep data were collected using sleep actigraphy and self-report. Across the entire sample, subjective and objective assessment methods of sleep were strongly correlated, although there were some notable within-group differences. Specifically, although sleep duration between groups did not differ based on actigraphy, veterans without PTSD reported sleeping 1 h and 11 min (p = .002) longer than did veterans with PTSD. In an effort to determine why individuals without PTSD might be overreporting sleep, we found that symptoms of emotional arousal (anger, anxiety, and nightmares) were significantly correlated with self-reported sleep duration, suggesting a pattern of higher autonomic arousal found in veterans with PTSD. Thus, although sleeping for 6 h, the higher levels of emotional arousal reported by veterans with PTSD may mean that they do not perceive their sleep as restful. Further research is necessary to determine if the sleep architecture of veterans with PTSD is actually different from that of combat veterans without PTSD and if such differences are actually amenable to standard behavioral treatments for this disorder.     

Reactive Aggression and Suicide‐Related Behaviors in Children and Adolescents: A Review and Preliminary Meta‐Analysis

The empirical literature on the association between reactive aggression and suicide‐related behaviors in children and adolescents was reviewed. A narrative review of seven studies that met inclusion/exclusion criteria is followed by a preliminary meta‐analysis to provide insight into the strength of the association between reactive aggression and suicide‐related behaviors. Each of the seven studies reported a statistically significant association between reactive aggression and suicide‐related behaviors, including suicide, nonfatal suicide attempt, and suicide ideation. Results from the meta‐analysis indicated a consistent, medium‐sized association (k  = 7; N  = 4,693; rbar = .25). The narrative review and results of the preliminary meta‐analysis support the promise of pursuing future research on reactive aggression and suicide‐related behaviors in children and adolescents. A theoretical model is proposed to guide the development of future research.     

Targeting Self-Stigma in Returning Military Personnel and Veterans: A Review of Intervention Strategies

Research suggests that mental health-related stigma significantly decreases the use of mental health services by military personnel and veterans. The goal of this article is to review what is known about mental health stigma as it relates to military personnel and veterans, as well as to offer an interpretive review of self-stigma intervention strategies that have been applied within the field. Target areas for future work and the concerns and challenges faced by interventionists are discussed.     

Physical Disability and Suicidal Ideation: A Community‐Based Study of Risk/Protective Factors for Suicidal Thoughts

Although the significance of poor physical health for suicide risk is well established, the potential relevance of physical disability, as distinct from diseases and traumas that give rise to disability, has received little attention. Prior evidence suggests the possible utility of the stress process theoretical model for understanding variations in risk for suicide ideation and the contribution of physical disability to such risk. In this article, we examine the independent and joint explanatory significance of physical disability and components of the stress process model for risk of suicide ideation. Data from an ethnically diverse and representative sample of disabled and nondisabled adults (n = 1,768) reveal that physical disability is associated with a greater risk of lifetime suicidal ideation.     

Prospective Study of Major Loss Life Events and Risk for Suicidal Thoughts and Behaviors Among Adolescents and Young Adults

This prospective, naturalistic study examined the association between major loss life experiences, other psychiatric risk factors (depression, hopelessness, and anxiety), and suicidal thoughts and behaviors (STBs) among adolescents followed through young adulthood for up to 14 years. Major loss life events were related to subsequent increases in STBs. Major loss life events were primarily related to increases in suicide ideation in the presence of lower levels of other risk factors. There was a bidirectional relationship between major losses and other risk factors. Implications for the association between loss experiences, other risk factors, and future STBs are discussed.     

Accuracy of Clinician Predictions of Future Self‐Harm: A Systematic Review and Meta‐Analysis of Predictive Studies

Assessment of a patient after hospital‐treated self‐harm or psychiatric hospitalization often includes a risk assessment, resulting in a classification of high risk versus low risk for a future episode of self‐harm. Through systematic review and a series of meta‐analyses looking at unassisted clinician risk classification (eight studies; N = 22,499), we found pooled estimates for sensitivity 0.31 (95% CI: 0.18–0.50), specificity 0.85 (0.75–0.92), positive predictive value 0.22 (0.21–0.23), and negative predictive value 0.89 (0.86–0.92). Clinician classification was too inaccurate to be clinically useful. After‐care should therefore be allocated on the basis of a needs rather than risk assessment.     

A Systematic Review: Non‐Suicidal Self‐injury in Australia and New Zealand's Indigenous Populations

Objective

To undertake a systematic review of non‐suicidal self‐injury (NSSI) prevalence, patterns, functions, and behavioural correlates for the Indigenous populations of Australia (Aboriginal and Torres Strait Islanders) and New Zealand (NZ; Maori).

Method

We searched the following electronic databases: PubMed, MedLine, Scopus, Web of Science, ScienceDirect, PsycInfo, and PsycArticles, CINAHL, and the Informit Health and Indigenous Peoples collections. Studies were included for review if they were published within the last 25 years and reported on NSSI in Australia and NZ's Indigenous populations.

Results

Seven studies were included, six of which came from Australia. The prevalence of NSSI in Australia ranged from 0.9% up to 22.50%; statistics varied by the different samples, types of prevalence, and relationship to alcohol. Several studies found that Aboriginal and Torres Strait Islander peoples had higher rates of NSSI than other Australians, but that this was not significantly higher. Two studies indicated that NSSI was linked to alcohol use, incarceration, and a younger age. The one NZ study was of injury and not specifically NSSI.

Conclusions

Findings are limited due to a small pool of literature. Cultural variations in NSSI presentation should be considered when working with Indigenous populations. Further research is required to help determine what cultural variations may exist.     

Risk Factors for Suicide and Suicidal Behavior Relevant to Emergency Health Care Settings: A Systematic Review of Post‐2007 Reviews

Suicide is a global public health problem, and with recent economic and societal changes, there may be emerging risk factors unrecognized by health care professionals. The aim of this systematic review was to update existing suicide risk factor literature applicable to emergency health care settings. A total of 35 articles identified from PsycINFO, CINAHL, and Medline met the inclusion criteria. Results supported the significance of existing suicide risk factors and identified emerging risk factors. The review provides a high‐quality update of risk factor literature that could be applied to emergency health care settings; however, further research is needed to confirm emerging risk factors.     

The Political Consequences of Combat: Post‐Traumatic Stress and Political Alienation Among Vietnam Veterans

On average, veterans are more civically and politically engaged than civilians. Previous research on the effects of military service, however, did not account for differences in veterans’ combat experiences. Using survey data from a representative sample of Vietnam veterans, this study presents evidence that veterans who were exposed to severe combat trauma and veterans who exhibited attitudes and fears associated with post‐traumatic stress had significantly lower levels of political efficacy and trust. The negative consequences of combat exposure and post‐traumatic stress are not mitigated when veterans have quality social support or when they seek professional counseling. These findings inform political psychology and hold implications for claims regarding the empowering influence of service in the U.S. military, increased political engagement, in particular. Among Vietnam veterans, exposure to severe combat trauma and post‐traumatic stress were both associated with reduced political efficacy and trust.     

Attachment Patterns as Mediators of the Link Between Combat Exposure and Posttraumatic Symptoms: A Study Among Portuguese War Veterans

We analyzed the role of both attachment anxiety and attachment avoidance as a mediators of the effects of combat exposure on posttraumatic stress disorder (PTSD) symptoms. Participants were Portuguese veterans (N = 60) divided into 2 groups: 30 suffered from chronic PTSD (nonrecovered) and 30 had remission from PTSD (recovered). Combat exposure, attachment patterns, and PTSD symptoms were assessed through self-report measures. Mediation test was performed by conducting several hierarchical regression analyses. Results showed higher attachment anxiety among nonrecovered participants. We did not find statistically significant differences between groups for both attachment avoidance and combat exposure level scores. In mediation analysis, at first step, attachment avoidance was not a significant predictor of PTSD symptoms, and attachment avoidance did not enter in subsequent analysis. Attachment anxiety was a partial mediator of the effect of combat exposure on PTSD symptoms. Implications of the findings for both attachment theory and clinical intervention on trauma are discussed.     

Body Mass Index Is an Important Predictor for Suicide: Results from a Systematic Review and Meta‐Analysis

Public health concerns for the independent management of obesity and suicidal behavior are rising. Emerging evidence suggests body weight plays an important role in quantifying the risk of suicide. In light of these findings, we aimed to clarify the association between body mass index (BMI) and suicidal behavior by systematically reviewing and evaluating the literature. Studies were identified by searching MEDLINE, EMBASE, PsycINFO, and CINAHL from inception to January 2015, supplemented by hand and grey literature searches. Study screening, data extraction, and risk of bias assessment were conducted in duplicate. We included 38 observational studies. Meta‐analyses supported an inverse association between BMI and completed suicide. Pooled summary estimates demonstrated that underweight was significantly associated with an increased risk of completed suicide (HR = 1.21, 95% CI 1.07 to 1.36, p = .002), and obesity (HR = 0.71, 95% CI 0.56 to 0.89, p = .003) and overweight (HR = 0.78, 95% CI 0.75 to 0.82, p < .0001) were significantly associated with a decreased risk of completed suicide relative to normal weight. A qualitative summary of the literature demonstrated conflicting evidence regarding the association between BMI and attempted suicide and revealed no association between BMI and suicidal ideation. BMI may be used to aid the assessment of suicide risk, especially that of completed suicide. However, unmeasured confounders and systematic biases of individual studies limit the quality of evidence.     

Racial Discrimination and Health Outcomes Among Racial/Ethnic Minorities: A Meta‐Analytic Review

In this meta‐analysis, the authors reviewed 105 studies on the relationships between racial discrimination and health outcomes among racial/ethnic minority Americans. The authors tested for moderator effects of measurement strategies, cultural factors, substance use, gender, and racial group differences. Findings indicate a statistically significant effect size between racial discrimination and health, with the largest effect for mental health and strongest for studies with multi‐item measures. En este metaanálisis, los autores revisaron 105 estudios sobre las relaciones entre la discriminación racial y los resultados para la salud entre americanos pertenecientes a minorías raciales o étnicas. Los autores examinaron los efectos moderadores de las estrategias de medición, los factores culturales, el uso de sustancias, el género y las diferencias entre grupos raciales. Los hallazgos indican un efecto de tamaño estadísticamente significativo entre la discriminación racial y la salud, con el máximo efecto observado en la salud mental y el más fuerte en estudios con mediciones múltiples.     

On the Iatrogenic Risk of Assessing Suicidality: A Meta‐Analysis

Previous studies have failed to detect an iatrogenic effect of assessing suicidality. However, the perception that asking about suicide may induce suicidality persists. This meta‐analysis quantitatively synthesized research concerning the iatrogenic risks of assessing suicidality. This review included studies that explicitly evaluated the iatrogenic effects of assessing suicidality via prospective research methods. Thirteen articles were identified that met inclusion criteria. Evaluation of the pooled effect of assessing suicidality with regard to negative outcomes did not demonstrate significant iatrogenic effects. Our findings support the appropriateness of universal screening for suicidality, and should allay fears that assessing suicidality is harmful.     

Self‐Criticism as a Transdiagnostic Process in Nonsuicidal Self‐Injury and Disordered Eating: Systematic Review and Meta‐Analysis

Nonsuicidal self‐injury (NSSI) and disordered eating (DE) are highly comorbid and may be regarded as belonging to a spectrum of self‐harm behaviors. We investigated self‐criticism as a transdiagnostic correlate of these behaviors, in keeping with etiological theories of both NSSI and DE. We reviewed the literature and meta‐analyzed the relation of self‐criticism to both NSSI (15 studies; 17 effect sizes) and DE (24 studies; 29 effect sizes). Results showed equivalent, moderate‐to‐large effects for the relation of self‐criticism to NSSI (r = .38; CI: .29–.46) and DE (r = .40; CI: .34–.45). The relation of NSSI to self‐criticism generalized across multiple potential moderators. DE behavior type moderated the relation of self‐criticism to DE, with a stronger relation emerging for purging than restriction. Findings support self‐criticism as a possible candidate for transdiagnostic pathways to self‐harm.