Lifetime Suicidal Behaviors and Career Characteristics Among U.S. Army Soldiers: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

The current report presents data on lifetime prevalence of suicide ideation and nonfatal attempts as reported by the large representative sample of U.S. Army soldiers who participated in the Consolidated All‐Army Survey of the Army Study to Assess Risk and Resilience in Servicemembers (N  =  29,982). We also examine associations of key Army career characteristics with these outcomes. Prevalence estimates for lifetime suicide ideation are 12.7% among men and 20.1% among women, and for lifetime suicide attempts are 2.5% and 5.1%, respectively. Retrospective age‐of‐onset reports suggest that 53.4%–70% of these outcomes had preenlistment onsets. Results revealed that, for both men and women, being in the Regular Army, compared with being in the National Guard or Army Reserve, and being in an enlisted rank, compared with being an officer, is associated with increased risk of suicidal behaviors and that this elevated risk is present both before and after joining the Army.     

Prior Mental Disorders and Lifetime Suicidal Behaviors Among US Army Soldiers in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

We report on associations of retrospectively reported temporally prior mental disorders and Army career characteristics with subsequent first onset of suicidal behaviors in a large, representative sample of US Army soldiers who participated in the Consolidated All‐Army Survey of the Army Study to Assess Risk and Resilience in Servicemembers (N = 29,982). Results reveal that among men and women, all self‐reported lifetime disorders measured (some assessed with screening scales) are associated with subsequent onset of suicide ideation. Among men, three disorders characterized by agitation and impulsiveness (intermittent explosive disorder, panic disorder, and substance disorders) predict the transition from suicide ideation to attempt. For both men and women, being in the Regular Army (vs. National Guard or Army Reserve) predicts suicide attempts in the total sample. For men, a history of deployment and junior rank are predictors of suicide attempts after adjusting for preenlistment disorders but not accounting for pre‐ and postenlistment disorders, suggesting that postenlistment disorders account for some of the increased suicide risk among these career characteristics. Overall, these results highlight associations between mental disorders and suicidal behaviors, but underscore limitations predicting which people with ideation attempt suicide.     

Mental Disorders,Comorbidity, and Pre‐enlistment Suicidal Behavior Among New Soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

We examined the associations between mental disorders and suicidal behavior (ideation, plans, and attempts) among new soldiers using data from the New Soldier Study (NSS) component of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS; N = 38,507). Most new soldiers with a pre‐enlistment history of suicide attempt reported a prior mental disorder (59.0%). Each disorder examined was associated with increased odds of suicidal behavior (ORs = 2.6–8.6). Only PTSD and disorders characterized by irritability and impulsive/aggressive behavior (i.e., bipolar disorder, conduct disorder, oppositional defiant disorder, and attention‐deficit/hyperactivity disorder) predicted unplanned attempts among ideators. Mental disorders are important predictors of pre‐enlistment suicidal behavior among new soldiers and should figure prominently in suicide screening and prevention efforts.     

无望与希望：从认知方式看无望抑郁的风险和恢复

由于视角和侧重点的差异, 无望抑郁认知研究基本上可以分为两大取向。一是以认知易感-压力模型为核心, 围绕“无望”展开的病因学研究, 关注认知危险因素、消极生活事件与无望以及抑郁风险之间的关系。二是以恢复模型为核心, 围绕重获“希望”展开的无望抑郁恢复研究, 关注认知保护因素、积极生活事件与重获希望以及抑郁缓解之间的关系。厘清一些相关问题、整合两个研究取向有利于准确评估个体无望抑郁的风险和弹性恢复。     

Suicides in the developing world: case study from Pakistan

There are no official data on suicide from Pakistan, a conservative South Asian Islamic country with traditionally low suicide rates. Both suicide and attempted suicide are illegal acts, as well as socially and religiously condemned, making research in this area difficult. Recent reports suggest an increase in suicide rates. In this study, police data from the Sindh province were examined to provide a unique picture of trends of suicide over 15 years (1985-1999). During this period there were 2,568 reported suicides (71% men, 39% women; ratio 1.8). The lowest number was 90 in 1987 and maximum was 360 in 1999. Poisoning by organophosphates was the most common method followed by hanging. This study, although limited in scope, provides evidence of an increase in suicide rates in Pakistan, from one data source. There is urgent need for further research on suicide in Pakistan; interventions for suicide prevention in the country can then be planned.     

The Viability of Organizational Wellness Programs: An Examination of Promotion and Results

Wellness programs in contemporary organizations are increasing in number, but attendance is low and results often are difficult to track. We examined participant and program characteristics in 2 organizations that offered extensive wellness activities. One organization considered its program successful and had been in operation for 10 years, while the other organization's program ran for 2 years and ended because of a lack of funding. In the successful program, wellness program attendance showed a relationship to time employees took off for sick days, and improved fitness produced similar results. In the less successful operation, interviews were held with mangers and employees regarding promotion and program support. Suggestions are provided for future wellness programs.     

How to Choose a Measure of Resilience: An Organizing Framework for Resilience Measurement

Existing measures of resilience include disparate content that is based on qualitatively different conceptualizations of the construct. Consequently, there is confusion and inconsistency regarding the measurement and application of resilience. To promote clarity, the authors conduct an examination of resilience measurement approaches. This was accomplished by elaborating on three fundamentally distinct conceptualizations of resilience that can serve as an organizing framework for measurement; (1) attribute/resource-focused; (2) process-focused; and (3) outcome-focused. To verify the utility of this framework, qualified and trained subject matter experts (SMEs) completed a content analysis categorization task by sorting 227 items from 11 scales into these categories. Frame-of-reference (FOR) training was used to prepare the SMEs. Results were largely supportive of the three category framework, as overall SME agreement was 86.76 percent and only 10 of 227 items (4.41%) were categorized as “unclear” with regard to the categories. At the same time, SME agreement varied across the scales and sub-dimensions examined, suggesting that some scales/sub-dimensions are more conceptually clear than others in terms of the three categories. Based on the results, the authors provide guidance for how to choose a measure of resilience and discuss different workplace applications that are aligned with the aforementioned categories.     

Youth Suicide Trends in California: An Examination of Immigrant and Ethnic Group Risk

Although immigrants are in better health than the U.S.-born population according to a variety of indicators, little research has investigated current foreign-born/U.S.-born differentials in suicide. A review of 32,928 California death certificates from 1970 to 1992 indicates that although foreign-born persons are consistently underrepresented in the suicide deaths of 15- to 34-year-olds (risk ratio = 0.60), any foreign- versus U.S.-born difference by ethnicity appears to be decreasing. Specifically, although Hispanics born outside the United States consistently are at significantly lower risk of suicide than U.S.-born Hispanics, the discrepancy between the two groups has diminished over time. And, in a comparable trend, non-Hispanic white persons born outside the United States were at higher risk of suicide than their U.S.-born counterparts until 1990, when their risk became similar. Black and Asian/other foreign- and U.S.-born persons have been at statistically similar risk since 1970. A man using a firearm at home was the typical pattern for both the foreign- and U.S.-born.     

Assessing Violence Risk Among Female IPV Perpetrators: An Examination of the B-SAFER

Intimate partner violence (IPV) is a global problem and one in which frontline assessment and management falls primarily to police. Although IPV is often conceptualized as a male-perpetrated crime, evidence substantiates female IPV perpetration and increased arrest rates, raising important issues for police. This article examines police use of the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER; Kropp, Hart, & Belfrage, 2005, 2010), a violence risk assessment tool for IPV. The B-SAFER was used to assess and manage 52 women arrested for IPV. When compared to Belfrage and Strand (2008), who examined men arrested for IPV in the same sample, women possessed fewer risk factors. Risk factors were related to summary risk judgments, although differences existed between genders and risk judgments were not related to management recommendations. Results suggest that risk factors, in addition to those in the B-SAFER, are required to assess risk for female IPV.     

Marriage Education in the Army: Results of a Randomized Clinical Trial

Although earlier studies have demonstrated promising effects of relationship education for military couples, these studies have lacked random assignment. The current study evaluated the short-term effects of relationship education for Army couples in a randomized clinical trial at two sites (476 couples at Site 1 and 184 couples at Site 2). At both sites, participant satisfaction with the program was high. Intervention and control couples were compared on relative amounts of pre-intervention to post-intervention change. At Site 1, not all variables showed the predicted intervention effects, although we found significant and positive intervention effects for communication skills, confidence that the marriage can survive over the long haul, positive bonding between the partners, and satisfaction with sacrificing for the marriage or the partner. However, at Site 2, we found significant and positive intervention effects for communication skills only. Possible site differences as moderators of intervention effects are discussed.     

Risk,Resilience, and the Rorschach: A Longitudinal Study of Children Who Experienced Sexual Abuse

Experiencing sexual abuse increases the risk that children will report or otherwise demonstrate problems with emotion, behavior, and health. This longitudinal study of 44 children who experienced sexual abuse examined whether information processing as assessed via the Rorschach Inkblot Test was associated with child-reported depression symptoms assessed via the Children's Depression Inventory (Kovacs, 1992) concurrently and an average of 15 months later. Children whose Rorschach protocols were relatively free of scores suggesting intense distress, complex processing, and sexual content were more likely to experience remission of depression symptoms at follow-up. Findings provide incremental validity for certain Rorschach indexes to inform prognosis regarding depression symptoms and perhaps their treatment.     

Mechanisms of Risk and Resilience in Military Families: Theoretical and Empirical Basis of a Family-Focused Resilience Enhancement Program

Recent studies have confirmed that repeated wartime deployment of a parent exacts a toll on military children and families and that the quality and functionality of familial relations is linked to force preservation and readiness. As a result, family-centered care has increasingly become a priority across the military health system. FOCUS (Families OverComing Under Stress), a family-centered, resilience-enhancing program developed by a team at UCLA and Harvard Schools of Medicine, is a primary initiative in this movement. In a large-scale implementation project initiated by the Bureau of Navy Medicine, FOCUS has been delivered to thousands of Navy, Marine, Navy Special Warfare, Army, and Air Force families since 2008. This article describes the theoretical and empirical foundation and rationale for FOCUS, which is rooted in a broad conception of family resilience. We review the literature on family resilience, noting that an important next step in building a clinically useful theory of family resilience is to move beyond developing broad “shopping lists” of risk indicators by proposing specific mechanisms of risk and resilience. Based on the literature, we propose five primary risk mechanisms for military families and common negative “chain reaction” pathways through which they undermine the resilience of families contending with wartime deployments and parental injury. In addition, we propose specific mechanisms that mobilize and enhance resilience in military families and that comprise central features of the FOCUS Program. We describe these resilience-enhancing mechanisms in detail, followed by a discussion of the ways in which evaluation data from the program’s first 2 years of operation supports the proposed model and the specified mechanisms of action.     

基于文化的心理复原力研究

随着对个体心理复原力研究不断深入,文化作为影响个体心理复原力的重要因素日益受到关注,研究者在厘清文化与复原力之间的关系后,尝试以积极心理学的视角,将中国传统文化中"天人合一"、"以人为本"、"自强不息"、"厚德载物"等文化精神引入到个体心理复原力发展的过程中,为个体心理复原力的研究贡献价值。     

Markers of Resilience and Risk: Adult Lives in a Vulnerable Population

In this report, we drew on data from an ongoing longitudinal study that began in 1978 (Hauser, Powers, Noam, Jacobson, Weiss, & Folansbee, 1984). Focusing on late, young-adult life among individuals who were psychiatrically hospitalized during adolescence, we examined markers of resilience empirically defined in terms of adult success and well-being. The study includes a demographically similar group recruited from a public high school. Major goals were to (a) develop preliminary models of adaptive functioning among adults in their 30s, (b) examine the extent to which adults with histories of serious mental disorders can be characterized by these models, and (c) explore predictors of successful adult lives from indicators of individuals' psychosocial adjustment at age 25. Results showed significant cohort effects on indexes of adaptive functioning, especially for men. Findings suggest that social relations as well as self-views of competence and relatedness play important roles in characterizing adjustment during the adult years. In addition, indexes of psychosocial adjustment as well as symptoms of psychiatric distress and hard drug use at age 25 made a difference in adult social functioning and well-being, providing hints of possible mechanisms likely to facilitate the ability to "bounce back" after a difficult adolescence.     

Markers of Resilience and Risk: Adult Lives in a Vulnerable Population

In this report, we drew on data from an ongoing longitudinal study that began in 1978 (Hauser, Powers, Noam, Jacobson, Weiss, & Folansbee, 1984). Focusing on late, young-adult life among individuals who were psychiatrically hospitalized during adolescence, we examined markers of resilience empirically defined in terms of adult success and well-being. The study includes a demographically similar group recruited from a public high school. Major goals were to (a) develop preliminary models of adaptive functioning among adults in their 30s, (b) examine the extent to which adults with histories of serious mental disorders can be characterized by these models, and (c) explore predictors of successful adult lives from indicators of individuals' psychosocial adjustment at age 25.Results showed significant cohort effects on indexes of adaptive functioning, especially for men. Findings suggest that social relations as well as self-views of competence and relatedness play important roles in characterizing adjustment during the adult years. In addition, indexes of psychosocial adjustment as well as symptoms of psychiatric distress and hard drug use at age 25 made a difference in adult social functioning and well-being, providing hints of possible mechanisms likely to facilitate the ability to "bounce back" after a difficult adolescence.     

A Screening Tool to Assess and Manage Behavioral Risk in the Postoperative Bariatric Surgery Patient: The WATCH

Bariatric surgery is increasingly recognized as a highly effective treatment for individuals who are severely obese. Amount of weight loss and resolution of comorbidities surpass those of nonsurgical approaches; however, suboptimal weight loss and weight regain are not uncommon. These outcomes, though not fully understood, are likely at least partially explained by failure to make long-term behavioral and/or cognitive changes. We are unaware of any established clinical tools to guide providers in assessing postoperative behaviors and identifying those who may require specialized treatment. The goal of this paper is to introduce a brief screening tool, The WATCH, to help clinicians assess and identify patients who may be at risk for poor or untoward outcomes post bariatric surgery. We first review the literature on postoperative outcomes, including weight loss, resolution of comorbidities, suboptimal outcomes, and development of problematic eating behaviors. We then provide an easily-recalled, five-item tool that assesses outcomes, and discuss patient responses that may necessitate further intervention or referral.     

Religion and HIV Risk Behaviors Among Married Men: Initial Results from a Study in Rural Sub-Saharan Africa

Although some scholars have identified religion as a possible protective factor in the AIDS pandemic in sub-Saharan Africa, evidence concerning the relationship between religion and AIDS behavior there remains sparse. Using a sample of married men from rural Malawi, we examine whether AIDS risk behavior and perceived risk are associated with religious affiliation or with religious involvement. Our analyses of data from the Malawi Diffusion and Ideational Change Project (2001) reveal substantial variation according to religious affiliation and religious involvement. Men belonging to Pentecostal churches consistently report lower levels of both HIV risk behavior and perceived risk. Regular attendance at religious services is associated both with reduced odds of reporting extramarital partners and with lower levels of perceived risk of infection.