Firearm Storage Practices and Risk Perceptions Among a Nationally Representative Sample of U.S. Veterans With and Without Self‐Harm Risk Factors

Despite the disproportionate use of firearms in Veteran suicides and the well‐established link between firearm access and suicide, little is known about how Veterans store their firearms or what they think about the relationship between firearm access and suicide risk. Using data from 2015 nationally representative online survey (response rate 60.9%), we compare characteristics of Veteran firearm owners with and without self‐harm risk factors with respect to how they store their firearms and their beliefs about suicide risk related to firearms. Overall, one in three U.S. Veteran firearm owners store household firearms loaded and unlocked, one in twenty believe that a firearm increases household suicide risk, and one in four consider their loaded and unlocked firearm to be inaccessible to suicidal household members. Storage practices and risk perceptions are similar among those with and without self‐reported suicide risk factors. Affecting risk perceptions may be a critical aspect of interventions addressing lethal means safety among U.S. Veterans.     

Suicide mortality among Kentucky farmers, 1979-1985

Farmers may be at high risk for suicide because of their social environment and because of chemical exposure resulting in neurotoxic effects in the workplace. Age-specific suicide rates are compared for Kentucky white farmers, Kentucky white males, and U.S. white males. Data for suicides occurring in Kentucky represent the 7-year period between 1979 and 1985; data for the United States suicides represent the period 1980. Overall, suicide rates were highest for Kentucky farmers, followed by Kentucky males and then by U.S. males. All males were most likely to use firearms as the mode of suicide, but the farmers used firearms significantly more often than the U.S. males, as did the other Kentucky males. These findings and other evidence support the need to assess suicide rates in this occupational group in other states, to begin suicide prevention programs for Kentucky, and to work to identify risk factors contributing to the Kentucky farm suicides.     

Mood,Anxiety, and Substance‐Use Disorders and Suicide Risk in a Military Population Cohort

There are meager prospective data from nonclinical samples on the link between anxiety disorders and suicide or the extent to which the association varies over time. We examined these issues in a cohort of 309,861 U.S. Air Force service members, with 227 suicides over follow‐up. Mental disorder diagnoses including anxiety, mood, and substance‐use disorders (SUD) were based on treatment encounters. Risk for suicide associated with anxiety disorders were lower compared with mood disorders and similar to SUD. Moreover, the associations between mood and anxiety disorders with suicide were greatest within a year of treatment presentation.     

Interaction of Combat Exposure and Unit Cohesion in Predicting Suicide‐Related Ideation Among Post‐Deployment Soldiers

Suicide is one of the leading causes of death among U.S. Army soldiers. Suicide‐related ideation, which is associated with suicide attempts and suicide, can cause considerable distress. In a sample of 1,663 recently redeployed soldiers, we used factor analysis and structural equation modeling to test the associations between combat exposure, unit cohesion, and their interaction in predicting suicide‐related ideation. We found that combat exposure was a significant risk factor for suicide‐related ideation, while unit cohesion was a significant protective factor. The significant interaction between the two factors indicated that soldiers who experienced greater combat exposure but also had higher levels of unit cohesion had relatively lower levels of suicide‐related ideation. In addition, those who had higher levels of combat exposure and lower unit cohesion were most at risk for suicide‐related ideation. Our findings indicate the importance of unit cohesion in protecting soldiers from suicide‐related ideation and suggest a higher risk group of soldiers who should be targeted for interventions.     

Demographic, criminal, and psychiatric factors related to inmate suicide

A review of 19 studies suggests that it may be feasible to identify prisoners with suicide risk on the basis of demographic, psychiatric, and criminal characteristics. The present study aimed to identify combinations of characteristics that are capable of identifying potential suicide victims. Characteristics of 95 suicide victims in the Dutch prison system were compared with those of a random sample of 247 inmates in ten jails. Combinations of indicators for suicide risk were also tested for their capability of identifying 209 suicides in U.S. jails and 279 prison suicides in England and Wales. A combination of six characteristics (age 40+, homelessness, history of psychiatric care, history of drug abuse, one prior incarceration, violent offence) was capable of correctly classifying 82% of the Dutch suicide victims (82% specificity). Less powerful combinations correctly classified 53% of the U.S. suicides and 47% of the U.K. suicides. It is concluded that a set of demographic and criminal characteristics and indicators of psychiatric problems is useful for the identification of suicide risk in jails and prisons.     

The Sexual Harassment–Suicide Connection in the U.S. Military: Contextual Effects of Hostile Work Environment and Trusted Unit Leaders

Sexual harassment has been associated with suicidal behaviors, and with the rise in suicides in the U.S. military, sexual harassment's role in suicide has been of growing interest. Lacking are studies that examine group‐ or unit‐level variables in the relationship of sexual harassment to suicidal behaviors (thoughts, plans, and attempts). In this study, survey data from soldiers (12,567 soldiers in 180 company‐sized units) who completed the Unit Risk Inventory administered during calendar year 2010 were analyzed using hierarchical linear modeling. At the individual level, sexual harassment was associated with a fivefold increase for risk of suicide. Reporting that leaders could be trusted was associated with a decreased suicide risk by about one‐third. There was no statistically significant interaction between sexual harassment and trusted leaders in predicting the suicidal behaviors. At the group level, units or companies having higher levels of sexual harassment also had soldiers three times more at risk for suicide. A cross‐leveling effect was also observed: Among units having higher levels of sexual harassment, the negative correlation (buffering effect of unit leaders on suicidal behaviors) was diminished. Implications of findings for preventing sexual harassment and suicide risk are discussed.     

Disentangling the Person and the Place as Explanations for Regional Differences in Suicide

Identifying whether suicides in a region are due to characteristics of the residents living there or to some enduring feature of the region is difficult when using cross‐sectional studies. To distinguish these factors, we compared the suicides of a region's residents with people who were temporarily visiting the region. Using U.S. death records from 1973–2004, we focused on states with the highest and lowest suicide rates over this period. The high suicide region consisted of Arizona, Colorado, Montana, New Mexico, Nevada, Oregon, and Wyoming; the low suicide region consisted of Connecticut, Illinois, Massachusetts, New Jersey, and New York. For each region, we considered three groups of decedents: residents who died inside the region, residents who died outside the region, and visitors to the region. Proportionate mortality ratios were calculated for all suicides and separately for firearm suicides. In the high suicide region, visitors to and residents away from the region both had elevated suicide levels, to about the same extent as residents dying inside the region. Therefore, short‐term exposure to the region and being a resident of the region each predicted suicide. In the low suicide region, the suicides of residents at home were reduced, but their suicides rose dramatically once they left the area. There was no decrease in suicides among visitors to the region. Firearm use was related to the suicide levels of each region. Overall, the results suggest that both the available means to commit suicide and the contextual features of the regions contributed to their extreme suicides. We discuss how an examination of visitors can help researchers generate novel inferences about the causes of suicide.     

Suicide in the U.S. Army: epidemiological and periodic aspects

An overview of suicide in the U.S. Army is presented in two sections: (1) the epidemiology of U.S. Army suicides, based on biennium reports, and (2) the temporal aspects of those suicides compared with the data for the United States as a whole. A brief historical review documents some of the changes in contemporary military suicide rates compared to those of the past century. The cycles in the number of suicides by day of the week, day of the month, and the month of the year for the U.S. Army are computed and contrasted with those reported for the U.S. resident population.     

Implementing Firearms Restriction for Preventing U.S. Army Suicide

Suicide among U.S. Army soldiers remains a significant concern for both population health and personnel readiness, with firearms constituting the majority of soldier suicides. Means restriction, or removing an at-risk soldier’s access to lethal means, is a well-established procedure for reducing suicides. Nonetheless, various cultural, legal, and practical concerns may encumber firearms restriction implementation in the U.S. Army. This article reviews policy relevant to firearms restriction, including federal laws, Department of Defense directives, and U.S. Army regulations. Recommendations are provided for providers and commanders that balance the rights of soldiers with the need to ensure safety. In particular, installation restriction, field settings, enlisting supportive others, unit engagement, and off-installation storage are discussed. These approaches span the public health intervention model, providing numerous potential avenues to a balanced approach for firearms restriction in preventing suicide.     

The Impact of Exposure to Peer Suicidal Self‐Directed Violence on Youth Suicidal Behavior: A Critical Review of the Literature

There is considerable evidence that being exposed to the suicide or suicidal behavior of another can increase the risk for suicide. Significant relationships between media coverage and youth suicide have been documented in the professional literature. Exposure to familial suicidal behavior has also been established as a risk factor for youth suicidal behavior; However, peer suicide exposure is not as clear cut as research results in this area have been mixed. In the current paper the empirical literature focused on the associations between exposure to peer suicides and suicide attempts and youth suicidal behavior is critically reviewed. Effect sizes were computed for each of the 23 studies included in the review to allow for cross‐study comparisons. The results demonstrate that having a friend or acquaintance attempt suicide is significantly related to risk for suicidal thoughts and behavior. However, the support for the relationship between the suicide of a peer and youth suicidal behavior was less consistent. Implications for clinical practice and suicide postvention as well as areas of future research are discussed.     

A drop in suicides around major national holidays

To study the fluctuation of suicides around the holidays, we examined 188,047 U.S. suicides from 1973 to 1979. Correcting for the effects of extraneous variables, such as seasons and days of the week, we found that suicides dropped by an annual average of -102.5 in the period surrounding the holidays. One set of holidays (Memorial Day, Thanksgiving, and Christmas) was associated with an unusually low risk of suicide before, during, and after the holiday. Another set of holidays (New Year's Day, July 4th, and Labor Day) was associated with a low risk of suicide before the holiday and a high risk just afterwards. Almost all demographic groups experienced a low risk of suicide around the holidays: whites, blacks, males, females, retired persons, and persons of working age. Only white teenagers deviated from this pattern. Thus, the evidence does not support the widespread popular assumption that holidays are a risk factor in suicide.     

Prior Health Care Utilization Patterns and Suicide Among U.S. Army Soldiers

Suicides among U.S. Army soldiers are increasing and, in January 2009, outpaced deaths due to combat. For this study, 1,873 army suicides identified through death, inpatient, and emergency room records were matched with 5,619 controls. In multivariate models, older, male, White, single, and enlisted soldiers with a prior injury (OR = 2.04, 95% CI = 1.64‐2.54), alcohol (OR = 3.41, 95% CI = 2.32‐4.99), or mental health hospitalization (OR = 6.62, 95% CI = 4.77‐9.20) were at increased risk for suicide. Risk was greatest immediately following diagnoses, but remained elevated even after 5 or more years of follow‐up. Most injury hospitalizations were unintentional but, nonetheless, significantly associated with suicide. Interactions indicate soldiers with both mental health and injury history are particularly vulnerable.     

Reasons for Attempting Suicide among a Community Sample of Adolescents

The motives of suicide attempts among a community sample of 99 U.S. high school students were explored. Participants completed an in‐depth computer‐assisted self interview about their most recent attempts as well as additional psychosocial measures. Results indicated that nearly 75% of the adolescents engaged in suicide attempts for reasons other than killing themselves and that depressive symptoms and premeditation prior to the attempt were significantly associated with increased risk for engaging in the attempts with death as a clear motive. Linking motive for an attempt (death, interpersonal communication, emotion regulation) and treatment approach may improve prevention of subsequent attempts and completed suicides.     

Moving Beyond Self‐Report: Implicit Associations about Death/Life Prospectively Predict Suicidal Behavior among Veterans

Reliance on self‐report limits clinicians' ability to accurately predict suicidal behavior. In this study the predictive validity of an objective measure, the death/suicide Implicit Association Test (d/sIAT), was tested among psychiatrically hospitalized veterans. Following acute stabilization, 176 participants completed the d/sIAT and traditional suicide risk assessments. Participants had similar d/sIAT scores regardless of whether they had recently attempted suicide. However, d/sIAT scores significantly predicted suicide attempts during the 6‐month follow‐up above and beyond other known risk factors for suicidal behavior (OR = 1.89; 95% CI: 1.15–3.12; based on 1SD increase). The d/sIAT may augment the accuracy of suicide risk assessment.     

Double Jeopardy: Suicide Rates in Forensic Hospitals

While a number of studies have described high and increasing rates of completed suicide among psychiatric patients, the suicide risk of forensic hospital patients is virtually unknown. This paper reports on the suicides that have taken place in the country's oldest continually operating institution housing persons formerly labeled “criminally insane,” the Bridgewater State Hospital. The results show considerable variation in the suicide rate by historical period, with suicide prior to 1968 a considerably more infrequent event. By contrast, the post-′68 rate of 232 per 100,000 is comparable to data reported in a series of studies of psychiatric suicides, and significantly higher than that found in U.S. studies of correctional populations. These differences are discussed. The results strongly suggest that forensic hospital populations have suicide rates broadly comparable to other psychiatric populations.     

Early suicide following discharge from a psychiatric hospital

Social and clinical risk factors for completed suicide occurring shortly after discharge from a psychiatric hospital were examined in this case-control study. Seventy-seven individuals who received "suicide" or "undetermined death" verdicts at inquest, and who had been previously discharged from psychiatric hospitals in Bradford, U.K., were compared with a control group. A history of deliberate self-harm was significantly associated with early suicides compared with both late suicides and controls. A diagnosis of mood disorder, specifically depression, and longer case-notes were also significantly associated with early suicides compared to controls. This study has implications for risk management of recently discharged psychiatric patients.     

Suicide Crisis Syndrome Mediates the Relationship Between Long‐term Risk Factors and Lifetime Suicidal Phenomena

In recent years, there has been growing attention to the distinction between acute and long‐term suicidal risk factors. We have previously characterized an acute, negative affect state, termed the suicide crisis syndrome (SCS ), as a marker of near‐term suicidal risk. Here, we test whether documented long‐term risk factors (i.e., trait vulnerabilities), including perfectionism, impulsivity, chronic substance abuse, insecure attachment, poor social support, and childhood trauma, associate to suicidal phenomena through a pathway of the SCS . A sample of 207 psychiatric inpatients were administered a battery of eight scales, including the Suicide Trigger Scale (STS ‐3) as a measure of the SCS . While both STS ‐3 and all trait vulnerabilities were associated with lifetime suicidal ideation and attempts, only STS ‐3 was related to pre‐admission suicide attempts. The STS ‐3 significantly mediated the effect of each trait vulnerability on lifetime suicidal phenomena (combining ideation and behavior), with the proportion of mediating effect ranging from .29 to .56. Reverse mediation analyses were only significant for insecure attachment, supporting a largely unidirectional mediation effect. The SCS appears to serve as an acute risk factor for suicidal behavior in psychiatric inpatients and may act as a mechanism by which long‐term risk factors increase suicidal risk.