Suicide Ideation in Female Survivors of Military Sexual Trauma: The Trauma Source Matters

Female veterans who have experienced military sexual trauma (MST) are at elevated suicide risk, yet knowledge is limited regarding correlates of suicide ideation (SI) in this population. MST is associated with a higher risk of posttraumatic stress disorder (PTSD) relative to other trauma types; however, no studies have examined whether experiencing SI differs based on the source of PTSD symptoms (MST‐related, non–MST‐related). Female service members/veterans (SM/Vs; n = 311) who screened positive for MST and reported exposure to a Criterion A event completed an online survey assessing self‐reported demographics, PTSD, depression, the source of their PTSD symptoms, and SI. Ninety‐one (29.3%) reported experiencing current SI, and 223 (71.7%) identified MST as the source of their current PTSD symptoms. Participants who identified MST as the source of their PTSD symptoms were over two times more likely to report SI, compared to those who described non–MST‐related events as the source of their PTSD symptoms. Compared to those who reported the source of their PTSD symptoms as combat‐/deployment‐related, those who identified MST as the source were at least three times as likely to report current SI. Results underscore the importance of efforts to address MST‐related PTSD symptoms when working with female SM/Vs.     

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.     

The direct and indirect benefits of dispositional mindfulness on self-esteem and social anxiety

This study investigated the long‐term health effects of combat stress reaction (CSR) among Israeli CSR casualties (112) and control veterans (184) of the 1973 Yom Kippur war. Posttraumatic stress disorder (PTSD), physical symptoms, and adverse health practices were examined 18 years after the war. The relationship between CSR, PTSD, physical symptoms and adverse health practices was examined via hierarchical linear regression. Findings indicate that although CSR was positively associated with more current physical symptoms and adverse health practices in univariate analyses, these associations were not significant once demographic differences between the groups were controlled. In contrast, current PTSD symptoms were positively associated with current physical symptoms (p < 0.001) and showed a trend association with adverse health practices (p = 0.06). PTSD was the most powerful predictor of current physical symptoms and appears to mediate the association between CSR and physical symptoms almost two decades after the war. Both combat stress reaction and the results of the study were discussed in the light of the theory of Conservation of Resources (COR).     

The Impact of Exercise on Suicide Risk: Examining Pathways through Depression,PTSD, and Sleep in an Inpatient Sample of Veterans

Suicide has a large public health impact. Although effective interventions exist, the many people at risk for suicide cannot access these interventions. Exercise interventions hold promise in terms of reducing suicide because of their ease of implementation. While exercise reduces depression, and reductions in depressive symptoms are linked to reduced suicidal ideation, no studies have directly linked exercise and suicide risk. The current study examined this association, including potential mediators (i.e., sleep disturbance, posttraumatic stress symptoms, and depression), in a sample of Veterans. SEM analyses revealed that exercise was directly and indirectly associated with suicide risk. Additionally, exercise was associated with fewer depressive symptoms and better sleep patterns, each of which was, in turn, related to lower suicide risk.     

Factors Associated with Suicidality Among a National Sample of Transgender Veterans

Correlates of past‐year suicidal ideation and lifetime suicide risk among a national sample of transgender veterans were examined. An online, convenience sample of 212 U.S. transgender veterans participated in a cross‐sectional survey in February–May 2014. We evaluated associations between sociodemographic characteristics, stigma, mental health, and psychosocial resources with past‐year suicidal ideation and lifetime suicide plans and attempts. Participants reported high rates of past‐year suicidal ideation (57%) as well as history of suicide plan or attempt (66%). Transgender‐related felt stigma during military service and current posttraumatic stress disorder and depressive symptoms were associated with suicide outcomes as were economic and demographic factors.     

The Relationship of Adverse Childhood Experiences to PTSD,Depression, Poly-Drug Use and Suicide Attempt in Reservation-Based Native American Adolescents and Young Adults

Adverse childhood experiences (ACEs) are associated with numerous risk behaviors and mental health outcomes among youth. This study examines the relationship between the number of types of exposures to ACEs and risk behaviors and mental health outcomes among reservation‐based Native Americans. In 2011, data were collected from Native American (N = 288; 15–24 years of age) tribal members from a remote plains reservation using an anonymous web‐based questionnaire. We analyzed the relationship between six ACEs, emotional, physical, and sexual abuse, physical and emotional neglect, witness to intimate partner violence, for those <18 years, and included historical loss associated symptoms, and perceived discrimination for those <19 years; and four risk behavior/mental health outcomes: post‐traumatic stress disorder (PTSD) symptoms, depression symptoms, poly‐drug use, and suicide attempt. Seventy‐eight percent of the sample reported at least one ACE and 40 % reported at least two. The cumulative impact of the ACEs were significant (p < .001) for the four outcomes with each additional ACE increasing the odds of suicide attempt (37 %), poly‐drug use (51 %), PTSD symptoms (55 %), and depression symptoms (57 %). To address these findings culturally appropriate childhood and adolescent interventions for reservation‐based populations must be developed, tested and evaluated longitudinally.     

An Innovative Approach to Treating Combat Veterans with PTSD at Risk for Suicide

Suicide rates among military personnel had a significant drop in 2013, but there is no evidence of a drop among veterans. The problem of suicide among combat veterans with posttraumatic stress disorder (PTSD) remains a source of concern. The Department of Defense and the Department of Veterans Affairs are now calling for innovative treatment approaches to the problem. A short‐term psychodynamic therapy presented here may be able to fill that need by dissipating the guilt from veterans' combat‐related actions that leads to suicidal behavior. The treatment showed promise of success with veterans of the war in Vietnam. Preliminary work with combat veterans of the wars in Iraq and Afghanistan indicates that it may be equally successful in treating them. Basic aspects of the psychodynamic approach could be incorporated into current therapies and should improve their ability to treat veterans with PTSD at risk for suicide.     

Depressive Symptoms and Suicide Risk in Older Adults: Value Placed on Autonomy as a Moderator for Men but Not Women

Risk for suicide is elevated among older men. We examined whether value placed on autonomy amplifies the relation between depressive symptoms and suicide risk differently for older men and women. Participants were 98 community‐dwelling older adults, M age 73.6 (SD = 8.6), 65.1% female, 93.1% White. Questionnaires measured suicide risk (SBQ‐R), depressive symptoms (CESD), and value placed on autonomy (PSI‐II autonomy). Among men, depressive symptoms were associated with suicide risk only when PSI‐II autonomy was elevated. Among women, greater depressive symptoms were associated with suicide risk at all levels of PSI‐II autonomy. Further research on attitudes toward autonomy is warranted.     

Physician-diagnosed medical disorders in relation to PTSD symptoms in older male military veterans.

The association between physician-diagnosed medical disorders and combat-related posttraumatic stress disorder (PTSD) symptoms was examined in 605 male combat veterans of World War II and the Korean conflict. Physician exams were performed at periodic intervals beginning in the 1960s. PTSD symptoms were assessed in 1990. Cox regression was used to examine the onset of each of 12 disorder categories as a function of PTSD symptoms, controlling for age, smoking, alcohol use, and body weight at study entry. Even with control for these factors, PTSD symptoms were associated with increased onset of arterial, lower gastrointestinal, dermatologic, and musculoskeletal disorders. There was only weak evidence that PTSD mediated the effects of combat exposure on morbidity. Possible mediators of the relationship between combat exposure, PTSD, and physical morbidity are discussed.     

The Interpersonal–Psychological Theory of Suicide in Adolescents: A Preliminary Report of Changes Following Treatment

This study investigated change in suicide risk in the framework of the interpersonal theory of suicide. Fifty‐four adolescents completed measures of interpersonal needs, acquired capability, depressive symptoms, and suicide risk at entry and exit from treatment. There was a significant drop following treatment in unmet interpersonal needs but not in acquired capability, consistent with the theory. Both change in the interaction between interpersonal needs and in depressive symptoms contributed unique prediction to change in suicide risk. These findings extend the research in understanding changes in suicide risk and inform treatment by suggesting cognitive targets for intervention.     

Does Reintegration Stress Contribute to Suicidal Ideation Among Returning Veterans Seeking PTSD Treatment?

Although posttraumatic stress disorder (PTSD) and other psychiatric symptoms are well‐established risk factors for suicidal ideation among returning veterans, less attention has been paid to whether the stress of reintegrating into civilian society contributes to suicidal ideation. Utilizing a sample of 232 returning veterans (95% male, mean age = 33.63 years) seeking PTSD treatment, this study tested whether reintegration difficulties contribute to suicidal ideation over and above the influence of PTSD symptoms, depression symptoms, and potential substance misuse. Logistic regressions indicated that reintegration stress had a unique effect on suicidal ideation over and above PTSD and depression symptoms. Reintegration stress interacted with substance misuse to predict suicidal ideation, such that the effect of reintegration stress on suicidal ideation was much larger for those with potential substance misuse. Exploratory analyses also examined which types of reintegration difficulties were associated with suicidal ideation, and found that difficulty maintaining military friendships, difficulty getting along with relatives, difficulty feeling like you belong in civilian society, and difficulty finding meaning/purpose in life were all significantly associated with suicidal ideation, beyond the effects of psychiatric symptoms and potential substance misuse. Findings highlight the importance of addressing reintegration stress for the prevention of suicide among returning veterans. Implications for treatment are discussed.     

Suicide Risk Among Wounded U.S. Service Members

The association between suicide and combat injuries sustained during the wars in Iraq and Afghanistan was examined. A retrospective population‐based cohort design was conducted using official military records to identify combat injuries (October 7, 2001, to December 31, 2007). Those who were injured during combat had higher crude suicide rates than those who deployed and were not injured (incidence rate ratio [IRR] = 1.50; confidence interval [CI] = 1.06, 2.12), or never deployed (IRR = 1.46; CI = 1.04, 2.06). After adjusting for demographics, these findings were no longer statistically significant. Although our data did not support an elevated suicide risk among wounded service members, additional research is needed to examine the impact of injury severity.     

Family support,family stress,and suicidal ideation in a combat-exposed sample of Operation Enduring Freedom/Operation Iraqi Freedom veterans

Background and Objectives: Deployment-related risk factors for suicidal ideation among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans have received a great deal of attention. Studies show that mental health symptoms mediate the association between most deployment stressors and suicidal ideation; however, family-related factors during deployment are largely unexplored. We examined posttraumatic stress disorder (PTSD) and depression symptoms as mediators of the associations between deployment family support and stress and post-deployment suicidal ideation in combat-exposed OEF/OIF veterans. Design: National cross-sectional mail survey. Methods: 1046 veterans responded to the survey. The sample for this study was 978 veterans who experienced combat. Regression-based path analyses were conducted. Results: Family support and stress had direct associations with suicidal ideation. When PTSD and depression symptoms were examined as mediators of these associations, results revealed significant indirect paths through these symptoms. Conclusions: This study contributes to the literature on suicidal ideation risk factors among OEF/OIF veterans. Deployment family support and family stress are associated with suicidal ideation; however these associations occur primarily through mental health symptomatology, consistent with findings observed for other deployment factors. This research supports ongoing efforts to treat mental health symptomatology as a means of suicide prevention.     

Aggressive Behaviors and Suicide Ideation in Inpatient Adolescents: The Moderating Roles of Internalizing Symptoms and Stress

The present study examined a conceptual model in which the association between aggressive behaviors and suicide ideation is moderated by internalizing symptoms and ongoing stress. Participants were 304 psychiatric inpatient adolescents (65.8% girls) ranging in age from 12 to 17 years (Mean age = 14.69). The association between aggressive behaviors and suicide ideation was significantly moderated by internalizing symptoms and ongoing stress; the association was positive in adolescents low in internalizing symptoms or high in ongoing stress, but negative in adolescents high in internalizing symptoms or low in ongoing stress. The three‐way interaction between aggressive behaviors, internalizing symptoms, and ongoing stress was not statistically significant. The current findings indicate that in adolescents who display high levels of aggressive behaviors, the presence of high ongoing stress provides a more useful indicator of levels of suicide ideation than the presence of high internalizing symptoms. Implications for case identification and prevention are discussed.     

Current and Military‐Specific Gender Minority Stress Factors and Their Relationship with Suicide Ideation in Transgender Veterans

Research suggests the prevalence of suicide ideation and suicide attempts in the transgender veteran community may be upwards of 20 times higher than nontransgender veterans, who are known to be at increased risk than the general US population. This study aimed to understand the potential influence of external and internal minority stress experienced during and after military service on past‐year and recent suicide ideation in a sample of 201 transgender veterans. Nonparametric bootstrapping analyses indicated past‐year transgender‐specific discrimination and rejection (external minority stress) indirectly predicted frequency of both past‐year and past 2‐week suicide ideation through past‐year shame related to gender identity (internal minority stress). This result was significant when controlling for symptoms of depression and demographics. Similar patterns emerged when examining relationships among military external and internal minority stress on suicide outcomes. These results suggest that attempts to reduce both the experience and impact of minority stressors related to gender identity during and after military service may be an important avenue for suicide prevention.     

Interpersonal Trauma,Posttraumatic Stress Disorder Symptoms,and the Interpersonal Theory of Suicide in Women Seeking Shelter from Intimate Partner Violence

This study examined how trauma exposure and posttraumatic stress disorder symptoms of reexperiencing, avoidance, numbing, dysphoric arousal, and anxious arousal relate to the major components of the interpersonal theory of suicide; namely, thwarted belongingness, perceived burdensomeness, and the acquired capability for suicide. A sample of 137 women seeking shelter from intimate partner violence completed self-report assessments. Symptoms of dysphoric arousal and numbing were uniquely and positively associated with thwarted belongingness. Numbing symptoms were uniquely and positively associated with perceived burdensomeness. Reexperiencing and anxious arousal symptoms were uniquely but negatively associated with the acquired capability for suicide. Interpersonal trauma was also positively associated with acquired capability, but only when examined independently. Posttraumatic stress disorder symptoms of dysphoric arousal and numbing symptoms might complement brief screenings for acute suicide risk and can help inform in-shelter activities as well as postshelter treatment recommendations to decrease suicide risk for shelter-seeking women.     

Correlates of Suicidal Ideation in Physically Injured Trauma Survivors

Epidemiologic studies have documented that injury survivors are at increased risk for suicide. We evaluated 206 trauma survivors to examine demographic, clinical, and injury characteristics associated with suicidal ideation during hospitalization and across 1 year. Results indicate that mental health functioning, depression symptoms, and history of mental health services were associated with suicidal ideation in the hospital; being a parent was a protective factor. Pre‐injury posttraumatic stress disorder symptoms, assaultive injury mechanism, injury‐related legal proceedings, and physical pain were significantly associated with suicidal ideation across 1 year. Readily identifiable risk factors early after traumatic injury may inform hospital‐based screening and intervention procedures.     

Childhood Abuse,the Interpersonal–Psychological Theory of Suicide,and the Mediating Role of Depression

Although childhood abuse is a well‐known risk factor for suicide, no studies have investigated the role of interpersonal–psychological (Joiner, 2005), constructs in this association. This study examined whether childhood physical, sexual, and emotional abuse were associated with IPTS constructs, and whether depressive symptoms mediated these associations. Ninety‐one participants completed self‐report measures. Emotional abuse predicted perceived burdensomeness and thwarted belongingness, and depressive symptoms mediated these associations. Physical abuse predicted the acquired capability for suicide, although depression did not mediate this association. These findings suggest that specific types of abuse differentially predict IPTS components and underscore depression as a potential mechanism.     

Shame,Guilt, and Suicide Ideation among Bondage and Discipline,Dominance and Submission,and Sadomasochism Practitioners: Examining the Role of the Interpersonal Theory of Suicide

To date, no study has examined rates of suicide ideation or theory‐based risk factors for suicide ideation among bondage and discipline, dominance and submission, and sadomasochism (BDSM) practitioners. Participants were 321 adults that endorsed BDSM involvement. Thirty‐seven percent of the sample indicated a nonzero level of suicide ideation. Thwarted belongingness and perceived burdensomeness (PB) were positively associated with suicide ideation and their interactive effect predicted additional variance in suicide ideation after adjusting for depressive symptoms. Overall, shame and guilt were positively associated with suicide ideation and these relations were mediated by thwarted belongingness and PB in parallel adjusting for depressive symptoms; however, there were some differences between demographic subgroups. Among BDSM practitioners, stigma‐related internalized feelings (i.e., shame and guilt) may be associated with increased thwarted belongingness and PB, which are associated with suicide ideation.     

Social and individual risk factors for suicide ideation among Chinese children and adolescents: A multilevel analysis

The objective of this study was to investigate the prevalence and predictors of suicide ideation among primary, middle and high school students. We used multilevel modelling to investigate suicide ideation among 12,733 Chinese children and adolescents aged 9–18 years from wide range of areas across China. Approximately, 32.09% of children and adolescents reported suicide ideation, with females were more likely to report suicide ideation than males (38.09% vs. 29.95%). Our results showed that the risk factors in primary school students were different from middle and high school student groups, whereas significant risk factors for middle and high school students were similar. The city's standard of living as indicated by the Engel coefficient and the city's divorce rate were positively associated with the prevalence of suicide ideation; in contrast, the school's pupil‐to‐teacher ratio was negatively correlated with elevated suicide ideation. Significant risk factors for suicide ideation included study anxiety, self‐accusation tendency, impulsive tendency, terror tendency and physical symptoms. These results have important implications for the prevention of suicide, suggesting that both contextual (city‐level) and compositional (individual‐level) factors could be important targets for prevention and intervention for children and adolescents at risk of suicide ideation.