The WHO/START Study: Promoting Suicide Prevention for a Diverse Range of Cultural Contexts

The WHO/Start Study is introduced and described in its four main components. The study originated as a response to growing concerns about trends of suicide, the prevalence of which in the Western Pacific Region of the World Health Organization is the highest among the six regions of the WHO. So far, nineteen centers have joined the study. This ambitious project is expected to provide important transcultural perspectives on both fatal and nonfatal suicidal behaviors, together with increased awareness for these phenomena and the growth of culture‐sensitive prevention programs.     

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.     

Meaning Made of Stress among Veterans Transitioning to College: Examining Unique Associations with Suicide Risk and Life‐Threatening Behavior

Meaning made of stress has been shown to be a unique predictor of mental and physical health. In this study, we examined the unique associations between two facets of meaning made of stress (comprehensibility and footing in the world) and suicide risk and life‐threatening behavior among military veterans who have transitioned to college were examined, controlling for demographic factors, religiousness, combat‐related physical injury, combat exposure, depressive symptoms, and posttraumatic stress symptoms. Findings suggest that comprehensibility (having “made sense” of a stressor) is uniquely associated with lower suicide risk and a lower likelihood of driving under the influence of drugs or alcohol and engaging in self‐mutilating behaviors.     

The Predictors of Suicidality in Previous Suicide Attempters following Case Management Services

Suicide attempts constitute a serious clinical problem. People who have attempted suicide are at an elevated risk for additional suicide attempts, but there is limited evidence regarding the predictors of suicidality of suicide attempters following case management services. In the present study the indicators of suicidality after case management were examined. A total of 1,056 subjects who had recently attempted suicide were recruited from January 1, 2011, to June 30, 2011. The suicide prevention center of Kaohsiung City in Taiwan provided case management services and followed up on suicide attempt cases for 6 months. The salient factors for repeat suicide attempts were estimated using a logistic regression analysis. The results showed that multiple factors, including a “willingness to receive mental health services during a crisis,” “social support,” “a history of mental disorders,” and “a history of suicide,” could predict repeat suicide attempts with hazard ratios (0.58, 0.54, 3.84, 1.51) and 95% confidence interval (0.39–0.86, 0.36–0.83, 2.41–6.10, 1.03–2.21). The four factors mentioned above were the most accurate predictors of subsequent suicidality when case management services were utilized after 6 months of follow‐up. The findings of our study could help clarify future strategies for suicide prevention.     

Hospitalizations for Suicide‐Related Drug Poisonings and Co‐occurring Alcohol Overdoses in Adolescents (Ages 12–17) and Young Adults (Ages 18–24) in the United States, 1999–2008: Results from the Nationwide Inpatient Sample

Drug poisoning is the leading method of suicide‐related deaths among females and third among males in the United States. Alcohol can increase the severity of drug poisonings, yet the prevalence of alcohol overdoses in suicide‐related drug poisonings (SRDP) remains unclear. Data from the Nationwide Inpatient Sample was examined to determine rates of inpatient hospital stays for SRDP and co‐occurring alcohol overdoses in adolescents (ages 12–17) and young adults (ages 18–24) between 1999 and 2008. Among adolescents, there were 14,615 hospitalizations for drug poisonings in 2008, of which 72% (10,462) were suicide‐related at a cost of $43 million. Rates of SRDP in this age group decreased between 1999 and 2008. The prevalence of co‐occurring alcohol overdoses increased from 5% in 1999 to 7% in 2008. Among young adults, there were 32,471 hospitalizations for drug poisonings in 2008, of which 64% (20,746) were suicide‐related at a cost of $110 million. Rates of SRDP did not change significantly between 1999 and 2008. The prevalence of co‐occurring alcohol overdoses increased from 14% in 1999 to 20% in 2008. Thus, while rates of SRDP decreased for adolescents and remained unchanged for young adults, the prevalence of co‐occurring alcohol overdoses increased for both age groups. Such hospitalizations provide important opportunities to employ intervention techniques to prevent further suicide attempts.     

PTSD Symptom Clusters Are Differentially Associated with Components of the Acquired Capability for Suicide

Previous research has established the link between posttraumatic stress disorder (PTSD) and suicidal behavior. In the current study, constructs proposed to explain this relationship were examined, applying the framework of the interpersonal‐psychological theory of suicide (IPTS). Relationships between acquired capability for suicide (ACS; i.e., fearlessness about death [FAD] and pain tolerance) and specific PTSD symptom clusters were explored. In a sample of 334 trauma‐exposed undergraduates, anxious arousal and FAD were negatively associated, and numbing and pain tolerance were positively associated. Results establish a foundation for investigating the role of ACS in understanding observed relationships between suicidal behavior and PTSD symptoms.