An Examination of Potential Misclassification of Army Suicides: Results from the Army Study to Assess Risk and Resilience in Servicemembers

Debate continues about the accuracy of military suicide reporting due to concerns that some suicides may be classified as accidents to minimize stigma and ensure survivor benefits. We systematically reviewed records for 998 active duty Army deaths (510 suicides; 488 accident, homicide, and undetermined deaths; 2005‐2009) and, using research criteria, reclassified 8.2% of the nonsuicide cases to definite suicide (1), suicide probable (4), or suicide possible (35). The reclassification rate to definite suicide was only 0.2% (1/488). This low rate suggests that flagrant misclassification of Army deaths is uncommon and surveillance reports likely reflect the “true” population of Army suicides.     

Trauma‐Related Guilt Mediates the Relationship between Posttraumatic Stress Disorder and Suicidal Ideation in OEF/OIF/OND Veterans

Posttraumatic stress disorder (PTSD) and trauma‐related guilt are risk factors for suicidal ideation (SI) in veterans. Components of trauma‐related guilt were examined as serial mediators of the relationship between PTSD and SI. In a sample of 53 OEF/OIF/OND combat veterans, PTSD had an indirect effect on SI through a serial mediation chain of guilt cognitions, distress, and global guilt, suggesting that trauma‐related guilt via cognitions, distress, and global guilt is a pathway from PTSD to SI. Attention should be given to assessing and addressing trauma‐related guilt in veterans experiencing PTSD to prevent SI.     

The Quadratic Relationship Between Body Mass Index and Suicide Ideation: A Nonlinear Analysis of Indirect Effects

A nonlinear indirect effects framework was used to investigate potential interpersonal indirect effects (i.e., perceived burden and thwarted belonging) accounting for the nonlinear relationship between body mass index (BMI) and suicide ideation. Using a sample of 338 undergraduates, results revealed a significant quadratic effect of BMI on suicide ideation via perceived burden only, which became significant as BMI fell below 18.00 kg/m² and above 28.00 kg/m². Our results provide novel information relevant for suicide risk screening in the context of weight‐ and health‐related interventions and provide justification for future longitudinal trials assessing suicide risk across the BMI spectrum.     

Mindfulness Moderates the Association Between Perceived Burdensomeness and Suicide Ideation in Adults With Elevated Depressive Symptoms

A conceptual model in which the associations between perceived burdensomeness and suicide ideation, and between thwarted belongingness and suicide ideation, are moderated by mindfulness was examined. Participants were 218 undergraduates (mean age = 20.81) with moderate‐to‐severe depressive symptoms. Mindfulness significantly moderated the association between perceived burdensomeness and suicide ideation; participants with thoughts of burdensomeness experienced lower levels of suicide ideation if they were high, as opposed to low, in mindfulness. Mindfulness did not significantly moderate the association between thwarted belongingness and suicide ideation. Implications for intervention and elaboration of the interpersonal psychological theory of suicide are discussed.     

Count out your intrusions: Effects of verbal encoding on intrusive memories

Peri-traumatic information processing is thought to affect the development of intrusive trauma memories. This study aimed to replicate and improve the study by Holmes, Brewin, and Hennessy (2004, Exp. 3) on the role of peri-traumatic verbal processing in analogue traumatic intrusion development. Participants viewed an aversive film under one of three conditions: counting backwards in 3s (“verbal interference”), verbalising emotions and thoughts (“verbal enhancement”), or without an extra task. A dual-process account of PTSD would predict that verbal interference would increase intrusion frequency compared to no task, whereas verbal enhancement would lead to a decrease. In contrast, mainstream memory theory predicts a decrease in intrusion frequency from any concurrent task that diverts attention away from the trauma film. The main finding was that the verbal interference task led to a decrease in intrusive memories of the film compared to the other two conditions. This finding does not support a dual-process account of PTSD, but is in line with general theories of memory and attention.     

Audit in psychoanalytic psychotherapy with children and adolescents

The importance of multidisciplinary audit in child and adolescent psychiatry, including the work of child psychotherapists, is discussed. Research is highlighted which shows that certain groups of children in particular benefit from psychoanalytic psychotherapy. The problems related to auditing psychoanalytic psychotherapy are discussed, and a possible method of audit based on peer review of notes, which takes into account both inner and outer change, is presented.

A patient is discussed whose notes have been audited using the audit form. It is suggested that this form of audit has good educational potential as well as ensuring a high standard of patient care.     

Relations Between Parenting Behavior and SES in a Clinical Sample: Validity of SES Measures

Two common methods of measuring socioeconomic status (SES) were examined in relation to observed parenting behaviors in a clinical sample of 89 mothers of 3- to 6-year-olds referred for treatment of oppositional defiant disorder. Families were 74% Caucasian, 9% African American, 5% Hispanic, 1% Asian, and 11% Biracial. Most children were male (75%). Parenting behaviors were measured with the Dyadic Parent–Child Interaction Coding System (DPICS) categories of prosocial talk and negative talk. Analyses were conducted with SES measured in two ways: (a) the Hollingshead Four-Factor Index of Social Status (HI) was correlated with parenting behaviors; and (b) family income, parent education (5 categories), and parent occupation (5 categories) were used to predict parent behavior. SES was significantly positively related to maternal prosocial talk. When SES was operationalized as income, occupation, and education, the model predicted three times more variance in maternal prosocial talk than the HI alone. SES was not related to maternal negative talk by either measure of SES.     

Prevalence and Risk Factors Associated With Suicides of Army Soldiers 2001–2009

Prevalence and risk factors associated with soldiers' suicides 2001–2009 (N = 874) were examined. Army suicide rates increased from 9 per 100,000 in 2001 to 22 per 100,000 in 2009. Soldier suicides were lower than civilians from 2001 to 2007, but higher than civilians after 2007. Army suicides were disproportionately higher for men, deployment experience, and a history of a mental health diagnosis/treatment; and lower for African Americans. Many involved planning (38%), communication (21%), alcohol (19%), or drugs (8%). Many had legal problems (31%), high stress loads (90%), a history of self-injury (10%), and other contributing factors prior to entry into the Army (31%). Implications for understanding suicide among military personnel are discussed.     

Prologue: Introduction and Overview to Special Volume

Abstract

The editors provide an overview of the obstacles that prevent us from ending child abuse in the United States and briefly summarize the various articles in this volume that address these obstacles from multiple points of view.     

Do conflict management styles affect group decision making? Evidence from a longitudinal field study

This study examined the relationship between group conflict management styles and effectiveness of group decision making in 11 ongoing, naturally occurring workgroups from 2 large U.S. organizations. The major postulate of the study was that groups develop norms regarding how they will manage conflicts that carry over to affect other activities, such as decision making, even when these activities do not involve open conflict. To determine the impact of conflict management style on decision effectiveness, a longitudinal design was used that identified conflict management styles in the initial portion of each team's series of meetings and then analyzed a group decision taken in a meeting near the end of that series. Group conflict management styles were determined using observational methods, and decision effectiveness was measured using multiple indices that tapped member, facilitator, and external observer viewpoints. Task complexity also was considered as a possible moderating variable. The findings suggest that groups that developed integrative conflict management styles made more effective decisions than groups that utilized confrontation and avoidance styles. Groups that never developed a stable style were also less effective than groups with integrative styles.