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.     

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.     

Explaining the Relation between Religiousness and Reduced Suicidal Behavior: Social Support Rather Than Specific Beliefs

Religiousness has been associated with decreased risk of suicidal ideation, suicide attempts, and completed suicide, but the mechanisms underlying these associations are not well characterized. The present study examined the roles of religious beliefs and social support in that relation. A survey measuring religiousness, social support, suicidal ideation, and suicide attempts was administered to 454 undergraduate students. Involvement in public, but not private, religious practices was associated with lower levels of both suicidal ideation and history of suicide attempts. Social support mediated these relations but religious beliefs did not. Results highlight the importance of social support provided by religious communities.     

Characteristics of a French African Caribbean Epidemiological Psychiatric Sample with a History of Suicide Attempt

Research on vulnerability factors among ethnic groups, independent of primary psychiatric diagnosis, may help to identify groups at risk of suicidal behavior. French African Caribbean general psychiatric patients (N = 362) were recruited consecutively and independently of the primary psychiatric diagnosis. Demographic and clinical characteristics and lifetime history of suicide attempts were recorded. Sixty‐five patients (18%) had a history of at least one suicide attempt. Presence of professional qualifications, children, poor social contacts, treatment with benzodiazepine at inclusion, and poor treatment compliance were all associated with a lifetime history of suicide attempts.     

Do Geographic Regions with Higher Suicide Rates also have Higher Rates of Nonfatal Intentional Self‐Harm?

Fatal and nonfatal intentional self‐harm events in eight U.S. states were compared using emergency department, hospital, and vital statistics data. Nonfatal event rates increased by an estimated 24.20% over 6 years. Case fatality ratios varied widely, but two northeastern states' total event rates (fatal plus nonfatal) were very high (New Hampshire 206.5/100,000 person years; Massachusetts 166.7/100,000). Geographic context did not uniformly impact the likelihood of self‐harm across event types. The state‐level public health burden posed by such acts cannot, therefore, be accurately estimated from either mortality or morbidity data alone.     

The Beliefs in the Inheritance of Risk Factors for Suicide Scale (BIRFSS): Cross‐Cultural Validation in Estonia,Malaysia, Romania,the United Kingdom,and the United States

The genetics of suicide is increasingly recognized and relevant for mental health literacy, but actual beliefs may lag behind current knowledge. We examined such beliefs in student samples (total N = 686) from Estonia, Malaysia, Romania, the United Kingdom, and the United States with the Beliefs in the Inheritance of Risk Factors for Suicide Scale. Cultural effects were small, those of key demographics nil. Several facets of construct validity were demonstrated. Marked differences in perceived plausibility of evidence about the genetics of suicide according to research design, observed in all samples, may be of general interest for investigating lay theories of abnormal behavior and communicating behavioral and psychiatric genetic research findings.     

Using psychodramatic techniques in structural family therapy

This article describes how psychodramatic techniques can be used in structural family therapy sessions. After a preliminary discussion of the therapist's spontaneity and role functions in both psychodrama and family therapy, specific action techniques are then discussed using case examples. Auxiliary Ego, Role Reversal, Double, Use of Space, Physicalization, Warm-up, Soliloquy, Surplus Reality, and Future Projection are illustrated.     

Sexual tensions in a remarried family

The remarried family is vulnerable to sexual tensions between adults and children because of the weakness of generational boundaries and because the emotional tasks confronting the new couple can result in the detouring of conflict through a child. The case presented here demonstrates the use of structural family therapy which included several therapeutic tools not usually associated with a structural approach. These included family and marital history, individual and subsystem work, education, and modeling. Unspoken sexual tensions between stepfather and stepdaughter were interwoven with the structural problems that the family was experiencing. Following three months of therapy, significant shifts were made in the family structure that resulted in clearer and more appropriate boundaries between parents and the identified patient.Appreciation is expressed by the author to David Abelson, MA, Karlotta Bartholomew, PhD, and Joellyn Ross, PhD, for their support.     

Spouse abuse: An ecosystemic approach

This paper provides a perspective on spouse abuse from an ecosystemic approach suggested by second order cybernetics. An attempt is made to demonstrate the interactional basis for an understanding of spouse abuse and to suggest that the failure to use an ecosystemic perspective may result in therapists and other helpers inadvertently exacerbating the problem. Borrowing from the work of Keeney and Bateson, an analysis of the relational aspects of the problem of spouse abuse is provided which illustrates the similar nature of typical intervention strategies to the problem.The ideas discussed in this paper were developed while the author was a therapist at the Family Therapy Clinic at Texas Tech University. Appreciation is expressed to Monte Bobele, Bradford Keeney, and Thomas Conran for the helpful comments and ideas provided during the preparation of this paper.     

A neglected triangle: Grandmother,mother, and daughter

This paper reports on exploratory research and therapeutic work with a neglected but highly important family triangle, the grandmother-mother-daughter triangle. Some characteristic relationships are described from a clinical sample of 18 daughters for whom such a triangle was important. The triangle may signal both problems and strengths for therapy and the daughters.