The Relationship between Trauma Exposure and Psychiatric Hospitalization for Suicide Ideation or Suicide Attempt among Patients Admitted to a Military Treatment Setting

Suicide attempts and psychiatric hospitalization represent the final outcomes of a complex dynamical system of interacting factors that influence a particular individual’s likelihood of engaging in suicidal behavior, as well as their ability to seek help prior to acting upon suicidal impulses. This study examined the association between different types of lifetime trauma exposure and the likelihood of psychiatric hospitalization following a suicide attempt (SA) rather than suicidal ideation (SI) alone. Electronic medical records for 1100 U.S. military service members and their dependents admitted to a military psychiatric inpatient setting for SA or SI were reviewed for documented lifetime trauma exposure history. Findings indicated that exposure to at least one childhood trauma of any type, and childhood neglect in particular, increased the likelihood that an individual would be hospitalized for SA rather than SI. Exploratory gender-stratified analyses demonstrated that childhood neglect, childhood sexual abuse, and adulthood traumatic loss may be linked with the likelihood of being hospitalized for SA. These findings demonstrate the importance of developing more detailed and nuanced conception of factors known to be associated with suicide as their effects may depend on details of their timing and nature, as well as their interactions with other systems.

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The Role of Past Suicidal Behavior on Current Suicidality: A Retrospective Study in the Israeli Military

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020649 ◽

2021 ◽

Vol 18 (2) ◽

pp. 649

Author(s):

Leah Shelef ◽

Jessica M Rabbany ◽

Peter M Gutierrez ◽

Ron Kedem ◽

Ariel Ben Yehuda ◽

...

Keyword(s):

Suicide Attempt ◽

Suicidal Behavior ◽

Military Service ◽

Suicide Ideation ◽

Rating Scale ◽

Suicide Attempts ◽

Significant Risk ◽

Significant Risk Factor ◽

Severity Rating ◽

Significant Difference

Past suicide attempts are a significant risk factor for future suicidality. Therefore, the present military-based study examined the past suicidal behavior of soldiers who recently made a severe suicide attempt. Our sample consisted of 65 active-duty soldiers (61.5% males), between the ages of 18 and 28 years old (M = 20.4, SD ± 1.3). The inclusion criterion was a recent severe suicide attempt, requiring at least a 24 h hospitalization. This sample was divided into two groups, according to previous suicidal behavior, namely whether their first suicide attempt was before or after enlistment (n = 25; 38.5% and n = 40; 61.5%, respectively). We then examined the lethality and intent of the recent event in regard to this division. Four measures were used to assess the subjects’ suicidal characteristics: the Columbia Suicide Severity Rating Scale, the Self-Harm Behavior Questionnaire, the Suicidal Behaviors Questionnaire-Revised, and the Beck Scale for Suicide Ideation. No significant difference in the severity of the suicide attempts (either actual or potential severity) were found between those who had suicide attempts before enlistment and those who had their first attempt in the service. As a matter of fact, most of the suicide attempts that occurred for the first time during military service had used a violent method (58.3%, n = 21). Finally, using multivariate analyses, we found that current thoughts and behavior, rather than past suicidality, was the strongest predictor for the lethality of suicide attempts.

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Demographic and Clinical Characteristics of Military Service Members Hospitalized Following a Suicide Attempt versus Suicide Ideation

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16183274 ◽

2019 ◽

Vol 16 (18) ◽

pp. 3274

Author(s):

Brianne J. George ◽

Sissi Ribeiro ◽

Su Yeon Lee-Tauler ◽

Allison E. Bond ◽

Kanchana U. Perera ◽

...

Keyword(s):

Personality Disorder ◽

Suicide Attempt ◽

Military Service ◽

Clinical Characteristics ◽

Suicide Ideation ◽

Suicide Attempts ◽

Adjustment Disorder ◽

Service Members ◽

Walter Reed Army Medical ◽

Risk Indicator

Psychiatric hospitalization for a suicide attempt (SA), rather than suicide ideation (SI) alone, is a stronger risk indicator for eventual suicide death. Yet, little is known about demographic and clinical characteristics differentiating those admitted for SA versus SI. Understanding these differences has implications for assessment and treatment. A retrospective review of electronic medical records (EMRs) was performed on service members (n = 955) admitted for SA or SI at the Walter Reed Army Medical Center between 2001–2006. Service members hospitalized for SA were younger compared to those hospitalized for SI. The proportion of women admitted for SA was significantly higher than those admitted for SI whereas their male counterparts showed the opposite pattern. Patients admitted for SA, versus SI, had significantly higher prevalence of adjustment disorder with mixed disturbance of emotion and conduct (MDEC), personality disorder not otherwise specified (PDNOS), and borderline personality disorder (BPD). Patients admitted for SI had significantly higher prevalence of adjustment disorder with depressed mood and deferred Axis II diagnosis, compared to those admitted for SA. There were no significant between-group differences in the average or median number of documented prior suicide attempts. Findings highlight the need for more standardized assessment, diagnostic decision-making, and documentation practices for all patients.

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Attachment Organization in Suicide Prevention Research

Crisis ◽

10.1027/0227-5910/a000231 ◽

2014 ◽

Vol 35 (1) ◽

pp. 60-66 ◽

Cited By ~ 10

Author(s):

Amanda Venta ◽

Carla Sharp

Keyword(s):

Risk Factors ◽

Suicidal Ideation ◽

Suicide Attempt ◽

Interpersonal Relationships ◽

Suicide Ideation ◽

Suicide Attempts ◽

Critical Role ◽

Self Report ◽

Future Research ◽

Self Harm

Background: Identifying risk factors for suicide-related thoughts and behaviors (SRTB) is essential among adolescents in whom SRTB remain a leading cause of death. Although many risk factors have already been identified, influential theories now suggest that the domain of interpersonal relationships may play a critical role in the emergence of SRTB. Because attachment has long been seen as the foundation of interpersonal functioning, we suggest that attachment insecurity warrants attention as a risk factor for SRTB. Aims: This study sought to explore relations between attachment organization and suicidal ideation, suicide attempts, and self-harm in an inpatient adolescent sample, controlling for demographic and psychopathological covariates. Method: We recruited 194 adolescents from an inpatient unit and assigned them to one of four attachment groups (secure, preoccupied, dismissing, or disorganized attachment). Interview and self-report measures were used to create four variables reflecting the presence or absence of suicidal ideation in the last year, single lifetime suicide attempt, multiple lifetime suicide attempts, and lifetime self-harm. Results: Chi-square and regression analyses did not reveal significant relations between attachment organization and SRTB, although findings did confirm previously established relations between psychopathology and SRTB, such that internalizing disorder was associated with increased self-harm, suicide ideation, and suicide attempt and externalizing disorder was associated with increased self-harm. Conclusion: The severity of this sample and methodological differences from previous studies may explain the nonsignificant findings. Nonsignificant findings may indicate that the relation between attachment organization and SRTB is moderated by other factors that should be explored in future research.

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The effect of sexual abuse and dissociation on suicide attempt

BMC Psychiatry ◽

10.1186/s12888-021-03662-9 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Silje Støle Brokke ◽

Thomas Bjerregaard Bertelsen ◽

Nils Inge Landrø ◽

Vegard Øksendal Haaland

Keyword(s):

Sexual Abuse ◽

Risk Factor ◽

Suicide Attempt ◽

Indirect Effects ◽

Suicide Ideation ◽

Suicide Attempts ◽

Suicidal Thoughts ◽

Dissociative Experiences ◽

Self Harm

Abstract Background Suicide attempt is the most predictive risk factor of suicide. Trauma – especially sexual abuse – is a risk factor for suicide attempt and suicide. A common reaction to sexual abuse is dissociation. Higher levels of dissociation are linked to self-harm, suicide ideation, and suicide attempt, but the role of dissociation in suicidal behavior is unclear. Methods In this naturalistic study, ninety-seven acute psychiatric patients with suicidal ideation, of whom 32 had experienced sexual abuse, were included. Suicidal behaviour was assessed with The Columbia suicide history form (CSHF). The Brief trauma questionnaire (BTQ) was used to identify sexual abuse. Dissociative symptoms were assessed with Dissociative experiences scale (DES). Results Patients who had experienced sexual abuse reported higher levels of dissociation and were younger at onset of suicidal thoughts, more likely to self-harm, and more likely to have attempted suicide; and they had made more suicide attempts. Mediation analysis found dissociative experiences to significantly mediate a substantive proportion of the relationship between sexual abuse and number of suicide attempts (indirect effects = 0.17, 95% CI = 0.05, 0.28, proportion mediated = 68%). Dissociative experiences significantly mediated the role of sexual abuse as a predictor of being in the patient group with more than four suicide attempts (indirect effects = 0.11, 95% CI = 0.02, 0.19, proportion mediated = 34%). Conclusion The results illustrate the importance of assessment and treatment of sexual abuse and trauma-related symptoms such as dissociation in suicide prevention. Dissociation can be a contributing factor to why some people act on their suicidal thoughts.

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Outpatient psychotherapy practice with adolescents following psychiatric hospitalization for suicide ideation or a suicide attempt

Clinical Child Psychology and Psychiatry ◽

10.1177/1359104509352893 ◽

2010 ◽

Vol 16 (1) ◽

pp. 53-64 ◽

Cited By ~ 10

Author(s):

Anthony Spirito ◽

Valerie Simon ◽

Mary Kathryn Cancilliere ◽

Rachel Stein ◽

Candace Norcott ◽

...

Keyword(s):

Suicide Attempt ◽

Suicide Ideation ◽

Psychiatric Hospitalization ◽

Outpatient Psychotherapy ◽

Psychotherapy Practice

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Repetitive negative thinking about suicide: Associations with lifetime suicide attempts

Clinical Psychology in Europe ◽

10.32872/cpe.5579 ◽

2021 ◽

Vol 3 (3) ◽

Author(s):

Tobias Teismann ◽

Thomas Forkmann ◽

Johannes Michalak ◽

Julia Brailovskaia

Keyword(s):

Suicide Attempt ◽

Suicidal Behavior ◽

Suicide Ideation ◽

Suicide Attempts ◽

Clinical Sample ◽

Cross Sectional Study ◽

Repetitive Negative Thinking ◽

Cross Sectional ◽

Suicide Attempters ◽

Negative Thinking

Background Repetitive negative thinking has been identified as an important predictor of suicide ideation and suicidal behavior. Yet, only few studies have investigated the effect of suicide-specific rumination, i.e., repetitive thinking about death and/or suicide on suicide attempt history. On this background, the present study investigated, whether suicide-specific rumination differentiates between suicide attempters and suicide ideators, is predictive of suicide attempt history and mediates the association between suicide ideation and suicide attempts. Method A total of 257 participants with a history of suicide ideation (55.6% female; Age M = 30.56, Age SD = 11.23, range: 18–73 years) completed online measures on suicidality, general and suicide-specific rumination. Results Suicide-specific rumination differentiated suicide attempters from suicide ideators, predicted suicide attempt status (above age, gender, suicide ideation, general rumination) and fully mediated the association between suicide ideation and lifetime suicide attempts. Conclusion Overall, though limited by the use of a non-clinical sample and a cross-sectional study design, the present results suggest that suicide-specific rumination might be a factor of central relevance in understanding transitions to suicidal behavior.

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Moral injury and peri- and post-military suicide attempts among post-9/11 veterans

Psychological Medicine ◽

10.1017/s0033291721005274 ◽

2022 ◽

pp. 1-10

Author(s):

Shira Maguen ◽

Brandon J. Griffin ◽

Dawne Vogt ◽

Claire A. Hoffmire ◽

John R. Blosnich ◽

...

Keyword(s):

Mental Health ◽

Suicide Attempt ◽

Military Service ◽

Suicide Attempts ◽

Moral Injury ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Nationally Representative ◽

Military Suicide ◽

The Impact

Abstract Background Our goal was to examine the association between moral injury, mental health, and suicide attempts during military service and after separation by gender in post-9/11 veterans. Methods A nationally representative sample of 14057 veterans completed a cross-sectional survey. To examine associations of exposure to potentially morally injurious events (PMIEs; witnessing, perpetrating, and betrayal) and suicidal self-directed violence, we estimated two series of multivariable logistic regressions stratified by gender, with peri- and post-military suicide attempt as the dependent variables. Results PMIE exposure accounted for additional risk of suicide attempt during and after military service after controlling for demographic and military characteristics, current mental health status, and pre-military history of suicidal ideation and attempt. Men who endorsed PMIE exposure by perpetration were 50% more likely to attempt suicide during service and twice as likely to attempt suicide after separating from service. Men who endorsed betrayal were nearly twice as likely to attempt suicide during service; however, this association attenuated to non-significance after separation in the fully adjusted models. In contrast, women who endorsed betrayal were over 50% more likely to attempt suicide during service and after separation; PMIE exposure by perpetration did not significantly predict suicide attempts before or after service among women in the fully adjusted models. Conclusions Our findings indicate that suicide assessment and prevention programs should consider the impact of moral injury and attend to gender differences in this risk factor in order to provide the most comprehensive care.

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Can Text Messages Identify Suicide Risk in Real Time? A Within-Subjects Pilot Examination of Temporally Sensitive Markers of Suicide Risk

Clinical Psychological Science ◽

10.1177/2167702620906146 ◽

2020 ◽

Vol 8 (4) ◽

pp. 704-722

Author(s):

Jeffrey J. Glenn ◽

Alicia L. Nobles ◽

Laura E. Barnes ◽

Bethany A. Teachman

Keyword(s):

Suicide Attempt ◽

Real Time ◽

Text Messaging ◽

Lower Risk ◽

Suicide Risk ◽

Suicide Ideation ◽

Suicide Attempts ◽

Text Messages ◽

Within Subjects ◽

Over Time

Objective tools to assess suicide risk are needed to determine when someone is at imminent risk. In this pilot laboratory investigation, we used a within-subjects design to identify patterns in text messaging (short message service) unique to high-risk periods preceding suicide attempts. Individuals reporting a history of suicide attempt ( N = 33) retrospectively identified past attempts and periods of lower risk (e.g., suicide ideation). Language analysis software scored 189,478 text messages to capture three psychological constructs: self-focus, sentiment, and social engagement. Mixed-effects models tested whether these constructs differed in general (means) and over time (slopes) 2 weeks before a suicide attempt relative to lower-risk periods. Regarding mean differences, no language features uniquely differentiated suicide attempts from other episodes. However, when examining patterns over time, anger increased and positive emotion decreased to a greater extent as participants approached a suicide attempt. Results suggest private electronic communication has the potential to provide real-time digital markers of suicide risk.

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An emergency department medical record review for adolescent intentional self-harm injuries

Injury Epidemiology ◽

10.1186/s40621-020-00293-8 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Anna Hansen ◽

Dessi Slavova ◽

Gena Cooper ◽

Jaryd Zummer ◽

Julia Costich

Keyword(s):

Emergency Department ◽

Suicide Attempt ◽

Suicide Ideation ◽

Suicide Attempts ◽

International Classification Of Diseases ◽

Case Definition ◽

Coding System ◽

Icd 10 ◽

Self Harm ◽

Coding Guidelines

Abstract Background Non-suicidal self-injury and suicide attempts are increasing problems among American adolescents. This study developed a definition for identifying intentional self-harm (ISH) injuries in emergency department (ED) records coded with International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. The definition is based on the injury-reporting framework proposed by the Centers for Disease Control and Prevention. The study sought to estimate the definition’s positive predictive value (PPV), and the proportion of ISH injuries with intent to die (i.e., suicide attempt). Methods The study definition, based on first-valid external cause-of-injury ICD-10-CM codes X71-X83, T14.91, T36-T65, or T71, captured 207 discharge records for initial encounters for ISH in one Kentucky ED. Medical records were reviewed to confirm provider-documented diagnosis for ISH, and identify intent to die or suicide ideation. The PPV of the study definition for capturing provider-documented ISH injuries was reported with its 95% confidence interval (95% CI). Results The estimated PPV for the study definition to capture ISH injuries was 88.9%, 95% CI (83.8%, 92.8%). The estimated percentage of ISH with intent to die was 45.9, 95% CI (47.1, 61.0%). The ICD-10-CM code “suicide attempt” (T14.91) captured only 7 cases, but coding guidelines restrict assignment of this code to cases in which the mechanism of the suicide attempt is unknown. Conclusions The proposed case definition supported a robust PPV for ISH injuries. Our findings add to the evidence that the current ICD-10-CM coding system and coding guidelines do not allow identification of ISH with intent to die; modifications are needed to address this issue.

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Attentional Bias and Prediction of Attempted Suicide in Clinical and Non-clinical Population

Practice in Clinical Psychology ◽

10.32598/jpcp.8.3.724.1 ◽

2020 ◽

Vol 8 (3) ◽

pp. 243-256

Author(s):

Elham Baghani ◽

◽

Ladan Fata ◽

Mahdiyeh Salehi ◽

Fariba Hasani ◽

...

Keyword(s):

Multivariate Analysis ◽

Reaction Time ◽

Discriminant Analysis ◽

Suicide Attempt ◽

Attentional Bias ◽

Suicide Ideation ◽

Suicide Attempts ◽

Clinical Population ◽

Scoring Methods ◽

Significant Difference

Objective: the aim of the present research was to analyze the predictability of suicide attempts, based on attentional bias in a clinical and non-clinical population. Methods: 120 participants (77 females and 43 males) were intentionally selected in three diagnostic groups: clinical suicides, clinical non-suicides, and non-clinical ones (40 individuals in each group). They participated in the Suicide Stroop Task as well as the Beck Scale of Suicide Ideation (BSS). The attentional bias parameters, including reaction time and interference time, were computed and the data were analyzed using Multivariate Analysis of Variance and Discriminant Analysis. Results: the results obtained from the multivariate analysis revealed that the variables of interference time did not have a significant indication for the three groups of individuals in suicide stroop (P<0.568; F=0.569), positive stroop (P<0.201; F=1.626), and negative stroop (P<0.863; F=0.147). However, in the case of reaction time, there was a significant difference in the values obtained for all the three groups in terms of suicide stroop (P<0.000; F=12.759), positive stroop (P<0.000; F=18.520), negative stroop (P<0.000; F=10.995), and neutral stroop (P<0.000; F=8.288). In addition, the results obtained from the discriminant analysis show that the variables of suicide ideation (0.822), reaction time in positive stroop (0.571), suicide stroop (0.470), negative stroop (0.438), and neutral stroop (0.376) were correspondingly crucial in predicting the behavior of the clinical suicide attempt, clinical non-suicide attempt, and non-clinical groups. Conclusion: We found that for suicide stroop, the clinical and non-clinical cases did not show a significant difference in terms of the interference effect; however, they differed in terms of reaction time. Therefore, it seems that using emotional stroop, attentional bias towards suicide-related topics is not dependent on the clinical situations, and other parameters, such as scoring methods should be considered. However, there is still a need to conduct more extensive studies.

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