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

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

Psychosocial interventions for self-harm in adults

Background: Self-harm (SH; intentional self-poisoning or self-injury) is common, often repeated, and associated with suicide. This is an update of a broader Cochrane review first published in 1998, previously updated in 1999, and now split into three separate reviews. This review focuses on psychosocial interventions in adults who engage in self-harm. Objectives: To assess the effects of specific psychosocial treatments versus treatment as usual, enhanced usual care or other forms of psychological therapy, in adults following SH. Search methods: The Cochrane Depression, Anxiety and Neurosis Group (CCDAN) trials coordinator searched the CCDAN Clinical Trials Register (to 29 April 2015). This register includes relevant randomised controlled trials (RCTs) from: the Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). Selection criteria: We included RCTs comparing psychosocial treatments with treatment as usual (TAU), enhanced usual care (EUC) or alternative treatments in adults with a recent (within six months) episode of SH resulting in presentation to clinical services. Data collection and analysis: We used Cochrane's standard methodological procedures

Improving health-related quality of life and reducing suicide in primary care: Can social problem–solving abilities help?

Problem-solving deficits and poor health–related quality of life are associated with suicide risk; yet, little is known about the interrelations between these variables. In 220 primary care patients, we examined the potential mediating role of physical and mental health–related quality of life on the relation between social problem–solving ability and suicidal behavior. Participants completed the Suicidal Behaviors Questionnaire-Revised, Social Problem Solving Inventory-Revised, and Short-Form 36 Health Survey. Utilizing bootstrapped mediation, our hypotheses were partially supported; mediating effects were found for mental health–related quality of life on the relation between social problem-solving and suicidal behavior. Physical health–related quality of life was not a significant mediator. Greater social problem–solving ability is associated with better mental health–related quality of life and, in turn, to less suicidal behavior. Interventions promoting social problem–solving ability may increase quality of life and reduce suicide risk in primary care patients

Development and psychometric evaluation of the Military Suicide Attitudes Questionnaire (MSAQ)

Background: To date, a culturally-sensitive psychological instrument has not been developed to evaluate military attitudes toward suicide. Understanding these attitudes can inform suicide prevention research, clinical practice, and policy. We aimed to develop such an instrument and to evaluate its psychometric properties using an active-duty military sample. Methods: A team of military personnel, suicidologists, and researchers assisted with item development. A cross-sectional design was used to evaluate the psychometric properties of the Military Suicide Attitudes Questionnaire (MSAQ) via an online survey battery. Exploratory and confirmatory factor analyses were conducted. Results: A total of 317 military service members met eligibility criteria and completed the online surveys. A four-factor model that explained 46.4% of the variance was identified: (1) Individual- Based Rejection versus Acceptance; (2) Psychache versus Pathological; (3) Unit-Based Rejection versus Acceptance; (4) Moral versus Immoral. The MSAQ demonstrated high partial validity and testretest reliability. Limitations: The study used a convenience sample and did not control for social desirability. Conclusions: The newly developed MSAQ is a promising measure that fills a notable gap in the assessment of suicide attitudes within the United States military. The MSAQ has the potential for future use in evaluating suicide prevention and stigma reduction programs within the Department of Defense. Additionally, the MSAQ may serve as a useful tool for leadership in the evaluation of command climates. In clinical settings, the MSAQ could be used along with other cognitive and attitudinal measures to track suicidal patients’ attitude towards suicide over the course of treatment

Diagnostic and psychosocial differences in psychiatrically hospitalized military service members with single versus multiple suicide attempts

Introduction: Individuals with multiple versus single suicide attempts present a more severe clinical picture and may be at greater risk for suicide. Yet group differences within military samples have been vastly understudied. Purpose: The objective is to determine demographic, diagnostic, and psychosocial differences, based on suicide attempt status, among military inpatients admitted for suicide-related events. Method: A retrospective chart review design was used with a total of 423 randomly selected medical records of psychiatric admissions to a military hospital from 2001 to 2006. Results: Chi-square analyses indicated that individuals with multiple versus single suicide attempts were significantly more likely to have documented childhood sexual abuse (p =.025); problem substance use (p = .001); mood disorder diagnosis (p = .005); substance disorder diagnosis (p =.050); personality disorder not otherwise specified diagnosis (p =.018); and Axis II traits or diagnosis (p = .038) when compared to those with a single attempt history. Logistic regression analyses showed that males with multiple suicide attempts were more likely to have problem substance use (p = .005) and a mood disorder diagnosis (p =.002), while females with a multiple attempt history were more likely to have a history of childhood sexual (p =.027). Discussion: Clinically meaningful differences among military inpatients with single versus multiple suicide attempts exist. Targeted Department of Defense suicide prevention and intervention efforts that address the unique needs of these two specific at-risk subgroups are additionally needed