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Active service members and Veterans with a combat-related traumatic brain injury (TBI) are four times more likely to attempt suicide than those without a TBI. TBIs are the signature injuries of the Post-9/11 conflicts and Combat Veterans (i.e., current and former service members who deployed in support of a combat mission) with these injuries are entitled to receive the Purple Heart medal. However, potentially tens of thousands of Combat Veterans did not receive, or were denied the Purple Heart during the first decade of the Global War on Terrorism because a TBI was not documented during the deployment. To our knowledge, this is the first study to explore the meaning of the Purple Heart and examine the impact of the Purple Heart on Army Combat Veterans with a combat-related TBI. Findings from this mixed methods study revealed that not receiving the Purple Heart is associated with increased suicide risk and lower quality of life after a brain injury. Additionally, thwarted belongingness, perceived burdensomeness, and perceived military institutional betrayal are associated with increased suicide risk in Army Combat Veterans with a TBI. This mixed methods study provides important insights into how Army culture is perceived and the power of the Purple Heart among this high-risk group of Combat Veterans. [ABSTRACT FROM AUTHOR]

This integrative review expands on the work of Kramer et al. (2020), by reviewing studies that utilized the Interpersonal Needs Questionnaire (INQ) to examine the interpersonal constructs (thwarted belongingness and perceived burdensomeness) of the Interpersonal Theory of Suicide (ITS) to understand suicidal thoughts and behaviors among service members and Veterans with combat experience. Very few studies (n = 9) in the literature were identified, however important relationships were revealed between combat exposure/experiences, thwarted belongingness, perceived burdensomeness, and suicidal thoughts and behaviors among military samples. Studies also reported risk factors for high levels of thwarted belongingness or perceived burdensomeness in military samples, such as moral injuries, betrayal, and aggression. This review highlights the utility of the INQ to measure ITS constructs among Post-9/11 U.S. Combat Veterans. [ABSTRACT FROM AUTHOR]

Objective: Suicidal ideation and suicidal behaviors are major public health concerns in the United States and are difficult to treat and predict. Risk factors that are incrementally informative are needed to improve prediction and inform prevention of suicidal thoughts and behaviors. Uncontrollability of suicidal ideation, one parameter of suicidal ideation, is one such candidate. Method: In the current study, we assessed the predictive power of uncontrollability of suicidal ideation, over and above overall suicidal ideation, for future suicidal ideation in a large sample of active‐duty service members. A total of 1044 suicidal military service members completed baseline assessments, of whom 664 (63.6%) completed 3‐month follow‐up assessments. Results: While baseline overall suicidal ideation itself was the strongest predictor of future suicidal ideation, uncontrollability of suicidal ideation added some incremental explanatory power. Conclusion: Further study of uncontrollability of suicidal thought is needed to elucidate its impact on suicidal outcomes. [ABSTRACT FROM AUTHOR]

The rise in suicide by African Americans in the United States is directly attributable to the dramatic, nearly three-fold increase in suicide rates of African American males. Gibbs (1997) hypothesized high social support, religiosity, and southern residence are protective factors against suicidality for Black people. This hypothesis was tested among 5,125 participants from the National Comorbidity Survey; 299 were African American males. In this study we hypothesized that there would be significantly lower suicidality in the South, and social support and religiosity would mediate this relationship. Our results indicate that Southern region is indeed a significant predictor of suicidal symptoms in African American men, such that suicidal symptoms were lower in the South, but religiosity and social support did not account for this effect. Other potential mediators were also examined.

To date, the field has been unable to provide a definitive answer on which suicide risk assessment measure or set of measures is most useful in applied clinical settings. This study pits several psychometrically sound suicide risk assessment measures against one another, to determine which tool optimally assesses the likelihood of future suicide-related outcomes over a 3-month period, in a large sample of military personnel seeking and/or referred to services due to suicide risk concerns. The risk assessment measures were (a) Columbia-Suicide Severity Rating Scale; (b) Self-Harm Behavior Questionnaire; (c) Suicidal Behaviors Questionnaire-Revised; and (d) Beck Scale for Suicide Ideation. A total of 1,044 suicidal military service members completed baseline assessments, of whom 758 (72.6%) completed 3-month follow-up assessments. The data indicate that there is no best measure for suicide risk assessment and clinicians are therefore encouraged to select the measure, from among the four studied, for use in regular practice that best suits the demands of their setting. (PsycInfo Database Record (c) 2021 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Objective: Firearms are the most common method of suicide in the United States. The provision of firearm-specific lethal means safety interventions is a best practice for the prevention and management of suicide risk. However, few data exist to inform firearm-specific lethal means safety interventions. This study tested four different lethal means safety interventions that varied on two dimensions salient to health behavior change (i.e., fear appeals and emphasis on temporariness). Method: Overall, 96 college-enrolled young adults with a history of suicidal ideation and current firearm familiarity (i.e., firearm ownership, access, and/or a desire/intention to obtain a firearm) were randomized to one of four different firearm-specific lethal means safety interventions occurring in the context of the Safety Planning Intervention. Assessments occurred at preintervention, postintervention, and 1-month follow-up. Results: Participants who received the firearm-specific lethal means safety intervention that deemphasized fear and emphasized temporariness reported significantly greater intentions to adhere to clinician recommendations to limit their access to firearms for safety purposes compared to individuals randomized to the other groups (Intervention × Time), F(6, 184) = 2.300, p =.036, corresponding to a medium effect size (ηp2 =.070). Across groups, 35.4% of participants reported an increase in engagement in firearm safety thoughts/behaviors from preintervention to 1-month follow-up; there were no significant group differences. All four intervention approaches were rated as similarly highly acceptable. Conclusions: Findings underscore the potential importance of deemphasizing fear and emphasizing temporariness in firearm-specific lethal means safety interventions. Future studies leveraging these pilot data are needed to replicate and extend findings. What is the public health significance of this article?: Over half of the suicide fatalities in the United States are enacted with firearms. Study findings suggest that firearm-specific lethal means safety psychoeducation that occurs within the context of the Safety Planning Intervention might increase buy-in from individuals at elevated suicide risk if it, with due caution, (a) focuses on normalizing firearm ownership and (b) emphasizes the temporariness of limiting access to firearms during at-risk periods. [ABSTRACT FROM AUTHOR]

Importance: Brief cognitive behavioral therapy (BCBT) is a clinically effective intervention for reducing risk of suicide attempts among suicidal US Army soldiers. However, because specialized treatments can be resource intensive, more information is needed on costs and benefits of BCBT compared with existing treatments.Objective: To evaluate the cost-effectiveness of BCBT compared with treatment as usual for suicidal soldiers in the US Army.Design, Setting, and Participants: A decision analytic model compared effects and costs of BCBT vs treatment as usual from a US Department of Defense (DoD) perspective. Model input data were drawn from epidemiologic data sets and a clinical trial among suicidal soldiers conducted from January 31, 2011, to April 3, 2014. Data were analyzed from July 3, 2018, to March 25, 2019.Interventions: The strategies compared were treatment as usual alone vs treatment as usual plus 12 individual BCBT sessions. Treatment as usual could include a range of pharmacologic and psychological treatment options.Main Outcomes and Measures: Costs in 2017 US dollars, suicide attempts averted (self-directed behavior with intent to die, but with nonfatal outcome), suicide deaths averted, and incremental cost-effectiveness ratios, assuming a 2-year time horizon for treatment differences but including lifetime costs.Results: In the base-case analysis, BCBT was expected to avert approximately 23 to 25 more suicide attempts and 1 to 3 more suicide deaths per 100 patients treated than treatment as usual. Sensitivity analyses assuming a range of treatment effects showed BCBT to be cost saving in most scenarios. Using the federal discount rate, the DoD was estimated to save from $15 000 to $16 630 per patient with BCBT vs treatment as usual. In a worst-case scenario (ie, assuming the weakest plausible BCBT effect sizes), BCBT cost an additional $1910 to $2250 per patient compared with treatment as usual.Conclusions and Relevance: Results suggest BCBT may be a cost-saving intervention for suicidal active-duty soldiers. The costs of ensuring treatment fidelity would also need to be considered when assessing the implications of disseminating BCBT across the entire DoD. [ABSTRACT FROM AUTHOR]

Background: Research is needed to identify the factors that explain the link between prior and future suicidality. This study evaluated possible mediators of the relationship between: (1) the severity of prior suicidality and (2) suicidal ideation severity at 3-month follow-up among a sample of high-risk military personnel. Methods: US military service members referred to or seeking care for suicide risk (N = 624) completed self-report psychiatric domain measures and a clinician interview assessing prior suicidality severity at baseline. Three months later, participants completed a self-report measure of suicidal ideation severity. Three separate percentile bootstrap mediation models were used to examine psychiatric factors (i.e. alcohol abuse, anxiety sensitivity, hopelessness, insomnia, posttraumatic stress symptoms, suicidal ideation, and thwarted belongingness) as parallel mediators of the relationship between prior suicidality severity (specifically, suicidal ideation, suicide attempt, and overall suicidality – i.e. ideation/attempt severity combined) at baseline and suicidal ideation severity at follow-up. Results: Hopelessness, specifically, and the total effect of all mediators, each significantly accounted for the relationship between prior suicidality severity and subsequent ideation severity across models. In the models with attempt severity and overall suicidality severity as predictors, thwarted belongingness was also a significant mediator. Conclusions: Hopelessness, thwarted belongingness, and overall severity of psychiatric indices may explain the relationship between prior suicidality severity and future suicidal ideation severity among service members at elevated suicide risk. Research is needed to replicate these findings and examine other possible mediators. [ABSTRACT FROM AUTHOR]

Suicide rates within the U.S. military are elevated, necessitating greater efforts to identify those at increased risk. This study utilized a multigroup confirmatory factor analysis to examine measurement invariance of the Military Suicide Research Consortium Common Data Elements (CDEs) across current service members (n = 2,015), younger veterans (<35 years; n = 377), and older veterans (≥35 years; n = 1,001). Strong factorial invariance was supported with adequate model fit observed for current service members, younger veterans, and older veterans. The structures of all models were generally comparable with few exceptions. The Military Suicide Research Consortium CDEs demonstrate at least adequate model fit for current military service members and veterans, regardless of age. Thus, the CDEs can be validly used across military and veteran populations. Given similar latent structures, research findings in one group may inform clinical and policy decision making for the other. [ABSTRACT FROM AUTHOR]

Suicide has become an issue of great concern within the U.S. military in recent years, with recent reports indicating that suicide has surpassed combat related deaths as the leading cause of death. One concern regarding suicide risk in the military is that existing self-report measures allow service members to conceal or misrepresent current suicidal ideation or suicide plans and preparations. Implicit association tests (IATs) are computer-based, reaction time measures that have been shown to be resilient to such masking of symptoms. The death/suicide implicit association test (d/s-IAT) is an empirically supported IAT that is specific to death and suicide. The present study examined whether the performance of 1,548 U.S. military service members on the d/s-IAT significantly predicted lifetime suicidal ideation and depression. Zero-inflated negative binomial regression analyses were used to test these associations. Results indicated that the d/s-IAT was neither associated with history of suicidal ideation nor history of depression. [ABSTRACT FROM AUTHOR]

The current studies examined the hypothesis that maturity fears are increasing among undergraduate men and women from the United States over time. Study 1 used a time-lag method to assess generational effects of maturity fears among a large sample (n = 3291) of undergraduate men and women assessed in 1982, 1992, 2002, and 2012. Results revealed that both men and women reported Significantly higher rates of maturity fears across time. Study 2 replicated these findings, and used a more restricted time frame to more closely examine the rate of change. Undergraduate women (n = 673) were assessed in 2001, 2003, 2009, and 2012. Maturity fears were again found to increase from 2001 to 2012. Recent cohorts of emerging adults seem more reluctant to mature than previous cohorts. Many contributing factors may be at play, including challenging economic times, social pressures to remain youthful, and/or internal fears of assuming increased responsibility. [ABSTRACT FROM AUTHOR]

Background Research regarding suicide mortality among firefighters within the U.S. has been sparse and has yielded inconsistent findings. This study aimed to: (i) describe suicide rates within a large, urban fire department; and (ii) compare firefighter suicide rates with demographically adjusted general population suicide rates. Methods Rosters were obtained from the Philadelphia Fire Department (PFD) for all members employed by or separated from the department between 1993 and 2014 (N = 4,395). Vital statistics for each member were obtained from the CDC's National Death Index. Results Overall, 272 deaths were recorded; 11 (4.0%) were certified as suicides. The overall suicide rate among firefighter affiliates of the PFD between 1993 and 2014 was 11.61 per 100,000 person-years. Conclusions The suicide rate among firefighters appears comparable to, and perhaps lower than, demographically adjusted general population estimates. Infrastructure to triangulate and monitor suicide rates from multiple departments, both career and volunteer, is needed to derive a more representative and informative estimate of firefighter suicide rates. Am. J. Ind. Med. 59:942-947, 2016. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective: Death by suicide is a serious and growing public health concern in the United States. This noncontrolled, naturalistic study examined professionals' knowledge about suicide and confidence in working with suicidal individuals, comparing those who had received either of two gatekeeper trainings-Question, Persuade, and Refer (QPR) or Applied Suicide Intervention Skills Training (ASIST)-or other suicide-relevant training or no training.Methods: Participants (N=16,693) were individuals in various professional roles in the field of behavioral health care in Indiana, Kentucky, New York, Pennsylvania, Tennessee, Texas, and Utah. Participants completed a survey assessing suicide knowledge and skills confidence.Results: Most participants (52.9%) reported no previous suicide prevention or assessment training. Individuals with suicide-relevant training demonstrated greater suicide knowledge and confidence than those with no such training. Among those who had received any training, no differences were found in suicide knowledge; however, individuals who had received ASIST reported greater confidence in working with suicidal individuals, compared with those who had received other training. Professional role and prior experience with a client who had died by suicide had significant positive relationships with suicide knowledge and confidence. Regional differences emerged between states and are examined within the context of statewide suicide prevention initiatives.Conclusions: Increasing access to and incentives for participating in suicide-relevant training among behavioral health care staff may foster a more knowledgeable and confident group of gatekeepers. Future research should examine whether increases in knowledge and confidence among staff translate into actual changes in practice that help protect and serve at-risk individuals. [ABSTRACT FROM AUTHOR]

Unlabelled: Utilizing Add Health longitudinal data, we compared 21 male suicide casualties to 10,101 living respondents identifying suicide correlates.Method: 21 suicide decedents completed surveys in 1994/1995 (Wave 1) and 11 completed at Wave 3; responses were compared with Chi-square and oneway ANOVA tests.Results: Suicide decedents were prone to higher delinquency and fighting at Wave 1, but not at Wave 3. At Wave 1 suicide decedents remained undistinguished from living respondents in depression, self-esteem, and drug uses. Yet, after Wave 3, the 11 respondents dying by suicide showed significantly higher depression, drug use and lower self-esteem.Conclusion: Delinquency trends can readily understood, but more complex causes are needed to account for unexpected changes in self-esteem, depression and drug uses. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to characterize rates and correlates of mental health service use, as well as barriers to care, among a sample of firefighters reporting a history of suicide ideation, plans, or attempts during their firefighting careers.Methods: Participants (N=483) completed a Web-based survey assessing history of suicidal thoughts and behaviors, prior mental health service utilization, and barriers to treatment.Results: Overall, 77% of participants reported receipt of mental health services during their firefighting careers (attempt history, 93%; plan but no attempt, 77%; and ideation only 68%). Firefighters with fewer years of service were less likely than those with more years to have accessed treatment. Service nonusers were more likely than service users to report concerns regarding reputation and embarrassment as barriers to care.Conclusions: Findings from this preliminary investigation suggest that the majority of firefighters with a history of elevated suicide risk have received mental health services. [ABSTRACT FROM AUTHOR]

This study was based on a sample of male high school students who completed National Longitudinal Adolescent Health Surveys in 1994, 1995, and 2001. We studied these students prospectively, comparing those who later died by suicide (n = 21) with those who were still living (n = 10,101). We employed chi-square and analysis of variance tests for statistical significance between suicide decedents and living respondents. Results showed suicide decedents were more likely to have experienced the suicide loss of another family member, to have been expelled from school, to have engaged in more delinquent actions including fighting, and to have greater involvement with the criminal justice system. Although one might have expected suicide casualties to have exhibited a greater amount of suicidal thoughts, attempts, and higher incidences of suicidality among their friends, our analyses did not find that these factors were associated with actual suicides. Should these findings be replicated, this would point to a need to refine youth suicide risk assessments. Collecting life histories, as well as identifying patterns of delinquency and fighting, may serve as more potentially fruitful means for assessing genuine suicide risk than some traditional risk assessment methods.z. [ABSTRACT FROM AUTHOR]

Purpose of the Study: Combat is a risk factor for posttraumatic stress disorder (PTSD); however, less is known about how exposure to combat in early adulthood may contribute to the development of PTSD as the individual ages. Prior exposure to trauma may "sensitize" people to respond more intensely to subsequent stressors. Further, aging initiates new challenges that may undermine previous coping strategies. Over the life course combat veterans may be more reactive to new stressors and thus be more vulnerable to PTSD. Design and Methods: This study draws on the two waves of the National Comorbidity Survey (NCS-1) and NCS-2 (10-year follow-up). Participants were male (noncombat N = 620 and combat N = 107) and 50-65 years of age at Wave-2. At baseline, participants were assessed for exposure to wartime combat, number of Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses in the past year, and life-time PTSD. At follow-up, PTSD occurring between waves was determined. A measure of recent life stressors was also obtained. Results: Using logistic regression analyses, combat predicted PTSD at follow-up (controlling for baseline demographics, number of DSM diagnoses in the past year, life-time PTSD). Recent life stressors were also associated with PTSD. Importantly, the effect of combat on PTSD was significant at high levels, but not low levels, of recent life stress. Implications: Veterans who have experienced combat may be more reactive to new stressors, and in turn be more vulnerable to PTSD. Combat veterans should be regularly assessed for current stressors and PTSD. [ABSTRACT FROM AUTHOR]

Objective: Despite the existence of efficacious interventions that reduce suicide risk, connecting high-risk individuals with care remains a problem. Little is known about factors that may be associated with service use and nonuse among suicidal adults. This study aimed to identify correlates of mental health service use among adults reporting past-year ideation, plans, or attempts.Methods: Data from the 2013 National Survey on Drug Use and Health (NSDUH) were analyzed to identify correlates of mental health service use among a nationally representative sample of adults reporting past-year suicide ideation (N=2,126), plans (N=690), or attempts (N=345). Findings were compared with results for individuals reporting no past-year suicidality (N=35,106).Results: Approximately 50% of adults with past-year ideation, plans, or attempts reported contact with any type of mental health services in the past year. Individuals who were more likely to have connected with services in the past year included females, non-Hispanic whites, those in worse general medical health, and those with a more severe clinical picture (that is, presence of serious psychological distress or a past-year diagnosis of a major depressive episode). Among the groups with suicide ideation, plans, or attempts, no significant differences in service use emerged between veterans and nonveterans or between married and nonmarried individuals.Conclusions: Findings underscore the low rates of service use among adults at elevated risk of suicide and reveal possible avenues by which to increase treatment engagement in this population. Additional research is warranted to examine correlates of service use within a prospective design. [ABSTRACT FROM AUTHOR]

Importance: Older adults have high rates of sleep disturbance, die by suicide at disproportionately higher rates compared with other age groups, and tend to visit their physician in the weeks preceding suicide death. To our knowledge, to date, no study has examined disturbed sleep as an independent risk factor for late-life suicide.Objective: To examine the relative independent risk for suicide associated with poor subjective sleep quality in a population-based study of older adults during a 10-year observation period.Design, Setting, and Participants: A longitudinal case-control cohort study of late-life suicide among a multisite, population-based community sample of older adults participating in the Established Populations for Epidemiologic Studies of the Elderly. Of 14 456 community older adults sampled, 400 control subjects were matched (on age, sex, and study site) to 20 suicide decedents.Main Outcomes and Measures: Primary measures included the Sleep Quality Index, the Center for Epidemiologic Studies-Depression Scale, and vital statistics.Results: Hierarchical logistic regressions revealed that poor sleep quality at baseline was significantly associated with increased risk for suicide (odds ratio [OR], 1.39; 95% CI, 1.14-1.69; P < .001) by 10 follow-up years. In addition, 2 sleep items were individually associated with elevated risk for suicide at 10-year follow-up: difficulty falling asleep (OR, 2.24; 95% CI, 1.27-3.93; P < .01) and nonrestorative sleep (OR, 2.17; 95% CI, 1.28-3.67; P < .01). Controlling for depressive symptoms, baseline self-reported sleep quality was associated with increased risk for death by suicide (OR, 1.30; 95% CI, 1.04-1.63; P < .05).Conclusions and Relevance: Our results indicate that poor subjective sleep quality is associated with increased risk for death by suicide 10 years later, even after adjustment for depressive symptoms. Disturbed sleep appears to confer considerable risk, independent of depressed mood, for the most severe suicidal behaviors and may warrant inclusion in suicide risk assessment frameworks to enhance detection of risk and intervention opportunity in late life. [ABSTRACT FROM AUTHOR]

The rise in suicide by African Americans in the United States is directly attributable to the dramatic, nearly three-fold increase in suicide rates of African American males. Gibbs (1997) hypothesized high social support, religiosity, and southern residence are protective factors against suicidality for Black people. This hypothesis was tested among 5,125 participants from the National Comorbidity Survey; 299 were African American males. In this study we hypothesized that there would be significantly lower suicidality in the South, and social support and religiosity would mediate this relationship. Our results indicate that Southern region is indeed a significant predictor of suicidal symptoms in African American men, such that suicidal symptoms were lower in the South, but religiosity and social support did not account for this effect. Other potential mediators were also examined. [ABSTRACT FROM AUTHOR]

Over 48,000 people died by suicide in 2018 in the United States, and more than 25 times that number attempted suicide. Research on suicide has focused much more on risk factors and adverse outcomes than on protective factors and more healthy functioning. Consequently, little is known regarding relatively positive long-term psychological adaptation among people who attempt suicide and survive. We recommend inquiry into the phenomenon of long-term well-being after nonfatal suicide attempts, and we explain how this inquiry complements traditional risk research by (a) providing a more comprehensive understanding of the sequelae of suicide attempts, (b) identifying protective factors for potential use in interventions and prevention, and (c) contributing to knowledge and public education that reduce the stigma associated with suicide-related behaviors. [ABSTRACT FROM AUTHOR]

Suicide is a serious public health threat in the U.S. as evidenced by increases in suicide rates between 1999 and 2018 and between 2020 and 2022. Opiate use has been implicated as a contributor of such trends in suicide rates by directly influencing overdose deaths and indirectly by exacerbating mental health and life circumstances. A moderated network model was estimated on a subset of the National Violent Death Reporting System Data (n = 78,089) to examine the partial correlation structure of suicidal thoughts and behaviors, opiate use at the time of death, stressful life circumstances, experience of depression, alcohol abuse, and substance abuse. Moderation effects of year of death and opiate use at the time of death were independently tested to compare network structures across suicide decedent cohorts/years and opiate use at the time of death. Results showed that overall network structures appeared to be very stable over years/cohorts. Opiate use at the time of death, stressful life circumstances, experience of depression, alcohol abuse, and substance abuse explained limited variance of suicidal thoughts and behaviors. Simultaneously, connections between suicidal thoughts and behaviors, as well as depressed mood, increasingly strengthened over years/cohorts. Alcohol and substance abuse were also increasingly co-occurring over years/cohorts, although they were less co-occurring in decedents who had used opiates at the time of death. Future studies should aim to examine if partial correlation structures identified in the current study generalize in non-decedents and in those with marginalized identities. [ABSTRACT FROM AUTHOR]

Introduction: Each year, a substantial proportion of trainees who enter the U.S. Air Force (USAF) Basic Military Training (BMT) are unable to complete training. Reentry to civilian life poses significant challenges, including finding employment, establishing a new career path, and paying for education. To our knowledge, no study has examined the association of discharge from USAF BMT and mental health symptoms. Utilizing a sample of 85 individuals discharged from USAF BMT for reasons other than mental health concerns, the present study aimed to: (1) characterize the severity of current depression and anxiety symptoms; (2) examine the relationship between the severity of current depression and anxiety symptoms and sociodemographic variables; and (3) determine whether or not a trainee agreed with the decision to be discharged from BMT is associated with differing severities of depression or anxiety symptoms.Materials and Methods: Participants were individuals who were prematurely discharged from USAF BMT for reasons other than mental health issues. Premature discharge is defined as any trainee who was unable to complete BMT in the USAF and was subsequently sent home. Participants were recruited from online Facebook groups for individuals who were prematurely discharged from USAF BMT. Participants were administered a battery of self-report questionnaires through a web-based survey platform. A structured demographic overview was administered to all participants to assess for age, gender, reason for discharge, amount of time spent in BMT, amount of time spent in medical hold, and whether or not the trainee agreed with the decision to be discharged. The Patient Health Questionnaire-9 (PHQ-9) was used to assess current symptoms consistent with depression. The Generalized Anxiety Disorder-7 (GAD-7) was used to assess current symptoms consistent with anxiety. Descriptive statistics were used to assess overall depression and anxiety rates, and analyses of covariance (ANCOVAs) were used to analyze group differences. This study was approved by the Institutional Review Board (IRB) at Florida State University (FSU).Results: In total, 85 participants (42.4% = female) were accounted for in these data. Regarding depression symptom severity, 58.8% of participants (n = 50) indicated moderate or higher levels of depression symptoms. Regarding anxiety symptoms, 45.9% of participants (n = 39) indicated moderate or higher levels of anxiety symptoms. There were no significant differences reported regarding depression or anxiety symptoms across gender, age, amount of time spent in BMT, and amount of time spent in medical hold. Significant differences were found between depression and anxiety symptoms and whether or not a trainee agreed with the decision to be discharged from the USAF, such that trainees who did not agree with this decision reported higher levels of depression and anxiety symptoms.Conclusions: The findings of this study indicate that this population of trainees who were prematurely discharged from USAF BMT for reasons other than mental health concerns has high levels of depression and anxiety symptoms. Discharge from BMT may be associated with substantial distress when the individual disagrees with the reason for discharge. Enhanced procedures and continued research regarding their postdischarge well-being seem warranted. [ABSTRACT FROM AUTHOR]

Drawing from the National Survey on Drug Use and Health (NSDUH; N = 611,880), a nationally representative survey of U.S. adolescents and adults, we assess age, period, and cohort trends in mood disorders and suicide-related outcomes since the mid-2000s. Rates of major depressive episode in the last year increased 52% 2005-2017 (from 8.7% to 13.2%) among adolescents aged 12 to 17 and 63% 2009-2017 (from 8.1% to 13.2%) among young adults 18-25. Serious psychological distress in the last month and suicide-related outcomes (suicidal ideation, plans, attempts, and deaths by suicide) in the last year also increased among young adults 18-25 from 2008-2017 (with a 71% increase in serious psychological distress), with less consistent and weaker increases among adults ages 26 and over. Hierarchical linear modeling analyses separating the effects of age, period, and birth cohort suggest the trends among adults are primarily due to cohort, with a steady rise in mood disorder and suicide-related outcomes between cohorts born from the early 1980s (Millennials) to the late 1990s (iGen). Cultural trends contributing to an increase in mood disorders and suicidal thoughts and behaviors since the mid-2000s, including the rise of electronic communication and digital media and declines in sleep duration, may have had a larger impact on younger people, creating a cohort effect. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Background: Given the negative consequences of excess weight, a large portion of the US population is seeking to obtain and maintain weight loss. Weight Suppression (WS) represents the difference between previous highest adult weight and current weight and may have negative psychological consequences. The current study examined the link between WS and lifetime non-suicidal self-injurious (NSSI) behavior and explored indirect effects in this link using survey data in two large samples.Methods: Sample 1 included 1011 college students (67% female, mean age = 19 years); Sample 2 included 2461 participants from an epidemiological study (68% female, mean age = 34 years). Models of direct and indirect effects were tested in MPlus using bootstrapping.Results: As hypothesized, greater WS was associated with increased likelihood of lifetime NSSI in both samples (OR = 1.05 and 1.02). In both samples, significant indirect effects of drive for thinness (Total R2 = 0.06 and 0.09) and depressive symptoms (Total R2 = 0.13 and 0.29) accounted for this association. Alternative models in which the indirect effect of WS was tested in associations between drive for thinness or depressive symptoms and NSSI were not supported.Conclusion: Results suggest that the link between WS and lifetime NSSI may be accounted for by eating or mood-related pathology. Future research should test whether addressing associated eating and mood problems would eliminate the link between WS and NSSI as a means for reducing suicide risk. [ABSTRACT FROM AUTHOR]

Prior research has shown that most known risk factors for suicide attempts in the general population actually predict suicide ideation rather than attempts among ideators. Yet clinical interest in predicting suicide attempts often involves the evaluation of risk among patients with ideation. We examined a number of characteristics of suicidal thoughts hypothesized to predict incident attempts in a retrospective analysis of lifetime ideators (N = 3,916) drawn from a large (N = 29,982), representative sample of United States Army soldiers. The most powerful predictors of first nonfatal lifetime suicide attempt in a multivariate model controlling for previously known predictors (e.g., demographics, mental disorders) were: recent onset of ideation, presence and recent onset of a suicide plan, low controllability of suicidal thoughts, extreme risk-taking or "tempting fate," and failure to answer questions about the characteristics of one's suicidal thoughts. A predictive model using these risk factors had strong accuracy (area under the curve [AUC] = .93), with 66.2% of all incident suicide attempts occurring among the 5% of soldiers with highest composite predicted risk. This high concentration of risk in this retrospective study suggests that a useful clinical decision support model could be constructed from prospective data to identify those with highest risk of subsequent suicide attempt. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Two proposed suicide-specific diagnoses, with accumulating research support, characterize the phenomenology of acute suicidal crises: Suicide Crisis Syndrome (SCS) and Acute Suicidal Affective Disturbance (ASAD). Despite conceptual overlap and some similar criteria, the two syndromes have never been compared empirically. The present study addressed this gap by examining SCS and ASAD utilizing a network analysis approach. A sample of 1568 community-based adults (87.6% cisgender women, 90.7% White, M age = 25.60 years, SD = 6.59) in the United States completed an online battery of self-report measures. SCS and ASAD were first examined in individual network models, followed by a combined network to determine changes in network structure, as well as identify bridge symptoms that connected SCS and ASAD. The proposed criteria of SCS and ASAD formed sparse network structures that were largely unaffected by the influence of the other syndrome in a combined network. Social disconnection/withdrawal and manifestations of overarousal—particularly agitation, insomnia, and irritability—emerged as bridge symptoms that may connect SCS and ASAD. Our findings indicate the network structures of SCS and ASAD exhibit patterns of independence, alongside interdependence between overlapping symptom domains (i.e., social withdrawal, overarousal). Future work should examine SCS and ASAD prospectively to better understand their temporal dynamics and predictive utility in relation to imminent suicide risk. [ABSTRACT FROM AUTHOR]

• We examined prospective firearm owners and those with current firearm ownership/access. • Suicidal ideation severity was higher among prospective firearm owners. • The intention to commence firearm ownership might signal increased suicide risk. • Research should seek to replicate findings in higher-risk samples. • Findings suggest clinicians should assess for intentions to obtain firearms. Most suicide deaths in the United States are enacted with a firearm, and recent and first-time purchasers of firearms represent at-risk groups. This study aimed to examine differences in indicators of suicide risk among individuals who either (a) reported current firearm ownership/access or (b) denied current firearm ownership/access but reported an intention to obtain a firearm (i.e., prospective firearm owners). Participants were 96 young adults with a lifetime history of suicidal ideation and firearm ownership, access, or interest. We assessed recent suicidal ideation severity with the Depressive Symptom Index-Suicidality Subscale (DSI-SS) and sought to internally replicate findings with the Patient Health Questionnaire (PHQ-9) item 9. Fifty-two (54.2%) participants reported firearm ownership/access and 44 (45.8%) identified as prospective firearm owners. Prospective firearm owners had significantly greater DSI-SS suicidal ideation severity scores compared with those who already own/have access to a firearm, corresponding to a medium effect size; results were consistent with the PHQ-9 suicidal ideation item. Findings of this initial investigation suggest that the intention to commence firearm ownership might represent an at-risk period, especially for individuals with a history of suicidal thinking. Replication of findings in larger and more clinically severe samples is needed. [ABSTRACT FROM AUTHOR]

Background: Suicide rates are elevated among United States (U.S.) military service members. Research has found that service members with autism spectrum disorder-related (ASD-related) traits are at increased risk for suicide. Complementary lines of inquiry have suggested that unit cohesion is a protective factor against developing suicidal ideation in military service members. However, given the social difficulties inherent in ASD, it is unclear whether unit cohesion might protect against suicide risk in this population.Method: Our sample consisted of 285 active duty U.S. military service members recruited online. We examined the interaction between ASD-related traits (as measured by the Autism Spectrum Quotient [AQ]), unit cohesion, and suicide risk (as measured by the Suicidal Behaviors Questionnaire-Revised [SBQ-R]). We also conducted exploratory analyses to examine whether unit cohesion attenuates the association between ASD-related traits and suicidal intent.Results: Elevated ASD-related traits were independently associated with higher levels of global suicide risk; however, unit cohesion was not independently associated with suicide risk. Unit cohesion did not significantly interact with ASD-related traits to predict suicide risk. Finally, we found that elevated ASD-related traits and unit cohesion have an independent effect on current suicidal intent.Discussion: Our findings suggest that unit cohesion might not buffer the effect of ASD-related traits on suicide risk. However, our results do show that greater unit cohesion may be independently associated with decreased suicidal intent. This study is limited by a cross-sectional design and use of self-report measures. [ABSTRACT FROM AUTHOR]

Background: Although insomnia has been identified as a robust predictor of suicidal ideation and behaviors, little is known about the mechanisms by which sleep disturbances confer risk for suicide. We investigated thwarted belongingness as an explanatory link between insomnia symptoms and suicidal ideation across three military service member and veteran samples.Methods: Data were collected among United States military service members and veterans (N1=937, N2=3,386, N3=417) who completed self-report measures of insomnia symptoms, thwarted belongingness, suicidal ideation, and related psychiatric symptoms (e.g., anxiety, hopelessness). Bias-corrected bootstrap mediation analyses were utilized to examine the indirect effects of insomnia symptoms on suicidal ideation through thwarted belongingness, controlling for related psychiatric symptoms.Results: Consistent with study hypotheses, thwarted belongingness significantly accounted for the relationship between insomnia and suicidal ideation across all three samples; however, insomnia symptoms did not significantly account for the relationship between thwarted belongingness and suicidal ideation, highlighting the specificity of our findings.Limitations: This study utilized cross-sectional self-report data.Conclusions: Insomnia may confer suicide risk for military service members and veterans, in part, through the pathway of thwarted belongingness. Additional prospective studies are warranted to further delineate this model of risk. Our results offer a potential therapeutic target for the prevention of suicide, via the promotion of belongingness, among service members and veterans experiencing insomnia symptoms. [ABSTRACT FROM AUTHOR]

Background: Past research suggests that suicide has a profound impact on surviving family members and friends; yet, little is known about experiences with suicide bereavement among military populations. This study aimed to characterize experiences with suicide exposure and their associations with lifetime and current psychiatric symptoms among military service members and veterans.Methods: A sample of 1753 United States military service members and veterans completed self-report questionnaires assessing experiences with suicide exposure, lifetime history of suicidal thoughts and behaviors, current suicidal symptoms, and perceived likelihood of making a future suicide attempt.Results: The majority of participants (57.3%) reported knowing someone who had died by suicide, and of these individuals, most (53.1%) reported having lost a friend to suicide. Chi-square tests, one-way ANOVAs, and logistic regression analyses revealed that those who reported knowing a suicide decedent were more likely to report more severe current suicidal symptoms and a history of suicidal thoughts and behaviors compared to those who did not know a suicide decedent. Hierarchical linear regression analyses indicated that greater self-reported interpersonal closeness to a suicide decedent predicted greater self-reported likelihood of a future suicide attempt, even after controlling for current suicidal symptoms and prior suicidal thoughts and behaviors.Limitations: This study utilized cross-sectional data, and information regarding degree of exposure to suicide was not collected.Conclusions: Military personnel and veterans who have been bereaved by suicide may themselves be at elevated risk for suicidal thoughts and behaviors. Additional work is needed to delineate the relationship between these experiences. [ABSTRACT FROM AUTHOR]

Although a suicide attempt history is among the single best predictors of risk for eventual death by suicide, little is known about the extent to which reporting of suicide attempts may vary by assessment type. The current study aimed to investigate the correspondence between suicide attempt history information obtained via a single-item self-report survey, multi-item self-report survey, and face-to-face clinical interview. Data were collected among a high-risk sample of undergraduates (N = 100) who endorsed a past attempt on a single-item prescreening survey. Participants subsequently completed a multi-item self-report survey, which was followed by a face-to-face clinical interview, both of which included additional questions regarding the timing and nature of previous attempts. Even though 100% of participants (n = 100) endorsed a suicide attempt history on the single-item prescreening survey, only 67% (n = 67) reported having made a suicide attempt on the multi-item follow-up survey. After incorporating ancillary information from the in-person interview, 60% of participants qualified for a Centers for Disease Control and Prevention (CDC)-defined suicide attempt. Of the 40% who did not qualify for a CDC-defined suicide attempt, 30% instead qualified for no attempt, 7% an aborted attempt, and 3% an interrupted attempt. These findings suggest that single-item assessments of suicide attempt history may result in the misclassification of prior suicidal behaviors. Given that such assessments are commonly used in research and clinical practice, these results emphasize the importance of utilizing follow-up questions and assessments to improve precision in the characterization and assessment of suicide risk. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Recent research suggests that firefighters experience elevated rates of suicidal ideation and behaviors. The interpersonal theory of suicide may shed light on this finding. This theory postulates that suicidal desire is strongest among individuals experiencing perceived burdensomeness and thwarted belongingness, and that the combination of suicide desire and acquired capability for suicide is necessary for the development of suicidal behaviors. We tested the propositions of the interpersonal theory in a large sample of current United States firefighters ( N =863). Participants completed self-report measures of perceived burdensomeness, thwarted belongingness, fearlessness about death (FAD; a component of acquired capability), and career suicidal ideation and suicide attempt history. Regression models were used to examine the association between interpersonal theory constructs, career suicidal ideation severity, and the presence of career suicide attempts. In line with theory predictions, the three-way interaction between perceived burdensomeness, thwarted belongingness, and FAD was significantly associated with career suicide attempts, beyond participant sex. However, findings were no longer significant after accounting for years of firefighter service or age. Contrary to predictions, the two-way interaction between perceived burdensomeness and thwarted belongingness was not significantly related to career suicidal ideation severity. Applications of the theory to firefighters and future research are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Suicide in the military is a growing concern. The interpersonal-psychological theory of suicidal behavior proposes that an individual will not die by suicide unless he or she experiences a combined disconnection from others, feelings that one is a burden on others, and the ability to do so, but this theory has not yet been rigorously tested with military samples. The current study tested the theory’s hypotheses in predicting history of suicide in a sample of 88 active duty US Air Force personnel, which was compared to a non-military undergraduate sample (n =309) and a non-military clinical sample (n =228). Active duty personnel demonstrated higher acquired capability when compared to a clinical non-military sample. As compared to non-military undergraduates, active duty personnel demonstrated less perceived burdensomeness, but did not differ in terms of thwarted belongingness. The interaction of burdensomeness and acquired capability significantly predicted suicidal history, but the three-way interaction between burdensomeness, belongingness, and acquired capability did not, providing partial support for the theory in a military sample. [Copyright &y& Elsevier]

Abstract: The purpose of this study was two-fold: a) to investigate the relationship between age and bulimic symptoms among a sample of women with a broad age range; and b) to investigate the relationship between geographic location within the United States and bulimic symptoms. The sample consisted of 1807 female health professionals from six different states (NC, VA, OH, LA, TN, and MO). Analyses revealed that there were no differences between the age groups on bulimic symptoms. There were differences across geographic locations on bulimic symptoms, such that the South Atlantic (NC, VA) states reported the most bulimic symptoms. Findings suggest that age may not serve as a protective factor against bulimic symptoms as some previous studies have suggested. These findings also provide further evidence on the influence of environment on bulimic symptoms among a sample of women. [Copyright &y& Elsevier]

Abstract: Quality of life and loneliness are closely associated with mental and physical health outcomes. This relationship is particularly important in Veterans who experience elevated rates of disabilities, comorbidities, and chronic health conditions as compared with non-Veterans. In the present project, we use data from the Military Health and Well-Being Project ( n = 1469, 67.2% men, 32.3% women, 0.5% transgender, nonbinary, prefer not to say) to investigate the link between five domains of quality of life ( i.e. , general quality of life, physical health, psychological health, social relationships, and environment) with loneliness in American Military Veterans. Findings indicated that every domain of quality of life was negatively and significantly associated with loneliness ( r 's < -0.45, p 's < 0.001), such that quality of life decreased as loneliness increased. We further found, using linear regression, that quality social relationships (β = -0.385, t = -13.23), psychological functioning (β = -0.196, t = -5.28), and physical health (β = -0.133, t = -4.174) were related to low levels of loneliness. Taken together, these findings indicate that in this sample of Veterans 1) general quality of life, physical health, psychological health, social relationships, and environment are all strongly connected with loneliness, and 2) of these, social relationships, psychological health, and physical health seem to protect most against loneliness, with large robust effect sizes. We recommend that intervention and policy researchers continue to investigate and develop feasible, acceptable, and cost-effective ways to promote social relationships, psychological health, and physical health among Veterans. Data were collected during the COVID-19 pandemic, which may limit generalizability of these findings., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Suicidality disproportionately affects Veterans, and in 2020 the Military Health and Well-Being Project was conducted in part to study the link between risk and protective constructs with suicidality among Veterans. In the present study, we investigate the relative contribution of risk (i.e., military self-stigma, daily stress, combat exposure, substance use, traumatic brain injury, and moral injury) and protective constructs (i.e., social integration, social contribution, public service motivation, purpose and meaning, and help-seeking) with suicidality. Using cross-sectional Pearson correlation and linear regression models, we studied the independent and relative contribution of risk and protective correlates in a sample of 1469 Veterans (male: n = 985, 67.1 %; female: n = 476, 32.4 %; transgender, non-binary, prefer not to say: n = 8, 0.5 %). When we investigated protective constructs individually as well as simultaneously, social contribution (β = -0.39, t = -15.59, p < 0.001) was the strongest protective construct against suicidality. Social integration (β = -0.13, t = -4.88, p < 0.001) additionally accounted for significant reduction in suicidality when all protective constructs were considered together. When we investigated the contribution of risk constructs towards suicidality, moral injury was most strongly associated with suicidality (r = 0.519, p < 0.001), yet when studied simultaneously for their relative contribution none of the constructs accounted for a significant amount of the variance in suicidality (|t|s ≤ 1.98, ps ≥ 0.07). These findings suggest that among Veterans it is possible that social contribution is protective against suicidality and could be a possible treatment target for the prevention or reduction of suicidality among Veterans., Competing Interests: Declaration of competing interest There are no competing interests to disclose., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Despite increased efforts to prevent suicide, attempts to die by suicide are rising amongst youth in the United States. Testing causal theories that depict suicide attempts from an adolescent development perspective could bolster prevention and intervention efforts. This study using system dynamics modeling to appraise whether a prevalent theory of suicide, the Interpersonal Theory of Suicide, predicts suicide attempts across adolescence., Methods: A system dynamics computational simulation model was conceptualized based on the Interpersonal Theory of Suicide, as described by Joiner and Van Orden et al. This model was parameterized with representative longitudinal data on adolescents in the United States who attempted suicide across four waves from the National Longitudinal Survey of Adolescent and Adult Health., Results: Though able to predict exponential growth in suicide attempts for early adolescents, the Interpersonal Theory of Suicide, when specified as a dynamic theory, did not adequately predict the nonlinear changes in suicide attempts from adolescence into adulthood. The theory was amended with potential feedback loops from literature and tested for fit., Conclusions: The study builds on a field of emerging views that suicide dynamics should be tested to account for nonlinear feedback effects. Results suggest that the Interpersonal Theory of Suicide should be amended to include the effect of interventions after an attempt and the dynamic developmental processes during adolescence that affect suicide behaviors over time., (© 2022 The Foundation for Professionals in Services for Adolescents.)

Objective: This study aims to document the impact of the COVID-19 pandemic on mental health., Method: We compared a nationally representative online sample of 2,032 U.S. adults in late April 2020 to 19,330 U.S. adult internet users who participated in the 2018 National Health Interview Survey (NHIS) using the Kessler-6 scale of mental distress in the last 30 days., Results: Compared to the 2018 NHIS sample, U.S. adults in April 2020 were eight times more likely to fit criteria for serious mental distress (27.7% vs. 3.4%) and three times more likely to fit criteria for moderate or serious mental distress (70.4% vs. 22.0%). Differences between the 2018 and 2020 samples appeared across all demographic groups, with larger differences among younger adults and those with children in the household., Conclusions: These considerable levels of mental distress may portend substantial increases in diagnosed mental disorders and in their associated morbidity and mortality., (© 2020 Wiley Periodicals LLC.)

Objective : Rates of some psychological disorders are higher among enlisted U.S. military personnel than socio-demographically matched civilians. Indirect evidence suggests some internalizing and externalizing psychological problems among enlistees onset prior to enlistment. However, the consistency and strength of the associations between pre-enlistment psychological problems and enlistment over time is unknown. We address this uncertainty by examining whether internalizing and externalizing problems in high school predicted subsequent military enlistment using a large cohort-sequential panel study. Method : The Monitoring the Future study administered baseline surveys from 1989-2014 and biennial follow-up surveys two and four years later to national samples of high-school seniors (N = 20,823). Validated self-report scales assessed internalizing (depression, low self-esteem) and externalizing (risk-taking, school misbehavior, conduct disorder, interpersonal violence, alcohol, and drug use) problems in each survey. Follow-up surveys assessed military enlistment. Logistic regression models were used to estimate associations of problems scales with subsequent enlistment. Results : School misbehavior in 12 th grade, and risk-taking in 12 th grade and two years after graduation were associated with significantly elevated odds of enlistment at follow-up. Although modest, these associations were linear and invariant across respondent sex and baseline survey year. Conclusions : School misbehavior and risk-taking predicted subsequent enlistment and there was no evidence of historical changes in these associations over the course of 25 years; these pre-enlistment psychological problems do not fully explain the high rates of psychological disorders among enlisted military personnel. Further research is needed to determine whether these predictors are associated with negative outcomes during or after military service.

Firefighters represent a group at elevated suicide risk. Identifying segments of the fire service at increased risk may facilitate the targeted provision of suicide prevention initiatives. Among the general population, American Indian/Alaska Native (AI/AN) individuals report higher rates of suicide attempts. This study sought to examine suicide attempt rates among AI/AN firefighters and to determine if greater exposure to painful and provocative events and/or fearlessness about death explains the relationship between AI/AN identity and suicidal behaviors. A total of 917 US firefighters completed a web-based mental health survey (6.2% AI/AN). Participants completed a modified version of the Self-Injurious Thoughts and Behaviors Interview-Short Form, the Painful and Provocative Events Scale, and the Acquired Capability for Suicide Scale-Fearlessness About Death scale. Bootstrap mediation analyses were conducted, controlling for years of service as a firefighter. Although AI/AN firefighters accounted for only 6.2% of the sample, they accounted for 34.4% of the career suicide attempts. AI/AN firefighters were 16.31 (95% CI = 7.96, 33.42) times more likely to report a career suicide attempt history than non-AI/AN firefighters, adjusting for years of service as a firefighter. Painful and provocative events, but not fearlessness about death, was a statistically significant mediator of the relationship between AI/AN identity and suicide attempts. Firefighters identifying as AI/AN represent a subgroup within the fire service at increased risk for suicide. Findings suggest that greater exposure to painful and provocative events among AI/AN firefighters may explain the elevated suicide risk among this population.

Background: Deployment-related experiences might be risk factors for soldier suicides, in which case identification of vulnerable soldiers before deployment could inform preventive efforts. We investigated this possibility by using pre-deployment survey and administrative data in a sample of US Army soldiers to develop a risk model for suicide attempt (SA) during and shortly after deployment., Methods: Data came from the Army Study to Assess Risk and Resilience in Servicemembers Pre-Post Deployment Survey (PPDS). Soldiers completed a baseline survey shortly before deploying to Afghanistan in 2011-2012. Survey measures were used to predict SAs, defined using administrative and subsequent survey data, through 30 months after deployment. Models were built using penalized regression and ensemble machine learning methods., Results: Significant pre-deployment risk factors were history of traumatic brain injury, 9 + mental health treatment visits in the 12 months before deployment, young age, female, previously married, and low relationship quality. Cross-validated AUC of the best penalized and ensemble models were .75-.77. 21.3-40.4% of SAs occurred among the 5-10% of soldiers with highest predicted risk and positive predictive value (PPV) among these high-risk soldiers was 4.4-5.7%., Conclusions: SA can be predicted significantly from pre-deployment data, but intervention planning needs to take PPV into consideration., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Interoceptive deficits (ID) have been associated with non-suicidal self-injury (NSSI) and suicidal behavior in multiple studies. Many of these studies are limited in scope, and have not fully examined possible mechanisms explaining how ID affect suicidal behavior., Methods: This study assesses how self-reported ID relate to suicide ideation and attempts in six distinct and geographically diverse samples of adults (n = 2706) and one sample of adolescents (n = 436). Participants responded to a variety of self-report questionnaires and interviews., Results: Contrary to our hypothesis, self-reported ID were only associated with suicidal ideation in two samples, one of which was the adolescent sample. Largely consistent with our predictions, self-reported ID exhibited an indirect effect on suicide attempts through versatility of NSSI in four of the five adult samples tested. Finally, the indirect effects of self-reported ID on suicide attempts through NSSI versatility did not act indirectly through behaviorally assessed pain tolerance., Conclusions: We found that, in adults, self-reported ID are not associated with suicidal ideation, but are connected with a history of suicide attempts, through an indirect effect via NSSI. Our findings also indicate that the mechanism of action leading from self-reported ID to suicidal behavior may differ between adolescents and adults, and relate to suicidal behavior independent of pain tolerance. Clinical implications and future directions are discussed.

Purpose: Past work has evidenced increased utilization of mental health services on college campuses, as well as rising rates of mood and suicide-related pathology in adolescents and young adults in recent years. We examined whether such findings are reflective of large-scale, nationwide trends in college student mental health in the past decade., Methods: We examined trends in mood, anxiety, and suicide-related outcomes among U.S. college students from 2007 to 2018 across two large national datasets: (1) the National College Health Assessment (n = 610,543; mean age = 21.25 years; 67.7% female; and 72.0% white) and (2) the Healthy Minds Study (n = 177,692; 86% students aged 18-22 years; 57% female; and 74% white). Participants, randomly selected by their educational institution, completed self-report measures of past-year mood, anxiety, nonsuicidal self-injury, and suicidal thoughts and behaviors., Results: In both samples, rates of depression, anxiety, nonsuicidal self-injury, suicidal ideation, and suicide attempts markedly increased over the assessed years, with rates doubling over the period in many cases. Anger, low flourishing, and suicide plans, each assessed in only one dataset, also exhibited upward trends., Conclusions: Findings demonstrate a broad worsening of mental health among U.S. college students over the past decade, a concerning result meriting further attention and intervention., (Copyright © 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Most nonfatal suicide attempts and suicide deaths occur among patients who deny suicidal ideation (SI) during suicide risk screenings. Little is known about risk factors for suicidal behaviors among such patients. We investigated this in a representative sample of U.S. Army soldiers who denied lifetime SI in a survey and were then followed through administrative records for up to 45 months to learn of administratively-recorded suicide attempts (SA). A novel two-stage risk assessment approach was used that combined first-stage prediction from administrative records to find the subsample of SI deniers with highest subsequent SA risk and then used survey reports to estimate a second-stage model identifying the subset of individuals in the high-risk subsample at highest SA risk. 70% of survey respondents denied lifetime SI. Administrative data identified 30% of this 70% who accounted for 81.2% of subsequent administratively-recorded SAs. A relatively small number of self-report survey variables were then used to create a prediction model that identified 10% of the first-stage high-risk sample (i.e., 3% of all soldiers) at highest SA risk (accounting for 45% of SAs in the total sample). We close by discussing potential applications of this approach for identifying future SI deniers at highest SA risk., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Purpose: This study examined prevalence of self-injurious thoughts and behaviors (SITBs) in transgender individuals with eating disorders, as compared to cisgender individuals with eating disorders and transgender individuals without eating disorders., Methods: Data were analyzed from 365,749 individuals (median age 21 years, 71.8% White/Caucasian, 34.9% male, 64.9% female, and 0.2% transgender) who participated in American College Health Association-National College Health Assessment, an annual national assessment of college student health, from 2008 to 2011., Results: Rates of past-year nonsuicidal self-injury, suicidal ideation, and suicide attempts were elevated in transgender participants with eating disorders (74.8%, 75.2%, and 74.8%, respectively), as compared to cisgender participants with eating disorders and transgender participants without eating disorders. Follow-up logistic regression analyses indicated these differences were statistically significant above and beyond the effects of demographic variables and depression., Conclusions: Results found extremely high rates of SITBs in transgender individuals with eating disorders. This combination of identities, each associated with SITBs, may have a compounding effect., (Copyright © 2018 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: Posttraumatic stress disorder (PTSD) symptoms are associated with increased suicide risk among firefighters. Few studies have examined modifiable factors, such as mindfulness facets, that might attenuate this association. This study examined the interactive effects of PTSD symptoms and mindfulness facets in relation to suicide risk among firefighters., Method: Overall, 831 career firefighters were assessed for PTSD symptoms, mindfulness facets, and suicide risk via the PTSD Checklist for DSM-5, Five Facet Mindfulness Questionnaire, and Suicidal Behaviors Questionnaire-Revised, respectively., Results: Greater PTSD symptoms were associated with more severe suicide risk; however, higher levels of two specific mindfulness facets, acting with awareness and nonjudging of inner experience, attenuated this association. By contrast, higher levels of the observing facet of mindfulness potentiated the association between PTSD symptoms and suicide risk., Conclusions: Suicide prevention initiatives among firefighters, particularly those experiencing trauma-related sequelae, might benefit from the inclusion of mindfulness-based practices alongside frontline empirically-supported approaches., (© 2019 Wiley Periodicals, Inc.)

The present study reports the multistage development and evaluation of a Spanish translation of the Interpersonal Needs Questionnaire (INQ). The INQ measures the constructs of thwarted belongingness and perceived burdensomeness, which the interpersonal theory of suicide proposes are proximal causes of suicidal desire. Participants were bilingual Hispanic college students in the United States (n = 56), heritage Spanish-speaking college students in the United States (n = 281), college students in Spain (n = 1,016), psychiatric inpatients in Mexico (n = 181), college students in Mexico (n = 239), and Spanish-speaking U.S. adults (n = 104). Results indicated that a 9-item 2-factor solution (INQ-S-9) provided good fit. Multiple group analyses were also consistent with measurement invariance across nationalities and clinical severity. Finally, both subscale scores demonstrated good internal consistency, test-retest reliability, convergent validity, and concurrent associations with scores on measures of suicide ideation. Cultural considerations and implications for use in clinical and research settings are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Background: High rates of mental disorders, suicidality, and interpersonal violence early in the military career have raised interest in implementing preventive interventions with high-risk new enlistees. The Army Study to Assess Risk and Resilience in Servicemembers (STARRS) developed risk-targeting systems for these outcomes based on machine learning methods using administrative data predictors. However, administrative data omit many risk factors, raising the question whether risk targeting could be improved by adding self-report survey data to prediction models. If so, the Army may gain from routinely administering surveys that assess additional risk factors., Methods: The STARRS New Soldier Survey was administered to 21,790 Regular Army soldiers who agreed to have survey data linked to administrative records. As reported previously, machine learning models using administrative data as predictors found that small proportions of high-risk soldiers accounted for high proportions of negative outcomes. Other machine learning models using self-report survey data as predictors were developed previously for three of these outcomes: major physical violence and sexual violence perpetration among men and sexual violence victimization among women. Here we examined the extent to which this survey information increases prediction accuracy, over models based solely on administrative data, for those three outcomes. We used discrete-time survival analysis to estimate a series of models predicting first occurrence, assessing how model fit improved and concentration of risk increased when adding the predicted risk score based on survey data to the predicted risk score based on administrative data., Results: The addition of survey data improved prediction significantly for all outcomes. In the most extreme case, the percentage of reported sexual violence victimization among the 5% of female soldiers with highest predicted risk increased from 17.5% using only administrative predictors to 29.4% adding survey predictors, a 67.9% proportional increase in prediction accuracy. Other proportional increases in concentration of risk ranged from 4.8% to 49.5% (median = 26.0%)., Conclusions: Data from an ongoing New Soldier Survey could substantially improve accuracy of risk models compared to models based exclusively on administrative predictors. Depending upon the characteristics of interventions used, the increase in targeting accuracy from survey data might offset survey administration costs.