Demographic and Clinical Characteristics of Military Service Members Hospitalized Following a Suicide Attempt versus Suicide Ideation
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Overall Sample Charecteristics
3.2. Demographic Characteristics across SA and SI Groups
3.3. Clinical Charecteristics across SA and SI Groups
4. Discussion
4.1. Limitations and Strengths
4.2. Recommendations and Implications
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
- World Health Organization. Global Health Observatory (GHO) Data. Available online: https://www.who.int/gho/mental_health/suicide_rates/en/ (accessed on 13 June 2019).
- Center for Disease Control and Prevention. Fatal Injury Reports, National, Regional and State, 1981–2017. Available online: https://webappa.cdc.gov/sasweb/ncipc/mortrate.html (accessed on 13 June 2019).
- Center for Disease Control and Prevention. National Vital Statistics Reports. Available online: https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_06.pdf (accessed on 13 June 2019).
- Armed Forces Health Surveillance Branch. Surveillance snapshot: Manner and cause of death, active component, U.S. Armed Forces, 1998–2013. MSMR 2014, 21, 21. [Google Scholar]
- Pruitt, L.D.; Smolenski, D.J.; Bush, N.E.; Skopp, N.A.; Edwards-Stewart, A.; Hoyt, T.V. Department of Defense Suicide Event Report Calendar Year 2016 Annual Report; National Center for Telehealth & Technology (T2): Joint Base Lewi-McChord, WA, USA, 2018; Available online: https://www.pdhealth.mil/sites/default/files/images/docs/DoDSER_CY_2016_Annual_Report_For_Public_Release_508_2.pdf (accessed on 17 June 2019).
- Defense Health Board Task Force on Mental Health. An Achievable Vision: Report of the Department of Defense Task Force on Mental Health; Defense Health Board: Falls Church, VA, USA, 2007; Available online: https://www.pdhealth.mil/strategy-policy-library/achievable-vision-report-department-defense-task-force-mental-health-june-2007 (accessed on 17 June 2019).
- Reimann, C.A.; Mazuchowski, E.L. Suicide rates among active duty service members compared with civilian counterparts, 2005–2014. Mil. Med. 2018, 183, 396–402. [Google Scholar] [CrossRef] [PubMed]
- Klonsky, E.D.; May, A.M.; Saffer, B.Y. Suicide, suicide attempts, and suicide ideation. Annu. Rev. Clin. Psychol. 2016, 12, 307–330. [Google Scholar] [CrossRef] [PubMed]
- Nock, M.K.; Borges, G.; Bromet, E.J.; Alonso, J.; Angermeyer, M.; Beautrais, A.; Bruffaerts, R.; Chiu, W.T.; de Girolamo, G.; Gluzman, S.; et al. Cross-national prevalence and risk factors for suicide ideations, plans, and attempts. Br. J. Psychiatry 2008, 192, 9–105. [Google Scholar] [CrossRef] [PubMed]
- Meadows, S.O.; Engel, C.C.; Collins, R.L.; Beckman, R.L.; Cefalu, M.; Hawes-Dawson, J.; Doyle, M.; Kress, A.M.; Sontag-Padilla, L.; Ramchand, R.; et al. 2015 Department of Defense Health Related Behaviors Survey; RAND: Santa Monica, CA, USA, 2018; Available online: https://www.rand.org/pubs/research_reports/RR1695.html (accessed on 13 June 2019).
- May, A.M.; Klonsky, E.D. What distinguishes suicide attempters from suicide ideators? A meta-analysis of potential factors. Clin. Psychol. Sci. Pract. 2016, 23, 5–20. [Google Scholar] [CrossRef]
- Bostwick, J.M.; Pabbati, C.; Geske, J.R.; McKean, A.J. Suicide attempt as a risk factor for completed suicide: Even more lethal than we know. Am. J. Psychiatry 2016, 173, 1094–1100. [Google Scholar] [CrossRef] [PubMed]
- De Araúho, R.M.; Lara, D.R. More than words: The association of childhood emotional abuse and suicidal behavior. Eur. Psychiatry 2016, 37, 14–21. [Google Scholar] [CrossRef]
- Boyda, D.; McFeeters, D. Childhood maltreatment and social functioning in adults with sub-clinical psychosis. Psychiatry Res. 2015, 226, 376–382. [Google Scholar] [CrossRef] [PubMed]
- Klonsky, E.D.; Qiu, T.; Safer, B.Y. Recent advances in differentiating suicide attempters from suicide ideators. Curr. Opin. Psychistry 2017, 30, 15–20. [Google Scholar] [CrossRef]
- Plemmons, G.; Hall, M.; Doupnik, S.; Gay, J.; Brown, C.; Browning, W.; Casey, R.; Freundlich, K.; Johnson, D.P.; Lind, C.; et al. Hospitalization for suicide ideation or attempt: 2008–2015. Pediatrics 2018, 141, e20172426. [Google Scholar] [CrossRef]
- Franklin, J.C.; Ribeiro, J.D.; Fox, K.R.; Bentley, K.H.; Kleiman, E.M.; Huang, X.; Musacchio, X.; Jaroszewski, K.M.; Chang, A.C.; Nock, M.K. Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychol. Bull. 2017, 143, 187. [Google Scholar] [CrossRef] [PubMed]
- Pruitt, L.D.; Smolenski, D.J.; Tucker, J.; Issa, F.; Chodacki, J.; McGraw, K.; Kennedy, C.H. Department of Defense Suicide Event Report Calendar Year 2017 Annual Report; Psychological Health Center of Excellence: Silver Spring, MD, USA, 2018.
- Gradus, J.L.; Qin, P.; Lincoln, A.K.; Miller, M.; Lawler, E.; Sørensen, H.T.; Lash, T.L. Posttraumatic stress disorder and completed suicide. Am. J. Epidemiol. 2010, 171, 721–727. [Google Scholar] [CrossRef] [PubMed]
- Foley, D.L.; Goldston, D.B.; Costello, E.J.; Angold, A. Proximal psychiatric risk factors for suicidality in youth: The Great Smoky Mountains Study. Arch. Gen. Psychiatry 2006, 63, 1017–1024. [Google Scholar] [CrossRef] [PubMed]
- Hallfors, D.D.; Waller, M.W.; Ford, C.A.; Halpern, C.T.; Brodish, P.H.; Iritani, B. Adolescent depression and suicide risk: Association with sex and drug behavior. Am. J. Prev. Med. 2004, 27, 224–231. [Google Scholar] [CrossRef] [PubMed]
- Ribeiro, J.D.; Pease, J.L.; Gutierrez, P.M.; Silva, C.; Bernert, R.A.; Rudd, M.D.; Joiner, T.E., Jr. Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military. J. Affect. Disord. 2012, 136, 743–750. [Google Scholar] [CrossRef] [PubMed]
- Defense Health Information System. Report to Congressional Defense Committees on Health Information Technology Organizational Structure and Future Plans. Available online: file:///C:/Users/abond/ Downloads/9-23-11-Health%20Information%20Technology%20(1).pdf (accessed on 17 June 2019).
- Cohen, J. Statistical Power Analysis for the Behavioral Sciences, 2nd ed.; Roulet: Hillsdale, NJ, USA, 1988; ISBN 978-080-580-283-2. [Google Scholar]
- Landis, J.R.; Koch, G.G. The measurement of observer agreement for categorical data. Biometrics 1997, 33, 159–174. [Google Scholar] [CrossRef]
- Erdfelder, E.; Faul, F.; Buchner, A. GPOWER: A general power analysis program. Behav. Res. Methods Instrum. Comput. 1996, 28, 1–11. [Google Scholar] [CrossRef]
- Piscopo, K.; Lipari, R.N.; Cooney, J.; Glasheen, C. Suicidal Thoughts and Behavior among Adults: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. Available online: http://www.samhsa.gov/data/ (accessed on 7 August 2019).
- Iribarren, C.; Sidney, S.; Jacobs, D.R., Jr.; Weisner, C. Hospitalization for suicide attempt and completed suicide: Epidemiological features in a managed care population. Soc. Psychiatry Psychiatr. Epidemiol. 2000, 35, 288–296. [Google Scholar] [CrossRef]
- Armed Forces Health Surveillance Branch. Hospitalizations among members of the active component, U.S. Armed Forces, 2012. MSMR 2013, 20, 11–17. [Google Scholar]
- Agency for Healthcare Research and Quality. Healthcare Utilization Project. Available online: https://www.ahrq.gov/data/hcup/index.html (accessed on 7 August 2019).
- Sanati, A. Does suicide always indicate a mental illness? Lond. J. Prim. Care 2009, 2, 93–94. [Google Scholar] [CrossRef] [Green Version]
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed.; Jaypee Brothers Medical Publis: Washington, DC, USA, 2000; ISBN 0890420610. [Google Scholar]
- Monahan, M.C.; Keener, J.K. Fitness-for-duty evaluations. In Military Psychology: Clinical and Operational Applications, 2nd ed.; Kennedy, C.H., Zillmer, E.A., Eds.; Guilford Press: New York, NY, USA, 2012; pp. 25–49. ISBN 978-146-250-649-1. [Google Scholar]
- Pagan, J.L.; Oltmanns, T.F.; Whitmore, M.J.; Turkheimer, E. Personality disorder not otherwise specified: Searching for an empirically based diagnostic threshold. J. Personal. Disord. 2005, 19, 674–689. [Google Scholar] [CrossRef] [PubMed]
- Wedig, M.M.; Silvermana, M.H.; Frankenburga, F.R.; Reich, D.B.; Fitzmauricea, G.; Zanarinia, M.C. Predictors of suicide attempts in patients with borderline personality disorder over 16 years of prospective follow-up. Psychol. Med. 2012, 42, 2395–2404. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kochanski, K.M.; Lee-Tauler, S.Y.; Brown, G.K.; Beck, A.T.; Perera, K.U.; Novak, L.; LaCroix, J.M.; Lento, R.M.; Ghahramanlou-Holloway, M. Single versus multiple suicide attempts: A prospective examination of psychiatric factors and wish to die/wish to live index among military and civilian psychiatrically admitted patients. J. Nerv. Ment. Dis. 2018, 206, 657–661. [Google Scholar] [CrossRef] [PubMed]
- Classen, C.A.; Larkin, G.L. Occult suicidality in an emergency department population. Br. J. Psychiatry 2005, 185, 352–353. [Google Scholar] [CrossRef] [PubMed]
- Jobes, D.A. Is it “appropriate” to ask about suicide? AAS Newslink 1995, 21, 5. [Google Scholar]
- Posner, K.; Brown, G.K.; Stanley, B.; Brent, D.A.; Yershova, K.V.; Oquendo, M.A.; Currier, G.W.; Melvin, G.A.; Greenhill, L.; Shen, S.; et al. The Columbia-Suicide Severity Rating Scale: Internal validity and internal consistency findings from three multisite studies with adolescents and adults. Am. J. Psychiatry 2011, 168, 1266–1277. [Google Scholar] [CrossRef] [PubMed]
Characteristic | Total (n = 955) | Suicide Ideation (n = 534) | Suicide Attempt (n = 421) | t-Statistic | ||||
---|---|---|---|---|---|---|---|---|
M | SD (Range) | M | SD (Range) | M | SD (Range) | t (df) | p | |
Age (in years) | 26.3 | 8.0 (17–60) | 26.8 | 8.5 (17–60) | 25.6 | 7.2 (17–59) | −2.312 (953) | 0.021 |
n | % | n | % | n | % | χ2 (df) | p value | |
Gender | ||||||||
Men | 657 | 68.8 | 396 | 74.2 | 261 | 62.0 | 16.220 (1) | <0.001 |
Women | 298 | 31.2 | 138 | 25.8 | 160 | 38.0 | ||
Race | ||||||||
White | 615 | 64.4 | 344 | 64.4 | 271 | 64.4 | 0.724 (3) | 0.867 |
African American | 200 | 20.9 | 108 | 20.2 | 92 | 21.9 | ||
Hispanic | 52 | 5.4 | 30 | 5.6 | 22 | 5.2 | ||
Other | 88 | 9.2 | 52 | 9.7 | 36 | 8.6 | ||
Marital Status | ||||||||
Single | 464 | 48.6 | 256 | 47.9 | 208 | 49.4 | 0.605 (2) | 0.739 |
Married | 343 | 35.9 | 191 | 35.8 | 152 | 36.1 | ||
Divorced/Separated/Widowed | 148 | 15.5 | 87 | 16.3 | 61 | 14.5 | ||
Service Branch | ||||||||
Army | 661 | 69.2 | 365 | 68.3 | 296 | 70.3 | 1.078 (4) | 0.898 |
Air Force | 128 | 13.4 | 76 | 14.2 | 52 | 12.4 | ||
Navy | 94 | 9.8 | 52 | 9.7 | 42 | 10.0 | ||
Marine Corps | 60 | 6.3 | 35 | 6.6 | 25 | 5.9 | ||
Coast Guard | 12 | 1.3 | 6 | 1.1 | 6 | 1.4 | ||
Rank ^ | ||||||||
E-1–E-4 | 666 | 69.7 | 365 | 68.4 | 301 | 71.5 | 5.366 (4) | 0.252 |
E-5–E-6 | 186 | 19.5 | 102 | 19.1 | 84 | 20.0 | ||
E-7–E-9 | 43 | 4.5 | 28 | 5.2 | 15 | 3.6 | ||
O-1–O-3 | 40 | 4.2 | 28 | 5.2 | 12 | 2.9 | ||
O-4–O-6 | 18 | 1.9 | 9 | 1.7 | 9 | 2.1 |
Clinical Characteristics | Total (n = 955) | Suicide Ideation (n = 534) | Suicide Attempt (n = 421) | t-Statistic | ||||
---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | χ2 (df) | p-Value | |
Axis I Primary Diagnoses | ||||||||
Adjustment Disorder with Depressed Mood | 104 | 10.9 | 68 | 12.7 | 36 | 8.6 | 4.245 (1) | 0.039 |
Adjustment Disorder with Mixed Disturbance of Emotion and Conduct | 252 | 26.4 | 117 | 21.9 | 135 | 32.1 | 12.501 (1) | <0.001 |
Alcohol Abuse | 81 | 8.5 | 44 | 8.2 | 37 | 8.8 | 0.091 (1) | 0.762 |
Alcohol Dependence | 110 | 11.5 | 63 | 11.8 | 47 | 11.2 | 0.093 (1) | 0.761 |
Bipolar Disorder | 41 | 4.3 | 24 | 4.5 | 17 | 4.0 | 0.119 (1) | 0.730 |
Dysthymic Disorder | 71 | 7.4 | 39 | 7.3 | 32 | 7.6 | 0.030 (1) | 0.862 |
Major Depressive Disorder | 241 | 25.2 | 147 | 27.5 | 94 | 22.3 | 3.374 (1) | 0.066 |
Posttraumatic Stress Disorder | 84 | 8.8 | 50 | 9.4 | 34 | 8.1 | 0.486 (1) | 0.486 |
Axis II Primary Diagnoses | ||||||||
Borderline Personality Disorder | 62 | 6.5 | 26 | 4.9 | 36 | 8.6 | 5.258 (1) | 0.022 |
Personality Disorder Not Otherwise Specified | 151 | 15.8 | 70 | 13.1 | 81 | 19.2 | 6.648 (1) | 0.010 |
Other Personality Disorder | 27 | 2.8 | 17 | 3.2 | 6 | 1.4 | 3.097 (1) | 0.078 |
Diagnosis Deferred | 115 | 12.0 | 75 | 14.0 | 40 | 9.5 | 4.589 (1) | 0.032 |
No Diagnosis | 401 | 42.0 | 231 | 43.3 | 169 | 40.1 | 0.939 (1) | 0.333 |
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
George, B.J.; Ribeiro, S.; Lee-Tauler, S.Y.; Bond, A.E.; Perera, K.U.; Grammer, G.; Weaver, J.; Ghahramanlou-Holloway, M. Demographic and Clinical Characteristics of Military Service Members Hospitalized Following a Suicide Attempt versus Suicide Ideation. Int. J. Environ. Res. Public Health 2019, 16, 3274. https://doi.org/10.3390/ijerph16183274
George BJ, Ribeiro S, Lee-Tauler SY, Bond AE, Perera KU, Grammer G, Weaver J, Ghahramanlou-Holloway M. Demographic and Clinical Characteristics of Military Service Members Hospitalized Following a Suicide Attempt versus Suicide Ideation. International Journal of Environmental Research and Public Health. 2019; 16(18):3274. https://doi.org/10.3390/ijerph16183274
Chicago/Turabian StyleGeorge, Brianne J., Sissi Ribeiro, Su Yeon Lee-Tauler, Allison E. Bond, Kanchana U. Perera, Geoffrey Grammer, Jennifer Weaver, and Marjan Ghahramanlou-Holloway. 2019. "Demographic and Clinical Characteristics of Military Service Members Hospitalized Following a Suicide Attempt versus Suicide Ideation" International Journal of Environmental Research and Public Health 16, no. 18: 3274. https://doi.org/10.3390/ijerph16183274