Is Suicidal Behavior in Mood Disorders Altered by Comorbid PTSD?

BACKGROUND: Suicide is a leading cause of death among US veterans. Associations between depression, posttraumatic stress disorder (PTSD), and suicidal behaviors have been found in this population, yet minimal research has explored how manifestations of self-injurious behavior (SIB) may vary among different diagnostic presentations. AIMS: This study aimed to identify clinically useful differences in SIB among veterans who experience comorbid mood disorder and PTSD (CMP) compared with those who experience a mood disorder alone (MDA). METHOD: Participants were 57 US military veterans who reported an incident of intentional SIB. The semistructured Post Self-Injury/Attempted Self-Injury Debriefing Interview was used to examine characteristics of the SIB. RESULTS: Veterans diagnosed with CMP were more likely than those with MDA to (a) report that the SIB was impulsive and (b) to be under the influence of substances at the time of self-injury. LIMITATIONS: Generalizability may be limited by small sample size and predominantly European American, male demographics. While highly relevant to routine clinical practice, caution is recommended, as study diagnoses were attained from medical records rather than structured interviews. CONCLUSION: Safety planning that emphasizes protection against impulsive suicide attempts (e.g., means restriction) may be especially important among veterans with comorbid mood disorder and PTSD.

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.

Individuals with multiple suicide attempts have a greater risk for eventual suicide death. We investigated clinical differences in participants with single versus multiple suicide attempts. Individuals with multiple attempts were more likely to have severe depressive symptoms, drug use disorder, and a higher wish to die. Borderline personality disorder traits and drug use disorder were significant predictors of multiple attempts when adjusting for other psychiatric disorders. Participants with multiple attempts sustained higher suicidal ideation-worst and wish to die/wish to live-worst scores during the 3-month assessment period. Clinical differences between individuals with multiple versus single attempts point to the need of tailored suicide prevention efforts.

Reducing the burden of suicide in the U.S.: the aspirational research goals of the National Action Alliance for Suicide Prevention Research Prioritization Task Force.

BACKGROUND: The National Action Alliance for Suicide Prevention Research Prioritization Task Force (RPTF) has created a prioritized national research agenda with the potential to rapidly and substantially reduce the suicide burden in the U.S. if fully funded and implemented. PURPOSE: Viable, sustainable scientific research agendas addressing challenging public health issues such as suicide often need to incorporate perspectives from multiple stakeholder groups (e.g., researchers, policymakers, and other end-users of new knowledge) during an agenda-setting process. The Stakeholder Survey was a web-based survey conducted and analyzed in 2011-2012 to inform the goal-setting step in the RPTF agenda development process. The survey process, and the final list of "aspirational" research goals it produced, are presented here. METHODS: Using a modified Delphi process, diverse constituent groups generated and evaluated candidate research goals addressing pressing suicide prevention research needs. RESULTS: A total of 716 respondents representing 49 U.S. states and 18 foreign countries provided input that ultimately produced 12 overarching, research-informed aspirational goals aimed at reducing the U.S. suicide burden. Highest-rated goals addressed prevention of subsequent suicidal behavior after an initial attempt, strategies to retain patients in care, improved healthcare provider training, and generating care models that would ensure accessible treatment. CONCLUSIONS: The Stakeholder Survey yielded widely valued research targets. Findings were diverse in focus, type, and current phase of research development but tended to prioritize practical solutions over theoretical advancement. Other complex public health problems requiring input from a broad-based constituency might benefit from web-based tools that facilitate such community input.

Raising the clinical standard of care for suicidal soldiers: an army process improvement initiative.

From 2004 to 2008, the suicide rate among US Army Soldiers increased 80%, reaching a record high in 2008 and surpassing the civilian rate for the first time in recorded history. In recent years, the rate of Army suicides rose again; the year 2012 reflects the highest rate of military suicides on record. There is a need to assess current behavioral health practices to identify both effective and ineffective practices, and to adapt services to meet the needs of the Army behavioral health patient population. This paper discusses a process improvement initiative developed in an effort to improve clinical processes for suicide risk mitigation in an Army behavioral health clinic located in the catchment area of the US Army Southern Regional Medical Command.

Assessing and treating different suicidal states in a danish outpatient sample.

The studies presented compare two methodologies for categorizing suicidal patients based on clinical data. Discussion follows regarding implications for risk assessment and treatment. In these studies, 52 outpatient subjects were placed into different groups based on coding their "suicidal motivation" (Study 1) and their "internal struggle" ratings (Study 2) using data collected at intake. Self-report ratings of 6 Suicide Status Form (SSF) Core Constructs (Psychological Pain, Stress, Agitation, Hopelessness, Self-Hate, and Overall Risk of Suicide) recorded both at intake and at completion of treatment were then compared to determine differences in Core Construct ratings among groups at different time points. In Study 1, overall differences among motivation groups (Life-motivated, Ambivalent, and Death-motivated) were significant for ratings at treatment completion of Overall Risk of Suicide, Self-Hate, and Psychological Pain. In Study 2, overall differences among groups (Wish to live, Ambivalent, and Wish to die) were significant for ratings at intake of Overall Risk of Suicide. At completion of treatment, overall differences among groups were significant for ratings of Overall Risk of Suicide, Hopelessness, and Self-Hate. In addition, significant interactions were found between test time and group for Overall Risk of Suicide and Self-Hate. Results suggest that categorizing suicidal patients by motivation and by the nature of their internal struggle could be beneficial to differential risk assessment with implications for clinical treatment.

Using the suicide index score to predict treatment outcomes among psychiatric inpatients.

For many suicidal people, the desire to die is moderated by a competing desire to live. This study aimed to demonstrate the ability of a wish-to-live versus wish-to-die index score to measure ambivalence and trichotomize suicidal inpatients into distinct stratified risk groups. Analyses revealed that index scores calculated for patients at treatment start significantly discriminated among the groups at index and uniquely predicted suicidal ideation, hopelessness, and depression scores across treatment. On average, patients with wish-to-live and wish-to-die orientations resolved suicidal ideation by discharge. Changes in suicidal ideation among ambivalently oriented patients were more variable. Clinical and research implications are discussed.

Eating behaviour and body image in a sample of young athletes.

UNLABELLED: BACKGROUND ANDAIM: Adolescence is a period of great risk for the development of eating disorders since many teenagers engage in long periods of dieting or exhausting sports activities in order to achieve their ideal body image. Research has shown that a potential majority of athletes display attitudes very similar to those observed in cases involving disturbed eating behaviour, particularly with regard to their exaggerated attention to their body image and the type of diet that they consider necessary for their activities. The aim of this study is to analyze young athletes dedicated to attaining the mesomorphic physical ideal and to identify possible dysfunctional eating habits like risk factors in the development of more serious disturbances. We further plan to evaluate possible differences in how members of the sample group perceive their bodies and behave in connection with their diet. METHODS: The sample is made up of 109 males and females, aged 16-24 years. Participants completed the Pisa Survey for Eating Disorders and underwent measurements for the calculation of body mass index (BMI). RESULTS: The young athletes in our sample show a markedly distorted perception of their own bodies. They show a widespread presence of eating behaviour that is not functional to high athletic achievement as well as a series of noteworthy risk factors connected with the onset of eating behaviour disturbances. CONCLUSIONS: The obtained results underscore the need for primary projects in prevention against and awareness of eating problems and awareness of dysmorphic and phobic disturbances in young athletes.