Listening to Our Patients: Learning About Suicide Risk and Protective Factors From Veterans With HIV/AIDS.

PURPOSE: We sought to gather perspectives of veterans with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) regarding suicide risk factors, warning signs, and protective factors. We also aimed to modify an existing Veterans Health Administration tool, the Suicide Risk Assessment Guide Pocket Card, for HIV/AIDS provider use. METHODS: Twenty male veterans participated in audio-recorded semistructured interviews that were transcribed and coded for themes. FINDINGS: Veterans highlighted personally relevant psychosocial stressors (i.e., poverty, social isolation and loneliness, and physical health). Although the concept of warning signs did not seem salient to participants, they named indicators of elevated imminent risk for self-directed violence (i.e., "relapse," "not take'n medications," and "miss'n appointments") and few protective factors. No themes emerged regarding recommended pocket card changes. CONCLUSIONS: This sample of veterans identified self-directed violence risks noted in the general population and others with HIV/AIDS, as well as proximal events associated with increased risk. Care providers are encouraged to explore the relevance of noted imminent and persistent indicators of increased risk with veterans seeking care.

Psychiatric diagnoses, mental health utilization, high-risk behaviors, and self-directed violence among veterans with comorbid history of traumatic brain injury and substance use disorders.

OBJECTIVES: To describe various characteristics of veterans with co-occurring histories of traumatic brain injury (TBI) and substance use disorder (SUD) for purposes of hypothesis generation. STUDY DESIGN: Archival data collected over a period of 4 years. PARTICIPANTS: Sixty-five veterans across eras of service with confirmed histories of TBI and SUD. METHODS: : Demographic and TBI information were obtained from an archival clinical database. Electronic medical records were reviewed for mental health utilization, psychiatric diagnoses, self-directed violence, and risk-taking behaviors. RESULTS: In addition to a SUD, veterans were reported to have an average of 3 additional psychiatric diagnoses and a median of 3 TBIs per person. All utilized various mental health services in addition to substance use treatment. Individuals were found to have engaged in a variety of risky behaviors. There were significant associations between suicidal ideation and assaultive behaviors, as well as between suicide attempt and impulsivity. CONCLUSIONS: This study describes a sample of veterans with co-occurring histories of TBI, SUD, risk-taking behaviors, and self-directed violence. More research is needed to examine these complex interrelationships and to identify specific risk factors for intervention/prevention strategies.

Posttraumatic stress disorder, traumatic brain injury, and suicide attempt history among veterans receiving mental health services.

History of posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) has been found to increase risk of suicidal behavior. The association between suicide attempt history among veterans with PTSD and/or TBI was explored. Cases (N = 81) and 2:1 matched controls (N = 160) were randomly selected from a Veterans Affairs Medical Center clinical database. PTSD history was associated with an increased risk for a suicide attempt (OR = 2.8; 95% CI: 1.5, 5.1). This increased risk was present for those with and without a history of TBI. Results support incorporating PTSD history when assessing suicide risk among veterans with and without TBI.

A review of "suicidal intent" within the existing suicide literature.

The results of a systematic literature review that investigated suicide intent are presented. Of the 44 relevant articles identified, 17 investigated the relationships between various suicide risk factors and suicide intent and 25 publications investigated the relationships between suicide intent and various suicide outcomes. Despite recent advancements in the definition and nomological validity of suicide intent, a high degree of variability in the empirical measurement and analysis of suicide intent was found. Such variability limits future research related to measuring suicidal risk and outcomes, reporting suicide intent, or the meaningful comparison of diagnostic approaches or treatments across multiple studies.

A preliminary investigation of suicidality in psychiatrically hospitalized veterans with traumatic brain injury.

The objective of this study was to explore suicidal behaviors documented at time of discharge from acute psychiatric hospitalization. Data from 114 acute psychiatric admissions were reviewed for 22 veterans with a history of traumatic brain injury (TBI). Information extracted included presence of suicidal ideation, nature of suicide attempts, and TBI characteristics. The Lethality of Suicide Attempt Rating Scale was used to classify veterans' non-lethal self-harm behavior. Post-TBI, 6 patients (27.3%) made a total of 14 suicide attempts. Half of those attempts required wounds being sutured, stomach lavage, or other medical attention. Clinicians and researchers are strongly encouraged to focus increased attention on suicide prevention in those with a history of TBI.