AnnaBelle O. Bryan

Suicide attempts before joining the military increase risk for suicide attempts and severity of suicidal ideation among military personnel and veterans

OBJECTIVE Past self-injurious thoughts and behaviors (SITB) are robust predictors of future suicide risk, but no studies have explored the prevalence of SITB occurring prior to military service among military personnel and veterans, or the association of premilitary SITB with suicidal ideation and suicide attempts during or after military service. The current study explores these issues in two separate samples. METHOD Self-report data were collected from 374 college student veterans via anonymous only survey (Study 1) and from 151 military personnel receiving outpatient mental health treatment (Study 2). RESULTS Across both studies, premilitary suicide attempts were among the most prominent predictor of subsequent suicide attempts that occurred after joining the military, even when controlling for demographics and more recent emotional distress. Among military personnel who made a suicide attempt during or after military service, approximately 50% across both samples experienced suicidal ideation and up to 25% made a suicide attempt prior to joining the military. Military personnel and veterans who made suicide attempts prior to joining the military were over six times more likely to make a later suicide attempt after joining the military. In Study 2, significantly more severe current suicidal ideation was reported by participants with histories of premilitary suicide risk, even when controlling for SITB occurring while in the military. CONCLUSIONS Military personnel and veterans who experienced SITB, especially suicide attempts, prior to joining the military are more likely to attempt suicide while in the military and/or as a veteran, and experience more severe suicidal crises.

Nonsuicidal self-injury among a sample of United States military personnel and veterans enrolled in college classes.

OBJECTIVE To investigate the rate of nonsuicidal self-injury (NSSI), to describe sociodemographic and clinical correlates of NSSI, and to examine the association of NSSI with suicidal thoughts and behaviors in a sample of U.S. military personnel and veterans. METHOD An anonymous online survey was completed by 335 U.S. military personnel and veterans (70.0% male; age mean = 36.67, standard error = 10.59; 82.3% Caucasian, 4.9% African American, 2.8% Asian, 3.7% Native American, 1.2% Pacific Islander, and 7.6% other) enrolled in college classes. Descriptive statistics were calculated, and logistic regression was used to test the associations among NSSI, suicide ideation, suicide planning, and suicide attempts. RESULTS Fourteen percent of the sample reported lifetime NSSI and 3% reported NSSI during the last 12 months. The most common method was cutting (78.7%), with 66% reporting use of 2 or more methods for NSSI. Average age of NSSI onset was 17.55 years. Increased likelihood of NSSI was associated with older age, shorter length of time in service, greater trauma exposure, female gender, Native American racial identity, and combat support deployments. Personnel in the Navy and with a history of combat deployment were significantly less likely to report NSSI. NSSI was significantly associated with suicide ideation, suicide planning, and suicide attempts even when adjusting for covariates. CONCLUSION The rate of NSSI is comparable to estimates in nonmilitary U.S. samples. NSSI is a significant risk factor for suicidal thoughts and behaviors in this group.

DEPRESSION MEDIATES THE RELATION OF INSOMNIA SEVERITY WITH SUICIDE RISK IN THREE CLINICAL SAMPLES OF U.S. MILITARY PERSONNEL

A growing body of empirical research suggests insomnia severity is directly related to suicide ideation, attempts, and death in nonmilitary samples, even when controlling for depression and other suicide risk factors. Few studies have explored this relationship in U.S. military personnel.

Depression, posttraumatic stress disorder, and grade point average among student servicemembers and veterans

The current study examined relationships among self-reported depression severity, posttraumatic stress disorder (PTSD) symptom severity, and grade point average (GPA) among student servicemembers and veterans. We asked 422 student servicemembers and veterans (72% male, 86% Caucasian, mean age = 36.29 yr) to complete an anonymous online survey that assessed self-reported GPA, depression severity, PTSD severity, and frequency of academic problems (late assignments, low grades, failed exams, and skipped classes). Female respondents reported a slightly higher GPA than males (3.56 vs 3.41, respectively, p = 0.01). Depression symptoms (beta weight = -0.174, p = 0.03), male sex (beta weight = 0.160, p = 0.01), and younger age (beta weight = 0.155, p = 0.01) were associated with lower GPA but not PTSD symptoms (beta weight = -0.040, p = 0.62), although the interaction of depression and PTSD symptoms showed a nonsignificant inverse relationship with GPA (beta weight = -0.378, p = 0.08). More severe depression was associated with turning in assignments late (beta weight = 0.171, p = 0.03), failed exams (beta weight = 0.188, p = 0.02), and skipped classes (beta weight = 0.254, p = 0.01). The relationship of depression with self-reported GPA was mediated by frequency of failed examns. Results suggest that student servicemembers and veterans with greater emotional distress also report worse academic performance.

Posttraumatic Stress, Depression, and Insomnia Among U.S. Air Force Pararescuemen

Few studies have examined rates of mental health problems among special duty military personnel, who often have frequent deployments and high exposure to operational stressors and trauma. The current study examined the severity and rates of positive screening for posttraumatic stress, depression, and insomnia among 194 U.S. Air Force pararescuemen (PJs) in the active duty (AD) and National Guard/Reserve (NG/R) components. Overall estimated rates were 11.6% for probable posttraumatic stress disorder (PTSD), 1.6% for probable depression, and 16.1% for clinical insomnia. PJs in the NG/R reported significantly more severe posttraumatic stress symptoms (F(1, 162) = 10.031, p = .002, partial η2 = .058) and were approximately twice as likely to screen positive for probable PTSD (8.5% vs. 19.1%; χ2[1] = 3.679, p = .055). No differences in the rate or severity of depression or insomnia symptoms were found. Rates of positive screens are comparable to or lower than previously published rates among military personnel.

Sociodemographic correlates of suicidal thoughts and behaviors among college student service members/veterans

Abstract Objective: The purpose of the study is to quantify the lifetime, past-year, and past-month incidence rates of suicidal ideation, planning, and attempts; frequency of suicide attempts; and suicide attempt methods among college student service members/veterans. Participants: Four hundred twenty-two college student service members/veterans completing an online survey from January to October 2013. Methods: An anonymous online survey was conducted. Results: Lifetime incidence rates were 33.4% (ideation), 13.7% (plan), and 6.9% (attempt). Past-year incidence rates were 14.7% (ideation), 3.6% (plan), and 0.7% (attempt). Past-month incidence rates were 7.6% (ideation), 1.9% (plan), and 0.5% (attempt). Rates among student service member/veterans were similar to general college student population rates. Native American student service members/veterans report significantly increased rates of ideation, plans, and attempts. Conclusions: Observed rates of suicidal thoughts and behaviors among student service members/veterans are comparable to general college study rates, but Native American student service members/veterans demonstrate increased risk.

Dangerous Words? An Experimental Investigation of the Impact of Detailed Reporting About Suicide on Subsequent Risk

OBJECTIVE Media reporting guidelines exist for suicide-related content; however, no experimental studies have examined the impact of guideline violations. As such, we utilized an experimental design to determine whether reading an article about suicide that violated guidelines would impact mood and suicidality relative to the same article without violations and to an article detailing death by cancer, both immediately and during 1-month follow-up. METHOD 273 students were randomly assigned to read one of three articles (1) an article that violated suicide reporting guidelines, (2) the same article with violations removed, or (3) an article that details death by cancer. RESULTS Individuals assigned to read the original suicide article were no more upset immediately afterwards or during 1-month follow-up. Amongst participants with prior ideation, those who read the original article reported a lower likelihood of future attempt relative to either other condition. CONCLUSION Results indicate some reporting guidelines may be unnecessary. Amongst individuals at risk for suicide, some guideline violations may be associated with a decreased likelihood of future attempt and result in a decrease in negative affect. Clinically, these results highlight the potential utility of exposing clients to in depth educational materials about suicide while mitigating concerns regarding certain aspects of the content.

Factors Associated With Burnout Among Active Duty versus National Guard/Reserve U.S. Air Force Pararescuemen

Mental health problems among U.S. military personnel remain an important public health problem. However, little research exists concerning burnout, which is comprised of three interrelated experiences: emotional exhaustion, depersonalization, and (lack of) personal accomplishment (Maslach & Leiter 1997). Burnout may be especially relevant to U.S. Air Force (USAF) pararescuemen (PJs) due to their high deployment and operations tempo relative to conventional military forces. We administered the Maslach Burnout Inventory (MBI; Maslach & Jackson, 1981) to 194 male PJs from six military bases. Results of regression analyses indicated depersonalization was significantly higher among National Guard/Reserve personnel (β = .203, p = .029). Emotional exhaustion was associated with depression (β = .286, p = .004) and posttraumatic stress disorder (PTSD) symptoms (β = .194, p = .053), whereas depersonalization was associated with PTSD symptoms only (β = .353, p < .001). Greater personal accomplishment showed a nonsignificant inverse relationship with depression (β = −.205, p = .064). Results suggest that different dimensions of burnout are associated with different types of psychological distress among PJs and may be related to mental health problems in this population. Burnout warrants further attention among researchers.

Examining the effectiveness of an intensive, 2-week treatment program for military personnel and veterans with PTSD: Results of a pilot, open-label, prospective cohort trial: BRYAN et al.

OBJECTIVE This study aimed to examine the effectiveness of cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) when administered on a daily basis during a 2-week period of time. METHOD In an open-label, prospective cohort pilot trial, 20 U.S. military personnel and veterans diagnosed with PTSD or subthreshold PTSD participated in 12 daily sessions of CPT. Primary outcomes included Clinician Administered PTSD Scale for DSM-5 and PTSD Checklist for DSM-5 scores. Secondary outcomes included Patient Health Questionnaire-8 and Beck Scale for Suicide Ideation (BSSI) scores. Interviews and self-report scales were completed at pretreatment, posttreatment, and 6 months after the treatment. RESULTS Relative to baseline, PTSD symptom severity and rates of PTSD diagnosis were significantly reduced at posttreatment and 6-month follow-up. Depression symptom severity did not significantly improve, but suicide ideation significantly decreased at 6-month follow-up. CONCLUSIONS Daily administration of CPT is associated with significant reductions in PTSD and suicide ideation.

Military sexual trauma and suicidal behavior among National Guard personnel

BACKGROUND Preliminary evidence suggests military sexual trauma (MST) may be associated with increased risk for suicidal behaviors among active duty military personnel and veterans. Among National Guard personnel, a high-risk subgroup, MST and suicide risk have not received much empirical attention. PURPOSE To examine the association of MST with suicide ideation and suicide attempts among National Guard personnel. PROCEDURES N = 997 National Guard personnel from Idaho and Utah participated in an anonymous online survey. Weighted analyses were conducted to minimize sampling bias. MAIN FINDINGS 9% of participants had a history of MST (6% of men, 28% of women). Among participants reporting MST, 68% reported a service member perpetrator and 44% reported a civilian perpetrator (12% reported both). A history of MST was associated with significantly increased risk for lifetime suicide attempt. MST remained a significant predictor of lifetime suicide attempt even when restricting the sample to the subgroup with a history of suicidal thoughts (n = 257, 27% of full sample). When adjusting for premilitary sexual victimization, MST was no longer significantly associated with lifetime suicide attempts, but premilitary sexual victimization was. CONCLUSIONS The rate of MST among National Guard personnel is comparable to rates among active duty military personnel, although the perpetrators of MST are less likely to be service members. MST is a risk factor for suicide attempts, but premilitary sexual victimization is a relatively stronger risk factor.