Marjan Ghahramanlou-Holloway

Psychometric properties of the Beck Depression Inventory-II in low-income, African American suicide attempters.

Cross-cultural examinations of the validity and reliability of the Beck Depression Inventory–II (Beck, Steer, Ball, & Ranieri, 1996) is essential for its use in assessment and monitoring of the effectiveness of suicide interventions across racial groups. We tested the fit of a second-order, two-factor model and the internal reliability of the BDI–II in a sample of 133 African Americans with a recent history of suicide attempts. Additionally, we examined the convergent validity with the Hamilton Rating Scale for Depression (Reynolds & Koback, 1995). The results indicate that the BDI–II is a reliable and valid measure of depressive symptoms for African American suicide attempters.

Self-Esteem and Suicide Ideation in Psychiatric Outpatients

Depression, hopelessness, and low self-esteem are implicated as vulnerability factors for suicide ideation. The association of self-esteem with suicide ideation after controlling for depressed mood and hopelessness was examined. Adult psychiatric outpatients (N = 338) completed measures of self-esteem, suicide ideation, hopelessness, and depression. Self-esteem was operationalized as beliefs about oneself (self-based self-esteem) and beliefs about how other people regard oneself (other-based self-esteem). Each dimension of self-esteem was negatively associated with suicide ideation after controlling for depression and hopelessness. Of the two dimensions of self-esteem, other-based self-esteem was the more robust predictor of suicide ideation. These findings suggest that even in the context of depression and hopelessness, low self-esteem may add to the risk for suicide ideation.

An Emergency Department-Based Brief Intervention for Veterans at Risk for Suicide (SAFE VET)

Reducing deaths from veteran suicide is a public health priority for veterans who receive their care from the Department of Veterans Affairs (VA) and those who receive services in community settings. Emergency departments frequently function as the primary or sole point of contact with the health care system for suicidal individuals; therefore, they represent an important venue in which to identify and treat veterans who are at risk for suicide. We describe the design, implementation and initial evaluation of a brief behavioral intervention for suicidal veterans seeking care at VA emergency departments. Initial findings of the feasibility and acceptability of the intervention suggest it may be transferable to diverse VA and non-VA settings, including community emergency departments and urgent care centers.

An Investigation of Interpersonal-Psychological Variables in Air Force Suicides: A Controlled-Comparison Study

Joiners (2005) theory attributes suicide to an individuals acquired capability to enact self-harm, perceived burdensomeness, and thwarted belongingness. This study evaluated whether Joiners theory could differentiate United States (US) Air Force (AF) personnel (n = 60) who died by suicide from a living active duty AF personnel comparison sample (n = 122). Responses from AF personnel on several scales assessing Joiners constructs were compared to data from a random sample of postmortem investigatory files of AF personnel who died by suicide between 1996–2006. This research also introduced a newly designed measure, the Interpersonal-Psychological Survey (IPS), designed to assess the three components of Joiners theory in one, easy-to-administer instrument. Analyses of the psychometric properties of the IPS support initial validation efforts to establish this scale as a predictive measure for suicide. Findings support that ones score on the Acquired Capability to Commit Suicide subscale of the IPS and the IPS overall score reliably distinguished between the two groups. The implications of these findings in relation to suicide prevention efforts in the US military are discussed.

Changes in problem-solving appraisal after cognitive therapy for the prevention of suicide

BACKGROUND Cognitive therapy has been found to be effective in decreasing the recurrence of suicide attempts. A theoretical aim of cognitive therapy is to improve problem-solving skills so that suicide no longer remains the only available option. This study examined the differential rate of change in problem-solving appraisal following suicide attempts among individuals who participated in a randomized controlled trial for the prevention of suicide. METHOD Changes in problem-solving appraisal from pre- to 6-months post-treatment in individuals with a recent suicide attempt, randomized to either cognitive therapy (n = 60) or a control condition (n = 60), were assessed by using the Social Problem-Solving Inventory-Revised, Short Form. RESULTS Improvements in problem-solving appraisal were similarly observed for both groups within the 6-month follow-up. However, during this period, individuals assigned to the cognitive therapy condition demonstrated a significantly faster rate of improvement in negative problem orientation and impulsivity/carelessness. More specifically, individuals receiving cognitive therapy were significantly less likely to report a negative view toward life problems and impulsive/carelessness problem-solving style. CONCLUSIONS Cognitive therapy for the prevention of suicide provides rapid changes within 6 months on negative problem orientation and impulsivity/carelessness problem-solving style. Given that individuals are at the greatest risk for suicide within 6 months of their last suicide attempt, the current study demonstrates that a brief cognitive intervention produces a rapid rate of improvement in two important domains of problem-solving appraisal during this sensitive period.

An empirical study of the personality characteristics of internet sex offenders

Abstract The present study evaluated the personality characteristics and psychopathology of internet sex offenders (ISOs) using the Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2) to determine whether ISO personality profiles are different to those of general sex offenders (GSOs; e.g. child molesters and rapists). The ISOs consisted of 48 convicted males referred to a private sex offender treatment facility for a psychosexual risk assessment. The GSOs consisted of 104 incarcerated non-internet or general sex offenders. Findings indicated that ISOs scored significantly lower on the following scales: L, F, Pd and Sc. A comparison of the MMPI-2 scores of the ISO and GSO groups indicated that ISOs are a heterogeneous group with considerable within-group differences. Current findings are consistent with the existing literature on the limited utility of the MMPI-2 in differentiating between subtypes of sex offenders.

Marital Status, Life Stressor Precipitants, and Communications of Distress and Suicide Intent in a Sample of United States Air Force Suicide Decedents

Life stressor precipitants and communications of distress and suicide intent were examined among a sample of United States Air Force (USAF) married versus unmarried suicide decedents. A total of 100 death investigations conducted by the Office of Special Investigations on active duty USAF suicides occurring between 1996 and 2006 were retrospectively reviewed. Married decedents were twice as likely 1) to have documented interpersonal conflict 24 hours prior to suicide and 2) to have communicated suicide intent to peers or professionals. Themes of distress communication for all decedents were intrapersonal (perceived stress, depression, psychological pain) and interpersonal (thwarted belongingness, rejection, loneliness). Suicide prevention programs and policies are encouraged to adapt efforts to the unique needs of married and unmarried individuals.

Diagnostic and psychosocial differences in psychiatrically hospitalized military service members with single versus multiple suicide attempts.

INTRODUCTION Individuals with multiple versus single suicide attempts present a more severe clinical picture and may be at greater risk for suicide. Yet group differences within military samples have been vastly understudied. PURPOSE The objective is to determine demographic, diagnostic, and psychosocial differences, based on suicide attempt status, among military inpatients admitted for suicide-related events. METHOD A retrospective chart review design was used with a total of 423 randomly selected medical records of psychiatric admissions to a military hospital from 2001 to 2006. RESULTS Chi-square analyses indicated that individuals with multiple versus single suicide attempts were significantly more likely to have documented childhood sexual abuse (p =.025); problem substance use (p=.001); mood disorder diagnosis (p=.005); substance disorder diagnosis (p =.050); personality disorder not otherwise specified diagnosis (p =.018); and Axis II traits or diagnosis (p=.038) when compared to those with a single attempt history. Logistic regression analyses showed that males with multiple suicide attempts were more likely to have problem substance use (p=.005) and a mood disorder diagnosis (p =.002), while females with a multiple attempt history were more likely to have a history of childhood sexual (p =.027). DISCUSSION Clinically meaningful differences among military inpatients with single versus multiple suicide attempts exist. Targeted Department of Defense suicide prevention and intervention efforts that address the unique needs of these two specific at-risk subgroups are additionally needed.

Gender Differences on Documented Trauma Histories: Inpatients Admitted to a Military Psychiatric Unit for Suicide-related Thoughts or Behaviors

Suicide is a leading cause of death among men and women in the United States Military. Using a retrospective chart review design, the current study investigated gender differences on documented traumas for people admitted to a military inpatient psychiatric unit for suicide-related thoughts or behaviors (N = 656). Men more often had no documented lifetime traumas and women more often had 2 or more trauma types. Women had significantly more documented incidences of childhood sexual abuse, adulthood sexual assault, adulthood physical assault, and pregnancy loss. The gender gap in documented trauma types for childhood and adulthood traumas persisted even after adjusting for demographic variables, psychiatric diagnoses, and comorbid trauma types (i.e., trauma types other than the one being used as the dependent variable). Given the observed gender differences in documented traumas, professionals working with military women admitted for suicide-related thoughts or behaviors need to consider trauma in the context of treatment.

A Guide for the Assessment and Treatment of Suicidal Patients With Traumatic Brain Injuries

People with traumatic brain injuries (TBIs) are at elevated risk for suicide. Postinjury cognitive limitations, personality factors, and psychological problems may independently or in conjunction with preinjury correlates contribute to suicidal thoughts and behaviors. Rehabilitation practitioners can best serve the needs of this high-risk population by increasing their knowledge and competence in evidence-informed approaches to suicide prevention. This article provides a review of suicide nomenclature, epidemiology, risk and protective factors, as well as evidence-informed assessment, management, and treatment practices for suicidal patients. The science of clinical practice in the area of rehabilitation and suicide prevention is in its infancy. Practitioners who provide treatment for suicidal patients with TBI are encouraged to adapt and individualize existing evidence-informed suicide assessment and prevention practices for implementation within their settings. Each patient with a TBI who endorses suicidal thoughts and/or behaviors presents a complex array of clinical challenges associated with the nature of his or her brain injury, preinjury, and postinjury functioning. Clinical as well as research recommendations are provided in the context of an understanding of such challenges and an overriding objective of minimizing suicide risk during the recovery process and maximizing treatment gains.