Matthew E. Schneider

Thwarted belongingness as an explanatory link between insomnia symptoms and suicidal ideation: Findings from three samples of military service members and veterans

BACKGROUND Although insomnia has been identified as a robust predictor of suicidal ideation and behaviors, little is known about the mechanisms by which sleep disturbances confer risk for suicide. We investigated thwarted belongingness as an explanatory link between insomnia symptoms and suicidal ideation across three military service member and veteran samples. METHODS Data were collected among United States military service members and veterans (N1=937, N2=3,386, N3=417) who completed self-report measures of insomnia symptoms, thwarted belongingness, suicidal ideation, and related psychiatric symptoms (e.g., anxiety, hopelessness). Bias-corrected bootstrap mediation analyses were utilized to examine the indirect effects of insomnia symptoms on suicidal ideation through thwarted belongingness, controlling for related psychiatric symptoms. RESULTS Consistent with study hypotheses, thwarted belongingness significantly accounted for the relationship between insomnia and suicidal ideation across all three samples; however, insomnia symptoms did not significantly account for the relationship between thwarted belongingness and suicidal ideation, highlighting the specificity of our findings. LIMITATIONS This study utilized cross-sectional self-report data. CONCLUSIONS Insomnia may confer suicide risk for military service members and veterans, in part, through the pathway of thwarted belongingness. Additional prospective studies are warranted to further delineate this model of risk. Our results offer a potential therapeutic target for the prevention of suicide, via the promotion of belongingness, among service members and veterans experiencing insomnia symptoms.

Examination of MMPI-2-RF Substantive Scales as Indicators of Acute Suicidal Affective Disturbance Components.

ABSTRACT A new suicide-specific diagnostic entity, acute suicidal affective disturbance (ASAD), was recently proposed to fill a void in the nomenclature. Although several studies have examined the reliability, validity, and potential clinical utility of ASAD, no studies have examined personality indicators of ASAD. This study sought to examine the association between personality and psychopathology factors, as assessed by the Minnesota Multiphasic Personality Inventory–2–Revised Form (MMPI–2–RF), and constructs that comprise ASAD in a sample of 554 psychiatric outpatients who completed all measures prior to their intake appointments. A smaller subset of patients (N = 58) also completed a measure designed to assess lifetime ASAD symptoms. Results indicated that ASAD symptoms were associated with traits characterized by emotional turmoil and atypical cognitive processes. Further, suicide-related criteria that comprise ASAD were related to low positive emotionality and hopelessness, whereas the overarousal criteria were associated with somatic symptoms and an inability to tolerate frustration and stress. These findings expand on previous research that examines the convergent and discriminant validity of ASAD and could inform clinical treatment by providing insight into personality traits that might be associated with acute suicide risk.

A systematic review of help-seeking and mental health service utilization among military service members

Research has demonstrated that military service members are at elevated risk for a range of psychiatric problems, and mental health services use is a conduit to symptom reduction and remission. Nonetheless, there is a notable underutilization of mental health services in this population. This systematic review aimed to identify and critically examine: (1) rates of service use; (2) barriers and facilitators to care; and (3) programs and interventions designed to enhance willingness to seek care and increase help-seeking behaviors among current military personnel (e.g., active duty, National Guard, Reserve). Overall, 111 peer-reviewed articles were identified for inclusion. Across studies, the rate of past-year service use among service members with mental health problems during the same time frame was 29.3% based on weighted averages. Studies identified common barriers to care (e.g., concerns regarding stigma, career impact) and facilitators to care (e.g., positive attitudes toward treatment, family/friend support, military leadership support) among this population. Although programs (e.g., screening, gatekeeper training) have been developed to reduce these barriers, leverage facilitators, and encourage service use, further research is needed to empirically test the effectiveness of these interventions in increasing rates of service utilization. Critical areas for future research on treatment engagement among this high-risk population are discussed.

Advancing the prediction and prevention of murder-suicide

The phenomenon of murder-suicide (aka. homicide-suicide) makes a sizeable impact on current public perceptions and policies regarding mental illness and risk for violence. However, within the past 25 years, our understanding of murder-suicide has remained relatively stable, and so has our relative inability to reliably predict and prevent it. The purpose of this paper is to propose pathways for furthering a cogent understanding of murder-suicide that may inform specific predictive and preventative practices.,Research literature regarding empirical and theoretical positions in the fields of murder-suicide, homicide, and suicide are reviewed and discussed.,While murder-suicide has many similarities to both homicide and suicide, no current theories of either alone have been successful in fully incorporating the phenomenon of murder-suicide. Theories specific to murder-suicide as a unique form of violence are in need of further research.,Developing and empirically testing theories of murder-suicide may lead to a vast and needed improvement of our understanding, prediction, and prevention of these tragedies.

Evaluation of Suicide Risk Assessment Measures in an Israel Defense Forces Military Sample

ABSTRACT The present study evaluates the psychometric properties of 4 commonly used measures of suicidal ideation and behaviors (Beck Scale for Suicide Ideation [BSS], Columbia-Suicide Severity Rating Scale [C-SSRS], Self-Harm Behavior Questionnaire [SHBQ], and Suicidal Behaviors Questionnaire—Revised [SBQ–R]) among a sample of Israel Defense Forces (IDF) soldiers. Measures were translated to Hebrew and completed by 65 active duty IDF soldiers who were recently hospitalized for at least 24 hours following a suicide attempt. Internal consistency and Pearsons r correlation analyses were conducted for all measures to test the reliability and validity of the measures. Findings support the reliability and validity of common suicide risk assessment measures among a sample of IDF soldiers. Instruments demonstrated acceptable-to-excellent internal consistency (αs = .72 to .93), save for the SBQ–R (α = .57). Further, all measures demonstrated associations as expected, suggesting convergent and divergent validity. The BSS, C-SSRS, and SHBQ can be reliably and validly used among IDF soldiers.

Evolutionary processes in suicide

Suicidal behavior contains several dynamic elements. Due to its complexity, empirical science may approach suicide through various avenues. One underutilized approach is taking an evolutionary perspective. Our review of the literature presents two evolutionary processes that may be implicated in suicidal behavior, namely eusocial behavior and antipredator response behaviors. Studies have indicated that aspects of suicidal behavior parallel self-sacrificial behavior in eusocial animals, and that systems similar to hyperarousal-shutdown systems involved in antipredator behaviors may be activated among suicidal individuals. Research on brain activity and decision-making processes among suicidal individuals also suggests that eusociality and antipredator response behaviors in suicide may not be mutually exclusive. These processes represent novel sources of information and potential solutions regarding suicide.

Evaluation of two web-based interventions in reducing the stigma of suicide

Suicide is more highly stigmatized than most mental health conditions; however, no interventions have aimed to modify the stigma of suicide in the general population. This study tested the efficacy of two brief web-based interventions-psychoeducation and interpersonal exposure-in reducing suicide-related stigma in a student/community sample. A sample of 266 adults completed baseline measures of suicide-related stigma, were randomized into one of three conditions (psychoeducation, interpersonal exposure, control), in which they browsed an assigned website for twenty minutes, and completed post-intervention and one-month follow-up stigma measures. Results indicated that the two interventions were more efficacious than the control in reducing suicide-related stigma; this effect was accentuated for individuals without prior exposure to suicide. Although future research is needed to understand the mechanisms of change and the generalizability of these findings, it is possible that web-based interventions could be a cost- and time-effective avenue of targeting the widespread stigma of suicide.

Sex Differences in Suicide-Related Symptoms in a Large Military Sample

ABSTRACT Little research has focused on suicide-related symptoms in female servicemembers, despite high rates of suicidal behaviors. This study examined sex differences in suicide-related risk factors in 3,374 U.S. Army Recruiters (91.9% male). Female servicemembers had a greater number of past major depressive and suicidal ideation episodes than did male servicemembers; there were no differences in suicide attempt histories or mental health visits. Female servicemembers reported significantly fewer symptoms of current suicidal ideation, perceived burdensomeness, and acquired capability. No significant sex differences emerged for thwarted belongingness, insomnia, or agitation. Our findings provide evidence for sex differences in rates of suicide-related symptoms among military personnel.

Perceived Interpersonal Burdensomeness as a Mediator between Nightmare Distress and Suicidal ideation in Nightmare Sufferers

Previous studies have supported the significant association between nightmares and suicidal ideation, but the underlying mechanisms are largely unknown. The purpose of the present study was to investigate perceived burdensomeness and thwarted belongingness as mediators in the relationship between nightmare distress and suicidal ideation. This sample consisted of 301 undergraduate students who endorsed experiencing nightmares (mean age 21.87 ± 2.17, 78.1% female). All participants completed questionnaires on nightmare distress (Nightmare Distress Questionnaire), unmet interpersonal needs (Interpersonal Needs Questionnaire), and suicidal ideation (Depressive Symptom Inventory – Suicidality Subscale). Analyses were performed using multiple mediation regression. Results indicated that nightmare distress was associated with perceived burdensomeness (r = 0.17, p < 0.001) and suicidal ideation (r = 0.24, p < 0.001), but was not related to thwarted belongingness (r = 0.10, p = 0.06). Multiple mediation analyses revealed that perceived burdensomeness partially mediated the relationship between nightmares and suicidal ideation, but thwarted belongingness did not. Additionally, this mediating relationship for perceived burdensomeness was moderated by gender, being significant only for females. These findings highlight the important role of interpersonal factors in the relationship between nightmares and suicidal ideation.