Shane Kuhlman

Assessing the unique role of religious coping in suicidal behavior among U.S. Iraq and Afghanistan veterans.

In this study we examined relations of positive and negative religious coping with risk for suicidal behavior in a sample of Iraq and/or Afghanistan Veterans. Participants completed self-report instruments assessing risk for suicidal behavior, religious coping, general combat exposure, morally injurious experiences, depression, and posttraumatic stress disorder (PTSD) symptoms. Frequency analyses revealed that half of all participants endorsed being religious, and adaptively drawing on religion to cope was more common than maladaptive coping. However, positive religious coping was not associated with suicidal behavior at the time of the study. In contrast, negative religious coping was uniquely associated with the risk for suicide when we controlled for demographic risk factors, war-zone experiences, depression, and PTSD. Although we expect adaptive reliance on religion to be beneficial for mental health, veterans who experience internal and/or external conflicts in the spiritual domain may be at increased risk for engaging in suicidal behavior following their war-zone service.

Interpersonal Trauma, Posttraumatic Stress Disorder Symptoms, and the Interpersonal Theory of Suicide in Women Seeking Shelter from Intimate Partner Violence

ABSTRACT This study examined how trauma exposure and posttraumatic stress disorder symptoms of reexperiencing, avoidance, numbing, dysphoric arousal, and anxious arousal relate to the major components of the interpersonal theory of suicide; namely, thwarted belongingness, perceived burdensomeness, and the acquired capability for suicide. A sample of 137 women seeking shelter from intimate partner violence completed self-report assessments. Symptoms of dysphoric arousal and numbing were uniquely and positively associated with thwarted belongingness. Numbing symptoms were uniquely and positively associated with perceived burdensomeness. Reexperiencing and anxious arousal symptoms were uniquely but negatively associated with the acquired capability for suicide. Interpersonal trauma was also positively associated with acquired capability, but only when examined independently. Posttraumatic stress disorder symptoms of dysphoric arousal and numbing symptoms might complement brief screenings for acute suicide risk and can help inform in-shelter activities as well as postshelter treatment recommendations to decrease suicide risk for shelter-seeking women.

Student veterans’ self-stigma of seeking help: Contributions of painful self-conscious emotions, traditional masculine norms, and war-zone service.

Despite established connections between traditional masculinity ideologies and self-stigma of seeking psychological help, few studies have examined relevant constructs in samples of veterans. The present study addressed this gap by testing a model specifying conformity to the masculine role norms of self-reliance and emotional control as mediating factors of the probable associations between painful self-conscious emotions (i.e., guilt and shame) and self-stigma of seeking help in a sample of student veterans (N = 349) with and without a history of war-zone deployment. After we controlled for gender, posttraumatic stress disorder symptoms, and depression, multigroup structural equation modeling revealed that painful self-conscious emotions were associated with conformity to masculine role norms in only the war-zone deployment group. In addition, emotional control and self-reliance mediated the associations between painful self-conscious emotions and self-stigma solely in the war-zone deployment group. Tests of measurement invariance suggested that the moderation effects in the model were not due to measurement differences across deployment groups. Structural invariance testing suggested the observed differences in indirect effects were attributed to the different associations between guilt and shame and emotional control between the deployment groups. Tests of an alternative model, in which guilt and shame were specified separately, indicated that the significant mediation effect of conformity to traditional masculine role norms occurred only when the shared variance between guilt and shame was modeled in a single latent variable. These results suggest that war-zone deployments may solidify military-congruent masculine role norms in ways that exacerbate generalized guilt and shame emotions and promote self-stigma.

A preliminary test of the interpersonal-psychological theory of suicide in women seeking shelter from intimate partner violence

Women seeking shelter from intimate partner violence (IPV) are at greater risk of suicide ideation and attempts compared with women in the general population. A theoretically grounded understanding of suicide risk in shelter-seeking women is critical to improve assessment and management of suicide risk in this population. The interpersonal-psychological theory of suicide (IPTS) proposes that suicide ideation results from hopelessness about thwarted belongingness and perceived burdensomeness. However, suicide ideation does not progress to death by suicide unless one has acquired the capability for suicide (i.e., pain tolerance and fearlessness about death) via repeated exposure to painful and fearsome events. The present study provides a preliminary test of the IPTS in a sample of 134 women seeking shelter from IPV. First, we examined factors theoretically related to suicide ideation, demonstrating that only at high levels of hopelessness was perceived burdensomeness associated with suicide ideation. The study also examined factors theoretically related to the acquired capability for suicide (ACS), indicating that physical partner violence perpetration was associated with ACS. These findings suggest that perceived burdensomeness, particularly in the context of increased hopelessness, is important in the assessment and treatment of suicide ideation. Furthermore, violence perpetration may indicate greater risk of the capability to die by suicide among women seeking shelter from IPV.

College students’ peer-helping behaviors and stigma of seeking help: Testing a moderated mediation model

Abstract Objective: College students are most likely to seek psychological help from their peers. Internalized public stigma (ie, personal stigma) may prevent peer-helpers from aiding others, and such help-negating effects may depend on contextual factors such as race and gender. The current study examined a moderated mediation model in which the relationship between public stigma and peer intervention behaviors was mediated by personal stigma and moderated by race and gender categories. Method: Undergraduate students (N = 5,183) from the national Healthy Minds Study completed measures of help-seeking stigma and peer-helping behaviors. Results: Conditional Process Modeling revealed that personal stigma fully mediated the link between public stigma and peer-helping behaviors. Gender (but not race) moderated these associations such that the indirect and direct effects were stronger from men than women. Conclusions: Peer-helper interventions may benefit from culture-specific re-norming messages and by addressing the role of gender in peer-helping.

Violence victimization and perpetration in relation to fearlessness about death in suicidal psychiatric inpatients

Purpose The interpersonal theory of suicide proposes that fearlessness about death, one aspect of the capability for suicide, may explain men’s greater risk for death by suicide. The purpose of this paper is to examine whether violence perpetration and victimization would mediate the relation of gender with fearlessness about death in suicidal psychiatric inpatients. Design/methodology/approach The current study used a cross-sectional survey design in a sample of 196 psychiatric inpatients admitted for suicide risk. Findings Men endorsed greater fearlessness about death compared to women. The relation of gender with fearlessness about death was partially mediated by violence perpetration, but not victimization. Violence perpetration may play a more central role in the development of fearlessness about death, the capability for suicide, and the transition from suicide ideation to action compared to violence victimization. Research limitations/implications The current study was cross-sectional and not able to definitively answer questions about the development of the capability for suicide. Future research must examine how fearlessness about death evolves over time. Practical implications Suicide risk assessment should include history of violence perpetration, as this may better identify those who may be at greater risk for suicide due to greater fearlessness about death. Originality/value The current study adds to the growing literature that aims to understand variables that explain the transition from suicide ideation to action.