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Psychological autopsy study comparing suicide decedents, suicide ideators, and propensity score matched controls: results from the study to assess risk and resilience in service members (Army STARRS)

Published online by Cambridge University Press:  18 May 2017

M. K. Nock ,
C. L. Dempsey ,
P. A. Aliaga ,
D. A. Brent ,
S. G. Heeringa ,
R. C. Kessler ,
M. B. Stein ,
R. J. Ursano  and
D. Benedek
M. K. Nock*
Affiliation:
Department of Psychology, Harvard University, Cambridge, MA, 02138, USA
C. L. Dempsey
Affiliation:
Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services, University of Health Sciences Bethesda, MD, 20814, USA
P. A. Aliaga
Affiliation:
Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services, University of Health Sciences Bethesda, MD, 20814, USA
D. A. Brent
Affiliation:
University of Pittsburgh School of Medicine Pittsburgh, PA, 15213, USA
S. G. Heeringa
Affiliation:
Institute for Social Research, University of Michigan, Ann Arbor, MI 48106, USA
R. C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
M. B. Stein
Affiliation:
University of California, San Diego, La Jolla, CA 92093, USA and VA San Diego Healthcare System, San Diego, CA 92161, USA
R. J. Ursano
Affiliation:
Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services, University of Health Sciences Bethesda, MD, 20814, USA
D. Benedek
Affiliation:
Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services, University of Health Sciences Bethesda, MD, 20814, USA
*
*Address for correspondence: M. K. Nock, Ph.D., Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA. (Email: [email protected])
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Abstract

Background

The suicide rate has increased significantly among US Army soldiers over the past decade. Here we report the first results from a large psychological autopsy study using two control groups designed to reveal risk factors for suicide death among soldiers beyond known sociodemographic factors and the presence of suicide ideation.

Methods

Informants were next-of-kin and Army supervisors for: 135 suicide cases, 137 control soldiers propensity-score-matched on known sociodemographic risk factors for suicide and Army history variables, and 118 control soldiers who reported suicide ideation in the past year.

Results

Results revealed that most (79.3%) soldiers who died by suicide have a prior mental disorder; mental disorders in the prior 30-days were especially strong risk factors for suicide death. Approximately half of suicide decedents tell someone that they are considering suicide. Virtually all of the risk factors identified in this study differed between suicide cases and propensity-score-matched controls, but did not significantly differ between suicide cases and suicide ideators. The most striking difference between suicides and ideators was the presence in the former of an internalizing disorder (especially depression) and multi-morbidity (i.e. 3+ disorders) in the past 30 days.

Conclusions

Most soldiers who die by suicide have identifiable mental disorders shortly before their death and tell others about their suicidal thinking, suggesting that there are opportunities for prevention and intervention. However, few risk factors distinguish between suicide ideators and decedents, pointing to an important direction for future research.

Keywords

militarypsychological autopsysuicidalsuicide
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 15 , November 2017 , pp. 2663 - 2674
Copyright
Copyright © Cambridge University Press 2017 

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References

Beautrais, AL (2003). Suicide and serious suicide attempts in youth: a multiple-group comparison study. American Journal of Psychiatry 160, 1093–1099.CrossRefGoogle ScholarPubMed
Beck, AT, Schuyler, D, Herman, I (1974). Development of suicidal intent scales. In The Prediction of Suicide (ed. Beck, A. T., Resnik, H. L. P. & Lettieri, D. J.). Charles Press: Bowie, MD. pp. 44–56.Google Scholar
Cavanagh, JT, Carson, AJ, Sharpe, M, Lawrie, SM (2003). Psychological autopsy studies of suicide: a systematic review. Psychological Medicine 33, 395–405.Google Scholar
Conner, KR, Beautrais, AL, Brent, DA, Conwell, Y, Phillips, MR, Schneider, B (2011). The next generation of psychological autopsy studies: part 1. Interview content. Suicide and Life-Threatening Behavior 41, 594–613.Google Scholar
Conner, KR, Beautrais, AL, Brent, DA, Conwell, Y, Phillips, MR, Schneider, B (2012). The next generation of psychological autopsy studies: part 2. Interview procedures. Suicide and Life-Threatening Behavior 42, 86–103.Google Scholar
Dedic, G, Panic, M (2010). Soldiers suicides risk factors in the Serbian Army Forces. Vojnosanit Pregl 67, 548–557.CrossRefGoogle ScholarPubMed
Department of Defense (2016). DoDSER: Department of Defense Suicide Event Report, 2014 Annual Report. The National Center for Telehealth & Technology (T2). 139 pages. Retrieved from http://t2health.dcoe.mil/programs/dodser Ref ID: 6–9C3997A.Google Scholar
Farberow, NL, Kang, HK, Bullman, TA (1990). Combat experience and postservice psychosocial status as predictors of suicide in Vietnam veterans. Journal of Nervous and Mental Disorders 178, 32–37.Google Scholar
Franklin, JC, Ribeiro, JD, Fox, KR, Bentley, KH, Kleiman, EM, Huang, X, Musacchio, KM, Jaroszewski, AC, Chang, BP, Nock, MK (2017). Risk factors for suicidal thoughts and behaviors: a meta-analysis of 50 years of research. Psychological Bulletin 143, 187–232.Google Scholar
Gahm, GA, Reger, MA, Kinn, JT, Luxton, DD, Skopp, NA, Bush, NE (2012). Addressing the surveillance goal in the National Strategy for Suicide Prevention: The Department of Defense Suicide Event Report. American Journal of Public Health 102(Suppl 1), S24–S28.Google Scholar
Hawton, K, Appleby, L, Platt, S, Foster, T, Cooper, J, Malmberg, A, Simkin, S (1998). The psychological autopsy approach to studying suicide: a review of methodological issues. Journal of Affective Disorders 50, 269–276.Google Scholar
Heeringa, SG, Gebler, N, Colpe, LJ, Fullerton, CS, Hwang, I, Kessler, RC, Naifeh, JA, Nock, MK, Sampson, NA, Schoenbaum, M, Zaslavsky, AM, Stein, MB, Ursano, RJ (2013). Field procedures in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). International Journal of Methods Psychiatric Research 22, 276–287.Google Scholar
Jacobs, DG, Baldessarini, RJ, Conwell, Y, Fawcett, J, Horton, L, Meltzer, H, Pfeffer, CR, Simon, RI (2010). Practice guideline for the assessment and treatment of patients with suicidal behaviors. American Psychiatric Association. http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/suicide.pdf Google Scholar
Joo, SH, Wang, SM, Kim, TW, Seo, HJ, Jeong, JH, Han, JH, Hong, SC (2016). Factors associated with suicide completion: a comparison between suicide attempters and completers. Asia Pacific Psychiatry 8, 80–86.Google Scholar
Kessler, RC, Berglund, P, Borges, G, Nock, M, Wang, PS (2005). Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. JAMA: the Journal of the American Medical Association 293, 2487–2495.Google Scholar
Kessler, RC, Calabrese, JR, Farley, PA, Gruber, MJ, Jewell, MA, Katon, W, Keck, PE, Nierenberg, AA, Sampson, NA, Shear, MK, Shillington, AC, Stein, MB, Thase, ME, Wittchen, HU (2013 a). Composite International Diagnostic Interview screening scales for DSM-IV anxiety and mood disorders. Psychological Medicine 43, 1625–1637.CrossRefGoogle ScholarPubMed
Kessler, RC, Santiago, PN, Colpe, LJ, Dempsey, CL, First, MB, Heeringa, SG, Stein, MB, Fullerton, CS, Gruber, MJ, Naifeh, JA, Nock, MK, Sampson, NA, Schoenbaum, M, Zaslavsky, AM, Ursano, RJ (2013 b). Clinical reappraisal of the Composite International Diagnostic Interview Screening Scales (CIDI-SC) in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). International Journal of Methods in Psychiatric Research 22, 303–321.Google Scholar
Nock, MK, Borges, G, Ono, Y (eds) (2012). Suicide: Global Perspectives from the WHO World Mental Health Surveys. Cambridge University Press: New York.Google Scholar
Nock, MK, Kessler, RC, Franklin, JC (2016). Risk factors for suicide ideation differ from those for the transition to suicide attempt: the importance of creativity, rigor, and urgency in suicide research. Clinical Psychology: Science and Practice 23, 31–34.Google Scholar
Orbach, I, Gilboa-Schechtman, E, Ofek, H, Lubin, G, Mark, M, Bodner, E, Cohen, D, King, R (2007). A chronological perspective on suicide--the last days of life. Death Studies 31, 909–932.Google Scholar
Pearl, J (2009). Causality: Models, Reasoning, and Inference, 2nd edn. Cambridge University Press: New York.Google Scholar
Posner, K, Brown, GK, Stanley, B, Brent, DA, Yershova, KV, Oquendo, MA, Currier, GW, Melvin, GA, Greenhill, L, Shen, S, Mann, JJ (2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry 168, 1266–77.Google Scholar
Robins, E, Gassner, S, Kayes, J, Wilkinson, RH Jr, Murphy, GE (1959). The communication of suicidal intent: a study of 134 consecutive cases of successful (completed) suicide. American Journal of Psychiatry 115, 724–733.CrossRefGoogle ScholarPubMed
Rosenbaum, PR, Rubin, DB (1983). The central role of the propensity score in observational studies for causal effects. Biometrika 70, 41–55.Google Scholar
Ursano, RJ, Colpe, LJ, Heeringa, SG, Kessler, RC, Schoenbaum, M, Stein, MB, Army, SC (2014). The Army study to assess risk and resilience in servicemembers (Army STARRS). Psychiatry 77, 107–119.Google Scholar
Weathers, FW, Litz, BT, Herman, DS, Huska, JA, Keane, TM (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the 9th Annual Conference of the ISTSS, San Antonio, TX, USA.Google Scholar
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