Hazardous drinking and military community functioning: Identifying mediating risk factors.

Objective: Hazardous drinking is a serious societal concern in military populations. Efforts to reduce hazardous drinking among military personnel have been limited in effectiveness. There is a need for a deeper understanding of how community-based prevention models apply to hazardous drinking in the military. Community-wide prevention efforts may be most effective in targeting community functioning (e.g., support from formal agencies, community cohesion) that impacts hazardous drinking via other proximal risk factors. The goal of the current study is to inform community-wide prevention efforts by testing a model of community functioning and mediating risk factors of hazardous drinking among active duty U.S. Air Force personnel. Method: A large, representative survey sample of U.S. Air Force active duty members (N = 52,780) was collected at 82 bases worldwide. Hazardous drinking was assessed with the widely used Alcohol Use Disorders Identification Test (Saunders, Aasland, Babor, de la Fuente, & Grant, 1993). A variety of individual, family, and community measures were also assessed. Structural equation modeling was used to test a hypothesized model of community functioning, mediating risk factors and hazardous drinking. Results: Depressive symptoms, perceived financial stress, and satisfaction with the U.S. Air Force were identified as significant mediators of the link between community functioning and hazardous drinking for men and women. Relationship satisfaction was also identified as a mediator for men. Conclusions: These results provide a framework for further community prevention research and suggest that prevention efforts geared at increasing aspects of community functioning (e.g., the U.S. Air Force Community Capacity model) may indirectly lead to reductions in hazardous drinking through other proximal risk factors. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Development of a Clinical Guide to Enhance Care for Suicidal Patients.

Suicidal thoughts and behavior are common among mental health patients and are a source of stress for clinicians, who typically receive limited formal training on suicide. The U.S. Air Force initiated a project to enhance care and increase practitioner confidence when working with suicidal patients. A clinical guide was developed containing 18 recommendations for assessing and managing suicidality, strategies for meeting the recommendations, and clinical tools to facilitate quality care. Training opportunities and marketing efforts accompanied distribution of the guide. This initial article reviews the guide's development, content, and evaluation plan as a model that other health care systems, clinics, or training programs can follow to enhance care for suicidal patients. Outcome data will be presented in a follow-up article. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determinants of suicidal ideation: the role of substance use disorders

BACKGROUND: This study tested the hypothesis that the amount of psychoactive substance consumed (frequency and/or quantity), life problems resulting from this use, and a DSM-IV diagnosis of substance abuse/dependence are independent risk factors associated with increased suicidal ideation in a population of psychiatric inpatients with major depressive disorder. METHOD: 891 hospitalized patients with a primary diagnosis of nonpsychotic major depressive disorder (MDD) received a standardized, psychiatrist-administered assessment battery. To examine the relationship between admission suicidality and demographic, psychiatric history, and admission variables, chi-square analyses were used for categorical data and one-way ANOVAs were used for continuous indices. Stepwise hierarchical multiple regression analyses were performed to determine the set of variables that was independently related to admission suicidality level. RESULTS: There was general agreement between our findings and previous literature in regard to the association between severity of Axis I diagnosis, depressed mood, hopelessness, male gender, unemployment, involuntary treatment, and alcohol/drug problems and higher suicidal ideation. In our sample of hospitalized patients with unipolar major depressive disorder, higher current drug and/or alcohol dependency and high current use of alcohol or other substances of abuse were independently associated with higher levels of suicidal ideation. CONCLUSION: This association with higher suicidal ideation lends support to the importance of treating patients for both alcohol/drug problems and depression in an effort to decrease their risk for future suicide. We hope that our findings will improve the care that patients with dual diagnoses receive.     

Hazardous alcohol use among active duty Air Force personnel: Identifying unique risk and promotive factors.

Hazardous drinking is a significant public health concern and an important target for prevention efforts within both military and civilian populations. For such efforts to be maximally effective, comprehensive information regarding factors that increase or decrease risk for hazardous drinking is necessary. This is the first study to investigate risk and promotive factors across individual, family, community, and organizational levels in a representative sample of Air Force personnel (N = 52,780). Unique predictors of men's and women's hazardous drinking were identified both within and across ecological levels. Predictors that accounted for the most variance in predicting hazardous versus non-hazardous drinkers included family income, number of children, depressive symptoms, religious involvement, and perceived financial stress for men and women; and years in the military for men. Among hazardous drinkers, a different set of predictors best explained variance in severity of drinking problems. Results of the current study help identify key targets for prevention efforts operating at different levels (e.g., individual therapy, community-wide programs). (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Social connections and suicidal thoughts and behavior.

Disrupted social connectedness is associated with suicidal thoughts and behaviors among individuals with substance use disorders (SUDs). The current study sought to further characterize this relationship by examining several indices of social connectedness—(a) living alone, (b) perceived social support, (c) interpersonal conflict, and (d) belongingness. Participants (n = 814) were recruited from 4 residential substance-use treatment programs and completed self-report measures of social connectedness as well as whether they had ever thought about or attempted suicide. Multivariate results indicated that interpersonal conflict and belongingness were significant predictors of a history of suicidal ideation, and that belongingness, perceived social support, and living alone were significant predictors of suicide attempt. These results indicate the most consistent support for the relationship between suicidality and thwarted belongingness, and also support the clinical utility of assessing whether individuals live alone. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Suicide prediction in the US Air Force: Implications for practice.

How can psychologists know which of the many variables in an individual's clinical presentation are most salient to that person's suicide risk? Such certainty requires an empirically validated prediction model that is specific to the population served. Data obtained through the U.S. Air Force (USAF) Office of Special Investigations and the USAF Institute for Environment, Safety, and Occupational Health Risk Analysis were analyzed using multivariate strategies of prediction based on an empirically validated model of suicide prediction (G. K. Brown, A. T. Beck, R. A. Steer, & J. R. Grisham, 2000) and suicide completer versus noncompleter status. The usefulness of the model to the USAF sample is discussed, and several factors unique to a military population are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors influencing dental utilization by U.S. military recruits

This study identifies factors that influence dental utilization by U.S. military recruits prior to entering military service. Data were collected between February and June 1994 at one recruit in-processing site per service using self-administered questionnaires. A prestratified, systematic, random sample of 2,711 Army, Air Force, Navy, and Marine recruits was drawn. Women and minorities were oversampled. Using logistic regression to determine what factors contribute to the likelihood of recruits having seen a dentist over the past year reveals that the likelihood is greater for females, singles, Air Force personnel, Native Americans, and the better educated; the likelihood is less for recruits who are black, above 19 years old, from the Midwest, Southwest, or Pacific regions of the U.S., and who perceive a need for dental care. Education is the strongest predictor of dental utilization prior to entering military service.     

Computerized prompts for cancer screening in a community health center

One hundred eleven (58%) of 191 adolescent inpatients previously admitted to the emergency wards at the Child and Adolescent Psychiatric Clinics in the cities of Uppsala and G?teborg participated in a 2-4 year follow-up evaluation. The prevalence, incidence, and stability of depressive symptoms, suicidal ideation, and suicide attempts among the adolescents, and predictors of follow-up functioning were examined. Although a majority of the patients substantially reduced their depressive symptoms over the 2-4 year period, a smaller group (13%), mainly girls (94%), continued reporting high symptom levels at follow-up, and one out of five adolescents had moderate-severe levels of suicidal ideation. The accumulated frequency of suicide attempts among the patients shortly prior to hospitalization and during the follow-up was 59% including two patients who committed suicide. Significant predictors of depressive symptom severity at follow-up were depressive symptom scores and V-diagnoses at inpatient assessment. Previous suicide attempts before hospitalization, high levels of self-reported depressive symptoms and nonintact family status at inpatient assessment predicted suicide attempts during the follow-up period. The high prevalence of attempted and completed suicide in this clinical group underscores the importance of developing effective treatments for suicidal adolescents.     

Prediction of local recurrence of ductal carcinoma in situ of the breast using five histological classifications: a comparative study with long follow-up

OBJECTIVE: To identify the independent and differential diagnostic and symptom correlates of suicidal ideation and suicide attempts and determine whether there are gender- and age-specific diagnostic profiles. METHOD: The relationships between suicidal ideation, suicide attempts, and psychiatric disorders were examined among 1,285 randomly selected children and adolescents, aged 9 to 17 years, of whom 42 had attempted suicide and 67 had expressed suicidal ideation only. Youths and their parents were interviewed as part of the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, using the Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3). RESULTS: Logistic regression analyses indicated that mood, anxiety, and substance abuse/dependence disorders independently increased the risk of suicide attempts, after controlling for sociodemographic characteristics. There was no significant independent contribution of disruptive disorders to suicide attempts, although its association with suicidal ideation was significant. Substance abuse/dependence independently differentiated suicide attempters from ideators. Noncriterion symptoms that remained significant predictors of suicide risk, after adjusting for psychiatric disorder, included panic attacks and aggressiveness. Perfectionism did not significantly increase suicide risk after adjusting for psychiatric disorder. The association of specific disorders and noncriterion symptoms with suicidality varied as a function of gender and age. CONCLUSION: A monolithic diagnostic risk profile for suicidality, ignoring gender- and age-specific risks, is inadequate. The contribution of substance abuse/dependence in the escalation from suicidal thoughts to suicide attempts is underscored.     

étude des composantes dépressives chez des adolescents à tendances suicidaires.

Studied symptoms of depression in adolescents with suicidal tendencies. Ss were 2,850 secondary school students (aged 12–18 yrs). Ss completed a questionnaire assessing sociodemographic variables, symptoms of depression, and suicidality. Results from the following subsamples were compared: (1) 105 Ss with suicidal ideation; (2) 206 Ss with suicidal ideation who had contemplated specific means of suicide; (3) 94 Ss who had attempted suicide; (4) 62 Ss with depression but without suicidal ideation; and (5) 336 age-, gender-, and grade-matched comparison Ss without suicidal ideation. The Dysphoria Scale by L. S. Radloff (1977) was used. (English abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating addictive patients at suicidal risk.

Presents a model for conceptualizing 4 basic types of suicidality among substance abusers (avoidance of painful consequences, the depressive experience of "crashing," the threat of personal loss, and environmental strain) and offers practical tips for treating the problem. Four general forms of intervention are discussed: pacing the crisis encounter; desensitizing the patient's sense of desperation; talking frankly about the suicidality; and attending to one's own needs as a counselor. These crisis-intervention tips are intended to aid counselors in handling suicidality as it is manifested in substance-abusing populations. Tips and guidelines for suicidal risk assessment with drug and alcohol abusers are given. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal trajectories and predictors of adolescent suicidal ideation and attempts following inpatient hospitalization.

Remarkably little is known regarding the temporal course of adolescent suicidal ideation and behavior, the prediction of suicidal attempts from changes in suicidal ideation, or the prediction of suicidal attempts after accounting for suicidal ideation as a predictor. A sample of 143 adolescents 12-15 years old was assessed during psychiatric inpatient hospitalization and again at 3, 6, 9, 15, and 18 months postdischarge through a series of structured interviews and parent- and adolescent-reported instruments. Symptoms of depression, posttraumatic stress disorder, externalizing psychopathology, hopelessness, and engagement in several forms of self-injurious/suicidal behaviors (i.e., suicide threats/gestures, plans, nonsuicidal self-injury [NSSI]) were assessed. Latent growth curve analyses revealed a period of suicidal ideation remission between baseline and 6 months following discharge, as well as a subtle period of suicidal ideation reemergence between 9 and 18 months postdischarge. Changes in suicidal ideation predicted suicide attempts. After accounting for the effects of suicidal ideation, baseline suicide threats/gestures also predicted future suicide attempts. Higher adolescent-reported depressive symptoms, lower parent-reported externalizing symptoms, and higher frequencies of NSSI predicted weaker suicidal ideation remission slopes. Findings underscore the need for more longitudinal research on the course of adolescent suicidality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suicidality as a function of impulsivity, callous–unemotional traits, and depressive symptoms in youth.

Suicidality represents one of the most important areas of risk for adolescents, with both internalizing (e.g., depression, anxiety) and externalizing–antisocial (e.g., substance use, conduct) disorders conferring risk for suicidal ideation and attempts (e.g., Bridge, Goldstein, & Brent, 2006). However, no study has attended to gender differences in relationships between suicidality and different facets of psychopathic tendencies in youth. Further, very little research has focused on disentangling the multiple manifestations of suicide risk in the same study, including behaviors (suicide attempts with intent to die, self-injurious behavior) and general suicide risk marked by suicidal ideation and plans. To better understand these relationships, we recruited 184 adolescents from the community and in treatment. As predicted, psychopathic traits and depressive symptoms in youth showed differential associations with components of suicidality. Specifically, impulsive traits uniquely contributed to suicide attempts and self-injurious behaviors, above the influence of depression. Indeed, once psychopathic tendencies were entered in the model, depressive symptoms only explained general suicide risk marked by ideation or plans but not behaviors. Further, callous–unemotional traits conferred protection from suicide attempts selectively in girls. These findings have important implications for developing integrative models that incorporate differential relationships between (a) depressed mood and (b) personality risk factors (i.e., impulsivity and callous–unemotional traits) for suicidality in youth. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Topical bleomycin for the treatment of dysplastic oral leukoplakia

The objective of this study was to predict suicidality in people with schizophrenia. Ninety-six patients with recent-onset schizophrenia were rated every 2 weeks for 1 year to examine (1) the temporal course of suicidal ideation and suicide attempts and (2) the extent to which anxiety, depression, and mild suicidal ideation were followed by significant suicidal ideation or a suicide attempt. The severity of suicidality changed rapidly. Low levels of suicidal ideation increased the risk for significant suicidal ideation or a suicide attempt during the subsequent 3 months. Depression was moderately correlated with concurrent suicidality, but not independently associated with future suicidality. Therefore, low levels of suicidal ideation may predict future suicidal ideation or behavior better than depressed mood in individuals with schizophrenia.     

Drinking to cope as a statistical mediator in the relationship between suicidal ideation and alcohol outcomes among underage college drinkers.

Etiological models of alcohol use that highlight the role of negative affect and depression have not been applied to the association of suicidality and alcohol use. The authors examined whether a motivational model of alcohol use could be applied to understand the relationship between suicidal ideation and alcohol outcomes in a sample of underage college drinkers who had a history of passive suicidal ideation (n = 91). In this cross-sectional study, regression analyses were conducted to examine whether drinking to cope with negative affect statistically mediated or was an intervening variable in the association between suicidal ideation and alcohol outcomes. Results revealed that drinking to cope was a significant intervening variable in the relationships between suicidal ideation and alcohol consumption, heavy episodic drinking, and alcohol problems, even while controlling for depression. These results suggest that the relationship between suicidal ideation and alcohol outcomes may be due to individuals using alcohol to regulate or escape the distress associated with suicidal ideation. Consideration of alcohol-related models can improve the conceptualization of research on suicidality and alcohol use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive symptoms and mechanisms of relational turbulence as predictors of relationship satisfaction among returning service members.

In contrast to romanticized portrayals of reunion after deployment, U.S. military personnel may contend with the harsh reality of both depressive symptoms and upheaval in their romantic relationships during the postdeployment transition. This study employed the relational turbulence model to evaluate mechanisms linking depressive symptoms with relationship satisfaction. Cross-sectional, self-report data were collected from 220 service members living in 27 states who had returned home from deployment within the past six months. As hypothesized, the negative association between depressive symptoms and relationship satisfaction was mediated by relational uncertainty and interference from partners. These findings advance scholarship on depressive symptoms and relational turbulence, and they also suggest guidelines for helping service members with depressive symptoms maintain satisfying romantic relationships upon reentry. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Operationalizing the Moskos institution-occupation model: An application of Gouldner's cosmopolitan-local research.

Evaluated the problems of developing and validating measures of institutional–occupational orientations in the US Air Force. The measures were developed by modifying A. W. Gouldner's (see PA, Vol 33:4757 and 33:8067) cosmopolitan–local measurement. A questionnaire was administered that contained 8 attitudinal items concerning military and civilian life, a measure of career intent, a job satisfaction measure, and several demographic questions. Factor analysis of the 8 attitudinal items revealed 2 independent dimensions: Institutional and Occupational Orientations. Hypothesized differences between various demographic groups in a survey of 10,687 Air Force personnel of various grades, seniority levels, and educational levels were observed. The Institutional orientation was positively associated with career intent, seniority, and job satisfaction, whereas the Occupational orientation was negatively associated with those criteria. It is concluded that the developed measures provide the means to assess trends longitudinally in the military, as posited by C. Moskos (1977). (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suicidal ideation and behavior in youthful nonpsychiatric populations.

Administered the Suicidal Incidence Survey developed by the authors to a total of 352 music, psychology, engineering, and medical college students, and 128 Air Force basic trainees. Median age was 21 for students and 19 for military trainees. 18% of the Ss reported suicidal gestures or attempts, or serious suicidal ideation at some time in their lives, while 59% reported experience with suicidal behavior in others. Ss reporting serious suicidal behavior in the self reported significantly more suicidal behavior in others, including relatives. Significant subgroup differences suggest the possibility of a repression-sensitization continuum. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression, hopelessness, suicidality, and related factors in sexual minority and heterosexual adolescents.

In the present study, the researchers examined factors related to depression, hopelessness, and suicidality in gay, lesbian, and bisexual adolescents, compared with demographically similar heterosexual adolescents. Sexual minority adolescents reported greater depression, hopelessness, and past and present suicidality than did heterosexual adolescents. However, when controlling for other psychological predictors of present distress, significant differences between the 2 samples disappeared. For past suicidality scores, the effects of sexual orientation were reduced, but still significant, when accounting for the other predictor variables. These results suggest that environmental factors associated with sexual orientation, which can be targeted and changed through prevention and intervention efforts, play a major role in predicting distress in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is There a Window of Heightened Suicide Risk If Patients Gain Energy in the Context of Continued Depressive Symptoms?

The authors' purpose is to provide some empirical perspective on the important but understudied possibility that when people become more energetic in the context of continued depressive symptoms, suicide risk escalates. The authors studied 109 suicidal young adults; among those who initially reported substantial depression, a subgroup was identified whose energy was increasing in context of continued depressive symptoms. They were compared with others with regard to suicidality 1 month later. Results suggested that those who have incomplete remissions (of any sort) may be more ill to begin with, and this may account for higher suicide risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)