VISN 19 MIRECC Specialties: Suicide Prevention

Research, Education and Clinical Care Related to
Suicide Prevention

Educational Products

Free Self-Directed Violence Toolkit and Classification System Clipboards!

The free clipboard has the SDVCS Clinical Tool printed right on it for the clinician on the go. The accompanying laminated page with the Classification System makes it easier than ever to use this widely adopted nomenclature.

Follow this link to get your free SDVCS Clipboard!

The VA Ace Card

The purpose of ACE is to help Veterans, their family members and friends learn that they can take the necessary steps to get help. The acronym ACE (Ask, Care, Escort) summarizes the steps needed to take an active and valuable role in suicide prevention.

View the ACE card and accompanying brochure. 

Order the VA ACE card and the supporting brochure online. It's free as is delivery.

Traumatic Brain Injury and Suicide in Veterans and Returning Military Personnel

Download the presentation that Lisa A. Brenner PhD ABPP gave at the 2010 American Association of Suicidology. 

How to Talk to a Child about a Suicide Attempt in Your Family: Guides Targeting Age Groups 4-8, 9-13 and 14-18

Description: This information sheet is intended to serve as a guide for adults to use when talking with a 4-8, 9-13 or 14-18 year-old child about a suicide attempt in the family. It is not intended to replace the advice of a mental health professional. In fact, it may be best to use this along with professional support if you or your child is struggling with how to talk about this difficult topic. It is important to consider the child’s level of development and ability to understand events when deciding how to talk with them about this issue.
Download:
How to talk to a 4-8 year old about a suicide attempt
How to talk to a 9-13 year old about a suicide attempt
How to talk to a 14-18 year old about a suicide attempt 

Suicide Attempt Survivor Family Resource Guide

This resource guide related to self-care, care for others (particularly children), and care for the suicide attempt survivor.
Download the Suicide Attempt Survivor Family Resource Guide. Updated 1 May 2011.

Providing Support for Suicide Survivors: Understanding Pertinent Military/Veteran Issues

Providing Support for Suicide Survivors: Understanding Pertinent Military/Veteran Issues
by Nazanin H. Bahraini PhD, Ryan E. Breshears, PhD, & Lisa A. Brenner PhD, ABPP (Rp)

Annotated Bibliography - Suicide and Traumatic Brain Injury (TBI) - Updated August 2011

This seven (7) page document provides quick and easy reference to the latest in research on Suicide and TBI. Download the bibliography.

Traumatic Brain Injury and Suicide - A Manual for Clinicians and Care Providers

There is a need for more resources that are specifically targeted toward TBI survivors who may be considering suicide. Based upon this need, researchers at the VA VISN 19 Mental Illness Research, Education, and Clinical Center (MIRECC) produced this information and resources guide. The target audience is clinicians and care providers working with TBI survivors. Download the 31 page manual.

Traumatic Brain Injury and Suicide Prevention

Easily reproducible brochure for veterans and the family/caregiver - Brochure

Traumatic Brain Injury and Suicide in Veterans and Returning Military Personnel

Download the presentation that Lisa A. Brenner PhD ABPP gave at the 2010 American Association of Suicidology. 

Recognizing Suicide Risk in Returning Combat Veterans

By Patricia A. Alexander PhD and Lisa A. Brenner, Ph.D ABPP (Rp). This paper suggest that assessing for feelings of burdensomeness, failed belongingness, and acquired ability may be important when evaluating suicide risk. Download the article from Military OneSource.

Suicide Pocket Card

Download the Suicide Pocket Card.

The Suicide Pocket Guide can be ordered through the local VA Suicide Prevention Coordinator (SPC). This link will take you to a page where the nearest SPC can be found.

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Research Projects

Blister Packaging Medication to Increase Treatment Adherence and Clinical Response: Impact on Suicide

Research Team: Peter M. Gutierrez PhD, Lisa A. Brenner PhD, Hal S. Wortzel MD, Jeffrey Rings PhD, Steve Bartlett RPh, Jeri E.Forster PhD, Becky Leitner BA 

Medication overdoses account for substantial numbers of suicide-related behaviors. Non-adherence is a significant issue for those with psychiatric illness.

Keywords: Suicide Prevention

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Burden Belonging and Response to Pain in Veterans

Research Team: Peter M. Gutierrez PhD, Lisa A. Brenner PhD, Theresa D. Hernández PhD, Nazanin H. Bahraini PhD, Bridget B. Matarazzo PsyD, James Pease MSW, Jennifer Olson-Madden PhD

This study is designed to test the psychometric properties of the Interpersonal Needs Questionnaire (INQ-12) and the Acquired Capability for Suicide Scale (ACSS) in a sample of military veterans, something which has not been done. These measures were developed to assess the constructs of Joiner’s interpersonal psychological theory of suicide. Secondary goals of the study are to determine if values mediate the relationship between reasons for living and suicide risk, and whether participants’ suicidal wish can be categorized as either escaping their problems or influencing other people.

Keywords: Suicide Prevention

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Effects of mild TBI and PTSD on Executive Functioning in OEF/OIF Veterans

Research Team: Marie Banich PhD, Lisa A. Brenner PhD, Jennifer Olson-Madden PhD, Brendan Depue PhD, Herbert Nagamoto MD, Elissa Roesch BA, Brooke Holliman MA, Melodi Billera MSW LSW

This project will determine whether methods drawn from basic science can robustly detect the effects of traumatic brain injury (TBI) and/or post traumatic stress disorder (PTSD) on executive function. Although TBI often occurs in the context of a traumatic event, very little research has attempted to disentangle the effects of TBI from PTSD, which also compromises executive function.

Keywords: Suicide Prevention, Post Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI)

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Examining Prolonged Grief Disorder and its Relationship to Self-Directed Violence (SDV) among Veterans

Research Team: Jeffrey Rings PhD, Peter M. Gutierrez PhD, Jeri E.Forster PhD, Becky Leitner BA

Losing a close friend or family member to death can be an incredibly painful and stressful occurrence. Some bereaved persons may experience additional symptoms associated with a severe and unending type of grief now referred to as prolonged grief (PG). The connection between PG and suicide among Veterans has not been studied, even though Veterans already are at a higher risk for suicide than are other groups.

Keywords: Suicide Prevention

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Examining the relationship between personal values, interpersonal needs, and suicidal ideation in a Veteran population

Research Team: Nazanin H. Bahraini PhD, Lisa A. Brenner PhD, Patricia Alexander PhD, Jeri E.Forster PhD, Stephen Bensen PhD, Marie Devore MS

Through this research we hope to understand which values (e.g., power, achievement, security) and value dimensions (e.g., importance, success) have the strongest impact on suicidality in this population.

Keywords: Suicide Prevention

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Executive Dysfunction and Suicide in Psychiatric Inpatients and Outpatients

Research Team: Lisa A. Brenner PhD, Beeta Homaifar PhD, Nazanin H. Bahraini PhD, Joe Huggins MSW MSCIS, Jeri E. Forster PhD, Herbert Nagamoto MD, Shea A. Lott MA, Brooke Holliman MA

This study will assess decision making in the context of an interaction between suicide and TBI.

Keywords: Suicide Prevention, Seriously Mentally Ill (SMI), Traumatic Brain Injury (TBI)

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Experiential avoidance in combat Veterans with and without posttraumatic stress disorder (PTSD)

Research Team: Nazanin H. Bahraini PhD, Lisa A. Brenner PhD, Marie Devore MS

This study is designed to test a novel method of measuring avoidance of trauma-related material in combat Veterans with and without PTSD, and to compare this novel behavioral measure of avoidance with other traditional self report measures of avoidance.

Keywords: Suicide Prevention, Post Traumatic Stress Disorder (PTSD)

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Home-Based Mental Health Evaluation (HOME): A Model for Assisting Suicidal Veterans with the Transition from Inpatient to Outpatient Settings

Research Team: Bridget B. Matarazzo PsyD, Michael H. Allen MD, Sean M. Barnes PhD, Herbert Nagamoto MD, Deborah Yurgelun-Todd PhD, Lisa A. Brenner PhD

Project Summary: The intent of the proposed clinical demonstration project, Home-Based Mental Health Evaluation (HOME) is to enhance the VA infrastructure for ensuring that Veterans with recent suicidal crises receive the care they need during the often difficult transition from psychiatric inpatient hospitalization to home. This will be accomplished by meeting Veterans in the home environment to review and revise aftercare plans. The primary goal of the HOME project is to increase engagement with aftercare, and decrease the risk of suicide during this time of transition and elevated suicide risk. The HOME demonstration project will be conducted in Denver and Salt Lake City.

Keywords: Evidence-Based Treatments, Suicide Prevention

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Military Suicide Research Consortium (MSRC)

Research Team: Peter M. Gutierrez PhD, Thomas Joiner PhD, Greg Riccardi PhD, Daniel McGee Sr. PhD, Kelly Moroney MA, James Pease MSW, Jetta Hanson MA

Consortium seeks to develop more effective prevention interventions, risk assessment methods, and treatments to decrease suicide in the military.

Keywords: Evidence-Based Treatments, Suicide Prevention

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Neurobiology of Suicide Risk in Traumatic Brain Injury and Substance Abuse

Research Team: Deborah Yurgelun-Todd PhD, Elliott Bueler

Traumatic brain injury is an important medical problem for Veterans. Individuals with traumatic brain injuries are at increased risk for various psychiatric problems, including those associated with suicide. This study seeks to better understand the relationship between these factors.

Keywords: Evidence-Based Treatments, Suicide Prevention, Substance Use Disorders (SUD), Traumatic Brain Injury (TBI)

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SAFE VET - A Brief Intervention to Reduce Suicide Risk in Military Service Members and Veterans

Research Team: Lisa A. Brenner PhD, Bridget B. Matarazzo PsyD, Patricia Alexander PhD, Kimberly Arne MSW, Parri Hinton BA, Melodi Billera MSW LSW

The purpose of this study is to compare the effectiveness of the SAFE VET (Suicide Assessment and Follow-up Engagement: Veteran Emergency Treatment) intervention versus enhanced usual care on Veterans’ suicide attempts, suicide ideation, outpatient mental health or substance abuse treatment, and suicide-related coping. SAFE VET uses a standardized intervention that is specifically adapted for use in the Emergency Department to mitigate suicide risk.

Keywords: Evidence-Based Treatment, Suicide Prevention

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Suicide & Self-Directed Violence Classification System

Resarch Team: Lisa A. Brenner PhD, Katherine Bellon PhD, Lisa Betthauser, Ryan Breshears PhD, Morton Silverman MD, Herbert Nagamoto MD

The purpose of this study is to further develop and adapt the VISN 19 MIRECC SDVCS and Clinical Tool to enhance feasibility for implementation in diverse VA treatment settings, and to assess its impact on healthcare system processes pertaining to the assessment and management of suicide risk.

Keywords: Suicide Prevention

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Using Complementary and Alternative Medicine (CAM) to Promote Stress Resilience in Those with Co-Occurring Mild TBI and PTSD

Research Team: Theresa D. Hernández PhD, Lisa A. Brenner PhD

The research team hypothesizes that, similar to other populations, active acupressure treatments will help promote stress resilience, improve cognition and sleep, helping to reduce suicidal ideation and ultimately suicidal behavior. In addition to these potential functional benefits in Veterans, active acupressure is an independent, portable, safe and no-cost (once learned) intervention that is non-pharmacological and therefore has no side effects. The study aims to address a need (reducing military/Veteran suicidality) that has to date gone largely unmet, a need that is also currently a Department of Defense priority.

Keywords: Complementary and Alternative Medicine, Evidence-Based Treatments, Suicide Prevention

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Window to Hope – Evaluating a Psychological Treatment for Hopelessness among Veterans with Traumatic Brain Injury

Research Team: Lisa A. Brenner PhD, Grahame Simpson PhD (Senior Research Fellow/ Research Team Leader, Brain Injury Rehabilitation Unit, Australia), Bridget B. Matarazzo PsyD, Jeri E. Forster PhD, Gina M. Signoracci PhD, Adam Hoffberg MHS

This proposed project will be the first to replicate a groundbreaking psychological treatment for suicide prevention among those with moderate or severe traumatic brain injury, Window to Hope (WtoH), developed by PI Simpson and colleagues in Sydney, Australia. WtoH has been successfully evaluated in a Randomized Controlled Trial (RCT), in which treated Australian civilians (n=17) with severe TBI recorded significant decreases in hopelessness. The current project aims to (i) undertake the cross-cultural adaptation of the WtoH program; (ii) establish the acceptability and feasibility of WtoH within the VAMC context; and (iii) conduct a RCT within the VAMC to replicate the results from the original trial (efficacy). Deliverables are expected to include an intervention suitable for a larger trial and broader dissemination.

Keywords: Complementary and Alternative Medicine, Evidence-Based Treatments, Suicide Prevention, Traumatic Brain Injury (TBI)

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Recent Presentations

The Self-Directed Violence Classification System (SDVCS) Training What it is and why it matters

3/16/2012

Bridget Matarazzo, PsyD

Jack C. Montgomery VAMC in Muskogee, OK and Tulsa CBOC

Keywords: Assessment, Suicide Prevention

PDF

Does a history of mild traumatic brain injury increase suicide risk in Veterans with PTSD?

3/14/2012

Sean M. Barnes PhD

University of Colorado, Department of Psychiatry Junior Faculty Poster Session

Keywords: PTSD, Suicide Prevention, TBI

PowerPoint | PDF

Suicide Risk Assessment in OEF/OIF/OND Veterans

10 February 2012

Bridget B. Matarazzo PsyD

VISN 6 MIRECC Educational Series

Keywords: Assessment, OEF/OIF/OND Veterans, Suicide Prevention

PDF

Suicide Risk Assessment and Safety Planning in Military Personnel

12/5/11

Bridget B. Matarazzo PsyD

Keywords: Assessment, OEF/OIF/OND Veterans, Suicide Prevention

PDF

Assessing and Managing Suicide Risk in Primary Care

10/19/11

Peter M. Gutierrez PhD 

Appleton, WI CBOC

Keywords: Assessment, Suicide Prevention

PowerPoint | PDF 

The Self-Directed Violence Classification System (SDVCS): How Learning to Use it will make you a Better Clinician

10/18/11

Peter M. Gutierrez PhD 

Appleton, WI CBOC

Keywords: Assessment, Evidence-Based Treatments, Suicide Prevention

PowerPoint | PDF 

Military Suicide Research Consortium

9/13/11

Peter M. Gutierrez PhD 

University of Utah National Center for Veterans Studies and American Psychological Association jointly sponsored Military and Veteran Suicide Prevention Clinical Best Practices Consensus Meeting in Washington, DC

Keywords: Evidence-Based Treatments, OEF/OIF/OND Veterans, Suicide Prevention

PowerPoint | PDF 

PTSD and Suicide in Veterans and Military Personnel

9/6/11

Bridget B. Matarazzo PsyD 

Northern California Healthcare System

Keywords: Post Traumatic Stress Disorder (PTSD), Suicide Prevention

PDF 

The Self-Directed Violence Classification System (SDVCS) Training: What it is and why it matters

9/6/11

Bridget B. Matarazzo PsyD

Northern California Healthcare System

Keywords: Suicide Prevention

PDF 

Suicide Risk Assessment and Prevention in Military Personnel

6/13/11

Nazanin H. Bahraini PhD 

Military Healthcare Convention & Conference in San Antonio, Texas

Keywords: Assessment, Evidence-Based Treatments, Suicide Prevention

PowerPoint | PDF 

Overview of Issues of Veterans and Suicide

5/23/11

Peter M. Gutierrez PhD

2011 Southeastern Arizona Suicide Prevention Seminar - Promoting Hope: Building a Stronger Community for Armed Forces Members and Their Families

Keywords: Evidence-Based Treatments, Suicide Prevention

PowerPoint | PDF 

Safety Planning with Suicidal Clients

5/23/11

Peter M. Gutierrez PhD

2011 Southeastern Arizona Suicide Prevention Seminar - Promoting Hope: Building a Stronger Community for Armed Forces Members and Their Families

Keywords: Assessment, Evidence-Based Treatments, TBI, Suicide Prevention

PowerPoint | PDF 

Department of Veterans Affairs and Community Partnerships: An Update

5/20/11

Pamela J. Staves RN MS NP

Bridging The Divide Summit

Keywords: Suicide Prevention

PowerPoint | PDF 

Suicide Risk Assessment: A Medicolegal Perspective

5/5/11

Hal S. Wortzel, MD

Boulder Mental Health Center

Keywords: Assessment, Incarcerated Veterans, Suicide Prevention

PowerPoint | PDF 

Suicide Risk Assessment: Tips & Tools

5/5/11

Bridget B. Matarazzo PsyD

Boulder Mental Health Center, Boulder, CO

Keywords: Assessment, Evidence-Based Treatments, Suicide Prevention

PowerPoint | PDF 

Traumatic Brain Injury and Suicidality: Assessment & Prevention

5/5/11

Gina M. Signoracci PhD

Boulder Mental Health Center, Boulder, CO

Keywords: Assessment, Evidence-Based Treatments, Suicide Prevention

PowerPoint | PDF 

Substance Use Disorders and Suicide

5/5/11

Jennifer Olson-Madden PhD

Boulder Mental Health Center, Boulder, CO

Keywords: Substance Use Disorders (SUD), Suicide Prevention

PowerPoint | PDF 

Safety Planning: A Stand Alone Intervention

5/5/11

Patricia Alexander PhD and Bridget B. Matarazzo PsyD

Boulder Mental Health Center, Boulder, CO

Keywords: Evidence-Based Treatments, Suicide Prevention

PowerPoint | PDF 

Loss of consciousness, depression, and PTSD are associated with suicidality among deployed service members with mild traumatic brain injury (mTBI).

2011

Poster presented at the annual meeting of the Association for Behavioral and Cognitive Therapy, Toronto, Canada.

Clemans, T.A., Bryan, C.J., Hernández, A.M., & Rudd, MD

Keywords: PTSD, Suicide, TBI

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PTSD and Suicide Risk: Assessment and Intervention

12/15/10

Pamela J. Staves RN MS NP

Boulder Mental Health Center

Keywords: Assessment, Post Traumatic Stress Disorder (PTSD), Suicide Prevention

PowerPoint | PDF 

Risk of TBI, PTSD & Suicide in OEF/OIF Veterans

11/1/10

Hal S. Wortzel, MD

29th Annual Conference of the Brain Injury Association of Ohio: “Building Community: Recognition, Response, Resilience”, Columbus, OH

Keywords: OEF/OIF/OND Veterans, Post Traumatic Stress Disorder (PTSD), Suicide Prevention, TBI

PowerPoint | PDF

Treatment Interventions for Suicide Prevention

9/6/10

Kate Comtois, PhD, MPH
University of Washington

Suicide Prevention Week 2010, Eastern Colorado Health Care System, Denver, CO

PowerPoint | PDF

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Recent Publications (since 2009)

Barnes, S.M., Walter, K.H., & Chard, K.M. (2012). Does a history of mild traumatic brain injury increase suicide risk in veterans with PTSD? Rehabilitation Psychology, 57, 18-26.

Objective: Research shows that posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) independently increase suicide risk; however, scant research has investigated whether mTBI increases suicide risk above and beyond the risk associated with PTSD alone. Design: The current research compared suicide risk factors among a matched sample of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) military personnel and veterans with PTSD alone or PTSD and a history of an mTBI. Results: Differences in the assessed risk factors were small and suggest that if PTSD and mTBI are associated with elevations in suicide risk relative to PTSD alone, the added risk is likely mediated or confounded by PTSD symptom severity. Conclusion: This finding highlights the importance of screening and treating military personnel and veterans for PTSD. Future explication of the impact of TBI-related impairments on suicide risk will be critical as we strive to ensure safety and optimize care for our military personnel and veterans.

Keywords: PTSD, Suicide, Traumatic Brain Injury (TBI)

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Bahraini NH, Gutierrez PM, Harwood JEF, Huggins JA, Hedegaard H, Chase M, Brenner LA. (2012). The Colorado Violent Death Reporting System (COVDRS): Validity and Utility of the Veteran Status Variable. Public Health Rep., May/Jun;127(3):304-309.

Objective. Using the Veterans Affairs Beneficiary Identification Record Locator Subsystem (BIRLS) as the criterion database, we evaluated the sensitivity and specificity of the death certificate information in the Colorado Violent Death Reporting System (COVDRS) to determine Veteran status for those who died by suicide. Methods. The study sample consisted of 3,820 individuals aged 18 years and older who died by suicide in Colorado from January 1, 2004, through December 31, 2008. To determine agreement on Veteran status, COVDRS data were submitted to the Veterans Benefits Administration for linkage to the BIRLS using Social Security numbers. Results. Sensitivity and specificity of the Veteran status information on the death certificate were 93.1% (95% confidence interval [CI] 90.7, 95.2) and 91.7% (95% CI 90.5, 92.8), respectively. The overall agreement between the death certificate and the BIRLS on Veteran status was very good (kappa 5 0.76; 95% CI 0.74, 0.79). Conclusions. This study of 3,820 suicide deaths in Colorado demonstrated a high level of agreement between the COVDRS Veteran status variable and the BIRLS. Such findings offer support for using the COVDRS in studying factors associated with suicide in the Veteran population.

Keywords: Suicide

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Bates MJ, Bradley JC, Bahraini NH, Goldenberg MN. (2012). Clinical Management of Suicide Risk with Military and Veteran Personnel. Chapter in Textbook of Suicide Assessment and Management, 2nd Edition Edited by Simon RI and Hales RE. The American Pyschiatric Publishing, Washington DC, 405-441.

No abstract available

Keywords: Suicide

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Brausch, A. M., & Gutierrez, P. M. (2009). The role of body image and disordered eating as risk factors for depression and suicide ideation in adolescents. Suicide and Life-Threatening Behavior, 39(1), 58-71.

There is much empirical literature on factors for adolescent suicide risk, but body image and disordered eating are rarely included in these models. In the current study, disordered eating and body image were examined as risk factors for suicide ideation since these factors are prevalent in adolescence, particularly for females. It was hypothesized that disordered eating and body image, in addition to depressive symptoms, would contribute to suicide ideation. It was also hypothesized that these relationships would be stronger for females than for males. Structural equation modeling was used to test a model of risk for suicide ideation incorporating the above factors in a sample of 392 high school students. Results indicated that disordered eating contributed to both suicide ideation and depressive symptoms, while body image only contributed to depressive symptoms. Depressive symptoms contributed to suicide ideation. The model was found to be cross-validated with males and females, and no gender differences emerged. Implications of these findings and their importance in constructing future models of adolescent suicide risk are discussed.

Keywords: Suicide

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Brausch, A. M. & Gutierrez, P. M. (2010). Differences in non-suicidal self-injury and suicide attempts in adolescents. Journal of Youth and Adolescence, 39(3), 233-244.

As suicide attempts and self-injury remain predominant health risks among adolescents, it is increasingly important to be able to distinguish features of self-harming adolescents from those who are at risk for suicidal behaviors. The current study examined differences between groups of adolescents with varying levels of self-harmful behavior in a sample of 373 high school students with a mean age of 15.04 (SD = 1.05). The sample was 48% female and the distribution of ethnicity was as follows: 35% Caucasian, 37.2% African-American, 16% Multi-ethnic, 9.2% Hispanic, and 2.3% Asian. The sample was divided into three groups: no history of self-harm, non-suicidal self-injury (NSSI) only, and NSSI in addition to a suicide attempt. Differences in depressive symptoms, suicidal ideation, social support, self-esteem, body satisfaction, and disordered eating were explored. Results indicated significant differences between the three groups on all variables, with the no self-harm group reporting the lowest levels of risk factors and highest levels of protective factors. Further analyses were conducted to examine specific differences between the two self-harm groups. Adolescents in the NSSI group were found to have fewer depressive symptoms, lower suicidal ideation, and greater self-esteem and parental support than the group that also had attempted suicide. The clinical implications of assessing these specific psychosocial correlates for at-risk adolescents are discussed.

Keywords: Suicide

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Brenner, L. A. et al. (in press). Associations among health promoting behaviors, health-related self efficacy, and other related constructs after moderate to severe traumatic brain injury. Brain Injury.

Keywords: Suicide

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Brenner, L. A. et al. (in press). Health and wellness characteristics of persons with traumatic brain injury. Brain Injury.

Keywords: Suicide

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Brenner LA, Barnes SM. (2012). Facilitating Treatment Engagement During High-Risk Transition Periods: A Potential Suicide Prevention Strategy. American Journal of Public Health, Supplement 1, Vol 102, No. S1

Abstract not available

Keywords: Suicide

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Brenner, L. A., Betthauser, L.M., Homaifar, B. Y., Villarreal, E., Harwood, J. E., Staves, P. J., & Huggins, J. A. (2011). Posttraumatic stress disorder, traumatic brain injury, and suicide attempt history among Veterans receiving mental health services. Suicide & Life Threatening Behavior, 41, 416-423.

History of posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) has been found to increase risk of suicidal behavior. The association between suicide attempt history among veterans with PTSD and/or TBI was explored. Cases (N = 81) and 2:1 matched controls (N = 160) were randomly selected from a Veterans Affairs Medical Center clinical database. PTSD history was associated with an increased risk for a suicide attempt (OR = 2.8; 95% CI: 1.5, 5.1). This increased risk was present for those with and without a history of TBI. Results support incorporating PTSD history when assessing suicide risk among veterans with and without TBI.

Keywords: Suicide, PTSD, Traumatic Brain Injury (TBI)

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Brenner, L.A., Breshears, R.E., Betthauser, L.M., Bellon, K. K., Holman, E., Harwood, J. E., Silverman, M. M., Huggins, J. & Nagamoto, H. T. (2011). Implementation of a suicide nomenclature within two VA healthcare settings. Journal of Clinical Psychology in Medical Settings.

Implementation of a Suicide Nomenclature within Two VA Healthcare Settings Those who work in the field of Veteran’s care, as well as educators, researchers, and professionals providing direct mental health services agree that learning more about and preventing suicide represents a highly critical goal. Yet, up to now, researchers and mental health professionals lacked a shared language for defining suicidal behavior. This study discusses implementation of the Center for Disease Controls’ Self-Directed Violence Classification System (SDVCS) and an accompanying Clinical Tool (CT) at two VA healthcare facilities (in Denver and Grand Junction, CO). Results of this study show that implementing a more unified language is possible, while at the same time highlights some of the challenges and barriers to adoption of this system. This study provides important information regarding implementation of the SDVCS throughout the VA system.

Keywords: Suicide

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Brenner, L. A., Carlson, N. E., Harrison-Felix, C., Ashman, T., Hammond, F. M., & Hirschberg, R. E. (2009). Self-inflicted traumatic brain injury: Characteristics and outcomes, Brain Injury, 23, 991-998.

OBJECTIVE: To characterize the population of those receiving inpatient rehabilitation who sustained a traumatic brain injury (TBI) secondary to a suicide attempt and identify differences between such individuals and a demographically-matched control group (n = 230) of those whose TBIs were of an unintentional aetiology. METHOD: Analysed cases were identified from the TBI Model Systems National Database. Based on ICD-9-CM external cause-of-injury codes, 79 participants incurred a TBI secondary to a suicide attempt. An approximate 1 : 3 matched case-control (age, gender, race, injury year) design was chosen to make statistical comparisons. RESULTS: Those who sustained a TBI secondary to a suicide attempt had greater pre-existing psychiatric and psychosocial problems (substance use problems (p = 0.01) prior suicide attempt (p < 0.0001), psychiatric hospitalization (p = 0.014) and non-productive activity (p = 0.014)), required more resources during acute and rehabilitative hospitalizations (i.e. charges per day; p = 0.024, p = 0.047) and had greater disability at the time of discharge, even after controlling for injury severity (p = 0.022). CONCLUSION: Individuals who sustained TBIs secondary to a suicide attempt had increased pre-injury psychiatric and psychosocial problems and poorer outcomes at discharge than those who incurred unintentional injuries. For these individuals, acute and rehabilitation charges per day were higher and could not be accounted for by injury severity.

Keywords: Suicide, Traumatic Brain Injury (TBI)

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Brenner, L. A., Ignacio, R. V., & Blow, F. C. (2011). Suicide and traumatic brain injury among individuals seeking Veterans Health Administration services. Journal of Head Trauma Rehabilitation, 26(4), 257-264.

This manuscript examines associations between a history of traumatic brain injury (TBI) diagnosis and death by suicide among individuals receiving care within the Veterans Health Administration (VHA). Among VHA users, those with a diagnosis of TBI were at greater risk for suicide than those without this diagnosis. Further research is indicated to identify evidence-based means of assessment and treatment for those with TBI and suicidal behavior.

Keywords: Suicide, Traumatic Brain Injury (TBI)

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Brenner, L. A., Ivins, B. J., Schwab, K., Warden, D., Nelson, L. A., Jaffee, M., et al. (2009). Traumatic brain injury, post traumatic stress disorder, and post concussive symptom reporting among troops returning from Iraq. Journal of Head Trauma Rehabilitation, 25(5), 307-312.

OBJECTIVES: Analyze the contribution of mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD) to the endorsement of postconcussive (PC) symptoms during Post Deployment Health Assessment. Determine whether a combination of mTBI and PTSD was more strongly associated with symptoms than either condition alone. METHODS: Cross-sectional study design where both the exposure, mTBI and/or PTSD, and the outcomes of interest, PC symptoms, were ascertained after return from deployment. Subjects were injured soldiers (n = 1247) from one Fort Carson Brigade Combat Team (n = 3973). MAIN OUTCOME MEASURES: Positive history of PC symptoms. RESULTS: PTSD and mTBI together were more strongly associated with having PC symptoms (adjusted prevalence ratio 6.27; 95% CI: 4.13-9.43) than either mTBI alone (adjusted prevalence ratio = 4.03; 95% CI: 2.67-6.07) or PTSD alone (adjusted prevalence ratio = 2.74; 95% CI: 1.58-4.74) after adjusting for age, gender, education, rank, and Military Occupational Specialty. CONCLUSIONS: In soldiers with histories of physical injury, mTBI and PTSD were independently associated with PC symptom reporting. Those with both conditions were at greater risk for PC symptoms than those with either PTSD, mTBI, or neither. Findings support the importance of continued screening for both conditions with the aim of early identification and intervention.

Keywords: Suicide, PTSD, Traumatic Brain Injury (TBI), OEF/OIF/OND

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Brenner, L.A. & Homaifar, B.Y. (2009). Deployment acquired TBI and suicidality: Risk and assessment. In L. Sher (Ed.), War and Suicide. New York: Nova Science Publishers.

Introduction: Existing literature suggests that those with deployment-acquired traumatic brain injury (TBI) may be at increased risk for future suicidal behavior. Pertinent background information and potential best practices for assessing the risk of intentional self-injury in those with deployment-related TBI will be discussed. Conclusion: With the aim of comprehensively assessing risk, clinicians are encouraged to increase understanding regarding possible contributing factors (eg, pre-existing vulnerabilities, TBI sequelae) in the context of military experiences. Using the Interpersonal-Psychological Theory of Suicide Risk and The International Classification of Functioning as organizing frameworks in conjunction with literature regarding post-TBI functioning may facilitate this process.

Keywords: Suicide, Traumatic Brain Injury (TBI)

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Brenner, L.A., Homaifar, B.Y., Adler, L.E., Wolfman, J.H., & Kemp, J. (2009). Suicidality and veterans with a history of traumatic brain injury: Precipitating events, protective factors, and prevention strategies. Rehabilitation Psychology,54(4), 390-397.

OBJECTIVES: To increase understanding regarding precipitating and preventative factors of suicidal behavior and to highlight past experiences and recommendations regarding services aimed at suicide prevention among Veterans with a history of traumatic brain injury (TBI). STUDY DESIGN: Qualitative. PARTICIPANTS: Sample of 13 Veterans with a history of TBI, and a history of clinically significant suicidal ideation or behavior. METHOD: In-person interviews were conducted and data were analyzed using a hermeneutic approach. RESULTS: Shared precipitants noted included loss-of-self post-TBI, cognitive sequelae, and psychiatric and emotional disturbances. Common protective factors noted included social supports, a sense of purpose regarding the future, religion and spirituality, and mental health care. Means of improving care were also identified (e.g., increasing the availability of services and mental health professionals' knowledge regarding TBI, providing more structured treatment). CONCLUSIONS: Findings highlight potential areas of importance in the assessment and treatment of suicidal Veterans with a history of TBI. Recommendations regarding means of improving care are also presented.

Keywords: Suicide, Traumatic Brain Injury (TBI)

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Brenner, L.A., Vanderploeg, R., Terrio, H. (2009). Assessment and Diagnosis of Mild Traumatic Brain Injury, Post Traumatic Stress Disorder, and Other Polytrauma Conditions: Burden of Adversity Hypothesis. Rehabilitation Psychology, Aug 54(3), 239-246.

OBJECTIVE/METHOD: Military personnel returning from Iraq and Afghanistan have been exposed to physical and emotional trauma. Challenges related to assessment and intervention for those with posttraumatic stress disorder (PTSD) and/or history of mild traumatic brain injury (TBI) with sequelae are discussed, with an emphasis on complicating factors if conditions are co-occurring. Existing literature regarding cumulative disadvantage is offered as a means of increasing understanding regarding the complex symptom patterns reported by those with a history of mild TBI with enduring symptoms and PTSD. IMPLICATIONS: The importance of early screening for both conditions is highlighted. In addition, the authors suggest that current best practices include treating symptoms regardless of etiology to decrease military personnel and veteran burden of adversity. (c) 2009 APA

Keywords: Suicide, Traumatic Brain Injury (TBI), PTSD

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Breshears, R. E., Brenner, L. A., Harwood, J. E. F., & Gutierrez, P. M. (2010). Predicting suicidal behavior in Veterans with traumatic brain injury: The utility of the Personality Assessment Inventory. Journal of Personality Assessment, 92,349-355.

In this study, we investigated the Personality Assessment Inventory's (PAI; Morey, 1991, 2007) Suicide Potential Index (SPI) and Suicide Ideation scale (SUI) as predictors of suicidal behavior (SB) in military Veterans with traumatic brain injury (TBI; N = 154). We analyzed electronic medical records were searched for SB in the 2 years post-PAI administration and data via logistic regressions. We obtained statistical support for the SPI and SUI as predictors of SB. Analyses we performed using receiver operating characteristics suggested an optimal SPI cutoff of > or = 15 for this sample. Findings suggest that SPI and SUI scores may assist in assessing suicide risk in those with TBI, particularly when population-based cutoffs are considered.

Keywords: Suicide, Traumatic Brain Injury (TBI)

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Bryan, C.J., Clemans, T.A., & Hernández, A.M. (2012). Perceived burdensomeness, fearlessness of death, and suicidality among deployed military personnel. Personality and Individual Differences, 52, 374-379.

Abstract: The interpersonal-psychological theory of suicide posits that the interaction of three elements is required for lethal suicidal behaviors: the perception that one is a burden on others, the perception that one does not belong, and fearlessness about death combined with high pain tolerance (termed "acquired capability" for suicide). Although an ever expanding research base supports the theory, very limited data exist supporting the theory among military personnel, a group that has experienced a rapid increase in suicides during the past several years. The current study tests the interpersonal-psychological theory in two clinical samples of military personnel while deployed to Iraq: those seeking treatment for mild traumatic brain injury, and those seeking outpatient mental health treatment. In both samples, perceived burdensomeness and acquired capability were significantly associated with suicidality, as was their interaction term. Results partially support the interpersonal-psychological theory of suicide, and indicate that perceptions of burdensomeness combined with fearlessness about death are associated with increased suicidality among deployed military personnel.

Keywords: Suicide

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DelMastro, K., Hellem, T., Kim, N., Kondo, D., Sung, Y. H., & Renshaw, P. F. (2011). Incidence of major depressive episode correlates with elevation of substate region of residence. Journal of Affective Disorders, 129(1-3), 376-379.

BACKGROUND: Major depressive disorder (MDD) is a common disorder that is often associated with suicide. We have recently suggested that elevation may play a role in regional variations in rates of suicide. We hypothesize that there is also a significant correlation between incidence of MDD and elevation of residence. METHODS: The substate estimates from the 2004 to 2006 National Surveys on Drug Use and Health (NSDUH) report from SAMHSA was used to extract substate level data related to percentages of people 18 years or older who experienced serious psychological distress or a major depressive episode in the past year. Mean elevation of each substate region was calculated by averaging the weighted elevations of its relevant counties. Average elevation for United States counties was calculated using the Shuttle Radar Topography Mission (SRTM) elevation dataset. Pearson correlation coefficients were computed to investigate the association between average substate elevation and rate of serious psychological distress or major depressive episode. RESULTS: There was a significant correlation between percentage of people experiencing serious psychological distress in the past year in a substate region and that substate region's mean elevation (r=0.18; p=0.0005), as well as between the percentage of people having at least one major depressive episode in the past year in a substate region and that substate region's mean elevation (r=0.27; p0.0001). CONCLUSIONS: Elevation appears to be a significant risk factor for MDD. Further studies are indicated to determine whether the increased incidence of depression with increased elevation may be due to the hypoxic effects on subjects with MDD.

Keywords: Suicide, Seriously Mentally Ill (SMI)

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Dennehy, E. B., Marangell, L. B., Allen, M. H., Chessick, C., Wisniewski, S. R., & Thase, M. E. (2011). Suicide and suicide attempts in the Systematic Treatment Enhancement Program for bipolar disorder (STEP-BD). 133, 423-427.

BACKGROUND: The current report describes individuals with bipolar disorder who attempted or completed suicide while participating in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study. METHODS: Baseline and course features of individuals with suicide events are described. RESULTS: Among the 4360 people with bipolar disorder enrolled, 182 individuals made 270 prospectively observed suicidal acts, including 8 completed suicides. This represents a suicide rate of .014 per 100 person years in STEP-BD, which included frequent clinical visits, evidence based care, and standardized assessment at each patient contact. Approximately 1/3 of those who attempted suicide had more than one attempt during study participation. Those who completed suicide tended to do so early in study participation, and half of them did so on their first attempt. LIMITATIONS: While this study is limited to description of individuals and precipitants of completed suicides and attempts in STEP-BD, further analyses are planned to explore risk factors and potential interventions for prevention of suicidal acts in persons with bipolar disorder. CONCLUSIONS: Persons with bipolar disorder are at high risk for suicide. Overall rates of suicide events in STEP-BD were lower than expected, suggesting that the combination of frequent clinical visits (i.e., access to care), standardized assessment, and evidence-based treatment were helpful in this population.

Keywords: Suicide, Seriously Mentally Ill (SMI)

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Fawcett, J. A., Baldessarini, R. J., Coryell, W. H., Silverman, M. M., & Stein, D. J. (2009). Defining and managing suicide risk in patients taking psychotropic medications. Journal of Clinical Psychiatry, 70(6), 1-8.

Abstract not available

Keywords: Suicide

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Freedenthal, S., Lamis, D. A., Osman, A., Kahlo, D. & Gutierrez, P. M. (2011). Evaluation of the psychometric properties of the Interpersonal Needs Questionnaire-12 in samples of men and women. Journal of Clinical Psychology, 67(6), 609-623.

This study analyzed the psychometric properties of the Interpersonal Needs Questionnaire-12 (INQ-12; Van Orden, Witte, Gordon, Bender, & Joiner, 2008a), designed to test Joiner's interpersonal-psychological theory of suicide. Study participants included 785 U.S. undergraduates (58.6% female; 77.2% White; ages 18-25). Confirmatory bifactor analyses discerned a general factor for overall distress, while also supporting separate subfactors for perceived burdensomeness and thwarted belongingness. The scale's factor structure did not vary by gender, and internal consistency reliability was strong among the male and female samples. Correlational analyses supported the scale's content validity. Overall, the analyses preliminarily support continued use of the INQ-12.

Keywords: Suicide

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Gutierrez, P. M. (2009). Suicidal thoughts: Essays on self-determined death [Review of the book]. American Journal of Psychiatry. Sep 166: 1069 - 1070

No abstract available.

Keywords: Suicide

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Gutierrez, P. M. (2010). The accidental suicidologist. In M. Pompili (Ed.), Suicide in the words of suicidologists (pp. 87-90). New York, NY: Nova Science Publishers, Inc.

No abstract available.

Keywords: Suicide

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Gutierrez, P. M., & Brenner, L. A. (2009) Introduction: Helping military personnel and recent veterans manage stress reactions. Journal of Mental Health Counseling,31, 95-100.

No abstract available.

Keywords: Suicide

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Gutierrez, P. M., & Brenner, L. A. (2011). Helping military personnel/veterans and families manage stress reactions and navigate reintegration. In A. Palmo, W. Weikel & D. Borsos (Eds.), Foundations of mental health counseling, fourth edition (pp. 280-286). Springfield, IL: Charles C. Thomas.

No abstract available.

Keywords: Suicide

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Gutierrez PM, Freedenthal S, Wong JL, Osman A, Norizuki T. Validation of the Suicide Resilience Inventory-25 (SRI-25) in Adolescent Psychiatric Inpatient Samples. J Pers Assess. 2012 Jan;94(1):53-61.

Resilience has been associated with a markedly decreased chance for risky behaviors following a trauma or other negative life event. This study examined the factor structure and psychometric properties of a self-report measure of resilience, the Suicide Resilience Inventory-25 (SRI-25; Osman et al., 2004 ), among psychiatric inpatient adolescents. In Study 1, we conducted confirmatory factor analysis to provide additional empirical support for the structure and invariance of the 3-factor model of the SRI-25 in youth samples, ages 14 to 17 years (N = 152 boys, 220 girls). Scale reliability analyses provided good evidence for internal consistency reliability of scores on the SRI-25 total and scales. In Study 2 (N = 30 boys, 40 girls), we presented data in support for the concurrent validity (i.e., known groups) of scores on the SRI-25. Additionally, we identified potential correlates for the SRI-25 total scale scores.

Keywords: Suicide

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Gutierrez, P.M., Brenner, L.A., Olson-Madden, J.H., Breshears, R., Homaifar, B.Y., Betthauser, L.M., et al. (Staves, P. J., & Adler, L.E.) (2009). Consultation as a means of veteran suicide prevention. Professional Psychology: Research and Practice, Vol 40(6), 586-592.

The development and implementation of a suicide consultation service being run by an interdisciplinary team in a metropolitan Veteran’s Administration (VA) medical center is described. This service is grounded in a collaborative theoretical framework. An overview of the consultation process and theoretical and empirical literature to support the framework used by the service are provided. Some of the interventions commonly recommended to referring clinicians to reduce client suicide risk are reviewed. Although there are many challenges to running a service such as this, the authors conclude that the model presented is flexible enough to be applied in a variety of settings.

Keywords: Suicide, Evidence Based Treatment

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Haas, A. P., Eliason, M., Mays, V. M., Mathy, R. M., Cochran, S. D., D'Augelli, A. R. et al. (Silverman, M. M.) (2010). Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: Review and recommendations. Journal of Homosexuality, 58, 10-51.

Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice.

Keywords: Suicide

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Haws, C., Gray, D.D., Yurgelun-Todd, D.A., Moskos, M., Meyer, L.J., & Renshaw, P.F. (2009). The possible effect of altitude on regional variation in suicide rates. Med. Hypotheses, 73(4): 587-590.

In the United States, suicide rates consistently vary among geographic regions; the western states have significantly higher suicide rates than the eastern states. The reason for this variation is unknown but may be due to regional elevation differences. States' suicide rates (1990-1994), when adjusted for potentially confounding demographic variables, are positively correlated with their peak and capital elevations. These findings indicate that decreased oxygen saturation at high altitude may exacerbate the bioenergetic dysfunction associated with affective illnesses. Should such a link exist, therapies traditionally used to treat the metabolic disturbances associated with altitude sickness may have a role in treating those at risk for suicide.

Keywords: Suicide

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Homaifar, B. Y., Bahraini, N.H., Silverman, M.M., Brenner, L.A.. (2012). Executive Functioning as a Component of Suicide Risk Assessment: Clarifying its Role in Standard Clinical Applications. Journal of Mental Health Counseling, 34(2), 110-120.

Clinically, because executive dysfunction (e.g., impulsivity, insight, thinking process) is often thought of in the context of those with traumatic brain injuries and other neurologic conditions, its formal assessment has historically been seen as the domain of those who assess and treat patients with neurologic disease. However, mental health counselors (MHCs) could benefit from learning how executive functioning relates to suicide risk assessment and coping strategies. Assessment of executive functions can be incorporated in routine clinical practice without the need for formal neuropsychological measures or other time-consuming procedures. In fact, during standard clinical assessment, mental health professionals often informally assess components of executive functioning such as impulsivity, insight, and thinking processes. This article highlights aspects of executive functioning with which MHCs may already be familiar and demonstrates their clinical utility in enhancing assessment and management of suicide-related thoughts and behaviors.

Keywords: Assessment, Suicide Prevention, Traumatic Brain Injury (TBI)

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Jobes, D. A., Comtois, K., Brenner, L.A. & Gutierrez, P.M. (2011). Clinical trial feasibility studies of the collaborative assessment and management of suicidality (CAMS). In R. O'Connor, S. Platt & J. Gordon (Eds.), International handbook of suicide prevention research, policy, and practice. (pp. 383-400). West Sussex, United Kingdom: John Wiley & Sons Ltd.

Abstract not available

Keywords: Suicide

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Kim, N., Mickelson, J. B., Brenner, B. E., Haws, C. A., Yurgelun-Todd, D.A., & Renshaw, P.F. (2011). Altitude, Gun Ownership, Rural Areas, and Suicide. American Journal of Psychiatry,168(1), 49-54.

OBJECTIVE: The authors recently observed a correlation between state altitude and suicide rate in the United States, which could be explained by higher rates of gun ownership and lower population density in the intermountain West. The present study evaluated the relationship between mean county and state altitude in the United States and total age-adjusted suicide rates, firearm-related suicide rates, and non-firearm-related suicide rates. The authors hypothesized that altitude would be significantly associated with suicide rate. METHOD: Elevation data were calculated with an approximate spatial resolution of 0.5 km, using zonal statistics on data sets compiled from the National Geospatial-Intelligence Agency and the National Aeronautics and Space Administration. Suicide and population density data were obtained through the Centers for Disease Control and Prevention (CDC) WONDER database. Gun ownership data were obtained through the CDC's Behavioral Risk Factor Surveillance System. RESULTS: A significant positive correlation was observed between age-adjusted suicide rate and county elevation (r=0.51). Firearm (r=0.41) and non-firearm suicide rates (r=0.32) were also positively correlated with mean county elevation. CONCLUSIONS: When altitude, gun ownership, and population density are considered as predictor variables for suicide rates on a state basis, altitude appears to be a significant independent risk factor. This association may be related to the effects of metabolic stress associated with mild hypoxia in individuals with mood disorders.

Keywords: Suicide

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Kirschner, K. L., Mukherjee, D., Gittler, M., Brenner, L.A., & Kelly, J. P. (2011). Setting limits: The threat of violence in the health care setting. The American Academy of Physical Medicine and Rehabilitation, 3, 68-72.

Abstract not available

Keywords: Suicide

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Knox KL, Stanley B, Currier GW, Brenner LA, Ghahramanlou-Holloway M, Brown GK. An emergency based brief intervention for veterans at risk for suicide (SAFE VET). Am J Public Health. 2012;102(S1):S33 – S37.

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.

Keywords: Suicide

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Muehlenkamp J. J., Williams K. L., Gutierrez, P.M., & Claes L. (2009). Rates of non-suicidal self-injury in high school students across five years. Archives of Suicide Research, 13(4), 317-29.

It is believed that the rate of non-suicidal self-injury (NSSI) among high school students is increasing. However, no known research has examined the rates of NSSI among non-clinical, high school samples of adolescents across several years. The current study utilized archival data from five academic years [2001 to 2005 (N = 1393)] to address this limitation by examining the lifetime prevalence rates of NSSI in urban high school students within the Midwestern United States. Results indicate a significant difference in rates across years by gender. Females showed a significant increase in their rates of NSSI compared to males, who showed a significant decline, during the last 3 years of the study. Implications of these findings for school personnel and directions for future research discussed.

Keywords: Suicide

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Muehlenkamp, J. J., Cowles, M. L., & Gutierrez, P.M. (2010). Validity of the self-harm behavior questionnaire with diverse adolescents. Journal of Psychopathology and Behavioral Assessment, 32, 236-245.

Suicide and non-suicidal self-injurious behavior (NSSI) continue to be significant health problems for adolescents. Although there are many instruments available to assess self-harm behaviors, few have been validated for use with adolescents, and even fewer have been validated for use with different racial/ethnic groups. The Self-Harm Behavior Questionnaire (SHBQ) assesses NSSI, suicidal ideation, suicide threats, and past suicide attempts. Data from 1,386 racially/ethnically diverse adolescents (57.5% minority) were collected to examine the validity of the SHBQ in this age group. Analyses supported the four-factor structure, revealed the SHBQ is internally consistent, and provided evidence for convergent validity within Caucasian, African American, and Hispanic adolescents. However, slight differences were noted. Overall, the findings suggest the SHBQ is a useful assessment tool appropriate for use with Caucasian, African American, and Hispanic adolescents.

Keywords: Suicide

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Ribeiro JD, Pease JL, Gutierrez PM, Silva C, Bernert RA, Rudd MD, Joiner TE Jr. Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military. J Affect Disord. 2012 Feb;136(3):743-50.

Background: Sleep problems appear to represent an underappreciated and important warning sign and risk factor for suicidal behaviors. Given past research indicating that disturbed sleep may confer such risk independent of depressed mood, in the present report we compared self-reported insomnia symptoms to several more traditional, well-established suicide risk factors: depression severity, hopelessness, PTSD diagnosis, as well as anxiety, drug abuse, and alcohol abuse symptoms.

Methods: Using multiple regression, we examined the cross-sectional and longitudinal relationships between insomnia symptoms and suicidal ideation and behavior, controlling for depressive symptom severity, hopelessness, PTSD diagnosis, anxiety symptoms, and drug and alcohol abuse symptoms in a sample of military personnel (N=311).

Results: In support of a priori hypotheses, self-reported insomnia symptoms were crosssectionally associated with suicidal ideation, even after accounting for symptoms of depression, hopelessness, PTSD diagnosis, anxiety symptoms and drug and alcohol abuse. Selfreported insomnia symptoms also predicted suicide attempts prospectively at one-month follow up at the level of a non-significant trend, when controlling for baseline self-reported insomnia symptoms, depression, hopelessness, PTSD diagnosis and anxiety, drug and alcohol abuse symptoms. Insomnia symptoms were unique predictors of suicide attempt longitudinally when only baseline self-reported insomnia symptoms, depressive symptoms and hopelessness were controlled.

Limitations: The assessment of insomnia symptoms consisted of only three self-report items. Findings may not generalize outside of populations at severe suicide risk. Conclusions: These findings suggest that insomnia symptoms may be an important target for suicide risk assessment and the treatment development of interventions to prevent suicide.

Keywords: Suicide, PTSD, Substance Use Disorders (SUD) 

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Reed, J., & Silverman, M. M. (2009). Examples of how to develop suicide prevention on the five continents: The United States of America. In D. Wasserman & C. Wasserman (Eds.), The Oxford textbook of suicidology and suicide prevention. (pp. 829-835). Oxford, UK: Oxford University Press.

Abstract not available

Keywords: Suicide

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Rudd, M. D., Joiner, T. E., Brown, G. K., Cukrowicz, K., Jobes, D. A., & Silverman, M. M. (2009). The realities of risk, the nature of hope, and the role of science: A response to Cook aand Vandecreek. Psychotherapy Theory, Research, Practice, Training, 46, 474-475.

Abstract not available

Keywords: Suicide

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Rudd, M. D., Joiner, T. E., Brown, G. K., Cukrowicz, K., Jobes, D. A., Silverman, M. M., et al. (2009). Informed consent with suicidal patients: Rethinking risks in (and out of) treatment. Psychotherapy: Theory, Research, Practice, Training, 46, 459-468.

Abstract not available

Keywords: Suicide

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Selby, E. A., Anestis, M. D., Bender, T. W., Ribeiro, J. D, Nock, M. K., Rudd, et al. (Gutierrez, P.M.) (2010). Overcoming the fear of lethal injury: Evaluating suicide in the military through the lens of the interpersonal-psychological theory of suicide. Clinical Psychology Review, 30, 298-307.

Suicide rates have been increasing in military personnel since the start of Operation Enduring Freedom and Operation Iraqi Freedom, and it is vital that efforts be made to advance suicide risk assessment techniques and treatment for members of the military who may be experiencing suicidal symptoms. One potential way to advance the understanding of suicide in the military is through the use of the Interpersonal-Psychological Theory of Suicide. This theory proposes that three necessary factors are needed to complete suicide: feelings that one does not belong with other people, feelings that one is a burden on others or society, and an acquired capability to overcome the fear and pain associated with suicide. This review analyzes the various ways that military service may influence suicidal behavior and integrates these findings into an overall framework with relevant practical implications. Findings suggest that although there are many important factors in military suicide, the acquired capability may be the most impacted by military experience because combat exposure and training may cause habituation to fear of painful experiences, including suicide. Future research directions, ways to enhance risk assessment, and treatment implications are also discussed.

Keywords: Suicide

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Silverman, M. M. (2009). In this issue. Suicide & Life-Threatening Behavior,39(1), iii-v.

Abstract not available

Keywords: Suicide

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Silverman, M. M. (2009). Suicide attempts in North America. Chapter 19, pp. 117-122. In D Wasserman and C Wasserman (eds). The Oxford Textbook of Suicidology and Suicide Prevention. Oxford, UK: Oxford University Press.

Abstract not available

Keywords: Suicide

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Simpson, G., & Brenner, L.A. (2011). Perspectives on suicide and traumatic brain injury. Journal of Head Trauma and Rehabilitation, 26(4), 241-243.

Abstract not available

Keywords: Suicide, Traumatic Brain Injury (TBI)

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Swogger, M. T., Walsh, Z., Homaifar, B. Y., Caine, E. D., & Conner, K. R. (2011). Predicting self- and other-directed violence among discharged psychiatric patients: the roles of anger and psychopathic traits. Psychological Medicine. Jul 18:1-9.

BACKGROUND: We examined the extent to which trait anger and psychopathic traits predicted post-discharge self-directed violence (SDV) and other-directed violence (ODV) among psychiatric patients.MethodParticipants were 851 psychiatric patients sampled from in-patient hospitals for the MacArthur Violence Risk Assessment Study (MVRAS). Participants were administered baseline interviews at the hospital and five follow-up interviews in the community at approximately 10-week intervals. Psychopathy and trait anger were assessed with the Psychopathy Checklist: Screening Version (PSC:SV) and the Novaco Anger Scale (NAS) respectively. SDV was assessed during follow-ups with participants and ODV was assessed during interviews with participants and collateral informants. Psychopathy facets and anger were entered in logistic regression models to predict membership in one of four groups indicating violence status during follow-up: (1) SDV, (2) ODV, (3) co-occurring violence (COV), and (4) no violence. RESULTS: Anger predicted membership in all three violence groups relative to a non-violent reference group. In unadjusted models, all psychopathy facets predicted ODV and COV during follow-up. In adjusted models, interpersonal and antisocial traits of psychopathy predicted membership in the ODV group whereas only antisocial traits predicted membership in the COV group. CONCLUSIONS: Although our results provide evidence for a broad role for trait anger in predicting SDV and ODV among discharged psychiatric patients, they suggest that unique patterns of psychopathic traits differentially predict violence toward self and others. The measurement of anger and facets of psychopathy during discharge planning for psychiatric patients may provide clinicians with information regarding risk for specific types of violence.

Keywords: Suicide

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Wortzel HS, Binswanger, I. A., Anderson, C. A. & Adler, L. E. (2009). Suicide among incarcerated veterans. Journal of the American Academy of Psychiatry and the Law, 37(1), 82-91.

Both veterans and jail/prison inmates face an increased risk of suicide. The incarcerated veteran sits at the intersection of these two groups, yet little is known about this subpopulation, particularly its risk of suicide. A Pubmed/Medline/PsycINFO search anchored to incarcerated veteran suicide, veteran suicide, suicide in jails/prisons, and veterans incarcerated from 2000 to the present was performed. The currently available literature does not reveal the suicide risk of incarcerated veterans, nor does it enable meaningful estimates. However, striking similarities and overlapping characteristics link the data on veteran suicide, inmate suicide, and incarcerated veterans, suggesting that the veteran in jail or prison faces a level of suicide risk beyond that conferred by either veteran status or incarceration alone. There is a clear need for a better characterization of the incarcerated veteran population and the suicide rate faced by this group. Implications for clinical practice and future research are offered.

Keywords: Incarcerated Veterans, Suicide

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Wortzel HS, Gutierrez PM, Homaifar BY, Breshears RE, Harwood JE. Surrogate endpoints in suicide research. Suicide Life Threat Behav. 2010 Oct;40(5):500-5.

Surrogate endpoints frequently substitute for rare outcomes in research. The ability to learn about completed suicides by investigating more readily available and proximate outcomes, such as suicide attempts, has obvious appeal. However, concerns with surrogates from the statistical science perspective exist, and mounting evidence from psychometric, neurochemical, genetic, and neuroimaging studies suggests that surrogates may be particularly problematic in suicide research. The need for greater phenotypic refinement of suicide-related behaviors, development of and adherence to a shared suicide nomenclature, and conservative interpretation of investigational results that are limited to the precise population and suicide-related behavior under examination are discussed.

Keywords: Suicide

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Yurgelun-Todd, D.A., Bueler, C. E., McGlade, E., Churchwell, J., Brenner, L.A., & Lopez-Larson, M. (2011). Neuroimaging correlates of traumatic brain injury and suicidal behavior. Journal of Head Trauma Rehabilitation, 26(4), 276-289.

INTRODUCTION: There is an urgent need to define the neurobiological and cognitive underpinnings of suicidal ideation and behavior in veterans with traumatic brain injury (TBI). Separate studies implicate frontal white matter systems in the pathophysiology of TBI, suicidality, and impulsivity. We examined the relationship between the integrity of major frontal white matter (WM) systems on measures of impulsivity and suicidality in veterans with TBI. METHODS: Fifteen male veterans with TBI and 17 matched healthy controls (HC) received clinical ratings, measures of impulsivity and MRI scans on a 3T magnet. Diffusion tensor imaging (DTI) data for the genu and cingulum were analyzed using Freesurfer and FSL. Correlations were performed for fractional anisotropy (FA) (DTI) values and measures of suicidality and impulsivity for veterans with TBI. RESULTS: Significantly decreased in FA values in the left cingulum (P = 0.02), and left (P = 0.02) and total genu (P = 0.01) were observed in the TBI group relative to controls. Measures of impulsivity were significantly greater for the TBI group and total and right cingulum FA positively correlated with current suicidal ideation and measures of impulsivity (P <0.03). CONCLUSION: These data demonstrate a significant reduction in FA in frontal WM tracts in veterans with mild TBI that was associated with both impulsivity and suicidality. These findings may reflect a neurobiological vulnerability to suicidal risk related to white matter microstructure.

Keywords: Brain & Biology, Suicide, Traumatic Brain Injury (TBI)

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