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Rocky Mountain MIRECC for VA Suicide Prevention

Updated: 3 October 2016

Biography

Peter M. GutierrezDr. Peter M. Gutierrez
Title: Clinical/Research Psychologist
Contact:
303-329-4408 ext 301
peter.gutierrez@va.gov
 
Fellowship Training Faculty
 
Clinical Interest: Cognitive-Behavioral Therapy for Major Depression and high suicide risk
 
Year of Licensure: 2008
 
Peter M. Gutierrez, PhD is a licensed Clinical Psychologist at the VA Rocky Mountain MIRECC. Dr. Gutierrez's clinical training was in child and adolescent psychology, with an emphasis on serious psychopathology and suicide. He is a Professor of Psychiatry at the University of Colorado School of Medicine. He has been studying suicide, focusing on screening, assessment, and intervention for over 20 years. Dr. Gutierrez is Past-President of the American Association of Suicidology (AAS). He was the 2005 recipient of the AAS Shneidman Award for outstanding contributions in research in suicidology and 2014 recipient of the Roger J. Tierney Award for Service. He is an Associate Editor of the journals Suicide and Life-Threatening Behavior and Military Behavioral Health, a consulting editor for Archives of Suicide Research, and regularly reviews for other psychology, psychiatry, and specialty journals.
 
Dr. Gutierrez is a member of the MIRECC psychology fellowship training committee, provides supervision for psychology pre-doctoral interns, and MIRECC psychology fellows. He has provided numerous VA trainings and conference presentations on issues related to clinical care of Veterans at high risk of suicide and related topics. In terms of funded research, Dr. Gutierrez is co-Director, with Dr. Thomas Joiner at Florida State University, of the DOD funded Military Suicide Research Consortium. He has a DOD sub-award looking at the predictive validity of standard suicide-specific self-report and interview-based measures in active duty military personnel. He is a co-PI on a DOD funded clinical trial of a new therapeutic framework aimed at reducing suicide risk in Soldiers. In terms of unfunded research, Dr. Gutierrez is PI or co-PI on a range of studies with MIRECC and outside collaborators on topics related to multiple aspects of Veteran, young adult, and adolescent suicidality.
 
Statement about research program: Dr. Gutierrez is a downstream suicide prevention researcher focusing on suicide-specific clinical interventions and assessment approaches. Within his assessment line of research he seeks to refine suicide assessment approaches to enable clinicians to make predictions about acute suicide risk so that treatment planning can be optimized for the greatest potential to prevent subsequent suicide-related behaviors. He believes the most promising work will focus on identification of near-term risk (i.e., warning signs). To be most useful, tools need to be validated in a range of clinical settings from Emergency Departments to Inpatient Psychiatric to Outpatient Mental and Behavioral Health.
 
Within his clinical interventions line of research he believes that suicide is a clinical problem requiring targeted interventions in order to reduce the probability of individual patients transitioning from thoughts of suicide to action (i.e., attempts and suicide). The most effective interventions will likely be those targeting factors which facilitate those transitions. To have broad uptake, interventions need to be simple enough that providers from multiple disciplines can learn to deliver them effectively and with fidelity. Interventions should also be available in individual and group format so as to increase the range of clinical settings in which they can be delivered in a cost-effective manner. Most suicide-specific interventions are currently psychosocial in nature and delivered face-to-face by a single clinician or co-facilitator team. Other modes of delivery, such as web-based, telehealth, and mobile applications also hold promise. Determining the optimal dose of intervention, as a function of type and delivery method is also essential to successful suicide prevention. Finally, interventions not strictly psychosocial in nature hold promise as an element of overall efforts to reduce suicide morbidity and mortality.
 
Clinical Interests: Dr. Gutierrez is a cognitive-behavioral therapist with extensive experience providing care for veterans at high risk of suicide. He is particularly interested in how veterans’ combat experiences contribute to their risk of suicidality, often through symptoms of PTSD and sleep disturbance. Additionally, Dr. Gutierrez’s clinical work is strongly influenced by Dr. Jobes’ Collaborative Assessment and Management of Suicide (CAMS) approach.
 
Available Projects for Fellows: Dr. Gutierrez is part of a multi-center team developing a group version of the Collaborative Assessment and Management of Suicide (CAMS-G). Fellows could be involved with a local feasibility study and with applications for larger scale grant projects. There are multiple planned projects utilizing data from Dr. Gutierrez’s Blister Packaging Medications to Increase Adherence and Clinical Response study with which fellows could be involved. Fellows would also be welcome to proposed additional projects utilizing data from the study. Similarly, there are multiple planned projects utilizing data from Dr. Gutierrez’s Burden and Belonging study with which fellows could be involved. This study collected a wide range of self-report data from a large sample of veterans on suicide-specific constructs such as Joiner’s Interpersonal Psychological Theory of Suicide, reasons for living, and suicidal ideation. Again, fellows would also be welcome to propose additional projects utilizing study data.

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Media

RMIRECC Short Takes Podcast - Response to "Is it time to abandon suicide risk assessment"

16 March 2016

Welcome to our third RM Short Takes podcast. This week Adam Hoffberg interviews Dr. Peter Gutierrez about an editorial by Dr Declan Murray in the British Journal of Psychiatry Open (DOI: 10.1192/bjpo.bp.115.002071) in which Dr Murray discusses abandoning suicide risk assessment. As you might expect, the answer is not a simple yes or no.

The podcast is approximately 14 minutes long.

You can subscribe to the RM Short Takes Podcast on iTunes or your favorite podcasts tool.

Categories: Suicide Prevention; Clinicians; Suicide Risk Assessment

RMIRECC Short Takes Podcast - Risk Factors, Warning Signs, and Drivers of Suicide

10 February 2016

Listen to our first podcast with Adam Hoffberg interviewing Dr. Peter Gutierrez regarding his latest publication "Risk Factors, Warning Signs, and Drivers of Suicide: What Are They, How Do They Differ, and Why Does It Matter?" in Suicide and Life-Threatening Behavior.

Resources:

The podcast is approximately 26 minutes long.

Categories: Suicide Prevention; Clinicians

Youth Suicide Warning Signs video:
Peter Gutierrez, PhD describes work creating a consensus Youth Suicide Warning Signs. Learn more at: http://www.youthsuicidewarningsigns.org/

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Recent Publications

Gutierrez, P. M., Wortzel, H. S., Forster, J. E., Leitner, R. A., Hostetter, T. A., & Brenner, L. A. (in press). Blister packaging medication increases treatment adherence for psychiatric patients. Journal of Psychiatric Practice.
Abstract not yet available
 
Hom, M. A., Stanley, I. H., Gutierrez, P. M., & Joiner, T. E. (2016). Exploring the association between exposure to suicide and suicide risk among military service members and veterans. Journal of Affective Disorders. doi:10.1016/j.jad.2016.09.043
Background: Past research suggests that suicide has a profound impact on surviving family members and friends; yet, little is known about experiences with suicide bereavement among military populations. This study aimed to characterize experiences with suicide exposure and their associations with lifetime and current psychiatric symptoms among military service members and veterans. Methods: A sample of 1,753 United States military service members and veterans completed self-report questionnaires assessing experiences with suicide exposure, lifetime history of suicidal thoughts and behaviors, current suicidal symptoms, and perceived likelihood of making a future suicide attempt. Results: The majority of participants (57.3%) reported knowing someone who had died by suicide, and of these individuals, most (53.1%) reported having lost a friend to suicide. Chi-square tests, one-way ANOVAs, and logistic regression analyses revealed that those who reported knowing a suicide decedent were more likely to report more severe current suicidal symptoms and a history of suicidal thoughts and behaviors compared to those who did not know a suicide decedent. Hierarchical linear regression analyses indicated that greater self-reported interpersonal closeness to a suicide decedent predicted greater self-reported likelihood of a future suicide attempt, even after controlling for current suicidal symptoms and prior suicidal thoughts and behaviors. Limitations: This study utilized cross-sectional data, and information regarding degree of exposure to suicide was not collected. Conclusions: Military personnel and veterans who have been bereaved by suicide may themselves be at elevated risk for suicidal thoughts and behaviors. Additional work is needed to delineate the relationship between these experiences. Keywords: Suicide; Bereavement; Survivor; Military service member; Veteran.
 
Gutierrez, P. M., Pease, J., Matarazzo, B. B., Monteith, L. L., Hernandez, T., & Osman, A. (2016). Evaluating the psychometric properties of the Interpersonal Needs Questionnaire and the Acquired Capability for Suicide Scale in military veterans. Psychological Assessment. http://dx.doi.org/10.1037/pas0000310
Joiner's (2005) interpersonal-psychological theory of suicide (IPTS) has become one of the most frequently studied in the field. Currently there are 2 primary measures designed to assess the 3 main constructs of the theory-the Interpersonal Needs Questionnaire (INQ; Van Orden, Witte, Gordon, Bender, & Joiner, 2008) and the Acquired Capability for Suicide Scale (ACSS; Van Orden et al., 2008). The psychometric properties of these 2 measures were evaluated in a sample of 477 U.S. military veterans. It was determined that the factor structure for both measures is consistent with the underlying theory and that all internal consistency reliability estimates are good. Acceptable convergent validity was found for the INQ, but not for the ACSS. Recommendations for refining the ACSS based on the results of the current analyses are provided. Comparisons of scale performance were made with data from participants with and without a history of 1 or more suicide attempts. Burdensomeness alone and the interaction between thwarted belongingness and burdensomeness were associated with prior suicide attempts. In conclusion, although some refinement may improve performance of the ACSS, both measures are appropriate and psychometrically sound for use in research and clinical applications with veterans of the U.S. military. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
 
Joiner TE, Hom MA, Rogers ML, Chu C, Stanley IH, Wynn GH, Gutierrez PM. Staring Down Death. Crisis. 2016 May;37(3):212-7. doi: 10.1027/0227-5910/a000367. Epub 2016 Jan 19. PubMed PMID: 27427541.
BACKGROUND: Lowered eye blink rate may be a clinically useful indicator of acute, imminent, and severe suicide risk. Diminished eye blink rates are often seen among individuals engaged in heightened concentration on a specific task that requires careful planning and attention. Indeed, overcoming one's biological instinct for survival through suicide necessitates premeditation and concentration; thus, a diminished eye blink rate may signal imminent suicidality. AIMS: This article aims to spur research and clinical inquiry into the role of eye blinks as an indicator of acute suicide risk. METHOD: Literature relevant to the potential connection between eye blink rate and suicidality was reviewed and synthesized. RESULTS: Anecdotal, cognitive, neurological, and conceptual support for the relationship between decreased blink rate and suicide risk is outlined. CONCLUSION: Given that eye blinks are a highly observable behavior, the potential clinical utility of using eye blink rate as a marker of suicide risk is immense. Research is warranted to explore the association between eye blink rate and acute suicide risk. KEYWORDS: blink rate; eye blink; suicide
 
Davidson CL, Anestis MD, Gutierrez PM. Ecological Momentary Assessment is a Neglected Methodology in Suicidology. Arch Suicide Res. 2016 Jan 29:1-11. [Epub ahead of print] DOI: 10.1080/13811118.2015.1004482 PubMed PMID: 26821811.
Ecological momentary assessment (EMA) is a group of research methods that collect data frequently, in many contexts, and in real-world settings. EMA has been fairly neglected in suicidology. The current article provides an overview of EMA for suicidologists including definitions, data collection considerations, and different sampling strategies. Next, the benefits of EMA in suicidology (i.e., reduced recall bias, accurate tracking of fluctuating variables, testing assumptions of theories, use in interventions), participant safety considerations, and examples of published research that investigate self-directed violence variables using EMA are discussed. The article concludes with a summary and suggested directions for EMA research in suicidology with the particular aim to spur the increased use of this methodology among suicidologists. KEYWORDS: Ecological Momentary Assessment; Experience Sampling Method; suicide
 
Gutierrez, P. M., Davidson, C., Friese, A., & Forster, J. (2016). Physical activity, suicide risk factors, and suicidal ideation in a veteran sample. Suicide and Life-Threatening Behavior, 46(3), 284-292. doi: 10.1111/sltb.12190
The association between current level of suicidal ideation and physical activity was tested in a broad sample of veterans seeking care from the Veterans Health Administration. It was hypothesized that the two variables would be significantly inversely related. It was further hypothesized that the relationship would be mediated by depressive symptoms, disturbed sleep, and a measure of heart rate variability based on existing research regarding physical activity and sleep. Due to the first hypothesis not being supported, the second could not be tested. Post hoc correlation analyses did find associations between physical activity and depressive symptoms, in expected directions, and are discussed. Possible explanations for the negative findings along with recommendations for future research to continue exploring links between suicide risk and physical activity are presented. We conclude by suggesting that physical activity may have promise as a risk reduction intervention and that prospective data are more likely to yield significant results than the cross-sectional methodology employed in the current study. © Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
 
Gutierrez, P. M. (2015). Introduction to the special section: The costs and benefits of working with pooled data. Military Behavioral Health. e-pub ahead of print. doi: 10.1080/21635781.2015.1085932
Five articles appear in a special section of this issue of the journal reporting analyses of data pooled from clinical trials funded by the Department of Defense on interventions for active-duty service members and veterans at risk of suicide. An overview of the studies contributing data and participant characteristics is provided. The rationale for pooling data along with the costs and benefits of such efforts is discussed. It is concluded that utilizing pooled data, in keeping with efforts being conducted by other large funders of clinical trials, is challenging but that the benefits outweigh the costs. The articles in the special section are useful for clinicians, researchers, and policymakers.
 
Villate, J., O’Connor, S., Leitner, R., Kerbrat, A., Johnson, L., and Gutierrez, P. M. (2015). Suicide attempt characteristics among veterans and active duty servicemembers: A pooled data analysis. Military Behavioral Health, 3(4), 316-327. doi: 10.1080/21635781.2015.1093981
Past suicidal behaviors are among the strongest and most consistent predictors of eventual suicide and may be particularly salient in military suicide. The current study compared characteristics of suicide attempts in veterans (N = 746) and active-duty service members (N = 1,013) receiving treatment for acute suicide risk. Baseline data from six randomized controlled trials were pooled and analyzed using robust regression. Service members had greater odds of having attempted suicide relative to veterans, though there were no differences in number of attempts made. Service members also had higher rates of premilitary suicide attempts and nonsuicidal self-injury (NSSI). Veterans disproportionately attempted suicide by means of overdose. In veterans, combat deployment was associated with lower odds of lifetime suicide attempt, while history of NSSI was associated with greater attempt odds. Neither was significantly associated with lifetime suicide attempt in service members. Implications for suicide assessment and treatment are discussed.
 
Tucker, R. P., Crowley, K., Davidson, C. L., & Gutierrez, P. M. (2015). Risk factors, warning signs, and drivers of suicide: What are they, how do they differ, and why does it matter? Suicide and Life-Threatening Behavior, 45(6), 679-689 . doi: 10.1111/sltb.12161
Research investigating suicide attempts and deaths by suicide has yielded many specific risk factors and warning signs for future suicidal behaviors. Yet, even though these variables are each valuable for suicide prevention efforts, they may be limited in their applicability to clinical practice. The differences among risk factors, warning signs, and “drivers,” which are person-specific variables that lead individuals to desire death by suicide, are highlighted. The scarce evidence on drivers is described and specific recommendations for conducting future drivers-focused research and targeting them in clinical practice are suggested.
Listen to Dr. Gutierrez podcast about this subect.
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Grants/Funding

Military Suicide Research Consortium
Military Operational Medicine Research Program (MOMRP)
 
Operation Worth Living (OWL)
Military Operational Medicine Research Program (MOMRP)
 
Gold Standard Suicide Assessment
Military Suicide Research Consortium
 
Patient Safety Center of Inquiry
Veterans Administration
 

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