Preventing Suicide Through Better Firearm Safety Policy in the United States

J. W. Swanson

Psychiatric Services

Volume 72, Issue 2

February 01, 2021, 174-179

Abstract

The U.S. suicide rate continues to increase, despite federal investment in developing preventive behavioral health care interventions. Important determinants of suicide—social, economic, and circumstantial—have little or no connection to psychopathology. Firearm injuries account for over half of suicides, and firearm access is perhaps the most important modifiable determinant. Thus gun safety policy deserves special attention as a pathway to suicide prevention. This article summarizes arguments for several recommended statutory modifications to firearm restrictions at the state level. The policy challenge is to develop and implement evidence-based strategies to keep guns out of the hands of people at highest risk of suicide, without unduly infringing the rights of a large number of gun owners who are unlikely to harm anyone. Recommendations for states include expansion and refinement of legal criteria prohibiting firearm purchase, possession, or access to better align with suicide risk, including prohibition for persons with brief involuntary psychiatric holds or repeated alcohol-impaired driving convictions; enactment of extreme risk protection order laws, which allow temporary removal of firearms from persons who are behaving dangerously, and entering purchase prohibition data for these persons in the FBI’s background-check database; and adoption of an innovative policy known as precommitment against suicide as well as voluntary self-enrollment in the FBI’s background-check database.

Highlights

• Suicide is caused by many factors in addition to mental illness and often cannot be prevented by mental health treatment alone.

• Access to firearms is one of the most important modifiable determinants of suicide mortality in the United States.

• Evidence-based firearm restrictions and policies that limit gun access to people who pose a clear risk of intentional self-harm could prevent many suicides without infringing the rights of lawful gun owners.

Important data points

Overall, 60% of males who died by suicide had no known mental health conditions. Across all age groups, firearm suicides were more common among males without known mental health conditions compared with males who had known mental health conditions. Between 32% and 40% of all young and middle-aged adults in the study had a history of problematic substance use. Between 43% and 48% of all young and middle-aged adults tested positive for alcohol at the time of their death.

The research is here.

Unemployment, Behavioral Health, And Suicide

R. Ramchand, L. Ayer, & S. O'Connor

Health Affairs

Originally posted 7 APR 22

Key Points:

• A large body of research, most of which is ecological, has investigated the relationship between job loss or unemployment rates and mental health, substance use, and suicide.

• Groups historically experiencing health disparities (for example, Black and Hispanic populations and those without a high school or college degree) have been differently affected by unemployment during the COVID-19 pandemic. Similarly, preliminary evidence from three states suggests that suicide has disproportionately affected Americans who are members of racial and ethnic minority groups over the course of the pandemic.

• COVID-19 has affected the workforce in unique ways that differentiate the pandemic from previous economic downturns. However, previous research indicates that increases in suicide rates associated with economic downturns were driven by regional variation in unemployment, availability of unemployment benefits, and duration and magnitude of changes in unemployment.

• Policy mitigation strategies may have offset the potential impact of unemployment fluctuations on suicide rates during the pandemic. Policies include expanded unemployment benefits and food assistance, as well as tax credits and subsidies that reduced child care and health care costs.

• Research is needed to disentangle which populations experienced the most benefit when these strategies were present and which had the greatest risk when they were discontinued.

• Evidence-based strategies that expand the mental health workforce and integrate mental health supports into employment and training settings may be promising ways to help workers as they navigate persistent changes to workforce demands.

Suicide In The United States

A recent Health Affairs Health Policy Brief provides an overview of suicide in the United States. In 2019, 47,511 Americans intentionally ended their lives, making suicide the tenth leading cause of death. This is likely an underestimate—in 2019, 75,795 Americans died of poisonings, the majority of which were drug poisonings categorized as unintentional, although some were likely suicide overdoses that were misclassified.

Suicide is a growing national concern despite the fact that the national suicide rate decreased between 2018 and 2019 and again in 2020. This decrease comes after nearly twenty years of the national suicide rate increasing annually, and it was not observed in some minority racial and ethnic groups. In addition, although suicide rates decreased between 2018 and 2020, the drug overdose death rate increased.

The info is here.

USS George Washington sailors detail difficult working conditions after string of suicides

Melissa Chan

NBCNews.com

Originally posted 28 APR 22

Here are two excerpts:

Crisostomo and several other George Washington sailors said their struggles were directly related to a culture where seeking help is not met with the necessary resources, as well as nearly uninhabitable living conditions aboard the ship, including constant construction noise that made sleeping impossible and a lack of hot water and electricity. 

Since Crisostomo’s attempt, at least five of her shipmates on the George Washington have died by suicide, including three within a span of a week this April, military officials said. The latest cluster of suicides is under investigation by the Navy and has drawn concern from the Pentagon and Rep. Elaine Luria, D-Va., who served in the Navy for two decades.

On April 15, Master-at-Arms Seaman Recruit Xavier Hunter Sandor died by suicide onboard the George Washington, according to the Navy and the state chief medical examiner’s office. He had been working on the warship for about three months, his family said.

His death came five days after Natasha Huffman, an interior communications electrician, died by suicide off-base in Hampton, officials said.

The day before, Retail Services Specialist 3rd Class Mika’il Rayshawn Sharp also died by suicide off-base in Portsmouth, said his mother, Natalie Jefferson. 

“Three people don’t just decide to kill themselves in a span of days for nothing,” said Crisostomo, who left the Navy in October 2021, on an honorable discharge with a medical condition following her suicide attempt.

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When asked about mental-health resources, Smith told sailors that the Navy would put more chaplains on smaller ships for the first time, but that it’s not easy to hire more psychologists, psychiatrists, and other mental health care workers, because they’re not “out there in abundance.”

“You can’t just snap your fingers and grow a psychiatrist,” he said, adding that the sailors should be “each other’s counselors.”

Myers said a larger Navy team is being built to assess quality-of-life conditions on aircraft carriers undergoing overhauls. 

“Their recommendations will inform potential future action, identify areas for improvements, and propose mitigation strategies to optimize [quality of life],” he said.

In 2020, the most recent year for which full data is available, 580 military members died by suicide, a 16 percent increase from 2019, when 498 died by suicide, according to the Defense Department. Nineteen out of every 100,000 sailors died by suicide in 2020, compared to members of the Army, which had the highest rate, at about 36 per 100,000, Pentagon statistics show.

The info is here.

As Suicide Attempts Rise in America, Mental Health Care Remains Stagnant

Kara Grant

MedPageToday.com

Originally posted 19 JAN 22

Despite the substantial increase in suicide attempts among U.S. adults over the last decade, use of mental health services by these individuals didn't match that growth, data from the National Surveys on Drug Use and Health (NSDUH) revealed.

From 2008 to 2019, suicide attempts among adults increased from 481.2 to 563.9 per 100,000 (adjusted odds ratio [aOR] 1.23, 95% CI 1.05-1.44, P=0.01), reported Greg Rhee, PhD, of the Yale School of Medicine in New Haven, Connecticut, and colleagues.

And according to their study in JAMA Psychiatry, there was a significant uptick in the number of individuals that attempted suicide within the past year who said they felt they needed mental health services but failed to receive it (34.8% in 2010-2011 vs 45.5% in 2018-2019).

Overall, the researchers found no significant changes in the likelihood of receiving past-year outpatient, inpatient, or medication services for mental health reasons, nor any change in substance use treatment services. An increase in the number of visits to mental health centers was detected, but even this change was no longer significant after correcting for different sources of mental health care.

"One would hope that as suicide attempts increase, the percentage of individuals who receive treatment in proximity to their attempt would also increase," Rhee and colleagues wrote. "Current suicide prevention interventions largely focus on individuals connected to treatment and high-risk individuals who have contact with the health care system."

"However, our finding that less than half of suicide attempters had clinical contact around the time of their attempt suggest[s] that it is not only important to expand initiatives for high-risk individuals with clinical contact, but also to implement public health-oriented strategies outside the formal treatment system," they suggested.

The info is here.

Treatments for the Prevention and Management of Suicide: A Systematic Review.

D'Anci KE, Uhl S, Giradi G, et al.
Ann Intern Med. 
doi: 10.7326/M19-0869

Abstract

Background:
Suicide is a growing public health problem, with the national rate in the United States increasing by 30% from 2000 to 2016.

Purpose:
To assess the benefits and harms of nonpharmacologic and pharmacologic interventions to prevent suicide and reduce suicide behaviors in at-risk adults.

Conclusion:
Both CBT and DBT showed modest benefit in reducing suicidal ideation compared with TAU or wait-list control, and CBT also reduced suicide attempts compared with TAU. Ketamine and lithium reduced the rate of suicide compared with placebo, but there was limited information on harms. Limited data are available to support the efficacy of other nonpharmacologic or pharmacologic interventions.

Discussion

In this SR, we reviewed and synthesized evidence from 8 SRs and 15 RCTs of nonpharmacologic and pharmacologic interventions intended to prevent suicide in at-risk persons. These interventions are a subset of topics included in the updated VA/DoD 2019 CPG for assessment and management of patients at risk for suicide. The full final guideline is available from the VA Web site (www.healthquality.va.gov).

Nonpharmacologic interventions encompassed a range of approaches delivered either face-to-face or via the Internet or other technology. We found moderate-strength evidence supporting the use of face-to-face or Internet-delivered CBT in reducing suicide attempts, suicidal ideation, and hopelessness compared with TAU. We found low-strength evidence suggesting that CBT was not effective in reducing suicides. However, rates of suicide were generally low in the included studies, which limits our ability to draw firm conclusions about this outcome. Data from small studies provide low-strength evidence supporting the use of DBT over client-oriented therapy or control for reducing suicidal ideation. For other outcomes and other comparisons, we found no benefit of DBT. There was low-strength evidence supporting use of WHO-BIC to reduce suicide, CRP to reduce suicide attempts, and Window to Hope to reduce suicidal ideation and hopelessness.

Campuses Are Short on Mental-Health Counselors. But They’ve Got Plenty of Antidepressants.

Lily Jackson

The Chronicle of Higher Education
Originally posted June 28, 2019

Here is an excerpt:

A Potential for Lopsided Treatment

It is generally accepted that the most effective treatment for medium-to-severe depression is a mix of therapy and medication. But on most college campuses, it’s easier to get the latter than the former.

A student experiencing symptoms of depression who wants to see a counselor may have to wait weeks. The average wait for a first-time appointment among all college counseling centers is about seven business days, according to a report by the Association for University and College Counseling Center Directors. And nearly two-thirds of counseling directors whose centers offer psychiatric services say they need “more hours of psychiatric services than they currently have to meet student needs,” according to the same report.

On many campuses, the path to a prescription is simpler. A student can walk into a campus clinic where a medical employee can administer an evaluation called the PHQ-9, a nine-question rubric, commonly used across medicine, that assesses the patient's well-being with questions like, “Have you been feeling blue for the last two weeks?” and “Have you experienced thoughts of suicide?”

Based on the student’s evaluation score, psychologists can direct them toward medication or therapy, or both, based on the severity of their symptoms. Some students are seeking mental health resources with a driving force of “instant relief,” said Gregory Eells, executive director of Counseling and Psychological Services at the University of Pennsylvania and the president-elect of Aucccd.

So they tell their physician what they want, Eells said, rather than inquiring about what they need.

It’s common, experts say, for a patient to leave the first visit with a prescription for an antidepressant.

“Most students come in knowing one thing: They want help,” said William E. Neighbor, clinical professor of family medicine at the University of Washington Hall Health Center. “They are interested in medications because most have friends who have been on them.”

The info is here.

A Prominent Economist’s Death Prompts Talk of Mental Health in the Professoriate

Emma Pettit
The Chronicle of Higher Education
Originally posted March 19, 2019

Reaching Out

For Bruce Macintosh, Krueger’s death was a reminder of how isolating academe can be. Macintosh is a professor of physics at Stanford University who was employed at a national laboratory, not a university, until about five years ago. That culture was totally different, he said. At other workplaces, Macintosh said, you interact regularly with peers and supervisors, who are paying close attention to you and your work.

“There’s nothing like that in an academic environment,” he said. “You can shut down completely for a year, and no one will notice,” as long as the grades get turned in.

It seems, Macintosh said, as if there should be multiple layers of support within a university department to help faculty members who experience depression or other forms of mental illness. But certain barriers still exist between professors and the resources they need.

A 2017 survey of 267 faculty members with mental-health histories or mental illnesses found that most respondents had little to no familiarity with accommodations at their institution. Even fewer reported using them.

The info is here.

Note: Career success, wealth, and prestige are not protective factors for suicide attempts or completions.  Interpersonal connections to family and friends, access to quality mental health care, problem-solving skills, meaning in life, and purposefulness are.

The Parking Lot Suicide

Emily Wax-Thibodeaux.
The Washington Post
Originally published February 11, 2019

Here is an excerpt:

Miller was suffering from post-traumatic stress disorder and suicidal thoughts when he checked into the Minneapolis Department of Veterans Affairs hospital in February 2018. After spending four days in the mental-health unit, Miller walked to his truck in VA’s parking lot and shot himself in the very place he went to find help.

“The fact that my brother, Justin, never left the VA parking lot — it’s infuriating,” said Harrington, 37. “He did the right thing; he went in for help. I just can’t get my head around it.”

A federal investigation into Miller’s death found that the Minneapolis VA made multiple errors: not scheduling a follow-up appointment, failing to communicate with his family about the treatment plan and inadequately assessing his access to firearms.

Several days after his death, Miller’s parents received a package from the Department of Veterans Affairs — bottles of antidepressants and sleep aids prescribed to Miller.

His death is among 19 suicides that occurred on VA campuses from October 2017 to November 2018, seven of them in parking lots, according to the Department of Veterans Affairs.

While studies show that every suicide is highly complex — influenced by genetics, financial uncertainty, relationship loss and other factors — mental-health experts worry that veterans taking their lives on VA property has become a desperate form of protest against a system that some veterans feel hasn’t helped them.

The most recent parking lot suicide occurred weeks before Christmas in St. Petersburg, Fla. Marine Col. Jim Turner, 55, dressed in his uniform blues and medals, sat on top of his military and VA records and killed himself with a rifle outside the Bay Pines Department of Veterans Affairs.

“I bet if you look at the 22 suicides a day you will see VA screwed up in 90%,” Turner wrote in a note investigators found near his body.

The info is here.

Suicide rates at a record high, yet insurers still deny care

Patrick Kennedy and Jim Ramstad
thehill.com
Originally posted February 15, 2019

Here is an excerpt:

A recent report from the Centers for Disease Control and Prevention (CDC) reinforces the seriousness of our nation’s mental health crisis. Life expectancy is declining in a way we haven’t seen since World War. With more than 70,000 drug overdose deaths in 2017 and suicides increasing by 33 percent since 1999, the message is clear: People are not getting the care they need. And for many, it’s a simple matter of access.

When the Mental Health Parity and Addiction Equity Act, also known as the Federal Parity Law, passed in 2008, those of us who drafted and championed the bill knew that talking about mental health wasn’t enough — we needed to ensure access to care as well. Hence, the Federal Parity Law requires most insurers to cover illnesses of the brain, such as depression or addiction, no more restrictively than illnesses of the body, such as diabetes or cancer. We hoped it would remove the barriers that families like Sylvia’s often face when trying to get help.

It has been 10 years since the law passed and, unfortunately, too many Americans are still being denied coverage for mental health and addiction treatment. The reason? A lack of enforcement.

As things stand, the responsibility to challenge inadequate systems of care and illegal denials falls on patients, who are typically unaware of the law or are in the middle of a personal crisis. This isn’t right. Or sustainable. The responsibility for mental health equity should lie with insurers, not with patients or their providers. Insurers should be held accountable for parity before plans are sold.

The info is here.

Doctors’ mental health at tipping point

Chris Hemmings
BBC.co.uk
Originally posted September 3, 2018

Here is an excerpt:

'Last taboo'

Dr Gerada says the lack of confidentiality is a barrier and wants NHS England to extend the London approach to any doctor who needs support.

She believes acknowledging that doctors also have mental health problems is "the last taboo in the NHS".

Louise Freeman, a consultant in emergency medicine, says she left her job after she felt she could not access appropriate support for her depression.

"On the surface you might think 'Oh, doctors will get great mental health care because they'll know who to go to'.

"But actually we're kind of a hard-to-reach group. We can be quite worried about confidentiality," she said, adding that she believes doctors are afraid of coming forwards in case they lose their jobs.

"I was absolutely desperate to stay at work. I never wavered from that."

One of the biggest issues, according to Dr Gerada, is the effect on doctors of complaints from the public, which she says can "shatter their sense of self".

The info is here.

Why are Americans so sad?

Monica H. Swahn
quartz.com
Originally published June 16, 2018

Suicide rates in the US have increased nearly 30% in less than 20 years, the Centers for Disease Control and Prevention reported June 7. These mind-numbing statistics were released the same week two very famous, successful and beloved people committed suicide—Kate Spade, a tremendous entrepreneur, trendsetter and fashion icon, and Anthony Bourdain, a distinguished chef and world traveler who took us on gastronomic journeys to all corners of the world through his TV shows.

Their tragic deaths, and others like them, have brought new awareness to the rapidly growing public health problem of suicide in the US. These deaths have renewed the country’s conversation about the scope of the problem. The sad truth is that suicide is the 10th leading cause of death among all Americans, and among youth and young adults, suicide is the third leading cause of death.

I believe it’s time for us to pause and to ask the question why? Why are the suicide rates increasing so fast? And, are the increasing suicide rates linked to the seeming increase in demand for drugs such as marijuana, opioids and psychiatric medicine? As a public health researcher and epidemiologist who has studied these issues for a long time, I think there may be deeper issues to explore.

Suicide: more than a mental health issue

Suicide prevention is usually focused on the individual and within the context of mental health illness, which is a very limited approach. Typically, suicide is described as an outcome of depression, anxiety, and other mental health concerns including substance use. And, these should not be trivialized; these conditions can be debilitating and life-threatening and should receive treatment. (If you or someone you know need help, call the National Suicide Prevention Lifeline at 1-800-273-8255).

The info is here.

Why are America's farmers killing themselves in record numbers?

Debbie Weingarten
The Guardian
Originally published December 6, 2017

Here is an excerpt:

“Farming has always been a stressful occupation because many of the factors that affect agricultural production are largely beyond the control of the producers,” wrote Rosmann in the journal Behavioral Healthcare. “The emotional wellbeing of family farmers and ranchers is intimately intertwined with these changes.”

Last year, a study by the Centers for Disease Control and Prevention (CDC) found that people working in agriculture – including farmers, farm laborers, ranchers, fishers, and lumber harvesters – take their lives at a rate higher than any other occupation. The data suggested that the suicide rate for agricultural workers in 17 states was nearly five times higher compared with that in the general population.

After the study was released, Newsweek reported that the suicide death rate for farmers was more than double that of military veterans. This, however, could be an underestimate, as the data collected skipped several major agricultural states, including Iowa. Rosmann and other experts add that the farmer suicide rate might be higher, because an unknown number of farmers disguise their suicides as farm accidents.

The US farmer suicide crisis echoes a much larger farmer suicide crisis happening globally: an Australian farmer dies by suicide every four days; in the UK, one farmer a week takes his or her own life; in France, one farmer dies by suicide every two days; in India, more than 270,000 farmers have died by suicide since 1995.

The article is here.

Lawsuit Over a Suicide Points to a Risk of Antidepressants

Roni Caryn Rabin
The New York Times
Originally published September 11, 2017

Here is an excerpt:

The case is a rare instance in which a lawsuit over a suicide involving antidepressants actually went to trial; many such cases are either dismissed or settled out of court, said Brent Wisner, of the law firm Baum Hedlund Aristei Goldman, which represented Ms. Dolin.

The verdict is also unusual because Glaxo, which has asked the court to overturn the verdict or to grant a new trial, no longer sells Paxil in the United States and did not manufacture the generic form of the medication Mr. Dolin was taking. The company argues that it should not be held liable for a pill it did not make.

Concerns about safety have long dogged antidepressants, though many doctors and patients consider the medications lifesavers.

Ever since they were linked to an increase in suicidal behaviors in young people more than a decade ago, all antidepressants, including Paxil, have carried a “black box” warning label, reviewed and approved by the Food and Drug Administration, saying that they increase the risk of suicidal thinking and behavior in children, teens and young adults under age 25.

The warning labels also stipulate that the suicide risk has not been seen in short-term studies in anyone over age 24, but urges close monitoring of all patients initiating drug treatment.

The article is here.

Individuals at High Risk for Suicide Are Categorically Distinct From Those at Low Risk.

Tracy K. Witte, Jill M. Holm-Denoma, Kelly L. Zuromski, Jami M. Gauthier, & John Ruscio
Psychological Assessment, Vol 29(4), Apr 2017, 382-393

Abstract

Although suicide risk is often thought of as existing on a graded continuum, its latent structure (i.e., whether it is categorical or dimensional) has not been empirically determined. Knowledge about the latent structure of suicide risk holds implications for suicide risk assessments, targeted suicide interventions, and suicide research. Our objectives were to determine whether suicide risk can best be understood as a categorical (i.e., taxonic) or dimensional entity, and to validate the nature of any obtained taxon. We conducted taxometric analyses of cross-sectional, baseline data from 16 independent studies funded by the Military Suicide Research Consortium. Participants (N = 1,773) primarily consisted of military personnel, and most had a history of suicidal behavior. The Comparison Curve Fit Index values for MAMBAC (.85), MAXEIG (.77), and L-Mode (.62) all strongly supported categorical (i.e., taxonic) structure for suicide risk. Follow-up analyses comparing the taxon and complement groups revealed substantially larger effect sizes for the variables most conceptually similar to suicide risk compared with variables indicating general distress. Pending replication and establishment of the predictive validity of the taxon, our results suggest the need for a fundamental shift in suicide risk assessment, treatment, and research. Specifically, suicide risk assessments could be shortened without sacrificing validity, the most potent suicide interventions could be allocated to individuals in the high-risk group, and research should generally be conducted on individuals in the high-risk group.

The article is here.

Risk considerations for suicidal physicians

Doug Brunk
Clinical Psychiatry News
Publish date: February 27, 2017

Here are two excerpts:

According to the American Foundation for Suicide Prevention, 300-400 physicians take their own lives every year, the equivalent of two to three medical school classes. “That’s a doctor a day we lose to suicide,” said Dr. Myers, a professor of clinical psychiatry at State University of New York, Brooklyn, who specializes in physician health. Compared with the general population, the suicide rate ratio is 2.27 among female physicians and 1.41 among male physicians (Am J Psychiatry. 2004;161[12]:2295-2302), and an estimated 85%-90% of those who carry out a suicide have a psychiatric illness such as major depressive disorder, bipolar disorder, alcohol use and substance use disorder, and borderline personality disorder. Other triggers common to physicians, Dr. Myers said, include other kinds of personality disorders, burnout, untreated anxiety disorders, substance/medication-induced depressive disorder (especially in clinicians who have been self-medicating), and posttraumatic stress disorder.

(cut)

Inadequate treatment can occur for physician patients because of transference and countertransference dynamics “that muddle the treatment dyad,” Dr. Myers added. “We must be mindful of the many issues that are going on when we treat our own.”

The article is here.

Why Suicide Keeps Rising for Middle-Aged Men

By Lisa Esposito
US News and World Report
Originally published Oct. 19, 2016

Suicide rates in the U.S. continue to rise, and working-age adults – particularly men – make up the largest increase, according to the Centers for Disease Control and Prevention. Middle-aged men in the 45 to 60 range experienced a 43 percent increase in suicide deaths from 1997 to 2014, and the rise has been even sharper since 2005. Untreated mental illness, the Great Recession, work-related issues and men's reluctance to reach out for help converge to put them at greater risk for taking their own lives. And because men are more likely than women to use a gun, their suicide attempts are more often fatal.

Historically, suicide rates have always been higher for men, says Dr. Alex Crosby, surveillance branch chief in the CDC's Division of Violence Prevention. "But what we've seen in these past few years is rates have been going up among males and females," he told journalists attending a National Press Foundation conference in September. "Still, rates are higher among males – about four times higher." For suicide attempts that don't prove fatal, the balance changes, with two to three times more females than males trying to take their own lives.

"In about half of the suicides in the United States, the mechanism or the method was a firearm," Crosby says. Males are more likely to use firearms, while poison is more common for females. However, he notes, "When you look at suicide in the military, females choose firearms almost as much as men."

The article is here.

Exploring the Association between Exposure to Suicide and Suicide Risk among Military Service Members and Veterans

Melanie A. Homa, Ian H. Stanley, Peter M. Gutierrezb, Thomas E. Joiner
Journal of Affective Disorders

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.

The article is here.

For one VA whistleblower, getting fired was too much

By Donovan Slack
http://www.wausaudailyherald.com
Originally posted April 12, 2015

Here are two excerpts:

There, officers found the body of Christopher Kirkpatrick, a 38-year-old clinical psychologist who had shot himself in the head after being fired from the Tomah Veterans Affairs Medical Center.

Kirkpatrick had complained some of his patients were too drugged to treat properly, but like other whistleblowers at the facility, he was ousted and his concerns of wrongdoing were disregarded.

Retaliation against whistleblowers has become a major problem at VA facilities across the country. The U.S. Office of Special Counsel is investigating 110 retaliation claims from whistleblowers in 38 states and the District of Columbia.

(cut)

VA officials said since Kirkpatrick's death, the agency has implemented online whistleblower training for 32,000 managers and executives at the agency, and now requires all employees to take a course every other year that includes a component about whistleblower rights. VA spokeswoman Genevieve Billia said notices of termination should contain language informing the affected employee of those rights. She did not respond to a message asking if that was mandatory.

The entire article is here.

The Growing Risk of Suicide in Rural America

Young people in the countryside have more guns, fewer doctors, and are more isolated than their urban counterparts—and a new study says they're killing themselves in greater numbers.

By Julie Beck
The Atlantic
Originally published March 10, 2015

In rural America, where there are more guns, fewer people, and fewer doctors than in the urban U.S., young people are at particular risk of suicide.

A study published Monday in JAMA Pediatrics analyzed suicides among people aged 10 to 24 between 1996 and 2010, and found that rates were nearly doubled in rural areas, compared to urban areas. While this gap existed in 1996 at the beginning of the data set, it widened over the course of this time period, according to Cynthia Fontanella, the lead author on the study, and a clinical associate professor of psychiatry at Ohio State University’s Wexner Medical Center.

The entire article is here.

Modelling suicide and unemployment: a longitudinal analysis

Modelling suicide and unemployment: a longitudinal analysis covering 63 countries, 2000–11
Nordt, Carlos et al.
The Lancet Psychiatry
DOI: http://dx.doi.org/10.1016/S2215-0366(14)00118-7

Summary

Background

As with previous economic downturns, there has been debate about an association between the 2008 economic crisis, rising unemployment, and suicide. Unemployment directly affects individuals' health and, unsurprisingly, studies have proposed an association between unemployment and suicide. However, a statistical model examining the relationship between unemployment and suicide by considering specific time trends among age-sex-country subgroups over wider world regions is still lacking. We aimed to enhance knowledge of the specific effect of unemployment on suicide by analysing global public data classified according to world regions.

Methods

We retrospectively analysed public data for suicide, population, and economy from the WHO mortality database and the International Monetary Fund's world economic outlook database from 2000 to 2011. We selected 63 countries based on sample size and completeness of the respective data and extracted the information about four age groups and sex. To check stability of findings, we conducted an overall random coefficient model including all study countries and four additional models, each covering a different world region.

Findings

Despite differences in the four world regions, the overall model, adjusted for the unemployment rate, showed that the annual relative risk of suicide decreased by 1·1% (95% CI 0·8–1·4) per year between 2000 and 2011. The best and most stable final model indicated that a higher suicide rate preceded a rise in unemployment (lagged by 6 months) and that the effect was non-linear with higher effects for lower baseline unemployment rates. In all world regions, the relative risk of suicide associated with unemployment was elevated by about 20–30% during the study period. Overall, 41 148 (95% CI 39 552–42 744) suicides were associated with unemployment in 2007 and 46 131 (44 292–47 970) in 2009, indicating 4983 excess suicides since the economic crisis in 2008.

Interpretation

Suicides associated with unemployment totalled a nine-fold higher number of deaths than excess suicides attributed to the most recent economic crisis. Prevention strategies focused on the unemployed and on employment and its conditions are necessary not only in difficult times but also in times of stable economy.