Studies of suicide

The three studies I examine today all deal with suicide, using very different samples. First, Schafer, Wilson-Lemoine & Joiner (2024) published “Loneliness in Veterans: A commonality across multiple pathways toward suicidality” in Traumatology. Here’s the edited abstract:

Veterans are significantly more likely to experience suicidality than the general population. A substantial amount of research has centered on risk factors of suicidality among veterans, identifying associations between Military-relevant risk factors including traumatic brain injuries (TBIs) and combat exposure with suicidality. Likewise, loneliness has been shown to be a strong correlate of suicidality. Among these constructs, loneliness is proposed by multiple recent theories of suicide to contribute to the development of suicidality. Thus, in the present study, we investigate the link between these three variables (i.e., TBI, combat exposure, and loneliness) with suicidality. We then investigate the mediating role of loneliness between TBI and combat exposure with suicidality. Using cross-sectional data from 1,469 veterans recruited in the Military Health and Well-Being Project, we conducted linear regression analyses and mediational models. Findings indicated that loneliness (β = .32) was most closely associated with the outcome variable (suicidality) compared to combat exposure (β = .11) and TBI (β = .12). Further, loneliness partially mediated the link between all other variables with suicidality at p < .001. These findings underscore the importance of loneliness in the experience of suicidality among veterans and indicate that cross-sectional effects between military-relevant risk factors including TBI and combat exposure with suicidality are driven through loneliness. Within the relationships between TBI and suicidality as well as combat exposure and suicidality, loneliness plays an integral role, channeling the effects of the independent variables.

This is a large sample size and an important topic. I was intrigued by the power of loneliness, especially given the potential trauma associated with combat exposure or TBIs. The next study turns to sex and gender. Cavanaugh, Rivera, Mabolis & Mireles (2025) published “Sex/Gender Differences in the Associations between Adverse Childhood Experiences and Intimate Partner Violence with Mental Disorders and Attempted Suicide: Variations by race/ethnicity” in Psychological Trauma: Theory, Research, Practice, and Policy. Here are the edited abstract and impact statement:

This cross-sectional study explored sex/gender differences in the associations between adverse childhood experiences (ACEs) and intimate partner violence (IPV) with mental health problems (i.e., attempted suicide and mental disorders), including whether sex/gender differences varied by race/ethnicity. Data were used from participants in the National Epidemiologic Survey on Alcohol and Related Conditions in the United States of America (Wave II: 2004–2005). Logistic regressions tested associations between ACEs (i.e., child abuse, child neglect, and child household dysfunction) and IPV or cumulative trauma with mental health problems along with sex/gender and race/ethnicity interactions. Females who experienced child abuse or three to four cumulative traumas had greater odds of attempted suicide than males with the same experiences. Males who experienced IPV had greater odds of attempted suicide than females who experienced IPV. There were significant sex/gender differences in the associations between cumulative trauma and mental disorders (i.e., mood disorder, anxiety disorder, alcohol use disorder, and nicotine dependence), except posttraumatic stress disorder. For example, females with cumulative trauma had greater odds of substance use disorders. Many sex/gender differences in associations between ACEs and IPV or cumulative trauma with mental health problems varied by race/ethnicity. For example, child neglect was associated with greater odds of attempted suicide for non-Hispanic Black males (adjusted odds ratio [AOR] = 3.53 vs. AOR = 1.29 for females), whereas no sex/gender differences in this association were revealed for non-Hispanic White or Hispanic adults. Findings show sex/gender differences in associations between trauma and mental health problems that vary by race/ethnicity and warrant further study.

Findings suggest interventions for treating co-occurring trauma and mental health problems may be tailored to address the following: (1) greater odds of attempted suicide among (a) females who have experienced child abuse or more cumulative trauma or (b) males who have experienced intimate partner violence, (2) greater odds of alcohol use disorder and nicotine dependence among females with cumulative trauma, (3) greater odds of attempted suicide or mood disorder among non-Hispanic Black males who experienced child neglect and intimate partner violence respectively, and (4) greater odds of posttraumatic stress disorder among Hispanic males who experienced child abuse or cumulative trauma.

This is another huge sample study though the data were collected in 2004-2005. I was intrigued by the finding that females were more adversely impacted by ACEs and males by IPV. The findings about neglect in non-Hispanic Black males and PTSD in Hispanic males are also interesting. This study makes it clear that the paths from early experience to suicidality are complex and multi-faceted. The final study looks at mental health providers. Fruhbauerova, Cerel, Aldrich, Kheibari, Long-Diehl & Shroyer (2024) published “Suicide Exposure in a Snowball Sample of Mental Health Providers” in Professional Psychology: Research and Practice. The edited abstract and impact statement follow:

Suicide exposure (i.e., knowing someone who died by suicide) can lead to serious bereavement and/or mental health difficulties, regardless of the nature of the relationship with the person who died by suicide. It is important to better understand the impact suicide exposure has on mental health professionals (MHPs) as they work directly with patients who experience suicidal ideation, have histories of suicide attempts, and who might go on to die by suicide. This study examines factors associated with suicide exposure in MHPs and the impact that it has on their personal and professional lives. Using snowball sampling, this study examined the lifetime prevalence of personal exposure as well as occupational and colleague suicide among 228 MHPs who completed an online survey. More than two thirds of MHPs reported experiencing at least one personal loss to suicide, and more than two thirds had lost at least one patient to suicide. More than one fifth reported that at least one of the suicides stayed with them, causing nightmares or recurring thoughts. The findings indicate that, despite their specialized interest in suicide, occupational experience, and perceived professional readiness, this snowball sample of MHPs was impacted by suicide exposure. This highlights the need to increase efforts to support MHPs who treat suicidal clients or who are exposed to suicide. 

A snowball sample of mental health professionals was shown to be affected by suicide exposure, experiencing intrusive thoughts, nightmares, guilt, and fears of lawsuits. Many reported significant impacts on their practice, with some limiting their scope or ceasing to see clients altogether. As a nontrivial number of mental health professionals in this study feel unprepared to address suicidality or the mental health implications of suicide exposure, future research is warranted to identify effective support and training methods. 

Although snowball samples are not ideal, I was surprised that 2/3 had experienced a personal loss and/or a patient lost to suicide. The fact that 20% have persistent consequences is scary. The need for further research is clear.