Studies of suicide

Today, we’re looking at three very different articles pertaining to suicide. 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.

Veterans aren’t the only ones dealing with loneliness. I thought this was important in that loneliness better predicted suicidality than combat exposure. It’s also notable that TBI and combat exposure were very comparable. The next study looks at suicide attempts.  Stanley & Marx (2024) published “Beyond a Dichotomous Operationalization of Suicide Attempts” in Journal of Psychopathology and Clinical Science. The edited abstract follows:

This article discusses a dichotomous operationalization of suicide attempts. Each year, millions of individuals worldwide make a suicide attempt (SA). Because of their obvious importance, clinicians and researchers commonly assess for a SA history by asking face-valid questions about whether an individual has engaged in any selfinjurious behavior with the intent to die within a given timeframe. Response options are typically dichotomous (yes/no), such that if an individual reported nonzero intent to die associated with their behavior(s) or if there were other indicators suggestive of intent, the individual would be considered to have attempted suicide. Regardless of the method of ascertainment, it is generally accepted that patients and study participants either do or do not have a SA history. The intention is not to suggest that more serious SAs—whether by the level of intent to die, means used, actual medical consequences, or chronicity criterion—are more worthy of clinical and scientific attention than less serious SAs. Instead, the intention is to bring greater awareness to considering—in theory testing and refinement, the design, analysis, and interpretation of research findings, and clinical practice—SAs as multidimensional behaviors that vary in levels of intent to die, means used, actual medical consequences, and chronicity. By doing so, the clinical impact of scientific findings will be more readily discernable. 

I thought it was important to note that self-injurious behavior is complex. Finally, we turn to the helpers. 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. Here are the edited abstract and impact statement:

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. 

I thought it was important to acknowledge the frequency of exposure to suicidality by mental health professionals and their need for help in addressing it in their clients.