Katherine C Cunningham1, Frances M Aunon2, Tapan A Patel2, Adam J Mann3, Bryann B DeBeer4, Eric C Meyer5, Sandra B Morissette6, Paul J Silvia7, Kim L Gratz8, Patrick S Calhoun9, Jean C Beckham10, Nathan A Kimbrel11. 1. Salem Veterans Affairs Medical Center, Salem, VA, USA. 2. Durham Veterans Affairs Health Care System, Durham, NC, USA. 3. Durham Veterans Affairs Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA. 4. VA Rocky Mountain Mental Illness, Research, Education, and Clinical Center, Aurora, CO; Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado. 5. Department of Rehabilitation Science and Technology, University of Pittsburgh. 6. VISN 17 Center of Excellence for Research on Returning War Veterans at Central Texas Veterans Health Care System, Waco, TX, USA; Department of Psychology, The University of Texas at San Antonio, San Antonio, TX, USA. 7. Department of Psychology, University of North Carolina at Greensboro, NC, USA. 8. Department of Psychology, University of Toledo, Toledo, OH, USA. 9. Durham Veterans Affairs Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA. 10. Durham Veterans Affairs Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA. 11. Durham Veterans Affairs Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA. Electronic address: Nathan.Kimbrel@va.gov.
Abstract
BACKGROUND: Expanding on research that has identified nonsuicidal self-injury (NSSI) as a strong predictor of suicide risk, the present study examined NSSI disorder (NSSID) and borderline personality disorder (BPD) as unique contributors to lifetime suicide attempts. To our knowledge, the present study represents the first exploration of these associations among veterans. METHODS: Participants included 124 male (74%) and female (26%) veterans diagnosed with at least one mental health disorder. Posttraumatic stress disorder (93%) and major depression (86%) were the most common mental health diagnoses. Large proportions of the sample met criteria for NSSID (48%) and BPD (40%). Suicide attempts were reported by 28% of the sample. Chi-square tests determined the bivariate associations among NSSID, BPD, history of suicide attempts, and other variables. Significant diagnostic (i.e., MDD, BPD, and NSSID) and demographic (i.e., age) characteristics were included as covariates in a logistic regression model examining the associations of BPD and NSSID with suicide attempts. RESULTS: BPD, Χ2=11.1, p<0.001, and NSSID, Χ2=13.9, p<0.001, were uniquely associated with suicide attempts. When all significant predictors were included in the final model, only NSSID emerged as a significant contributor to suicide attempts, OR = 4.9, p < 0.001. LIMITATIONS: Causality cannot be determined from cross-sectional analyses. CONCLUSION: These findings highlight NSSID as a powerful and unique correlate of suicide attempts among veterans, beyond the associations of established diagnostic risk factors. Improving our understanding of the relationship between NSSID and suicide risk has the potential to inform suicide prevention efforts and improve clinical outcomes among veterans.
BACKGROUND: Expanding on research that has identified nonsuicidal self-injury (NSSI) as a strong predictor of suicide risk, the present study examined NSSI disorder (NSSID) and borderline personality disorder (BPD) as unique contributors to lifetime suicide attempts. To our knowledge, the present study represents the first exploration of these associations among veterans. METHODS: Participants included 124 male (74%) and female (26%) veterans diagnosed with at least one mental health disorder. Posttraumatic stress disorder (93%) and major depression (86%) were the most common mental health diagnoses. Large proportions of the sample met criteria for NSSID (48%) and BPD (40%). Suicide attempts were reported by 28% of the sample. Chi-square tests determined the bivariate associations among NSSID, BPD, history of suicide attempts, and other variables. Significant diagnostic (i.e., MDD, BPD, and NSSID) and demographic (i.e., age) characteristics were included as covariates in a logistic regression model examining the associations of BPD and NSSID with suicide attempts. RESULTS: BPD, Χ2=11.1, p<0.001, and NSSID, Χ2=13.9, p<0.001, were uniquely associated with suicide attempts. When all significant predictors were included in the final model, only NSSID emerged as a significant contributor to suicide attempts, OR = 4.9, p < 0.001. LIMITATIONS: Causality cannot be determined from cross-sectional analyses. CONCLUSION: These findings highlight NSSID as a powerful and unique correlate of suicide attempts among veterans, beyond the associations of established diagnostic risk factors. Improving our understanding of the relationship between NSSID and suicide risk has the potential to inform suicide prevention efforts and improve clinical outcomes among veterans.
Authors: M C Zanarini; F R Frankenburg; D B Reich; G Fitzmaurice; I Weinberg; J G Gunderson Journal: Acta Psychiatr Scand Date: 2008-02-01 Impact factor: 6.392
Authors: Megan S Chesin; Hanga Galfavy; Cemile Ceren Sonmez; Amanda Wong; Maria A Oquendo; J John Mann; Barbara Stanley Journal: Suicide Life Threat Behav Date: 2017-02-17
Authors: Nathan A Kimbrel; Kim L Gratz; Matthew T Tull; Sandra B Morissette; Eric C Meyer; Bryann B DeBeer; Paul J Silvia; Patrick C Calhoun; Jean C Beckham Journal: Psychiatry Res Date: 2015-04-01 Impact factor: 3.222
Authors: Nathan A Kimbrel; Shaun P Thomas; Terrell A Hicks; Michael A Hertzberg; Carolina P Clancy; Eric B Elbogen; Eric C Meyer; Bryann B DeBeer; Georgina M Gross; Paul J Silvia; Sandra B Morissette; Kim L Gratz; Patrick S Calhoun; Jean C Beckham Journal: Suicide Life Threat Behav Date: 2017-09-19
Authors: Katherine C Cunningham; Chloe Farmer; Stefanie T LoSavio; Paul A Dennis; Carolina P Clancy; Michael A Hertzberg; Claire F Collie; Patrick S Calhoun; Jean C Beckham Journal: J Affect Disord Date: 2017-06-21 Impact factor: 4.839
Authors: Nathan A Kimbrel; Eric C Meyer; Bryann B DeBeer; Suzy B Gulliver; Sandra B Morissette Journal: Psychiatry Res Date: 2016-06-16 Impact factor: 3.222