Prevalence and correlates of suicidal ideation and suicide attempts among veterans in primary care referred for a mental health evaluation

Ashrafioun, Lisham; Pigeon, Wilfred R.; Conner, Kenneth R.; Leong, Shirley H.; Oslin, David W.

doi:10.1016/j.jad.2015.09.014

Cited by 43 publications

(39 citation statements)

References 39 publications

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“…Consistent with the findings of Borges et al (2016) and Kimbrel et al (in press), we hypothesized that CUD would be significantly associated with both current suicidal ideation and lifetime history of suicide attempts in this sample of Iraq/Afghanistan-era veterans, even after accounting for established predictors of suicidal behavior among veterans, including sex, PTSD, depression, alcohol use disorder, non-cannabis drug use disorder, history of childhood sexual abuse, and combat exposure (Ashrafioun et al, 2016; Kimbrel et al, 2014, 2015, 2016a, 2016b, in press; Maguen et al, 2015). …”

Section: Introductionsupporting

confidence: 57%

“…Both adjusted and unadjusted models were conducted. Sex (male=0; female=1), lifetime PTSD (not present = 0; present = 1), lifetime depression (not present = 0; present = 1), lifetime alcohol use disorder (not present = 0; present = 1), lifetime non-cannabis drug use disorder (not present = 0; present = 1), history of childhood sexual abuse (not present = 0; present = 1), and combat exposure (continuous) were included in the adjusted models based on prior research demonstrating significant associations between these variables and suicidal behavior in veterans (e.g., Ashrafioun et al, 2016; Kimbrel et al, 2014, 2015, 2016a, 2016b; Maguen et al, 2015). …”

Section: Methodsmentioning

confidence: 99%

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Cannabis use disorder and suicide attempts in Iraq/Afghanistan-era veterans

Kimbrel

Newins

Dedert

et al. 2017

Journal of Psychiatric Research

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The objective of the present research was to examine the association between lifetime cannabis use disorder (CUD), current suicidal ideation, and lifetime history of suicide attempts in a large and diverse sample of Iraq/Afghanistan-era veterans (N = 3,233) using a battery of well-validated instruments. As expected, CUD was associated with both current suicidal ideation (OR = 1.683, p = 0.008) and lifetime suicide attempts (OR = 2.306, p < 0.0001), even after accounting for the effects of sex, posttraumatic stress disorder, depression, alcohol use disorder, non-cannabis drug use disorder, history of childhood sexual abuse, and combat exposure. Thus, the findings from the present study suggest that CUD may be a unique predictor of suicide attempts among Iraq/Afghanistan-era veterans; however, a significant limitation of the present study was its cross-sectional design. Prospective research aimed at understanding the complex relationship between CUD, mental health problems, and suicidal behavior among veterans is clearly needed at the present time.

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Section: Introductionsupporting

confidence: 57%

Section: Methodsmentioning

confidence: 99%

Cannabis use disorder and suicide attempts in Iraq/Afghanistan-era veterans

Kimbrel

Newins

Dedert

et al. 2017

Journal of Psychiatric Research

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“…A prior mental health disorder was defined as any previous diagnosis of depression, bipolar disorder, post-traumatic stress disorder (PTSD) or psychosis, as these diagnoses are most likely to affect suicidal thoughts and influence efavirenz prescription. 24,25 Undetectable viral load was defined as <50 copies/mL.…”

Section: Methodsmentioning

confidence: 99%

The Relationship Between Efavirenz as Initial Antiretroviral Therapy and Suicidal Thoughts Among HIV-Infected Adults in Routine Care

Bengtson

Pence

Mollan

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Evidence about the effect of initiating efavirenz-containing combination antiretroviral therapy (ART) as first-line therapy on suicidal thoughts remains conflicting. Methods Using data from a cohort of HIV-infected adults enrolled in routine care across 5 sites in the United States, we included participants with a baseline patient-reported outcome measure and detectable viral load who initiated ART between 2011 and 2014. Participants were followed until the earliest of the following: first suicidal thoughts, discontinuation of initial ART regimen, death, loss to care (>12 months with no HIV appointments), or administrative censoring (2014 to 2015). Suicidal thoughts were measured using a Patient Health Questionnaire-9 item. We used weighted marginal structural Cox models to estimate the effect of initiating efavirenz-containing ART, versus efavirenz-free ART, on the hazard of active or passive suicidal thoughts after ART initiation, accounting for confounding by channeling bias. Results Overall, 597 participants were followed for a median of 19 months (13,132 total person-months); 147 (25%) initiated efavirenz-containing ART. At ART initiation, 38% of participants reported suicidal thoughts or depressive symptoms. Initiating efavirenz-based ART was associated with a hazard ratio (HR) for suicidal thoughts below the null in the crude analysis (HR 0.88 (95% CI 0.53, 1.45), and above the null in the weighted analysis (HR 1.21, 95% CI 0.66, 2.28). Among those with a prior mental health issue, the weighted HR was 1.76 (95% CI 0.45, 6.86). Conclusions After accounting for measured channeling bias, we observed no strong evidence that initiating efavirenz-containing ART increased the hazard of suicidal thoughts.

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“…55 Suicide decedents tend to spend more time in the hospital for both medical and psychiatric reasons in the months prior to their death, endorse lower global quality of life assessment scores, and suffer from more physical impairment. 29,53 Similar risk for depression and suicide is also found in adolescent populations with chronic physical illnesses. 56 While some illnesses cannot be cured, the amount of disability or functioning may be modifiable with therapy.…”

Section: Management Goalsmentioning

confidence: 82%

“…39,52,53 This risk is significantly greater during active periods of illness and correlates with severity of illness. 48,54 Hopelessness in the setting of depression increases the risk for suicide and is typically modifiable with treatment of the mental health disorder.…”

Section: Management Goalsmentioning

confidence: 99%

Psychiatric Emergencies

Weber

Michail

Thompson

et al. 2017

Medical Clinics of North America

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SYNOPSIS The assessment of suicide risk is a daunting, but increasingly frequent task for the outpatient practitioner. Guidelines for depression screening identify more individuals at risk for treatment and mental health resources are not always easily accessible. For those patients identified as in need of a formal risk assessment, this article reviews established risk and protective factors for suicide and provides a framework for the assessment and management of individuals at risk of suicide. The assessment should be explicitly documented with a summary of the most relevant risk/protective factors for that individual with a focus on interventions that may mitigate risk such as means restriction, psychotherapy and pharmacotherapy for psychiatric disorders or substance use, hospitalization, and safety planning.

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Prevalence and correlates of suicidal ideation and suicide attempts among veterans in primary care referred for a mental health evaluation

Cited by 43 publications

References 39 publications

Cannabis use disorder and suicide attempts in Iraq/Afghanistan-era veterans

Cannabis use disorder and suicide attempts in Iraq/Afghanistan-era veterans

The Relationship Between Efavirenz as Initial Antiretroviral Therapy and Suicidal Thoughts Among HIV-Infected Adults in Routine Care

Psychiatric Emergencies

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