Cognitive Therapy and Research

, Volume 40, Issue 1, pp 22–30 | Cite as

The Interactive Effects of the Capability for Suicide and Major Depressive Episodes on Suicidal Behavior in a Military Sample

  • Carol Chu
  • Matthew C. Podlogar
  • Christopher R. Hagan
  • Jennifer M. Buchman-Schmitt
  • Caroline Silva
  • Bruno Chiurliza
  • Jennifer L. Hames
  • Ian H. Stanley
  • Ingrid C. Lim
  • Thomas E. Joiner
Original Article


Major depressive symptoms are associated with increased risk for suicidal ideation and behavior. Suicide is fearsome; as such, the interpersonal theory of suicide proposes that individuals who engage in suicidal behavior possess not only the desire to die, but also the acquired capability (AC) for suicide. This study examined whether major depressive episodes (MDEs) may be particularly relevant to suicidal behavior when considered in the context of AC. History of MDEs, AC, and suicide attempt history were examined in a large (n = 3377) sample of military members. Data were analyzed using hierarchical multiple regression. Results indicated that among individuals with high AC, the number of MDEs was significantly, positively associated with number of previous suicide attempts; MDEs were not significantly related to suicide attempt history among individuals with low AC. Findings held in the presence of robust covariates associated with suicidal behavior. Findings suggest that a history of MDEs alone may not indicate severe suicide risk—increased AC for suicide appears necessary for increased suicide risk. Implications for suicide treatment and prevention in military personnel are discussed.


Military Suicide Major depressive episodes Acquired capability for suicide 



This work was supported, in part, by the Military Suicide Research Consortium, an effort supported by the Office of the Assistant Secretary of Defense for Health Affairs under Award No. (W81XWH-10-2-0181). This research was also partially supported by grants from the National Institute of Mental Health to Carol Chu (5 T32 MH093311-04) and Jennifer M. Buchman-Schmitt (5 T32 MH093311-04).

Compliance with Ethical Standards

Conflict of Interest

Carol Chu, Matthew C. Podlogar, Christopher R. Hagan, Jennifer M. Buchman-Schmitt, Caroline Silva, Bruno Chiurliza, Jennifer L. Hames, Ian H. Stanley, Ingrid C. Lim, Thomas E. Joiner declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the university and the United Stated Army Medical Department’s institutional research boards and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Animal Rights

No animal studies were carried out by the authors for this article.


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, text revision (DSM-IV-TR). American Psychiatric Association.Google Scholar
  2. Anestis, M. D., Bryan, C. J., Cornette, M. M., & Joiner, T. E. (2009). Understanding suicidal behavior in the military: An evaluation of joiner’s interpersonal-psychological theory of suicidal behavior in two case studies of active duty post-deployers. Journal of Mental Health Counseling, 31(1), 60–75.CrossRefGoogle Scholar
  3. Bastien, C. H., Vallières, A., & Morin, C. M. (2001). Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Medicine, 2, 297–307.CrossRefPubMedGoogle Scholar
  4. Bender, T. W., Gordon, K. H., Bresin, K., & Joiner, T. E. (2011). Impulsivity and suicidality: The mediating role of painful and provocative experiences. Journal of Affective Disorders, 129, 301–307.CrossRefPubMedGoogle Scholar
  5. Bryan, C. J. (2011). The clinical utility of a brief measure of perceived burdensomeness and thwarted belongingness for the detection of suicidal military personnel. Journal of Clinical Psychology, 67(10), 981–992.CrossRefPubMedGoogle Scholar
  6. Bryan, C. J., Cukrowicz, K. C., West, C. L., & Morrow, C. E. (2010). Combat experience and the acquired capability for suicide. Journal of Clinical Psychology, 66(10), 1044–1056.CrossRefPubMedGoogle Scholar
  7. Bryan, C. J., Clemans, T. A., & Hernandez, A. M. (2012). Perceived burdensomeness, fearlessness of death, and suicidality among deployed military personnel. Personality and Individual Differences, 52(3), 374–379.CrossRefGoogle Scholar
  8. Ellis, T. E., & Rufino, K. A. (2015). A psychometric study of the Suicide Cognitions Scale with psychiatric inpatients. Psychological Assessment, 27(1), 82–89.CrossRefPubMedGoogle Scholar
  9. Fennig, S., Craig, T. J., Tanenberg-Karant, M., & Bromet, E. J. (1994). Comparison of facility and research diagnoses in first-admission psychotic patients. The American Journal of Psychiatry, 151, 1423–1429.CrossRefPubMedGoogle Scholar
  10. Franklin, J. C., Hessel, E. T., & Prinstein, M. J. (2011). Clarifying the role of pain tolerance in suicidal capability. Psychiatry Research, 189(3), 362–367.CrossRefPubMedGoogle Scholar
  11. Gadermann, A. M., Engel, C. C., Naifeh, J. A., Nock, M. K., Petukhova, M., Santiago, L. P. N., et al. (2012). Prevalence of DSM-IV major depression among US military personnel: Meta-analysis and simulation. Psychological Health and Traumatic Brain Injury, 177(8), 47–59.Google Scholar
  12. Greene-Shortridge, T. M., Britt, T. W., & Castro, C. A. (2007). The stigma of mental health problems in the military. Military Medicine, 172(2), 157–161.CrossRefPubMedGoogle Scholar
  13. Harkavy-Friedman, J. M., Nelson, E. A., Venarde, D. F., & Mann, J. J. (2004). Suicidal behavior in schizophrenia and schizoaffective disorder: Examining the role of depression. Suicide and Life-Threatening Behavior, 34(1), 66–76.CrossRefPubMedGoogle Scholar
  14. Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.Google Scholar
  15. Joiner, T. E., & Lonigan, C. J. (2000). Tripartite model of depression and anxiety in youth psychiatric inpatients: Relations with diagnostic status and future symptoms. Journal of Clinical Child Psychology, 29(3), 372–382.CrossRefPubMedGoogle Scholar
  16. Joiner, T. E., Pfaff, J. J., & Acres, J. G. (2002). A brief screening tool for suicidal symptoms in adolescents and young adults in general health settings: Reliability and validity data from the Australian National General Practice Youth Suicide Prevention Project. Behaviour Research and Therapy, 40, 471–481.CrossRefPubMedGoogle Scholar
  17. Kang, H. K., & Bullman, T. A. (2009). Is there an epidemic of suicides among current and former US military personnel? Annals of Epidemiology, 19(10), 757–760.CrossRefPubMedGoogle Scholar
  18. Kessler, R. C., Borges, G., & Walters, E. E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry, 56(7), 617–626.CrossRefPubMedGoogle Scholar
  19. Kessler, R. C., Colpe, L. J., Fullerton, C. S., Gebler, N., Naifeh, J. A., Nock, M. K., & Heeringa, S. G. (2013). Design of the army study to assess risk and resilience in servicemembers (Army STARRS). International Journal of Methods in Psychiatric Research, 22(4), 267–275.PubMedCentralCrossRefPubMedGoogle Scholar
  20. Klonsky, E. D., & May, A. M. (2014). Differentiating suicide attempters from suicide ideators: A critical frontier for suicidology research. Suicide and Life-Threatening Behavior, 44(1), 1–5.CrossRefPubMedGoogle Scholar
  21. Kuehn, B. M. (2009). Soldier suicide rates continue to rise. JAMA, 301(11), 1111–1113.CrossRefPubMedGoogle Scholar
  22. LeardMann, C. A., Powell, T. M., Smith, T. C., Bell, M. R., Smith, B., Boyko, E. J., & Hoge, C. W. (2013). Risk factors associated with suicide in current and former US military personnel. JAMA, 310(5), 496–506.CrossRefPubMedGoogle Scholar
  23. Lonigan, C. J., Carey, M. P., & Finch, A. J. (1994). Anxiety and depression in children and adolescents: Negative affectivity and the utility of self-reports. Journal of Consulting and Clinical Psychology, 62(5), 1000–1008.CrossRefPubMedGoogle Scholar
  24. McGirr, A., Renaud, J., Seguin, M., Alda, M., & Turecki, G. (2008). Course of major depressive disorder and suicide outcome: A psychological autopsy study. The Journal of Clinical Psychiatry, 69(6), 966–970.Google Scholar
  25. Metalsky, G. I., & Joiner, T. E. (1997). The hopelessness depression symptom questionnaire. Cognitive Therapy and Research, 21, 359–384.CrossRefGoogle Scholar
  26. Morin, C. M., Belleville, G., Bélanger, L., & Ivers, H. (2011). The insomnia severity index: Psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep, 34, 601–608.PubMedCentralPubMedGoogle Scholar
  27. Nademin, E., Jobes, D. A., Pflanz, S. E., Jacoby, A. M., Ghahramanlou-Holloway, M., Campise, R., & Johnson, L. (2008). An investigation of interpersonal-psychological variables in air force suicides: A controlled-comparison study. Archives of Suicide Research, 12(4), 309–326.CrossRefPubMedGoogle Scholar
  28. Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., & Lee, S. (2008). Suicide and suicidal behavior. Epidemiologic Reviews, 30(1), 133–154.PubMedCentralCrossRefPubMedGoogle Scholar
  29. Nock, M. K., Hwang, I., Sampson, N. A., & Kessler, R. C. (2010). Mental disorders, comorbidity and suicidal behavior: Results from the National Comorbidity Survey Replication. Molecular Psychiatry, 15(8), 868–876.PubMedCentralCrossRefPubMedGoogle Scholar
  30. Nock, M. K., Borges, G., & Ono, Y. (Eds.). (2012). Suicide: Global perspectives from the WHO World Mental Health Surveys. New York: Cambridge University Press.Google Scholar
  31. Nock, M. K., Deming, C. A., Fullerton, C. S., Gilman, S. E., Goldenberg, M., Kessler, R. C., & Ursano, R. J. (2013). Suicide among soldiers: A review of psychosocial risk and protective factors. Psychiatry, 76(2), 97–125.PubMedCentralCrossRefPubMedGoogle Scholar
  32. O’Connor, R. (2011). Towards an integrated motivational–volitional model of suicidal behaviour. International handbook of suicide prevention: Research, policy and practice (pp. 181–198). Chichester, UK: John Wiley & Sons, Ltd.Google Scholar
  33. Pompili, M., Innamorati, M., Forte, A., Longo, L., Mazzetta, C., Erbuto, D., & Girardi, P. (2013). Insomnia as a predictor of high-lethality suicide attempts. International Journal of Clinical Practice, 67(12), 1311–1316.CrossRefPubMedGoogle Scholar
  34. Ribeiro, J. (2013). Acute overarousal and the acquired capability for suicide: Understanding acute suicide risk through the lens of the interpersonal theory of suicide (unpublished doctoral dissertation). Tallahassee, FL: Florida State University.Google Scholar
  35. Ribeiro, J. D., Bender, T. W., Selby, E. A., Hames, J. L., & Joiner, T. E. (2011). Development and validation of a brief self-report measure of agitation: The brief agitation measure. Journal of Personality Assessment, 93, 597–604.CrossRefPubMedGoogle Scholar
  36. Ribeiro, J. D., Braithwaite, S. R., Pfaff, J. J., & Joiner, T. E. (2012). Examining a brief suicidal screening tool in older adults engaging in risky alcohol use. Suicide and Life-Threatening Behavior, 42, 405–415.CrossRefPubMedGoogle Scholar
  37. Ribeiro, J. D., Witte, T. K., Van Orden, K. A., Selby, E. A., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2014). Fearlessness about death: The psychometric properties and construct validity of the revision to the acquired capability for suicide scale. Psychological Assessment, 26, 115–126.PubMedCentralCrossRefPubMedGoogle Scholar
  38. Ribeiro, J. D., Yen, S., Joiner, T., & Siegler, I. C. (2015). Capability for suicide interacts with states of heightened arousal to predict death by suicide beyond the Effects of depression and hopelessness. Journal of Affective Disorders, 188, 53–59.Google Scholar
  39. Rudd, M. D., Joiner, T. E., & Rajab, M. H. (2004). Treating suicidal behavior: An effective, time-limited approach. New York, NY: Guilford Press.Google Scholar
  40. Schoenbaum, M., Kessler, R. C., Gilman, S. E., Colpe, L. J., Heeringa, S. G., Stein, M. B., & Cox, K. L. (2014). Predictors of suicide and accident death in the army study to assess risk and resilience in servicemembers (Army STARRS): Results from the army study to assess risk and resilience in servicemembers (Army STARRS). JAMA Psychiatry, 71(5), 493–503.PubMedCentralCrossRefPubMedGoogle Scholar
  41. Selby, E. A., Anestis, M. D., Bender, T. W., Ribeiro, J. D., Nock, M. K., Rudd, M. D., & Joiner, T. E. (2010). Overcoming the fear of lethal injury: Evaluating suicidal behavior in the military through the lens of the interpersonal-psychological theory of suicide. Clinical Psychology Review, 30(3), 298–307.PubMedCentralCrossRefPubMedGoogle Scholar
  42. Smith, P. N., & Cukrowicz, K. C. (2010). Capable of suicide: A functional model of the acquired capability component of the interpersonal-psychological theory of suicide. Suicide and Life-Threatening Behavior, 40(3), 266–274.CrossRefPubMedGoogle Scholar
  43. Smith, P. N., Cukrowicz, K. C., Poindexter, E. K., Hobson, V., & Cohen, L. M. (2010). The acquired capability for suicide: A comparison of suicide attempters, suicide ideators, and non-suicidal controls. Depression and Anxiety, 27(9), 871–877.CrossRefPubMedGoogle Scholar
  44. Smith, A. R., Fink, E. L., Anestis, M. D., Ribeiro, J. D., Gordon, K. H., Davis, H., & Joiner, T. E. (2013). Exercise caution: Over-exercise is associated with suicidality among individuals with disordered eating. Psychiatry Research, 206(2), 246–255.CrossRefPubMedGoogle Scholar
  45. Street, A. E., Gilman, S. E., Rosellini, A. J., Stein, M. B., Bromet, E. J., Cox, K. L., & Kessler, R. C. (2015). Understanding the elevated suicide risk of female soldiers during deployments. Psychological Medicine, 45, 717–726.CrossRefPubMedGoogle Scholar
  46. United States Army. (2010). Health promotion, risk reduction, and suicide prevention report. Retrieved from:
  47. Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2008). Suicidal desire and the capability for suicide: Tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76, 72–83.CrossRefPubMedGoogle Scholar
  48. Van Orden, K. A., Witte, T. K., Curkrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117, 575–600.PubMedCentralCrossRefPubMedGoogle Scholar
  49. World Health Organization. (2014). Preventing suicide: A global imperative. Retrieved from: Accessed 26 Feb 2015.

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Carol Chu
    • 1
  • Matthew C. Podlogar
    • 1
  • Christopher R. Hagan
    • 1
  • Jennifer M. Buchman-Schmitt
    • 1
  • Caroline Silva
    • 1
  • Bruno Chiurliza
    • 1
  • Jennifer L. Hames
    • 1
  • Ian H. Stanley
    • 1
  • Ingrid C. Lim
    • 2
  • Thomas E. Joiner
    • 1
  1. 1.Department of PsychologyFlorida State UniversityTallahasseeUSA
  2. 2.Office of the Surgeon General, Defense Health HeadquartersFalls ChurchUSA

Personalised recommendations