The Interactive Effects of the Capability for Suicide and Major Depressive Episodes on Suicidal Behavior in a Military Sample
- 441 Downloads
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.
KeywordsMilitary 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.
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 was obtained from all individual participants included in the study.
No animal studies were carried out by the authors for this article.
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, text revision (DSM-IV-TR). American Psychiatric Association.Google Scholar
- 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
- 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
- Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.Google Scholar
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- United States Army. (2010). Health promotion, risk reduction, and suicide prevention report. Retrieved from: http://csf.army.mil/downloads/HP-RR-SPReport2010.pdf.
- 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
- World Health Organization. (2014). Preventing suicide: A global imperative. Retrieved from: http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/. Accessed 26 Feb 2015.