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

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Abstract

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.

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Notes

  1. Given previous research indicating strong internal consistency (Joiner et al. 2002; Ribeiro et al. 2012), a moderate alpha coefficient is notable. The lower alpha in the given sample may suggest an underreporting of suicide symptom severity (Nock et al. 2008).

  2. Given that suicide attempt history may be treated as a count variable, we examined our data using poisson regression. In this model, the predictors (acquired capability, MDEs, and their interaction), the criterion variable (suicide attempt history), and covariates were entered. The results from the poisson regression supported our findings: significant effects of acquired capability, MDEs, and their interaction were found (all p < 0.001). However, the goodness-of-fit Chi-squared test was statistically significant, which suggests that the poisson regression results do not fit our data well (Deviance = 123.99, df = 3289, p = 0.038). Thus, multiple regression was selected to characterize the relationship between study variables.

  3. Levels of acquired capability are traditionally higher among military personnel (Bryan et al. 2010). Thus, the interaction was probed at 1.5 SD to capture individuals with lower and higher levels of acquired capability. Notably, interactions were probed at 1 SD, and the pattern of results was the same, such that the simple effect of number of MDEs on suicide attempt history was greater at high levels of acquired capability.

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Acknowledgments

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).

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Authors and Affiliations

  1. Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA

    Carol Chu, Matthew C. Podlogar, Christopher R. Hagan, Jennifer M. Buchman-Schmitt, Caroline Silva, Bruno Chiurliza, Jennifer L. Hames, Ian H. Stanley & Thomas E. Joiner

  2. Office of the Surgeon General, Defense Health Headquarters, 7700 Arlington Blvd, Falls Church, VA, 22042, USA

    Ingrid C. Lim

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  1. Carol Chu
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Correspondence to Carol Chu.

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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.

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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.

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

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

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Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Military Suicide Research Consortium or the United States Department of Defense.

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Chu, C., Podlogar, M.C., Hagan, C.R. et al. The Interactive Effects of the Capability for Suicide and Major Depressive Episodes on Suicidal Behavior in a Military Sample. Cogn Ther Res 40, 22–30 (2016). https://doi.org/10.1007/s10608-015-9727-z

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