Journal Article Annotations
2018, 4th Quarter
Annotations by Kemuel Philbrick, MD, FACLP
Type of study: Case control
The finding: Gender (female) and education (less than high-school completion) were the two socio-demographic variables of significance for risk of suicide attempt in the multivariable model. Lifetime history of interpersonal violence, legal problems, and relationship problems were the stressor variables most associated with suicide attempt. Major depression, posttraumatic stress disorder and substance use disorder were the psychiatric diagnoses most associated with suicide attempt. When attempting to identify factors that distinguished between those with suicidal ideation and those with suicide attempts, only posttraumatic stress disorder was positively associated whereas a history of intermittent explosive disorder and at least some college education were negatively associated.
Strength and weaknesses: This study was creatively designed in an attempt to shed light on factors that might contribute to the transition of suicidal ideation to action. It is a challenging endeavor in that many, if not most, of the risk factors for suicide attempt are also risk factors for suicidal ideation. The negative multivariable association of intermittent explosive disorder with suicide attempt could reflect that anger may play a different role (potentially adaptive) in military populations; results in a civilian population may be different. All participants in this study were volunteers and might not therefore fully reflect the target population.
Relevance: Consultation psychiatrists regularly face the challenge of discerning likely subsequent risk for suicide in individuals who prompt a consult request due to perceived or expressed suicidal ideation. Although this study was conducted in U.S. Army soldiers, it serves to remind us of the potential effects of comorbid posttraumatic stress disorder in our patients who experience suicidal ideation.