Description
Of the substance disorders, alcohol-related disorders are the most prevalent even though only a small percentage of individuals actually receive help. Recidivism in the substance treatment world is also very high. As research into treatment has developed, more and more evidence shows that genes for alcohol-metabolizing enzymes can vary by genetic inheritance. Women have been identified as particularly vulnerable to the impacts of alcohol. Native Americans, Asians, and some Hispanic and Celtic cultures also have increased vulnerability to alcohol misuse.
Even with these developments, treatment continues to spark debate. For many years, the substance use field itself has disagreed with mental health experts as to what treatments are the most effective for substance use disorders and how to improve outcomes. The debate is often over medication-assisted treatment (MAT) versus abstinence-based treatment (ABT). Recently the American Psychiatric Association has issued guidelines to help clinicians consider integrated solutions for those suffering with these disorders. In this Discussion, you consider your treatment plan for an individual with a substance use disorder.
In preparation for the Assignment:
Read “The Case of Kaylin” and the materials for the Assignment (ATTACHED)
In your Assignment:
- Assume that you are the social worker meeting with Kaylin and you recorded this case.
- Provide the full DSM-5 diagnosis for Kaylin. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may need clinical attention).
- Identify and describe the assessment(s) you would use to validate her diagnosis, clarify missing information, or track her progress.
- Clearly describe how you would explain the diagnosis to Kaylin.
- Explain how you would engage her in treatment
- Identifying potential cultural considerations related to substance use.
- Describe your initial recommendations for her treatment and explain why you would recommend MAT or ABT.
- Identify specific resources to which you would refer her and explain for each resource why you would recommend it based on her diagnosis and other identity characteristics (e.g., age, sex, gender, sexual orientation, class, ethnicity, religion, etc.).
- Thoroughly support each of your explanations with social work concepts, theory, and principles from the assigned learning materials and from the scholarly articles you selected.
- Document your references and cite them throughout your post following APA guidelines.
The Case of Kaylin Ma
Kaylin is 22 years old and the oldest child of two working-class parents. Her father is a
heating and air conditioning technician, and her mother is an administrative assistant at
a local community college. Both parents immigrated from Korea as children. Kaylin has
one younger brother, aged 9, who has been diagnosed with attention deficit
hyperactivity disorder (ADHD). Kaylin appeared normally dressed and is 5’4” tall.
Kaylin’s childhood was otherwise unremarkable. She reported that she has always
worked hard at school and generally was an “A” student through high school. She ran
track and was involved in many activities, socializing with boyfriends and her wide
friendship circle. She reported no particular difficulties with her parents other than
fighting with them over her decision to leave the state for college. After delaying
admission for a year and working, Kaylin left her home in New Hampshire at 20 to
attend college in Florida. As a freshman, she lived off campus with three other
roommates. She has been waitressing in Tampa since freshman year at a
bar/restaurant to supplement financial aid for tuition. She had very good grades (B+ to
A) in her first 2 years of college.
Kaylin is now a junior. She complained of chronic anxiety and problems with
concentration and attention. She still works long hours, and she recently took a course
in bartending so she can serve drinks and “make more.” She had managed to maintain
a B+ grade point average while studying juvenile justice up until this year. Kaylin initially
began drinking with friends at the restaurant after closing during her second semester of
sophomore year. She now drinks regularly on weekends with her college and “bar”
friends. She reported that since her 21st birthday party she has at times been “out all
night partying and drinking.”
She missed enough classes this year that her grades have begun to suffer. She had to
drop at least one course (and will need to retake it next year) due to nonattendance.
“This is because I don’t get enough sleep,” Kaylin said, and she stated that she was
simply unable to wake up in time for that course.
Kaylin attended this session with the social work counselor on campus because she
hadn’t been interested much in food this past semester. Her roommates insisted that
she get some help, as she had gone from “slight” to “reed thin.” Kaylin stated that they
are worried that she has an eating disorder. Kaylin denied any eating disorder, but she
admitted that she often has no time for meals and at times has “no appetite.” She often
reported mild nausea. Current weight was reported at 104 pounds.
Upon further assessment, Kaylin reported that she spent much of the last 2 months of
weekends drinking at her workplace as well as at college parties. She used “hair of the
dog” practices—e.g., a morning Bloody Mary—to feel better this past month, as she
sometimes had mild hand tremors in the morning and was strongly nauseous. She
admitted to being “foggy.” During these weekend experiences, she claimed to have full
memory (she denies blackouts) but reported that the hangovers make her “sound
sensitive” with headaches. She said she “feels” normal by the end of the day most
Mondays, but she also stated that she has trouble sleeping several nights a week
without an evening beer. Her mood varies over the week, and she admitted to chronic
anxiety and some tendency to get into “arguments” with her roommates when sober.
She set some limits for herself, such as three cocktails per weekend evening, but she
has often “not bothered” to maintain those limits for “other reasons.” She admitted
occasional alcohol use in high school, but her status as a varsity athlete motivated her
to limit her use. At the time of the assessment she was not involved in sports, clubs, or
other steady exercise, and she stated that she “has no time” for that or for boyfriends.
Journal of Psychiatric Research 79 (2016) 108e115
Contents lists available at ScienceDirect
Journal of Psychiatric Research
journal homepage: www.elsevier.com/locate/psychires
Insomnia brings soldiers into mental health treatment, predicts
treatment engagement, and outperforms other suicide-related
symptoms as a predictor of major depressive episodes
Melanie A. Hom a, *, Ingrid C. Lim b, Ian H. Stanley a, Bruno Chiurliza a,
Matthew C. Podlogar a, Matthew S. Michaels a, Jennifer M. Buchman-Schmitt a,
Caroline Silva a, Jessica D. Ribeiro c, Thomas E. Joiner Jr. a
a
Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee FL 32306, United States
Office of the Army Surgeon General, 7700 Arlington Boulevard, Falls Church, VA 22041, United States
c
Department of Psychological Sciences, Vanderbilt University, 111 21st Avenue South, Nashville, TN 37240, United States
b
a r t i c l e i n f o
a b s t r a c t
Article history:
Received 29 August 2015
Received in revised form
4 April 2016
Accepted 9 May 2016
Given the high rates of suicide among military personnel and the need to characterize suicide risk factors
associated with mental health service use, this study aimed to identify suicide-relevant factors that
predict: (1) treatment engagement and treatment adherence, and (2) suicide attempts, suicidal ideation,
and major depressive episodes in a military sample. Army recruiters (N ¼ 2596) completed a battery of
self-report measures upon study enrollment. Eighteen months later, information regarding suicide attempts, suicidal ideation, major depressive episodes, and mental health visits were obtained from participants’ military medical records. Suicide attempts and suicidal ideation were very rare in this sample;
negative binomial regression analyses with robust estimation were used to assess correlates and predictors of mental health treatment visits and major depressive episodes. More severe insomnia and
agitation were significantly associated with mental health visits at baseline and over the 18-month study
period. In contrast, suicide-specific hopelessness was significantly associated with fewer mental health
visits. Insomnia severity was the only significant predictor of major depressive episodes. Findings suggest
that assessment of sleep problems might be useful in identifying at-risk military service members who
may engage in mental health treatment. Additional research is warranted to examine the predictive
validity of these suicide-related symptom measures in a more representative, higher suicide risk military
sample.
© 2016 Elsevier Ltd. All rights reserved.
Keywords:
Suicide
Depression
Sleep
Agitation
Treatment engagement
1. Introduction
Suicide has become a growing problem in the U.S. military, with
research indicating that service members die by suicide at higher
rates than civilians (Kuehn, 2009). These elevated rates may be due,
in part, to risk factors unique to military personnel, such as
military-specific stress (e.g., exposure to killing, physical wounds),
greater access to lethal means (e.g., firearms), and demographic
composition (e.g., predominantly young males; Nock et al., 2013;
Schoenbaum et al., 2014). Consequently, the development of military suicide prevention strategies has become a public health
* Corresponding author.
E-mail address: hom@psy.fsu.edu (M.A. Hom).
http://dx.doi.org/10.1016/j.jpsychires.2016.05.008
0022-3956/© 2016 Elsevier Ltd. All rights reserved.
priority, motivating a marked increase in research in this area (U.S.
Department of Health and Human Services [HHS], 2012). In
particular, connecting at-risk service members to care has been
identified as critical to suicide prevention efforts (Kuehn, 2009;
Brenner and Barnes, 2012).
Although interventions to reduce suicide risk have yielded
promising results among military populations (Britton et al., 2012;
Knox et al., 2012; Rudd et al., 2015; Trockel et al., 2015), many
service members remain reluctant to engage with mental health
services, often due to stigma, negative beliefs about treatment, and
concerns about career impact (Vogt, 2011; Blais et al., 2014; Britt
et al., 2015). Thus, efforts must be made to understand patterns
and predictors of mental health service use among military
personnel, especially those at elevated suicide risk.
As an initial step towards enhancing treatment engagement
M.A. Hom et al. / Journal of Psychiatric Research 79 (2016) 108e115
among at-risk service members, it may be helpful to identify suicide risk factors associated with greater help-seeking behaviors. To
maximize utility, symptoms used to screen for suicide risk should
signal short-term, acute risk rather than long-term risk. Longerterm risk factors may be informative by revealing mechanisms by
which risk is conferred, identifying at-risk sociodemographic or
psychiatric groups (see Nock et al., 2008 for review), and informing
public health prevention approaches (e.g., reducing access to
means for suicide; Mann et al., 2005). However, in clinical settings,
acute warning signs are arguably more useful in informing risk
level categorization and treatment provision. Detection of acute
warning signs may also be useful in gatekeeper training approaches
to suicide prevention (e.g., equipping unit leaders to identify at-risk
unit members).
In considering the vast body of suicide risk factors, there are at
least five short-term risk symptoms assessable via brief, self-report
survey: (1) agitation; (2) insomnia; (3) suicide-specific hopelessness; (4) talk about suicide/reported suicidal ideation; and (5)
interpersonal theory of suicide constructs (i.e., perceived burdensomeness, thwarted belongingness, and capability for suicide).
Each of these factors is supported by a body of literature justifying
its selection as a focus of suicide risk screening (Chu et al., 2015).
Agitation has been shown to be a precursor to suicidal behaviors
(Fawcett et al., 1990), correlated with near-lethal attempts (Hall and
Platt, 1999), and related to higher suicidality among individuals
with a higher capability for suicide (Ribeiro et al., 2015). Insomnia is
also a robust predictor of future suicide risk, including among
military samples (Fawcett et al., 1990; Bernert et al., 2005, 2014;
Ribeiro et al., 2012), even when controlling for depression and
hopelessness (Ribeiro et al., 2012). Relatedly, hopelessness appears
to play an integral role both in the emergence and maintenance of
suicidal thoughts (Beck, 1986; Rudd et al., 2001). Suicidal ideation
itself and disclosure of ideation have also been well-established as
warning signs for suicide (Rudd et al., 2006). Finally, the interpersonal theory of suicide (Joiner, 2005; Van Orden et al., 2010) proposes that three constructs interact to confer risk for suicide:
capability for suicide (i.e., heightened pain tolerance, fearlessness
about death), thwarted belongingness (i.e., unmet need to belong),
and perceived burdensomeness (i.e., feeling like a burden on
others). Capability for suicide may especially be impacted by military service (Selby et al., 2010), and there is evidence for the association between suicidal history and these constructs among
service members (Bryan et al., 2010).
1.1. The present study
Research identifying suicide risk factors associated with treatment engagement is critical to examine within a military sample
since mental health services are more readily available and accessible in this population relative to civilians, for whom structural
barriers are potent (Bruffaerts et al., 2011). Utilizing a large, diverse
sample of U.S. Army recruiters, this study aimed to identify suiciderelated factors: (1) associated with treatment engagement and
adherence; and (2) predicting future suicide risk in a military
sample (i.e., attempts, ideation, major depressive episodes [MDEs]).
Due to a dearth of research examining the relationship between
these variables and treatment engagement indices, a priori hypotheses were not posited.
This study examined predictors of any type of mental health
care visits as well as visits excluding standard mental health
screenings (i.e., Pre-Post-Deployment Health Assessments to detect
deployment-related health concerns) to identify factors predicting
voluntary visits. With regard to utilizing depression as an outcome
measure, although most individuals with depression will not die by
suicide (Bostwick and Pankratz, 2000), depression treatment is a
109
key avenue for suicide prevention since it is one of the most
common psychiatric disorders among suicide decedents (Cavanagh
et al., 2003) and is highly treatable (Mann et al., 2005). As a result,
although MDEs are not the suicide risk factor with the greatest
specificity, taking into account the potentially low rates of suicide
ideation and attempts in this sampledboth of which are rare in the
general populationdMDEs were included at the study’s outset as
an additional outcome measure, with consideration that depression is related to but not the sole contributor to suicide risk.
2. Material and method
2.1. Participants
A total of 3391 Army recruiters and recruiter candidates enrolled
in the study and completed baseline self-report measures. Only
those with available medical record data (N ¼ 2596) were included
in analyses. There were no statistically significant demographic
differences between those with missing medical record data and
those included in the study. Included participants were primarily
male (92.2%) and ranged from 20 to 57 years of age (M ¼ 29.8,
SD ¼ 4.8; see Table 1). Regarding race/ethnicity, 66.4% identified as
White/Caucasian, 14.8% as Black/African American, 13.4% as Hispanic/Latino, 2.8% as Asian, 1.4% as Native Hawaiian/Other Pacific
Islander, and 1.2% as American Indian/Alaska Native.
2.2. Measures
Due to study setting constraints, factor analyses of previous
datasets were used to select a subset of items from each self-report
measure to comprise a brief assessment battery.
2.2.1. Acquired Capability for Suicide Scale (ACSS; Van Orden et al.,
2008; Ribeiro et al., 2014)
An abbreviated 4-item version of the ACSS assessed perceived
fearlessness about death and physical pain tolerance. Respondents
rated four items (e.g., “I am not afraid to die”) on a 5-point Likert
scale. Total scores on the abbreviated ACSS range from 0 to 16, with
higher scores indicating greater perceived pain tolerance and
Table 1
Participant demographics and characteristics (N ¼ 2596).
Characteristic
Sex
Male
Female
Age (M ¼ 29.8, SD ¼ 4.8)
18e24
25e34
35e44
45e54
55e64
Race/Ethnicity
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White or Caucasian
Rank
Sergeant
Staff Sergeant
Sergeant First Class
First Sergeant/Master Sergeant
Command Sergeant Major/Sergeant Major
Second Lieutenant
Captain
Valid %
92.2%
7.8%
12.6%
72.2%
14.5%
0.7%
Purchase answer to see full
attachment
Kaylin is 22 years old and the oldest child of two working-class parents. Her father is a
heating and air conditioning technician, and her mother is an administrative assistant at
a local community college. Both parents immigrated from Korea as children. Kaylin has
one younger brother, aged 9, who has been diagnosed with attention deficit
hyperactivity disorder (ADHD). Kaylin appeared normally dressed and is 5’4” tall.
Kaylin’s childhood was otherwise unremarkable. She reported that she has always
worked hard at school and generally was an “A” student through high school. She ran
track and was involved in many activities, socializing with boyfriends and her wide
friendship circle. She reported no particular difficulties with her parents other than
fighting with them over her decision to leave the state for college. After delaying
admission for a year and working, Kaylin left her home in New Hampshire at 20 to
attend college in Florida. As a freshman, she lived off campus with three other
roommates. She has been waitressing in Tampa since freshman year at a
bar/restaurant to supplement financial aid for tuition. She had very good grades (B+ to
A) in her first 2 years of college.
Kaylin is now a junior. She complained of chronic anxiety and problems with
concentration and attention. She still works long hours, and she recently took a course
in bartending so she can serve drinks and “make more.” She had managed to maintain
a B+ grade point average while studying juvenile justice up until this year. Kaylin initially
began drinking with friends at the restaurant after closing during her second semester of
sophomore year. She now drinks regularly on weekends with her college and “bar”
friends. She reported that since her 21st birthday party she has at times been “out all
night partying and drinking.”
She missed enough classes this year that her grades have begun to suffer. She had to
drop at least one course (and will need to retake it next year) due to nonattendance.
“This is because I don’t get enough sleep,” Kaylin said, and she stated that she was
simply unable to wake up in time for that course.
Kaylin attended this session with the social work counselor on campus because she
hadn’t been interested much in food this past semester. Her roommates insisted that
she get some help, as she had gone from “slight” to “reed thin.” Kaylin stated that they
are worried that she has an eating disorder. Kaylin denied any eating disorder, but she
admitted that she often has no time for meals and at times has “no appetite.” She often
reported mild nausea. Current weight was reported at 104 pounds.
Upon further assessment, Kaylin reported that she spent much of the last 2 months of
weekends drinking at her workplace as well as at college parties. She used “hair of the
dog” practices—e.g., a morning Bloody Mary—to feel better this past month, as she
sometimes had mild hand tremors in the morning and was strongly nauseous. She
admitted to being “foggy.” During these weekend experiences, she claimed to have full
memory (she denies blackouts) but reported that the hangovers make her “sound
sensitive” with headaches. She said she “feels” normal by the end of the day most
Mondays, but she also stated that she has trouble sleeping several nights a week
without an evening beer. Her mood varies over the week, and she admitted to chronic
anxiety and some tendency to get into “arguments” with her roommates when sober.
She set some limits for herself, such as three cocktails per weekend evening, but she
has often “not bothered” to maintain those limits for “other reasons.” She admitted
occasional alcohol use in high school, but her status as a varsity athlete motivated her
to limit her use. At the time of the assessment she was not involved in sports, clubs, or
other steady exercise, and she stated that she “has no time” for that or for boyfriends.
Journal of Psychiatric Research 79 (2016) 108e115
Contents lists available at ScienceDirect
Journal of Psychiatric Research
journal homepage: www.elsevier.com/locate/psychires
Insomnia brings soldiers into mental health treatment, predicts
treatment engagement, and outperforms other suicide-related
symptoms as a predictor of major depressive episodes
Melanie A. Hom a, *, Ingrid C. Lim b, Ian H. Stanley a, Bruno Chiurliza a,
Matthew C. Podlogar a, Matthew S. Michaels a, Jennifer M. Buchman-Schmitt a,
Caroline Silva a, Jessica D. Ribeiro c, Thomas E. Joiner Jr. a
a
Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee FL 32306, United States
Office of the Army Surgeon General, 7700 Arlington Boulevard, Falls Church, VA 22041, United States
c
Department of Psychological Sciences, Vanderbilt University, 111 21st Avenue South, Nashville, TN 37240, United States
b
a r t i c l e i n f o
a b s t r a c t
Article history:
Received 29 August 2015
Received in revised form
4 April 2016
Accepted 9 May 2016
Given the high rates of suicide among military personnel and the need to characterize suicide risk factors
associated with mental health service use, this study aimed to identify suicide-relevant factors that
predict: (1) treatment engagement and treatment adherence, and (2) suicide attempts, suicidal ideation,
and major depressive episodes in a military sample. Army recruiters (N ¼ 2596) completed a battery of
self-report measures upon study enrollment. Eighteen months later, information regarding suicide attempts, suicidal ideation, major depressive episodes, and mental health visits were obtained from participants’ military medical records. Suicide attempts and suicidal ideation were very rare in this sample;
negative binomial regression analyses with robust estimation were used to assess correlates and predictors of mental health treatment visits and major depressive episodes. More severe insomnia and
agitation were significantly associated with mental health visits at baseline and over the 18-month study
period. In contrast, suicide-specific hopelessness was significantly associated with fewer mental health
visits. Insomnia severity was the only significant predictor of major depressive episodes. Findings suggest
that assessment of sleep problems might be useful in identifying at-risk military service members who
may engage in mental health treatment. Additional research is warranted to examine the predictive
validity of these suicide-related symptom measures in a more representative, higher suicide risk military
sample.
© 2016 Elsevier Ltd. All rights reserved.
Keywords:
Suicide
Depression
Sleep
Agitation
Treatment engagement
1. Introduction
Suicide has become a growing problem in the U.S. military, with
research indicating that service members die by suicide at higher
rates than civilians (Kuehn, 2009). These elevated rates may be due,
in part, to risk factors unique to military personnel, such as
military-specific stress (e.g., exposure to killing, physical wounds),
greater access to lethal means (e.g., firearms), and demographic
composition (e.g., predominantly young males; Nock et al., 2013;
Schoenbaum et al., 2014). Consequently, the development of military suicide prevention strategies has become a public health
* Corresponding author.
E-mail address: hom@psy.fsu.edu (M.A. Hom).
http://dx.doi.org/10.1016/j.jpsychires.2016.05.008
0022-3956/© 2016 Elsevier Ltd. All rights reserved.
priority, motivating a marked increase in research in this area (U.S.
Department of Health and Human Services [HHS], 2012). In
particular, connecting at-risk service members to care has been
identified as critical to suicide prevention efforts (Kuehn, 2009;
Brenner and Barnes, 2012).
Although interventions to reduce suicide risk have yielded
promising results among military populations (Britton et al., 2012;
Knox et al., 2012; Rudd et al., 2015; Trockel et al., 2015), many
service members remain reluctant to engage with mental health
services, often due to stigma, negative beliefs about treatment, and
concerns about career impact (Vogt, 2011; Blais et al., 2014; Britt
et al., 2015). Thus, efforts must be made to understand patterns
and predictors of mental health service use among military
personnel, especially those at elevated suicide risk.
As an initial step towards enhancing treatment engagement
M.A. Hom et al. / Journal of Psychiatric Research 79 (2016) 108e115
among at-risk service members, it may be helpful to identify suicide risk factors associated with greater help-seeking behaviors. To
maximize utility, symptoms used to screen for suicide risk should
signal short-term, acute risk rather than long-term risk. Longerterm risk factors may be informative by revealing mechanisms by
which risk is conferred, identifying at-risk sociodemographic or
psychiatric groups (see Nock et al., 2008 for review), and informing
public health prevention approaches (e.g., reducing access to
means for suicide; Mann et al., 2005). However, in clinical settings,
acute warning signs are arguably more useful in informing risk
level categorization and treatment provision. Detection of acute
warning signs may also be useful in gatekeeper training approaches
to suicide prevention (e.g., equipping unit leaders to identify at-risk
unit members).
In considering the vast body of suicide risk factors, there are at
least five short-term risk symptoms assessable via brief, self-report
survey: (1) agitation; (2) insomnia; (3) suicide-specific hopelessness; (4) talk about suicide/reported suicidal ideation; and (5)
interpersonal theory of suicide constructs (i.e., perceived burdensomeness, thwarted belongingness, and capability for suicide).
Each of these factors is supported by a body of literature justifying
its selection as a focus of suicide risk screening (Chu et al., 2015).
Agitation has been shown to be a precursor to suicidal behaviors
(Fawcett et al., 1990), correlated with near-lethal attempts (Hall and
Platt, 1999), and related to higher suicidality among individuals
with a higher capability for suicide (Ribeiro et al., 2015). Insomnia is
also a robust predictor of future suicide risk, including among
military samples (Fawcett et al., 1990; Bernert et al., 2005, 2014;
Ribeiro et al., 2012), even when controlling for depression and
hopelessness (Ribeiro et al., 2012). Relatedly, hopelessness appears
to play an integral role both in the emergence and maintenance of
suicidal thoughts (Beck, 1986; Rudd et al., 2001). Suicidal ideation
itself and disclosure of ideation have also been well-established as
warning signs for suicide (Rudd et al., 2006). Finally, the interpersonal theory of suicide (Joiner, 2005; Van Orden et al., 2010) proposes that three constructs interact to confer risk for suicide:
capability for suicide (i.e., heightened pain tolerance, fearlessness
about death), thwarted belongingness (i.e., unmet need to belong),
and perceived burdensomeness (i.e., feeling like a burden on
others). Capability for suicide may especially be impacted by military service (Selby et al., 2010), and there is evidence for the association between suicidal history and these constructs among
service members (Bryan et al., 2010).
1.1. The present study
Research identifying suicide risk factors associated with treatment engagement is critical to examine within a military sample
since mental health services are more readily available and accessible in this population relative to civilians, for whom structural
barriers are potent (Bruffaerts et al., 2011). Utilizing a large, diverse
sample of U.S. Army recruiters, this study aimed to identify suiciderelated factors: (1) associated with treatment engagement and
adherence; and (2) predicting future suicide risk in a military
sample (i.e., attempts, ideation, major depressive episodes [MDEs]).
Due to a dearth of research examining the relationship between
these variables and treatment engagement indices, a priori hypotheses were not posited.
This study examined predictors of any type of mental health
care visits as well as visits excluding standard mental health
screenings (i.e., Pre-Post-Deployment Health Assessments to detect
deployment-related health concerns) to identify factors predicting
voluntary visits. With regard to utilizing depression as an outcome
measure, although most individuals with depression will not die by
suicide (Bostwick and Pankratz, 2000), depression treatment is a
109
key avenue for suicide prevention since it is one of the most
common psychiatric disorders among suicide decedents (Cavanagh
et al., 2003) and is highly treatable (Mann et al., 2005). As a result,
although MDEs are not the suicide risk factor with the greatest
specificity, taking into account the potentially low rates of suicide
ideation and attempts in this sampledboth of which are rare in the
general populationdMDEs were included at the study’s outset as
an additional outcome measure, with consideration that depression is related to but not the sole contributor to suicide risk.
2. Material and method
2.1. Participants
A total of 3391 Army recruiters and recruiter candidates enrolled
in the study and completed baseline self-report measures. Only
those with available medical record data (N ¼ 2596) were included
in analyses. There were no statistically significant demographic
differences between those with missing medical record data and
those included in the study. Included participants were primarily
male (92.2%) and ranged from 20 to 57 years of age (M ¼ 29.8,
SD ¼ 4.8; see Table 1). Regarding race/ethnicity, 66.4% identified as
White/Caucasian, 14.8% as Black/African American, 13.4% as Hispanic/Latino, 2.8% as Asian, 1.4% as Native Hawaiian/Other Pacific
Islander, and 1.2% as American Indian/Alaska Native.
2.2. Measures
Due to study setting constraints, factor analyses of previous
datasets were used to select a subset of items from each self-report
measure to comprise a brief assessment battery.
2.2.1. Acquired Capability for Suicide Scale (ACSS; Van Orden et al.,
2008; Ribeiro et al., 2014)
An abbreviated 4-item version of the ACSS assessed perceived
fearlessness about death and physical pain tolerance. Respondents
rated four items (e.g., “I am not afraid to die”) on a 5-point Likert
scale. Total scores on the abbreviated ACSS range from 0 to 16, with
higher scores indicating greater perceived pain tolerance and
Table 1
Participant demographics and characteristics (N ¼ 2596).
Characteristic
Sex
Male
Female
Age (M ¼ 29.8, SD ¼ 4.8)
18e24
25e34
35e44
45e54
55e64
Race/Ethnicity
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White or Caucasian
Rank
Sergeant
Staff Sergeant
Sergeant First Class
First Sergeant/Master Sergeant
Command Sergeant Major/Sergeant Major
Second Lieutenant
Captain
Valid %
92.2%
7.8%
12.6%
72.2%
14.5%
0.7%
Purchase answer to see full
attachment
Categories: