A network analysis of risk factors for suicide in Iraq/Afghanistan-era veterans

Graziano, Robert; Aunon, Frances M.; LoSavio, Stefanie T.; Elbogen, Eric B.; Beckham, Jean C.; Dillon, Kirsten H.; Brancu, Mira; Calhoun, Patrick S.; Dedert, Eric A.; Fairbank, John A.; Hurley, Robin A.; Kilts, Jason D.; Kimbrel, Nathan A.; Kirby, Angela C.; Marx, Christine E.; McDonald, Scott D.; Moore, Scott D.; Morey, Rajendra A.; Naylor, Jennifer C.; Rowland, Jared A.; Shura, Robert D.; Swinkels, Cindy; Szabo, Steven T.; Taber, Katherine H.; Tupler, Larry A.; Voorhees, Elizabeth E. Van; Yoash-Gantz, Ruth E.

doi:10.1016/j.jpsychires.2021.03.065

Cited by 16 publications

(8 citation statements)

References 62 publications

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“…At the same time, PTSD symptoms might be more important for nonattempters. In previous studies, PTSD symptoms have emerged as cross‐sectional (Graziano et al, 2021) and longitudinal predictors of SB using network analysis (Spitzer et al, 2020). However, according to the edge difference test, PTSD and depression symptoms were of equal importance as perceived burdensomeness in attempters, whereas depression symptoms and insomnia were of equal importance in nonattempters in the current sample.…”

Section: Discussionmentioning

confidence: 99%

“…The use of network analysis to investigate SB is in a relatively nascent stage. To date, network analysis has been used to examine cross‐sectional predictors of SI in community samples (Bloch‐Elkouby et al, 2020; de Beurs et al, 2019; Gijzen et al, 2021; Ordóñez‐Carrasco et al, 2021), clinical samples (Bloch‐Elkouby et al, 2020; Schönfelder et al, 2021), and in veterans (Armour et al, 2017; Graziano et al, 2021; Simons et al, 2019). Across these cross‐sectional studies, perceived burdensomeness, psychological pain, defeat, loneliness, rumination, internal entrapment, and self‐destructive behavior were significantly related to the presence and severity of SI.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors of suicidal behaviors in ahigh‐risklongitudinal veteran sample: A network analysis

Saulnier

Volarov

Velimirović

et al. 2022

Suicide & Life Threat Behav

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Introduction: Suicide is a substantial public health burden, particularly among veterans. Risk factors have been delineated for suicide; however, the dynamic interrelations between risk factors have not been fully examined. Such research has the potential to elucidate processes that contribute to suicide risk between individuals with a past suicide attempt (attempters) and those without a past suicide attempt (nonattempters). Methods:In the current study, network analysis was used to compare networks between attempters and nonattempters in a high-risk veteran sample (N = 770; M age = 32.3 years, SD = 6.8; 326 with a past suicide attempt) who were followed over 1 year. Networks were estimated to examine (1) concurrent relations of suicide risk factors at baseline and (2) predictability of prospective suicidal behavior (SB).Results: There were no differences in the overall connectivity of attempter and nonattempter networks. Perceived burdensomeness and posttraumatic stress disorder (PTSD) symptoms were most central in the attempters' network, whereas PTSD symptoms and insomnia were most central in the nonattempters' network. The risk factors prospective SB in either network. However, attempters were more likely to engage in SB over the course of the study. Conclusion:These findings highlight the difficulty in predicting who will attempt suicide.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk factors of suicidal behaviors in ahigh‐risklongitudinal veteran sample: A network analysis

Saulnier

Volarov

Velimirović

et al. 2022

Suicide & Life Threat Behav

View full text Add to dashboard Cite

show abstract

“…For example, contrary to expected results, a study of depressed individuals found anxiety symptoms to have similar importance (centrality) as depressive symptoms to the maintenance of major depressive disorder (Fried et al, 2016), highlighting the importance of addressing anxiety symptoms in those who present for depressive concerns. Further, a study of risk factors in veteran suicide, showed a number of key relationships such as PTSD only indirectly predicting suicidal ideation (SI; through depressive symptoms) and anger directly predicting SI (Graziano et al, 2021).…”

Section: Network Analysismentioning

confidence: 99%

Examination of PTSD symptom networks over the course of cognitive processing therapy.

Graziano¹,

LoSavio²,

White³

et al. 2024

Psychological Trauma: Theory, Research, Practice, and Policy

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Objectives: Cognitive processing therapy (CPT) is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD); however, little is known about how interrelationships between PTSD symptoms change over the course of treatment. The current study examined baseline, midtreatment, and posttreatment PTSD symptom networks during CPT for PTSD. Method: Adults with PTSD (n = 107) received 12 sessions of CPT as part of a randomized trial. Self-reported PTSD symptoms were assessed at pretreatment, midtreatment, and posttreatment, and network analysis was used to examine the interrelationships between symptoms at these three timepoints. Linear regression was conducted to examine whether any baseline symptoms or midpoint symptoms predicted overall treatment change. Results: In the baseline PTSD network, feelings of detachment and feeling upset at reminders of the trauma were central to the symptom network. These symptoms were no longer central at midtreatment, possibly suggesting that CPT quickly reduces the importance of these symptoms. These findings were consistent with regression results that, after accounting for multiple comparisons, high baseline scores of feeling upset at trauma reminders predicted later treatment change. At the conclusion of treatment, strong negative emotions were the most central symptom and may be most important in maintaining or lowering other PTSD symptoms at the conclusion of treatment. Conclusions: Though replication is necessary, these findings offer insights into identifying which symptoms may be most predictive of treatment outcomes and the course by which CPT reduces PTSD symptoms. Clinical Impact StatementThis study examined how the relationships between symptoms of PTSD change over the course of CPT. Before treatment, detachment and feeling upset from reminders of the trauma were found to be important in maintaining the other PTSD symptoms, but over the course of treatment this did not persist. In fact, individuals with high levels of feeling upset from reminders of the trauma, experienced the greatest reductions in PTSD symptoms.

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“…Unfortunately, the previously mentioned variables are the only characteristics that have been examined in relation to suicide risk among suicide‐exposed SMVs. Other factors known to be related to suicide risk in SMVs, such as substance use, depression, anxiety, insomnia, PTSD symptoms, and interpersonal theory variables (e.g., thwarted belongingness, fearlessness about death) (Graziano et al, 2021; Hom et al, 2019; Pompili et al, 2013; Pruitt et al, 2019), have yet to be concurrently examined in relation to suicide risk after suicide exposure in this population. Increased mental health symptoms, reliance on substance use, and feeling like one does not belong could all be important for understanding the impact of suicide exposure given prior evidence that these factors can increase suicidal desire following an extremely stressful experience, such as losing someone to suicide (Gradus et al, 2013; Kline et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Suicide risk profiles among service members and veterans exposed to suicide

Peterson,

Chen,

Bozzay

et al. 2023

J Clin Psychol

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ObjectivesRates of suicide exposure are high among service members and Veterans and are especially concerning given the link between suicide exposure and subsequent suicide risk. However, to date, it is unclear which individuals who are exposed to suicide are subsequently at high risk for suicide. Latent profile analysis (LPA) can provide information on unique risk profiles and subgroups of service members and Veterans who have higher suicide risk after suicide exposure, which has not yet been empirically studied. The purpose of this study was to utilize LPA to identify subgroups of service members and Veterans who are at the highest risk for suicidal thoughts and behaviors following suicide exposure.MethodsWe analyzed data using LPA from 2570 service members and Veterans (82.1% male, 69.5% White, and 12.1% Latino/a/x) who completed the Military Suicide Research Consortium's Common Data Elements, a battery of self‐report suicide‐related measures. Psychopathology, substance use, mental health service utilization, interpersonal theory of suicide, and suicide exposure variables were used to validate classes.ResultsThree latent classes emerged from analyses, one low‐risk class and two‐high risk classes with differing profile compositions (one primarily differentiated by anxiety symptoms and one differentiated by substance use).ConclusionClass‐specific recommendations for suicide prevention efforts will be discussed.

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A network analysis of risk factors for suicide in Iraq/Afghanistan-era veterans

Cited by 16 publications

References 62 publications

Risk factors of suicidal behaviors in ahigh‐risklongitudinal veteran sample: A network analysis

Risk factors of suicidal behaviors in ahigh‐risklongitudinal veteran sample: A network analysis

Examination of PTSD symptom networks over the course of cognitive processing therapy.

Suicide risk profiles among service members and veterans exposed to suicide

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