Depression and impulsiveness among soldiers who died by suicide: A psychological autopsy study

Shelef, Leah; Korem, Neta; Yavnai, Nirit; Yedidya, Rinat; Ginat, Keren; Shahar, Golan; Yacobi, Assaf

doi:10.1016/j.jad.2018.04.068

Cited by 11 publications

(11 citation statements)

References 45 publications

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“…This understanding becomes critical when assessing soldiers' potential die by suicide. Support for our conclusions can be found in a recent study among IDF soldiers which showed that despite all the soldiers in the study performing an act that was lethal enough to result in death it seems that the intent of the subjects without depression was not as high as the intent of those with depression [49]. The group without depression was more impulsive, and scored lower on the SIS questionnaire [50].…”

Section: Discussionsupporting

confidence: 80%

Suicide ideation severity is associated with severe suicide attempts in a military setting

Shelef

Klomek

Fruchter

et al. 2019

European Psychiatry

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Background: There is an ongoing debate on the effectiveness of suicidal behavior prevention measures in the military. The association of three widely used tools with severe suicide attempts was assessed in this setting. Methods: Thirty-nine Israeli soldiers (59% males), mean age 19 yrs., who attempted suicide during military service were divided into two groups: severe (n = 14; 35.9%) and moderate suicide attempts, and were assessed using the Scale for Suicide Ideation (SSI), Suicide Intent Scale (SIS) and the Columbia Suicide Severity Rating Scale (C-SSRS). Results: Seven items from the SSI (p = 0.008), two items from SIS and one item from C-SSRS were associated with severe suicide attempts. Kendall's tau-b correlation with bootstrap demonstrated stability of these correlations. Conclusion: Greater severity of suicidal ideation was associated with more severe suicide attempts. The combination of male gender, available firearms and current severe suicide ideation is high-risk danger sign in a military setting, even when reported intent to die is low.

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Section: Discussionsupporting

confidence: 80%

Suicide ideation severity is associated with severe suicide attempts in a military setting

Shelef

Klomek

Fruchter

et al. 2019

European Psychiatry

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“…Risk-taking may represent a behavioral marker for an underlying tendency towards trait-like impulsivity or the tendency to act impulsively on suicidal thoughts. Shelef and colleagues (2018) found that impulsive suicide decedents showed higher levels of risk-taking behaviors (e.g., aggression), as well as lower levels of suicidal planning when compared to suicide decedents without longstanding patterns of impulsivity. High risk-takers may have significant difficulty conceptualizing the possible consequences of dangerous or reckless behaviors.…”

Section: Discussionmentioning

confidence: 99%

“…Impulsive suicide attempters (Brown et al, 1991) and decedents (Shelef et al, 2018) show lower levels of depression and hopelessness compared to non-fatal suicide attempters who show higher levels of suicidal planning. Suicide decedents with a history of risk-taking behaviors may experience more stressors in the days before suicide (Shelef et al, 2018) and repeated non-fatal suicide attempts are associated with the interaction between early childhood adversity, recent negative life experiences, and recent psychopharmalogical treatment (Pompili et al, 2011). However, results from the present study suggest that risk-taking behaviors increase risk of non-fatal suicide attempts over and above the effects of stressors.…”

Section: Discussionmentioning

confidence: 99%

Risk-taking behaviors and stressors differentially predict suicidal preparation, non-fatal suicide attempts, and suicide deaths

Athey

Overholser

Bagge

et al. 2018

Psychiatry Research

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Negative life events are elevated in suicidal populations. Diathesis-stress and kindling effects models suggest different mechanisms by which negative life events increase suicide risk. Different forms of negative life events - risk-taking behaviors and stressors - may have different effects on non-fatal suicide attempts and suicide. We assessed the effects of risk-taking behaviors and stressors on suicide, history of non-fatal suicide attempts, and active preparation for suicide in a sample of adults who died by suicide or other causes (N = 377). Psychological autopsy procedures using family member interviews and collateral record review were used to complete a risk-taking behaviors composite measure from the Structured Interview for DSM-IV Personality Disorders, the Modified Life Experiences Scale, and the planning subscale of the Suicide Intent Scale. Stressors were significantly associated with death by suicide, even when accounting for demographic and diagnostic characteristics. Risk-taking behaviors were significantly associated with non-fatal suicide attempts, even when accounting for demographic and diagnostic characteristics. Suicide decedents who did not actively prepare for suicide showed significantly higher risk-taking scores than suicide decedents who actively planned for suicide. Our results suggest that risk-taking behaviors and stressors impact suicide risk through separate mechanisms. Risk-taking behaviors may represent a longstanding vulnerability to act impulsively on suicidal thoughts. Stressors may impact risk for fatal suicidal behaviors in mood disordered populations.

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“…Nearly all included studies (85%; n = 60) used versions of the DSM as their chosen diagnostic classification standard. Only eight studies (11%) used versions of the ICD (Beglyankin et al, 2019;Gibbons, 2007;Houston et al, 2001;Koeda et al, 2012;Phillips et al, 2017;Shelef et al, 2015Shelef et al, , 2018Zhu et al, 2021). Two studies (Csorba et al, 2010a(Csorba et al, , 2010b did not specify the diagnostic framework they employed but used the Mini International Neuropsychiatric Interview (MINI Plus) as a diagnostic tool, so could have adopted either DSM or ICD diagnostic criteria.…”

Section: Includedmentioning

confidence: 99%

Correlates of suicidality in young people with depressive disorders: A systematic review

Moller

Davey

Badcock

et al. 2022

Aust N Z J Psychiatry

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Objective: Depression is one of the most prevalent and disabling mental health conditions among young people worldwide. The health and economic burdens associated with depressive illness are substantial. Suicide and depression are closely intertwined, yet a diagnosis of depression itself lacks predictive specificity for suicidal behaviour. To better inform suicide prevention and early intervention strategies for young people, improved identification of modifiable intervention targets is needed. The objective of this review was to identify clinical, psychosocial and biological correlates of suicidality in young people diagnosed with a broad range of unipolar and bipolar depressive disorders. Method: Systematic searches were conducted across MEDLINE, Embase and PsycINFO to identify studies of young people aged 15–25 years diagnosed with unipolar or bipolar depressive disorders. An assessment of suicidality was required for inclusion. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Synthesis Without Meta-analysis guidelines. Results: We integrated findings from 71 studies including approximately 24,670 young people with clinically diagnosed depression. We identified 26 clinical, psychosocial and biological correlates of suicidality. Depression characteristics (type and severity), psychiatric comorbidity (particularly anxiety and substance use disorders) and neurological characteristics emerged as having the most evidence for being associated with suicidal outcomes. Our ability to pool data and conduct meaningful quantitative synthesis was hampered by substantial heterogeneity across studies and incomplete reporting; thus, meta-analysis was not possible. Conclusion: Findings of this review reinforce the notion that suicidality is a complex phenomenon arising from the interplay of multiple contributing factors. Our findings question the utility of considering a diagnosis of depression as a specific risk factor for suicidality in young people. Suicidality itself is transdiagnostic; adoption of a transdiagnostic approach to investigating its aetiology and treatment is perhaps warranted. Future research investigating specific symptoms, or symptom networks, might help to further our understanding of suicidality among young people experiencing mental illness.

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Depression and impulsiveness among soldiers who died by suicide: A psychological autopsy study

Cited by 11 publications

References 45 publications

Suicide ideation severity is associated with severe suicide attempts in a military setting

Suicide ideation severity is associated with severe suicide attempts in a military setting

Risk-taking behaviors and stressors differentially predict suicidal preparation, non-fatal suicide attempts, and suicide deaths

Correlates of suicidality in young people with depressive disorders: A systematic review

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