Elsevier

Psychiatry Research

Volume 227, Issues 2–3, 30 June 2015, Pages 360-362
Psychiatry Research

Brief report
Non-suicidal self-injury as a predictor of active and passive suicidal ideation among Iraq/Afghanistan war veterans

https://doi.org/10.1016/j.psychres.2015.03.026Get rights and content

Highlights

  • Lifetime NSSI was relatively common (14%) among Iraq/Afghanistan veterans.

  • Lifetime NSSI was associated with current suicidal ideation at the bivariate level.

  • NSSI remained a predictor of active ideation when other risk factors were considered.

  • NSSI may be a particularly useful marker of active suicidal ideation among veterans.

Abstract

The present study examined the association between lifetime non-suicidal self-injury (NSSI) and current suicidal ideation among Iraq/Afghanistan veterans. NSSI was positively associated with passive, active, and concurrent active–passive suicidal ideation at the bivariate level. NSSI remained a predictor of active, OR=5.15, and concurrent active–passive suicidal ideation, OR=7.01, when other risk factors were considered. These findings suggest that NSSI may be a particularly useful marker of active suicidal ideation among veterans.

Introduction

Non-suicidal self-injury (NSSI) is the act of deliberately destroying one׳s body tissue without conscious suicidal intent (Chapman et al., 2006). Although NSSI is, by definition, distinct from suicidal behaviors that involve some intent to die, the Interpersonal Theory of Suicide (Joiner, 2005) proposes that NSSI increases suicide risk by increasing an individual׳s acquired capability for suicide (defined as an enhanced tolerance of physiological pain and diminished fear of death and/or bodily harm; Joiner, 2005, Nock et al., 2006). A recent literature review supports this theory, finding that NSSI is associated with suicidality across a variety of populations, even after accounting for key demographic variables such as age, race, and gender (Hamza et al., 2012).

Unfortunately, despite high rates of death by suicide among Iraq/Afghanistan veterans with mental health disorders (Kang and Bullman, 2008), there has been relatively little research on NSSI among veterans. We recently conducted the first study of NSSI among male Iraq/Afghanistan veterans seeking treatment for posttraumatic stress disorder (PTSD; Kimbrel et al., 2014) and found that this behavior was highly prevalent and strongly associated with suicidal ideation. This study did, however, have several limitations that the current study was designed to overcome. First, we used a single item in our previous study that only assessed active suicidal ideation, which made it impossible for us to determine whether NSSI was associated with both active and passive suicidal ideation. Given the growing recognition that active suicidal ideation (i.e., specific thoughts of killing oneself or committing suicide) represents a more severe form of ideation than passive suicidal ideation (e.g., wishing to be dead or wishing to fall asleep and to not wake up; Posner et al., 2011), the current study examined active and passive ideation separately in order to determine if NSSI was more strongly related to one of these specific forms of suicidal ideation. A second limitation of our previous study was that we were not able to consider the association between NSSI and suicidal ideation within the context of other important risk factors for suicidality, such as major depressive disorder (MDD), alcohol-use disorder (AUD), and childhood sexual abuse (CSA; Joiner, 2005, Nock et al., 2008). Finally, a third limitation of our previous study was that we examined current NSSI as a predictor of current ideation in the regression analyses when it would have been optimal to examine lifetime NSSI as a predictor of current ideation.

The objective of the present study was to address these limitations by: (1) examining the association between lifetime NSSI and current passive and current active suicidal ideation in a sample of Iraq/Afghanistan veterans; and (2) determining if the hypothesized association between lifetime NSSI and current suicidal ideation among Iraq/Afghanistan veterans would remain significant within the context of other well-established risk factors for suicidal ideation.

Section snippets

Participants and procedures

Participants included 197 Iraq/Afghanistan veterans recruited from the Central Texas Veterans Health Care System to participate in two studies on the genetics of PTSD. Participants with PTSD were oversampled through targeted mailings, flyers, and hospital staff recruitment, resulting in high rates of current PTSD (35%), MDD (21%), and AUD (8%) in the final sample. Both treatment-seeking and non-treatment-seeking veterans were included. Schizophrenia and bipolar disorder were exclusionary

Results

Approximately 21% of participants endorsed passive suicidal ideation; 13% endorsed active suicidal ideation; and 9% endorsed concurrent active–passive ideation. In addition, approximately 14% reported a history of NSSI, and 24% reported a history of CSA. As expected, NSSI was positively associated with passive ideation, χ2=6.855(1), p=0.009, active ideation, χ2=5.669(1), p=0.017, and concurrent active–passive ideation, χ2=7.163(1), p=0.007, at the bivariate level (Fig. 1).

Stepwise logistic

Discussion

Consistent with the Interpersonal Theory of Suicide (Joiner, 2005), the present study found that NSSI was associated with both passive and active suicidal ideation among an at-risk sample of Iraq/Afghanistan war veterans at the bivariate level. The present study also adds to the literature by demonstrating that NSSI was uniquely associated with both active suicidal ideation and concurrent passive–active suicidal ideation after accounting for other well-established risk factors. These results

Acknowledgments

This work was supported by a Career Development Award (IK2 CX000525) to Dr. Kimbrel from the Clinical Science Research and Development Service of the Department of Veterans Affairs (VA) Office of Research and Development (ORD), a VA VISN 17 New Investigator Award to Dr. Kimbrel entitled Genetic and Environmental Effects on PTSD, Depression, and Alcohol Misuse, a Merit Award (I01RX000304) to Dr. Morissette from the Rehabilitation Research and Development Service of the VA ORD, the VA VISN 17

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