Predicting Suicide Risk in Veterans

Dr Marianne Goodman presented at the APA Annual Meeting on the Assessment of Predictors of High-Risk Mixed-Diagnosis Suicidal Veterans. Dr Goodman examined suicidal veterans and asked whether measures of impulsive aggression differ across patient groups. These included non-attempters, single attempters, and multiple attempters, with a hypothesis that indices of impulsive aggression would distinguish across groups.

Veterans between the ages of ages 18 and 55 years who were non-psychotic and without significant head trauma were eligible to participate. A total of 155 subjects enrolled in the Department of Defense-funded study of risk assessment completed a battery of measures. These included structured clinical interviews, resiliency, trauma, demographics, and interpersonal functioning. Items relating to impulsivity or aggression were selected from the Diagnostic Instrument for Borderline Personality Disorder, the Alcohol Severity Index, and Interpersonal Psychological Survey (IPS), and responses across groups (88 non attempters, 28 single attempters, and 39 multiple attempters) were compared. Among the key findings revealed in the presentation:

•Service members make up 1% of the US population, but they account for 20% of the suicides
•18 veterans complete suicide daily. Research by Mann and others suggests a commonality in the neurobiology of suicide and other forms of aggressive behavior.
•Results were notable for significant differences across suicide attempt groups for female gender, depression scores, all 9 criteria for borderline personality disorder, childhood physical and emotional abuse, and scores on the IPS but not for other demographic variables, combat exposure, any Axis I diagnosis, or any impulsive aggressive variable.
•Single attempters did not differ from multiple attempters on any variable except a history of childhood physical abuse.
•While the study is limited by the absence of standardized measures of impulsive aggression, the exclusion of psychosis, and small number of single attempters, the results “do raise the possibility that even single attempts confer significant risk.”

In this video, Dr Goodman gives a brief synopsis on her study results. Dr Goodman is a Clinical Associate Professor at the Mount Sinai School of Medicine and clinical researcher in suicide at the VISN 3 Mental Illness Research Education Clinical Center (MIRECC) at the James J Peters Veteran Affairs (VA) Medical Center in Bronx, New York. She has worked in the field of Borderline Personality Disorder (BPD) for over 15 years, initially as a clinician and later as a clinical researcher. Over the past 10 years, she initiated and developed a VA based clinical research program studying Dialectical Behavioral Therapy (DBT) and she has studied neurobiological and imaging predictors of DBT treatment response in patients with BPD. In July 2009, she was funded by the Department of Defense to examine the efficacy of DBT for high-risk suicidal behavior in Iraqi Veterans.