Abuse subtypes affect suicide risk among military psychiatric inpatients

Co-occurrence of multiple abuse subtypes across childhood and adulthood was linked to higher psycho-social risk and suicide attempt history among military service members hospitalized due to suicide risk, study results showed.

“Large-scale surveillance data within the military estimated that service members who were admitted for psychiatric inpatient care were five times more likely to eventually die by suicide,” Jeremy W. Luk, PhD, a clinical psychologist at the National Institute on Alcohol Abuse and Alcoholism, and colleagues wrote in Journal of Psychiatric Research. “In the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), childhood maltreatment was found in nearly 1 in 5 new soldiers and was associated with increased odds of lifetime suicidal ideation, plan, attempt and progression from ideation to plan/attempt. To further explore the associations between childhood abuse and suicide attempt in a psychiatric inpatient sample, it would be informative to differentiate between types of attempts.”

The researchers noted subtypes of childhood abuse that may continue into adulthood include physical, emotional and sexual abuse. In the current study, they used latent class analysis to elucidate how these abuse subtypes co-occur during childhood and adulthood among a high-risk sample of 115 military service members and adult beneficiaries who underwent psychiatric hospitalization after a suicide-related crisis. They investigated latent class differences in psychosocial characteristics and subtypes of suicide attempt history: aborted, interrupted and actual.

Results showed 29.6% of participants experienced multiple and persistent abuse, 27% experienced childhood physical and persistent emotional abuse and 43.5% experienced minimal abuse. Women more often reported a history of multiple and persistent abuse than men. The researchers controlled for gender and found that those in the multiple and persistent abuse class had higher scores of depressive symptoms and hazardous drinking, poorer sleep quality and increased social stress compared with those in the minimal abuse class. Those in the multiple and persistent abuse class had increased risk for lifetime interrupted suicide attempt (OR = 3.81; 95% CI, 1.2-12.07) and actual suicide attempt (OR = 3.65; 95% CI, 1.23-10.85), as well as the greatest number of total suicide attempts.

“Clinicians working with military psychiatric inpatients need to assess the persistence of multiple abuse types across development, consider how psychological health may be associated with risk for suicide-related behaviors and utilize empirically-supported approaches to mitigate the negative impact of abuse history on health,” Luk and colleagues wrote. “Future longitudinal research is needed to chart the developmental sequence of how different types and co-occurrence of abuse are associated with psychosocial problems, and test these as potential mechanistic pathways to suicide-related behaviors.”