Transgender adults serve in the U.S. military at 2 to 3 times the rate of the general adult population. Unfortunately, transgender veterans die by suicide at twice the rate of their cisgender veteran ...peers and approximately 5.85 times the rate of the general population. This article reviews the literature regarding the prevalence of suicidal thoughts and behaviors in transgender veterans. Suicide risk and resilience factors are reviewed, and future areas of study are detailed that incorporate findings from the broader suicide-prevention literature and research on transgender mental-health disparities. Individual services and broader prevention considerations are discussed, including the adaptation of evidence-based suicide-specific psychological interventions, national transgender health-training resources, and relevant veteran suicide-prevention initiatives. Finally, U.S. Department of Defense and U.S. Department of Veterans Affairs policies regarding transgender service and health care are reviewed. State-level policies relevant to transgender veteran suicide such as firearm ownership and nondiscrimination laws are also reviewed, and their implications for suicide prevention are discussed. The aim of this article is to provide a broad review of research findings from multiple fields of study to assist health-care providers, researchers, and policymakers in their efforts to prevent transgender veteran suicide.
Over the past decade, the interpersonal theory of suicide has contributed to substantial advances in the scientific and clinical understanding of suicide and related conditions. The interpersonal ...theory of suicide posits that suicidal desire emerges when individuals experience intractable feelings of perceived burdensomeness and thwarted belongingness and near-lethal or lethal suicidal behavior occurs in the presence of suicidal desire and capability for suicide. A growing number of studies have tested these posited pathways in various samples; however, these findings have yet to be evaluated meta-analytically. This paper aimed to (a) conduct a systematic review of the unpublished and published, peer-reviewed literature examining the relationship between interpersonal theory constructs and suicidal thoughts and behaviors, (b) conduct meta-analyses testing the interpersonal theory hypotheses, and (c) evaluate the influence of various moderators on these relationships. Four electronic bibliographic databases were searched through the end of March, 2016: PubMed, Medline, PsycINFO, and Web of Science. Hypothesis-driven meta-analyses using random effects models were conducted using 122 distinct unpublished and published samples. Findings supported the interpersonal theory: the interaction between thwarted belongingness and perceived burdensomeness was significantly associated with suicidal ideation; and the interaction between thwarted belongingness, perceived burdensomeness, and capability for suicide was significantly related to a greater number of prior suicide attempts. However, effect sizes for these interactions were modest. Alternative configurations of theory variables were similarly useful for predicting suicide risk as theory-consistent pathways. We conclude with limitations and recommendations for the interpersonal theory as a framework for understanding the suicidal spectrum.
Public Significance Statement
This meta-analysis generally found support for the interpersonal theory of suicide-thwarted belongingness and perceived burdensomeness were significant correlates of suicidal ideation severity, and thwarted belongingness, perceived burdensomeness, and capability for suicide were significantly associated with suicide attempt history. Effect sizes for these relationships were weak-to-moderate, suggesting potentially modest clinical significance. However, there was insufficient research on the theory's specific hypotheses, including its capacity for predicting death by suicide and the role of viewing thwarted belongingness and perceived burdensomeness as intractable in suicidal desire.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ
Despite an exponential growth in research on mindfulness-based interventions, the body of scientific evidence supporting these treatments has been criticized for being of poor methodological quality.
...The current systematic review examined the extent to which mindfulness research demonstrated increased rigor over the past 16 years regarding six methodological features that have been highlighted as areas for improvement. These feature included using active control conditions, larger sample sizes, longer follow-up assessment, treatment fidelity assessment, and reporting of instructor training and intent-to-treat (ITT) analyses.
We searched PubMed, PsychInfo, Scopus, and Web of Science in addition to a publically available repository of mindfulness studies.
Randomized clinical trials of mindfulness-based interventions for samples with a clinical disorder or elevated symptoms of a clinical disorder listed on the American Psychological Association's list of disorders with recognized evidence-based treatment.
Independent raters screened 9,067 titles and abstracts, with 303 full text reviews. Of these, 171 were included, representing 142 non-overlapping samples.
Across the 142 studies published between 2000 and 2016, there was no evidence for increases in any study quality indicator, although changes were generally in the direction of improved quality. When restricting the sample to those conducted in Europe and North America (continents with the longest history of scientific research in this area), an increase in reporting of ITT analyses was found. When excluding an early, high-quality study, improvements were seen in sample size, treatment fidelity assessment, and reporting of ITT analyses.
Taken together, the findings suggest modest adoption of the recommendations for methodological improvement voiced repeatedly in the literature. Possible explanations for this and implications for interpreting this body of research and conducting future studies are discussed.
Despite widespread scientific and popular interest in mindfulness-based interventions, questions regarding the empirical status of these treatments remain. We sought to examine the efficacy of ...mindfulness-based interventions for clinical populations on disorder-specific symptoms. To address the question of relative efficacy, we coded the strength of the comparison group into five categories: no treatment, minimal treatment, non-specific active control, specific active control, and evidence-based treatment. A total of 142 non-overlapping samples and 12,005 participants were included. At post-treatment, mindfulness-based interventions were superior to no treatment (d=0.55), minimal treatment (d=0.37), non-specific active controls (d=0.35), and specific active controls (d=0.23). Mindfulness conditions did not differ from evidence-based treatments (d=−0.004). At follow-up, mindfulness-based interventions were superior to no treatment conditions (d=0.50), non-specific active controls (d=0.52), and specific active controls (d=0.29). Mindfulness conditions did not differ from minimal treatment conditions (d=0.38) and evidence-based treatments (d=0.09). Effects on specific disorder subgroups showed the most consistent evidence in support of mindfulness for depression, pain conditions, smoking, and addictive disorders. Results support the notion that mindfulness-based interventions hold promise as evidence-based treatments.
•We examined the relative efficacy of mindfulness-based interventions on clinical symptoms of psychiatric disorders.•142 randomized clinical trials were included (N=12,005 participants). Control conditions were coded on a five-tier system.•At post-treatment, mindfulness interventions were equivalent to evidence-based treatments and superior to other comparisons.•At follow-up, mindfulness interventions were equivalent to minimal and evidence-based treatments and superior to others.•The most consistent evidence for mindfulness-based interventions was seen for depression, pain, smoking, and addictions.
Extant literature suggests that dispositional mindfulness may reduce the impact perceived stress has on the severity of suicidal ideation (SI). Only one study has analyzed this question but did so ...with a cross-sectional design in a sample of undergraduate women.
This study analyzed the potential moderating role of dispositional mindfulness on the relation between perceived stress and SI cross-sectionally and at one-week follow-up in a sample of US adults (N = 598) with a history of SI.
Results indicated that dispositional mindfulness and its facets were inversely related to perceived stress, SI severity at baseline, and SI severity one week later. At baseline, regression results indicated that only the nonreacting component of dispositional mindfulness interacted with perceived stress to concurrently predict SI severity. This relation was not significant when SI severity was measured one week later.
Study results are limited by the high attrition rate from baseline to follow-up and the relatively homogeneous sample.
Study results indicate that dispositional mindfulness, particularly components related to nonreacting, is inversely related to SI severity concurrently but not prospectively. Interventions focused on mindfulness skills, particularly skills around nonreaction to inner experience, may be beneficial for those considering suicide.
•Support for a two-factor (i.e., internal and external entrapment) Entrapment Scale was observed for both samples of young adults.•External entrapment factor loadings varied by U.K. versus U.S. ...sample.•Both types of entrapment were associated with poorer mental health, elevated suicidal cognitions, and escalated suicide-related behavior.•Internal entrapment and perceived burdensomeness were robustly associated with suicide outcomes in the United Kingdom sample only.•External entrapment was modestly associated with suicide outcomes in the United States sample only.
Entrapment is an emerging theoretical and empirical factor associated with suicide. The current study expanded our understanding of entrapment by examining the Entrapment Scale factor structure, demographic correlates, and association with suicidal thoughts and behaviors (STBs). Data from an online cross-national study of suicide were analyzed from two samples of young adults aged 18–34 (United Kingdom U.K. sample N = 418; United States U.S. N = 414). Primary findings included: (1) factor-analytic support for a two factor (i.e., internal and external) Entrapment Scale structure; (2) variation in external entrapment subscale factor loadings by sample; (3) significant demographic correlates of elevated entrapment of younger age, female gender, and U.S. sample; (4) significant convergent positive associations for both entrapment types with cognitive (e.g., perceived burdensomeness), mental health (e.g., anxiety), and STB correlates; and (5) significant, robust associations of internal entrapment and perceived burdensomeness with STBs in the U.K. sample. Implications are reviewed for suicide prevention theory, research and practice.
•Wish to live is concurrently protective of experiencing suicidal desire.•Wish to die may drive some change in suicidal desire over time.•Suicidal ambivalence may also drive change in suicidal ...desire.•Wish to live and wish to die are distinct and must be considered in tandem.
The internal debate hypothesis (Kovacs & Beck, 1977) suggests that those at risk for suicidal thoughts and behaviors may experience fluctuations in both the wish to live (WTL) and wish to die (WTD). Previous research has investigated this hypothesis using various cross-sectional (Goods et al., 2019 cf. Page & Stritzke, 2020) and longitudinal methodologies (e.g., Bryan et al., 2016). No investigations have determined the within-day temporal dynamics of WTL and WTD using ecological moment assessment (EMA), however. N = 49 undergraduate university students recruited from a research participant pool from a large southeastern university in the United States with a lifetime history of suicide ideation completed the current 10-day EMA investigation. Results demonstrated that WTL, WTD, and resulting suicidal ambivalence (i.e., relatively equal WTL/WTD ratings) demonstrated similar within-person person variability; however, WTD scores appeared to demonstrate higher average variability compared to WTL and ambivalence scores. Although state WTL and WTD were concurrently related to state suicidal desire, only WTD prospectively predicted suicidal desire when controlling for the influence of the outcome variable at the previous timepoint. Ambivalence scores also prospectively predicted suicidal desire when controlling for suicidal desire at the previous timepoint. Results support the clinical and theoretical utility of separate WTL and WTD assessment. WTD was relatively stable within this sample but may be closely related to risk for future suicidal thinking. Changes in WTL may reduce state risk for suicidal desire but could be more trait-like in nature compared to WTD. Future research that investigates these hypotheses should consider the study limitations outlined.
•A total of 374 multi-detector CT scans are made available to the research community, the biggest such dataset on spine until date (VerSe’19: https://osf.io/nqjyw/; VerSe’20: ...https://osf.io/t98fz/).•The VerSe benchmark includes annotations for two fundamental processing tasks, namely vertebrae labelling and segmentation.•Twenty-six fully-automated algorithms (eleven for VerSe’19, thirteen for VerSe’20, and one baseline) are benchmarked on this dataset, with the top performing algorithm achieving a mean vertebrae identification rate of 96.6% and a Dice coefficient of 91.7% in VerSe’20.•Further insights into these algorithms are provided by examining them at various levels of granularity ranging from dataset-level experiments to vertebrae-level performances to a field-of-view-related analysis.
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Vertebral labelling and segmentation are two fundamental tasks in an automated spine processing pipeline. Reliable and accurate processing of spine images is expected to benefit clinical decision support systems for diagnosis, surgery planning, and population-based analysis of spine and bone health. However, designing automated algorithms for spine processing is challenging predominantly due to considerable variations in anatomy and acquisition protocols and due to a severe shortage of publicly available data. Addressing these limitations, the Large Scale Vertebrae Segmentation Challenge (VerSe) was organised in conjunction with the International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI) in 2019 and 2020, with a call for algorithms tackling the labelling and segmentation of vertebrae. Two datasets containing a total of 374 multi-detector CT scans from 355 patients were prepared and 4505 vertebrae have individually been annotated at voxel level by a human-machine hybrid algorithm (https://osf.io/nqjyw/, https://osf.io/t98fz/). A total of 25 algorithms were benchmarked on these datasets. In this work, we present the results of this evaluation and further investigate the performance variation at the vertebra level, scan level, and different fields of view. We also evaluate the generalisability of the approaches to an implicit domain shift in data by evaluating the top-performing algorithms of one challenge iteration on data from the other iteration. The principal takeaway from VerSe: the performance of an algorithm in labelling and segmenting a spine scan hinges on its ability to correctly identify vertebrae in cases of rare anatomical variations. The VerSe content and code can be accessed at: https://github.com/anjany/verse.
•Non-suicidal self-injury and suicidal ideation/attempt elevated in transgender individuals.•Transgender veterans have a lower prevalence of lifetime non-suicidal self-injury.•Transgender veterans ...are hospitalized due to lifetime non-suicidal self-injury more.•Veteran status may be protective against care avoidance.
Transgender and gender diverse (TGD) individuals, especially veterans, experience elevated rates of non-suicidal self-injury (NSSI) and suicide related behaviors compared to gender majority individuals. Research has yet to compare TGD veterans to non-veterans or look at correlates of NSSI and related behaviors to suicide related outcomes. This study examines prevalence and suicide related correlates of NSSI among TGD veterans and TGD non-veterans.
Data analyzed in the were part of the Trans Lifeline Mental Health Survey. Both TGD veterans (N = 313) and non-veterans (N = 3,972) completed an online, cross-sectional survey that included self-report measures of NSSI, suicidal ideation (SI), and suicidal attempt (SA) along with lifetime hospitalization and avoidance of care due to NSSI.
Results of this paper indicate that prevalence of NSSI, SI, and SA are elevated in both the TGD veterans and non-veteran subpopulations. Further, veterans compared to non-veterans have a lower prevalence of NSSI but higher prevalence of hospitalization when self-harm is inflicted, reflecting more healthcare utilization or increased severity of NSSI episodes. Additionally, veterans were less likely to avoid care due to NSSI. Further, veteran status seemed to be a protective factor against demographic differences that increased rates of NSSI history in non-veteran TGD individuals.
The limitations of this study include its cross-sectional study design, one question assessing SA, and few TGD male veterans.
NSSI is an important risk factor in future suicide related outcome such as SI and SA. Further, differences in healthcare utilization among TGD veterans and non-veterans are apparent.
•BPD traits correlated highly with suicide risk, insomnia, and nightmares.•BPD traits had a significant indirect effect on suicide risk through insomnia.•Nightmare distress or impairment did not have ...a significant indirect effect.•BPD was still a significant predictor of suicide risk in the tested mediation models.
: Borderline personality disorder (BPD) is associated with high rates of suicide risk and problems related to sleep, including insomnia and nightmares. The purpose of the current study was to assess the potential indirect effect of BPD traits on suicide risk through both/either insomnia and nightmares.
: Participants (N = 281) were recruited via Amazon's Mechanical Turk to complete the study remotely online. Participants completed measures of BPD traits and symptoms, suicide risk (history of suicidal thoughts and behaviors), insomnia symptoms, and distress and impairment related to nightmares.
: BPD traits and symptoms were moderately to highly correlated to suicide risk, insomnia, and nightmares. In parallel mediation models, BPD traits had a significant indirect effect on suicide risk through insomnia symptoms but not nightmares.
: The current study assessed problems within the general population and not in a clinical sample. Second, the study relied solely on self-report measures. Futures studies would benefit from investigating these relations in clinical samples utilizing observer-report and interview methods.
: BPD traits appear to relate to increased risk for suicide through the relation with sleep concerns, particularly insomnia symptoms. Therefore, assessing and treating sleep problems within individuals with BPD may result in a lower risk for suicide.
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