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. 2021 Nov 1:294:430-440.
doi: 10.1016/j.jad.2021.07.088. Epub 2021 Jul 21.

Temporal sequences of suicidal and nonsuicidal self-injurious thoughts and behaviors among inpatient and community-residing military veterans

Jaclyn C Kearns  1 , Sarah L Brown  2 , Ian Cero  3 , Kaitlyn R Gorman  4 , Matthew K Nock  5 , Terence M Keane  6 , Brian P Marx  7
Affiliations

Temporal sequences of suicidal and nonsuicidal self-injurious thoughts and behaviors among inpatient and community-residing military veterans

Jaclyn C Kearns et al. J Affect Disord. .

Abstract

Background: Suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) are major health concerns among military veterans yet little is known about the temporal relations among these outcomes. This study examined the temporal relations between suicidal and nonsuicidal SITBs among higher-risk veterans. Specifically, we identified when SITBs emerged and evaluated the role of nonsuicidal self-injury (NSSI) in the medical lethality of suicide attempts (SA), relative risk, and survival time of suicidal SITBs (i.e., suicide ideation [SI], suicide plan, SA).

Method: Cross-sectional data were collected from two samples examining suicide risk among veterans receiving inpatient psychiatric care (n = 157) and community-residing veterans with current depression and/or past month SI (n = 200). Participants completed an interview to assess SITBs.

Results: SITBs emerged between ages 14-28 years with behaviors emerging, on average, earlier among inpatient veterans. The time lag between SITBs was not significantly different between groups. Inpatient veterans had a significantly shorter time lag from SI to SA. NSSI history predicted an increase in relative risk for all suicidal SITBs and shorter survival time. There was no association between NSSI history and medical lethality of the most serious SA for both groups.

Limitations: Limitations included use of cross-sectional, retrospective self-report with age-of-onset endorsed in years and not all SITBs were assessed (e.g., passive SI).

Conclusions: Veterans with a NSSI history are at high risk for suicidal SITBs and have a shorter survival time. Results showed thoughts (i.e., NSSI thoughts, SI) emerged before behavior (i.e., NSSI, SA) and NSSI emerged before SA.

Keywords: Military; Nonsuicidal self-injury; Suicide; Suicide attempt; Veterans.

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Conflict of interest statement

Declaration of Competing Interest

Authors have no known conflict of interest to disclose.

Figures

Fig. 1.
Fig. 1.
Survival curves for time to suicide ideation according to history of nonsuicidal self-injury.
Fig. 2.
Fig. 2.
Survival curves for time to suicide plan according to history of nonsuicidal self-injury.
Fig. 3.
Fig. 3.
Survival curves for time to suicide attempt according to history of nonsuicidal self-injury.
See this image and copyright information in PMC

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