Budd, F. (2001). Preventing workplace violence.The Air Force Psychologist, 19(1), 8-12.

The Air Force (AF) has put forth aggressive prevention efforts including training in both suicide and violence awareness. The article describes a two-pronged approach to violence prevention in the AF. The identified benefits to the program were the early referrals to mental health by co-workers, supervisors, family members and the individuals themselves. The most likely targets for violence in the Air Force were found to be the Child Development Center and Youth Center staff and volunteers, hospital employees and mental health staff. The article reviews the training topics and interventions for each of the defined target groups. The next step in the prevention effort was to develop a team capable of responding immediately to a potential workplace violence incident. A protocol was developed to further educate the team about the best estimation of the nature and likelihood of violence based in part on guidelines from the High Risk for Violence Response Team through the Family Advocacy program.

Dube, S.R., Anda, R.F., Felitti, V. J., Chapman, D.P, Williamson, D.F. and Giles, W.H. (2001). Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: Findings from the Adverse Childhood Experiences study. JAMA, 286(24), 3089-3096.

An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including attempted suicide among adolescents and adults. The study used a retrospective cohort of 17,337 adult HMO members (54% female; mean age 57 yrs), who attended a primary care clinic in San Diego CA, within a 3 yr period. They completed a survey about childhood abuse and household dysfunction, suicide attempts (including age at first attempt), and multiple other health-related issues. Results showed that adverse childhood experiences increased the risk of attempted suicide 2- to 5-fold. There was strong statistical evidence of a trend between early childhood adverse events and the risk of suicide attempts across the life span; particularly for adolescents. Perhaps suicide appears to be a viable solution, because the immediacy of the stress and the pain of physical, emotional or sexual abuse or witnessing domestic violence are not easily escaped by children or adolescents. Other factors increase risk of suicide in adults, including substance abuse, depression, and the number of adverse childhood events. The authors conclude that recognizing adverse childhood experiences are common and frequently take place as multiple events may be the first step in preventing their occurrence. Additionally, they conclude identifying and treating persons who have been affected by such experiences may have substantial value in evolving efforts to prevent suicide.

Florkowski, A, Gruszczynski, W and Wawrzyniak, Z (2001). Evaluation of psychopathological factors and origins of suicides committed by soldiers, 1989 to 1998. Military Medicine, 166, 44-47.

The study is a retrospective analysis of the origins and factors leading to successful suicides undertaken by soldiers. They found that the rate of suicide by Polish soldiers during this time remained relatively constant. Both psychosocial and biological factors appeared to take part in the decision for suicide. Junior enlisted troops committed 62.7% of the suicides with an age range of 22 to 34 years, 42% suffered from personality disorders, and 28% were diagnosed with a depressive disorder. Cited reasons for the suicides included adaptive difficulties, unfulfilled love, jealousy or unfaithfulness, or fear of punishment. The majority of cases killed themselves either by hanging or gunshot. Among the professional soldiers, in 36% of the cases, the suicides were committed between the 11th and 15th year; whereas the highest rate among junior enlisted was observed during the first 12 months of service. The research also showed that soldiers usually commit suicide because of interdependent and intermingled problems accumulated over time.

Patterson, J., Jones, D., Marsh, R, and Drummond, F. (2001). Aeromedical management of U.S. Air Force aviators who attempt suicide. Aviation, Space, and Environmental Medicine, vol 72(12), 1081-1085.

The authors reviewed all case reports of fliers evaluated at the USAF School of Aerospace Medicine’s Aeromedical Consultation Service between 1981-1996 for possible return to flying duties after a suicide attempt. Fourteen aviators were examined and 11 (79%) ultimately received a recommendation for return to flying duties.

Simpson, S. (2001). Practice limited to psychiatric and psychological malpractice. Retrieved 26 April 2002 from the World Wide Web: http://www.skipsimpson.com/faq.html.

A lawyer addresses frequently asked questions regarding negligence and wrongful death lawsuits in psychiatry and psychology. The article defines negligence, stating that it occurs when a mental health provider fails to comply with acceptable standards of practice, usually in either diagnosis or treatment. The article further lists several examples of legal negligence

1999

U.S. Department of Health and Human Services. (1999). Suicide prevention among active duty Air Force personnel-United States, 1990-1999. Morbidity and Mortality Weekly Report, 48(46), 1053-1057.

In response to increasingly higher prevalence rates of suicide among USAF personnel, senior leadership organized a task force that was designed to produce a comprehensive suicide prevention strategy. The prevention strategy focused on reducing suicide through development of a youth suicide prevention program, restructuring prevention services offered on USAF installations (e.g., Limited Privilege Suicide Prevention program and the Integrated Delivery System) and establishing a central surveillance database for fatal and nonfatal self-injuries. Results indicated that a substantial decline in the suicide rate was associated with the community-wide program. The study results highlight that suicide is a preventable health problem and demonstrates the importance of using multiple agencies to address the issue.

Joiner, T. E., Walker, R. L. Rudd, M. D. and Jobes, D. A. (1999). Scientizing and routinizing the assessment of suicidality in outpatient practice. Professional Psychology: Research and Practice, 30, 447 – 453.

The authors provide a framework for suicide risk assessment that emphasizes 2 domains—history of past attempt and the nature of current suicidal symptoms—that have emerged in suicide research as crucial variables. These domains, when combined with other categories of risk factors, produce a categorization of risk for the individual patient, leading, in turn, to relatively routinized clinical decision making and activity. The domains and risk factors are previous suicidal behavior, nature of the current suicidal symptoms, precipitant stressors, general symptom presentation, hopelessness, impulsivity, and self control. The framework also addresses the importance of protective factors including available social support and problem solving ability in the prediction of suicide. The article concludes with a practical “To-Do” list and decision tree.

Kleespies, P. M., Deleppo, J. D., Gallagher, P. L. and Niles, B. L. (1999). Managing suicidal emergencies: Recommendations for the practitioner. Professional Psychology: Research and Practice, 30, 454 – 463.

This article conceptualizes what a “behavioral emergency” is and gives recommendations for containing the emergency client's emotional turmoil. It also sets forth an evidence-based approach, using diagnosis-specific risk factors, for improving the clinician's ability to estimate suicide risk. These factors include duty of care in emergencies, evaluation of imminent risk, estimation of level of risk, lethality assessment, outpatient vs hospitalization, and inpatient management of imminent suicidal risk. Recommendations are also given for appropriate responses to the patient or client on the basis of the level of estimated risk. The authors emphasized the clinician's need to observe good risk management practices, which include the twin pillars of risk management: documentation and consultation.

1996

Rowan, A.B. (1996). Demographic, clinical and military factors related to military mental health referral patterns. Military Medicine, 161, 324-328.

This retrospective study examined 693 cases of active duty members from all service branches seen in an Air Force outpatient mental health clinic over a 3-yr period. The purpose was to identify the characteristics of active duty members who seek military mental health services, as well as to target interventions to increase self-initiated help-seeking behavior. Results showed that members who self-referred were more likely to be older and married; they tended not to have a mental disorder; they tended to be NCOs and officers and to be permanently assigned to the installation, with no special duty status. These findings may be used to tailor interventions to specific audiences in order to facilitate help-seeking behaviors. Commanders and supervisors may be able to use this information to supplement their knowledge about warning signs of stress and suicide, particularly for those populations less likely to seek mental health services.

1995

Rowan, A. (1995). Overcoming the stigma of seeking mental health treatment: The sequel. Military Psychology Bulletin, 13(3), 6-7.

This article is a follow-up from the original 1994 piece; the author extends his examination of the impact of seeking treatment on SCI status. The author reviewed mental health records for active duty members over a 3 yr period (n=693). The study examined: a) unit contact (yes/no), b) recommendations, and c) diagnosis. Results showed that 80% of members seen in MH were not diagnosed w/ a “mental disorder”; only 7% of the self-referrals had unit contact and that only 3% of the self-referrals had negative career recommendations. The results illustrated the importance of early intervention to reduce negative career impact.

1994

Rowan, A. (1994). Overcoming the stigma of seeking mental health treatment. Military Psychology Bulletin, 12(3), 13.

Mental health records were reviewed to assess whether there were negative consequences to help-seeking behaviors. The study specifically assessed recommendations for special duty status, as well as military suitability and fitness issues. The data indicated that the biggest negative impact on SCI certifications at Goodfellow AFB occurred when members were either referred through the CDE process or First Shirt. The author suggests that providers become proactive in educating their local units about the impact of help-seeking on their careers by conducting a review of records at their local mental health clinic and when meeting members of the base community ask about a person’s beliefs or expectations about the mental health clinic, using the results of the record review to correct any misconceptions.