CONTENTS

About This Course

Table of Contents

1. The Nature and Scope of Suicide
2. Recognizing the Progressive Development of Suicide
3. Substance Abuse as a Major Contributor to Suicide
4. Suicide Across the Life Span
5. Special Populations and Suicide Risk
6. Prevention and Early Intervention for Suicide and Substance Abuse Problems

Supplements
References
Resources

Holding the Lifeline
A Guide to Suicide Prevention

Suicide Risk Factors for Veterans

Another study of veterans with PTSD identified high risk for negative behaviors (violence, suicide attempts, and substance abuse). Recent high-risk behaviors, rather than the patient's history, appeared to be more predictive of high-risk behaviors following discharge from a VA residential rehabilitation program.ref Following from this study, suicide prevention efforts could be best targeted at recent high-risk behaviors, in contrast to behaviors that occurred longer ago.

As this course has shown, it is extremely challenging to predict suicidal behaviors. Even someone who has a number of risk factors for suicide will not necessarily die by suicide, or even attempt it.

However, a Department of Veterans Affairs study sought to determine just what factors differentiate a suicide attempter (SA) from a suicide completer (SC). Certain themes within psychiatric patients' suicide messages and the number of suicide messages, helped the VA to determine SAs from SCs.

SCs were more likely to have a fear of being killed and to show hopelessness and symptom distress. SAs were more likely to make a contract not to commit suicide while no SCs did so. ref

Staff often overlooked or ignored indirect or unclear messages. This finding is particularly useful for community members who are in a position to hear or observe potentially suicidal messages. It points to the need for greater awareness and perception of distress among those who are at risk for suicide. In this study, all of the patients who died by suicide after hospital discharge did so in the first six weeks after discharge, pointing to the ongoing vulnerability that suicide attempters have to suicidal behaviors.

Gender differences among homeless veterans are also a factor in suicide risk. Childhood and current sexual and physical abuse, depression, fearfulness, relationship problems, limited social support, and low self-esteem were more strongly associated with suicidal thoughts and attempts for women than for men. Extent of alcohol and other drug use, aggression, resilience, self-efficacy, combat exposure, combat-related PTSD, and work problems were more strongly associated with suicidal thoughts and attempts for men than for women. ref