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published_or_final_version / Gerontology / Master / Master of Social Sciences

OBJECTIVE: This study explores psychological experiences that may influence service members’ self-concepts and future orientations. As stable, optimistic, future orientations have been associated with resilience to psychological distress and suicidality (Johnson, et al., 2011), it is worthwhile to explore how service members’ attitudes toward the future might be shaped in the context of intrapersonal and interpersonal experiences. METHOD: Data were collected from service members of the Virginia National Guard (N = 192) and included a Transportation unit, an Engineer unit, an Infantry unit and a group with no specific unit affiliation or substantive military experience. The study is a cross-sectional design that seeks support for the hypothesis that interpersonal and intrapersonal psychological needs differentially influence one’s future orienation. RESULTS: Analysis demonstrated that autonomy, competence and relatedness each play partial mediating roles with respect to the identity style-identity commitment relationship. Further analysis demonstrated that all three psychological needs also significantly predict identity commitment, but that the intrapersonal needs of autonomy and competence are stronger predictors than the interpersonal need, relatedness. The competing hypothesis that psychological needs balance would outperform the psychological needs variables as predictors of identity commitment was not confirmed. CONCLUSIONS: The data indicate that all three psychological needs variables are significantly influential (by degree and category) with regard to protective factors that involve identity-based processes and identity-based beliefs. Implications and areas for future research are discussed.

Veterans in the United States experience heightened suicide risk, compared to civilians, accounting for approximately 7,400 suicides annually. Among many potential risk factors, insomnia (i.e., difficulty falling asleep or staying asleep) is prevalent in veterans. Individuals with insomnia often encounter difficulties in daily functioning (e.g., fatigue, difficulty concentrating, decreased work performance) and, as a result, may experience perceived burdensomeness (i.e., perceptions of being restrictive or taxing to others), a known contributor to suicide risk. However, not all veterans who suffer from insomnia or perceive themselves as a burden engage in suicidal behaviors, perhaps due to individual-level protective factors. One such factor, self-compassion (i.e., the extension of kindness to oneself in adverse or difficult times), is comprised of self-kindness, common humanity, and mindfulness, and may reduce suicide risk by buffering against negative self-evaluations regarding sleeplessness and performance. However, this premise has not been previously investigated; therefore, in the current study, we examined the mediating role of perceived burdensomeness on the relation between insomnia and suicide risk and, further, the moderating role of self-compassion on these paths. At the bivariate level, we hypothesized that insomnia, perceived burdensomeness, and suicidal ideation would be positively related, and self-compassion would be inversely related to these factors. At the multivariate level, we hypothesized that the relation between insomnia and suicide risk would be mediated by perceived burdensomeness, and that this association would be moderated by self-compassion on all model paths; such that increased insomnia would be associated with higher levels of perceived burdensomeness and, in turn, suicide risk, and that self-compassion would weaken these deleterious linkages. Participants (N=551; Mean Age=50.4, SD=16.6) were community-dwelling veterans, most of whom were White (85.1%) males (69.3%) and were recruited via online invitations distributed to veteran-related social media groups and organizations. Participants completed an online survey, including: Insomnia Severity Index, Interpersonal Needs Questionnaire, Suicidal Behaviors Questionnaire – Revised, and SelfCompassion Scale Short-Form. All bivariate hypotheses were supported, with significance at the p

Opioid morbidity and mortality and suicide are two current and central public health problems in the U.S. Both have continuously increased in the last two decades, and disproportionately affected some groups more than others, leading to the suggestion that these epidemics are connected. However, there is little evidence on the potential role that the opioid epidemic had on the rise of suicides. The overarching goal of this dissertation was to advance our understanding of the effects of the opioid epidemic on the rise in suicide rates in the U.S. First, a systematic review of the literature was conducted to critically evaluate the evidence on the effects of different opioid exposures on suicidal outcomes (e.g., suicidal ideation, attempts and suicides). There was ample evidence of individual-level associations between opioid use and related abuse/ dependence on suicidal outcomes. In contrast, the gap in the literature on group-level effects was clear, with only two studies examining these effects and showing that opioid availability was associated with suicide behavior in different populations. Several limitations were also identified in the reviewed studies that could partially explain the observed associations, indicating the need for further research. Second, the individual-level effects of prescription opioids nonmedical use and related abuse/ dependence on persistence and onset of suicidal ideation and attempts were examined. Longitudinal data from a national representative sample of the adult U.S. population was used to examine these associations. Results showed that heavy/ frequent use of prescription opioids and related abuse/ dependence had an effect on persistence and onset of suicidal ideation and persistence of attempts. However, none of these exposures were associated with onset of suicide attempt. Overall, these findings suggest that by increasing the number of those using prescription opioids and with opioid abuse/ dependence, and in turn the number of those with suicidal ideation/ behavior, the prescription opioid epidemic could have led to increases in suicide rates in the population. Finally, the group-level (i.e., state level) effects of three state level exposures, i.e., increasing trends in the per capita volume of prescription opioids, in the nonmedical use of these drugs, and in unintentional fatal opioid overdoses, on the increase in suicide rates were examined. For this, pooled cross sectional time series data from the 50 states (1999-2016) were used in linear regression models with state and year fixed effects. Although the volume of prescription opioids and the rate of fatal opioid overdoses increased over the study period, the prevalence of nonmedical use of prescription opioids decreased in most states. Results showed that the rate of unintentional fatal prescription opioid overdoses was associated with an increase in the rate of suicides. The range of effects sizes compatible with the data also suggested that the increase in the per capita volume of prescription opioids was linked to increases in suicide rates. Overall, this dissertation increased our understanding of the possible role that the opioid epidemic played on the increase in suicide rates in the U.S. As public efforts continue to fight the opioid epidemic, these findings can help inform future research that will guide the development of suicide prevention strategies and approaches to reduce the burden that the opioid epidemic poses on communities.

Among the 19.3 million veterans residing in the U.S., suicide is a primary mental health concern, with risk for suicide among veterans being 21% higher than for the general population. Increased suicide risk for veterans may be linked to strong negative emotions associated with the requirements of being in the military. For instance, many veterans describe feelings of guilt, defined as remorse or responsibility for one's actions, such as for experiences during combat exposure (e.g., having to kill someone). Shame, or the belief that there is something inherently wrong or defective with the self, often occurs following a violation of personal values or morals (e.g. participation in violence, missing important family events during deployment), and frequently coexists with feelings of guilt. As well, many members of the military experience sexual trauma, which may induce shame. For some veterans, suicide may become a viable alternative to these overwhelming negative feelings. However, not all veterans are at risk for suicide, perhaps due to individual-level protective factors. One such factor is self-compassion, which is composed of self-kindness, community, and mindfulness. Positive emotions (i.e. selfcompassion) may buffer against negative feelings about the self or one's actions (i.e. guilt and shame), thereby decreasing suicide risk. Our study aimed to test these associations in the context of moderation analyses. At the bivariate level, we hypothesized that guilt and shame would be negatively related to self-compassion and positively related to suicide risk. Also, we hypothesized that self-compassion would be negatively related to suicide risk. At the multivariate level, we hypothesized that self-compassion would moderate the relations between guilt and suicide risk, and between shame and suicide risk, weakening both associations. Our sample of veterans (N=422) was primarily white (n=366) and male (n=291). Participants completed self-report measures including the Differential Emotions Scale-IV, Self-Compassion Scale Short-Form, and Suicide Behaviors Questionnaire-Revised. Bivariate correlations and multivariate analyses, per Hayes (2013), were conducted covarying age, sex, and ethnicity. In bivariate correlations, guilt and shame were positively related to suicide risk (p

Background: Insomnia has been shown to have direct and indirect associations with suicidal ideation, attempts, and death in U.S. military and veteran populations. However, transdiagnostic models of insomnia and psychopathology have not been used to examine the contribution of psychopathology. Method: The present study is a secondary analysis examining the associations among insomnia symptoms, posttraumatic stress disorder (PTSD) and depressive symptoms, interpersonal theory of suicide variables, and risk for suicidal behavior in community veterans (n = 392). Serial mediation was used to test sequential associations, allowing for examination of direct and indirect associations. Results: The model with insomnia, PTSD, and depressive symptoms, and thwarted belongingness, accounted for 29% of the variance in risk. Insomnia symptoms had an indirect association through PTSD and depressive symptoms, and thwarted belongingness. The model with insomnia, PTSD, and depressive symptoms, and perceived burdensomeness accounted for 35% of the variance in risk. Insomnia symptoms had an indirect association through PTSD and depressive symptoms, and perceived burdensomeness. Limitations: Data are cross-sectional, precluding the testing of causal associations. Conclusions: In veterans, insomnia symptoms may be associated with increased PTSD and depressive symptoms, which may be associated with increased risk for suicidal behavior directly and indirectly through relationship disruptions.

Sleep problems are robust suicide risk correlates. According to the interpersonal theory of suicide, thwarted belongingness (TB) and perceived burdensomeness (PB) may explain the link between sleep problems and suicide risk. This study examined these relationships among 331 community-dwelling adults identifying as sexual and/or gender minorities. Self-report measures of sleep problems, TB, PB, suicide risk, and anxiety were completed. Bootstrap mediation analyses were conducted to test TB and PB as interacting, individual, and parallel explanatory factors linking sleep problems and suicide risk. Sleep problems were associated with greater TB, PB, and suicide risk. TB and PB, in parallel and individually, accounted for the relationship between sleep problems and suicide risk, beyond age and anxiety. In contrast to the interpersonal theory, the indirect effect of PB was stronger at lower levels of TB and the indirect effect of TB was stronger at lower levels of PB. Exploratory analyses indicated significant differences between sexual minorities, gender minorities, and individuals identifying as both sexual and gender minorities: the indirect effect of sleep problems on suicide risk through PB was descriptively strongest among sexual minorities, and the indirect effect through TB was descriptively stronger among gender minorities and individuals identifying with both minority groups. Findings suggest that intervening upon TB and PB may thwart the trajectory from sleep problems to suicide risk among sexual and gender minorities. Further work is needed to determine whether suicide risk pathways differ across minority groups.

This study examined the role of ethnic identity and loneliness as predictors of suicide risk, namely, hopelessness and suicidal behaviors, in Latino college students. One hundred sixty Latino students completed a survey assessing for the aforementioned constructs. Results of conducting regression analyses indicated that ethnic identity was a significant predictor of suicide risk. When loneliness was added into the regression model, it was found to account for a significant amount of incremental variance in both of the suicide risk indices. Our findings indicate that ethnic identity dimensions and loneliness are involved in suicide risk among Latinos.