Download Suicide Among Veterans with Posttraumatic Stress Disorder


Five Categories:
› First category:
 Individual must have been exposed to a trauma in which he or she was
confronted with an event that involved actual or threatened death or serious
injury, or a threat to self or others’ physical well-being
› Second category:
 Continuously reliving the traumatic event by dreams, recurrent recollections
of the event, flashback episodes, intense psychological distress that resemble
trauma, and physiologic reactivity on exposure to events related to trauma
› Third category:
 Individual persistently avoiding stimuli in at least three ways including
attempting to avoid thoughts, feelings, activities, people, or situations
associated with the trauma, diminishing interest in significant activities,
voluntary social isolation, numbing feelings, and sensing a foreshortened
future.
› Fourth category:
 Persistent symptoms of increased nervous system arousal by at least two
ways: difficulty sleeping, irritability, difficulty concentrating, hypervigilance,
and exaggerated startle reactions.
› Fifth category:
 The person experience disturbance which causes clinically significant distress
or impairment in social, occupational, or other critical areas of living

Posttraumatic Stress Disorder was first
recognized among Wars I and II
Veterans.
› originally called shell shock, combat fatigue,
and war neurosis

Vietnam War
› human services professions and the public
became aware of Veterans with
Posttraumatic Stress Disorder
› began support groups to help cope with
their issues with the war
About 14 percent of the general
population in the USA is expected to
experience PTSD in his or her lifetime
 Symptoms in 90% of individuals with PTSD
persisted longer than three months

› Over 70% lasted longer than a year
› More than 1/3 of people never fully recover
Roughly 30% of men and 27% of women of
Vietnam Veterans had PTSD at some point
in the lives
 Approximately 24% Veterans of the Persian
Gulf War has experienced Posttraumatic
Stress Disorder
 Dealings in Iraq and Afghanistan are still
ongoing

› Approximately 12.5% of those already deployed
and returned home has developed PTSD

Suicide is the 8th leading cause of death
in the US
› 13% of all Americans reported a history of
suicidal thoughts
› 3.9% actually made a suicide plan
› 4.6% reported they attempted suicide

Ages between 15-24 / 65 and older
count for the largest portion of suicides in
America
Veterans account for 20% who commit
suicide
 Male Veterans are twice as likely as
civilians to commit suicide
 People with mental disorders (PTSD)
completed suicides 90% more than those
without mental disorders


Used to identify warning signs
of suicide: IS PATH WARM
Ideation of suicide
› Substance abuse

Scale used to identify
potential suicidal individuals:
SAD PERSONS
›
Purposelessness
› Anxiety
› Trapped
› Hopelessness
›
Sex (male)
› Age (15-34, 65 & older)
› Depression
›
›
›
›
Withdrawal
› Anger
› Recklessness
› Mood change
›
›
›
›
›
Previous exposure to suicide
Ethanol (alcohol) drug use
Rational thinking loss
Social support system lacking
Organized plan
No spouse or significant other
Sickness

About 2/3 of people who complete or
attempt suicide are depressed
› Must address the issue of depression

Symptoms of depression include weight
loss or gain, increased or decreased
sleep, fatigue, and inability to
concentrate or make decisions
› Interferes with one’s ability to function in all
areas of life (work, school, family, etc.)

Most commonly used treatments are
antidepressants, psychotherapy, and
electro-convulsive therapy (ECT).
More effective to start immediately with
correct dosage to reduce the symptoms
of depression in a timely fashion.
 Side effects:

› Dry mouth
› Weight gain or loss

Overall, effective and highly favored

Group cognitive behavior therapy (CBT),
individual CBT, and an interpersonal
group therapy (IGT) approach are
effective methods.



Mainly used when individuals are not responding to
antidepressants and psychotherapy
Use an electrical shock to cause seizures in the
brain which releases chemicals in the brain
› Brain cells work better when these chemicals are
released which improves brain cells and make
chemical messengers better
Side effects:
› temporary short-term memory loss, confusion,
nausea, muscle aches and headache


A number of scales to detect PTSD:
› CAPS-1, Mississippi Scale for Combat Related
PTSD, Impact of Events Scale, Keane PK Scales of
MMPI/MMPI-2, etc.
Most Veterans with PTSD refuse early intervention
due to denial and the idea that they should be
able to deal with their own problems.
› Important to educate people with PTSD in order
to accept their condition by removing selfblame, self-doubt, guilt and correct
misunderstandings

Two main intervention/treatment
methods for Veterans with PTSD:
› Individual intervention
 Cognitive Behavior Therapy and
antidepressants
› Group intervention
 Couples’ therapy and Posttraumatic Stress
Disorder support groups
Cognitive Behavior Therapy
Couples Therapy

Teaches relaxation techniques, cognitive
rewiring, anger management, and
desensitization skills

Offers a means of increasing social
support, decreasing interpersonal conflict,
and addressing the experimental
avoidance that maintains posttraumatic
symptoms

May decrease PSTD symptoms and
suicide risk:
› Positive social support
› Religion
› Life satisfaction
› Positive problem solving and coping skills
› Positive therapeutic relationships
› Responsibility to family members
› Community support
Corcoran, J. & Walsh, J. (2009). Mental Health in Social Work. Boston,
MA: Pearson Education, Inc.
Erbes, C., Polusny, M., MacDermid, S., & Compton, J. (2008). Couples
therapy with combat veterans and their partners. Journal of Clinical
PsychologyJames, R. (2008). Crisis Intervention Strategies. Belmont,
CA: Thomson Brooks/Cole Corporation.
Friedman, M. (2006). Posttraumatic stress disorder among military
returnees from Afghanistan and Iraq. American Journal of
Psychiatry, 163, 586-593.
Jakupcak, M. & et al. (2006). A pilot study of behavioral activation for
veterans with posttraumatic stress disorder. Journal of Traumatic
Stress, 19, 387-391.Suicide Prevention Resource Center (2006).
Retrieved September 21, 2008 from
http://webdev.sprc.org/thismonth/archives/thismonth_apr_jun06.as
p.
Manguno-Mire, G. & et al. (2007). Psychological distress and
burden among female partners of combat veterans with
PTSD. Journal of Nervous and Mental Disease, 195, p. 144-151.
Tull, M. (2007). PTSD in Military Veterans. Retrieved September 23,
2008 from
http://ptsd.about.com/od/prevalence/a/MilitaryPTSD.htm.
United States Department of Veteran Affairs (2008). What is
Posttraumatic Stress Disorder (PTSD)? Retrieved September 22,
2008 from
http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_what
_is_ptsd.html