Peter M. Gutierrez, PhD is a licensed Clinical Psychologist at the VA VISN 19 MIRECC. Dr. Gutierrez's clinical training was in child and adolescent psychology, with an emphasis on serious psychopathology and suicide. He is an Associate Professor of Psychiatry at the University of Colorado School of Medicine. He has been studying suicide, focusing on screening, assessment, and intervention for almost 20 years. Dr. Gutierrez is Past-President of the American Association of Suicidology (AAS). He was the 2005 recipient of the AAS Shneidman Award for outstanding contributions in research in suicidology. He is an Associate Editor of the journal Suicide and Life-Threatening Behavior and a consulting editor for Archives of Suicide Research, and regularly reviews for other psychology, psychiatry, and specialty journals.
At the VISN 19 MIRECC, he is a member of the suicide consultation service and treats patients with TBI, major depression, and Post Traumatic Stress Disorder (PTSD). Dr. Gutierrez is a member of the psychology training committee, MIRECC psychology fellowship training committee, provides supervision for psychology pre-doctoral interns, and MIRECC psychology fellows. He has provided numerous VA trainings and conference presentations on issues related to clinical care of Veterans at high risk of suicide, the interplay of TBI, PTSD and suicide, and related topics.
In terms of funded research, Dr. Gutierrez is Principle Investigator (PI) on a Department of Defense (DOD) funded study of a novel intervention to improve medication adherence, decrease psychiatric symptom distress, and associated suicide risk in Veteran mental health patients. He is co-Director, with Dr. Thomas Joiner at Florida State University, of the DOD funded Military Suicide Research Consortium. He is also a co-PI on a DOD funded clinical trial of a new therapeutic framework aimed at reducing suicide risk in Soldiers. Dr. Gutierrez is co-investigator on a newly funded VA Patient Safety Center of Inquiry and a consultant on a DOD funded suicide screening study. In terms of unfunded research, Dr. Gutierrez is PI or co-PI on a range of studies with MIRECC and outside collaborators on topics related to multiple aspects of Veteran, young adult, and adolescent suicidality.
Medication overdoses account for substantial numbers of suicide-related behaviors. Non-adherence is a significant issue for those with psychiatric illness.
This study is designed to test the psychometric properties of the Interpersonal Needs Questionnaire (INQ-12) and the Acquired Capability for Suicide Scale (ACSS) in a sample of military veterans, something which has not been done. These measures were developed to assess the constructs of Joiner’s interpersonal psychological theory of suicide. Secondary goals of the study are to determine if values mediate the relationship between reasons for living and suicide risk, and whether participants’ suicidal wish can be categorized as either escaping their problems or influencing other people.
This study will use VHA data toward the ultimate goal of establishing a mechanism by which VA clinicians could access data on Veterans regarding suicidal thoughts and/or behaviors that occurred when they were on active duty, as documented in the Department of Defense Suicide Event Report (DoDSER).
The proposed investigation is a pilot study intended to establish the safety and tolerability of lithium augmentation of standard psychopharmacological treatment of PTSD for combat veterans seeking treatment at the Denver VA Medical Center.
Research Team: Peter M. Gutierrez PhD, Thomas Joiner PhD, Greg Riccardi PhD, Jon Maner, PhD, Kelly Moroney MA, Karen Gronau, Megan Dwyer, Jetta Hanson MA
Consortium seeks to develop more effective prevention interventions, risk assessment methods, and treatments to decrease suicide in the military.
Status of Department of Defense Funded Suicide Research - Panel Discussion
4/20/2012
2012 American Association of Suicidology Conference
Presentation 1.
Dr. Diana J. Fitek
Portfolio Manager – Suicide, Substance Abuse & Violence Prevention
U.S. Army Medical Research and Materiel Command
Military Operational Medicine Research Program
Fort Detrick, MD
Presentation 2.
Thomas Joiner, Ph.D., Florida State University; Peter M. Gutierrez, PhD, VISN 19 MIRECC, University of Colorado School of Medicine
Co-Directors MSRC
University of Utah National Center for Veterans Studies and American Psychological Association jointly sponsored Military and Veteran Suicide Prevention Clinical Best Practices Consensus Meeting in Washington, DC
Bahraini NH, Gutierrez PM, Harwood JEF, Huggins JA, Hedegaard H, Chase M, Brenner LA. (2012). The Colorado Violent Death Reporting System (COVDRS): Validity and Utility of the Veteran Status Variable. Public Health Rep., May/Jun;127(3):304-309.
Objective. Using the Veterans Affairs Beneficiary Identification Record Locator Subsystem (BIRLS) as the criterion database, we evaluated the sensitivity and specificity of the death certificate information in the Colorado Violent Death Reporting System (COVDRS) to determine Veteran status for those who died by suicide. Methods. The study sample consisted of 3,820 individuals aged 18 years and older who died by suicide in Colorado from January 1, 2004, through December 31, 2008. To determine agreement on Veteran status, COVDRS data were submitted to the Veterans Benefits Administration for linkage to the BIRLS using Social Security numbers. Results. Sensitivity and specificity of the Veteran status information on the death certificate were 93.1% (95% confidence interval [CI] 90.7, 95.2) and 91.7% (95% CI 90.5, 92.8), respectively. The overall agreement between the death certificate and the BIRLS on Veteran status was very good (kappa 5 0.76; 95% CI 0.74, 0.79). Conclusions. This study of 3,820 suicide deaths in Colorado demonstrated a high level of agreement between the COVDRS Veteran status variable and the BIRLS. Such findings offer support for using the COVDRS in studying factors associated with suicide in the Veteran population.
Brausch, A. M. & Gutierrez, P. M. (2010). Differences in non-suicidal self-injury and suicide attempts in adolescents. Journal of Youth and Adolescence, 39(3), 233-244.
As suicide attempts and self-injury remain predominant health risks among adolescents, it is increasingly important to be able to distinguish features of self-harming adolescents from those who are at risk for suicidal behaviors. The current study examined differences between groups of adolescents with varying levels of self-harmful behavior in a sample of 373 high school students with a mean age of 15.04 (SD = 1.05). The sample was 48% female and the distribution of ethnicity was as follows: 35% Caucasian, 37.2% African-American, 16% Multi-ethnic, 9.2% Hispanic, and 2.3% Asian. The sample was divided into three groups: no history of self-harm, non-suicidal self-injury (NSSI) only, and NSSI in addition to a suicide attempt. Differences in depressive symptoms, suicidal ideation, social support, self-esteem, body satisfaction, and disordered eating were explored. Results indicated significant differences between the three groups on all variables, with the no self-harm group reporting the lowest levels of risk factors and highest levels of protective factors. Further analyses were conducted to examine specific differences between the two self-harm groups. Adolescents in the NSSI group were found to have fewer depressive symptoms, lower suicidal ideation, and greater self-esteem and parental support than the group that also had attempted suicide. The clinical implications of assessing these specific psychosocial correlates for at-risk adolescents are discussed.
Brenner, L. A., Terrio, H., Homaifar, B. Y., Gutierrez, P. M., Staves, P. J., Harwood, J. E. F., et al. (2010). Neuropsychological test performance in soldiers with blast-related mild TBI. Neuropsychology,24(2), 160-175.
This exploratory study was conducted to increase understanding of neuropsychological test performance in those with blast-related mild traumatic brain injury (mTBI). The two variables of interest for their impact on test performance were presence of mTBI symptoms and history of posttraumatic stress disorder (PTSD). Forty-five soldiers postblast mTBI, 27 with enduring mTBI symptoms and 18 without, completed a series of neuropsychological tests. Seventeen of the 45 met criteria for PTSD. The Paced Auditory Serial Addition Test (Frencham, Fox, & Mayberry, 2005; Spreen & Strauss, 1998) was the primary outcome measure. Two-sided, 2-sample t tests were used to compare scores between groups of interest. Presence of mTBI symptoms did not impact test performance. In addition, no significant differences between soldiers with and without PTSD were identified. Standard neuropsychological assessment may not increase understanding about impairment associated with mTBI symptoms. Further research in this area is indicated.
Breshears, R. E., Brenner, L. A., Harwood, J. E. F., & Gutierrez, P. M. (2010). Predicting suicidal behavior in Veterans with traumatic brain injury: The utility of the Personality Assessment Inventory. Journal of Personality Assessment, 92,349-355.
In this study, we investigated the Personality Assessment Inventory's (PAI; Morey, 1991, 2007) Suicide Potential Index (SPI) and Suicide Ideation scale (SUI) as predictors of suicidal behavior (SB) in military Veterans with traumatic brain injury (TBI; N = 154). We analyzed electronic medical records were searched for SB in the 2 years post-PAI administration and data via logistic regressions. We obtained statistical support for the SPI and SUI as predictors of SB. Analyses we performed using receiver operating characteristics suggested an optimal SPI cutoff of > or = 15 for this sample. Findings suggest that SPI and SUI scores may assist in assessing suicide risk in those with TBI, particularly when population-based cutoffs are considered.
Freedenthal, S., Lamis, D. A., Osman, A., Kahlo, D. & Gutierrez, P. M. (2011). Evaluation of the psychometric properties of the Interpersonal Needs Questionnaire-12 in samples of men and women. Journal of Clinical Psychology, 67(6), 609-623.
This study analyzed the psychometric properties of the Interpersonal Needs Questionnaire-12 (INQ-12; Van Orden, Witte, Gordon, Bender, & Joiner, 2008a), designed to test Joiner's interpersonal-psychological theory of suicide. Study participants included 785 U.S. undergraduates (58.6% female; 77.2% White; ages 18-25). Confirmatory bifactor analyses discerned a general factor for overall distress, while also supporting separate subfactors for perceived burdensomeness and thwarted belongingness. The scale's factor structure did not vary by gender, and internal consistency reliability was strong among the male and female samples. Correlational analyses supported the scale's content validity. Overall, the analyses preliminarily support continued use of the INQ-12.
Gutierrez, P. M. (2010). The accidental suicidologist. In M. Pompili (Ed.), Suicide in the words of suicidologists (pp. 87-90). New York, NY: Nova Science Publishers, Inc.
Gutierrez, P. M., & Brenner, L. A. (2011). Helping military personnel/veterans and families manage stress reactions and navigate reintegration. In A. Palmo, W. Weikel & D. Borsos (Eds.), Foundations of mental health counseling, fourth edition (pp. 280-286). Springfield, IL: Charles C. Thomas.
Gutierrez PM, Freedenthal S, Wong JL, Osman A, Norizuki T. Validation of the Suicide Resilience Inventory-25 (SRI-25) in Adolescent Psychiatric Inpatient Samples. J Pers Assess. 2012 Jan;94(1):53-61.
Resilience has been associated with a markedly decreased chance for risky behaviors following a trauma or other negative life event. This study examined the factor structure and psychometric properties of a self-report measure of resilience, the Suicide Resilience Inventory-25 (SRI-25; Osman et al., 2004 ), among psychiatric inpatient adolescents. In Study 1, we conducted confirmatory factor analysis to provide additional empirical support for the structure and invariance of the 3-factor model of the SRI-25 in youth samples, ages 14 to 17 years (N = 152 boys, 220 girls). Scale reliability analyses provided good evidence for internal consistency reliability of scores on the SRI-25 total and scales. In Study 2 (N = 30 boys, 40 girls), we presented data in support for the concurrent validity (i.e., known groups) of scores on the SRI-25. Additionally, we identified potential correlates for the SRI-25 total scale scores.
Jobes, D. A., Comtois, K., Brenner, L.A. & Gutierrez, P.M. (2011). Clinical trial feasibility studies of the collaborative assessment and management of suicidality (CAMS). In R. O'Connor, S. Platt & J. Gordon (Eds.), International handbook of suicide prevention research, policy, and practice. (pp. 383-400). West Sussex, United Kingdom: John Wiley & Sons Ltd.
Muehlenkamp, J. J., Cowles, M. L., & Gutierrez, P.M. (2010). Validity of the self-harm behavior questionnaire with diverse adolescents. Journal of Psychopathology and Behavioral Assessment, 32, 236-245.
Suicide and non-suicidal self-injurious behavior (NSSI) continue to be significant health problems for adolescents. Although there are many instruments available to assess self-harm behaviors, few have been validated for use with adolescents, and even fewer have been validated for use with different racial/ethnic groups. The Self-Harm Behavior Questionnaire (SHBQ) assesses NSSI, suicidal ideation, suicide threats, and past suicide attempts. Data from 1,386 racially/ethnically diverse adolescents (57.5% minority) were collected to examine the validity of the SHBQ in this age group. Analyses supported the four-factor structure, revealed the SHBQ is internally consistent, and provided evidence for convergent validity within Caucasian, African American, and Hispanic adolescents. However, slight differences were noted. Overall, the findings suggest the SHBQ is a useful assessment tool appropriate for use with Caucasian, African American, and Hispanic adolescents.
Osman, A., Bagge, C. L., Freedenthal, S., Gutierrez, P.M., & Emmerich, A. (2011). Development and evaluation of the social anxiety and depression life interference-24 (SADLI-24) inventory. Journal of Clinical Psychology, 67(1), 82-98.
We describe the development of a new self-report instrument, the Social Anxiety and Depression Life Interference-24 (SADLI-24) inventory. We initially retained 30 content specific items for the instrument (Study 1). In Study 2 (N = 438), we established a 2-factor solution, Social Anxiety Life Interference-12 (SALI-12) and Depression Life Interference-12 (DLI-12). We also examined estimates of known-groups and concurrent validity. Confirmatory factor analysis in Study 3 (N = 430) provided support for the oblique two-factor structure. In Study 4 (N = 179), we provided additional support for estimates of known-groups validity. In Study 5 (N = 63), we evaluated estimates of test-retest reliability. Both SADLI-24 scale scores showed good estimates of internal consistency.
Osman, A., Freedenthal, S., Fang, Q., Willis, J., Norizuki, T., & Gutierrez, P.M. (2011). The UTSA Future Disposition Inventory: Further analyses of reliability, validity, and potential correlates in non-clinical samples. In A. M. Columbus (Ed.) Advances in psychology research. Hauppauge, NY: Nova Science Publishers, Inc.
Osman, A., Freedenthal, S., Gutierrez, P.M., Wong, J. L., Emmerich, A., & Lozano, G. (2011). The Anxiety Depression Distress Inventory-27 (ADDI-27): A short version of the Mood and Anxiety Symptom Questionnaire-90. Journal of Clinical Psychology, 67(6), 591-608.
The authors conducted three studies to construct and examine the psychometric properties of a 27-item version of the Mood and Anxiety Symptom Questionnaire-90 (MASQ-90; Watson & Clark, 1991a). The Anxiety Depression Distress Inventory-27 (ADDI-27) contains three empirically derived scales: Positive Affect, Somatic Anxiety, and General Distress, which are relevant dimensions of the tripartite model of affect. Each scale is composed of nine items, and the estimate of scale reliability for each scale score was ≥ .80 across the three studies. Results of exploratory and confirmatory factor analyses provided adequate support for a 3-factor model. Additional estimates of concurrent validity documented the ADDI-27 scales' convergent and discriminant validity. We also identified three construct relevant correlates for each scale score. Overall, the ADDI-27 appears to be a content valid, reliable, and multidimensional measure of the tripartite model of affect.
Osman, A., Gutierrez, P.M., Bagge, C. L., Fang, Q., & Emmerich, A. (2010). Reynolds adolescent depression scale-second edition: A reliable and useful instrument. Journal of Clinical Psychology, 66(12), 1324-1345.
The authors conducted two studies to address issues of the dimensionality, scale reliability, and psychometric properties of scores on the Reynolds Adolescent Depression Scale-Second Edition (RADS-2; Reynolds, 2002) in samples of adolescent psychiatric inpatients. In Study 1 (N=262), they used bifactor analysis to further evaluate the general and specific components of the RADS-2. In Study 2 (N=196), they used confirmatory factor analysis to evaluate the fit of a 1-factor model, the original 4-factor model, a second-order model, and a bifactor model to a new sample data. In both studies, the total RADS-2 and content-specific subscale scores showed acceptable estimates of reliability (i.e., scale reliability estimates >.80). Estimates of concurrent validity were also examined. Scores of the RADS-2 total and content-specific subscale scores were useful in differentiating between the responses of youth with mood disorder diagnoses and those with other primary psychiatric disorder diagnoses. The authors also conducted correlation analyses to identify potential correlates for the total RADS-2 scale and the proposed subscale scores.
Osman, A., Gutierrez, P.M., Barrios, F., Wong, J. L., Freedenthal, S., & Lozano, G. (2010). Development and Initial Psychometric Properties of the UTSA Future Disposition Inventory. Journal of Clinical Psychology, 66(4), 1-20.
We describe the development and initial psychometric properties of a 24-item self-report measure, the University of Texas at San Antonio Future Disposition Inventory (UTSA FDI). This instrument is designed to evaluate future related thoughts and feelings that are associated with suicide-related risk behaviors: positive focus, suicide orientation, and negative focus. The items were generated by clinical and nonclinical samples. The structure of the instrument was defined in a sample of 350 university undergraduate students (Study 1). Using CFA, we confirmed the fit of the 3-factor solution in an independent sample of college age students (n=452; Study 2). Scale reliability estimates were good (all rho's>or=.80) in both studies. Known-groups validation analyses showed that scores on each scale were useful in differentiating the responses of the study groups. Correlates for the scales were identified when scores on measures of suicide-related risk and general psychological symptoms were included as validation self-report instruments.
Osman, A., Gutierrez, P.M., Schweers, R., Fang, Q., Holguin-Mills, R. L., & Cashin, M. (2010). Psychometric Evaluation of the Body Investment Scale for Use with Adolescents. Journal of Clinical Psychology, 66(3), 259-276.
We conducted two studies to examine the psychometric properties of the Body Investment Scale (BIS; Orbach & Mikulincer, 1998) in U.S. adolescent samples. The BIS was designed to assess bodily experiences that are associated with suicide-related behaviors. In Study 1, confirmatory factor analysis (CFA) with data from a combined sample of 204 high school adolescents (83 boys, 121 girls) and 197 psychiatric inpatient (101 boys, 96 girls) adolescents provided moderate support for the oblique four-factor solution: Body Feelings (rho=.86, 95% CI=.83-.89), Body Touch (rho=.71, 95% CI=.65-.76), Body Care (rho=.78, 95% CI=.71-.81), and Body Protection (rho=.78, 95% CI=.73-.82); robust comparative fit index=.88 and the robust Tucker Lewis Index=.83. The second-order factor model also provided moderate fit to the data. In Study 2, results of the CFA with data from adolescent psychiatric inpatients (N=205; 101 boys, 104 girls) provided additional support for the four-factor solution. In addition, results of the receiver operating characteristic and logistic regression analyses showed that scores on the Body Feelings and Body Protection scales were most useful in differentiating the responses of suicidal and nonsuicidal adolescents, all Cohen's d values >.30. The study also examined associations between scores on the BIS scales and the validation self-report measures of hopelessness, suicide-related behavior, and reasons for living.
Osman, A., Gutierrez, P.M., Smith, K., Fang, Q., Lozano, G., & Devine, A. (2010). The Anxiety Sensitivity Index-3: Analyses of Dimensions, Reliability Estimates, and Correlates in Nonclinical Samples. Journal of Personality Assessment, 92(1), 45-52.
We investigated the factor structure, reliability estimates, and correlates of the Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007) in 2 studies. We established a bifactor model in Study 1 as an alternative representation of the structure of the ASI-3. Analyses of gender differences on the total ASI-3 and subscale scores were not statistically significant (Study 1, N = 462). In Study 2 (N = 293), results of a series of confirmatory factor analyses provided stronger support for the fit of the bifactor model compared with 2 alternative models. Estimates of scale reliability were adequate (all rho values > or = .80) and not "p" (as in italic p for significance). in the 2 studies. In addition, using simultaneous regression analyses, we found anxiety-specific correlates for the total ASI-3 and subscale scores to include responses on self-report measures of interpersonal sensitivity, obsessive-compulsive anxiety, paranoid ideation, and phobic anxiety.
Osman, A., Gutierrez, P.M., Wong, J. L., Freedenthal, S., Bagge, C. L., & Smith, K. D. (2010). Development and Psychometric Evaluation of the Suicide Anger Expression Inventory--28. Journal of Psychopathology and Behavior Assessment, 32, 595-608.
Osman A, Wong JL, Bagge CL, Freedenthal S, Gutierrez PM, Lozano G. The Depression Anxiety Stress Scales-21 (DASS-21): Further Examination of Dimensions, Scale Reliability, and Correlates. J Clin Psychol. 2012 Dec;68(12):1322-38.
OBJECTIVES: We conducted two studies to examine the dimensions, internal consistency reliability estimates, and potential correlates of the Depression Anxiety Stress Scales-21 (DASS-21; Lovibond & Lovibond, 1995). METHOD: Participants in Study 1 included 887 undergraduate students (363 men and 524 women, aged 18 to 35 years; mean [M] age = 19.46, standard deviation [SD] = 2.17) recruited from two public universities to assess the specificity of the individual DASS-21 items and to evaluate estimates of internal consistency reliability. Participants in a follow-up study (Study 2) included 410 students (168 men and 242 women, aged 18 to 47 years; M age = 19.65, SD = 2.88) recruited from the same universities to further assess factorial validity and to evaluate potential correlates of the original DASS-21 total and scale scores. RESULTS: Item bifactor and confirmatory factor analyses revealed that a general factor accounted for the greatest proportion of common variance in the DASS-21 item scores (Study 1). In Study 2, the fit statistics showed good fit for the bifactor model. In addition, the DASS-21 total scale score correlated more highly with scores on a measure of mixed depression and anxiety than with scores on the proposed specific scales of depression or anxiety. Coefficient omega estimates for the DASS-21 scale scores were good. CONCLUSIONS: Further investigations of the bifactor structure and psychometric properties of the DASS-21, specifically its incremental and discriminant validity, using known clinical groups are needed.
Ribeiro JD, Pease JL, Gutierrez PM, Silva C, Bernert RA, Rudd MD, Joiner TE Jr. Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military. J Affect Disord. 2012 Feb;136(3):743-50.
Background: Sleep problems appear to represent an underappreciated and important warning sign and risk factor for suicidal behaviors. Given past research indicating that disturbed sleep may confer such risk independent of depressed mood, in the present report we compared self-reported insomnia symptoms to several more traditional, well-established suicide risk factors: depression severity, hopelessness, PTSD diagnosis, as well as anxiety, drug abuse, and alcohol abuse symptoms.
Methods: Using multiple regression, we examined the cross-sectional and longitudinal relationships between insomnia symptoms and suicidal ideation and behavior, controlling for depressive symptom severity, hopelessness, PTSD diagnosis, anxiety symptoms, and drug and alcohol abuse symptoms in a sample of military personnel (N=311).
Results: In support of a priori hypotheses, self-reported insomnia symptoms were crosssectionally associated with suicidal ideation, even after accounting for symptoms of depression, hopelessness, PTSD diagnosis, anxiety symptoms and drug and alcohol abuse. Selfreported insomnia symptoms also predicted suicide attempts prospectively at one-month follow up at the level of a non-significant trend, when controlling for baseline self-reported insomnia symptoms, depression, hopelessness, PTSD diagnosis and anxiety, drug and alcohol abuse symptoms. Insomnia symptoms were unique predictors of suicide attempt longitudinally when only baseline self-reported insomnia symptoms, depressive symptoms and hopelessness were controlled.
Limitations: The assessment of insomnia symptoms consisted of only three self-report items. Findings may not generalize outside of populations at severe suicide risk. Conclusions: These findings suggest that insomnia symptoms may be an important target for suicide risk assessment and the treatment development of interventions to prevent suicide.
Rings JA, Alexander PA, Silvers VN, Gutierrez PM. (2012). Adapting the Safety Planning Intervention for Use in a Veterans Psychiatric Inpatient Group Setting. Journal of Mental Health Counseling, 34(2), 95-109.
The Department of Veterans Affairs (VA) recently has adopted the Safety Planning Intervention (SPI; Stanley & Brown, 2011), a brief collaborative intervention, for use with veterans who are at high risk of suicide. The SPI is a hierarchical list of strategies for veterans to use in coping with a suicidal crisis. Its developers recommended that it be used with individual psychiatric inpatients working toward discharge, but its utility in a group format has not previously been addressed. This article describes the facilitation of a safety planning group with psychiatric inpatients at a large urban VA medical center. It depicts each step in the safety plan and offers case examples, anecdotal support, and specific considerations for its use in groups. Directions for further research are also discussed.
Selby, E. A., Anestis, M. D., Bender, T. W., Ribeiro, J. D, Nock, M. K., Rudd, et al. (Gutierrez, P.M.) (2010). Overcoming the fear of lethal injury: Evaluating suicide in the military through the lens of the interpersonal-psychological theory of suicide. Clinical Psychology Review, 30, 298-307.
Suicide rates have been increasing in military personnel since the start of Operation Enduring Freedom and Operation Iraqi Freedom, and it is vital that efforts be made to advance suicide risk assessment techniques and treatment for members of the military who may be experiencing suicidal symptoms. One potential way to advance the understanding of suicide in the military is through the use of the Interpersonal-Psychological Theory of Suicide. This theory proposes that three necessary factors are needed to complete suicide: feelings that one does not belong with other people, feelings that one is a burden on others or society, and an acquired capability to overcome the fear and pain associated with suicide. This review analyzes the various ways that military service may influence suicidal behavior and integrates these findings into an overall framework with relevant practical implications. Findings suggest that although there are many important factors in military suicide, the acquired capability may be the most impacted by military experience because combat exposure and training may cause habituation to fear of painful experiences, including suicide. Future research directions, ways to enhance risk assessment, and treatment implications are also discussed.
Wortzel HS, Gutierrez PM, Homaifar BY, Breshears RE, Harwood JE. Surrogate endpoints in suicide research. Suicide Life Threat Behav. 2010 Oct;40(5):500-5.
Surrogate endpoints frequently substitute for rare outcomes in research. The ability to learn about completed suicides by investigating more readily available and proximate outcomes, such as suicide attempts, has obvious appeal. However, concerns with surrogates from the statistical science perspective exist, and mounting evidence from psychometric, neurochemical, genetic, and neuroimaging studies suggests that surrogates may be particularly problematic in suicide research. The need for greater phenotypic refinement of suicide-related behaviors, development of and adherence to a shared suicide nomenclature, and conservative interpretation of investigational results that are limited to the precise population and suicide-related behavior under examination are discussed.
Dr. Peter M. Gutierrez 
Osman A, Wong JL, Bagge CL, Freedenthal S, 
