Self-injurious thoughts and behaviors that differentiate soldiers who attempt suicide from those with recent suicide ideation

James A. Naifeh, Matthew K. Nock, Catherine L. Dempsey, Matthew W. Georg, Danielle Bartolanzo, Tsz Hin Hinz Ng, Pablo A. Aliaga, Hieu M. Dinh, Carol S. Fullerton, Holly B.Herberman Mash, Tzu Cheg Kao, Nancy A. Sampson, Gary H. Wynn, Alan M. Zaslavsky, Murray B. Stein, Ronald C. Kessler, Robert J. Ursano*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: Risk for suicide attempt (SA) versus suicide ideation (SI) is clinically important and difficult to differentiate. We examined whether a history of self-injurious thoughts and behaviors (SITBs) differentiates soldiers with a recent SA from nonattempting soldiers with current/recent SI. Methods: Using a unique case-control design, we administered the same questionnaire (assessing the history of SITBs and psychosocial variables) to representative U.S. Army soldiers recently hospitalized for SA (n = 132) and soldiers from the same Army installations who reported 30-day SI but did not make an attempt (n = 125). Logistic regression analyses examined whether SITBs differentiated attempters and ideators after controlling for previously identified covariates. Results: In separate models that weighted for systematic nonresponse and controlled for gender, education, posttraumatic stress disorder, and intermittent explosive disorder, SA was positively and significantly associated with the history of suicide plan and/or intention to act (odds ratio [OR] = 12.1 [95% confidence interval {CI} = 3.6–40.4]), difficulty controlling suicidal thoughts during the worst week of ideation (OR = 3.5 [95% CI = 1.1–11.3]), and nonsuicidal self-injury (NSSI) (OR = 4.9 [95% CI = 1.3–18.0]). Area under the curve was 0.87 in a full model that combined these SITBs and covariates. The top ventile based on predicted risk had a sensitivity of 24.7%, specificity of 99.8%, and positive predictive value of 97.5%. Conclusions: History of suicide plan/intention, difficult to control ideation, and NSSI differentiate soldiers with recent SA from those with current/recent SI independent of sociodemographic characteristics and mental disorders. Longitudinal research is needed to determine whether these factors are prospectively associated with the short-term transition from SI to SA.

Original languageEnglish
Pages (from-to)738-746
Number of pages9
JournalDepression and Anxiety
Issue number8
StatePublished - 1 Aug 2020
Externally publishedYes


  • military
  • nonsuicidal self-injury
  • suicide attempt
  • suicide ideation
  • suicide plan


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