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Research ArticleRegular Article

Childhood Trauma, Traumatic Brain Injury, and Mental Health Disorders Associated With Suicidal Ideation and Suicide-Related Behavior in a Community Corrections Sample

Tracy D. Gunter, John T. Chibnall, Sandra K. Antoniak, Robert A. Philibert and Donald W. Black
Journal of the American Academy of Psychiatry and the Law Online June 2013, 41 (2) 245-255;
Tracy D. Gunter
Dr. Gunter is Associate Professor of Clinical Psychiatry, Department of Psychiatry, Indiana University School of Medicine, and Adjunct Professor, Indiana University McKinney School of Law, Bloomfield, IN. Dr. Chibnall is Professor of Psychiatry, Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St. Louis, MO. Dr. Antoniak is a Fellow in Forensic Psychiatry, Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY. Drs. Philibert and Black are Professors of Psychiatry, Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA.
MD
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John T. Chibnall
Dr. Gunter is Associate Professor of Clinical Psychiatry, Department of Psychiatry, Indiana University School of Medicine, and Adjunct Professor, Indiana University McKinney School of Law, Bloomfield, IN. Dr. Chibnall is Professor of Psychiatry, Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St. Louis, MO. Dr. Antoniak is a Fellow in Forensic Psychiatry, Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY. Drs. Philibert and Black are Professors of Psychiatry, Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA.
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Sandra K. Antoniak
Dr. Gunter is Associate Professor of Clinical Psychiatry, Department of Psychiatry, Indiana University School of Medicine, and Adjunct Professor, Indiana University McKinney School of Law, Bloomfield, IN. Dr. Chibnall is Professor of Psychiatry, Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St. Louis, MO. Dr. Antoniak is a Fellow in Forensic Psychiatry, Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY. Drs. Philibert and Black are Professors of Psychiatry, Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA.
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Robert A. Philibert
Dr. Gunter is Associate Professor of Clinical Psychiatry, Department of Psychiatry, Indiana University School of Medicine, and Adjunct Professor, Indiana University McKinney School of Law, Bloomfield, IN. Dr. Chibnall is Professor of Psychiatry, Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St. Louis, MO. Dr. Antoniak is a Fellow in Forensic Psychiatry, Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY. Drs. Philibert and Black are Professors of Psychiatry, Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA.
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Donald W. Black
Dr. Gunter is Associate Professor of Clinical Psychiatry, Department of Psychiatry, Indiana University School of Medicine, and Adjunct Professor, Indiana University McKinney School of Law, Bloomfield, IN. Dr. Chibnall is Professor of Psychiatry, Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St. Louis, MO. Dr. Antoniak is a Fellow in Forensic Psychiatry, Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY. Drs. Philibert and Black are Professors of Psychiatry, Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA.
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Article Figures & Data

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    Table 1

    Sample Characteristics

    Characteristics% (n) or Mean (SD)
    Gender
        Male70 (291)
        Female30 (127)
    Race
        Caucasian75 (313)
        African American21 (89)
        Other4 (16)
    Age, years33.5 (9.6)
    Marital status
        Single, never married59 (246)
        Divorced22 (90)
        Separated8 (35)
        Widowed (widower)1 (4)
        Married10 (43)
    Education
        <High school, no GED/diploma24 (99)
        GED37 (155)
        High school diploma39 (164)
    Full-time employment82 (341)
    • View popup
    Table 2

    Correctional Characteristics

    Correctional Characteristics% (n)
    Multiple convictions92 (386)
    Current conviction
        Person11 (45)
        Property40 (167)
        Driving while intoxicated21 (88)
        Drug25 (105)
        Other3 (13)
    • View popup
    Table 3

    Suicidal Ideation and Suicide-Related Behavior

    Ideation and Behavior% (n)
    No suicidal ideation or behavior56 (235)
    Any suicidal ideation41 (171)
    Any suicide-related behavior27 (113)
    Suicidal ideation without suicide-related behavior17 (70)
    • Categories are not mutually exclusive.

    • View popup
    Table 4

    Descriptive Data for Trauma and Mental Health Variables

    Variables% (n) or Mean (SD)
    Childhood traumatic life experience31 (131)
    Lifetime brain injury22 (92)
    Anxiety disorder31 (130)
    Depression symptom sum3.3 (3.7)
    Depressive disorder41 (171)
    Avoidant personality
        Borderline9 (38)
        Clinical11 (47)
    Three or more ASPD DSM criteria A88 (368)
    Any substance use disorder93 (388)
    Number substance use disorders2.9 (1.6)
    Drug dependence67 (278)
    PCL:SV Factor 14.5 (3.2)
    PCL:SV: Factor 26.6 (3.0)
    • View popup
    Table 5

    Variables Screened for Possible Association With Suicidal Ideation or Suicide-Related Behavior

    Demographic Variables
        Gender
        Age (younger)*
        Race*+
        Ethnicity
        Marital status
        Current spouse or partner
        Number of separations from spouse or partner*
        Educational achievement
        Employment and type
        Usual occupation
        Annual income
    Criminal Justice Variables
        Current supervision status
        Current conviction type
        Number of prior convictions
        Prior conviction type
    Health and Treatment Histories
        Current health
        Current health relative to past health
        Prior diagnoses by care provider
            Sexually transmitted diseases*
            Mental health or substance use disorder*
            Traumatic brain injury*†
            Fractures*
        Inpatient medical treatment
        Outpatient medical treatment
        Outpatient surgeries
        Emergency department visits
        Scheduled medical visits last six months
        Inpatient mental health and/or substance abuse treatment*
        Outpatient mental health and/or substance abuse treatment*
        Current mental health treatment*
        Medications prescribed more than two weeks ever
            Any*, sleep*, anxiety*, depression*, energy*, steroid*
            Headache, birth control, other
        Medications prescribed within past 30 days
            Any*, sleep*, anxiety*, depression*
            Energy, steroid, headache, birth control, other
        Talked to a professional about mental health concerns ever*
        Traumatic life experience (type, frequency, chronicity, age*†)
    SSAGA 2 Lifetime Diagnoses
        Antisocial personality disorder
            Number of DSM A Criteria*
            Individual DSM A Criteria
            Repeated illegal acts
            Deception*
            Impulsivity*
            Irresponsibility*
            Recklessness
            Irritability/aggression
            Lack of remorse
        Anxiety disorder*†
            Panic disorder
            Agoraphobia
            Generalized anxiety disorder
            Posttraumatic stress disorder
            Social phobia
        Depressive disorder*
            Number of depressive criteria during most severe episode*†
            Number of depressive episodes
        Eating disorder (any)
        Substance use disorder (any)
            Number of substance use disorders*
            Alcohol abuse and dependence
            Cocaine abuse and dependence*
            Marijuana abuse and dependence
            Other drug abuse and dependence
            Stimulant abuse and dependence*
            Tobacco dependence*
    Achenbach Adult Behavior Checklist Self-Report (last six months)
        DSM-Associated Scales
            Antisocial personality*
            Anxiety*
            Attention deficit hyperactivity*
            Avoidant*†
            Depression*
            Somatic
        Problem Scales
            Alcohol
            Drug
            Tobacco
            Mean substance use*
    Hare Psychopathy Checklist Screening Version
        PCL:SV total score*
        Factor 1 score*
        Factor 2 score*†
    • ↵* Significant uncontrolled univariate associations with ideator or actor group membership.

    • ↵† Differentiated ideator or actor group from control group.

    • View popup
    Table 6

    Multinomial Model: Suicidal Ideation Relative to No Suicidal Ideation/Action

    Factorp ≤WaldOdds Ratio (95% CI)
    Caucasian.00114.585.98 (2.38–14.97)
    Depression symptom sum.0038.591.13 (1.04–1.23)
    Brain injury.0077.192.63 (1.30–5.35)
    Childhood trauma.0087.132.70 (1.30–5.61)
    Avoidant personality.0284.812.97 (1.12–7.87)
    PCL:SV Factor 2 score.0703.281.10 (0.99–1.22) ns
    Any anxiety disorder.0753.170.55 (0.28–1.06) ns
    • View popup
    Table 7

    Multinomial Model: Suicide-Related Behavior Relative to No Suicidal Ideation/Action

    Factorp ≤WaldOdds Ratio (95% CI)
    Depression symptom sum.00129.081.24 (1.14–1.35)
    PCL:SV Factor 2 score.00115.621.23 (1.10–1.36)
    Brain injury.00113.933.61 (1.84–7.10)
    Avoidant personality.00113.025.24 (2.13–12.87)
    Childhood trauma.00110.332.97 (1.52–5.76)
    Caucasian.0057.792.69 (1.34–5.39)
    Any anxiety disorder.0126.312.21 (1.19–4.10)
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Journal of the American Academy of Psychiatry and the Law Online: 41 (2)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 41, Issue 2
1 Jun 2013
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Childhood Trauma, Traumatic Brain Injury, and Mental Health Disorders Associated With Suicidal Ideation and Suicide-Related Behavior in a Community Corrections Sample
Tracy D. Gunter, John T. Chibnall, Sandra K. Antoniak, Robert A. Philibert, Donald W. Black
Journal of the American Academy of Psychiatry and the Law Online Jun 2013, 41 (2) 245-255;

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Childhood Trauma, Traumatic Brain Injury, and Mental Health Disorders Associated With Suicidal Ideation and Suicide-Related Behavior in a Community Corrections Sample
Tracy D. Gunter, John T. Chibnall, Sandra K. Antoniak, Robert A. Philibert, Donald W. Black
Journal of the American Academy of Psychiatry and the Law Online Jun 2013, 41 (2) 245-255;
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