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Research ArticleRegular Article

Trauma and Suicide Attempts among Insanity Acquittees

Anusha Mamidipaka, Jeffrey Guina, James Cameron, Andrew Lemmen and Nicole Kletzka
Journal of the American Academy of Psychiatry and the Law Online September 2022, 50 (3) 396-404; DOI: https://doi.org/10.29158/JAAPL.210104-21
Anusha Mamidipaka
Ms. Mamidipaka is an Undergraduate at Michigan State University, Lansing, MI. Dr. Guina is Psychiatry Residency Program Director, Beaumont Health, Southfield, MI, and Chief Medical Officer, Easterseals Michigan, Auburn Hills, MI. Mr. Cameron is a Child Care Worker, Hawthorn Center, Northville, MI. Mr. Lemmen is Program Development Associate, Neuroscience Education Institute, Carlsbad, CA. Dr. Kletzka is Forensic Psychologist, Center for Forensic Psychiatry, Saline, MI.
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Jeffrey Guina
Ms. Mamidipaka is an Undergraduate at Michigan State University, Lansing, MI. Dr. Guina is Psychiatry Residency Program Director, Beaumont Health, Southfield, MI, and Chief Medical Officer, Easterseals Michigan, Auburn Hills, MI. Mr. Cameron is a Child Care Worker, Hawthorn Center, Northville, MI. Mr. Lemmen is Program Development Associate, Neuroscience Education Institute, Carlsbad, CA. Dr. Kletzka is Forensic Psychologist, Center for Forensic Psychiatry, Saline, MI.
MD
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James Cameron
Ms. Mamidipaka is an Undergraduate at Michigan State University, Lansing, MI. Dr. Guina is Psychiatry Residency Program Director, Beaumont Health, Southfield, MI, and Chief Medical Officer, Easterseals Michigan, Auburn Hills, MI. Mr. Cameron is a Child Care Worker, Hawthorn Center, Northville, MI. Mr. Lemmen is Program Development Associate, Neuroscience Education Institute, Carlsbad, CA. Dr. Kletzka is Forensic Psychologist, Center for Forensic Psychiatry, Saline, MI.
BS
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Andrew Lemmen
Ms. Mamidipaka is an Undergraduate at Michigan State University, Lansing, MI. Dr. Guina is Psychiatry Residency Program Director, Beaumont Health, Southfield, MI, and Chief Medical Officer, Easterseals Michigan, Auburn Hills, MI. Mr. Cameron is a Child Care Worker, Hawthorn Center, Northville, MI. Mr. Lemmen is Program Development Associate, Neuroscience Education Institute, Carlsbad, CA. Dr. Kletzka is Forensic Psychologist, Center for Forensic Psychiatry, Saline, MI.
BS
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Nicole Kletzka
Ms. Mamidipaka is an Undergraduate at Michigan State University, Lansing, MI. Dr. Guina is Psychiatry Residency Program Director, Beaumont Health, Southfield, MI, and Chief Medical Officer, Easterseals Michigan, Auburn Hills, MI. Mr. Cameron is a Child Care Worker, Hawthorn Center, Northville, MI. Mr. Lemmen is Program Development Associate, Neuroscience Education Institute, Carlsbad, CA. Dr. Kletzka is Forensic Psychologist, Center for Forensic Psychiatry, Saline, MI.
PhD
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Article Figures & Data

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    Table 1

    Participant Characteristics for Those Who Have and Have Not Attempted Suicide

    Suicide Attempts
    CharacteristicAll Participants0≧1
    Participants, n (%)107 (100.0)59 (55.1)48 (44.9)
    Gender
     Men, n (%)94 (87.9)56 (59.6)38 (40.4)
     Women, n (%)13 (12.1)3 (23.1)10 (76.9)*a
     Age, mean (SD)39.98 (14.2)39.86 (14.2)40.13 (14.3)
    Race, n (%)
     White60 (56.1)34 (56.7)26 (43.3)
     Black34 (32.8)20 (58.8)14 (41.2)
     Native American8 (7.5)5 (62.5)3 (37.5)
     Asian3 (2.8)1 (33.3)2 (66.7)
     Hispanic2 (1.9)1 (50.0)1 (50.0)
     Not specified8 (7.4)3 (37.5)5 (62.5)
    Marital status, n (%)
     Single85 (79.4)47 (55.3)38 (44.7)
     Single & cohabitating6 (5.6)3 (50.0)3 (50.0)
     Married2 (1.9)2 (100.0)0 (0.0)
     Divorced9 (8.4)5 (55.6)4 (44.4)
     Widowed5 (4.7)2 (40.0)3 (60.0)
    Psychiatric disorder, n (%)
     Schizophrenia-spectrum79 (73.8)59 (74.7)46 (58.2)
     Substance use41 (38.3)21 (51.2)20 (48.8)
     Bipolar22 (20.5)11 (50.0)11 (50.0)
     Anxiety9 (8.41)3 (33.3)6 (66.7)
     Borderline personality5 (4.67)2 (40.0)3 (60.0)
     Antisocial personality5 (4.67)1 (20.0)4 (80.0)
     Depressive1 (2.1)0 (0.0)1 (100.0)
     Suicide attempts, mean (SD)1.05 (2.06)0 (0.0)2.39 (2.55)
    • ↵a Numbers in bold indicate significantly more suicide attempts than comparison group.

    • ↵* P < .05.

    • View popup
    Table 2

    Odds Ratio, Adjusted (AOR) for Sex and Age, for Association between Explanatory Variable, and Suicide Attempt Prevalence and Mean Number of Attempts among Those with at Least 1 Suicide Attempt

    Suicide Attempt Prevalence (%)Mean Number of Suicide Attempts
    Explanatory VariableWithWithoutAdjusted Odds RatioWith (n)Without (n)F
    Any ACE71.728.31.4552.64 (33)1.77 (13)4.056*a
     Parents separated/divorced50.0050.850.9672.67 (24)2.09 (22)3.645
     Household member-substance35.5945.831.5312.95 (21)1.92 (25)4.283*
     Emotional abuse37.532.21.0093.29 (17)1.86 (29)14.539***
     Physical abuse37.2931.252.0352.86 (14)2.19 (32)2.947
     Emotional neglect32.2037.501.2633.61 (18)1.61 (28)28.520***
     Household member-mental23.7329.171.3243.15 (13)2.09 (33)2.033
     Sexual abuse22.0320.831.1983.80 (10)2.00 (36)20.132***
     Physical neglect20.8316.951.2894.00 (10)1.94 (36)18.081***
     Witnessed domestic violence18.7516.951.1312.67 (9)2.32 (37)1.523
     Household member-prison11.8620.831.9552.60 (10)2.33 (36)0.286
    Any Trauma89.5883.051.7552.51 (41)1.40 (5)2.214
     Sudden death of loved one62.555.91.2122.28 (29)2.59 (17)0.892
     Witnessed death/injury35.4234.591.1862.88 (16)2.13 (30)1.575
     Adult physical assault29.1737.391.2592.79 (14)2.22 (32)0.770
     Motor vehicle accident33.3333.901.0473.13 (16)2.00 (30)6.888*
     Weapon attack33.3330.511.2941.69 (16)2.77 (30)2.513
     Childhood physical abuse35.5918.753.162*3.44 (9)2.14 (37)11.716***
     Childhood sexual abuse27.0820.341.0753.00 (12)2.18 (34)4.978*
     Natural disaster22.9216.950.7441.18 (11)2.77 (35)2.959
     Adult sexual assault25.0013.561.0522.91 (11)2.23 (35)2.335
     Other severe accident12.518.641.7492.00 (6)2.45 (40)3.441
     Military4.175.082.7381.00 (2)2.45 (44)1.525
     Other31.2535.590.8832.93 (15)2.13 (31)0.628
    PTSD diagnosis30.428.81.0172.79 (14)2.22 (32)0.571
     Intrusion65.262.71.0062.17 (30)2.81 (16)1.532
      Intrusive memories45.643.61.0052.19 (31)2.80 (15)2.108
      Nightmares43.646.20.9892.79 (24)1.95 (22)1.821
      Flashbacks48.340.81.7832.43 (28)2.33 (18)0.272
      Psychological reactivity46.641.20.9752.44 (34)12 (2.25)0.247
      Physical reactivity49.140.01.0442.11 (27)2.79 (19)2.255
     Avoidance46.141.90.9063.05 (20)1.88 (26)3.480
      Internal avoidance43.347.50.9352.24 (29)2.65 (17)1.400
      External avoidance47.839.51.0972.47 (32)2.21 (14)0.263
     NACM69.661.91.121*2.34 (32)2.50 (14)0.072
      Amnesia51.837.31.1912.66 (29)1.94 (17)1.242
      Negative beliefs50.039.31.2112.45 (29)2.29 (17)0.009
      Blame44.944.71.0652.37 (30)2.44 (16)0.045
      Negative emotions52.028.12.664**2.63 (38)1.25 (8)4.383*
      Anhedonia50.037.82.146*2.07 (30)3.00 (16)2.713
      Detachment49.238.11.2202.16 (31)2.87 (15)1.040
      Emotional numbness51.736.71.1642.55 (29)2.12 (17)0.832
     Arousal49.247.81.0263.05 (22)1.79 (24)14.491***
      Irritability47.242.60.9902.52 (25)2.24 (21)1.549
      Recklessness48.941.91.0272.33 (21)2.44 (25)0.119
      Hypervigilant48.538.51.0612.41 (32)2.36 (14)0.057
      Excessive startle48.440.01.1342.80 (30)1.63 (16)7.945**
      Inattention46.442.11.1892.72 (32)1.64 (14)3.972*
      Insomnia45.344.21.0922.28 (29)2.59 (17)0.440
    Substance-related problems72.963.01.7862.86 (29)1.59 (17)6.984*
     Alcohol28.342.40.8673.46 (13)1.97 (33)15.525***
     Stimulants22.010.93.0902.60 (5)2.37 (41)0.013
     Opioids16.910.91.0901.80 (5)2.46 (41)1.691
     Cannabinoids44.137.01.2012.59 (17)2.28 (29)0.543
     Nicotine47.942.61.6262.90 (21)1.96 (25)2.670
     Sedatives25.946.50.2232.43 (44)1.50 (2)1.778
     Hallucinogens35.746.20.3643.00 (5)2.24 (41)1.005
     Inhalants57.144.01.5672.90 (4)2.45 (42)0.531
    • ↵a Numbers in bold indicate significantly more suicide attempts than comparison group.

    • ↵* P < .05. ** P < .01. *** P < .001.

    • Abbreviations: ACE = adverse childhood experience, NACM = negative alterations of cognitions and mood, PTSD = posttraumatic stress disorder.

    • View popup
    Table 3

    Intercorrelations Related to Suicide Attempts and Trauma-Related Variables

    Variable12345678910
    1. Suicide attempts1 
    2. Age−0.0161 
    3. Marital status0.011−0.1171 
    4. Gender−0.106−0.0920.1391 
    5. Race0.0040.386*a,b−0.1220.1881
    6. Alcohol0.266*−0.1240.310*c0.0970.1881 
    7. Arousal0.113−0.1930.0640.061−0.0270.1381 
    8. NACM0.0370.042−0.025−0.0230.088−0.0990.776***1
    9. ACE score0.331*−0.103−0.146−0.1460.0420.1690.293*0.1991 
    10. Total traumas0.073−0.0450.126−0.1260.0490.0170.229*0.2930.553***1
    Mean1.05039.540.8000.7800.5400.2806.93010.112.9703.170
    SD1.29614.240.4010.4170.5040.4555.5876.6312.6152.308
    • ↵a Numbers in bold indicate significant correlation.

    • ↵b Caucasian race significantly associated with higher age (P = .004).

    • ↵c Alcohol-related problems significantly correlated with being single (P = .018).

    • * P < .05. *** P < .001.

    • Abbreviations: ACE = adverse childhood experience, NACM = negative alterations of cognitions and mood.

    • View popup
    Table 4.

    Hierarchical Multiple Regression Predicting Number of Suicide Attempts

     R²βtP
    Block 10.000 
     Age0.130.8170.419
     Marital status−0.03−0.2140.832
     Gender0.08−0.7210.419
     Race−0.13−0.7930.433
    Block 20.082 
     Alcohol-related problems0.221.2790.209
    Block 30.089 
     Arousal symptoms0.050.2030.841
     NACM−0.01−0.0360.971
    Block 40.254 
     ACE score0.502.7490.009*a
     Total traumas 0.372.1240.040*
    • ↵a Numbers in bold indicate significantly more suicide attempts.

    • ↵* P < .05.

    • Abbreviations: ACE = adverse childhood experience, NACM = negative alterations of cognitions and mood.

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Journal of the American Academy of Psychiatry and the Law Online: 50 (3)
Journal of the American Academy of Psychiatry and the Law Online
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1 Sep 2022
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Trauma and Suicide Attempts among Insanity Acquittees
Anusha Mamidipaka, Jeffrey Guina, James Cameron, Andrew Lemmen, Nicole Kletzka
Journal of the American Academy of Psychiatry and the Law Online Sep 2022, 50 (3) 396-404; DOI: 10.29158/JAAPL.210104-21

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Trauma and Suicide Attempts among Insanity Acquittees
Anusha Mamidipaka, Jeffrey Guina, James Cameron, Andrew Lemmen, Nicole Kletzka
Journal of the American Academy of Psychiatry and the Law Online Sep 2022, 50 (3) 396-404; DOI: 10.29158/JAAPL.210104-21
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Keywords

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