Soldier Background and Postinvestigative Events Associated With Timing of Suicide Following Deployment of U.S. Army National Guard Soldiers

The present study examined the timing of suicide and its associated soldier background and postinvestigative events among deployed Army National Guard (ARNG) soldiers from calendar years 2007 through 2014. Suicide deaths were nearly equally distributed between soldiers who had been deployed and those who had not. Among those deployed, however, suicides occurred mostly 1 year or more after having returned from deployment. Soldier background and postsuicide investigative events were associated with the timing of suicide. Having more years of military service, more previous deployments, and being married were associated with in-theater suicides. Soldiers younger in age (17–24 years), single, nonprior service, and lower in rank, in addition to having parent-family conflicts, full-time employment problems, and military transition problems were associated with suicides that had occurred 1–120 days and 120–365 days since return from deployment. Soldiers aged (24–29 years), married, and higher in rank, along with more reported problems including past behavioral health conditions, postdeployment behavior health referrals, criminal behaviors, and military performance were associated with suicides that had occurred 1 year or more after return. Findings likely represent time periods of suicide vulnerability for identifiable groups of soldiers, based on soldier background and events surrounding the suicide. Practical and theoretical implications of the findings are discussed.     

The Sexual Harassment–Suicide Connection in the U.S. Military: Contextual Effects of Hostile Work Environment and Trusted Unit Leaders

Sexual harassment has been associated with suicidal behaviors, and with the rise in suicides in the U.S. military, sexual harassment's role in suicide has been of growing interest. Lacking are studies that examine group‐ or unit‐level variables in the relationship of sexual harassment to suicidal behaviors (thoughts, plans, and attempts). In this study, survey data from soldiers (12,567 soldiers in 180 company‐sized units) who completed the Unit Risk Inventory administered during calendar year 2010 were analyzed using hierarchical linear modeling. At the individual level, sexual harassment was associated with a fivefold increase for risk of suicide. Reporting that leaders could be trusted was associated with a decreased suicide risk by about one‐third. There was no statistically significant interaction between sexual harassment and trusted leaders in predicting the suicidal behaviors. At the group level, units or companies having higher levels of sexual harassment also had soldiers three times more at risk for suicide. A cross‐leveling effect was also observed: Among units having higher levels of sexual harassment, the negative correlation (buffering effect of unit leaders on suicidal behaviors) was diminished. Implications of findings for preventing sexual harassment and suicide risk are discussed.     

Comparison of Suicide Attempters and Decedents in the U.S. Army: A Latent Class Analysis

A clearer understanding of risk factors for suicidal behavior among soldiers is of principal importance to military suicide prevention. It is unclear whether soldiers who attempt suicide and those who die by suicide have different patterns of risk factors. As such, preventive efforts aimed toward reducing suicide attempts and suicides, respectively, may require different strategies. We conducted a latent class analysis (LCA) to examine classes of risk factors among suicide attempters (n = 1,433) and decedents (n = 424). Both groups were represented by three classes: (1) External/Antisocial Risk Factors, (2) Mental Health Risk Factors, and (3) No Pattern. These findings support the conceptualization that military suicide attempters and decedents represent a single population.     

Impact of a Suicide‐Specific Intervention within Inpatient Psychiatric Care: The Collaborative Assessment and Management of Suicidality

A growing body of literature indicates that suicidal patients differ from other psychiatric patients with respect to specific psychological vulnerabilities and that suicide‐specific interventions may offer benefits beyond conventional care. This naturalistic controlled‐comparison trial (n = 52) examined outcomes of intensive psychiatric hospital treatment (mean length of stay 58.8 days), comparing suicidal patients who received individual therapy from clinicians utilizing the Collaborative Assessment and Management of Suicidality (CAMS) to patients whose individual therapists did not utilize CAMS. Propensity score matching was used to control for potential confounds, including age, sex, treatment unit, and severity of depression and suicidality. Results showed that both groups improved significantly over the course of hospitalization; however, the group receiving CAMS showed significantly greater improvement on measures specific to suicidal ideation and suicidal cognition. Results are discussed in terms of the potential advantages of treating suicide risk with a suicide‐specific intervention to make inpatient psychiatric treatment more effective in reducing risk for future suicidal crises.     

Behavioral Health Adjustment in Reserve Component Soldiers During a Noncombat Deployment to Africa

This study benchmarked rates of mental health problems, adjustment difficulties, and perceptions of unit climate among 505 U.S. soldiers (primarily National Guard) deployed to the Horn of Africa in 2012. In addition, the study examined whether differences across these outcomes exist between combat veterans (n = 239) and noncombat veterans (n = 242). Rates of mental health problems among soldiers on this noncombat deployment were lower than rates typically found among soldiers on combat deployments. Furthermore, soldiers without previous combat experience had lower rates of mental health problems and aggression than combat veterans. Similar differences were evident when adjustment difficulties and unit climate variables were compared. Although combat veterans could be valuable in training new soldiers, the results of this study indicate that combat veterans may need more targeted resources to facilitate their adjustment if they are to be optimally utilized.     

Distress Tolerance and Anxiety Sensitivity Cognitive Concerns: Testing the Incremental Contributions of Affect Dysregulation Constructs on Suicidal Ideation and Suicide Attempt

Empirical work has suggested relationships among suicide-related outcomes and several constructs related to affect dysregulation, notably anxiety sensitivity (AS) and distress tolerance (DT). However, important questions remain, including the relative contributions of these affect regulation variables as well as the direct contribution of DT on suicidal ideation and prior attempts. The current study sought to better elucidate the nature of these relationships by examining AS, DT, and suicidal ideation and attempt in a clinical sample (N = 192). Consistent with prior work and prediction, findings revealed a significant relationship between the AS cognitive concerns subfactor and suicidal ideation and suicide attempt history after accounting for the effects of DT, gender, and depressive symptoms. In addition, depressive symptoms significantly moderated the relationship between the AS cognitive concerns subfactor and suicidal ideation. After accounting for the influence of AS, analyses revealed that DT approached significance in predicting suicidal ideation, but did not significantly predict suicide attempt history. These results suggest that elevated AS cognitive concerns are particularly relevant to suicide in the context of depressive symptoms. Clinicians may benefit from implementing AS reduction strategies with individuals who endorse elevated suicide risk as well as elevated AS cognitive concerns.     

Combat exposure,psychological symptoms,and marital satisfaction in National Guard soldiers who served in Operation Iraqi Freedom from 2005 to 2006

Abstract

In current military operations in Iraq and Afghanistan, US National Guard (NG) troops are serving longer deployments than ever before. Little is known, however, about how such deployments affect this population of individuals, relative to active component (AC) troops. This study investigated the extent of combat exposure, severity of post-deployment psychological symptoms, and general interpersonal functioning, as well as the interrelationships of these variables, in 50 NG soldiers who served a 12-month deployment in Iraq from 2005 to 2006. The results indicate that combat exposure and post-deployment post-traumatic stress symptoms in this sample are greater than those in NG veterans of past military operations, and similar to those of full-time soldiers in current operations. Furthermore, the patterns of interrelationships between combat exposure, psychological symptoms, and interpersonal variables were similar to those detected in prior research on AC troops. These results suggest that NG veterans of current military operations may require similar services as active duty veterans. Given that NG troops are less integrated into the military structure, specific outreach efforts may be needed to help NG veterans to receive such services.     

Combat exposure, psychological symptoms, and marital satisfaction in National Guard soldiers who served in Operation Iraqi Freedom from 2005 to 2006

In current military operations in Iraq and Afghanistan, US National Guard (NG) troops are serving longer deployments than ever before. Little is known, however, about how such deployments affect this population of individuals, relative to active component (AC) troops. This study investigated the extent of combat exposure, severity of post-deployment psychological symptoms, and general interpersonal functioning, as well as the interrelationships of these variables, in 50 NG soldiers who served a 12-month deployment in Iraq from 2005 to 2006. The results indicate that combat exposure and post-deployment post-traumatic stress symptoms in this sample are greater than those in NG veterans of past military operations, and similar to those of full-time soldiers in current operations. Furthermore, the patterns of interrelationships between combat exposure, psychological symptoms, and interpersonal variables were similar to those detected in prior research on AC troops. These results suggest that NG veterans of current military operations may require similar services as active duty veterans. Given that NG troops are less integrated into the military structure, specific outreach efforts may be needed to help NG veterans to receive such services.     

History of military service and the risk of suicidal ideation: findings from the 2008 national survey on drug use and health

Studies of completed suicide by history of military service have produced inconsistent findings; no representative population‐based study has compared the risk of nonfatal suicidal behavior among veterans with risk among nonveterans. The objective of this study was to examine whether male veterans of the U.S. military are at heightened risk of suicidal ideation, compared with males who never served in the U.S. military. A total of 17,641 adult men completed the 2008 National Survey on Drug Use and Health (NSDUH). Subjects provided information about history of ever having served in the U.S. armed forces, past suicidal ideation, alcohol and drug abuse and dependence, measures of psychological distress, and sociodemographic data. Overall, men who had ever served in the armed forces were no more likely than men who had never served to report having seriously considered suicide over the prior 12 months. Military status was not differentially associated with other known suicide risk factors assessed by NSDUH, including psychiatric disorders. Our findings suggest that evidence‐based suicide prevention strategies applicable to the general population should be employed to reduce suicide risk among the veteran population as well.     

Suicide and the military justice system.

The United States military is sensitive to suicide. There are military policies that direct the formation of active suicide prevention programs. The U.S. military emphasizes a humanitarian approach. Modern military law, however, may view suicidal behavior as deviant. The prosecution of this behavior, although theoretically possible, has never occurred until recently. The U.S. military has now convicted soldiers for attempted suicide and assisted suicide. This article reviews these recent court decisions and suggests revisions in the military law.     

Interaction of Combat Exposure and Unit Cohesion in Predicting Suicide‐Related Ideation Among Post‐Deployment Soldiers

Suicide is one of the leading causes of death among U.S. Army soldiers. Suicide‐related ideation, which is associated with suicide attempts and suicide, can cause considerable distress. In a sample of 1,663 recently redeployed soldiers, we used factor analysis and structural equation modeling to test the associations between combat exposure, unit cohesion, and their interaction in predicting suicide‐related ideation. We found that combat exposure was a significant risk factor for suicide‐related ideation, while unit cohesion was a significant protective factor. The significant interaction between the two factors indicated that soldiers who experienced greater combat exposure but also had higher levels of unit cohesion had relatively lower levels of suicide‐related ideation. In addition, those who had higher levels of combat exposure and lower unit cohesion were most at risk for suicide‐related ideation. Our findings indicate the importance of unit cohesion in protecting soldiers from suicide‐related ideation and suggest a higher risk group of soldiers who should be targeted for interventions.     

Mental Disorders,Comorbidity, and Pre‐enlistment Suicidal Behavior Among New Soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

We examined the associations between mental disorders and suicidal behavior (ideation, plans, and attempts) among new soldiers using data from the New Soldier Study (NSS) component of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS; N = 38,507). Most new soldiers with a pre‐enlistment history of suicide attempt reported a prior mental disorder (59.0%). Each disorder examined was associated with increased odds of suicidal behavior (ORs = 2.6–8.6). Only PTSD and disorders characterized by irritability and impulsive/aggressive behavior (i.e., bipolar disorder, conduct disorder, oppositional defiant disorder, and attention‐deficit/hyperactivity disorder) predicted unplanned attempts among ideators. Mental disorders are important predictors of pre‐enlistment suicidal behavior among new soldiers and should figure prominently in suicide screening and prevention efforts.     

Post-Admission Cognitive Therapy for a Transgender Service Member With a Recent Suicidal Crisis: A Case Study of Gender-Affirming Care

While elevated suicide risk in the American military and veteran population has led to the development of targeted interventions, the increased risk of suicidal ideation and behavior among transgender and gender diverse (TGD) Service members requires that interventions address suicide risk within the context of minority stressors and gender-affirming care. This case study presents Jordan (an alias), a transgender Service member who received inpatient psychiatric treatment following a suicide attempt precipitated by distress relating to gender dysphoria, minority status, and associated stressors. Jordan completed Post-Admission Cognitive Therapy (PACT; Ghahramanlou-Holloway, Cox, & Greene, 2012), a cognitive-behavioral intervention targeting suicide risk among military personnel and dependents psychiatrically hospitalized following a suicidal crisis. Within the context of PACT, Jordan’s treatment included identifying and addressing distress related to minority stressors (externalized stigma, internalized transphobia, anticipated rejection, gender concealment) using gender-affirming best practices. Marked changes in Jordan's self-report measures from baseline to follow-up, as well as qualitative changes reported by Jordan, demonstrate that she felt comfortable, safe, and ready to be discharged from the inpatient unit after completing PACT treatment and gaining exposure to the skills necessary to help prevent and/or manage future suicidal crises. Treatment implications and recommendations for addressing suicide risk within the context of gender-affirming care and prevalent minority stressors are discussed.     

Factors Associated with Suicidality Among a National Sample of Transgender Veterans

Correlates of past‐year suicidal ideation and lifetime suicide risk among a national sample of transgender veterans were examined. An online, convenience sample of 212 U.S. transgender veterans participated in a cross‐sectional survey in February–May 2014. We evaluated associations between sociodemographic characteristics, stigma, mental health, and psychosocial resources with past‐year suicidal ideation and lifetime suicide plans and attempts. Participants reported high rates of past‐year suicidal ideation (57%) as well as history of suicide plan or attempt (66%). Transgender‐related felt stigma during military service and current posttraumatic stress disorder and depressive symptoms were associated with suicide outcomes as were economic and demographic factors.     

Interoceptive Abnormalities and Suicidality: A Systematic Review

Dysfunction of interoception (i.e., difficulties sensing the physiological state of one's own body) is increasingly linked to different mental health disorders and suicidal outcomes. The aim of this study was to systematically review the literature on the association between suicidality and interoception, as well as identify potential confounders and mediators of the relationship. We conducted a systematic review of four databases, allowing for critical examination of the role of different measures of interoception (accuracy, sensibility, awareness, cognitive/emotional evaluation) across the suicide continuum (ideation, plans, attempts, deaths). The search strategy identified 22 studies (14,988 participants). Preliminary but limited evidence was found for impaired interoceptive accuracy among those reporting suicide attempt histories. We found evidence of interoceptive sensibility disturbances across the suicide continuum, including experiences of not trusting one’s own body sensations and impaired abilities to sustain and control attention to such sensations. Consistent evidence was also reported for disturbances related to cognitive and emotional evaluations of interoceptive sensations. The latter was particularly pronounced for those reporting suicide attempts, relative to those reporting suicidal thinking or planning alone. Overall, this review’s results suggest that interoceptive abnormalities are potentially important indicators of risk for suicidal thinking, intentions, and behaviors. However, due to the inconsistent adjustment for variables of interest, and cross-sectional designs, it is unclear whether interoceptive changes and disturbances have a direct role, or whether the association is explained and mediated by key third variables (e.g. depression, disordered eating, emotional dysregulation). We discuss the implications with respect to suicidal risk and therapeutic interventions.     

Firearms Matter: The Moderating Role of Firearm Storage in the Association Between Current Suicidal Ideation and Likelihood of Future Suicide Attempts Among United States Military Personnel

The relationship between firearm ownership and suicide is well documented. This study hypothesized that how soldiers store their firearms would moderate the relationship between suicidal ideation and the self-reported likelihood of engaging in a future suicide attempt, and that this relationship would be explained by fearlessness about death. There were 432 military personnel (91.3% men, 74.2% White, M_age = 27.60) who endorsed current ownership of a private firearm and who were recruited from a military base in the southeastern United States (94.5% National Guard). Firearm storage moderated the relationship between suicidal ideation and the self-reported likelihood of engaging in a future suicide attempt, but this relationship was not explained by fearlessness about death. Individuals who reported keeping their firearms loaded and stored in an unsecure location exhibited higher mean levels of fearlessness about death. Findings highlight the need for research examining contributors to suicide risk in the context of firearm storage, and provide support for suicide prevention efforts involving restricting means.     

Suicide Exposure and Posttraumatic Stress Disorder: Is Marriage a Protective Factor for Veterans?

Alarming numbers of military veterans end their lives each day which has a profound effect on the military population. This study examines a sample (N?=?434) of suicide-exposed (i.e., personally knowing someone who has died by suicide) veterans to determine whether the proportion of individuals who report high impact from suicide exposure and those who have clinically-significant posttraumatic stress disorder symptoms is related to marital status. Using Hill’s (Social Casework 49: 139–150, 1958) ABC-X model for conceptualizing the relationships between variables, mean scores for posttraumatic stress disorder were significantly different between groups, and the odds of a married veteran reporting high-impact suicide exposure were 2.19 times lower than the odds of a single veteran reporting high-impact. Likewise, the odds of a veteran with high-impact suicide exposure having clinically-significant posttraumatic stress disorder symptoms were 10.04 times higher than veterans with low-impact suicide exposure. Findings indicate that veterans who are married are less likely to be highly-affected by another individual’s suicide. Thus, marriage is a protective factor for suicide-exposed veterans.     

Latino and Latina Adolescents' Help‐seeking Behaviors and Attitudes Regarding Suicide Compared to Peers with Recent Suicidal Ideation

Although Latinas have consistently reported higher rates of suicidal behavior for the past 20 years (CDC, 1996), there is a dearth of information regarding their help‐seeking attitudes and behaviors when dealing with distress and suicide. Associations between adolescents' ideation and help‐seeking from adults were different for non‐Hispanic Whites and Latinos from 14 high schools (N = 4,983). Among females, ideators and Latinas reported lower levels of help‐seeking attitudes than nonideators and non‐Hispanic Whites. Males showed interaction effects of ideation by race/ethnicity on help‐seeking. Within sex by race/ethnicity, differences showed that while non‐Hispanic White students reported consistent differences between suicidal ideation and no reported suicidal ideation, Latinos were more similar between these groups, particularly with having support from friends and family to seek help from adults. Research should clarify how culture contributes to decreased help‐seeking norms among those with suicidal ideation.     

Familias Unidas’ Crossover Effects on Suicidal Behaviors among Hispanic Adolescents: Results from an Effectiveness Trial

The long‐term impact of Familias Unidas on suicidal behaviors among Hispanic 8th graders (N = 746) was examined along with parent–adolescent communication as a moderator of intervention effectiveness. At baseline, 9.2% (95% CI = 7.3%–11.6%) of adolescents reported suicide ideation and 5.7% (95% CI = 4.1%–7.7%) reported a past year suicide attempt. There were no significant intervention effects on suicidal behaviors; however, parent–adolescent communication was a moderator of suicide attempts in the past year, across the intervention (b = ?.01, p = .01). Results suggest that Familias Unidas reduces suicidal behaviors among Hispanic adolescents with low levels of parent–adolescent communication despite no suicide‐specific intervention content. Implications of these findings are discussed.     

Lifetime Suicidal Behaviors and Career Characteristics Among U.S. Army Soldiers: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

The current report presents data on lifetime prevalence of suicide ideation and nonfatal attempts as reported by the large representative sample of U.S. Army soldiers who participated in the Consolidated All‐Army Survey of the Army Study to Assess Risk and Resilience in Servicemembers (N  =  29,982). We also examine associations of key Army career characteristics with these outcomes. Prevalence estimates for lifetime suicide ideation are 12.7% among men and 20.1% among women, and for lifetime suicide attempts are 2.5% and 5.1%, respectively. Retrospective age‐of‐onset reports suggest that 53.4%–70% of these outcomes had preenlistment onsets. Results revealed that, for both men and women, being in the Regular Army, compared with being in the National Guard or Army Reserve, and being in an enlisted rank, compared with being an officer, is associated with increased risk of suicidal behaviors and that this elevated risk is present both before and after joining the Army.