A Qualitative Study of Potential Suicide Risk Factors Among Operation Iraqi Freedom/Operation Enduring Freedom Soldiers Returning to the Continental United States (CONUS)

Reintegration of crisis services employees: a systematic literature review

Purpose

Crisis services personnel are frequently deployed around the globe under highly demanding conditions. This raises the need to better understand the deployment process and more especially, sustainable reintegration after deployment. Despite recent research efforts, the study of the post-deployment stage, more specifically the reintegration process, remains fragmented and limited. To address these limitations, this review aims at (1) describing how reintegration is conceptualised and measured in the existing literature, (2) identifying what dimensions are associated with the reintegration process and (3) identifying what we know about the process of reintegration in terms of timing and phases.

Design/methodology/approach

Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol, the authors identified 5,859 documents across several scientific databases published between 1995 and 2021. Based on predefined eligibility criteria, 104 documents were yielded.

Findings

Research has primarily focused on descriptive studies of negative individual and interpersonal outcomes after deployment. However, this review indicates that reintegration is dynamic, multi-sector, multidimensional and dual. Each of its phases and dimensions is associated with distinct challenges.

Originality/value

To the authors’ knowledge, this is the first research that investigates reintegration among different crisis services and provides an integrative social-ecological framework that identifies the different dimensions and challenges of this process.

A psychometric assessment of the Military Suicide Attitudes Questionnaire (MSAQ)

Suicide rates remain high among military populations. Stigmatizing beliefs about suicide contribute to the problem of heightened suicide risk as a deterrent for help-seeking. Measurement of military suicide stigma is therefore an important gap in the literature as a necessity toward the development of military suicide prevention programming. This paper assessed the factor structure, reliability, and validity of the Military Suicide Attitudes Questionnaire (MSAQ). Study 1 featured secondary analysis of a suicide risk dataset from active duty treatment-seeking military personnel (N = 200). Study 2 was a secondary analysis of a statewide assessment of Army National Guard service members' beliefs about mental health and suicide (N =1116). Factor analyses results collectively supported a four-factor Military Suicide Attitudes Questionnaire (MSAQ) structure: discomfort, unacceptability, support, and empathic views. Subscale reliabilities ranged from 0.77 to 0.83 across samples. Unacceptability and support displayed significant negative correlations with psychological distress. Men displayed more negative suicide-related beliefs compared to women counterparts. Discomfort and unacceptability beliefs displayed significant positive associations with perceived barriers to care. The final short version of the MSAQ is an efficient, multi-dimensional measure of military suicide-related beliefs. The instrument can be used for public health assessment and program evaluation in military settings.

Emotional numbing in PTSD is associated with lower amygdala reactivity to pain

Posttraumatic stress disorder (PTSD) is associated with altered pain perception, namely increased pain threshold and higher pain response. While pain consists of physiological and affective components, affective components are often overlooked. Similar patterns of increased threshold-high response in PTSD were shown in response to emotional stimuli, i.e., emotional numbing. As both emotional numbing and pain processing are modulated by the amygdala, we aimed to examine whether individuals diagnosed with PTSD show lower amygdala activation to pain compared with combat controls, and whether the amygdala responses to pain correlates with emotional numbing. To do so, two independent samples of veterans (original study: 44 total (20 PTSD); conceptual replication study: 40 total (20 PTSD)) underwent threat conditioning, where a conditioned stimulus (CS+; visual stimulus) was paired with an unconditioned stimulus (US; electric-shock). We contrasted the amygdala activity to the CS + US pairing with the CS+ presented alone and correlated it with emotional numbing severity. In both samples, the PTSD group showed a robust reduction in amygdala reactivity to shock compared to the Combat Controls group. Furthermore, amygdala activation was negatively correlated with emotional numbing severity. These patterns were unique to the amygdala, and did not appear in comparison to a control region, the insula, a pivotal region for the processing of pain. To conclude, amygdala response to pain is lower in individuals with PTSD, and is associated with emotional numbing symptoms. Lower amygdala reactivity to mild pain may contribute to the "all-or-none" reaction to stressful situations often observed in PTSD.

Suicidal Ideation in a Veterans Affairs Residential Posttraumatic Stress Disorder Treatment Setting: The Roles of Thwarted Belongingness and Perceived Burdensomeness

Suicide is a significant public health concern, and, specifically, the veteran population has exhibited a 22% higher risk of death by suicide than the general population (Department of Veterans Affairs, 2017). The interpersonal psychological theory of suicide (IPTS; Joiner, 2005) appears to be the most widely researched theory to examine factors associated with suicidal ideation. The IPTS applies to veteran suicidal ideation in that veterans may feel they are burdensome to others or that they do not belong following their transition from active duty. The current study sought to (a) identify the prevalence and correlates of the IPTS constructs perceived burdensomeness and thwarted belongingness; (b) examine the main and interactive effects of these constructs on suicidal ideation; and (c) examine their indirect effects in the associations between posttraumatic stress disorder (PTSD) symptomatology, depressive symptomatology, and substance use with suicidal ideation in a sample of veterans in PTSD residential treatment (N = 125). Regression results demonstrated that perceived burdensomeness was significantly associated with suicidal ideation, β = .50, p < .001; however, thwarted belongingness and the interaction of the two were not. In the models of indirect effects, perceived burdensomeness emerged as the only significant indirect effect in the association between PTSD symptomatology and suicidal ideation, β = .01 (SE = .00), 95% CI [.0050, .0149], as well as between depressive symptomatology and suicidal ideation, β = .02 (SE = .01), 95% CI [.0109, .0311]. Study limitations and future directions are also discussed.

The deadly gap: Understanding suicide among veterans transitioning out of the military

In the period following separation from the military, service members face the challenge of transitioning to a post-military civilian life. Some evidence suggests these transitioning Veterans are at higher risk for suicide compared with both the broader Veteran population and the United States public, yet they often do not receive adequate support and resources. In this review, we use the Three-Step Theory of suicide to outline characteristics of transitioning Veterans and the transition process that may affect suicide risk. We then highlight relevant services available to this specific subgroup of Veterans and make recommendations that address barriers to care. Cumulatively, this literature suggests transitioning Veterans fall within a "deadly gap" between the end of their military service and transition into civilian life. This "deadly gap" consists of limited psychiatric services and increased suicide risk factors which together may explain the increase in suicide during this transition period.

Making the transition: How finding a good job is a risky business for military Veterans in Northern Ireland

Veterans transitioning from the military to civilian life may encounter difficulties in different domains of functioning. Most research in this area comes from the US and Israel, with Veterans in Northern Ireland (NI) in the United Kingdom, remaining an understudied population. This qualitative study aimed to examine the nature of transition experiences of NI Veterans by analyzing responses (N = 252) to an open-ended question related to the transition process, in a self-report survey. Thematic analysis highlighted both positive and negative experiences across high-level themes. These were related to (1a) how good the military life had been, (1b) the transition had been easy for some Veterans, and (1c) the skills gained in the military have been valuable; (2) it was hard to adjust to civilian life/still adjusting; (3) negative employment experiences; (4) lack of trust; (5) transitioning is hard in NI; and (6) inadequate support, post-service. The findings highlight that NI Veterans share some of the same challenges as other Veterans; however, the challenges in NI are compounded by ongoing security concerns and political tensions, which means living under the radar is a reality for many, making finding meaningful work and community integration difficult. The findings indicate that preparation for civilian life and the acculturation process needs to start many months before discharge. Perhaps more crucially, regiments should work closely with and support civilian employers to equip them to recognize and value the skills ex-Services Veterans can offer, and find a good fit for their skills within their organizations.

A Qualitative Investigation of Barriers to Seeking Treatment for Suicidal Thoughts and Behaviors Among Army Soldiers with a Deployment History

This study aimed to identify barriers to treatment seeking and service utilization among previously deployed Army soldiers who recently experienced a suicidal crisis. Confidential interviews were conducted on a psychiatric inpatient unit with 12 Army soldiers with a deployment history following a suicidal crisis. Qualitative analysis focused on statements coded as "barriers to seeking help" and "explicit recommendations." Suicidal Army soldiers with a deployment history experienced different barriers to seeking help, including stigma and logistical challenges (e.g., long wait times for appointments). Negative and positive perceptions of support were reported for various resources - for example, family, crisis hotlines, chaplains, and command. Suicidal Army soldiers, interviewed in this study, experienced a number of challenges and frustrations associated with various helping resources. This study highlights the need for greater attention toward understanding these challenges and subsequently addressing them through appropriate resource allocation and additional training for those working directly with Army soldiers at risk for suicide.

Circumstances of suicide among individuals with a history of cancer

OBJECTIVE

Cancer can trigger psychological distress, which may be associated with risk of suicide. We explored precipitating circumstances of suicides among decedents with and without a history of cancer.

METHODS

Coroner or medical examiner and law enforcement narratives of adult suicides were coded from 17 participating states in Centers for Disease Control and Prevention's National Violent Death Reporting System during 2004 to 2013. Bivariate and multivariate analyses examined associations between cancer history and factors that precipitated suicide.

RESULTS

Of 90 581 suicides, 4182 decedents (4.6%) had a history of cancer. Significantly more decedents with a history of cancer (versus without) were male, non-Hispanic white, married, veterans, and aged 55 or older (P < .001). Decedents with a history of cancer were more likely to die of suicide by firearm and less likely to die of suicide by suffocation compared to poisoning. In matched case analyses controlling for demographic and recent circumstances, fewer decedents with a history of cancer had mental health problems, history of suicide attempts, alcohol use problems, intimate partner problems, financial problems, job problems, and recent crisis.

CONCLUSIONS

Findings highlight the potential to identify high-risk populations for suicide prevention in clinical practice.

Occupational Therapy and Veteran Suicide: A Call to Action

Suicide in the U.S. military veteran population is an epidemic with a wide-ranging impact on individuals, families, and society. Death by suicide is preventable. The purpose of this article is to ignite a professional discussion about veteran suicide, a serious mental health issue that is underrepresented in the occupational therapy research literature. Occupational therapy practitioners respond to the changing needs of populations and promote preventive measures to improve health. Actively exploring occupational therapy's role in suicide prevention is a professional responsibility aligned with tenets of the Centennial Vision and Vision 2025. Applying the concept of the scholarship of integration, the authors present a case for the inclusion of suicide prevention training as a professional competency and explore opportunities to address suicide risk through the use of evidence-based interventions for posttraumatic stress disorder, combat stress, and depression. Professional implications include the need to advance professional knowledge through education, advocacy, and intervention research targeting the veteran population.

Evidence for the Propositions of the Interpersonal Theory of Suicide Among a Military Sample

OBJECTIVE

Although the interpersonal theory of suicide may explain the elevated suicide risk among military service members, past explorations have been equivocal. This study aimed to investigate the propositions of the interpersonal theory in a sample of U.S. Army recruiters.

METHOD

Participants (N = 3,428) completed self-report measures assessing the interpersonal theory's constructs (i.e., thwarted belongingness (TB), perceived burdensomeness (PB), acquired capability for suicide), current suicidal ideation, agitation, and insomnia. History of depression was obtained from medical records.

RESULTS

Hierarchical multiple regression analyses revealed that the interaction between TB and PB was associated with current suicidal ideation, controlling for depression, agitation, and insomnia. This effect was especially notable among those with high capability for suicide.

CONCLUSION

Findings provide support for the interpersonal theory in a large, diverse military sample. It may be advantageous to assess and therapeutically address TB and PB among at-risk service members.