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Geraci JC, Edwards ER, May D, Halliday T, Smith-Isabell N, El-Meouchy P, Lowell S, Armstrong N, Cantor G, DeJesus C, Dichiara A, Goodman M. Veteran Cultural Competence Training: Initial Effectiveness and National-Level Implementation. Psychiatr Serv 2024; 75:32-39. [PMID: 37554004 DOI: 10.1176/appi.ps.202100437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Because service professionals often lack cultural competence in working with veterans, veterans often perceive such professionals as "not understanding." The authors developed, evaluated, and implemented Veteran Cultural Competence Training (VCCT), combining educational and experiential components in an in-person training focused on building awareness, knowledge, and skills to better work with veterans. METHODS Study 1 was a type 1 effectiveness-implementation hybrid trial examining VCCT effectiveness in a sample of social service professionals (N=41) compared with a matched comparison group (N=41) via the Multicultural Counseling Self-Efficacy Scale-Veteran Form (MCSE-V) instrument. In study 2, the authors used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to conduct a type 2 effectiveness-implementation hybrid trial and implemented VCCT with an expanded population (N=312) during eight training sessions in three U.S. states. RESULTS Results from study 1 indicated that VCCT significantly increased self-efficacy of trainees in veteran cultural competence compared with the matched group (p<0.001). In study 2, the RE-AIM framework highlighted the importance of building coalitions and utilizing implementation facilitation to maintain fidelity. The within-group effectiveness of VCCT was statistically significant and maintained across settings and professions (p<0.001), and trainees were satisfied with VCCT. Maintenance analysis revealed expansion of VCCT after implementation in terms of the number of training sessions (N=9), regions hosting the training (N=5), staff hired (N=13), and trainee applications (N=1,018). CONCLUSIONS VCCT effectively increases self-efficacy in veteran cultural competence. Gains appeared across different professions, demographic characteristics, and locations. Participation in VCCT may increase professionals' competence in understanding veteran culture, thereby potentially improving veteran services.
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Affiliation(s)
- Joseph C Geraci
- Transitioning Servicemember/Veteran and Suicide Prevention Center, Veterans Integrated Service Network (VISN) 2, Mental Illness Research, Education and Clinical Center, James J. Peters Department of Veterans Affairs Medical Center, New York City (Geraci, Edwards, May, Halliday, Smith-Isabell, Dichiara, Goodman); Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller Department of Veterans Affairs Medical Center, Waco, Texas (Geraci, Goodman); Resilience Center for Veterans & Families, Teachers College, Columbia University, New York City (May, Halliday); Fielding Graduate University, Santa Barbara, California (El-Meouchy, Lowell); Institute for Veterans & Military Families, Syracuse University, Syracuse, New York (Armstrong, Cantor); Department of Psychology, Hofstra University, Hempstead, New York (DeJesus)
| | - Emily R Edwards
- Transitioning Servicemember/Veteran and Suicide Prevention Center, Veterans Integrated Service Network (VISN) 2, Mental Illness Research, Education and Clinical Center, James J. Peters Department of Veterans Affairs Medical Center, New York City (Geraci, Edwards, May, Halliday, Smith-Isabell, Dichiara, Goodman); Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller Department of Veterans Affairs Medical Center, Waco, Texas (Geraci, Goodman); Resilience Center for Veterans & Families, Teachers College, Columbia University, New York City (May, Halliday); Fielding Graduate University, Santa Barbara, California (El-Meouchy, Lowell); Institute for Veterans & Military Families, Syracuse University, Syracuse, New York (Armstrong, Cantor); Department of Psychology, Hofstra University, Hempstead, New York (DeJesus)
| | - David May
- Transitioning Servicemember/Veteran and Suicide Prevention Center, Veterans Integrated Service Network (VISN) 2, Mental Illness Research, Education and Clinical Center, James J. Peters Department of Veterans Affairs Medical Center, New York City (Geraci, Edwards, May, Halliday, Smith-Isabell, Dichiara, Goodman); Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller Department of Veterans Affairs Medical Center, Waco, Texas (Geraci, Goodman); Resilience Center for Veterans & Families, Teachers College, Columbia University, New York City (May, Halliday); Fielding Graduate University, Santa Barbara, California (El-Meouchy, Lowell); Institute for Veterans & Military Families, Syracuse University, Syracuse, New York (Armstrong, Cantor); Department of Psychology, Hofstra University, Hempstead, New York (DeJesus)
| | - Tiffany Halliday
- Transitioning Servicemember/Veteran and Suicide Prevention Center, Veterans Integrated Service Network (VISN) 2, Mental Illness Research, Education and Clinical Center, James J. Peters Department of Veterans Affairs Medical Center, New York City (Geraci, Edwards, May, Halliday, Smith-Isabell, Dichiara, Goodman); Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller Department of Veterans Affairs Medical Center, Waco, Texas (Geraci, Goodman); Resilience Center for Veterans & Families, Teachers College, Columbia University, New York City (May, Halliday); Fielding Graduate University, Santa Barbara, California (El-Meouchy, Lowell); Institute for Veterans & Military Families, Syracuse University, Syracuse, New York (Armstrong, Cantor); Department of Psychology, Hofstra University, Hempstead, New York (DeJesus)
| | - Natesha Smith-Isabell
- Transitioning Servicemember/Veteran and Suicide Prevention Center, Veterans Integrated Service Network (VISN) 2, Mental Illness Research, Education and Clinical Center, James J. Peters Department of Veterans Affairs Medical Center, New York City (Geraci, Edwards, May, Halliday, Smith-Isabell, Dichiara, Goodman); Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller Department of Veterans Affairs Medical Center, Waco, Texas (Geraci, Goodman); Resilience Center for Veterans & Families, Teachers College, Columbia University, New York City (May, Halliday); Fielding Graduate University, Santa Barbara, California (El-Meouchy, Lowell); Institute for Veterans & Military Families, Syracuse University, Syracuse, New York (Armstrong, Cantor); Department of Psychology, Hofstra University, Hempstead, New York (DeJesus)
| | - Paul El-Meouchy
- Transitioning Servicemember/Veteran and Suicide Prevention Center, Veterans Integrated Service Network (VISN) 2, Mental Illness Research, Education and Clinical Center, James J. Peters Department of Veterans Affairs Medical Center, New York City (Geraci, Edwards, May, Halliday, Smith-Isabell, Dichiara, Goodman); Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller Department of Veterans Affairs Medical Center, Waco, Texas (Geraci, Goodman); Resilience Center for Veterans & Families, Teachers College, Columbia University, New York City (May, Halliday); Fielding Graduate University, Santa Barbara, California (El-Meouchy, Lowell); Institute for Veterans & Military Families, Syracuse University, Syracuse, New York (Armstrong, Cantor); Department of Psychology, Hofstra University, Hempstead, New York (DeJesus)
| | - Sarah Lowell
- Transitioning Servicemember/Veteran and Suicide Prevention Center, Veterans Integrated Service Network (VISN) 2, Mental Illness Research, Education and Clinical Center, James J. Peters Department of Veterans Affairs Medical Center, New York City (Geraci, Edwards, May, Halliday, Smith-Isabell, Dichiara, Goodman); Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller Department of Veterans Affairs Medical Center, Waco, Texas (Geraci, Goodman); Resilience Center for Veterans & Families, Teachers College, Columbia University, New York City (May, Halliday); Fielding Graduate University, Santa Barbara, California (El-Meouchy, Lowell); Institute for Veterans & Military Families, Syracuse University, Syracuse, New York (Armstrong, Cantor); Department of Psychology, Hofstra University, Hempstead, New York (DeJesus)
| | - Nicholas Armstrong
- Transitioning Servicemember/Veteran and Suicide Prevention Center, Veterans Integrated Service Network (VISN) 2, Mental Illness Research, Education and Clinical Center, James J. Peters Department of Veterans Affairs Medical Center, New York City (Geraci, Edwards, May, Halliday, Smith-Isabell, Dichiara, Goodman); Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller Department of Veterans Affairs Medical Center, Waco, Texas (Geraci, Goodman); Resilience Center for Veterans & Families, Teachers College, Columbia University, New York City (May, Halliday); Fielding Graduate University, Santa Barbara, California (El-Meouchy, Lowell); Institute for Veterans & Military Families, Syracuse University, Syracuse, New York (Armstrong, Cantor); Department of Psychology, Hofstra University, Hempstead, New York (DeJesus)
| | - Gilly Cantor
- Transitioning Servicemember/Veteran and Suicide Prevention Center, Veterans Integrated Service Network (VISN) 2, Mental Illness Research, Education and Clinical Center, James J. Peters Department of Veterans Affairs Medical Center, New York City (Geraci, Edwards, May, Halliday, Smith-Isabell, Dichiara, Goodman); Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller Department of Veterans Affairs Medical Center, Waco, Texas (Geraci, Goodman); Resilience Center for Veterans & Families, Teachers College, Columbia University, New York City (May, Halliday); Fielding Graduate University, Santa Barbara, California (El-Meouchy, Lowell); Institute for Veterans & Military Families, Syracuse University, Syracuse, New York (Armstrong, Cantor); Department of Psychology, Hofstra University, Hempstead, New York (DeJesus)
| | - Chris DeJesus
- Transitioning Servicemember/Veteran and Suicide Prevention Center, Veterans Integrated Service Network (VISN) 2, Mental Illness Research, Education and Clinical Center, James J. Peters Department of Veterans Affairs Medical Center, New York City (Geraci, Edwards, May, Halliday, Smith-Isabell, Dichiara, Goodman); Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller Department of Veterans Affairs Medical Center, Waco, Texas (Geraci, Goodman); Resilience Center for Veterans & Families, Teachers College, Columbia University, New York City (May, Halliday); Fielding Graduate University, Santa Barbara, California (El-Meouchy, Lowell); Institute for Veterans & Military Families, Syracuse University, Syracuse, New York (Armstrong, Cantor); Department of Psychology, Hofstra University, Hempstead, New York (DeJesus)
| | - Ariana Dichiara
- Transitioning Servicemember/Veteran and Suicide Prevention Center, Veterans Integrated Service Network (VISN) 2, Mental Illness Research, Education and Clinical Center, James J. Peters Department of Veterans Affairs Medical Center, New York City (Geraci, Edwards, May, Halliday, Smith-Isabell, Dichiara, Goodman); Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller Department of Veterans Affairs Medical Center, Waco, Texas (Geraci, Goodman); Resilience Center for Veterans & Families, Teachers College, Columbia University, New York City (May, Halliday); Fielding Graduate University, Santa Barbara, California (El-Meouchy, Lowell); Institute for Veterans & Military Families, Syracuse University, Syracuse, New York (Armstrong, Cantor); Department of Psychology, Hofstra University, Hempstead, New York (DeJesus)
| | - Marianne Goodman
- Transitioning Servicemember/Veteran and Suicide Prevention Center, Veterans Integrated Service Network (VISN) 2, Mental Illness Research, Education and Clinical Center, James J. Peters Department of Veterans Affairs Medical Center, New York City (Geraci, Edwards, May, Halliday, Smith-Isabell, Dichiara, Goodman); Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller Department of Veterans Affairs Medical Center, Waco, Texas (Geraci, Goodman); Resilience Center for Veterans & Families, Teachers College, Columbia University, New York City (May, Halliday); Fielding Graduate University, Santa Barbara, California (El-Meouchy, Lowell); Institute for Veterans & Military Families, Syracuse University, Syracuse, New York (Armstrong, Cantor); Department of Psychology, Hofstra University, Hempstead, New York (DeJesus)
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2
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Edwards ER, Coolidge B, Ruiz D, Epshteyn G, Krauss A, Gorman D, Connelly B, Redden C, El-Meouchy P, Geraci J. Situational stress and suicide attempt behavior in Army soldiers and veterans: Insights from the Army Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study. Suicide Life Threat Behav 2023; 53:642-654. [PMID: 37306332 DOI: 10.1111/sltb.12970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/07/2023] [Accepted: 05/07/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Prevention of suicide-related behaviors is considered a top clinical priority within the Departments of Veterans Affairs and Defense. Despite previous literature attesting to the likely importance of situational stress as a key correlate of acute changes in suicide risk, longitudinal research into associations between situational stress and suicide-related outcomes among military personnel has been relatively limited. METHODS The current study examined associations between situational stress, recent suicide attempt, and future suicide attempt using data from 14,508 Army soldiers and recently discharged veterans enrolled in the Army Study to Assess Risk and Resilience in Servicemembers-Longitudinal Studies (STARRS-LS). RESULTS Recent situational stress was more common among recently discharged veterans (vs. soldiers), those with a recent suicide attempt (vs. those without), and those with a subsequent suicide attempt (vs. those without). Job loss was more closely associated with suicide attempts among soldiers, whereas financial crisis, police contact, and death, illness, or injury of close others were more closely associated with suicide attempts among recently discharged veterans. CONCLUSION Findings further highlight situational stress as a salient risk factor for suicide-related outcomes among military personnel, particularly among recently discharged veterans. Implications for screening and treatment of at-risk military personnel are discussed.
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Affiliation(s)
- Emily R Edwards
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Brettland Coolidge
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Psychology, University of Central Florida, Orlando, Florida, USA
| | - Danny Ruiz
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
| | - Gabriella Epshteyn
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Alison Krauss
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Health Care System, Waco, Texas, USA
| | - Daniel Gorman
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
| | - Brigid Connelly
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
| | - Clare Redden
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
| | - Paul El-Meouchy
- Department of Psychology, Fielding Graduate University, Santa Barbara, California, USA
| | - Joseph Geraci
- VISN 2 Mental Illness, Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Bronx, New York, USA
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
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3
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Geraci JC, Finley EP, Edwards ER, Frankfurt S, Kurz AS, Kamdar N, Vanneman ME, Lopoo LM, Patnaik H, Yoon J, Armstrong N, Greene AL, Cantor G, Wrobleski J, Young E, Goldsmith M, Seim RW, Goodman M. Partnered implementation of the veteran sponsorship initiative: protocol for a randomized hybrid type 2 effectiveness-implementation trial. Implement Sci 2022; 17:43. [PMID: 35804354 PMCID: PMC9264302 DOI: 10.1186/s13012-022-01212-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The USA is undergoing a suicide epidemic for its youngest Veterans (18-to-34-years-old) as their suicide rate has almost doubled since 2001. Veterans are at the highest risk during their first-year post-discharge, thus creating a "deadly gap." In response, the nation has developed strategies that emphasize a preventive, universal, and public health approach and embrace the value of community interventions. The three-step theory of suicide suggests that community interventions that reduce reintegration difficulties and promote connectedness for Veterans as they transition to civilian life have the greatest likelihood of reducing suicide. Recent research shows that the effectiveness of community interventions can be enhanced when augmented by volunteer and certified sponsors (1-on-1) who actively engage with Veterans, as part of the Veteran Sponsorship Initiative (VSI). METHOD/DESIGN The purpose of this randomized hybrid type 2 effectiveness-implementation trial is to evaluate the implementation of the VSI in six cities in Texas in collaboration with the US Departments of Defense, Labor and Veterans Affairs, Texas government, and local stakeholders. Texas is an optimal location for this large-scale implementation as it has the second largest population of these young Veterans and is home to the largest US military installation, Fort Hood. The first aim is to determine the effectiveness of the VSI, as evidenced by measures of reintegration difficulties, health/psychological distress, VA healthcare utilization, connectedness, and suicidal risk. The second aim is to determine the feasibility and potential utility of a stakeholder-engaged plan for implementing the VSI in Texas with the intent of future expansion in more states. The evaluators will use a stepped wedge design with a sequential roll-out to participating cities over time. Participants (n=630) will be enrolled on military installations six months prior to discharge. Implementation efforts will draw upon a bundled implementation strategy that includes strategies such as ongoing training, implementation facilitation, and audit and feedback. Formative and summative evaluations will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and will include interviews with participants and periodic reflections with key stakeholders to longitudinally identify barriers and facilitators to implementation. DISCUSSION This evaluation will have important implications for the national implementation of community interventions that address the epidemic of Veteran suicide. Aligned with the Evidence Act, it is the first large-scale implementation of an evidence-based practice that conducts a thorough assessment of TSMVs during the "deadly gap." TRIAL REGISTRATION ClinicalTrials.gov ID number: NCT05224440 . Registered on 04 February 2022.
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Affiliation(s)
- Joseph C Geraci
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA. .,Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller VA Medical Center, Waco, TX, USA. .,Resilience Center for Veterans & Families, Teachers College, Columbia University, New York, NY, USA. .,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Erin P Finley
- Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller VA Medical Center, Waco, TX, USA.,Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, New York, USA
| | - Emily R Edwards
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sheila Frankfurt
- Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller VA Medical Center, Waco, TX, USA.,Central Texas Veterans Healthcare System, Temple, TX, USA
| | - A Solomon Kurz
- Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller VA Medical Center, Waco, TX, USA
| | - Nipa Kamdar
- Center for Innovations in Quality, Effectiveness and Safety, VA, VA, Houston, USA
| | - Megan E Vanneman
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Leonard M Lopoo
- Department of Public Administration and International Affairs, Syracuse University, Syracuse, NY, USA
| | - Hannah Patnaik
- Department of Public Administration and International Affairs, Syracuse University, Syracuse, NY, USA
| | - Jean Yoon
- VA Health Economics Resource Center, VA Palo Alto Healthcare System, Livermore, CA, USA.,Center for Primary Care and Outcomes Research, Stanford University, Palo Alto, CA, USA
| | - Nicholas Armstrong
- Institute for Veterans and Military Families, Syracuse University, Syracuse, NY, USA
| | - Ashley L Greene
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gilly Cantor
- Institute for Veterans and Military Families, Syracuse University, Syracuse, NY, USA
| | - Joseph Wrobleski
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA.,Resilience Center for Veterans & Families, Teachers College, Columbia University, New York, NY, USA
| | - Erin Young
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA.,Resilience Center for Veterans & Families, Teachers College, Columbia University, New York, NY, USA.,Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
| | - Matthew Goldsmith
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA.,Resilience Center for Veterans & Families, Teachers College, Columbia University, New York, NY, USA
| | - Richard W Seim
- Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller VA Medical Center, Waco, TX, USA
| | - Marianne Goodman
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA.,Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller VA Medical Center, Waco, TX, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Sokol Y, Gromatsky M, Edwards ER, Greene AL, Geraci JC, Harris RE, Goodman M. The deadly gap: Understanding suicide among veterans transitioning out of the military. Psychiatry Res 2021; 300:113875. [PMID: 33901974 DOI: 10.1016/j.psychres.2021.113875] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/13/2021] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Yosef Sokol
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States.
| | - Molly Gromatsky
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States
| | - Emily R Edwards
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States
| | - Ashley L Greene
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States
| | - Joseph C Geraci
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Resilience Center for Veterans & Families, Teachers College, Columbia University, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States; Columbia University, United States; Syracuse University, Institute for Veterans and Military Families, United States
| | - Rachel E Harris
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; William Paterson University, United States
| | - Marianne Goodman
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States
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5
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Lewison G, Sullivan R, Kiliç C. Mental health disorders research in the countries of the Organisation of Islamic Cooperation (OIC), 2008-17, and the disease burden: Bibliometric study. PLoS One 2021; 16:e0250414. [PMID: 33891637 PMCID: PMC8064544 DOI: 10.1371/journal.pone.0250414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/06/2021] [Indexed: 11/19/2022] Open
Abstract
The 57 countries of the Organisation of Islamic Cooperation are suffering from an increasing burden from mental health disorders. We investigated their research outputs during 2008–17 in the Web of Science in order to compare them with the burden from different mental health disorders and in different countries. The papers were identified with a complex filter based on title words and journals. Their addresses were parsed to give fractional country counts, show international collaboration, and also reveal country concentration on individual disorders and types of research. We found 17,920 papers in the decade, with output quadrupling. Foreign contributions accounted for 15% of addresses; they were from Europe (7%), Canada + USA (5%) and elsewhere (3%). They were much greater for Qatar and Uganda (> 60%), but less than 10% for Iran and Turkey. Schizophrenia and bipolar disorder were over-researched, but suicide and self-harm were seriously neglected, relative to their mental health disorder burdens. Although OIC research has been expanding rapidly, some countries have published little on this subject, perhaps because of stigma. Turkey collaborates relatively little internationally and as a result its papers received few citations. Among the large OIC countries, it has almost the highest relative mental health disorders burden, which is also growing rapidly.
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Affiliation(s)
- Grant Lewison
- Department of Cancer and Pharmaceutical Sciences, Institute of Cancer Policy, Guy’s Hospital, King’s College London, London, United Kingdom
- * E-mail:
| | - Richard Sullivan
- Department of Cancer and Pharmaceutical Sciences, Institute of Cancer Policy, Guy’s Hospital, King’s College London, London, United Kingdom
| | - Cengiz Kiliç
- Department of Psychiatry, and Stess Assessment and Research Centre (STAR), Hacettepe University, Ankara, Turkey
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6
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Geraci JC, Mobbs M, Edwards ER, Doerries B, Armstrong N, Porcarelli R, Duffy E, Loos CM, Kilby D, Juanamarga J, Cantor G, Sutton L, Sokol Y, Goodman M. Expanded Roles and Recommendations for Stakeholders to Successfully Reintegrate Modern Warriors and Mitigate Suicide Risk. Front Psychol 2020; 11:1907. [PMID: 32973608 PMCID: PMC7471060 DOI: 10.3389/fpsyg.2020.01907] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/10/2020] [Indexed: 11/13/2022] Open
Abstract
This article draws upon the legends of warriors from ancient Greece and other traditions to illuminate the journey of Modern Warriors (MWs) who have served in the United States military over the last century. It then turns to stakeholders that can assist current MWs in their reintegration to civilian life and mitigate suicide risk. Until this point, without an existing and coordinated local, federal, non-profit, and private system, rates of suicide for post-9/11 MWs after leaving the military have greatly increased, especially for young and women MWs. This is due in part to the military satisfying many of MWs’ needs by providing units, leaders, and a mission during the Departure and Initiation stages of the MW journey. However, as MWs exit the military and face the difficult task of reintegration, the absence of units, leaders, and mission leads to deteriorating psychological health and increasing suicide risk. Written primarily by post-9/11 MWs, this article proposes recommendations for stakeholders to better reintegrate MWs and mitigate suicide risk. The authors strive to develop a system that satisfies MWs’ reintegration needs and enables MWs to be well positioned to continue their next ‘mission’ – to serve and improve society.
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Affiliation(s)
- Joseph C Geraci
- Transitioning Servicemember/Veteran and Suicide Prevention Center, VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, The Bronx, NY, United States.,Resilience Center for Veterans and Families, Teachers College, Columbia University, New York City, NY, United States.,Institute for Veterans and Military Families, Syracuse University, Syracuse, NY, United States
| | - Meaghan Mobbs
- Resilience Center for Veterans and Families, Teachers College, Columbia University, New York City, NY, United States
| | - Emily R Edwards
- Transitioning Servicemember/Veteran and Suicide Prevention Center, VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, The Bronx, NY, United States
| | - Bryan Doerries
- Theater of War Productions, New York City, NY, United States
| | - Nicholas Armstrong
- Institute for Veterans and Military Families, Syracuse University, Syracuse, NY, United States
| | | | - Elana Duffy
- Pathfinder.vet, New York City, NY, United States
| | | | - Daniel Kilby
- Transitioning Servicemember/Veteran and Suicide Prevention Center, VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, The Bronx, NY, United States.,Resilience Center for Veterans and Families, Teachers College, Columbia University, New York City, NY, United States
| | - Josephine Juanamarga
- Resilience Center for Veterans and Families, Teachers College, Columbia University, New York City, NY, United States
| | - Gilly Cantor
- Institute for Veterans and Military Families, Syracuse University, Syracuse, NY, United States
| | - Loree Sutton
- NYC Department of Veterans' Services, New York City, NY, United States
| | - Yosef Sokol
- Transitioning Servicemember/Veteran and Suicide Prevention Center, VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, The Bronx, NY, United States
| | - Marianne Goodman
- Transitioning Servicemember/Veteran and Suicide Prevention Center, VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, The Bronx, NY, United States
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