The association between specific combat experiences and aspects of the Interpersonal Theory of Suicide

The Purple Heart and suicide risk in Post-9/11 U.S. Army Combat Veterans with a traumatic brain injury: A mixed methods study

Active service members and Veterans with a combat-related traumatic brain injury (TBI) are four times more likely to attempt suicide than those without a TBI. TBIs are the signature injuries of the Post-9/11 conflicts and Combat Veterans (i.e., current and former service members who deployed in support of a combat mission) with these injuries are entitled to receive the Purple Heart medal. However, potentially tens of thousands of Combat Veterans did not receive, or were denied the Purple Heart during the first decade of the Global War on Terrorism because a TBI was not documented during the deployment. To our knowledge, this is the first study to explore the meaning of the Purple Heart and examine the impact of the Purple Heart on Army Combat Veterans with a combat-related TBI. Findings from this mixed methods study revealed that not receiving the Purple Heart is associated with increased suicide risk and lower quality of life after a brain injury. Additionally, thwarted belongingness, perceived burdensomeness, and perceived military institutional betrayal are associated with increased suicide risk in Army Combat Veterans with a TBI. This mixed methods study provides important insights into how Army culture is perceived and the power of the Purple Heart among this high-risk group of Combat Veterans.

Exploring the use of the Interpersonal Needs Questionnaire to examine suicidal thoughts and behaviors among Post-9/11 U.S. Combat Veterans: An integrative review

This integrative review expands on the work of Kramer et al. (2020), by reviewing studies that utilized the Interpersonal Needs Questionnaire (INQ) to examine the interpersonal constructs (thwarted belongingness and perceived burdensomeness) of the Interpersonal Theory of Suicide (ITS) to understand suicidal thoughts and behaviors among service members and Veterans with combat experience. Very few studies (n = 9) in the literature were identified, however important relationships were revealed between combat exposure/experiences, thwarted belongingness, perceived burdensomeness, and suicidal thoughts and behaviors among military samples. Studies also reported risk factors for high levels of thwarted belongingness or perceived burdensomeness in military samples, such as moral injuries, betrayal, and aggression. This review highlights the utility of the INQ to measure ITS constructs among Post-9/11 U.S. Combat Veterans.

Use of the acquired capability for suicide scale (ACSS) among United States military and Veteran samples: A systematic review

BACKGROUND

Military personnel and Veterans are at increased risk for suicide. Theoretical and conceptual arguments have suggested that elevated levels of acquired capability (AC) could be an explanatory factor accounting for this increased risk. However, empirical research utilizing the Acquired Capability for Suicide Scale (ACSS) in military populations has yielded mixed findings.

METHODS

To better ascertain what factors are associated with AC, and whether methodological limitations may be contributing to mixed findings, a systematic review was conducted.

RESULTS

A total of 31 articles utilized the ACSS to examine factors associated with AC, including combat history, in United States (U.S.) military personnel and Veterans. Nearly all studies (96.8%) were rated high risk of bias. Use of the ACSS varied, with seven different iterations utilized. Nearly all studies examined correlations between the ACSS and sample characteristics, mental health and clinical factors, Interpersonal Theory of Suicide constructs, and/or suicide-specific variables. Results of higher-level analyses, dominated by cross-sectional designs, often contradicted correlational findings, with inconsistent findings across studies.

LIMITATIONS

Included studies were non-representative of all U.S. military and Veteran populations and may only generalize to these populations.

CONCLUSIONS

Due to the high risk of bias, inconsistent use of the ACSS, lack of sample heterogeneity, and variability in factors examined, interpretation of current ACSS empirical data is cautioned. Suggestions for future research, contextualized by these limitations, are discussed.

Validation of a Chinese Version of the Acquired Capability for Suicide Scale

This study aimed to revise and validate a Chinese Version of the Acquired Capability for Suicide Scale (ACSS-CV). In study 1 of 395 Chinese college students, a two-factor model comprising fearlessness about death and pain tolerance achieved satisfactory model fit. In study 2 of 491 different students, the ACSS-CV had good internal consistency, test-retest reliability, convergent validity, and discriminant validity. The ACSS-CV may be considered a useful instrument for measuring the acquired capability for suicide in Chinese college students.