Recent Stressful Experiences and Suicide Risk: Implications for Suicide Prevention and Intervention in U.S. Army Soldiers

Perspectives of suicide loss survivors: Qualitative analysis of data from a psychological autopsy study of U.S. Army soldiers

INTRODUCTION

Suicide loss survivors can provide information not otherwise available about the circumstances preceding a suicide. In this study, we analyzed interview data from suicide loss survivors collected as part of a psychological autopsy study of U.S. Army soldiers.

METHODS

Next-of-kin (NOK) (n = 61) and Army supervisors (SUP) (n = 107) of suicide decedents (n = 135) who had died in the last 2-3 months answered open-ended questions about suicide risk factors, ideas for improving suicide prevention, and the impact of the suicide. Responses were coded using conventional content analysis methods to identify common themes.

RESULTS

Many NOK (30%) and SUP (50%) did not observe any signs of risk preceding the soldier's suicide. The most common idea regarding suicide prevention from SUP was that the suicide was inevitable, whereas NOK were more likely to emphasize the importance of increasing mental health treatment and reducing stigma. Both NOK and SUP reported negative effects of the suicide, but SUP reported some positive effects (e.g., increased unit connectedness).

CONCLUSIONS

Results underscore the challenges of using informants to identify soldiers at high risk of suicide, given many respondents did not observe any warning signs. Findings also highlight attitudinal barriers present in the military that, if targeted, may increase soldiers' help-seeking and willingness to disclose their risk.

Psychometric properties, predictive utility and diagnostic capacity of the Persian version of the Scale of Resilience to Suicide Attempts in army conscripts

INTRODUCTION

Suicide among army conscripts represents a poorly understood and complex public health issue that has escalated in recent decades. The early identification of individuals at risk holds the potential to significantly contribute to the effective prevention of suicide attempts. To address this, the Scale of Resilience to Suicide Attempts-18 (SRSA-18) has been developed to assess protective factors related to suicide attempts. The present study aimed to develop a Persian version of SRSA-18 (P-SRSA) and examine its psychometric properties and predictive utility within a sample of the Iranian Army.

METHODS

The initial study sample consisted of 400 male conscripts from the Iranian Army grand forces (M=19.86, SD=1.40). Subsequently, for the follow-up stage, 296 participants (M=19.83, SD=1.39) were recruited. The participants were assessed using various measures of resilience, social support, suicide and hopelessness at baseline and a 6-month follow-up.

RESULTS

In contrast to the original version, both exploratory and confirmatory factor analyses supported an 18-item two-factor model of the P-SRSA (root mean square error of approximation=0.076; 95% CI (0.069 to 0.086), comparative fit index=0.943, Tucker-Lewis index=0.936). P-SRSA strongly correlated with convergent/divergent measures and demonstrated satisfactory internal consistency (α=0.82). Furthermore, regression analysis revealed that the P-SRSA significantly predicted suicide reattempts at baseline and during a 6-month follow-up period.

CONCLUSION

The study confirms that the P-SRSA, comprising a two-factor, 18-item solution, is a reliable measure of resilience, displaying robust discriminant and predictive validity. These findings provide substantial support for implementing P-SRSA in samples from the Iranian Army, highlighting its potential to identify suicidal conscripts effectively.

Preventing job loss and functional decline: Description and demonstration of the Veterans Health Administration supported Employment: Engage and Keep (SEEK) program

The high incidence of untreated mental health concerns among veterans can harm other areas of life, including employment. Loss of employment can lead to other adverse outcomes, such as financial instability, functional decline, and increased risk for suicide. Current Veterans Health Administration (VHA) vocational services are limited in that they primarily serve veterans who are unemployed and already enrolled in VHA. There is a need to prevent job loss among veterans who are struggling with mental health and vocational concerns and are not accessing VHA services, thus decreasing the risk of suicide and more costly interventions. Consistent with the existing national VHA initiatives on increasing access to health care and preventing suicide, a novel work-based intervention, Supported Employment: Engage and Keep (SEEK), was created. Building on the supported employment framework, SEEK assertively outreaches to already employed veterans by collaborating with workplaces that employ veterans. SEEK providers build rapport with employers and veterans and become a trusted VHA resource. SEEK engages veterans, facilitates enrollment in needed health care, and provides needed job maintenance support. This article outlines the SEEK model and provides a case demonstration and analysis of the course of SEEK care provided to a veteran at risk of losing their job. Clinical recommendations for implementing SEEK and future directions for evaluating this model are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).