When a soldier commits suicide in Iraq: impact on unit and caregivers

Negotiating the postvention situation: A grounded theory of NHS staff experiences when supporting their coworkers following a colleague's suicide

Suicide is a leading cause of death. NHS workers, especially female nurses, have heightened vulnerability. Being impacted by a colleague's suicide can lead to increased suicidality. Postvention refers to support following a suicide. We investigated current, available postvention for NHS workers following a colleague's suicide and the experiences of staff who deliver it ("supporters"). Twenty-two supporters were interviewed, and data were analyzed using classic grounded theory. The theory of negotiating postvention situations was developed. Supporters must negotiate enabling and disabling elements that form a "postvention situation" and impact behaviors and postvention efficacy. Postvention delivery is emotionally burdensome. Supporters need support, which they do not always receive. Postvention can lead to learning, which can better inform future postvention. The extent to which NHS workers can effectively support colleagues will depend on their postvention situation. As such, work must be done to enable supporters to offer effective postvention in the future.Suicide; postvention; healthcare workers; grounded theory.

Investigating the effects of suicide exposure among a clinical sample of active duty service members

Suicide exposure warrants further investigation as a risk factor for suicide among military service members. This study aimed to examine associations among suicide exposure, suicidal ideation (SI), and psychological symptoms in a clinical sample of service members (N = 1,565, 64.4% suicide-exposed) and identify how one's relationship with the deceased impacts suicidality and psychological health in exposed individuals. A secondary analysis of cross-sectional survey data was conducted. Generalized linear regression analyses were used to identify associations between suicide exposure and both current SI and psychological symptoms among all participants; the associations between suicide exposure characteristics and psychological symptoms were only examined among exposed individuals. Exposure was not significantly associated with higher SI, β = .007, SE = .16, p = .965, but was associated with PTSD, β = 1.60, SE = 0.49, p = .001; anxiety, β = .68, SE = .31, p = .031; and insomnia symptoms, β = .98, SE = .25, p < .001. Among participants who had been exposed, high/long impact of exposure was positively associated with SI, β = 0.94, SE = .26, p < .001, and psychological symptoms, PTSD: β = 2.32, SE = .77, p = .002; anxiety: β = 1.39, SE = .50, p = .005; insomnia: β = .96, SE = .39, p = .015. Results illustrate the significant issue of suicide exposure within the military and show consideration of suicide exposure as a potential risk factor for adverse psychological outcomes is warranted.

The Impact of Colleague Suicide and the Current State of Postvention Guidance for Affected Co-Workers: A Critical Integrative Review

People bereaved by suicide are affected psychologically and physically and may be at greater risk of taking their own lives. Whilst researchers have explored the impact of suicide on family members and friends, the area of colleague suicide has been neglected and postvention guidance for supporting surviving colleagues is often poorly developed. This critical integrative review explored the impact of colleague suicide on surviving co-workers and reviewed postvention guidance for workplaces. Systematic searches found 17 articles that met the inclusion criteria. Articles were appraised for quality and extracted data were analysed using a thematic network method. Article quality was moderate. Two global themes were developed: impact of a colleague suicide comprised themes of 'suicide loss in the workplace'; 'professional identities and workplace roles'; 'perceptions of professional uniqueness'; and 'professional abandonment and silencing'. Postvention following a colleague suicide comprised 'individualised responses'; 'the dual function of stigma'; and 'complex pressure on managers'. A unifying global network 'after a colleague suicide' describes the relationships between all themes. A series of disconnects between existing postvention guidance and the needs of impacted workers are discussed. This review demonstrates the need for robust, systemic postvention for colleagues impacted by the complex issue of colleague suicide.

An Examination of Suicide Exposure and Fearlessness about Death on Suicide Risk among Active Duty Service Members, Veterans, and Civilians

Suicide exposure is associated with an increased risk for suicide. There is limited research on the mechanisms that increase this risk. This study aims to: (1) compare suicide exposure and associated variables in veteran, active duty, and civilian participants, (2) examine the extent to which fearlessness about death and suicide risk factors differ as a function of group membership and suicide exposure, and (3) determine the degree to which relationship to the decedent, perceived closeness, and reported impact of the death are associated with fearlessness about death and suicide-related outcomes. 1,533 participants were included, of whom 48% of active duty service members, 65% of veterans, and 58% of civilians reported knowing someone who died by suicide. A series of regressions were conducted. There were group differences by military service on the suicide exposure variables. Furthermore, there were significant main effects for military service group and suicide exposure on the outcome variables. In general, civilians reported greater suicide risk and active duty service members reported greater fearlessness about death. Fearlessness about death mediated the associations between perceived closeness and a history of suicide attempts. The loss of a military colleague to suicide was found to be unique and distinguishable from other important relationships. Results suggest the need to consider suicide exposure and closeness as salient variables associated with fearlessness about death and suicide risk factors. Inquiring about suicide exposure, closeness to the decedent, fearlessness about death, and beyond familial losses to suicide may indicate important avenues of intervention.

Those left behind: A scoping review of the effects of suicide exposure on veterans, service members, and military families

Veteran and service member suicide remains a significant public health concern. One factor that may impact suicide risk is suicide exposure-knowing someone who has died by suicide or attempted suicide. However, the majority of the extant literature has focused on nonmilitary samples, which may not generalize to military veterans and service members. The current review synthesizes findings regarding suicide exposure in military veterans, service members, their families, and military systems. Our review suggests that the relationship between suicide exposure, suicide risk, and mental health outcomes remains inconsistent. Future research should further explore this important area.

A Psycholinguistic Analysis of Responses to Live-Stream Suicides on Social Media

Live-stream suicide has become an emerging public health problem in many countries. Regular users are often the first to witness and respond to such suicides, emphasizing their impact on the success of crisis intervention. In order to reduce the likelihood of suicide deaths, this paper aims to use psycholinguistic analysis methods to facilitate automatic detection of negative expressions in responses to live-stream suicides on social media. In this paper, a total of 7212 comments posted on suicide-related messages were collected and analyzed. First, a content analysis was performed to investigate the nature of each comment (negative or not). Second, the simplified Chinese version of the LIWC software was used to extract 75 psycholinguistic features from each comment. Third, based on 19 selected key features, four classification models were established to differentiate between comments with and without negative expressions. Results showed that 19.55% of 7212 comments were recognized as "making negative responses". Among the four classification models, the highest values of Precision, Recall, F-Measure, and Screening Efficacy reached 69.8%, 85.9%, 72.9%, and 47.1%, respectively. This paper confirms the need for campaigns to reduce negative responses to live-stream suicides and support the use of psycholinguistic analysis methods to improve suicide prevention efforts.

Suicide Postvention for the United States Military: Literature Review, Conceptual Model, and Recommendations

Suicide continues to be a significant public health problem in the United States and the Department of Defense (DoD). Timely and systematic postvention efforts can play an instrumental role in helping family members, peers, and military command to best manage the aftermath of a suicide. To date, several postvention efforts have been implemented in the military. However, there continues to be an overall lack of understanding of the specific short- and long-term effects of exposure to military suicide. In addition, more emphasis needs to be placed on empirically driven approaches to postvention and program evaluation. The purpose of this article is threefold: (1) to provide a summary of the postvention literature with special emphasis placed on the military organization; (2) to propose a conceptual model as a framework for understanding Military-Unit Suicide Survivorship; and (3) to briefly highlight postvention strategies within the DoD in the context of a number of research, clinical, and policy recommendations.

Risk of Suicide Attempt Among Soldiers in Army Units With a History of Suicide Attempts

IMPORTANCE

Mental health of soldiers is adversely affected by the death and injury of other unit members, but whether risk of suicide attempt is influenced by previous suicide attempts in a soldier's unit is unknown.

OBJECTIVE

To examine whether a soldier's risk of suicide attempt is influenced by previous suicide attempts in that soldier's unit.

DESIGN, SETTING, AND PARTICIPANTS

Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers (STARRS), this study identified person-month records for all active-duty, regular US Army, enlisted soldiers who attempted suicide from January 1, 2004, through December 31, 2009 (n = 9650), and an equal-probability sample of control person-months (n = 153 528). Data analysis was performed from August 8, 2016, to April 10, 2017.

MAIN OUTCOMES AND MEASURES

Logistic regression analyses examined the number of past-year suicide attempts in a soldier's unit as a predictor of subsequent suicide attempt, controlling for sociodemographic features, service-related characteristics, prior mental health diagnosis, and other unit variables, including suicide-, combat-, and unintentional injury-related unit deaths. The study also examined whether the influence of previous unit suicide attempts varied by military occupational specialty (MOS) and unit size.

RESULTS

Of the final analytic sample of 9512 enlisted soldiers who attempted suicide and 151 526 control person-months, most were male (86.4%), 29 years or younger (68.4%), younger than 21 years when entering the army (62.2%), white (59.8%), high school educated (76.6%), and currently married (54.8%). In adjusted models, soldiers were more likely to attempt suicide if 1 or more suicide attempts occurred in their unit during the past year (odds ratios [ORs], 1.4-2.3; P < .001), with odds increasing as the number of unit attempts increased. The odds of suicide attempt among soldiers in a unit with 5 or more past-year attempts was more than twice that of soldiers in a unit with no previous attempts (OR, 2.3; 95% CI, 2.1-2.6). The association of previous unit suicide attempts with subsequent risk was significant whether soldiers had a combat arms MOS or other MOS (ORs, 1.4-2.3; P < .001) and regardless of unit size, with the highest risk among those in smaller units (1-40 soldiers) (ORs, 2.1-5.9; P < .001). The population-attributable risk proportion for 1 or more unit suicide attempts in the past year indicated that, if this risk could be reduced to no unit attempts, 18.2% of attempts would not occur.

CONCLUSIONS AND RELEVANCE

Risk of suicide attempt among soldiers increased as the number of past-year suicide attempts within their unit increased for combat arms and other MOSs and for units of any size but particularly for smaller units. Units with a history of suicide attempts may be important targets for preventive interventions.

Code-51: keeping suicidal veterans safe in the emergency department

Safety of suicidal veterans is a national issue. Veterans have a higher rate of depressive disorder than the general population, which puts them at higher risk for suicide. The staff in the emergency department (ED) of one Department of Veterans Affairs hospital developed and implemented an innovative process that increases the safety of suicidal veterans in the hospital setting. This process is called Code-51 and is similar to a military unit watch. This is one of the first unit watches implemented throughout an entire Veteran Affairs hospital, not only in the ED. The Code-51 process is a model for other EDs in both public and private sectors to help keep suicidal patients safe.