Suicide Among Service Members

Understanding the Reasons for Suicide Ideation and Treatment Strategies

By Craig J. Bryan, PsyD, ABPP | July 14, 2011

Dr Bryan is Assistant Professor in the department of psychiatry at the University of Texas Health Science Center at San Antonio. He reports that he has received honoraria from the American Association of Suicidology, consults for the Department of Defense, and has received grant support from the Department of Defense and the San Antonio Life Sciences Institute.

Conclusions

Based on what we know (and don’t know) about military suicide, 3 overarching lessons can maximize clinicians’ ability to assist service members in crisis.

1. Remember that combat can increase vulnerability to suicide by increasing the likelihood of other, more proximal causes for suicide (eg, life stressors, emotion-regulation problems). In treating patients, clinicians should be careful not to be distracted from these proximal risk factors by overemphasizing combat exposure.

2. Remember that the military has a unique cultural context that views death and emotional distress in ways that differ from the views of civilians. Clinicians should not discourage these qualities. Rather, they should help foster and maintain a more adaptive “warrior mindset.”

3. Finally, remember that there are few effective treatments for suicidal behaviors. Mental health professionals should seek out and receive adequate training and supervision in the evidence-based treatments for suicidal behaviors and use these as front-line interventions.

By being committed to cultural competence and evidence-based practice, mental health professionals are poised to have a positive impact on the problem of military suicide.

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by William Sauve | July 18, 2011 8:00 PM EDT

I'll agree, Dr. Nasky, with the concept of immaturity in many of our young patients - working on inpatient, I became increasingly convinced many of our patients threatening suicide lack a true understanding of death, as one might expect of a five year old - so working on basic problem solving skills would seem a good strategy.

As far as the "warrior mindset,"I might suggest a reframe. Not so much changing the culture as elaborating on the meaning of "warrior." I think any true warrior would agree that you don't get strong all at once, nor do you usually do it alone. Thinking that the culture demands the concealment of weakness is not a problem with the culture, it is a misinterpretation of the culture (which is, admittedly, epidemic ...)

by Kevin Nasky | July 18, 2011 7:14 PM EDT

I disagree with #2. The 'culture' is part of the problem. The 'warrior mindset' as it's understood is antagonistic to the message that people are NOT fortresses of resilience, and that rather than 'suck it up,' people need to acknowledge feeling overwhelmed and ask for help. This Aussie PSA hits all the right notes, I think:

http://youtu.be/e-evWaD2mlM

This warrior mindset nonsense is just that. As the article says, the vast majority of these suicides are those that haven't deployed. We need to look at this population for what it is: protracted adolescence. These are young males who--compared to their civilian counterparts--I would argue are, on the whole, less mature. I don't say this to insult this population, but rather as an argument that our paradigm needs to change. We're not treated warriors; we're treating kids right out of high school with abysmally poor coping mechanisms (and a crap ton of stress). Add in the crazy girl/wife problems and alcohol and you've got a mess on your hands. If the servicemember is a bottom 5%-er, i.e. poor performer, you've got a high risk situation on your hands (because now this guy feels a sense of thwarted belongingness to unit).

Anyway, sorry for rambling. My main point that I'm trying to make is that we need to CHANGE military culture to acknowledge that many are psychologically weak (yes, I said it). We all get so uptight, and beat around the bush, about this issue, but everyone in mental health knows that there are people who are psychologically weak. Call it want you want: poor ego strength (lack of affect tolerance, lack of frustration tolerance), poor coping skills, utilization of immature defenses, highly external locus of control, little resilience, poor self-efficacy, lack of future-orientation, inability to self-soothe...the list could go on and on, but someone with many of these traits (arguably, some of them can be "states") is not going to hold up well under pressure, i.e. they're psychologically weak. Again not in a pejorative sense, but in a descriptive prognosticating one. So, when we're designing primary prevention efforts aimed at mental health, we need to first assess the level of (mental) health of our population. Overestimating them as "warriors" does them a disservice. Sometimes too HIGH of expectations can be harmful too.

Also in this Special Report

Introduction: Serving Those Who Serve

The Long War Comes Home

Traumatic Brain Injury Among Veterans Returning From Afghanistan and Iraq

Suicide Among Service Members

Returning Veterans With Addictions

Addressing Postdeployment Needs

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Suicide Among Service Members

Understanding the Reasons for Suicide Ideation and Treatment Strategies

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