Military service has traditionally been seen as a protective factor against suicide, with rates of suicides and suicide attempts historically lower among service members than the general population. However, repeated combat tours with Operation Iraqi Freedom and Operation Enduring Freedom seem to be taking their toll, and for the first time in known history, suicide risk among active-duty U.S. military personnel and veterans is now greater than comparable males in the general population.

The Defense Department wants to help its service members and reverse this startling trend. To do so, it has enlisted the help of an expert research team led by M. David Rudd, PhD, of the University of Memphis. A former Army psychologist, Dr. Rudd is one of the leading suicide researchers in the nation. Together with investigators from The University of Texas Health Science Center at San Antonio and STRONG STAR, he has developed a program based at Fort Carson, Colorado, to deliver the leading civilian treatment for suicide risk to an active-duty military population, to evaluate the treatment's success, and to determine how best to tailor it to our men and women in uniform.

Dr. Rudd's study is nearly a first of its kind. Research on the treatment of suicidality is sparse, particularly with military populations. In fact, the only published study of a randomized clinical trial targeting suicidality with a military sample was by Dr. Rudd in the 1990s.

Effective treatment

Civilian research does point to one form of psychotherapy, or talk therapy, as the clear leader, with the most scientific support that it effectively reduces suicide attempts. That therapy is called Cognitive Behavior Therapy (CBT), and it embodies several key elements that are known to enhance treatment success:

• Its theoretical model is easily explained to patients (specifically, it teaches them about the relationship between thoughts, emotions, and behaviors).
• A manual-driven treatment approach with fidelity checks ensures consistency among providers.
• Providers using this therapy focus on treatment compliance, and they teach patients specific skills as well as how to assume personal responsibility.

Military questions

But military research with this therapy is still needed. Will it be as effective, and how might it need to be tailored to meet the needs of a unique population that faces death on a regular basis; that has a higher tolerance for pain and suffering; and that must have access to weapons to carry out its job?

These are questions being asked by Dr. Rudd and his colleagues in a research program funded by the DoD's Military Operational Medicine Research Program. The project delivers a Brief Cognitive-Behavior Therapy (B-CBT) that includes all the empirically supported treatment components of CBT in a modified, 12-session program.

Study participants, who are referred by providers at Fort Carson clinical facilities (e.g., outpatient clinic, emergency room, or inpatient facility), are randomly assigned to receive either B-CBT or the existing outpatient treatment currently available at Fort Carson; study evaluations at various points over the course of 24 months are used to follow patients' progress.

Expected outcomes

It is hoped that the study will reduce suicide attempts and self-harm behavior among military in the short term by offering an evidence-based therapy to at-risk individuals at Fort Carson, and in the long term by providing the DoD and VA with an effective treatment program that can be disseminated among their own providers.

In addition, Dr. Rudd and his colleagues will conduct a prospective investigation of suicide risk factors and warning signs, and they will develop a centralized software assessment/management tracking system for high-risk suicidal individuals. Outcomes of both efforts could prove to be highly valuable to all of the health professionals working to save the lives of psychologically wounded men and women who have served and continue to serve our country with great honor.