Development and Validation of a Theory Based Screening Process for Suicide Risk


The goal of this study is to increase the capacity of military-based health services to accurately identify service members at risk for suicide and to make effective treatment referrals.

Population-level screening for suicide risk is a difficult task. It has long been known that military service members are reluctant to admit suicide-related behaviors due to stigma and concerns about career ramifications. Is it possible to improve risk detection by asking targeted questions addressing direct and indirect risk factors? This is a key question posed by Steven Vannoy, PhD, of the University of Massachusetts at Boston, whose research is supported by the Department of Defense.

Suicide prevention is a priority health care concern for the Army. Identifying service members who may be at risk for suicide is a critical task for Army suicide prevention efforts. Recent reports suggest that the routine screening instruments currently used to assess suicidal thoughts are underdetecting the rates of suicide ideation in active-duty service members.

The U.S. Army Medical Research and Materiel Command’s Military Operational Medicine Research Program (MOMRP) brought together a panel of mental health experts to assess and recommend improvements to the Army’s ability to identify personnel at elevated risk for suicide through routine, universal screening. The panel produced a recommended protocol based on best practices and integration of the current literature base in suicide research. The protocol included direct assessment of imminent risk, current and past suicide related behavior, identification of acute indicators of risk, and common stressors considered to increase vulnerability.

What’s the process?

In order to evaluate the impact of the proposed protocol, Steven Vannoy, PhD, designed a research study involving the survey of 4,000 U.S. Army Soldiers who have recently returned from deployment. At the time they complete the Army’s Post-Deployment Health Reassessment (PDHRA), the Soldiers are invited to volunteer for the study survey.

Those who choose to participate complete a confidential questionnaire that includes the expert-panel-recommended items; some additional items that might provide validation for the Interpersonal Theory of Suicide; and a two-question anonymous survey dealing specifically with suicide ideation and willingness to seek support. The purpose of the anonymous survey is to generate estimated rates of service members who report suicide ideation when there is no risk of stigma or penalty.

The Interpersonal Theory of Suicide hypothesizes which individuals are most likely to follow through with action once suicidal ideation develops. This theory, developed by Thomas Joiner, maintains that three factors are necessary: feelings of being a burden to friends, family and/or society; feelings of being an outsider or not being understood; and a learned insensitivity to harm through exposure to violent or high-risk experiences.

At the conclusion of the data collection phase of the study, subjects’ study data will be associated with key medical/experiential information from their PDHRA medical record. Using descriptive statistics, Dr. Vannoy will compare and contrast the two data sources to accurately identify suicide risk, to evaluate the proposed decision support algorithm for clinical risk management, and to advance clinically relevant knowledge related to the relationship between the Interpersonal Psychological Theory of Suicide and common risk factors for military personnel and their corresponding general population peers.

The benefits of success

If the results show that the inclusion of the study questionnaire and strategy in the screening process improve the accuracy of detecting soldiers in need of additional mental health support, there is the potential to save lives and improve the stability of the military work force.

Suicide risk detection and suicide prevention is a national health care priority. Although the prevention of suicide in this study is aimed primarily at working age adults, the knowledge gained may inform efforts across the age and gender spectrums.

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