Reasons for Living Among U.S. Army Personnel Thinking About Suicide
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Reasons for living are associated with reduced suicide risk, but have not received much empirical attention among U.S. military personnel, a population with elevated suicide risk. The present study examined the factor structure, reliability, and validity of the Brief Reasons for Living Inventory (BRFLI) in a clinical sample of 97 treatment-seeking Army personnel with recent suicide ideation and/or a history of suicide attempts. Results supported a five-factor structure for the BRFLI. Each factor had good internal consistency (ω’s > 0.94) and demonstrated convergent and divergent validity. Survival and coping beliefs and responsibility to family subscale scores were negatively correlated with recent suicidal thinking. Responsibility to family subscale scores were associated with significantly reduced risk of suicide attempts during follow-up. BRFLI subscale scores showed little to no clinical responsivity following intervention. Results suggest survival and coping beliefs and responsibility to family may be protective for high-risk military personnel.
KeywordsMilitary Suicide Reasons for living Protective factors
This study was supported in part by the Military Suicide Research Consortium (MSRC), an effort supported by the Office of the Assistant Secretary of Defense for Health Affairs under award #W81XWH-10-2-0181. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the U.S. Government, the Department of Defense, the Department of the Army, or the MSRC.
Compliance with Ethical Standards
Conflict of interest
Dr. Bryan reports grant funding from the Department of Defense and Department of Veterans Affairs, and consultation salary from Neurostat Analytical Solutions. Mr. Oakey and Ms. Harris report no potential conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- Beck, A. T., & Steer, R. A. (1993). Manual for the beck hopelessness scale. San Antonio, TX: Psychological Corporation.Google Scholar
- Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the beck depression inventory—II. San Antonio, TX: Psychological Corporation.Google Scholar
- Bryan, C. J., Clemans, T. A., Hernandez, A. M., & Rudd, M. D. (2013). Loss of consciousness, depression, posttraumatic stress disorder, and suicide risk among deployed military personnel with mild traumatic brain injury (mTBI). Journal of Head Trauma Rehabilitation, 28, 13–20. https://doi.org/10.1016/j.comppsych.2017.05.006.CrossRefPubMedGoogle Scholar
- Bryan, C. J., Gonzales, J., Rudd, M. D., Bryan, A. O., Clemans, T. A., Ray-Sannerud, B., Wertenberger, E., Leeson, B., Heron, E. A., Morrow, C. E., & Etienne, N. (2015). Depression mediates the relation of insomnia severity with suicide risk in three clinical samples of U.S. Military Personnel. Depression and Anxiety, 32, 647–655. https://doi.org/10.1002/da.22383.CrossRefPubMedGoogle Scholar
- Bryan, C. J., Griffith, J. E., Pace, B. T., Hinkson, K., Bryan, A. O., Clemans, T. A., & Imel, Z. E. (2015). Combat exposure and risk for suicidal thoughts and behaviors among military personnel and veterans: A systematic review and meta-analysis. Suicide and Life-Threatening Behavior, 45, 633–649. https://doi.org/10.1111/sltb.12163.CrossRefPubMedGoogle Scholar
- Bryan, C. J., Mintz, J., Clemans, T. A., Leeson, B., Burch, T. S., Williams, S. R., Maney, E., & Rudd, M. D. (2017). Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army Soldiers: A randomized control trial. Journal of Affective Disorders, 212, 64–72. https://doi.org/10.1016/j.jad.2017.01.028.CrossRefPubMedGoogle Scholar
- Bryan, C. J., Rudd, M. D., Peterson, A. L., Young-McCaughan, S., & Wertenberger, E. G. (2016). The ebb and flow of the wish to live and the wish to die among suicidal military personnel. Journal of Affective Disorders, 202, 58–66. https://doi.org/10.1016/j.jad.2016.05.049.CrossRefPubMedGoogle Scholar
- Bryan, C. J., Rudd, M. D., Wertenberger, E., Etienne, N., Ray-Sannerud, B. N., Morrow, C. E., Peterson, A. L., & Young-McCaughon, S. (2014). Improving the detection and prediction of suicidal behavior among military personnel by measuring suicidal beliefs: An evaluation of the Suicide Cognitions Scale. Journal of Affective Disorders, 159, 15–22.CrossRefGoogle Scholar
- Jobes, D. A. (2016). Managing suicidal risk: A collaborative approach. New York: Guilford Publications.Google Scholar
- Joiner, T. E., Pfaff, J. J., & Acres, J. G. (2002). A brief screening tool for suicidal symptoms in adolescents and young adults in general health settings: Reliability and validity data from the Australian National General Practice Youth Suicide Prevention Project. Behaviour Research and Therapy, 40, 471–481.CrossRefGoogle Scholar
- Linehan, M. M., Comtois, K. A., Brown, M. Z., Heard, H. L., & Wagner, A. (2006). Suicide attempt self-injury interview (SASII): Development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury. Psychological Assessment, 18, 303–312. https://doi.org/10.1037/1040-35184.108.40.2063.CrossRefPubMedGoogle Scholar
- McDonald, R. P. (1999). Test theory: A unified treatment. Mahwah, NJ: Erlbaum.Google Scholar
- Muthen, L. K., & Muthen, B. O. (1998–2010). Mplus User’s Guide. 6th ed., Los Angeles, CA: Muthen & Muthen.Google Scholar
- Nock, M. K., Ursano, R. J., Heeringa, S. G., Stein, M. B., Jain, S., Raman, R., Sun, X., Chiu, W. T., Colpe, L. J., Fullerton, C. S., Gilman, S. E., Hwang, I., Naifeh, J. A., Rosellini, A. J., Sampson, N. A., Schoenbaum, M., Zaslavsky, A. M., & Kessler, R. C. (2015). Mental disorders, comorbidity and pre-enlistment suicidal behavior among new soldiers in the US Army: Results from the army study to assess risk and resilience in servicemembers (Army STARRS). Suicide and Life-Threatening Behavior, 45, 588–599. https://doi.org/10.1111/sltb.12153.CrossRefPubMedGoogle Scholar
- O’Connor, S.S., Jobes, D.A., Yeargin, M.K., Fitzgerald, M.E., Rodriguez, V.M., Conrad, A. K., & Lineberry, T.W. (2012). A crosssectional investigation of the suicidal spectrum: Typologies of suicidality based on ambivalence about living and dying. Comprehensive Psychiatry, 53(5), 461–467.CrossRefGoogle Scholar
- Pruitt, L. D., Smolenski, D. J., Bush, N. E., Skopp, N. A., Hoyt, T. V., & Grady, B. J. (2016). DoDSER: Department of defense suicide event report: Calendar year 2015 annual report. Washington, DC: Department of Defense.Google Scholar
- Ribeiro, J. D., Pease, J. L., Guttierrez, P. M., Silva, C., Bernert, R. A., Rudd, M. D., & Joiner, T. E. (2012). Sleep problems outperform depression and hopelessness as a cross-sectional and longitudinal predictors of suicidal ideation and behaviorin young adults in the military. Journal of Affective Disorders, 136, 743–750. https://doi.org/10.1016/j.jad.2011.09.049.CrossRefPubMedGoogle Scholar
- Taasoobshirazi, G., & Wang, S. (2016). The performance of the SRMR, RMSEA, CFI, and TLI: An examination of sample size, path size, and degrees of freedom. Journal of Applied Quantitative Methods, 11, 31–39.Google Scholar
- Ursano, R. J., Heeringa, S. G., Stein, M. B., Jain, S., Raman, R., Sun, X., Chiu, W. T., Colpe, L. J., Fullerton, C. S., Gilman, S. E., Hwang, I., Naifeh, J. A., Nock, M. K., Rosellini, A. J., Sampson, N. A., Schoenbaum, M., Zaslavsky, A. M., & Kessler, R. C. (2015). Prevalence and correlates of suicidal behavior among new Soldiers in the U.S. Army: Results from the army study to assess risk and resilience in servicemembers (Army STARRS). Depression and Anxiety, 32, 3–12. https://doi.org/10.1002/da.22317.CrossRefPubMedGoogle Scholar
- Ursano, R. J., Kessler, R. C., Naifeh, J. A. S., Heberman-Mash, H., Fullerton, C. S., Bliese, P. D., Zaslavsky, A. M., Ng, T. H. H., Aliaga, P. A., Wynn, G. H., Dinh, H. M., McCarroll, J. E., Sampson, N. A., Kao, T. C., Schoenbaum, M., Heeringa, S. G., & Stein, M. B. (2017). Risk of suicide attempt among soldiers in army units with a history of suicide attempts. JAMA Psychiatry, 74, 924–931. https://doi.org/10.1001/jamapsychiatry.2017.1925.CrossRefPubMedPubMedCentralGoogle Scholar
- Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the annual meeting of the International Society for Traumatic Stress Studies, San Antonio, TX.Google Scholar
- Weathers, F. W., Litz, B. T., Herman, D. S., Husker, J. A., & Keane, T. M. (1994) PCL – C for DSM-IV. National Center for PTSD – Behavioral Sciences Division. Retrieved from: https://www.ptsd.va.gov/professional/assessment/documents/APCLC.pdf.