A Qualitative Study of Potential Suicide Risk Factors in Returning Combat Veterans

Abstract

According to the interpersonal-psychological theory of attempted and completed suicide (Joiner, 2005) suicide-related behavior is contingent upon three factors: acquired ability, burdensomeness, and failed belongingness. Qualitative research methodology was employed to explore these concepts among a group of returning Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) combat veterans. A sample of 16 individuals participated in interviews. Themes emerged regarding combat as a context for exposure to pain, subsequent coping strategies, and perceptions of burdensomeness, failed belongingness, and increased pain tolerance. Suicidal behavior was also articulated as a means of coping with risk factors outlined by Joiner. These results highlight the potential utility of this theory for OEF/OIF veterans. Interventions aimed at decreasing emotional dysregulation, and lessening perceptions of burdensomeness and failed belongingness may reduce risk for suicidal behavior.

Examining the relationship between coping strategies and suicidal desire in a sample of United States military personnel

“…However, camaraderie with other military members may heighten feelings of belongingness, serving as a protective factor against suicide. Supporting this idea, Brenner et al [7] observed that those returning from deployment felt connected with other military personnel, which was partly due to shared combat experiences. Furthermore, Scoville, Gubata, Potter, White, & Pearse [11] found that suicide rates for those undergoing basic military training are lower than those of the same age in the general population.…”

“…The first state, perceived burdensomeness, refers to an individual's feelings of being a burden to others and beliefs that others would benefit more from their death than life. Veterans returning from Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) have previously reported feelings of burdensomeness, specifically relating to reintegrating into society postdeployment [7]. Furthermore, associations between perceived burdensomeness and suicidal ideation have been observed in military populations, particularly when jointly present with elevated levels of the acquired capability for suicide [8,9].…”

“…Brenner et al [7] reported that military members felt a sense of disconnect with those not involved in the military, indicating the possibility of heightened levels of thwarted belongingness when reintegrating into civilian life after deployment. Recent research has supported this finding, as thwarted belongingness was found to be a predictor of suicidal ideation in an inpatient veteran sample [10].…”

The clinical utility of a brief measure of perceived burdensomeness and thwarted belongingness for the detection of suicidal military personnel

“…Social isolation, loneliness, and feelings of low connectedness have also been linked to suicide (Trout, 1980;Woznica & Shapiro, 1990) and have traditionally been viewed as risk factors for suicide (see Van Orden et al, 2010). Elevations in PB and TB have been reported in case reports and qualitative studies of suicidal military personnel (Anestis, Bryan, Cornette, & Joiner, 2009;Brenner et al, 2008), but to date only one quantitative study has demonstrated a clear link between PB and a history of suicidality among military personnel ). This study was limited, however, by a restricted sample without any combat or deployment experience, an important factor given the significant impact that military service can have on a service member's sense of connectedness and sense of self-worth within a group context .…”

Optimizing Screening and Risk Assessment for Suicide Risk in the U.S. Military

“…Although research directly measuring these variables in the military are few, especially for acquired capability, several studies have reported findings that are consistent with these constructs (e.g., Brenner et al, 2008; Kaplan et al, 2007). In clinical practice, actual measures of perceived burdensomeness, thwarted belongingness, and acquired capability may provide the most accurate assessment, but many of the variables displayed in Fig.…”