Development of the U.S. Army’s Suicide Prevention Leadership Tool: The Behavioral Health Readiness and Suicide Risk Reduction Review (R4)

Abstract

Introduction Although numerous efforts have aimed to reduce suicides in the U.S. Army, completion rates have remained elevated. Army leaders play an important role in supporting soldiers at risk of suicide, but existing suicide-prevention tools tailored to leaders are limited and not empirically validated. The purpose of this article is to describe the process used to develop the Behavioral Health Readiness and Suicide Risk Reduction Review (R4) tools for Army leaders that are currently undergoing empirical validation with two U.S. Army divisions. Materials and Methods Consistent with a Secretary of the Army directive, approximately 76 interviews and focus groups were conducted with Army leaders and subject matter experts (SMEs) to obtain feedback regarding existing practices for suicide risk management, leader tools, and institutional considerations. In addition, reviews of the empirical literature regarding predictors of suicide and best practices for the development of practice guidelines were conducted. Qualitative feedback, empirical predictors of suicide, and design considerations were integrated to develop the R4 tools. A second series of 11 interviews and focus groups with Army leaders and SMEs was also conducted to validate the design and obtain feedback regarding the R4 tools. Results Leaders described preferences for tool processes (eg, incorporating engaged leadership, including multiple risk identification methods), formatting (eg, one page), organization (eg, low-intermediate-high risk scoring system), content (eg, excluding other considerations related to vehicle safety, including readiness implications), and implementation (eg, accounting for leadership judgment, tailoring process to specific leadership echelons, consideration of institutional barriers). Evidence-based predictors of suicide risk and practice guideline considerations (eg, design) were integrated with leadership feedback to develop the R4 tools that were tailored to specific leadership echelons. Leaders provided positive feedback regarding the R4 tools and described the importance of accounting for potential institutional barriers to implementation. This feedback was addressed by including recommendations regarding the implementation of standardized support meetings between different echelons of leadership. Conclusions The R4 development process entailed the simultaneous integration of leadership feedback with evidence-based predictors of suicide risk and design considerations. Thus, the development of these tools builds upon previous Army leadership tools by specifically tailoring elements of those tools to accommodate leader preferences, accounting for potential implementation barriers (eg, institutional factors), and empirically evaluating the implementation of those tools. Future studies should consider utilizing a similar process to develop empirically based resources that are more likely to be incorporated into the routine practice of leaders supporting soldiers at risk of suicide, very often located at the company level and below.

Polygenic risk for major depression is associated with lifetime suicide attempt in US soldiers independent of personal and parental history of major depression

“…Nowhere has this concern raised more alarms than in the United States military, where from 2014 to 2019, the suicide death rate for the Active Component increased from 20.4 to 25.9 suicides per 100,000 Service members (Defense, 2020). Despite a great deal of research into risk factors (Holliday et al, 2020) and substantial investments in suicide prevention (Curley et al, 2020; Stein, Kessler, & Ursano, 2019), it remains uncertain why suicidality has trended higher. These observations have called for the development of better risk prediction models that can help target those individuals at highest risk (Kessler, Bossarte, Luedtke, Zaslavsky, & Zubizarreta, 2020).…”

“…Nowhere has this concern raised more alarms than in the United States military, where from 2014 to 2019, the suicide death rate for the Active Component increased from 20.4 to 25.9 suicides per 100,000 Service members (Defense, 2020). Despite a great deal of research into risk factors (Holliday et al, 2020) and substantial investments in suicide prevention (Curley et al, 2020;, it remains uncertain why suicidality has trended higher.…”

Military suicide prevention: The importance of leadership behaviors as an upstream suicide prevention target

“…Despite these limitations, the current study has important implications. Previous military suicide interventions have attempted to implement improved screening (Curley et al, 2019), clinic‐based care (Rudd et al, 2015), or peer‐to‐peer intervention training (Knox et al, 2003). As of yet, these interventions may be limited in reach as they rely on soldiers self‐referring for care or in the case of peer‐to‐peer training, have demonstrated mixed results (Pistone et al, 2019), and require better evaluation (Isaac et al, 2009).…”

Importancia de cursos de prevención del suicidio en ciencias de la salud y fuerzas armadas

“…El estudio refiere que los líderes pueden realizar diversas actividades recomendables (Figura 2). Por ejemplo: conversaciones cara a cara con los soldados y otros miembros importantes (familiares, amigos y compañeros de la unidad) para una mejor comprensión y abordaje del problema, reuniones entre líderes para discutir sobre los soldados en probable riesgo, seguimiento de casos focalizados, reuniones mensuales multidisciplinares (batallón, brigada, divisón, pelotón, compañía) y profesionales (líderes, oficiales, capellanes) para la toma de decisiones, entre otras actividades (Curley et al, 2019). En consecuencia, tanto los estudiantes y líderes de las instituciones militares se convierten en miembros activos de la prevención del suicidio, siendo una estrategia favorable para identificar probables casos en riesgo y sensibilización para la búsqueda de ayuda profesional.…”

“…Asimismo, experimentaron grandes avances en el conocimiento fundamental sobre la prevención del suicidio y reducciones significativas en su estigma y actitudes negativas hacia el suicidio en comparación del grupo control (Muehlenkamp & Thoen, 2019). Experiencias similares también se evidencian en líderes y miembros de las instituciones militares, dado que algunos miembros de las fuerzas armadas presentan algunas barreras para buscar ayuda profesional: vergüenza, desconfianza en sus superiores y preocupaciones sobre ser tratados de manera diferente (Curley et al, 2019;VanSickle et al, 2016;Wyman et al, 2020). Los cursos de prevención del suicidio pueden reducir estas barreras para solicitar apoyo.…”