In this study we examined relations of positive and negative religious coping with risk for suicidal behavior in a sample of Iraq and/or Afghanistan Veterans. Participants completed self-report instruments assessing risk for suicidal behavior, religious coping, general combat exposure, morally injurious experiences, depression, and posttraumatic stress disorder (PTSD) symptoms. Frequency analyses revealed that half of all participants endorsed being religious, and adaptively drawing on religion to cope was more common than maladaptive coping. However, positive religious coping was not associated with suicidal behavior at the time of the study. In contrast, negative religious coping was uniquely associated with the risk for suicide when we controlled for demographic risk factors, war-zone experiences, depression, and PTSD. Although we expect adaptive reliance on religion to be beneficial for mental health, veterans who experience internal and/or external conflicts in the spiritual domain may be at increased risk for engaging in suicidal behavior following their war-zone service.

Gatekeeper training for suicide prevention was evaluated on a college campus to examine the impact of training on gatekeeper enactment of behaviors in support of suicide prevention and identify predictors of enactment of gatekeeper behaviors. Trained gatekeepers (N = 216) displayed greater perceived knowledge and self-efficacy for suicide prevention and reported higher rates of self-reported actual gatekeeper behaviors, including inquiring about suicidal ideation and referring for mental health treatment when they encountered someone in distress, compared to their untrained counterparts (N = 169). Consistent with the Theory of Planned Behavior, SEM results indicated that attitudes, self-efficacy, and perceived knowledge explained intentions to engage in gatekeeper behaviors, accounting for 59% of the variance in intentions to inquire about suicidal ideation and supporting the role of attitudes and perceived behavioral control in intentions to act. These intentions explained self-reported actual gatekeeper behaviors among participants who encountered someone in distress, with each one-point increase in intention associated with nearly twice the likelihood of both inquiring about suicidal ideation and referring someone for mental health care. On the other hand, self-reported situational barriers were associated with a decreased likelihood of referral behavior, indicating the role of actual behavioral control over volitional actions. Findings support the value of gatekeeper training for promoting factors that influence the likelihood of action on behalf of suicide prevention.

Given troubling suicide rates among military veterans and active duty personnel, there is increasing interest in the possible clinical utility of incorporating spirituality in prevention efforts. However, there has been limited empirical research and discussion of ethical challenges involved in integrating spirituality into preventive and treatment interventions with military populations. As such, the purpose of this commentary is to (a) briefly summarize supporting evidence for addressing spirituality in preventive and treatment interventions with military populations and (b) introduce several ethical concerns that providers may need to consider as they attempt to attend to spiritual concerns among veterans and other military personnel who might be at risk for prematurely ending their lives.

Despite established connections between traditional masculinity ideologies and self-stigma of seeking psychological help, few studies have examined relevant constructs in samples of veterans. The present study addressed this gap by testing a model specifying conformity to the masculine role norms of self-reliance and emotional control as mediating factors of the probable associations between painful self-conscious emotions (i.e., guilt and shame) and self-stigma of seeking help in a sample of student veterans (N ϭ 349) with and without a history of war-zone deployment. After we controlled for gender, posttraumatic stress disorder symptoms, and depression, multigroup structural equation modeling revealed that painful self-conscious emotions were associated with conformity to masculine role norms in only the war-zone deployment group. In addition, emotional control and self-reliance mediated the associations between painful self-conscious emotions and self-stigma solely in the war-zone deployment group. Tests of measurement invariance suggested that the moderation effects in the model were not due to measurement differences across deployment groups. Structural invariance testing suggested the observed differences in indirect effects were attributed to the different associations between guilt and shame and emotional control between the deployment groups. Tests of an alternative model, in which guilt and shame were specified separately, indicated that the significant mediation effect of conformity to traditional masculine role norms occurred only when the shared variance between guilt and shame was modeled in a single latent variable. These results suggest that war-zone deployments may solidify military-congruent masculine role norms in ways that exacerbate generalized guilt and shame emotions and promote self-stigma.