Circumstances preceding suicide in U.S. soldiers: A qualitative analysis of narrative data.

Abstract

To gain a better understanding of military suicide, we examined suicide narratives for 135 Soldiers extracted from two large-scale surveillance systems: the Department of Defense Suicide Event Report (DoDSER) and the Centers for Disease Control and Prevention's (CDC) National Violent Death Reporting System (NVDRS). Using coroner/medical examiner and law enforcement narratives captured in the NVDRS and mental health provider narrative data collected across multiple domains from the DoDSER, we examined circumstances surrounding military suicides using a qualitative content analysis approach. We identified five common proximal circumstances: (1) intimate partner relationship problems (63.0%); (2) mental health/substance abuse (51.9%); (3) military job-related (46.7%); ( 4) financial (17.8%); and (5) criminal/legal activity (16.3%). Evidence of premeditation was present in 37.0% of suicides. Decedents frequently struggled with multiple, high-stress problems and exhibited symptoms of coping and emotion regulation difficulties. Findings demonstrate potential points of intervention for suicide prevention strategies.

Not discussed: Inequalities in narrative text data for suicide deaths in the National Violent Death Reporting System

“…manipulating large amounts of text such as natural language processing (NLP) algorithms [13] but most applying traditional qualitative approaches (i.e., content analysis) to smaller subsets of the registry [14][15][16][17][18].…”

“…The NVDRS narratives are an important resource for researchers and policy makers as they seek to inform and implement evidence-based programs to reduce suicide risk, particularly to identify novel risk factors. For example, researchers have used the narrative texts to identify suicides related to transitioning into long-term care [13], intimate partner violence [15], risk factors among military personnel [17], and how multiple risk factors interact for middle-age men and women [14]. Such efforts are needed to address the stagnation in the field noted by Franklin et al [6].…”

Utilizing the couple relationship to prevent suicide: A preliminary examination of Treatment for Relationships and Safety Together

“…The majority of current suicide-specific interventions are individual treatments and largely ignore one's relational context. However, the majority of suicidal veterans have romantic partners (Skopp et al, 2019) and both positive and negative relationship dynamics influence one's suicidal thoughts and behaviors. Intervening on the couple level has the potential to enhance suicide treatment outcomes and save veteran lives.…”

“…In support of this, recent research has found that poor relationship quality, conflict, and relationship separation were associated with death by suicide (Kazan et al, 2016). Among veterans specifically, a relationship problem is the most frequently endorsed stressor preceding suicide attempts (e.g., Skopp et al, 2019). Furthermore, distressed interpersonal relationships are associated with increased likelihood of making multiple suicide attempts (Choi et al, 2013).…”

Veteran and partner interest in addressing suicidality from a couple-based treatment approach.

“…Consistent relationship issues are associated with prolonged periods of suicidality and an increased number of suicide attempts (Bryan et al, 2015). While the majority of suicidal veterans are married or in committed relationships (e.g., Skopp et al, 2019), they also experience a number of stressors that increase their likelihood of experiencing relationship distress. Deployment and reintegration cycles can cause family disruption and marital strain (Knobloch et al, 2013).…”