Life course well-being framework for suicide prevention in Canadian Armed Forces Veterans

Abstract

Introduction: The risks of suicidality (suicidal ideation or behaviour) are higher in Canadian Armed Forces (CAF) Veterans (former members) than in the Canadian general population (CGP). Suicide prevention is everyone’s responsibility, but it can be difficult for many to see how they can help. This article proposes an evidence-based theoretical framework for discussing suicide prevention. The framework informed the 2017 joint CAF – Veterans Affairs Canada (VAC) suicide prevention strategy. Methods: Evidence for the framework was derived from participation in expert panels conducted by the CAF in 2009 and 2016, a review of findings from epidemiological studies of suicidality in CAF Veterans released since 1976, suicide prevention literature reviews conducted at VAC since 2009, and published theories of suicide. Results: Common to all suicide theories is the understanding that suicide causation is multifactorial, complex, and varies individually such that factors interact rather than lie along linear causal chains. Discussion: The proposed framework has three core concepts: a composite well-being framework, the life course view, and opportunities for prevention along the suicide pathway from ideation to behaviour. Evidence indicates that Veterans are influenced onto, along, and off the pathway by variable combinations of mental illness, stressful well-being problems and life events, individual factors including suicidal diathesis vulnerability, barriers to well-being supports, acquired lethal capability, imitation, impulsivity, and access to lethal means. The proposed framework can inform discussions about both whole-community participation in prevention, intervention and postvention activities at the individual and population levels, and the development of hypotheses for the increased risk of suicidality in CAF Veterans.

Cluster analysis of Canadian Armed Forces veterans living with chronic pain: Life After Service Studies 2016

“…In this framework, well-being fluctuates across the life course in response to interconnected determinants from all domains. 26 , 36 , 37 …”

Characteristics of suicidal male and female soldiers in various military forces

“…Due to concerns expressed since the early 1990's about increase in suicide rates and their possible relationship to deployment, several initiatives attempting to reduce suicidality, were launched over the years. Those included the establishment of the National Mental Health Commission of Canada, development of a federal framework for suicide prevention, large investments in military and veteran mental health services, and targeted efforts to formulate comprehensive suicide prevention strategies among military and veteran populations [32][33][34]. Contrary however, to a report on increased suicidality among CAF members, current data suggest otherwise.…”

Glossary of terms: A shared understanding of the common terms used to describe psychological trauma

“…• The physical, mental, social, and some say spiritual, functioning of a person, which can range from poor to good (Huber, 2010;Huber, Knottnerus, Green, van der Horst, Jadad, Kromhout … & Smid, 2011;Thompson, MacLean, Roach, Banman, Mabior & Pedlar 2016;Thompson, Heber, VanTil, Simkus, Carrese, Sareen & Pedlar, 2019). • Health can be described subjectively such as a person's own description of their health, psychological well-being, or health-related quality of life.…”

“…The cultural/ social environment includes a diverse range of factors like values, norms, and healthcare and other social security systems. Elements of each domain in this framework can vary from poor to good based on subjective and objective measurements (Thompson, MacLean, Roach, Banman, Mabior & Pedlar 2016;Thompson, Heber, VanTil, Simkus, Carrese, Sareen & Pedlar, 2019). • In the VAC-CAF type of well-being framework, health is one domain of well-being that can interact with the other domains to impact wellbeing; for example, having a good job supports good mental health, but it is equally true that having good mental health supports finding and keeping a good job.…”