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Violence in The Military ISBN 3031268822, 9783031268823 Full Text

The document discusses the impact of military training and experiences on service members' mental health and behavior, particularly focusing on non-combat-related violence such as suicidality, sexual violence, and domestic violence. It highlights the long-term consequences of military life on violence propensity, emphasizing the need for addressing these issues for the well-being of service members and their families. The comprehensive review includes various factors contributing to violence, including personality traits, mental health, and interpersonal dynamics.
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0% found this document useful (0 votes)
5 views17 pages

Violence in The Military ISBN 3031268822, 9783031268823 Full Text

The document discusses the impact of military training and experiences on service members' mental health and behavior, particularly focusing on non-combat-related violence such as suicidality, sexual violence, and domestic violence. It highlights the long-term consequences of military life on violence propensity, emphasizing the need for addressing these issues for the well-being of service members and their families. The comprehensive review includes various factors contributing to violence, including personality traits, mental health, and interpersonal dynamics.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
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Violence in the Military

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Monty T. Baker Alyssa R. Ojeda
College of Psychology College of Psychology
Nova Southeastern University Nova Southeastern University
Fort Lauderdale, FL, USA Fort Lauderdale, FL, USA

Hannah Pressley Jessica Blalock


College of Psychology College of Psychology
Nova Southeastern University Nova Southeastern University
Fort Lauderdale, FL, USA Fort Lauderdale, FL, USA

Riki Ann Martinez Brian A. Moore


College of Psychology Kennesaw State University
Nova Southeastern University Kennesaw, GA, USA
Fort Lauderdale, FL, USA

Vincent B. Van Hasselt


Department of Clinical and School Psychology
Nova Southeastern University
Fort Lauderdale, FL, USA

ISSN 2192-8363     ISSN 2192-8371 (electronic)


SpringerBriefs in Psychology
ISSN 2194-1866     ISSN 2194-1874 (electronic)
SpringerBriefs in Behavioral Criminology
ISBN 978-3-031-26882-3 ISBN 978-3-031-26883-0 (eBook)
https://doi.org/10.1007/978-3-031-26883-0

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Preface

The global war on terrorism resulted in a continual involvement of the US military


and allied nations from 2001 to 2021. While the training and experiences of service
members are essential to national security, 20 years of conflict and ongoing military
operations greatly impacted service members, families, and veterans. This impact is
not unique to the US military but also extends to many of our close allies including
Canada, the United Kingdom, Australia, and New Zealand. Standardized training,
such as initial entry training, and specialized training, such as advanced schools for
combat operations, develop the service member to withstand intense physical con-
ditions and instill in them the courage to fight despite an oncoming danger. This
training necessitates the need for a structure that contains and employs organized
violence in an effective, efficient way. For this brief, violence is defined as behavior
directed toward the self or others with the intent to injure or kill. The proponents of
organized violence, such as military function, individual warfighters, and organiza-
tional structure, have changed as national threats evolve. The US military and sup-
porting organizations are expected to deploy rapidly with extensive capabilities to
address issues ranging from armed conflict to national emergencies. The require-
ment and expectation of constant readiness for or exposure to organized violence
may contribute to the expression of violence outside of the military through the
exacerbation of aggressive traits. This in turn is likely to impact mental health.
Nevertheless, each service member acts within the realm of factors contributing to
their environment, genetics, health, and experience. This comprehensive review
addresses the impact of the aforementioned training and experiences on service
members’ mental health, behavior, and propensity toward non-combat-related vio-
lence. Non-­combat-­related violence manifests in a variety of ways, including sui-
cidality and self-harm, sexual violence, intimate partner and domestic violence, and
other violent criminal behaviors. Factors contributing to the perpetration of violence
include personality traits (i.e., aggression), the military life cycle, interpersonal
dynamics, and mental health. Each of the violence subtypes and contributing factors
will be explored in this review. Violence in military populations can result in emo-
tional, interpersonal, legal, and financial consequences for service members and
their families. Additionally, the effects of military life on the propensity for violence

v
vi Preface

do not dissipate when an individual leaves military service. Thus, identifying and
addressing violent behavior and the factors enabling or exacerbating it is crucial for
the long-term health and safety of service members, their families, and the commu-
nities in which they live.

Fort Lauderdale, FL, USA Monty T. Baker


Fort Lauderdale, FL, USA Alyssa R. Ojeda
Fort Lauderdale, FL, USA Hannah Pressley
Fort Lauderdale, FL, USA Jessica Blalock
Fort Lauderdale, FL, USA Riki Ann Martinez
Kennesaw, GA, USA Brian A. Moore
Fort Lauderdale, FL, USA Vincent B. Van Hasselt
Acknowledgments

We want to extend a sincere thank you to our colleagues at Nova Southeastern


University, Kennesaw State University, and University of Texas Health Sciences
Center at San Antonio that enabled us to make this brief possible. The synergy of
world-­class military research teammates, military violence subject matter experts,
and cutting-edge evidence-based training and treatment culminated in this in-depth
review. A special thank you to all contributors for their willingness to dedicate
months to synthesize the research in each of their respective chapters. To our service
members, their families, veterans, and allies, we greatly appreciate all the sacrifices
that are made every day to keep our world a safer place. Finally, thank you to all our
family and friends that provided support and patience during this process. For all of
us, violence in the military is a very important and personal topic and everyone
contributed in their own way in order to complete this brief.

vii
Contents

1 
Introduction to Violence in the Military��������������������������������������������������   1
References����������������������������������������������������������������������������������������������������   2
2 
Suicide and Self-Harm in the Military����������������������������������������������������   3
2.1 Recent Suicide Statistics ��������������������������������������������������������������������   4
2.1.1 Methods for Suicide����������������������������������������������������������������   5
2.1.2 Known Concerns��������������������������������������������������������������������   6
2.2 The Interpersonal Theory of Suicide��������������������������������������������������   6
2.2.1 IPTS Risk and Protective Factors ������������������������������������������   7
2.2.2 Military IPTS Research����������������������������������������������������������   7
2.3 Shame, Guilt, and Moral Injury����������������������������������������������������������   9
2.4 Other Mental Health Factors: Depression, Substance Use,
Posttraumatic Stress Disorder, and Traumatic Brain Injury �������������� 11
2.5 Suicide Prevention Efforts������������������������������������������������������������������ 12
2.6 Summary �������������������������������������������������������������������������������������������� 13
References���������������������������������������������������������������������������������������������������� 14
3 
Military Sexual Violence: Sexual Assault, Sexual Harassment,
and Sexual Hazing������������������������������������������������������������������������������������� 19
3.1 Case Study������������������������������������������������������������������������������������������ 19
3.2 Military Sexual Trauma: Types of MST �������������������������������������������� 20
3.2.1 Sexual Assault������������������������������������������������������������������������ 20
3.2.2 Sexual Harassment������������������������������������������������������������������ 21
3.2.3 Sexual Hazing ������������������������������������������������������������������������ 21
3.3 Prevalence of Military Sexual Trauma������������������������������������������������ 22
3.4 Reporting Procedures�������������������������������������������������������������������������� 23
3.4.1 Unrestricted Reporting������������������������������������������������������������ 23
3.4.2 Restricted Reporting �������������������������������������������������������������� 24
3.4.3 Why Do Service Members Choose Not to Report?���������������� 24
3.5 Health Consequences of Military Sexual Trauma������������������������������ 25
3.5.1 Physical Health ���������������������������������������������������������������������� 25
3.5.2 Sexual Satisfaction������������������������������������������������������������������ 26

ix
x Contents

3.5.3 Mental Health������������������������������������������������������������������������� 26


3.6 Outcomes of Military Sexual Trauma������������������������������������������������ 26
3.6.1 Survivor Outcomes ���������������������������������������������������������������� 27
3.6.2 Abuser Outcomes�������������������������������������������������������������������� 29
3.7 Summary �������������������������������������������������������������������������������������������� 29
References���������������������������������������������������������������������������������������������������� 29
4 
Intimate Partner and Domestic Violence Among Military
Populations ������������������������������������������������������������������������������������������������ 33
4.1 Intimate Partner Violence and Domestic Violence������������������������������ 33
4.2 Types of Maltreatment������������������������������������������������������������������������ 34
4.3 Intimate Partner Violence Recidivism and Escalation������������������������ 34
4.4 Prevalence Among Military Populations�������������������������������������������� 35
4.4.1 Reported Incidents������������������������������������������������������������������ 36
4.5 Context of Violence���������������������������������������������������������������������������� 39
4.6 Factors Associated with Military Service ������������������������������������������ 40
4.7 Summary �������������������������������������������������������������������������������������������� 42
References���������������������������������������������������������������������������������������������������� 44
5 
Violent Criminal Behavior in the Military���������������������������������������������� 49
5.1 Risk Factors for Violent Crime ���������������������������������������������������������� 52
5.2 Factors Contributing to Violence�������������������������������������������������������� 53
5.2.1 Aggression������������������������������������������������������������������������������ 53
5.2.2 Service-Related Factors���������������������������������������������������������� 54
5.2.3 Mental Health������������������������������������������������������������������������� 58
5.3 Summary �������������������������������������������������������������������������������������������� 67
References���������������������������������������������������������������������������������������������������� 68
6 
Clinical Implications, Limitations, Future Directions,
and Conclusions ���������������������������������������������������������������������������������������� 75
6.1 Clinical Implications�������������������������������������������������������������������������� 75
6.1.1 Suicide and Self-Harm in the Military������������������������������������ 75
6.1.2 Military Sexual Violence: Culture������������������������������������������ 76
6.1.3 Intimate Partner and Domestic Violence Among Military
Populations������������������������������������������������������������������������������ 78
6.1.4 Violent Criminal Behavior������������������������������������������������������ 78
6.2 Limitations������������������������������������������������������������������������������������������ 79
6.2.1 Suicide and Self-Harm in the Military������������������������������������ 79
6.2.2 Military Sexual Violence�������������������������������������������������������� 80
6.2.3 Intimate Partner and Domestic Violence Among Military
Populations������������������������������������������������������������������������������ 80
6.2.4 Violent Criminal Behavior in the Military������������������������������ 81
6.3 Future Directions�������������������������������������������������������������������������������� 81
6.3.1 Suicide and Self-Harm in the Military������������������������������������ 81
6.3.2 Military Sexual Violence�������������������������������������������������������� 82
Contents xi

6.3.3 Intimate Partner and Domestic Violence Among Military


Populations������������������������������������������������������������������������������ 83
6.3.4 Violent Criminal Behavior in the Military������������������������������ 83
6.4 Conclusions���������������������������������������������������������������������������������������� 84
References���������������������������������������������������������������������������������������������������� 86

Index�������������������������������������������������������������������������������������������������������������������� 89
About the Authors

Monty T. Baker, Ph.D. (Lieutenant Colonel, USAF, Ret.), received his Ph.D. in
2002 in Clinical Psychology at Nova Southeastern University. He completed his
Clinical Psychology Residency at the Malcolm Grow Medical Center Andrews
AFB, Maryland. Dr. Baker served over 30 years in the Military as an Operational
and Clinical Psychologist with numerous combat deployments in support of OIF/
OEF. He has also served as Military Primary Investigator on several grant-funded
research studies and has over 160 academic presentations and publications. Dr.
Baker is currently a POTFF Psychologist for U.S. Army Special Forces Underwater
Operations Unit (SFUWO), Senior Advisor to the Military Psychology Group
(MPG) at Nova Southeastern University, and Adjunct Professor at University of
Texas-Health Science Center at San Antonio.

Alyssa R. Ojeda, M.S., is a fourth-year clinical psychology doctoral student at


Nova Southeastern University and recipient of the two-year U.S. Army Health
Professions Scholarship Program. She is the program coordinator of the Military
Psychology Group within the First Responder Research and Training Team, led by
Dr. Vincent Van Hasselt. Her research and clinical interests include resilience, post-
traumatic growth, and the integration of physical activity for mental health preven-
tion and intervention.

Hannah Pressley, MA, MS, is a fourth-year clinical psychology doctorate student


at Nova Southeastern University. Prior to attending Nova, she earned a Master’s
degree in forensic and legal psychology at Marymount University. At present, she is
active in the First Responder Research and Training Team throughout completing
various projects, led by Dr. Vincent Van Hasselt. Hannah’s primary research and
clinical interests include health functioning of K9 handlers, neuropsychological
evaluation and testing, and the clinical impact of military sexual trauma.

xiii
xiv About the Authors

Jessica Blalock, M.S., is a fourth-year doctoral student in clinical psychology


with a focus on first responders and forensic populations. She is an active member
of the First Responder Research and Training Team and pioneered the largest survey
of a national sample of first responders assessing occupational stress and mental
well-being.

Riki Ann Martinez, MA, is a fourth-year clinical psychology doctoral student at


Nova Southeastern University. She is currently the program coordinator of the
Psychological Services for the Emotionally Distressed (PSED) clinic and works as
a teacher’s assistant for the Forensic Psychology Master’s Program. Her clinical
experiences consist of providing individual psychotherapy for individuals with seri-
ous mental illness and forensic populations. She also has significant experience
conducting forensic evaluations for the court and working as a psychology trainee
in a correctional facility. Her research interests include forensic assessment and
criminal behavior and incarceration of military members.

Brian A. Moore, Ph.D., is an Assistant Professor of Psychology and the Director


of the Center for the Advancement of Military and Emergency Services (AMES)
Research at Kennesaw State University. Dr. Moore served 13 years in the Army and
has extensively published on topics related to military and military-relevant
populations.

Vincent B. Van Hasselt, PhD, is a Professor of psychology and Director of the


Family Violence Program at Nova Southeastern University. He is also editor of
Aggression and Violent Behavior: A Review Journal and Journal of Family Violence.
Dr. Van Hasselt has served as Lecturer and Consultant to the FBI’s Behavioral
Science, Crisis Negotiation, and Law Enforcement Communication Units, and is
part of the bureau’s Crisis Prevention and Intervention Program. His clinical and
research interests are in the areas of crisis and hostage negotiations, police stress
and mental health, critical incident response, and the emerging field of behavioral
criminology. Dr. Van Hasselt is also a certified police officer with the Plantation,
Florida, Police Department.
Chapter 1
Introduction to Violence in the Military

The global war on terrorism resulted in a continual involvement of the United States
military and allied nations from 2001 to 2021. Typically, only 10% of the active-­
duty force is deployed into combat (Bledsoe, 2022). However, service members
require high-operational tempos to maintain training levels and occupational skill-
sets. While the training and experiences of service members are essential to national
security, 20 years of conflict and ongoing military operations greatly impacted both
the service member and their families. This impact is not unique to the US military
but also extends to many of our close allies including Canada, the United Kingdom,
Australia, and New Zealand.
The purpose of the military is to provide organized violence as a solution to
national threats (Thornhill, 2016). By entering such an organization, service mem-
bers must prepare to be both the perpetrator and receiver of such violence. For this
brief, violence is defined as behavior directed toward the self or others with the
intent to injure or kill. Standardized training, such as initial entry training, and
specialized training, such as advanced schools for combat operations, develop the
service member to withstand intense physical conditions and instill in them the
courage to fight despite an oncoming danger. This training necessitates the need for
a structure that contains and employs organized violence in an effective, efficient
way. The proponents of organized violence, such as military function, individual
warfighters, and organizational structure, have changed as national threats evolve
(Thornhill, 2016).
The US military and supporting organizations are expected to deploy rapidly
with extensive capabilities to address issues ranging from armed conflict to national
emergencies. Indeed, US forces are expected to withstand any threat to national
security at any time, and thus, service members maintain constant training and vigi-
lance. While the operational tempo of the US military has significantly decreased
over the past few years, US forces maintain operational readiness through troop
retention, training exercises, and training deployments to allied countries. This is
also relevant for many service members in our allied counties.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 1


M. T. Baker et al., Violence in the Military, SpringerBriefs in Psychology,
https://doi.org/10.1007/978-3-031-26883-0_1
2 1 Introduction to Violence in the Military

The requirement and expectation of constant readiness for or exposure to orga-


nized violence may contribute to the expression of violence outside of the military
through the exacerbation of aggressive traits. This in turn is likely to impact mental
health. Nevertheless, each service member acts within the realm of factors contrib-
uting to their environment, genetics, health, and experience. This comprehensive
review addresses the impact of the aforementioned training and experiences on ser-
vice members’ mental health, behavior, and propensity toward non-combat-related
violence. Highlighting such issues provides military leaders insight into a broad
range of behavioral, familial, and legal problems service members are facing and
allows for change to be enacted to reduce the negative impact of warfighting on
service members, their families, and citizens in the community. When possible, rel-
evance to our allied countries will be discussed throughout the brief.
Non-combat-related violence manifests in a variety of ways, including suicidal-
ity and self-harm, sexual violence, intimate partner and domestic violence, and
other violent criminal offenses. Factors contributing to the perpetration of violence
include personality traits (i.e., aggression), the military life cycle, interpersonal
dynamics, and mental health. Each of the violence subtypes and contributing factors
will be explored in this review. Violence in military populations can result in emo-
tional, interpersonal, legal, and financial consequences for service members and
their families. Additionally, the effects of military life on the propensity for violence
do not dissipate when an individual leaves military service. Of the 1869 veterans
convicted of a federal crime in the 2019 fiscal year, 17.6% were convicted of violent
crimes (United States Sentencing Commission, 2021). Thus, identifying and
addressing violent behavior and the factors enabling or exacerbating it is crucial for
the long-term health and safety of service members, their families, and the commu-
nities in which they live.

References

Bledsoe, E. (2022). Answering: What percentage of military sees combat?. The Soldiers Projects.
https://www.thesoldiersproject.org/what-­percentage-­of-­the-­military-­sees-­combat/
Thornhill, P. G. (2016). The crisis within: America’s military and the struggle between the over-
seas and guardian paradigms. RAND Corporation-Project Air Force.
United States Sentencing Commission. (2021). Federal offenders who served in the armed forces.
https://www.ussc.gov/sites/default/files/pdf/research-­and-­publications/research-­publications/
2021/20211028_armed-­forces.pdf
Chapter 2
Suicide and Self-Harm in the Military

Suicide is the most prevalent form of non-combat-related violence among US ser-


vice members. Suicide is defined as, “death caused by self-directed injurious behav-
ior with any intent to die as a result of the behavior” (Crosby et al., 2011). Suicide
is the tenth leading cause of death in the United States across demographics and the
second leading cause of death for individuals between the ages of 10 and 34
(National Institute of Mental Health, 2022).
The entry process to the US military requires that an individual is in good physi-
cal and psychological health, which might indicate that service members have a
higher resiliency level than the general US population. Yet, US service members
have been afflicted with consistently elevated rates of suicide deaths and suicidal
behavior over the past two decades (Kang et al., 2015). By 2009, suicide rates within
the military exceeded rates among the general US population, particularly for
Whites and females (Reger et al., 2018b). Conversely, suicide trends in allied coun-
tries such as Canada and the United Kingdom do not reflect such trends. Suicide
rates among the regular Canadian Armed Forces have not significantly increased
over the past two decades and reflect patterns seen in their general populations
(Boulos, 2021). Since the 1990s, the regular armed forces of the United Kingdom
saw a decrease in suicides per year, and rates remained consistently lower than that
of the general population. Notably, suicide rates within the UK military and the
general male population have increased over the past 5 years (Ministry of
Defence, 2020).
Considering this, we note that suicide in the US military has substantial impacts
on the social, familial, and financial wellness of military members, community, and
organizational readiness. Additionally, high suicide rates have significant implica-
tions for the mission readiness of the military. Rising suicide rates have prompted
the Department of Defense and Congressional leaders to initiate an investigation
into causes of suicidal behavior and factors that prevent it. Additionally, the service
components have been provided resources to develop programs intended to bolster
health and resilience in US service members (Department of Defense [DoD], 2022).

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 3


M. T. Baker et al., Violence in the Military, SpringerBriefs in Psychology,
https://doi.org/10.1007/978-3-031-26883-0_2
4 2 Suicide and Self-Harm in the Military

Despite these efforts, suicide remains a significant problem within the US military.
Following the report of the most recent DoD suicide statistics (DoD, 2021), this
chapter aims to provide insight into research investigating relevant theories and
other contributing factors of suicidal behavior within the US military, such as
Thomas Joiner’s interpersonal theory of suicide (Joiner, 2005), the role of self-­
conscious emotions in suicide, and mental illness. Clinical implications and future
directions for research are then proposed for the enhancement of suicide prevention
and mental health treatment in the military.

2.1 Recent Suicide Statistics

In 2019, 344 active-duty service members, 65 reserve service members, and 89


national guard members died by suicide, with suicide mortality rates of 25.9, 18.2,
and 20.3 per 100,000 service members, respectively (DoD, 2021). Across compo-
nents, demographic features with higher suicide mortality rates include men, White/
Caucasian and Asian/Pacific Islander race, non-Hispanic ethnicity, ages 20–24,
enlisted, and divorced and never-married individuals. Ground combat occupations
(e.g., infantry, gun crews, seamanship specialists) and electrical/mechanical equip-
ment repairers both had the highest suicide mortality rate, each with 18.2 per
100,000. Interestingly, 56.1% of service members who died by suicide in 2019 had
never deployed (DoD, 2021). Unfortunately, suicide mortality rates across all active
duty and reserve branches have increased per year since 2011 (DoD, 2011). The
national guard suicide mortality rate typically increases similarly to the active and
reserve components; however, the national guard suicide mortality rate appeared to
be drastically lower in 2019 than in previous years. In US veterans, the sex- and
age-adjusted mortality rate was 26.9 per 100,000 in 2019 and was highest among
males aged 18–34 (United States Department of Veterans Affairs, 2021). It is impor-
tant to note that the increase in suicide mortality rates in US military members is
comparable to that in the general US population, while suicide mortality rates in US
veterans exceed those of the general US population.
A suicide attempt is defined as “A non-fatal self-directed potentially injurious
behavior with any intent to die as a result of the behavior” (Crosby et al., 2011). In
2019, 1462 suicide attempts were reported among 1388 individuals, some of whom
attempted suicide more than once (DoD, 2021). Demographic features of service
members who attempted suicide were similar to those who died by suicide; how-
ever, almost all minority demographic groups had an increased proportion of sui-
cide attempts. For example, 8.5% of service members who died by suicide in 2019
were female, while 31% of service members who attempted suicide were female. In
2019, enlisted personnel composed 97% of suicide attempts among active-duty ser-
vice members. The most common occupational groups of service members who
attempted suicide were electrical/mechanical equipment repairers (21.1%) among
enlisted personnel and tactical operations officers (0.8%) and healthcare officers
(0.7%) among commissioned officers. Seventy-two percent of service members
who attempted suicide in 2019 had never deployed (DoD, 2021).
2.1 Recent Suicide Statistics 5

Demographic variables of suicide risk have been well established in both civilian
and military populations (Schafer et al., 2021; Steele et al., 2018). A comprehensive
meta-analysis of suicide risk factors in military members found that gender and race
were not associated with suicide behavior in active-duty service members; however,
service members were found to be at lower risk for suicidal behavior as they age.
This is contrary to suicide risk trends in civilian populations, in which older
Caucasian males are at the highest risk of suicide behavior (Conwell et al., 2002).
While a small percentage of the total active-duty military force identifies as
American Indian or Alaskan Native, suicide behavior is disproportionately higher in
service members belonging to these two racial groups (O’Keefe & Reger, 2017).
Several studies have produced mixed results regarding the impact of deployment
on suicide risk; however, most studies indicate a lack of or small association between
deployment and suicide (Bryan et al., 2015). A report from Canadian forces exam-
ined members and identified a lack of association between deployment and suicide
(Boulos, 2021). Additionally, methodological issues with deployment and suicide
research and suggest that killing and witnessing death in combat specifically may be
stronger predictive risk factors than “deployment” generally (Reger et al., 2018a, b).
Finally, an epidemiological study found that combat deployment was not associated
with suicide risk among veterans (Kang et al., 2015). Limited research has been
conducted on deployed service members; however, what is known is that in severe
cases (i.e., service members who received psychiatric aeromedical evacuation) ser-
vice members who demonstrate suicidal behavior were more likely to be female,
persons of color, in the Air Force, and serving in combat support or combat service
support roles (Straud et al., 2020). Notably, a study using a large sample of psychi-
atric hospitalizations indicated that service members were five times more likely to
die by suicide than service members with no psychiatric hospitalization, with the
risk highest within 30 days after hospital discharge (Luxton et al., 2013). Among
veterans, Bullman et al. (2018) found that veterans had a 56% increased risk of
suicide after separation from the military compared to the general US population.
The risk of suicide decreased as veterans’ time since military separation increased,
with suicide risk highest within 1 year of separation from the military. This may
indicate identity dissonance concerns (Moore et al., 2022) and a point for future
interventions and social support-building activities. Regardless, increased under-
standing of the demographic characteristics and predictors of suicide behavior in
US service members and veterans is important, but only one piece of a complex,
nuanced picture.

2.1.1 Methods for Suicide

Personally owned firearms are the most common method of completed suicide
among active-duty military service members, comprising 59.9% of suicides (DoD,
2021). Similarly, firearms comprised 69.2% of suicide deaths among veterans
(U.S. Department of Veteran Affairs, 2021). Among suicide attempts, drug/alcohol
overdose is the most common method, comprising 53.1% of suicide attempts. Other
6 2 Suicide and Self-Harm in the Military

known methods include a military-issued firearm, hanging/asphyxiation, poison,


and trauma. Suicide methods in the UK military differed slightly in that 56% of
completed suicides resulted from hanging, strangulation, or suffocation, while only
17% of suicides utilized firearms or explosives (Ministry of Defence, 2020). These
differences likely reflect a cultural ubiquity, rather than intent to complete the
suicide.

2.1.2 Known Concerns

Ten percent of US service members who died by suicide had a history of self-harm,
and 43.6% had a mental health diagnosis, most commonly mood disorder, anxiety
disorder, or substance use disorder. Similarly, Canadian Armed Forces reported
mental health diagnoses of depressive, anxiety, posttraumatic stress, and other
trauma or stress-related disorders as the most prevalent among those who completed
suicide (Boulos, 2021). Of US service members with past suicide attempts, 30.1%
had a history of self-harm, and 57.3% had a mental health diagnosis, most com-
monly mood, anxiety, or adjustment disorder (DoD, 2021). Lastly, 52.4% of active-­
duty service members who died by suicide and 61.7% of active-duty service
members who attempted suicide in 2019 sought medical treatment within 90 days
before their death or attempt. Specifically, 32% of service members who died by
suicide and 47.2% of suicide attempters sought mental health treatment. Service
members who died by or attempted suicide were likely to have relationship prob-
lems, legal/administrative involvement, or work stressors within 90 days of their
death (DoD, 2021).

2.2 The Interpersonal Theory of Suicide

The interpersonal theory of suicide (IPTS; Joiner, 2005; Van Orden et al., 2010) has
become widely accepted in suicide research and clinical practice. IPTS posits that
three distinct characteristics separate those who die or nearly die by suicide from
those who do not: thwarted belongingness, perceived burdensomeness, and acquired
capability for suicide. Thwarted belongingness transcends temporary feelings of
being left out or feeling alone and refers to the absence of meaningful, mutually
supportive relationships. Perceived burdensomeness suggests the presence of rela-
tionships; however, an individual may feel their self is an unworthy, problematic
liability to others, and that others would be better off without them. The theory
explicitly notes that these views are often unfounded, and it is the perception of
burdensomeness that can escalate an individual to contemplate and ultimately
attempt suicide (Van Orden et al., 2010). Together, thwarted belongingness and per-
ceived burdensomeness result in the desire for suicide, which can vary in intensity.
Hopelessness about these two constructs—the perception that one will always be
2.2 The Interpersonal Theory of Suicide 7

alone and a burden—is hypothesized to mediate the relationship between passive


and active suicidal ideation (Van Orden et al., 2010).
Indeed, the high prevalence of suicidal ideation and low incidence of suicide sug-
gests that the desire for suicide alone does not motivate an individual to complete
suicide. Humans are evolutionarily programmed to fear and avoid threats to surviv-
ability; thus, an individual must acquire the ability to overcome this basic human
process to complete suicide. The IPTS suggests this acquisition of capability for
suicide consists of both reduced fear of death and increased physical pain tolerance,
which are developed by habituation through repeated exposure to fear-inducing and
physically painful experiences (Van Orden et al., 2010). Such experiences can
include abuse, combat exposure, previous suicide attempts and self-harm, and even
reckless activities one might engage in through genetically impulsive behavior. In
summary, an individual must experience lasting feelings of isolation and perceived
expendability while developing the ability to overcome our most basic survival
instinct, to transition from suicidal desire to death by suicide.

2.2.1 IPTS Risk and Protective Factors

Unique factors contribute to the mitigation or exacerbation of risk factors described


by IPTS among military personnel. For example, military values of camaraderie,
honor, and duty can both enhance a sense of belongingness and increase susceptibil-
ity to feeling unworthy or self-contemptuous if an individual becomes afflicted by
physical or psychological injury which interferes with their ability to serve their
units or their families (Lusk et al., 2015; McCormick et al., 2019). Combat training
and exposure to weapons and death may contribute to the capability for suicide;
however, research investigating the impact of combat on suicidality is inconclusive.
A meta-analysis investigating the association between deployment, combat experi-
ences, and suicidal behavior found a small, positive effect between deployment and
suicidality, with specific exposure to killing and war atrocities having the greatest
effect on suicidal behavior in military personnel (Bryan et al., 2015). Notably, mili-
tary personnel are more likely than civilians to have a history of childhood abuse
(Blosnich et al., 2014) and sexual abuse (Schultz et al., 2006). The aforementioned
exposure to painful experiences contributes to a generally higher capability of sui-
cide and therefore greater risk of suicide attempt or completion among military
personnel compared to civilians (Assavedo et al., 2018; Bryan et al., 2010).

2.2.2 Military IPTS Research

Research investigating IPTS constructs within the military has been variable; how-
ever, perceived belongingness and acquired capability for suicide are consistently
shown to be significant factors influencing suicidal behavior in military personnel.

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