A Qualitative Study of Potential Suicide Risk Factors in Returning Combat Veterans

By Brenner, Lisa A.; Gutierrez, Peter M. et al. | Journal of Mental Health Counseling, July 2008 | Go to article overview

A Qualitative Study of Potential Suicide Risk Factors in Returning Combat Veterans


Brenner, Lisa A., Gutierrez, Peter M., Cornette, Michelle M., Betthauser, Lisa M., Bahraini, Nazanin, Staves, Pamela J., Journal of Mental Health Counseling


According to the interpersonal-psychological theory of attempted and completed suicide (Joiner, 2005) suicide-related behavior is contingent upon three factors: acquired ability, burdensomeness, and failed belongingness. Qualitative research methodology was employed to explore these concepts among a group of returning Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) combat veterans. A sample of 16 individuals participated in interviews. Themes emerged regarding combat as a context for exposure to pain, subsequent coping strategies, and perceptions of burdensomeness, failed belongingness, and increased pain tolerance. Suicidal behavior was also articulated as a means of coping with risk factors outlined by Joiner. These results highlight the potential utility of this theory for OEF/OIF veterans. Interventions aimed at decreasing emotional dysregulation, and lessening perceptions of burdensomeness and failed belongingness may reduce risk for suicidal behavior.

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While the ability to identify factors that make an individual more or less likely to engage in suicidal behavior has significant clinical utility (Beck, Steer, Kovacs, & Garrison, 1985; Jobes & Mann, 1999), such knowledge does not allow us to predict who will die by suicide. Recent work by Joiner (2005) represents years of theory building, refinement, and empirical validation aimed at increasing understanding about how and why people become suicidal. The foundation of Joiner's (2005) theory, the interpersonal-psychological theory of attempted and completed suicide, is that lethally suicidal individuals perceive that they are an unbearable burden on their family, friends, and/or society (burdensomeness); their efforts at establishing and maintaining social connections have repeatedly been thwarted or have failed (failed belongingness); and through multiple experiences they have acquired the ability to engage in suicidal behavior. When all three elements are present, suicidal behavior with lethal intent is likely and imminent.

Components of the theory have been tested in adults (Joiner, Pettit, Walker, Voelz, Cruz, & Rudd, 2002; Joiner & Rudd, 2000), college students, and adolescents (Joiner, Rudd, Rouleau, & Wagner, 2000). However, research has only begun to explore whether the theory applies to veterans (Cornette, Deboard, Clark, Holloway, Brenner, Gutierrez, et al., 2007; Cornette, deRoon-Cassini, Joiner, & Proescher, 2006). The importance of identifying means of assessing risk in this population is highlighted by a recent study of U.S. male military veterans aged 18 and older (Kaplan, Huguet, McFarland, & Newsom, 2007). Such individuals were twice as likely to die by suicide when compared with nonveteran males. Those who were white, had [greater than or equal to] 12 years of education, or activity limitations were at greater risk (Kaplan, Huguet, McFarland, & Newsom, 2007). Previous research has demonstrated that combat-related experiences also place veterans at risk (Bullman & Kang, 1996). Demographically, those aged 20-29 represent the majority of returning Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veterans who seek care within the Veterans Administration (VA) system (VHA Office of Public Health, 2006); in the U.S. general population, young people aged 15-24 make the largest number of suicide attempts each year (Centers for Disease Control and Prevention [CDC], 2006). Suicide is also on the rise among soldiers, with 2006 having the highest number of confirmed cases since 1990 (Lorge, 2008). To facilitate treatment and prevent future OEF/OIF suicides, increased understanding of risk factors for veteran suicidal behavior is needed.

Acquiring the ability to engage in suicidal behavior may be related to "hav[ing] witnessed, experienced, or engaged in more violence than others, because violence exposure would be one way to habituate--either directly or vicariously--to pain and provocation" (Joiner, 2005, p. …

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