Integrating Two Theoretical Models to Understand and Prevent Military and Veteran Suicide

• Author: Andrea L. Wolfe-Clark,Craig J. Bryan
• DOI: 10.1177/0095327X16646645
• Published date: 01 July 2017
• Date: 01 July 2017
• Subject Matter: Articles

Article

Integrating Two

Theoretical Models

to Understand and

Prevent Military and

Veteran Suicide

Andrea L. Wolfe-Clark

1

and Craig J. Bryan

1

Abstract

Despite increasing prevention efforts, military suicide rates have surpassed those of

the general population. This trend may reflect a deficit in our understanding of

suicide, historically atheoretical and based on decreasing risk factors of suicide. The

interpersonal–psychological theory of suicide (IPTS) provides a theoretical foun-

dation to understand suicide but only assesses three risk factors of suicide and is

primarily aimed at explaining who may die by suicide, but not when. The fluid vul-

nerability theory (FVT) provides a broad theoretical framework to understand and

organize risk and protective factors of suicide in order to understand the process of

suicide risk over time. Overlaying the IPTS’s constructs of thwarted belongingness,

perceived burdensomeness, and the acquired capability for suicide within the FVT

framework provides a robust model to understand not only who is at risk for suicide

but also when suicide risk is likely to emerge.

Keywords

psychology, military culture, suicide, fluid vulnerability theory (FVT), interpersonal–

psychological theory of suicide (IPTS), catastrophe theory

1

National Center for Veterans Studies, University of Utah, Salt Lake City, UT, USA

Corresponding Author:

Andrea L. Wolfe-Clark, 380 S 1530 E, Beh S Ste 631, Salt Lake City, UT 84112, USA.

Email: andrea.wolfeclark@psych.utah.edu

Armed Forces & Society

2017, Vol. 43(3) 478-499

ªThe Author(s) 2016

Reprints and permission:

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DOI: 10.1177/0095327X16646645

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In 2009, the rate of military suicides surpassed that of suicides in the U.S. general

population (Dao & Lehren, 2013). While suicide was the 10th ranked cause of death

in the U.S. general population in 2013 (Xu, Murphy, Kochanek, & Bastian, 2016),

during this same time suicide was the leading cause of death among active duty

military personnel, with more personnel dying by suicide than combat (Armed

Forces Health Surveillance Center, 2014). The belief in the ‘‘healthy soldier effect,’’

that individuals at risk for suicide would not be selected for service, no longer holds

true (Bruce, 2010). Military suicide is a national priority under Executive Order

13625 (Department of Defense, Department o f Veterans Affairs, Department of

Health and Human Services, & Department of Education, 2013), and further study

is needed to reverse these deadly trends.

In light of increasing rates of military suicide, the U.S. Government and the

Department of Defense (DoD) have funded over 900 suicide prevention programs

(Brewin, 2013a, 2013b; Department of Defense, Department of Veterans Affairs,

Department of Health and Human Services, & Department of Education, 2013) that

include research, prevention outreach, and treatment interventions that address spe-

cific aspects of suicidal thoughts and behaviors. Since military rates of suicide rates

are rising faster than those of the general population, military-specific suicide

research that incorporates military values, norms, culture, and experiences in theo-

retical and methodological design is warranted. Military culture may lead to unique

vulnerabilities for suicide, protective factors against suicide, and generate a need for

tailored identification and treatment approaches (Bryan, Jennings, Jobes, & Bradley,

2012). For example, because military members are discouraged from demonstrating

weakness or vulnerability, they are less likely to reach out and ask for help (Bryan

et al., 2012; Castro & Kintzle, 2014). Military members may feel shame as a result of

experiencing psychological distress because they beli eve they should be able to

handle these feelings on their own (Stecker, Fortney, Hamilton, & Ajzen, 2007).

Because the military is concerned for the well-being of its members and ensuring

they are fit for duty, suicide risk can rarely remain confidential when seeking

military mental health treatment. When suicidal thoughts or behaviors of a service

member are disclosed to commanders and supervisors, service members fear stig-

matization when seeking military mental health treatment. Public statements made

by Army leadership have reinforced the stigma surrounding disclosing suicidal

thoughts and behaviors (Castro & Kintzle, 2014; Shelef, Fruchter, Mann, & Yacobi,

2014). These factors likely perpetuate shame and guilt surrounding suicide.

In addition to cultural differences, military-specific risk factors, such as exposure

to combat, but not deployments in general, are associated with an increased risk of

suicidal thoughts and behaviors in military members (Bryan, Griffith, et al., 2014).

Early suicide research focused on identifying ‘‘common denominators’’ across sui-

cides using postmortem or prospective studies (Bartone, 2013), resulting in numer-

ous personal, social, and environmental factors correlated with suicidal thoughts and

behaviors. Despite the unique culture of the military, a growing body of risk factor

research in military populations has demonstrated civilian risk factors of suicide also

Wolfe-Clark and Bryan 479