Intervening at Critical Moments: Disrupting Suicidal Ideation Amongst Military Veterans

By Steve Lazoritz, MD, Medical Director, GoMo Health 

For many years I have had the honor of performing medical qualification examinations on young men and woman who are joining the military service. I have oftentimes asked the 17 or 18-year olds how their mother felt about them enlisting, and typically the response is “she’s scared.”

“Scared of what?” I would ask. “Scared of me getting killed,” is the usual response. Truly, no mother wants her baby to die in combat. When my own 17-year old son wanted to join the Marines, we had to take my wife kicking and screaming to meet with the recruiter.

Many of the applicants themselves allude to their own fears of being a war casualty.  But in the thousands of youths that I have interviewed over the years, not one had ever mentioned the real danger that lurks in the decision to serve our country; death at their own hands.

Each day, 22 veterans take their own life – that’s 6,000 veterans per year. In contrast, in 2018, 17 military members died in combat.

How can this be? We have known for years that in our society, rates of suicide were increasing, and that the rate for military veterans is 1.5 times that of civilians. Despite years of research, innovative programs and better screening, the numbers continue to climb. After every armed conflict since World War I, the question was raised, “how can we predict who is likely to be a mental health casualty of war?” And the answer has always been — we can’t.

The major determinant of those who might take their own life is what they experienced after combat. With the exception of prior suicide attempts, there are really no valid predictors.

Perhaps one of the reasons that we have not made headway in reducing suicides among veterans is our lack of real understanding of the true nature of the suffering that these heroes go through. The author William Styron, himself a victim of severe depression, wrote, “the pain of severe depression is quite unimaginable to those who have not suffered it. The prevention of suicide will continue to be hindered until there is a general awareness of the nature of this pain.”

Over the years, we have learned a few useful things about suicidality. Victims have in common feelings of isolation, separation and lack of social support. Styron offered this advice for those of us who would like to help our friends, colleagues and family members who are under siege from depression. “Those who are suffering,” he advised, need to “be told — convinced, rather — that the illness will run its course and that they will pull through. A tough job, this; calling “Chin up!”

From the safety of the shore, to a drowning person, this is tantamount to insult; but it has been shown over and over again that if the encouragement is dogged enough and the support equally committed and passionate, the endangered one can nearly always be saved.

One method of “dogged encouragement” that has been studied is the use of text messaging.

A recent study randomized 658 soldiers and Marines augmenting standard care with text-based messaging (“Caring Contact”). While the group receiving text messaging did not show reduced suicide risk or ideation at 12-month follow up visit, it did reduce the odds of having a suicidal ideation or making a suicide attempt.  In this study*, text messages were sent at day-1, week-1, and months 2, 3, 4, 6, 8, 10 and 12, and on the participant’s birthday. The authors concluded that this program offered promise, but additional research is needed.

Reading this study raised several questions;

• Was the messaging personalized to meet the patient’s individual need(s)?
• Was the messaging sent at the right time, or was it random?
• Does the messaging meet Styron’s criteria of “dogged encouragement”?
• Was the patient activated and supported?

High rates of undiagnosed depression leading to astonishing suicide rates among military veterans is a national disgrace. We owe it to our country’s heroes to make concerted efforts to understand the depths of their pain, and make innovative, effective interventions to support them. BehavioralRx®, the science of human persuasion, activation and motivation, addresses supporting people in their moments of need and decision making, at their preferred time, with the “voice” that will best support them and be most well received.  Read more about this fascinating science or schedule a demo to see it in action.

* Effect of Augmenting Standard Care for Military Personnel with Brief Caring Text Messages for Suicide Prevention