Advertisement

Cognitive Therapy and Research

, Volume 42, Issue 6, pp 758–768 | Cite as

Reasons for Living Among U.S. Army Personnel Thinking About Suicide

  • Craig J. Bryan
  • D. Nicolas Oakey
  • Julia A. Harris
Original Article
  • 121 Downloads

Abstract

Reasons for living are associated with reduced suicide risk, but have not received much empirical attention among U.S. military personnel, a population with elevated suicide risk. The present study examined the factor structure, reliability, and validity of the Brief Reasons for Living Inventory (BRFLI) in a clinical sample of 97 treatment-seeking Army personnel with recent suicide ideation and/or a history of suicide attempts. Results supported a five-factor structure for the BRFLI. Each factor had good internal consistency (ω’s > 0.94) and demonstrated convergent and divergent validity. Survival and coping beliefs and responsibility to family subscale scores were negatively correlated with recent suicidal thinking. Responsibility to family subscale scores were associated with significantly reduced risk of suicide attempts during follow-up. BRFLI subscale scores showed little to no clinical responsivity following intervention. Results suggest survival and coping beliefs and responsibility to family may be protective for high-risk military personnel.

Keywords

Military Suicide Reasons for living Protective factors 

Notes

Acknowledgements

This study was supported in part by the Military Suicide Research Consortium (MSRC), an effort supported by the Office of the Assistant Secretary of Defense for Health Affairs under award #W81XWH-10-2-0181. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the U.S. Government, the Department of Defense, the Department of the Army, or the MSRC.

Compliance with Ethical Standards

Conflict of interest

Dr. Bryan reports grant funding from the Department of Defense and Department of Veterans Affairs, and consultation salary from Neurostat Analytical Solutions. Mr. Oakey and Ms. Harris report no potential conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Animal Rights

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. Beck, A. T., Brown, G., Berchick, R. J., Stewart, B. L., & Steer, R. A. (1990). Relationship between hopelessness and ultimate suicide: A replication with psychiatric outpatients. The American Journal of Psychiatry, 147, 190.CrossRefGoogle Scholar
  2. Beck, A. T., & Steer, R. A. (1993). Manual for the beck hopelessness scale. San Antonio, TX: Psychological Corporation.Google Scholar
  3. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the beck depression inventory—II. San Antonio, TX: Psychological Corporation.Google Scholar
  4. Brown, G. K., Ten Have, T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005). Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial. JAMA, 294, 563–570.  https://doi.org/10.1001/jama.294.5.563.CrossRefPubMedGoogle Scholar
  5. Bryan, C. J. (2011). The clinical utility of a brief measure of perceived burdensomeness and thwarted belongingness for the detection of suicidal military personnel. Journal of Clinical Psychology, 67, 981–992.CrossRefGoogle Scholar
  6. Bryan, C. J., & Clemans, T. A. (2013). Repetitive traumatic brain injury, psychological symptoms, and suicide risk in a clinical sample of deployed military personnel. JAMA Psychiatry, 70(7), 686–691.CrossRefGoogle Scholar
  7. Bryan, C. J., Cerel, J., & Bryan, A. O. (2017). Exposure to suicide is associated with increased risk for suicidal thoughts and behaviors among National Guard military personnel. Comprehensive Psychiatry, 77, 12–19.CrossRefGoogle Scholar
  8. Bryan, C. J., Clemans, T. A., Hernandez, A. M., & Rudd, M. D. (2013). Loss of consciousness, depression, posttraumatic stress disorder, and suicide risk among deployed military personnel with mild traumatic brain injury (mTBI). Journal of Head Trauma Rehabilitation, 28, 13–20.  https://doi.org/10.1016/j.comppsych.2017.05.006.CrossRefPubMedGoogle Scholar
  9. Bryan, C. J., Gonzales, J., Rudd, M. D., Bryan, A. O., Clemans, T. A., Ray-Sannerud, B., Wertenberger, E., Leeson, B., Heron, E. A., Morrow, C. E., & Etienne, N. (2015). Depression mediates the relation of insomnia severity with suicide risk in three clinical samples of U.S. Military Personnel. Depression and Anxiety, 32, 647–655.  https://doi.org/10.1002/da.22383.CrossRefPubMedGoogle Scholar
  10. Bryan, C. J., Griffith, J. E., Pace, B. T., Hinkson, K., Bryan, A. O., Clemans, T. A., & Imel, Z. E. (2015). Combat exposure and risk for suicidal thoughts and behaviors among military personnel and veterans: A systematic review and meta-analysis. Suicide and Life-Threatening Behavior, 45, 633–649.  https://doi.org/10.1111/sltb.12163.CrossRefPubMedGoogle Scholar
  11. Bryan, C. J., Jennings, K. W., & Jobes, D. A. (2012). Understanding and preventing military suicide. Archives of Suicide Research, 16, 95–110.CrossRefGoogle Scholar
  12. Bryan, C. J., Kanzler, K. E., Grieser, E., Martinez, A., Allison, S., & McGeary, D. (2017). A shortened version of the Suicide Cognitions Scale for identifying chronic pain patients at risk for suicide. Pain Practice, 17, 371–381.CrossRefGoogle Scholar
  13. Bryan, C. J., Mintz, J., Clemans, T. A., Leeson, B., Burch, T. S., Williams, S. R., Maney, E., & Rudd, M. D. (2017). Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army Soldiers: A randomized control trial. Journal of Affective Disorders, 212, 64–72.  https://doi.org/10.1016/j.jad.2017.01.028.CrossRefPubMedGoogle Scholar
  14. Bryan, C. J., Rudd, M. D., Peterson, A. L., Young-McCaughan, S., & Wertenberger, E. G. (2016). The ebb and flow of the wish to live and the wish to die among suicidal military personnel. Journal of Affective Disorders, 202, 58–66.  https://doi.org/10.1016/j.jad.2016.05.049.CrossRefPubMedGoogle Scholar
  15. Bryan, C. J., Rudd, M. D., Wertenberger, E., Etienne, N., Ray-Sannerud, B. N., Morrow, C. E., Peterson, A. L., & Young-McCaughon, S. (2014). Improving the detection and prediction of suicidal behavior among military personnel by measuring suicidal beliefs: An evaluation of the Suicide Cognitions Scale. Journal of Affective Disorders, 159, 15–22.CrossRefGoogle Scholar
  16. Carroll, T. D., Currier, J. M., McCormick, W. H., & Drescher, K. D. (2017). Adverse childhood experiences and risk for suicidal behavior in male Iraq and Afghanistan veterans seeking PTSD treatment. Psychological Trauma, 9, 583–586.  https://doi.org/10.1037/tra0000250.CrossRefPubMedGoogle Scholar
  17. Cha, C. B., Najmi, S., Park, J. M., Finn, C. T., & Nock, N. K. (2010). Attentional bias toward suicide-related stimuli predicts suicidal behavior. Journal of Abnormal Psychology, 119, 616–622.  https://doi.org/10.1037/a0019710.CrossRefPubMedPubMedCentralGoogle Scholar
  18. de Winter, J. D., Dodou, D. I. M. I. T. R. A., & Wieringa, P. A. (2009). Exploratory factor analysis with small sample sizes. Multivariate Behavioral Research, 44(2), 147–181.CrossRefGoogle Scholar
  19. Dozois, D. J. A., Dobson, K. S., & Ahnberg, J. L. (1998). A psychometric evaluation of the Beck Depression inventory-II. Psychological Assessment, 10, 83–89.  https://doi.org/10.1037/1040-3590.10.2.83.CrossRefGoogle Scholar
  20. Ellis, T. E., & Rufino, K. A. (2015). A psychometric study of the Suicide Cognitions Scale with psychiatric inpatients. Psychological Assessment, 27, 82–89.CrossRefGoogle Scholar
  21. Gutierrez, P. M., Osman, A., Kopper, B. A., & Barrios, F. X. (2000). Why young people do not kill themselves: The reasons for living inventory for adolescents. Journal of Clinical Child Psychology, 29, 177–187.  https://doi.org/10.1207/S15374424jccp2902_4.CrossRefPubMedGoogle Scholar
  22. Ivanoff, A., Jang, S. J., Smyth, N. J., & Linehan, M. M. (1994). Fewer reasons for staying alivev when you are thinking of killing yourself: The brief reasons for living inventory. Journal of Psychopathology and Behavioral Assessment, 16, 1–13.CrossRefGoogle Scholar
  23. Jobes, D. A. (2016). Managing suicidal risk: A collaborative approach. New York: Guilford Publications.Google Scholar
  24. Joiner, T. E., Pfaff, J. J., & Acres, J. G. (2002). A brief screening tool for suicidal symptoms in adolescents and young adults in general health settings: Reliability and validity data from the Australian National General Practice Youth Suicide Prevention Project. Behaviour Research and Therapy, 40, 471–481.CrossRefGoogle Scholar
  25. Joiner, T. E., Van Orden, K. A., Witte, T. K., & Rudd, M. D. (2009). The interpersonal theory of suicide: Guidance for working with suicidal clients. Worcester: American Psychological Association.CrossRefGoogle Scholar
  26. Keen, S. M., Kutter, C. J., Niles, B. L., & Krinsley, K. E. (2008). Psychometric properties of PTSD Checklist in a sample of male veterans. Journal of Rehabilitation Research and Development, 45, 465–474.CrossRefGoogle Scholar
  27. Koenig, H. G., & Büssing, A. (2010). The Duke University Religion Index (DUREL): A five-item measure for use in epidemiological studies. Religions, 1, 78–85.CrossRefGoogle Scholar
  28. Kovacs, M., & Beck, A. T. (1977). The wish to die and the wish to live in attempted suicides. Journal of Clinical Psychology, 33, 361–365.CrossRefGoogle Scholar
  29. Lance, C. E., Butts, M. M., & Michels, L. C. (2006). The sources of four commonly reported cutoff criteria: What did they really say? Organizational Research Methods, 9, 202–220.CrossRefGoogle Scholar
  30. Linehan, M. M., Comtois, K. A., Brown, M. Z., Heard, H. L., & Wagner, A. (2006). Suicide attempt self-injury interview (SASII): Development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury. Psychological Assessment, 18, 303–312.  https://doi.org/10.1037/1040-3590.18.3.303.CrossRefPubMedGoogle Scholar
  31. Linehan, M. M., Goodstein, J. L., Nielsen, S. L., & Chiles, J. A. (1983). Reasons for staying alive when you are thinking of killing yourself: The reasons for living inventory. Journal of Consulting and Clinical Psychology, 51, 276–286.CrossRefGoogle Scholar
  32. MacCallum, R. C., Widaman, K. F., Preacher, K. J., & Hong, S. (2001). Sample size in factor analysis: The role of model error. Multivariate Behavioral Research, 36(4), 611–637.CrossRefGoogle Scholar
  33. MacCallum, R. C., Widaman, K. F., Zhang, S., & Hong, S. (1999). Sample size in factor analysis. Psychological Methods, 4(1), 84.CrossRefGoogle Scholar
  34. McDonald, R. P. (1999). Test theory: A unified treatment. Mahwah, NJ: Erlbaum.Google Scholar
  35. Metalsky, G. I., & Joiner, T. E. (1997). The hopelessness depression symptom questionnaire. Cognitive Therapy and Research, 21, 359–384.CrossRefGoogle Scholar
  36. Muthen, L. K., & Muthen, B. O. (1998–2010). Mplus User’s Guide. 6th ed., Los Angeles, CA: Muthen & Muthen.Google Scholar
  37. Nock, M. K., & Banaji, M. R. (2007). Prediction of suicide ideation and attempts among adolescents using a brief performance-based test. Journal of Consulting Clinical Psychology, 75, 707–715.CrossRefGoogle Scholar
  38. Nock, M. K., Park, J. M., Finn, C. T., Deliberto, T. L., Dour, H. J., & Banaji, M. R. (2010). Measuring the suicidal mind: Implicit cognition predicts suicidal behavior. Psychological Science, 21, 511–517.  https://doi.org/10.1177/0956797610364762.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Nock, M. K., Ursano, R. J., Heeringa, S. G., Stein, M. B., Jain, S., Raman, R., Sun, X., Chiu, W. T., Colpe, L. J., Fullerton, C. S., Gilman, S. E., Hwang, I., Naifeh, J. A., Rosellini, A. J., Sampson, N. A., Schoenbaum, M., Zaslavsky, A. M., & Kessler, R. C. (2015). Mental disorders, comorbidity and pre-enlistment suicidal behavior among new soldiers in the US Army: Results from the army study to assess risk and resilience in servicemembers (Army STARRS). Suicide and Life-Threatening Behavior, 45, 588–599.  https://doi.org/10.1111/sltb.12153.CrossRefPubMedGoogle Scholar
  40. O’Connor, S.S., Jobes, D.A., Yeargin, M.K., Fitzgerald, M.E., Rodriguez, V.M., Conrad, A. K., & Lineberry, T.W. (2012). A crosssectional investigation of the suicidal spectrum: Typologies of suicidality based on ambivalence about living and dying. Comprehensive Psychiatry, 53(5), 461–467.CrossRefGoogle Scholar
  41. Osman, A., Downs, W. R., Kopper, B. A., Barrios, F. X., Baker, M. T., Osman, J. R., et al. (1998). The reasons for living inventory for adolescents (RFL-A): Development and psychometric properties. Journal of Clinical Psychology, 54(8), 1063–1078.CrossRefGoogle Scholar
  42. Osman, A., Kopper, B. A., Barrios, F. X., Osman, J. R., Besett, T., & Linehan, M. M. (1996). The brief reasons for living inventory for adolescents (BRFL-A). Journal of Abnormal Child Psychology, 11, 433–443.CrossRefGoogle Scholar
  43. Pruitt, L. D., Smolenski, D. J., Bush, N. E., Skopp, N. A., Hoyt, T. V., & Grady, B. J. (2016). DoDSER: Department of defense suicide event report: Calendar year 2015 annual report. Washington, DC: Department of Defense.Google Scholar
  44. Reist, C., Mee, S., Fujimoto, K., Rajani, V., Bunney, W. E., & Bunney, B. G. (2017). Assessment of psychological pain in suicidal veterans. PLoS ONE, 12, e0177974.CrossRefGoogle Scholar
  45. Ribeiro, J. D., Pease, J. L., Guttierrez, P. M., Silva, C., Bernert, R. A., Rudd, M. D., & Joiner, T. E. (2012). Sleep problems outperform depression and hopelessness as a cross-sectional and longitudinal predictors of suicidal ideation and behaviorin young adults in the military. Journal of Affective Disorders, 136, 743–750.  https://doi.org/10.1016/j.jad.2011.09.049.CrossRefPubMedGoogle Scholar
  46. Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A re-evaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67, 1063–1078.CrossRefGoogle Scholar
  47. Shelef, L., Fruchter, E., Hassidim, A., & Zalsman, G. (2015). Emotional regulation of mental pain as moderator of suicidal ideation in military settings. European Psychiatry, 30, 765–769.CrossRefGoogle Scholar
  48. Shneidman, E. S. (1964). Suicide, sleep, and death: Some possible interrelations among cessation, interruption, and continuous phenomena. Journal of Consulting Psychology, 28, 95–106.CrossRefGoogle Scholar
  49. Steger, M. F., Frazier, P., Oishi, S., & Kaler, M. (2006). The meaning in life questionnaire: Assessing the presence of and search for meaning in life. Journal of Counseling Psychology, 53, 80–93.CrossRefGoogle Scholar
  50. Stone, D. M., Simon, T. R., Fowler, K. A., et al. (2018). Vital signs: Trends in state suicide rates—United States, 1999–2016 and circumstances contributing to suicide—27 states, 2015. Morbidity and Mortality Weekly Report, 67, 617–624.CrossRefGoogle Scholar
  51. Storch, E. A., Roberti, J. W., Heidgerken, A. D., Storch, J. B., Lewin, A. B., Killiany, E. M., … Geffken, G. R. (2004). The duke religion index: A psychometric investigation. Pastoral Psychology, 53, 175–181.CrossRefGoogle Scholar
  52. Storch, E. A., Strawser, M. S., & Storch, J. B. (2004). Two-week test-retest reliability of the Duke Religion Index. Psychological Reports, 94, 993–994.CrossRefGoogle Scholar
  53. Taasoobshirazi, G., & Wang, S. (2016). The performance of the SRMR, RMSEA, CFI, and TLI: An examination of sample size, path size, and degrees of freedom. Journal of Applied Quantitative Methods, 11, 31–39.Google Scholar
  54. Ursano, R. J., Heeringa, S. G., Stein, M. B., Jain, S., Raman, R., Sun, X., Chiu, W. T., Colpe, L. J., Fullerton, C. S., Gilman, S. E., Hwang, I., Naifeh, J. A., Nock, M. K., Rosellini, A. J., Sampson, N. A., Schoenbaum, M., Zaslavsky, A. M., & Kessler, R. C. (2015). Prevalence and correlates of suicidal behavior among new Soldiers in the U.S. Army: Results from the army study to assess risk and resilience in servicemembers (Army STARRS). Depression and Anxiety, 32, 3–12.  https://doi.org/10.1002/da.22317.CrossRefPubMedGoogle Scholar
  55. Ursano, R. J., Kessler, R. C., Naifeh, J. A. S., Heberman-Mash, H., Fullerton, C. S., Bliese, P. D., Zaslavsky, A. M., Ng, T. H. H., Aliaga, P. A., Wynn, G. H., Dinh, H. M., McCarroll, J. E., Sampson, N. A., Kao, T. C., Schoenbaum, M., Heeringa, S. G., & Stein, M. B. (2017). Risk of suicide attempt among soldiers in army units with a history of suicide attempts. JAMA Psychiatry, 74, 924–931.  https://doi.org/10.1001/jamapsychiatry.2017.1925.CrossRefPubMedPubMedCentralGoogle Scholar
  56. Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2008). Suicidal desire and the capability for suicide: Tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76, 72–83.CrossRefGoogle Scholar
  57. Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the annual meeting of the International Society for Traumatic Stress Studies, San Antonio, TX.Google Scholar
  58. Weathers, F. W., Litz, B. T., Herman, D. S., Husker, J. A., & Keane, T. M. (1994) PCLC for DSM-IV. National Center for PTSD – Behavioral Sciences Division. Retrieved from: https://www.ptsd.va.gov/professional/assessment/documents/APCLC.pdf.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.National Center for Veterans StudiesSalt Lake CityUSA
  2. 2.Department of PsychologyThe University of UtahSalt Lake CityUSA

Personalised recommendations