Over time psychologists have developed a number of models to predict which individuals are most at risk of dying by suicide, but for the most part these models have been tested only on civilian populations. Because there are a number of differences between civilians and Veterans that could affect suicidal behavior, it cannot be taken for granted that models that are effective in predicting risk among civilians will work equally well for military populations. Thus Michael Anestis at the University of Southern Mississippi is testing several of these models on a group of Veterans to see which are most effective at predicting the likelihood of suicide. He is also adding his own twist with the use of “collateral reporters” in an attempt to improve the models’ ability to predict suicidal behavior.
Over the first six months of the study, Anestis and his colleagues will collecting data from 1,000 Veterans at Camp Shelby outside Hattiesburg, Mississippi, an Army National Guard base which is one of the primary locations for demobilization, especially of Veterans arriving home from Afghanistan. The data collected will include information relevant to predicting suicidal behavior, such as the presence of depression and feelings of hopelessness. Some of the subjects will be demobilizing Veterans, while others will be at Camp Shelby for drills. By looking at soldiers in different stages of their careers, such as having recently returned from combat versus being a year or more removed from overseas duty, Anestis will be able to examine such questions as whether different models should be used at different stages in a Veteran’s career.
Anestis will collect follow-up data from the subjects at 6, 12, and 18 months after the initial interview. The follow-up data, which will be collected with online questionnaires, will include information about suicidal thoughts and suicide attempts.
With all this data Anestis will test a number of models for predicting suicidal behavior to see which are most effective for Veterans. Some of the models have been tested in groups of civilians but not in Veterans. Others have been tested in Veterans but only looking at previous suicidal behavior—that is, the studies took data from Veterans who had already attempted suicide and compared them with Veterans who had not attempted suicide. Because Anestis is first collecting data from the Veterans then following them for 18 months, he will be able to test whether the models are useful in predicting future suicidal behavior—a crucial capability if clinicians are to be able to determine ahead of time which Veterans are most at risk for suicide.
A major issue in determining suicide risks in Veterans, Anestis notes, is that many individuals in the armed services are hesitant to discuss depressions, the presence of suicidal thoughts, or anything else that might be considered to be a weakness and thus affect how others think of them or hurt their careers. To account for this, Anestis will also be giving his subjects a psychological test called the implicit association test that can reveal the presence of suicidal thoughts even in individuals who might not report them in an interview or on a questionnaire.
Finally, Anestis will encourage each participant to recruit a “collateral reporter” to take part in the project with him or her. The collateral reporter should be the person with whom the soldier will spend the greatest amount of time with over the following 18 months and to whom he or she feels closest. The collateral reporter will also take part in the study, providing the same information about himself or herself as the first subject, and both of them will be asked questions about the other. One thing Anestis will be examining is how the relationship between the two changes over the course of the study. He will also be looking to see if those Veterans with collateral reporters—and thus at least one close friend who would take part in such a study with them—are any less likely to attempt suicide. The primary goal, however, is to see if the additional information provided by the collateral reporters can improve the accuracy of predictions concerning the likelihood of future suicide attempts.
Soldiers deserve to have suicide-prevention efforts based upon sound, military-based research data, Anestis says. Too little such data exists now, but this study will help to address that lack.