Jay Morse & Heidi Radunovich, PhD
While most clinicians are aware that the best predictor of future behavior is past behavior, the impact of previous suicide ideation and history on future suicidal behavior has not previously been studied with a military population. Bryan and colleagues (2014)  examined this phenomenon with two separate samples, and found evidence that suicidal thoughts and behaviors prior to enlistment were associated with increased risk for suicidal behavior in the military.
A large body of literature about suicide and suicide prevention exists. However, the utility of this information and the ability to interpret it is often questionable. Consistent data allow researchers to better gauge the scope of the problem, identify high-risk groups, and monitor the effects of prevention programs and policies. The Centers for Disease Control and Prevention (CDC) publishes a set of suicide related definitions to be used by researchers and practitioners .
In a previous blog, we discussed suicide risk in the military and research conducted by Bryan and colleagues (2014) related to suicide and the military. In this more recent publication, the researchers studied the prevalence of self-injurious thoughts and behaviors (SITB) prior to joining the military, as well as its relationship to incidence of suicidal thoughts and attempts made during military service or as a veteran.
Two samples of self-reported data were collected: one from 374 college student veterans, and one from 151 military members receiving mental health treatment. In both studies, instruments with good reliability (herself-injurious thoughts and behaviors, (STIB), The Patient Health Questionaire-9 (PHQ-9), PTSD Checklist Short Form (PCL-SF)) were used to measure SITB and suicide attempts, depression, and post-traumatic stress. The second study utilized the preceding three measures plus an additional measure of current suicidal ideation.
Past self-injurious thoughts and behaviors were calculated by comparing the age of the first onset of suicidal ideation, suicide plans, non-suicidal injury, and suicide attempts with the age of the participant when they joined the military.
Student veteran study results
Of the 374 students completing the survey, 82 or 21.9% reported suicidal ideation prior to joining the military and 12 or 3.2% made a suicide attempt. Of those attempting suicide after joining the military, 18 (50%) reported having had suicidal ideations and 3 (16.7%) had made suicide attempts prior to joining the military.
Active duty results
In the active duty sample of 151 active duty personnel receiving mental health treatment, 16.6% reported a history of suicidal ideation and 3.3% reported a suicide attempt prior to joining the military. Of those that made a suicide attempt (16) after joining the military, 8 (50%) reported suicidal ideation prior to joining the military, and 2 or 25% had made a suicide attempt prior to joining the military.
Although both studies included fairly small (the authors recommended larger studies), and relied on self-report and retrospective report, both studies provided support for the idea that prior suicidal ideation and behavior increases the likelihood of suicide attempts after entering the military.
Helpful tools: SAMHSA provides FREE wallet cards for mental health professionals with a mnemonic as a helpful reminder for assessing suicide risk. Similarly, they also provide FREE wallet cards with the national toll-free suicide hotline and a guide for when to ask for help following a traumatic event for the general public:
- National Suicide Prevention Lifeline Wallet Card: Assessing Suicide Risk: Initial Tips for Counselors
- National Suicide Prevention Lifeline Wallet Card: Having Trouble Coping? With Help Comes Hope.
 Bryan, C. J., Bryan, A. O., Ray-Sannerud, B. N., Etienne, N. & Morrow, C. E. (2014) Suicide attempts before joining the military increase risk for suicide attempts and severity of suicidal ideation among military personnel and veterans. Comprehensive Psychiatry 55(3) 534-541.
 Crosby AE, Ortega L, Melanson C. (2011). Self-directed Violence Surveillance: Uniform Definitions and Recommended Data Elements, Version 1.0. Atlanta (GA): Centers for Disease Control and Prevention. National Center for Injury Prevention and Control.
 SAMHSA (2014) National Suicide Prevention Lifeline Wallet Card: Assessing Suicide Risk: Initial Tips for Counselors. Retrieved from: http://store.samhsa.gov/product/National-Suicide-Prevention-Lifeline-Wallet-Card-Assessing-Suicide-Risk-Initial-Tips-for-Counselors/SVP13-0153.
 SAMHSA (2014) National Suicide Prevention Lifeline Wallet Card: Having Trouble Coping? With Help Comes Hope. Retrieved from: http://store.samhsa.gov/product/National-Suicide-Prevention-Lifeline-Wallet-Card-Having-Trouble-Coping-With-Help-Comes-Hope-/SVP13-0155R.
This post was written by Jay Morse & Heidi Radunovich, PhD, members of the MFLN Family Development (FD) team which aims to support the development of professionals working with military families. Find out more about the Military Families Learning Network FD concentration on our website, on Facebook, on Twitter, YouTube, and on LinkedIn.