Home | Military Suicide Research Consortium

Suicide Risk and Sleep in Treatment

Lily Brown

Sleep disorders are remarkably common in military service members. Most prior studies on the associations among sleep disturbances and suicidal thoughts/behaviors have relied on retrospective recall. Dr. Lily Brown plans to use ecological momentary assessment (EMA) to breakdown the complex associations among sleep disturbances and suicidal ideation and behavior in active duty military personnel receiving treatment for recent suicidal thoughts or behaviors.

Jessica Ribeiro

It is commonly said that suicide risk changes the closer an individual gets to attempting suicide. Though this belief is widely accepted, it is a belief that is based on little-to-no scientific evidence. In addition to this issue, a team of researchers recently found that, overall, traditional risk factors and approaches to predicting suicide risk are little better than chance at determining who will die by suicide. Dr. Jessica Ribeiro, Assistant Professor in Psychology at Florida State University, aims to address these two problems.

David Vogel

While many of the questions in the MSRC database are established mental health and suicide screening tools in civilian populations, most have not been verified using military samples. Testing if specific groups of service members ascribe similar meanings to questions assessed by these tools is called measurement equivalence/invariance (ME/I) testing and it is necessary to be able to generalize findings across different groups of people (i.e. civilians, military personnel, veterans, etc.).

Bridget Matarazzo

For suicidal Veterans who are treated on an inpatient psychiatric unit, the weeks and months following their discharge pose a special risk. Much of the risk seems to be rooted in the transition from inpatient care to outpatient care, which can leave Veterans feeling unsettled. Bridget Matarazzo at the Rocky Mountain MIRECC is testing the Home-Based Mental Health Evaluation program, or HOME, designed to lower the risk.

Michael Anestis

Strikingly, firearm suicides account for approximately half of all suicide deaths each year in the United States (U.S.). Certain segments of the U.S. population, such as military service members, demonstrate firearm suicide rates higher than that of the general population. One approach that clinicians use to mitigate risk of firearm suicide is lethal means safety counseling. Although lethal means safety counseling is considered a best practice for firearm suicide prevention (and suicide prevention more broadly), research on its acceptability and utility is remarkably underdeveloped.

Marjan Holloway

Transitioning from active duty status back to civilian life can be stressful. One notable part of that transition involves the Medical Evaluation Board (MEB) and subsequent Physical Evaluation Board (PEB). To help military members through these transitions, Dr. Holloway is interested in the role peers could play.

Andrew Littlefield

It has consistently been shown that there is a need for better methods to predict suicidal thoughts and behaviors. When examining the most prevalent means of assessing the likelihood of an individual engaging in suicidal thoughts and behaviors, researchers have shown that little progress has been made over the past 50 years. Dr. Andrew Littlefield and colleagues hopes to utilize multiple techniques labeled as machine learning to better examine predictors of suicide.

Nigel Bush

One of the strategies that clinicians have used to help patients remember their reasons for living is the "hope box." It can be a real wooden box, a shoe box, a manila envelope, or pretty much any other sort of container. Throughout 2013 Nigel Bush at the National Center for Telehealth and Technology carried out usability testing on an initial version of the virtual hope box. Although the original version seemed quite successful, Bush expects the new version to prove to be even better.

Courtney Bagge, Kenneth Conner

Clinicians have a variety of well-tested ways of identifying individuals who are at highest risk for suicide, but they have no such well-tested methods for determining when a particular individual is most likely to attempt suicide

Courtney Bagge and Kenneth Conner will be studying Veterans and civilians who have recently attempted suicide to try and answer the question ‘Why today?'

Courtney Bagge

Recent research Dr. Courtney Bagge and colleagues conducted with veterans and civilians has shown evidence that certain observable behaviors increase in the hours before a suicide attempt. Identifying those observable behaviors, which Bagge calls behavioral warning signs (BWS), can help in determining which individuals are at imminent risk for suicide. Therefore, understanding the relation between BWS and suicide in these individuals could help in predicting and preventing suicidal behaviors.

Brad Schmidt

Researchers at Florida State University have previously found that they could reduce risk factors for suicide with a brief computer-based intervention designed to improve mood and reduce anxiety. However, one limitation of that promising study was its limited duration. Now that group of researchers is returning to their original subjects to see if that brief intervention can indeed reduce risk factors related to suicide for years afterward.

Tracy Witte

What differentiates people who die by suicide from other people? This is a key question for any clinician or professional who would like to be able to predict which people are most at risk for death by suicide. Unfortunately there is still very much about that question that remains unknown, including a very basic issue: Is suicidality a categorical trait - people either are suicidal, or they aren’t - or is it more of a continuous trait, where people can fall anywhere on a spectrum from not suicidal at all to highly suicidal? The answer has implications both for the assessment of suicidality and for its treatment.

Brad Schmidt

According to the interpersonal theory of suicide two factors are particularly important in conferring risk for suicide: perceived burdensomeness and thwarted belongingness. Research has shown that people who score high on these factors are more likely to think about and attempt suicide. Brad Schmidt, a psychologist at Florida State University, says it may be possible to reduce the risk of suicide by decreasing feelings of perceived burdensomeness and thwarted belongingness

Julie Cerel

When someone dies by suicide, it can have devastating effects on the people left behind. This is particularly true in close-knit communities such as the military. Some of the survivors may even be more likely to attempt suicide themselves. Julie Cerel is conducting a study focused on determining how many Veterans know someone who died by suicide and what their reactions are to the suicide.

Brian Marx

Written Exposure Therapy (WET)is included in the 2017 VA/DOD Clinical Practice Guidelines for managing PTSD. However, WET has yet to be tested with patients at high risk for suicide requiring inpatient hospitalization management.

April Smith

Many studies have been dedicated to unveiling suicide risk factors, yet accurate suicide prediction is no better than chance. To advance prediction, methodologies must shift from studying single risk factors in isolation and over multi-year intervals to assessing multiple risk factors simultaneously over very short prediction windows. Several disparate symptoms are often present in the hours or days preceding suicidal behavior. These include drastic increases in suicidal intent, alienation from self or others, hopelessness about alienation, and over arousal.

Alexis May

The partners of military service members are in an excellent position to identify suicide warning signs in and provide support to service members; however, many partners do not know how best to respond in crisis situations. Further, no couples-based suicide prevention interventions have been developed.

Katherine A. Comtois

"Caring letters" have long been identified as an effective suicide intervention. This study aims to use text messaging or short messaging service (SMS) as a low cost caring contact, in hopes of decreasing suicidal thinking and behavior for active duty military personnel.

Participants will receive text messages at pre-scheduled times over a 12 month period to asses the effectiveness of such intervention.

Beeta Homaifar, Melissa Amick

When people are under stress, they naturally find it more difficult to think clearly and to deal with the sorts of problems that arise in daily living. In a study being carried out at the VA medical center in Boston, researchers are examining differences in the effects that stress has on the thinking of people with suicidal thoughts versus those who do not have suicidal thoughts. This may point the way to identifying Veterans at risk of developing suicidal behavior

April Smith

The scientific term for sensitivity to the internal states of the body is interoception. Research has found that people who score low on measures of interoception are more likely to try to injure themselves or attempt suicide. With this in mind, April Smith of Miami University is leading a research effort to study the relationship between interoception and self-injuring and suicidal behaviors specifically in a military population.

Thomas Joiner & Peter Gutierrez

Suicide rates have increased in the U.S. military in recent years, which has prompted many researchers to look at how clinicians are treating those experiencing suicidality. Although efficacious interventions and treatments exist connecting individuals at elevated risk to behavioral health care services, these connections remain an uphill battle. Less than one third of service members with mental health problems, including those at elevated suicide risk, access care.

Michael Anestis

Michael Anestis at the University of Southern Mississippi is testing several existing prediction 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.

Joseph Franklin, Jessica Ribeiro

Although there is likely some overlap among the processes associated with suicidality across active duty individuals, veterans, and civilians, there may be important differences as well. Drs. Franklin and Ribeiro are conducting a study to investigate whether machine learning algorithms can accurately distinguish between active duty servicemembers, veterans, and civilians with a history of suicidal thoughts or behaviors.

Brad Schmidt

One of the major factors that has been found to contribute to suicide risk is a pattern of experiencing feelings of anxiety. If ways could be found to help Veterans reduce feelings of anxiety, it could also reduce suicide risk in those Veterans. This is exactly what Wen Li and Brad Schmidt have set out to do, focusing on helping Veterans and others learn to handle anxiety-causing smells.

Thomas Joiner, Peter Gutierrez

When a clinician deals with an emotionally troubled patient, one of the most important questions to ask is, “How great is the risk that this person will engage in some form of suicidal behavior in the near future?” Unfortunately there is still no clear-cut best way to gauge the likelihood of near-term suicidal behavior in a given individual. To identify such a “gold standard” for clinical suicide risk assessment, Thomas Joiner and Peter Gutierrez are testing four widely used measures to determine which measure or combination of measures offers the most accurate prediction of suicide-related behaviors three months into the future.

Lisa Brenner

Veterans with traumatic brain injury are significantly more likely than other Veterans to die by suicide. A recent study in Australia found that it was possible to reduce hopelessness among adults with traumatic brain injury with a treatment program using cognitive behavioral therapy. Lisa Brenner and Grahame Simpson are heading up a study to determine if a similar cognitive behavioral approach can reduce hopelessness among a group of U.S. Veterans suffering from lasting effects of traumatic brain injury.

Deborah Yurgelun-Todd

Neuroscientists have used brain imaging techniques to learn many things about the brain but there have been few studies attempting to find brain characteristics that are associated with suicidal behavior. Thus Deborah Yurgelun-Todd of the University of Utah is now studying a group of Veterans, half of whom have a history of self-directed violence, to search for brain differences between Veterans who have attempted to hurt themselves and those who have not.

Sarra Nazem

Over the past decade or so it has become increasingly clear that there is a link between sleep problems and suicide. The evidence indicates that insomnia is a separate risk factor that itself makes a person more likely to think about and to attempt suicide. Sarra Nazem, a clinical research psychologist at the Denver VA Medical Center and the University of Colorado Medical Center, is testing an Internet-based intervention that is designed to help Veterans and Service Members address problems with insomnia.

Lisa Brenner, Ph.D.

Naval personnel experience concerning levels of anxiety, stress, and suicidal ideation while deployed. Moreover, periods of post-deployment transition, during which Sailors are faced with home-front related stressors have been shown to be particularly risky. Using smartphone technology, real-time data regarding individuals' behaviors, mood, and symptoms can be recorded, stored, displayed, and monitored by self and others.

Katherine A. Comtois

Service members screening positive for suicide risk frequently do not attend behavioral health outpatient care. Barriers to care, such as concern about unit stigma, remain prevalent. Dropping out of care is also common. Dr. Kate Comtois will continue her previous study in order to understand the long-term outcomes of providing Caring Contacts via text message.

Rebecca Bernert

Recent research has shown a link between suicidal behaviors and poor sleep quality. Those with suicidal thoughts appear to be at greater risk for sleep disturbances, including insomnia symptoms, poor sleep quality, and nightmares. Rebecca Bernert and Alan Schatzberg are carrying out a clinical trial testing the use of a brief behavioral sleep therapy to improve sleep and evaluate its therapeutic impact on suicide prevention.

Jesse Cougle

Research into the connection between anger and suicide suggests that people who are angry much of the time tend to isolate themselves from others and that they are much more likely to feel that they are a burden to others. Given the relationship between anger and increased suicide risk, a natural question to ask is whether reducing feelings of anger among those at high risk for suicide could reduce the likelihood that they would attempt to harm themselves. This is the question that Jesse Cougle at Florida State University has set out to answer.

Matthew Nock

It is well known that people at high risk for suicide have certain emotional differences from those people who are not at risk, but are there cognitive differences as well? This is a question that Matthew Nock at Harvard University has set out to answer in a study that will eventually involve 400 subjects at Harvard and at the Boston VA Medical Center.

Daniel Capron

The suicide rate in the National Guard is one of the highest in the U.S. Armed Forces and yet, many do not seek mental health services. Dr. Daniel Capron aims to address barriers to National Guard personnel accessing services and their increased risk for suicide by studying the utility of mobile technology (e.g., smartphones) that targets ASCC among this population.

Dr. Lora Johnson

Therapists have found group therapy to be effective for treating Veterans for depression, chronic traumatic stress, and various other mental ailments, but it has generally not been used to deal with suicide-related issues. For the past several years Johnson, with funding from the MSRC, has been exploring the use of group therapy for treating suicidal Veterans, including those who have attempted suicide.

Julie Cerel

There is growing evidence that exposure to the suicide of non-family members is associated with reduced mental health and increased suicidal behavior among those with perceptions of closeness to the decedent. Only a handful of studies have examined the prevalence and correlates of suicide exposure among military and veteran populations, and none have examined the longitudinal experience of loss of a military colleague to suicide.

Schmidt

Two mood factors are believed to be key aspects in determining whether a person will commit suicide: thwarted belongingness and perceived burdensomeness.

To help individuals deal with these two types of feelings, Brad Schmidt has developed a new Web-based treatment program aimed at helping people recognize them and address them.

Daniel Capron

The suicide rate in the National Guard is one of the highest in the U.S. Armed Forces and yet, many do not seek mental health services. Dr. Daniel Capron’s innovative approach to this problem is pairing it with another line of work called behavioral economics. Behavioral economics has been successful in anticipating human decision-making errors and using techniques to help increase the probability of desired outcomes, including treatment seeking.

Craig J. Bryan

A successful treatment technique used by therapists is to put together a list written on a note card of things that make the patient’s life worth living. Craig Bryan and his coworkers will be testing the effectiveness of providing military patients with these note cards at crisis-triggered visits to a clinician, instead of through multi-session psychotherapy.

Lora Johnson

Group therapy has proved effective in dealing with a variety of mental health issues, from depression to chronic traumatic stress in Veterans, but it has rarely been used to help individuals at risk of suicide.

Lora Johnson of the VA Medical Center in Louisville, Kentucky, is using group therapy to treat suicidal Veterans, including many who have attempted suicide, in order to develop objective evidence on the method’s effectiveness.

James McNulty, Michael A. Olson

Research has shown that interpersonal problems are closely linked with an increased risk of suicide, so it seems likely that the high rates of marital disruption among service members and Veterans might influence the high rates of suicide among these groups. James McNulty and Michael A. Olson are hoping to improve military marriages with a novel, computer-based technique for strengthening relationships.

Jessica Ribeiro

Over the past several decades, despite an increase in scientific efforts to better understand and prevent suicide, the suicide rate in the United States (U.S.) has remained largely unchanged. Remarkably, some segments of the U.S. population, such as military service members, have actually demonstrated an increase in the rate of suicide deaths. Researchers from Florida State University believe they have a solution to optimize suicide risk detection: the use of complex statistical algorithms, such as machine learning.

April Smith

Research from Dr. Smith’s lab at Miami University suggests that interoceptive deficits may not only differentiate those who are thinking about suicide from those who engage in suicidal behavior, but it may also provide information about who is at imminent risk for suicidal behavior. This project evaluates a novel, brief intervention for interoceptive deficits and suicidal behavior with the potential to be acceptable and feasible for a military population.

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Identifying risk and providing evidence-based prevention and treatment strategies.

Suicide Risk and Sleep in Treatment

Lily Brown

Examining the Nature of Suicide Risk over Time Using Machine Learning

Jessica Ribeiro

Establishing Measurement Equivalence of MRSC Database Assessments Across Demographic Groups

David Vogel

Improving the Inpatient-to-Outpatient Transition

Bridget Matarazzo

Project Safe Guard

Michael Anestis

Brief Peer-Support Cognitive Behavioral Intervention For Military Life Transitions (MIL-iTRANSITION) Following Medical And Physical Evaluation Boards

Marjan Holloway

Enhancing Identification of Suicide Risk among Military Service Members and Veterans: A Machine Learning Approach to Suicidality

Andrew Littlefield

An Improved Virtual Hope Box

Nigel Bush

Looking for Suicide Warning Signs

Courtney Bagge, Kenneth Conner

Profiles of Behavioral Warning Signs for Suicide Attempts in the Prediction of Future Suicidality

Courtney Bagge

Long Term Follow-Up for the MSRC DARTS Clinical Trial

Brad Schmidt

A Taxometric Investigation of Suicide

Tracy Witte

Building Stronger Allies: Development and Evaluation of a Web Application Targeting Interpersonal Risk Factors for Suicide in Active Duty Service Members

Brad Schmidt

Suicide Bereavement in Veterans and Military Families

Julie Cerel

Decreasing Suicide Risk Among Service Members With Posttraumatic Stress Using Written Exposure Therapy

Brian Marx

Characterizing the Dynamics of Acute Suicidal Affective Disturbance

April Smith

Couples Crisis Response Planning to Reduce Post-Discharge Suicide Risk

Alexis May

Texting a brief intervention to prevent suicidal ideation and behavior

Katherine A. Comtois

Thinking Under Stress and the Risk of Suicide

Beeta Homaifar, Melissa Amick

Interoceptive Deficits and Suicidality

April Smith

Increasing Connection to Care Among Military Service Members at Elevated Suicide Risk

Thomas Joiner & Peter Gutierrez

Predicting Suicide Risk in a Military Population

Michael Anestis

Using Machine Learning to Distinguish among Active Duty, Veteran, and Civilian Suicidality

Joseph Franklin, Jessica Ribeiro

Retraining reactions to smells

Brad Schmidt

Toward a Gold Standard for Suicide Risk Assessment for Military Personnel

Thomas Joiner, Peter Gutierrez

Window to Hope: A cognitive behavioral approach to reducing hopelessness

Lisa Brenner

Using Brain Imaging to Study Suicide Risk

Deborah Yurgelun-Todd

A Web-Based Treatment for Insomnia

Sarra Nazem

Facilitating Assessment of At-Risk Sailors With Technology (FAAST)

Lisa Brenner, Ph.D.

Reviewing the Effects of Caring Contacts (RECON): A Long-Term Follow-Up Study from the Military Continuity Project

Katherine A. Comtois

Behavioral Sleep Intervention for the Prevention of Suicide

Rebecca Bernert

Using Anger-Reduction Treatment to Reduce Suicide Risk

Jesse Cougle

Looking for Cognitive Differences in Suicidal Veterans

Matthew Nock

Mobile Intepretation Bias Modification Clinical Trial

Daniel Capron

Group Therapy for Treating Suicidal Veterans

Dr. Lora Johnson

Personal and Professional Exposure to Suicide in Military Populations

Julie Cerel

Preventing Suicide by Decreasing Anxiety and Improving Mood

Schmidt

Behavioral Ecomomics Intervention to Increase Treatment Seeking in the National Guard

Daniel Capron

Will Hope Notes Work at the E.R.?

Craig J. Bryan

Studying Group Therapy for Suicidal Veterans