According to the interpersonal theory of suicide, developed by Thomas Joiner at Florida State University, two factors are particularly important in conferring risk for suicide: perceived burdensomeness and thwarted belongingness. Perceived burdensomeness is the sense that one is a burden on one’s loved ones or society as a whole, while thwarted belongingness is the feeling that one has failed to become an accepted and valued member of a group. Research has shown that people who score high on these factors are more likely to think about and attempt suicide.

Thus, says Brad Schmidt, a psychologist at Florida State University, it may be possible to reduce the risk of suicide by decreasing feelings of perceived burdensomeness and thwarted belongingness. Both factors appear to be malleable—that is, they can be modified with the right intervention—so it is a natural approach to try, but to this point there has been relatively little research on the topic.

That is about to change. With funding from the Military Suicide Research Consortium, Schmidt is preparing to carry out two clinical trials at Fort Campbell to see whether suicide risk can be affected by modifying soldiers’ feelings of perceived burdensomeness and thwarted belongingness.

Schmidt and his colleagues will be using a computer-based tool they call Building Stronger Allies, or BSA, which is designed to help individuals improve the effectiveness of their personal interactions as a way of dealing with and lessening these negative feelings. It requires about an hour to complete and can be done in private at a person’s convenience.

BSA was shown to be effective at decreasing perceived burdensomeness (although not thwarted belongingness) in an earlier study with individuals recruited at FSU. The group was followed for six months after the use of BSA, and the effect persisted, indicating that even a single session with BSA could lead to an extended reduction in suicide risk. However, although Schmidt’s group worked to recruit a large number of Veterans to the study and Veterans made up about 40 percent of the study group, still the majority in the trial were civilians. So Schmidt will now test the intervention in a group that consists purely of active-duty soldiers.

BSA will be tested in two separate trials, Schmidt explains. The first is designed to test the effectiveness of BSA in primary prevention—that is, in addressing the risk factors before an individual begins to have suicidal thoughts. Working with 400 soldiers at Fort Campbell who are participating in mandatory suicide awareness training, the trial will put half of them through the BSA program, and the other half will be given health education training, which is somewhat similar in approach but does not have any effect on perceived burdensomeness or thwarted belongingness. They will then follow these 400 soldiers for three months and compare the perceived burdensomeness and thwarted belongingness scores of the two treatment groups.

A preventive approach like this can be valuable, Schmidt says, but in general only about 5 percent of the soldiers selected at random will report having suicidal thoughts, so the overall effect of the BSA will be diluted by the large number of soldiers who would not think about suicide in any event. This is why the second trial will focus specifically on soldiers who are experiencing suicidal thoughts. Schmidt and his colleagues will recruit 110 soldiers who come to an embedded health clinic reporting thoughts of suicide. Again, half will be given the BSA program, and half will get health education training, and they will all be followed for three months to compare the levels of perceived burdensomeness and thwarted belongingness between treatment groups and also whether there is a decrease in suicidal thoughts over that time.

The study results will greatly inform, Schmidt says, whether BSA could be a valuable tool both in preventing soldiers from starting to think about suicide in the first place and in treating soldiers who have already begun to think about suicide. It is an inexpensive, easy-to-administer intervention that could produce a significant decrease in the risk of suicide.