This study evaluates long-term outcomes of a clinical trial of Caring Contacts via text message through the addition of administrative datasets to evaluate predictors of suicide death, compare covert suicidal behavior (i.e., unknown to treatment providers or to command) vs. overt suicidal behavior (i.e., resulting in medical treatment or otherwise known to treatment providers or command), and the impact of separation from the military on suicide-specific outcomes.

Service members screening positive for mental health concerns, including suicide, frequently do not attend behavioral health outpatient care. Despite considerable efforts within the DoD, barriers to care such as concern about unit stigma (i.e., how a service member will be viewed by peers and leadership) and organizational barriers (e.g., difficulty getting time off work to attend treatment) remain prevalent. Dropping out of care is also common. Service members are also a highly transient population, with care potentially being disrupted by permanent change of station, temporary duty assignments, and deployments. Mental health problems, including suicidality, also contribute to attrition from active duty military service. This highlights the potential value of a suicide prevention intervention that does not require ongoing visits to a behavioral health clinic—and that can follow a service member to another installation, on deployment, and into civilian life, if separated from military service. 

An innovative intervention—caring contacts (e.g., letters, postcards)—may be an important adjunct or alternative to outpatient care. Caring Contacts are brief, periodic messages that express unconditional care and concern and have been previously shown to prevent suicide deaths, attempts, ideation, and hospitalizations. In order to help prevent suicidal behaviors among military service members, Dr. Kate Comtois and colleagues have conducted past research on whether Caring Contacts delivered via text message can help reduce suicidal thoughts and behaviors at one-year follow-up. Comtois found that adding a Caring Contacts intervention to the usual treatment reduced the likelihood of U.S. Marines and Army Soldiers experiencing suicidal ideation and suicide attempts. Now, Comtois will continue the study in order to understand the long-term outcomes of providing Caring Contacts via text message. Through the addition of administrative datasets, Comtois will evaluate predictors of suicide death, will compare “covert” suicidal behaviors that are unknown to treatment providers or command to those “overt” behaviors that are known to treatment providers or command (for example, because medical treatment occurred), and will investigate the impact of separation from the military on individuals’ future suicidal behaviors. In doing so, Comtois’ study will extend and deepen our understanding of suicides, suicide attempts, and related outcomes among suicidal Soldiers and Marines.

In conducting this study, Comtois will review the descriptions of suicidality, psychological experiences, exposure to suicide, and treatment history that the decedents in the study themselves provided. These will be integrated with decedents’ administrative records (e.g., death records, medical records, specialized DoD suicide surveillance records). The results of these in-depth reviews may help clinicians optimally treat suicidal service members, in addition to opening up new avenues for research. Moreover, the study will extend the initial Caring Contacts study, allowing for replication of the original findings and more thorough evaluation of the effectiveness of Caring Contacts in reducing suicidal behaviors. Finally, comparison of “covert” and “overt” suicidal behavior will inform interpretation of surveillance evaluating only “overt” suicidal behavior (i.e., those reported in military and/or medical records).