Abstract
Suicide is one of the causes of death that cannot easily be predicted. In fact, according to the World Health Organization, suicide accounts for over 16% of the total deaths worldwide. In the US, suicide is rated tenth among the causes of death. Further, within the US military, the death rate due to suicide exceeds the deaths resulting from other risk factors. Essentially, suicide remains to be the social and psychological factor that is unpredictable, unpreventable and the leading cause of death not only in the US but also across the globe. The cause of the rising rate of suicide among the US army has been evaluated through various researches.
However, the protective risk factors associated with the increasing rate of suicide have not been thoroughly examined. As such, the study tends to examine the protective risk factors recognized to be connected with an increased prevalence rate of suicide behaviors among US soldiers. In addition, the paper will provide a general description of the protective factors and the manner in which they remain important in understanding and prevention suicide among US military service members.
Introduction
Military organizations are one of the institutions established by the society in which professionally trained soldiers apply physical force to provide defense against external aggressions and internal strife (Kuehn, 2009; Levin, 2009; McCarthy, Thompson, & Knox, 2012; Payne, Hill & Johnson, 2008; Warden, 2006). In other words, military organizations within modern society have the main duty of protecting society from external attacks and maintaining order through the application of force.
Given this function, risks associated with injuries and deaths due to the application of force are eminent (Hyman, Ireland, Frost & Cottrell, 2012; Logan, Skopp, Karch, Reger & Gahm, 2012; Stanley, Knox, Currier, Brenner, Ghahramanlou-Holloway & Brown, 2012). Traditionally, the risks normally occur when the soldiers are open to injuries and death from the enemies during wars and conflicts (Kuehn, 2009; Levin, 2009; Warden, 2006).
However, new kinds of risks have currently emerged among the soldiers. The US military personnel are currently exposed to additional risks besides the ones they face on the war fronts (Hill, Johnson & Barton, 2006; Bush, Skopp, McCann & Luxton, 2011). One of the additional risks is self-inflicting injuries. In fact, evidence from various studies on military suicide indicates that there is increasing risks arising from self-inflicted death among the military service personnel (Brailey, Vasterling, Proctor, Constans & Friedman, 2007; Hill et al., 2006; Bush et al., 2011; Kuehn, 2009; Hyman et al., 2012; Cha & Nock, 2009).
The increased exposure to forms of risks accounts for the current increases in suicidal deaths within the military. A study conducted by Logan et al (2012) indicated that the suicide rate among military personnel has increased significantly from 2005 to 2009. However, compared with the suicide death rate among the civilian population, the suicide rate among the military service members was below average in the first five years of the study. Even though the suicide rate among US soldiers was below the average rate of suicide among the general population, the current rate of suicide among the army has significantly increased and has surpassed that of the general population (Logan et al., 2012; McGurk, Hoge, Thomas, Cox, Engel & Castro, 2008; Knox, Pflanz, Talcott, Campise, Lavigne, Bajorska & Caine, 2010).
The main goal of the study is to examine protective factors that can be used to prevent and reduce the increased rate of suicide among US military service members. However, the study will first briefly determine the scope of suicide among military personnel and evaluate the known adjustable psycho-social risks. The study will then provide a thorough analysis of how protective factors interact with other risk factors to reduce and prevent the prevalence rate of suicide within the US military. In other words, the study will examine the protective factors for suicide among US soldiers focusing on how protective factors are relevant in the prevention of suicide as well as their applicability within the military.
Further, the study will enhance the understanding of the manner in which suicide occurs within the US military as well as determine innovative protective factors that can be applied in the reduction and prevention of suicide. In addition, the study will help in developing new procedures through which suicide behavior among US army personnel can be predicted. Moreover, the study will be significant in understanding the mechanism as well as a conduit through which suicide behavior develops.
Besides, the study is evidence of the increasing commitment and consideration by the scientists, military personnel as well as society to the need to understand the increasing severity and frightening predicament of suicide among the US soldiers. Essentially, the study will not only add to the existing knowledge on general suicide but also the ability to predict and prevent tragic outcomes in the future.
The Current Scope of Suicide Problem among the Military Personnel
Studies indicate an increased prevalence of suicide among military personnel (Kuehn, 2009; Levin, 2009; Warden, 2006; Hill et al., 2006; Logan et al., 2012; McGurk et al., 2008; Knox et al., 2010). According to World Health Organization (WHO), suicide is rated sixteenth among the leading causes of death globally. However, among the US population, suicide accounts for over 1.45% approximately the tenth leading cause of death (Logan et al., 2012; Griffith, 2002).
The rate of suicide within military organizations has been below the average of the general suicide rate until recently (Logan et al., 2012; Griffith, 2002; Hoge, Auchterlonie & Milliken, 2006). A study by Logan et al. (2012) observed that the rate of suicide among military personnel has been below the average rate of suicide among the civilian populations until 2007 when the rate has started to increase significantly.
The traditional recruitment methods and screening practice within the military where the service members with mental problems criminal history were rejected can be used to explain the chronological low rate of suicide prevalence among the military personnel (Kuehn, 2009; Levin, 2009; Warden, 2006; Hill et al., 2006; Logan et al., 2012; McGurk et al., 2008; Knox et al., 2010). In addition, the availability of strong social networks and increased access to health care also explain the reduced rate of suicide among military service members (Hill et al., 2006; Bush et al., 2011).
However, the year 2008 became the turning point for the service members. Studies indicate that the suicide rate started to increase significantly exceeding that of the civilian population (Kuehm, 2009; Levin, 2009; Warden, 2006; Hill et al., 2006; Logan et al., 2012; McGurk et al., 2008; Knox et al., 2010; Logan et al., 2012; Griffith, 2002). Besides, some studies have indicated that the increasing prevalence of suicide rate among military personnel began earlier in 2005. In fact, the rise began immediately after the US military operations in Iraq and has continued despite numerous efforts by the military management to prevent or stop such actions (Hill et al., 2006; Logan et al., 2012; Levin, 2009).
The problem escalated in 2010 and 2011 when the numbers of military personnel committing suicide were more than the number that died through normal combat (Logan et al., 2012; Hyman et al., 2012). Several theories have been advanced to explain the trend in suicide deaths among military personnel. In most cases, the psychological, emotional and mental problems have been pointed out. Moreover, the most critical observation that has been made is that the suicide rate increases with the increase in mental health problems (Bruffaerts, Demyttenaere, Hwang, Chiu, Sampson, Kessler & Nock, 2011; Edwards-Stewart, Kinn, June, Fullerton, 2011; Bush et al., 2011). Besides the studies have not proven the hypothesis that has been advanced regarding the relationship between mental illness and high rate of suicide (Bush et al., 2011).
The majority of researchers in military psychology have strongly associated mental illness and military personnel (Logan et al., 2012; Edwards-Stewart et al., 2011; Bush et al., 2011). While it is expected that the servicemembers carrying out susceptible military work and coming face to face with extreme war stressors are likely to developmental disorders that may be suicidal, researches indicate otherwise. In fact, the relationship between suicide among military personnel and mental problems has not been proven. Studies normally identify various factors working together ranging from psychological to social risk factors (Kuehn, 2009; Levin, 2009; Warden, 2006; Hill et al., 2006; Logan et al., 2012; McGurk et al., 2008; Knox et al., 2010).
However, the current spates of suicide among military personnel have little or no significant explanation supported conclusive studies. As indicated, the studies that have been conducted have majorly concentrated on the potential risk factors. However, studies on the protective factors have been scarce.
As such, there is a need for serious actions that can result in the prevention of suicidal behavior among military personnel. Moreover, given the seriousness and the scope of the problem, there is a need to increase the understanding of the problem particularly on methods through which it can be prevented. Therefore, this study is significant in widening the knowledge and understanding of the protective factors that can be applied to prevent suicidal cases among the US military.
The Risk and Protective Factors
There are differences between risk factors and protective factors. While the risk factors cause an increase in the probability of suicidal behaviors among the military personnel, the protective factors cause the decreases in the probability of imminent risk of developing suicidal behaviors particularly among the military personnel with known risk factors (Brailey et al., 2007; Brent & Mann, 2006; Bruffaerts et al., 2011; Edwards-Stewart et al., 2011).
As indicated, the studies on the protective factors have not been fully undertaken in a similar manner and passion as the risk factors particularly due to deficiencies in the empirical data (Schneiderman, Braver & Kang, 2008; McCarthy et al., 2012; Stanley, 2012). The study on the protective factors on the prevention of suicide among military personnel is highly deficient (Seligman & Fowler, 2011). Ribeiro et al., 2012 argue that the present spate of suicide among the US military is still new in the field of psychology and medicine and has not attracted many scientific studies. Besides, the protective factors on suicide have been perceived with increased uncertainty, particularly among the practitioners and researchers. However, few studies that have been conducted in this area have produced tremendous results (Hyman et al., 2012; Knox et al., 2010; Kuehn, 2009; Payne et al., 2008).
The protective factors that have been identified to play a critical role in the prevention and management of suicide particularly among the military service members include social or family support, religious affiliations, psychological protective factors, unit support among other factors (Bruffaerts et al., 2011).
Protective Factors for Suicide among the US Military Personnel
Before embarking on the protective factors that can be used to prevent suicide cases among the military personnel, it is critical to understand certain issues that surround the cases of suicide particularly factors that work together to put the individuals at risk. In fact, complex processes explain the suicide behavior among individuals (Brent, & Mann, 2006; Borges, Nock, Haro, Hwang, Sampson, Alonso & Kessler, 2010).
The risk factors are numerous but grouped together by their origination and the manner in which they work together to explain suicidal behavior in individuals. The risk factors are categorized as psychosomatic, societal, neurobiological and demographic (Asarnow, Porta, Spirito, Emslie, Clarke, Wagner & Brent, 2011; Braden & Sullivan, 2008). Most studies have observed that these factors combine to place individuals at risk of developing suicide behaviors (Brent, & Mann, 2006; Braden & Sullivan, 2008; Agrawal, Gunderson, Holmes & Lyons-Ruth, 2004; Ribeiro, Pease, Gutierrez, Silva, Bernert, Rudd & Joiner, 2012).
While considering protective factors for suicide, it is critical to acknowledge the fact that the effectiveness of these factors may differ depending on the type of suicidal process they predict (Bertolote, Fleischmann, De Leo, Bolhari, Botega & Wasserman, 2005; Borges et al.,2010). For the normal purposes of normal scientific studies and clinical uses, it is critical to understand the differences between suicide ideation, suicide plans, suicide death, and suicide attempt as well as suicide gesture (Bush et al., 2011; Brezo, Paris & Turecki, 2006). Besides, it is critical to understand the differences between suicidal self-injury and non-suicidal self-injury (Borges et al., 2010). All these concepts differ and tend to determine the type of protective factors associated with suicide.
Suicidal ideation is the process where an individual is seriously thinking about how to take away their own life (Brezo et al, 2006; Borges et al., 2010). On the other hand, a suicidal plan is an authentic arrangement to take own life (Borges et al., 2010). A suicidal attempt is taking an action with the intent of killing oneself while suicidal death is the actual killing of oneself (Bertolote et al., 2005). Distinguishing these concepts is critical in understanding how protective factors work in the prevention of suicide since the result of each concept differ in terms of associations, pathways and rates. Similarly, suicide gesture is the process of making people believe that one has made a suicide attempt. People normally make such gestures to communicate their feelings of distress or disappointment on certain issues. In addition, such gestures are used to influence the behavior of others towards one emotional status (Ghahramanlou-Holloway, Bhar, Brown, Olsen & Beck, 2012).
Social/Family Support
Family or social support of the soldiers that have signs of developing suicidal problems have been shown to be critical in alleviating such problems particularly among the service members (Levin, 2009; Hoge et al., 2006; Cha & Nock, 2009). In fact, family protective factors have been studied extensively in the recent past. The studies have indicated an inverse correlation between increased risk of suicide and family support. For instance, a controlled study by McCarthy et al. (2012) indicated low risk in individuals military service members that have a family connection, family responsibility, having children or being pregnant.
The study indicated a significant reduction of suicide risk in such individuals. The study concluded that family affiliations contribute hugely to the prevention and reduction of suicide cases among US soldiers. A study by Hyman et al. (2012) also made similar observations and concluded that all the family support is relevant in the reduction and prevention of suicide among the service members.
The notion that one is having responsibility particularly to the family members such as children reduces the chances of taking own life. Various studies indicate the increased suicide cases among bachelor soldiers compared with service members with families (Brailey et al., 2007; Brent & Mann, 2006; Bruffaerts et al., 2011; Edwards-Stewart et al., 2011; Stanley et al., 2012; Schneiderman et al., 2008). Similarly, the cases of increased distress are higher among the unmarried compared with the married service members (Brailey et al., 2007; McCarthy et al., 2012; Brent & Mann, 2006; Bruffaerts et al., 2011; Kuehn, 2009; Payne et al., 2008; Edwards-Stewart et al., 2011).
In addition, increased conversation with family members while the soldiers are in the assignment has also been associated with a reduced rate of depression which is the major risk factor for suicide cases among the military personnel (Kuehn, 2009; Hyman et al., 2012; Hill et al., 2006).
Stanley et al. (2012) studied the protective factors on veterans at increased risk of developing suicide problems and noted that like all other forms of social support, family affiliation remains a significant factor in the suicide risk reduction. The study by Stanley et al. (2012) also noted that individual work units are also important in the management of risks related to military personnel suicide. For instance, the study identified unit cohesion, the frequency with which the soldiers are in contact with family members such as the spouses and friends, social networks contributed hugely to the reduction of war stresses that increases the chance of developing suicide-associated complications.
The soldier’s experiences with their units at work are critically important in shaping their behaviors particularly concerning suicide (Hill et al., 2006; Brailey et al., 2007; McCarthy et al., 2012; Brent & Mann, 2006). A study by Payne et al. (2008) indicated close relations between happiness and better experiences with combat units. In fact, the study indicated that military personnel working under supportive work units have reduced the chances of developing risk factors associated with suicide. The social support from the units has been proven in various studies to be critically important in reducing the chances of developing suicidal behaviors among the army personnel (Levin, 2009; Hoge et al., 2006; Cha & Nock, 2009; Brailey et al., 2007; Brent & Mann, 2006; Bruffaerts et al., 2011).
In addition, prior researches by Warden (2006); Agrawal et al. (2004); Bertolote et al. 2005 indicated that the soldiers getting leadership support combined with strong peer associations reduces the probability of leaving the army and increases the likelihood of perceived combat readiness. Most importantly, unit cohesion is critical in prevention against the injurious consequences of stress, the development of Post-Traumatic Stress Disorder (PTSD) as well as other psychiatric signs (Levin, 2009; Hoge et al., 2006; Cha & Nock, 2009). In addition, unit cohesion is critical in the prevention of any occurrence of suicidal behavior (McCarthy et al., 2012; Brent & Mann, 2006).
Information pertaining to the history of the family concerning mental disorders is critical in the assessment of dangers relating to suicidal behaviors in the military environment (Kuehn, 2009; Levin, 2009; Warden, 2006). Further, stressful family-related events such as family and romantic conflicts, separation from family members, infidelity and family illness can also result in suicidal attempts among members of the military service (Hill et al., 2006; Bush et al., 2011; Kuehn, 2009; Hyman et al., 2012; Cha & Nock, 2009).
The family can play a significant role in determining the direction of the behavior of the members of the military by avowing and supporting positive behavior among the service members (Kuehn, 2009; Levin, 2009; Warden, 2006). Besides, members of the military service together with their families often undergo adversity and split up (Knox et al., 2010). As such, the family members are obliged to be observant, caring and involved in streamlining the behaviors of military service family members.
Actually, engagement in healthy social networks that support the welfare and optimum unit performance between individual service members and their families is critical (Hill et al., 2006; Logan et al., 2012; McGurk et al., 2008; Knox et al., 2010; Logan et al., 2012). Essentially, recurrent communication between members of the family and military service members is a critical protective factor.
Psychological Protective Factors
The past decade has seen an increasing trend in studies focusing on the psychological factor that may contribute to the negative outcome of suicide cases among the US military personnel (Asarnow et al., 2011; Bertolote et al., 2005; Braden, & Sullivan, 2008; Brent & Mann, 2006; Brezo et al., 2006; Bruffaerts et al., 2011). As studies have been dubbed positive psychology owing to their positive contribution and development of constructive outcomes in the prevention and management of suicide cases. Moreover, the work in the area of positive psychology has resulted in a number of constructs and procedures that are significantly critical in the understanding of the reasons why some people respond adaptively to stressful events (Bruffaerts et al., 2011).
Studies indicate a close association between mental disorders and suicidal behaviors (Asarnow et al., 2011; Bertolote et al., 2005; Braden, & Sullivan, 2008; Brent & Mann, 2006; Brezo et al., 2006). However, the manner in which the mental disorder and suicidal behavior interact cannot be explained. Increased evidence from various studies tends to relate emotional factors unrelated to psychological disturbances with increased cases of suicide (Bruffaerts et al., 2011; Asarnow et al., 2011; Bertolote et al., 2005; Braden, & Sullivan, 2008).
For instance, a study by Bertolote et al., 2005 linked emotional reactivity with psychopathology suicide ideation. In addition, the study indicated that emotional reactivity is the major cause of suicide in relation to the psychological factors unrelated to the mental disorders.
A study by Cha and Nock, (2009) categorized the psychological factors associated with increased vulnerability to the risk of suicide behavior into two major groups. The first grouping is the intolerance reported psychosomatic aspects, which directly envisage the miserable conducts (Cha & Nock, 2009). According to Cha and Nock (2009), the prejudice-reported emotional aspects range from personality to cognitive traits. In between the continuum are the temperamental factors. Cha and Nock, (2009) identified cognitive traits to include impetuosity and desperation. The next class is the dispassionately considered neurocognitive aspects, which fall within the sphere of executive functioning (Cha & Nock, 2009).
In fact, the neurocognitive aspects have been closely linked to suicidal behavior among military personnel. The impartially measured neurocognitive problems among the soldiers include getting solutions to the predicaments, decision-making procedures, emotional control and communication fluency (Cha & Nock, 2009). The most important thing regarding psychological protective factors is how to determine the combination that has a greater influence on suicidal behavior. Various models have been proposed to explain the manner in which certain combinations have been influencing suicide behavior (Schneiderman et al., 2008). However, the proposed models are still investigated to be representing the dynamics of the combined factors (Schneiderman et al., 2008).
Most models suggest that the likelihood of suicide behaviors develops depend on the mentioned conceptions acting together in order to elevate the intensity of distress a person feels in relation to a destructive situation such as high reactivity (Schneiderman et al., 2008; Cha & Nock, 2009). In addition, the previously mentioned ideas are acting together in order to decrease an individual capability of overcoming the predicaments or look for help through adaptive procedures (Bonanno, 2012; Agrawal et al., 2012; Borges et al., 2014). Besides, the probability of an individual escaping from an unattractive situation through suicide is increased through the previously mentioned concept of working together (Schneiderman et al., 2008; Cha & Nock, 2009; Bonanno, 2012).
Concerning the mental disorder, the assumption is that the psychological constructs are highly likely to influence an individual to participate in suicidal behaviors among the US military personnel. As such, finding ways through which mental behaviors can be reduced is one way through which suicide cases can be reduced.
Logan et al (2012) postulated that psychological aspects such as personality attributes, temperamental factors and cognitive-affective states including impulsiveness have often led to suicidal attempts among members of the military service. Additionally, difficulties in making choices, solving problems as well as cognitive control and verbal articulacy are risk factors that can lead to suicidal behaviors (Kuehn, 2009; Levin, 2009; Warden, 2006).
As such, imparting skills in problem-solving, conflict resolution and nonviolent handling of disagreements are effective factors that be utilized in handling suicidal attempts in the military service (Knox et al., 2010). In other words, the incorporation, as well as optimization of mental, emotional and behavioral aptitudes of the service members to increase output in terms of job performance and resilience, is invaluable (Hill et al., 2006; Logan et al., 2012; McGurk et al., 2008; Knox et al., 2010; Logan et al., 2012).
Besides, such skills and abilities are capable of enabling the service members to handle the psychological stresses and shortcomings in the military (Logan et al., 2012; Griffith, 2002). In general, strengthening psychological fitness among members of the service is responsible for ensuring that the members have the ability to survive, grow and acclimatize under perplexing situations that pose latent hazards of depression-related injuries in the line of duty.
Unit Cohesion
Studies indicate the significant unit cohesion play in the prevention and management of risks associated with suicide (Hill et al., 2006; Brailey et al., 2007; McCarthy et al., 2012). The leadership and support of the units play a significant role in the mental and emotional status of the soldiers. Besides, the mental problems that increase the risks associated with suicide are significantly reduced in situations where unit cohesion is achieved and maintained (Hill et al., 2006; Brailey et al., 2007).
In a study to determine the protective factors on veterans at increased risk of developing suicide problems, Stanley et al. (2012) noted that like all other forms of social support, unit cohesion remains a significant factor in suicide risk prevention and management. The study by Stanley et al. (2012) also noted that support from individual work units is also important in the management of risks related to military personnel suicide. For instance, the study identified unit cohesion, the type and level of support soldiers are getting from their leaders during combat, social interactions among the soldiers, the power distance and the chain of command contributed hugely to the reduction of war stresses that increases the chance of developing suicide-associated complications.
The soldier’s experience with their units at work is critically important in shaping their behaviors, particularly concerning suicide (Hill et al., 2006; Brailey et al., 2007; McCarthy et al., 2012; Brent & Mann, 2006). A study by Payne et al. (2008) indicated close relations between happiness and better experiences with combat units. In fact, the study indicated that military personnel working under supportive work units have reduced the chances of developing risk factors associated with suicide. The social support from the units has been proven in various studies to be important in reducing the chances of developing suicidal behaviors among the army personnel (Levin, 2009; Hoge et al., 2006; Cha & Nock, 2009; Brailey et al., 2007; Brent & Mann, 2006; Bruffaerts et al., 2011).
In addition, prior researches by Warden (2006); Agrawal et al. (2004); Bertolote et al. (2005) indicated that the soldiers getting leadership support combined with strong peer associations reduces the probability of leaving the army and increases the likelihood of perceived combat readiness. Most importantly, unit cohesion is critical in prevention the injurious consequences of stress, the development of Post-Traumatic Stress Disorder (PTSD) as well as other psychiatric signs (Levin, 2009; Hoge et al., 2006; Cha & Nock, 2009). In addition, unit cohesion is critical in prevention of any occurrence of suicidal behavior (McCarthy et al., 2012; Brent & Mann, 2006).
The context of Total Force Fitness (TFF)
In the US Army, the conventional health care systems utilized in the identification, assessment as well as prevention of suicides has often been centered on a deficit-based paradigm (Hyman et al., 2012; Cha & Nock, 2009). Nonetheless, contemporary society has adopted diverse ideas that are strength-based including competency, well-being, psychological fitness and resilience in preventing suicidal attempts within members of the US military service (Bush et al., 2011; Brezo et al., 2006). Actually, such concepts have been effective in addressing suicidal behaviors among members of the military (; McGurk et al., 2008).
Total Force Fitness (TFF) can be described as a combination of body spheres within a context of the body and mind (Brezo et al, 2006; Borges et al., 2010). The framework influences skills within an individual, family as well as an organizational framework to sustain prime health, performance and performance under all circumstances (Hyman et al., 2012).
The capabilities of the service members to undertake the missions of the service in their entirety and also remain fit as well as meet the standards relating to deployment, retention and continued participation in the service is critical in the prevention of suicidal behaviors (Hill et al., 2006; Bush et al., 2011; Kuehn, 2009; Hyman et al., 2012; Cha & Nock, 2009). Actually, the service offers a well-versed physical fitness package that encompasses diverse cardio training entailing basic strengthening exercises, flexibility and speed, as well as dexterity, working out (Hill et al., 2006; Bush et al., 2011; Kuehn, 2009; Hyman et al., 2012; Cha & Nock, 2009).
Additionally, the provision of opposite amounts of sleep and recovery along with effective mind-body programs to members of the military service are also utilized in the preclusion of cases relating to suicide (Griffith, 2002). Generally, maintenance of physical fitness among members of the military is a significant aspect of physical and mental well-being, performance, and enthusiasm and willingness for tasks in any situation (Bush et al., 2011). As such, by integrating physical fitness programs in the military, the service members are capable of being ready for the intensity of the operative stresses and burdens of the service without thinking about involving themselves in suicidal attempts (Hyman et al., 2012; Cha & Nock, 2009).
Cultural Factors
Cultural beliefs have been a major bottleneck in the prevention of suicides in the US military. For example, in the US military, culture leads to ignominies on soldiers from seeking assistance (Hill et al., 2006; Logan et al., 2012; McGurk et al., 2008). Riddance of dogmas that victimize soldiers who seek mental health counseling through the maintenance of privacy between soldiers and mental care providers as well as evaluation of strategies and procedures pertaining to the prohibition of soldiers from receiving necessary assistance is a critical protective factor (McGurk et al., 2008).
Further, aspects such as spiritual fitness are critical in the prevention of suicidal attempts among members of the military service (Hill et al., 2006). For instance, maintenance of strong spiritual fitness enables individuals to uphold beliefs, principles and values that are essential in providing sustenance during periods of depression among members of the service (Hill et al., 2006; Logan et al., 2012; McGurk et al., 2008). Besides, spiritual beliefs enhance personal abilities requisite during times of anxiety, adversity and misfortune (Kuehn, 2009; Levin, 2009; Warden, 2006; Hill et al., 2006; Logan et al., 2012; McGurk et al., 2008; Knox et al., 2010).
Essentially, the personal attributes emanate from religion, temperament, decision-making, integrity and philosophical values of service members (Kuehn, 2009; Hyman et al., 2012; Cha & Nock, 2009). In reality, spiritual attributes are important in providing service members with a clear comprehension of individuals’ fundamental values and feelings of individuality. As such, service members are capable of embracing unswerving behaviors in conformity with the morals, distinctiveness and veracity of individuals.
The constituents of spiritual fitness encompass spiritual beliefs, values and practices, self-awareness as well as reflection and self-examination. The components are essential in the promotion of resilience and the abilities of service members to alleviate adversarial antiphons to depressions such as suicide.
Constrained access to highly lethal means of committing suicide
The enactment of barricades to stress-free contact to disastrous means of suicide is a serious factor in the prevention of suicide cases among members of the service (Payne, Hill & Johnson, 2008; Warden, 2006). Studies indicate that having ready experience and access to lethal means such as firearms have been blamed for numerous suicide cases in the US Army (Kuehn, 2009; Levin, 2009; Warden, 2006). As such, policy interventions aimed at enhancing the safety of firearms are essential (Constans & Friedman, 2007).
For example, following policy interventions in the Israeli Army in 2006 concerning the restriction of access to firearms, close to forty percent reduction in suicide cases among the soldiers was realized (Hill et al., 2006; Bush et al., 2011; Kuehn, 2009; Hyman et al., 2012; Cha & Nock, 2009). Further, controlling access to alcohol is also an important protective measure against suicide by military service members (Kuehn, 2009; Levin, 2009; Warden, 2006).
Mental Health Treatment
Clear comprehension of mental health service among the members of the military service is a vital measure in the mitigation of suicidal behaviors in the service (Logan et al., 2012; Griffith, 2002). Essentially, structural aspects ranging from financial obstructions to deficiency of services as well as perceptual views such as superficial ineffectiveness of treatment, stigma and the desire to handle health concerns single-handedly are some of the factors obstructing the provision of mental health treatment services (Kuehn, 2009; Levin, 2009; Warden, 2006; Hill et al., 2006; Logan et al., 2012). More prominently, evaluation of alleged humiliation and shame in obtaining mental health services should be an aspect of critical concern among the soldiers. In fact, the physical health of soldiers is averred as an important suicide protective mechanism among soldiers (Griffith, 2002).
In principle, regular aerobic exercises and intake of vitamins by soldiers diminish signs of depression among individuals. Besides, instead of seeking conventional methods of mental health treatment, peer support, enhanced treatment of suicidal cases by unit command, media and online-based involvements are also considered as effective means of handling mental health concerns of members of the military service (Logan et al., 2012).
Studies indicate that Dialectical Behavior Therapy (DBT), Cognitive Therapy (CT) and Collaborative Assessment and Management of Suicidality (CAMS) are some of the psychological treatment options for suicidal behaviors among soldiers (Warden, 2006; Hill et al., 2006). To begin with, DBT is utilized in the treatment of individuals exhibiting protracted suicidal views and behaviors. On the other hand, CT aims to improve problem-solving competencies by asserting that when individuals are distressed, committing suicide is not the solution to such problems (Hill et al., 2006). In principle, suicidal attempts are seen as dysfunctional tactics of managing emotions that arise from severe sorrows and anguish. Considering CAMS, a partnership between the clinicians and the suicide patients is underscored.
As such, the phenomenological perspectives of the patients are stressed thereby providing effective appraisals concerning patients’ suicidal behaviors. Actually, such modes of psychological treatments have achieved greater reductions in suicide cases.
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