Exploring military providers’ attitudes assessing and treating patients’ suicidality

Abstract:Suicide is a major public health problem and among the leading causes of death in the United States. Active-duty US Army soldiers are at greater risk for suicide compared to civilians. A high percentage of individuals who die by suicide have seen a primary care provider (PCP) or behavioral health (BH) provider within 1-12 months of death. Theseproviders are well-positioned to engage in suicide prevention. Researchers have explored providers' views and attitudes in assessing and treating suicidality, however, military providers are understudied.Twenty-two PCPs and 61 BH providers working in military treatment facilities (MTFs) completed surveys that included an established measure adapted for military personnel, abouttheir practices and attitudes towards patients’ suicidality. While most participants were White males, >20% percent were Black, and >20% were of Hispanic ethnicity. Most providers were uniformed with clinical training in military settings.PCPs reported often screening while BH providers reported always screening for suicidality at initial appointments (p <.001), but PCPs were using depression-based screeners while BH providers reported using suicide risk screeners. Compared to PCPs, BH providers reported more often using a standardized protocol for identified suicidal patients (p <.05); andhaving more formal training and expertise in interventions used to treat a suicidal patient (p <.001).Compared to PCPs, BH providers scored higher on the adapted measure’s composite scales for professional training, perceived competency, willingness to assess, willingness to treat suicidality (p <.001 for all). Regression models found professional training predicted perceived competency in both PCPs and BH providers. In BH providers only, perceived competency predicted willingness to assess. Perceived competency and personal experience with BH issues predicted willingness to treat (p <.001 for all).Study findings among military providers are consistent with literature among providers in civilian settings. Suicide prevention requires a multipronged approach (patient, provider; strategic and policy level changes). Future research should test the adapted measure among a larger and more diverse sample of providers. Further, we propose a series of policy changes to encourage more training of providers in MTFs in both suicide assessment and intervention and collection of real-time suicide surveillance data to measure effectiveness.