Self-reported reasons for suicidal ideation in the military: Common non-combat occupational stressors as overlooked factors

Abstract: INTRODUCTION: Identifying common reasons for Suicidal Ideation (SI) is central to prevention. Military suicide research has typically focused on combat experiences or non-work challenges such as mental illness, romantic relationships, finance, and legal issues. Stressors of performing military jobs in garrison are either absent from most suicide research, are uninformative by being presented as a homogenous category, or are restricted to relatively uncommon situations such as being under investigation. However, there are a number of reasons related to methodology and military culture to question whether more common non-combat occupational stressors, such as simply disliking one's job, might be more impactful to suicide behavior and SI than is currently reflected in the literature. MATERIALS AND METHODS: As part of a climate survey across seven U.S. Army installations, 15,496 soldiers completed anonymous surveys, which included items from the Columbia-Suicide Severity Rating Scale (C-SSRS). Where SIs were indicated, soldiers were asked to select from a list of 16 potential non-combat related reasons any they felt were "main causes" for their SI. RESULTS: In total, 1617 soldiers (10.4%) reported a wish to be dead or thoughts of suicide in the past month. The top four endorsed reasons were all common occupational stressors: "Disliking your job" (51.0%); "Feeling like a failure in your career" (50.5%); "Feeling like you don't fit in at work" (46.2%); and "Lack of support from leaders" (34.9%). In total, 76.3% of soldiers with SI endorsed at least one of these stressors as a main cause. Problems with romantic partners and finances were identified less frequently (30.4% and 28.9%, respectively). Legal issues were endorsed by 9.7% and 5.9% for Army and non-Army legal/administrative actions, respectively. Soldiers who had some intention of acting on their SI (2.7% of soldiers) had a similar distribution of responses. CONCLUSIONS: Results show the importance of common non-combat occupational stressors as identified contributors to SI, and suggest that these factors have been underestimated for cultural and methodological reasons. Results suggest that suicide prevention efforts should include leader training to ensure that subordinates find satisfaction in their work, receive regular career-based counseling, form connections with their peers, and feel supported by their leaders.