Staff Perspective: Suicide Risk During the Transition from Military to Civilian Life
As Suicide Prevention month just wrapped up, I wanted to share an article I recently read focusing on the suicide risk for transitioning Service members. Data has shown that the period of transition from military service to civilian life is one of increased risk for Service members. According to the 2023 National Veteran Suicide Prevention Annual Report, suicide rates in the 12 months following separation from the military were 48.9 per 100,000 for those who separated in 2019.
After transitioning, veterans can face challenges in a variety of areas (e.g., employment, finances, mental health, social support), as well as reduced access to health care. In an article published in 2021, Dr. Yosef Sokol and his colleagues outlined how characteristics of both transitioning Service members and the transition process itself may contribute to suicide risk using the Three-Step Theory (3ST) as a framework. The 3ST, which was developed by Drs. David Klonsky and Alexis May, explains suicide ideation and attempts in terms of four factors: pain, hopelessness, connectedness, and suicide capacity.
The first step of the 3ST explains that pain and hopelessness interact to predict suicidal ideation. When considering the transition from military service to civilian status, these authors note that Service members may experience service-related behavioral health issues and/or physical injuries alongside difficulties accessing support services. In addition, they may also be coping with challenges related to reintegrating into civilian life, such as finding and maintaining a job or continuing their education.
Step two posits that connectedness protects against the escalation of suicidal ideation among those who are high in both pain and hopelessness. However, Service members may experience disruptions to social connections during the period of transition (e.g., a simultaneous loss of military social connections and difficulty rebuilding civilian ones). In addition, as noted in the article, they may also experience disruptions of personal identity. For example, they may find that there is a sharp contrast between the military and civilian culture and values, and they may find it difficult to translate the skills that served them well in the military to civilian life.
In the third step, dispositional, acquired, and practical contributors to suicide capacity help distinguish suicide attempters from those experiencing ideation, but not attempts. Service members often have both high practical (e.g., increased access to and familiarity with lethal weapons) and acquired capacity for suicide (e.g., military training, combat exposure).
Given that we know the period of transition is one of increased risk, I think it’s important to better understand the factors that might be at play during this time. These authors did a very elegant job of describing potential risk factors for transitioning Service members through the lens of one of the prevailing theories in the field of suicidology, and I encourage you to check out the article for more details.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Marjorie Weinstock, Ph.D., is a counseling psychologist currently serving as an Associate Director at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
References:
Klonsky, D. E., & May, A. M. (2015). The three-step theory (3ST): A new theory of
suicide rooted in the "ideation-to-action" framework. International Journal of
Cognitive Therapy, 8(2), 114-129. https://doi.org/10.1521/ijct.2015.8.2.114
Sokol, Y., Gromatsky, M., Edwards, E. R., Greene, A. L., Geraci, J. C., Harris, R. E., &
Goodman, M. (2021). The deadly gap: Understanding suicide among veterans
transitioning out of the military. Psychiatric Research, 300, 113875.
https://doi.org/10.1016/j.psychres.2021.113875
U.S. Department of Veterans Affairs, Office of Mental Health and Suicide Prevention.
(2023). 2023 National Veteran Suicide Prevention Annual Report.
https://www.mentalhealth.va.gov/docs/data-sheets/2023/2023-National-Veteran-
Suicide-Prevention-Annual-Report-FINAL-508.pdf
As Suicide Prevention month just wrapped up, I wanted to share an article I recently read focusing on the suicide risk for transitioning Service members. Data has shown that the period of transition from military service to civilian life is one of increased risk for Service members. According to the 2023 National Veteran Suicide Prevention Annual Report, suicide rates in the 12 months following separation from the military were 48.9 per 100,000 for those who separated in 2019.
After transitioning, veterans can face challenges in a variety of areas (e.g., employment, finances, mental health, social support), as well as reduced access to health care. In an article published in 2021, Dr. Yosef Sokol and his colleagues outlined how characteristics of both transitioning Service members and the transition process itself may contribute to suicide risk using the Three-Step Theory (3ST) as a framework. The 3ST, which was developed by Drs. David Klonsky and Alexis May, explains suicide ideation and attempts in terms of four factors: pain, hopelessness, connectedness, and suicide capacity.
The first step of the 3ST explains that pain and hopelessness interact to predict suicidal ideation. When considering the transition from military service to civilian status, these authors note that Service members may experience service-related behavioral health issues and/or physical injuries alongside difficulties accessing support services. In addition, they may also be coping with challenges related to reintegrating into civilian life, such as finding and maintaining a job or continuing their education.
Step two posits that connectedness protects against the escalation of suicidal ideation among those who are high in both pain and hopelessness. However, Service members may experience disruptions to social connections during the period of transition (e.g., a simultaneous loss of military social connections and difficulty rebuilding civilian ones). In addition, as noted in the article, they may also experience disruptions of personal identity. For example, they may find that there is a sharp contrast between the military and civilian culture and values, and they may find it difficult to translate the skills that served them well in the military to civilian life.
In the third step, dispositional, acquired, and practical contributors to suicide capacity help distinguish suicide attempters from those experiencing ideation, but not attempts. Service members often have both high practical (e.g., increased access to and familiarity with lethal weapons) and acquired capacity for suicide (e.g., military training, combat exposure).
Given that we know the period of transition is one of increased risk, I think it’s important to better understand the factors that might be at play during this time. These authors did a very elegant job of describing potential risk factors for transitioning Service members through the lens of one of the prevailing theories in the field of suicidology, and I encourage you to check out the article for more details.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Marjorie Weinstock, Ph.D., is a counseling psychologist currently serving as an Associate Director at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
References:
Klonsky, D. E., & May, A. M. (2015). The three-step theory (3ST): A new theory of
suicide rooted in the "ideation-to-action" framework. International Journal of
Cognitive Therapy, 8(2), 114-129. https://doi.org/10.1521/ijct.2015.8.2.114
Sokol, Y., Gromatsky, M., Edwards, E. R., Greene, A. L., Geraci, J. C., Harris, R. E., &
Goodman, M. (2021). The deadly gap: Understanding suicide among veterans
transitioning out of the military. Psychiatric Research, 300, 113875.
https://doi.org/10.1016/j.psychres.2021.113875
U.S. Department of Veterans Affairs, Office of Mental Health and Suicide Prevention.
(2023). 2023 National Veteran Suicide Prevention Annual Report.
https://www.mentalhealth.va.gov/docs/data-sheets/2023/2023-National-Veteran-
Suicide-Prevention-Annual-Report-FINAL-508.pdf