U.S. combat veterans' responses to suicide and combat deaths: A mixed-methods study (original) (raw)
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DISENFRANCHISED GRIEF IN MILITARY COMBATANTS
, (MBA, Bsocsc (SW), PGDIP (Sup & mangt), Strategic Management (cert) ABSTRACT Purpose: The aim of this study is to explore the effects of combat on the social functioning of combatants. Methodology: This study engaged in the exploratory study and performed in-depth one to one interviews to collect data from respondents. The samples were members that were involved in the battle of Bangui in Central African Republic. Results: The findings from this study suggest that combatants experience the dis-enfranchised grief which is different from traumatic experience Research Limitations: The limitation was time however this did not affect the quality and the generalizability of the results. Practical Implications: The paper indicates methods to be in place to support and assist patients to maintain healthy social life. Originality/value: The study highlights the importance of acknowledging and allowing the combatants to experience franchised grief for their psycho-social recovery.
2013
According to the interpersonal-psychological theory of attempted and completed suicide (Joiner, 2005) suicide-related behavior is contingent upon three factors: acquired ability, burdensomeness, and failed belongingness. Qualitative research methodology was employed to explore these concepts among a group of returning Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) combat veterans. A sample of 16 individuals participated in interviews. Themes emerged regarding combat as a context for exposure to pain, subsequent coping strategies, and perceptions of burdensomeness, failed belongingness, and increased pain tolerance. Suicidal behavior was also articulated as a means of coping with risk factors outlined by Joiner. These results highlight the potential utility of this theory for OEF/OIF veterans. Interventions aimed at decreasing emotional dysregulation, and lessening perceptions of burdensomeness and failed belongingness may reduce risk for suicidal behavior.
Journal of Clinical Psychology, 2015
According to the interpersonal-psychological theory of attempted and completed suicide (Joiner, 2005) suicide-related behavior is contingent upon three factors: acquired ability, burdensomeness, and failed belongingness. Qualitative research methodology was employed to explore these concepts among a group of returning Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) combat veterans. A sample of 16 individuals participated in interviews. Themes emerged regarding combat as a context for exposure to pain, subsequent coping strategies, and perceptions of burdensomeness, failed belongingness, and increased pain tolerance. Suicidal behavior was also articulated as a means of coping with risk factors outlined by Joiner. These results highlight the potential utility of this theory for OEF/OIF veterans. Interventions aimed at decreasing emotional dysregulation, and lessening perceptions of burdensomeness and failed belongingness may reduce risk for suicidal behavior.
Background: Although research has identified numerous risk factors for military suicide, the contribution of combat exposure to suicide risk has not been clearly established. Previous studies finding no association of suicidality with combat exposure have employed overgeneral measures of exposure, which do not differentiate among the varieties of combat experiences. This study disaggregated the forms of combat exposure to assess the contribution of combat-related killing to morbid thoughts and suicidal ideation (MTSI) in National Guard troops deployed to Iraq. Methods: We conducted parallel analyses of two related samples: a cross-sectional sample (n = 1,665) having postdeployment interview data only and a longitudinal subsample (n = 922) having pre-and postdeployment data. We used multiple logistic regression to examine the role of killing-related exposures, after controlling for general combat and other suicide risks, and examined interactions between killing and other suicide vulnerability factors. Results: Killing-related exposure approximately doubled the risk of MTSI in the cross-sectional mul-tivariate model (Adjusted Odds Ratio [AOR] = 1.87; CI = 1.26–2.78) and the longitudinal model (AOR = 2.02; CI = 1.06–3.85), which also controlled for pre-deployment risks. Killing exposures further increased the MTSI risk associated with other suicide vulnerability factors, including depression (AOR = 14.89 for depression and killing vs. AOR = 9.92 for depression alone), alcohol dependence (AOR = 5.63 for alcohol and killing vs. 1.91 for alcohol alone), and readjustment stress (AOR = 4.90 for stress and killing vs. 1.48 for stress alone). General combat exposure had no comparable effects. Conclusions: The findings underscore a need for assessment and treatment protocols that address the psychological effects of killing-related and other potentially " morally injurious " experiences among combat soldiers. Depression and Anxiety 00:1–10, 2016.
2013
To date, the US military has made major strides in acknowledging and therapeutically addressing trauma and post-traumatic stress disorder (PTSD) in service members and their families. However, given the nature of warfare and high rates of losses sustained by both military members (e.g., deaths of fellow unit members) and military families (e.g., loss of a young parent who served in the military), as well as the ongoing threat of loss that military families face during deployment, we propose that a similar focus on grief is also needed to properly understand and address many of the challenges encountered by bereaved service members, spouses, and children. In this article, we describe a newly developed theory of grief (multidimensional grief theory) and apply it to the task of exploring major features of military-related experiences during the phases of deployment, reintegration, and the aftermath of combat death-especially as they impact children. We also describe implications for designing preventive interventions during each phase and conclude with recommended avenues for future research. Primary aims are to illustrate: (1) the indispensable role of theory in guiding efforts to describe, explain, predict, prevent, and treat maladaptive grief in military service members, children, and families; (2) the relevance of multidimensional grief theory for addressing both losses due to physical death as well as losses brought about by extended physical separations to which military children and families are exposed during and after deployment; and (3) a focus on military-related grief as a much-needed complement to an already-established focus on military-related PTSD.
Postvention in the U.S. Military: Survey of Survivors of Suicide Loss from 2010-2014
2018
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Suicide and guilt as manifestations of PTSD in Vietnam combat veterans
American Journal of Psychiatry
Although studies have suggested a disproportionate rate of suicide among war veterans, particularly those with postservice psychiatric illness, there has been little systematic examination ofthe underlying reasons. This study aimed to identify factors predictive of suicide among Vietnam combat veterans with posttraumatic stress disorder (PTSD). Meth-Qth Of 1 87 veterans referred to the study through a Veterans Administration hospital, 100 were confirmed by means ofa structured questionnaire and five clinical interviews as having had combat experience in Vietnam and as meeting the DSM-III criteria for PTSD. The analysis is based on these 1 00 cases. Results: Nineteen of the 1 00 veterans had made a postservice suicide attempt, and 1 5 more had been preoccupied with suicide since the war. Five factors were significantly related to suicide attempts: guilt about combat actions, survivor guilt, depression, anxiety, and severe PTSD. Logistic regression analysis showed that combat guilt was the most significant predictor of both suicide attempts and preoccupation with suicide. For a significant percentage of the suicidal veterans, such disturbing combat behavior as the killing ofwomen and children took place while they were feeling emotionally out of control because of fear or rage. Conclusions: In this study, PTSD among Vietnam combat veterans emerged as a psychiatric disorder with considerable risk for suicide, and intensive combat-related guilt was found to be the most significant explanatory factor. These findings point to the need for greater clinical attention to the role ofguilt in the evaluation and treatment of suicidal veterans with PTSD.
Grief and physical health outcomes in U.S. soldiers returning from combat
Journal of Affective Disorders, 2012
Background: Few studies have measured the burden of physical health problems after Iraq/ Afghanistan deployment, except in association with post-traumatic stress disorder (PTSD) or mild traumatic brain injury (mTBI). Grief, a correlate of health problems in the general population, has not been systematically examined. We aimed to identify the prevalence of post-deployment physical health problems and their association with difficulty coping with grief. Methods: Infantry soldiers (n = 1522) completed anonymous surveys using validated instruments six months following deployment in November-December 2008. Multiple logistic regression was used to assess the association of difficulty coping with grief and physical health. Results: The most frequent physical health symptoms reported were: sleep problems (32.8%), musculoskeletal pain (32.7%), fatigue (32.3%), and back pain (28.1%). Difficulty coping with grief over the death of someone close affected 21.3%. There was a dose-response relationship between level of difficulty coping with grief and principal physical health outcomes (ps b .002). Controlling for demographics, combat experiences, injuries, PTSD, depression, and other factors, grief significantly and uniquely contributed to a high somatic symptom score (adjusted odds ratio (AOR) = 3.6), poor general health (AOR = 2.0), missed work (AOR = 1.7), medical utilization (AOR = 1.5), difficulty carrying a heavy load (AOR=1.7), and difficulty performing physical training (AOR = 1.6; all 95% confidence intervals >1). Limitations: Data are cross-sectional and grief was measured with one item. Conclusions: Over 20% of soldiers reported difficulty coping with grief. This difficulty was significantly associated with physical health outcomes and occupational impairment. Clinicians should be aware of the unique role grief plays in post-deployment physical health when treating patients.
What Can Reactions to Veteran Suicide Tell Us About Patriotism in the United States?
Journal of Veterans Studies, 2021
In the United States, patriotism has meant many things. The ultimate definition, though, is one where a military member's death is offered as a sacrifice in service of his or her country: "The irrefutable sign of national faith, which we call patriotism, is making one's body an offering, a sacrifice" (Marvin & Ingle, 1999, p. 15). Every person who signs up for the military knows that (s)he may be required to die in order to complete the mission or ensure one's comrades are safe. When one thinks of military death, scenes of enemy combat first come to mind. But in the United States, there is another, far more deadly, cause of death for current and former members of the military: suicide. From 2003 to 2017, there were just over 4,400 American fatalities from combat; in 2014 alone, over 7,300 veterans killed themselves. Unfortunately, this is nothing new; suicide has long been recognized as a problem in the veteran community. This article argues that perceptions of and reactions to veteran suicide by fellow veterans tell us several things about how early 21st century American veterans interpret patriotism. To better explore this subject, we reflect on themes gathered from qualitative interviews with American veterans about suicide prevention strategies. The interviews revealed that patriotism is conceptualized as three things: as loyalty, as a perfomative value, and as a value that generates obligations from multiple levels of society.
Military Psychology, 2017
The impact of service member suicides on families is not well understood. Civilian studies have demonstrated that family survivors of suicide deaths experience complicated grief, feel guilt and shame, and often do not receive sufficient social support. In this exploratory study, spouse survivors of Marines who died by suicide (N ϭ 17), accident (N ϭ 19), and in combat (N ϭ 34) retrospectively reported on their immediate pre-and postmortem and current personal and family functioning. Nonparametric analyses revealed that several between-group differences existed. Observation of the means suggested that the spouses and families of Marines who died by suicide exhibited significantly poorer pre-and postmortem functioning compared with those whose spouses died in combat. Specific challenges included low family cohesion, high family conflict, perceived stigma, and shame. There were no differences in current spouse or family functioning, and there was weak evidence for posttraumatic growth among surviving spouses of those dying by suicide. These results should be considered preliminary and interpreted with caution given several methodological challenges. What is the public significance of this article? This study found that there was less closeness and more conflict among families whose Marine fathers died by suicide compared to families whose fathers died by other means. Spouses of those who died by suicide experience more difficult feelings emotions than those who die by other means. Prevention efforts may be enhanced by working with the families of those who are at risk for suicide. Suicide survivors would benefit from services/supports targeted to their unique needs.