Suicide Prevention Starts with Reexamining Coping Skills

Suicide Prevention Starts with Reexamining Coping Skills

If you or someone you know is in crisis, contact the Veteran/Military Crisis Line for immediate assistance. Dial 988; then press 1.

Suicide is seldom attributed to a single circumstance or event. Instead, death by suicide tends to result from a combination of individual, interpersonal, community, and societal factors. According to the Centers for Disease Control and Prevention, suicide rates for the U.S. population increased approximately 36% from 2000 to 2022, with one death occurring about every 11 minutes.

According to the CDC, in 2020 suicide was the 12th leading cause of death in the United States of all ages, and it is also the second leading cause of death among service members, with the first being unintentional injuries (accidents).

According to the "U.S. Army Mortality Surveillance in Active Duty Soldiers, 2014-2019" published in the May 2024 Medical Surveillance Monthly Report, a peer-reviewed journal of Defense Health Agency-Public Health's Armed Forces Health Surveillance Division, self-inflicted gunshot wounds are the most common method of suicide death among soldiers and the U.S. civilian population. The report consistently found 50-70% of suicide deaths were due to firearms.

Suicide Prevention

Suicide prevention involves the collective effort of local and national organizations, health care professionals, individuals, and support systems, such as family, friends, unit leaders, and peers.

"A large part of supporting someone who is in crisis is providing practical strategies and solutions for managing difficulties," said Kimberly Buckingham, a licensed clinical psychologist at DHA-PH in Aberdeen, Maryland. "Suicide is often about escaping the pain rather than about dying. Offering someone hope that they can change their situation is an integral part of support."

The 2022 Annual Report on Suicide in the Military describes suicide as multifaceted and indicates relationship problems, workplace difficulties, administrative/legal concerns, and financial difficulties are among the top stressors for service members. Building coping skills to manage the stressors that contribute to suicidal thoughts, and preventing harmful thoughts from resulting in harmful behaviors, are essential to preventing suicide.

Building Positive Coping Skills

Service members are known for their strength, dedication, and resilience. Building healthy coping skills that enhance abilities to adapt positively to expected and unexpected life challenges play a critical role in suicide prevention and reducing self-directed harmful behaviors. Equipping service members with healthy stress management, time management, and decision making strategies, including the ability to problem-solve, destress, and adapt to change can help foster health and readiness.

Skill-based programs that teach effective relationship, communication and parenting skills have been shown to reduce suicide risk and can help both the service member and their family. Strong unit cohesiveness fostered by engaged leadership has also been shown to promote protective factors and reduce suicide risk. The U.S. Army's R2 Performance Centers are an example of a customized performance and resilience training and education program provided to service members to help build readiness, resilience, performance, and unit cohesion.

"The courses offered through the R2 Performance Centers effectively cover both doctrine and psychological performance tools related to leadership development, values-based communication, and building commitment and trust within teams," said U.S. Army Lt. Col. Virgil Rivera, a board-certified, licensed clinical social worker with DHA-PH Health education and application division.

Effective Coping Strategies to Build Resilience

A 2016 study by the U.S. Army Research Program Office examined the relationship between coping and resilience among U.S. military veterans and active duty service members, who face many stressors both at home and while deployed. For example, the study mentioned service members are "exposed to the horrors of war either by direct encounters or through the injuries and deaths of their fellow service members. Many service members deploy multiple times, often within short periods of time. In addition to exposure to combat itself, deployments bring prolonged family separations and require skills that may have only been employed during training exercises."

The Army study defined resilience as positively adapting "when faced with challenges and adversity." Another way of putting it, according to the study, is the "ability to maintain equilibrium and 'bounce back" from trauma without sacrificing functional capabilities or social appropriateness."

According to this 2016 Army study, the most frequently used coping strategies by service members and veterans included acceptance, positive reframing, active coping, planning, and religion. Here is how each is defined from the study:

• Acceptance - Acknowledging that some things are out of our control
• Positive Reframing - Thinking about a challenging situation in a positive way
• Active Coping - Actions a person directly takes to manage a stressor
• Planning - Thinking about the methods and steps to improve the situation
• Religion - Involvement with one's religious faith

How can this be practically applied? Here is how someone might use "active coping" to manage stress:

• Engaging in consistent physical activity like walking, running or exercise
• Maintaining adequate nutrition, which includes getting a daily dose of fresh fruits, vegetables and proteins
• Getting at least six-eight hours of sleep daily
• Volunteering, mentoring, and involvement in community improvement projects to build self-esteem and a sense of purpose

"A healthy lifestyle enhances overall well-being and improves resilience, mindset, and coping skills," said U.S. Army Col. Michael Cohen, command surgeon for United States Africa Command. "Sleep is essential for cognitive function and proper response to stress. Physical activity releases endorphins that improve mood and reduce stress. A balanced diet fuels the body and brain and contributes to emotional stability. Prioritizing adequate sleep, regular exercise and a healthy diet enables the mind and body to respond to mental and physical challenges properly."

Here are some additional healthy coping strategies:

• Connect with others - Spend time with family, friends, unit members
• Talk to people you trust
• Ask for support
• Journal to reframe unhelpful thoughts and causes of stress
• Practice positive affirmations and self-talk
• Connect with a faith-based community/pray
• Write down personal goals and values
• Engage in hobbies
• Spend time outdoors
• Prioritize tasks/Use a timer/organizer/schedule system to manage time
• Find a healthy method of emotional expression
  • Creating art
  • Journaling
  • Crafting
  • Playing an instrument
  • Photography
  • Making a gratitude list/Sending an encouraging email
• Relax
  • Deep breathing
  • Muscle relaxation
  • Guided imagery
  • Yoga/stretching
• Engage your mind
  • Read
  • Do puzzles
  • Listen to music

"What most people don't know is that over 99.9%of people who experience suicidal thoughts do not go on to die by suicide," said Dr. Craig Bryan, a board-certified clinical psychologist and the Trott Gebhardt Philips Professor of Psychiatry and Behavioral Health at The Ohio State University. "In most cases, people can make it through the challenges and stress they face even though it can feel hard to do. Most of us can do this by doing things we enjoy, doing things that keep us busy, or spending time with other people."

Leadership's Role in Addressing Suicide

Leadership engagement at all levels is key for reducing the stigma of asking for help and for improving overall well-being of the military family. Leaders are encouraged to create environments that establish group interaction, the personification of military service values, and support service members' sense of purpose. Additionally, leaders who utilize tools and resources to safely and effectively communicate about suicide and harmful behaviors with service members, units, and military communities can influence attitudes and behaviors and positively shape the way service members and their families view seeking help.

Recommendations

Here are tips to enhance suicide prevention and build an environment that promotes healthy techniques for managing stress, seeking help with life challenges, addressing health problems, and implementing safety measures against the common methods of suicide.

• Promote stories of resilience, help-seeking behaviors, and positive coping skills. These are powerful prevention approaches, especially when they come from trusted leaders and individuals such as family, friends, peers in the military, and other sources of support.
• Advocate help-seeking behavior by offering information and resources about crisis and noncrisis services.
• Integrate wellness and resilience topics and strategies into a unit's training calendar, such as classes on developing healthy interpersonal relationships, anger management, relaxation exercises, and the operational environment (like the use of Master Resiliency Trainers).
• Enforce the availability of gun safes, locks, and other safety devices for service members to store their personal firearms.
• Employ targeted marketing campaigns and strategies to increase awareness of healthy and unhealthy coping skills as well as lethal means safety.

Resources for Service Members, Veterans, and Families

• DOD Suicide Prevention Spotlight
• Military Crisis Line: Dial 988, then press 1; or text 838255
• Military OneSource
• Community Resource Guides
• Defense Suicide Prevention Office
• Leaders Suicide Prevention Safe Messaging Guide
• Postvention Toolkit for Military Suicide Loss
• Veterans Crisis Line: Dial 988, then press 1; or text 838255

Service-specific Programs

• Army Suicide Prevention Program
• Navy Personnel Command - Suicide Prevention
• U.S. Marine Corps Manpower & Reserve Affairs - Suicide Prevention Capability
• Department of the Air Force Integrated Resilience - Suicide Prevention