Military Providers' Attitudes Towards Assessing and Treating Suicidality

Background and Purpose: Suicide remains a significant public health concern in the United States, particularly within military populations. Primary care (PCPs) and behavioral health (BH) providers who work in military treatment facilities are well positioned to engage in suicide prevention efforts, as many individuals who attempt or die by suicide have seen a provider in the previous weeks or months. The use of evidence-based screeners and treatments for suicidality have been shown to reduce suicidal thoughts and behaviors, as well as suicide rates overall, and this is an important area in which to align policy and practice with social work research. Little is known about military providers’ attitudes and practices in this area, and how to ensure best practices in this potentially influential area.

Methods: 83 providers (61 behavioral health and 22 PCPs) working in military facilities were recruited using convenience and snowball sampling. Participants completed surveys measuring their practices and attitudes. Attitudes including professional training, perceived competency, willingness to assess and willingness to treat were adapted from Graham et al., (2011).

Results: 98% of BH providers and 41% of PCPs routinely screen for suicidality at initial appointments. The Columbia Suicide Severity Rating Scale was most commonly used in BH settings, whereas PCPs frequently relied on the Patient Health Questionnaire and Beck Hopelessness Scale. Most BH providers were trained in Collaborative Assessment and Management of Suicidality and Brief Cognitive Behavioral Therapy, while both groups commonly received training in Suicide Risk Triage and Crisis Intervention. Regression analyses revealed that professional training significantly predicted perceived competency among both groups, and, among BH providers, perceived competency further predicted willingness to assess and treat suicidal individuals (p levels for all models < .001).

Conclusions and Implications: Military providers, especially BH providers, strongly endorse the use of evidence-based screeners and protocols for treating suicidal individuals, and many have been exposed to trainings in EBPs, however, gaps remain. Policies could be adopted to encourage universal screening at initial PCP appointments, and to encourage providers to develop standard, evidence-based, protocols for people identified as suicidal. Training strongly promotes perceptions of competence, which in turn promote willingness to assess and treat. Continued efforts to train military providers in the best evidence-based practices, and policies supporting frequent screening, is an important area for the application of policy and practice with social work science.

Findings underscore the importance of aligning provider training and policy with evidence-based suicide prevention practices. Promoting universal screening in primary care and expanding training opportunities in evidence-based interventions may enhance provider competence and willingness to engage in suicide prevention, supporting broader goals in military mental health policy and social work research.