USC Center for Innovation and Research                                                    on Veterans & Military Families ...
USC Center for Innovation and Research                                                                on Veterans & Milita...
USC Center for Innovation and Research                                                                on Veterans & Milita...
USC Center for Innovation and Research                                                                   on Veterans & Mil...
USC Center for Innovation and Research                                                                     on Veterans & M...
Upcoming SlideShare
Loading in …5

Cir policy brief_jun2011_a.fulginiti_&_e.rice


Published on

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Cir policy brief_jun2011_a.fulginiti_&_e.rice

  1. 1. USC Center for Innovation and Research on Veterans & Military Families (CIR) POLICY BRIEF ǀ JUNE 2011 TOGETHER WE STAND, bers during the course of Operation Iraqi Freedom (OIF) and Operation Enduring Free- DIVIDED WE FALL: dom (OEF) (Tanielian & Jaycox, 2008 in CONNECTEDNESS, SUICIDE, AND Bryan & Cukrowicz, 2011), the relationship SOCIAL MEDIA IN THE MILITARY between deployment and suicide risk war- rants close monitoring, further investigation, ANTHONY FULGINITI and careful consideration in suicide preven- ERIC RICE tion programming. Mental health issues, particularly post- traumatic stress disorder (PTSD) and Major Suicide in the Military Depression, have been implicated in suicide Although the suicide rate in the military has in military populations. For instance, combat traditionally been lower than the civilian exposure has been identified as a risk factor rate (Kang & Bullman, 2008), suicide rates in for greater depression (Lapierre, Schwegler, recent years have trended upwards in active & LaBauve, 2007), PTSD (Bullman & Kang, duty military personnel and 1994; Elbogen, Beckham, veterans (Kang & Bullman, The relationship between Butterfield, Swartz, & 2008), spurring the charac- deployment and suicide risk Swanson, 2008), and terization of suicide as a warrants close monitoring, substance abuse sympto- “hidden epidemic” in the Armed Forces (Sklar, 2007 further investigation, and matology (Hooper, Rona, Jones, Fear, Hull, & Wes- in Braswell & Kushner, careful consideration in suicide sely, 2008). A recent 2010). Suicide is now the prevention programming. RAND survey indicated second leading cause of that almost one-third of death in the military (Ritchie, Keppler, & servicemembers returning from deployment Rothberg, 2003; U.S. Department of Defense, in Iraq or Afghanistan suffered a traumatic 2007 in Bryan & Cukrowicz, 2011) and sui- brain injury (TBI) or satisfied the criteria for cide rates have consistently increased across PTSD or Major Depression (Kuehn, 2009). all branches since 2006 (Carden, 2010 in PTSD has been identified as the most com- Braswell & Kushner, 2010). mon diagnosis among veterans committing Repeated or prolonged deployments in tan- suicide (Kang & Bullman, 2008), is strongly dem with related combat exposure have associated with suicidal behavior (Kessler, been identified as potential factors leaving 2000), and is a potent predictor of the trajec- servicemembers at elevated risk for suicide tory from suicidal ideation to attempt (Nock, Hwang, Sampson, Kessler, Angermeyer, (Bryan & Cukrowicz, 2011; Stewart, 2009 in Braswell & Kushner, 2010). For example, Beautrais, et. al., 2009). tour of duty duration has been linked to The Department of Defense (DoD) and the completed suicides (Adams, Barton, Mitchell, Department of Veterans Affairs (VA), sensi- Moore, & Einagel, 1998) and increased expo- tive to escalating concerns over the need for sure to combat violence has been linked to mental health service improvement, have im- increased suicidal ideation (Beckham, plemented programs to enhance screening Feldman, & Kirby, 1998; Yehuda, Southwick, and treatment of these mental health disor- & Giller, 1992). An Institute of Medicine ders in primary care environments (Keuhn, (2007) committee has similarly concluded 2008). Mental health needs have been fur- that warzone deployment confers added risk ther addressed through the establishment of for suicide in the years subsequent to de- suicide prevention coordinators in every VA ployment. Given the greater frequency and hospital in the United States and the develop- duration of deployments for servicemem- ment of a national suicide hotline staffed spe- 1
  2. 2. USC Center for Innovation and Research on Veterans & Military Families (CIR) cifically for veterans (Mills, Huber, Watts, & Varied sources have documented the relation- Bagian, 2011). ship between military life and social disintegra- tion. Combat exposure or deployment has been Social Integration in the Military linked to domestic violence, child maltreatment (Gibbs, Martin, Kupper, & Johnson, 2007), inti- In addition to mental health issues, researchers mate partner violence (Marshall, Panuzio, & Taft, have speculated that increases in suicide rates in 2005), and divorce (Prigerson, Maciejewski, & the military may be an adverse consequence of Rosenheck, 2002), with greater combat expo- disruptions in social connectedness and social sure being associated with poorer family adjust- integration. A recent study examining the root ment post-combat zone deployment (Taft, cause of suicide identified poor communication Schumm, Panuzio, & Proctor, 2008). Consistent and coordination with the veteran’s family or with the influence of disconnectedness, being social network in the community as contributing single, divorced, or separated was strongly asso- to elevated suicide risk (Mills et al., 2011). In ciated with completed suicide among service- fact, several other root causes have been linked members (Thoresen, Mehlum, Roysamb, & Ton- to broader issues of communication break- nessen, 2006). downs, such as continuity of care, coordination of care, and provider communication (Mills et al., It is important to recognize that the deployment- 2011). related disintegration in civilian social networks is accompanied by commensurate integration In an effort to aid suicide prevention efforts in into the military social network (Braswell & military personnel, recent and ongoing endeav- Kushner, 2010). Moreover, these military social ors have aimed to elucidate mechanisms driving networks can be protective with respect to sui- suicidal phenomena. Social connectedness has cide. The historically lower suicide rates in the often been touted as centrally important to suici- military during peacetime have left many to dal processes (You, Van Orden, & Conner, 2011). credit the social group cohesiveness of military Along with other well-known risk factors for sui- life as protective against suicide (Mahon, Tobin, cide, such as mental disorder, past suicide at- Cusack, Kelleher, & Malone, 2005; Martin, Ghah- tempts, physical illness, family conflict and un- ramanlou-Holloway, Lou, & Tucciarone, 2009). employment, social isolation is considered an Addressing and balancing dual social networks especially robust risk factor for suicide (Van Or- lies at the core of Battlemind Transition Train- den, Cukrowicz, Witte, Braithwaite, & Joiner, ing, which is a reintegration program that in- 2010). In fact, the strength and reliability of so- cludes, but is not limited to, simultaneously cial isolation in predicting suicidal ideation, at- maintaining both military and non-military rela- tempts, and behavior is arguably unmatched tionships (Adler, Castro, Bliese, McGurk, & Mil- (Van Orden et al., 2010). liken, 2007 in Selby, Anestis, Bender, Ribeiro, The stress associated with extended deploy- Nock, Rudd et al., 2010). ments and returning home post-deployment have been proposed as factors that may exacer- Suicide and Social Media bate suicide risk for servicemembers (Kuehn, Over the past decade a great concern has arisen 2009). Rising suicide rates have been attributed in both the academic and popular press sur- to the disintegration of family relationships, ties, rounding the role of the internet in promoting and structures associated with frequent, ex- suicidal behavior in the civilian population. The tended deployments (Stewart, 2009 in Braswell concerns focus around the idea that websites & Kushner, 2010). Interviews with OEF/OIF and user groups are discussing the means by combat veterans suggest a profound sense of which one can commit suicide, while other sites disconnection from civilians and civilian life and groups are going so far as to promote sui- (Brenner, Gutierrez, Cornette, Betthauser, Bah- cide as a solution to life’s problems and discour- raini, & Staves, 2008) and detachment from oth- age persons from seeking psychological care ers during, and subsequent to, deployment (e.g. Mehlum, 2000; Alao, Soderberg, Pohl, & (Anestis, Bryan, Cornette, & Joiner, 2009).JUNE 2011 2
  3. 3. USC Center for Innovation and Research on Veterans & Military Families (CIR) Alao, 2006). Researchers often recognize the years, Facebook has helped bridge the gap be- potential for the internet to be a vehicle for dis- tween Soldiers and their Families during ex- seminating suicide prevention messages tended separations.” (Brown, 2011). (Mehlum, 2000) or as a means by which to iden- Social media, like Facebook, may provide an ex- tify those with suicidal ideation and link them to cellent opportunity for early identification of care (Alao et al., 2006). persons at risk for suicide. To the extent that In the contemporary era, social networking web- military personnel as well as their friends and sites like Facebook and Twitter provide new op- family are made more aware of signs of emo- portunities for suicide prevention in the form of tional distress and suicidal thoughts, social me- increasing social support, social integration, and dia may be an excellent communication tool for a sense of belonging. Social me- concerned persons to reach out dia can empower persons who Social media may provide to servicemembers and veterans are physically disconnected a platform that allows when they are showing signs of from their social support net- distress. works to easily and regularly servicemembers to monitor communicate with those net- the stream of disclosure Recommendations works, which has been shown in over time, thereby allowing civilian populations to promote them to balance the level In light of the previous literature healthy behaviors (Rice, Monro, of attention to familial or that makes a clear case for the Barman-Adhikari, & Young, importance of social support 2010). civilian social networks in a and social connections in the measured way. prevention of suicide among ac- The introduction and imple- tive duty service members and mentation of social media to promote and pre- veterans, we suggest the following ways to em- serve connectedness between servicemembers ploy social media toward suicide prevention: and their social networks may aid in this urgent suicide prevention endeavor. It has long been 1. Within the constraints of necessary security recognized that communication with familial measures, encourage servicemembers, vet- networks during the period of deployment is key erans, and their families to utilize social me- to promoting morale (Wong & Gerras, 2006 in dia, such as Facebook, to maintain relation- Durham, 2010). However, servicemembers have ships with military and civilian social net- expressed that striking the balance between an works, especially during critical transitional excessive and inadequate amount of communi- periods of deployment and community rein- cation is challenging when situated in a combat tegration when social networks may be com- environment (Wong & Gerras, 2006). Moreover, promised. the ability to feel connected to loved ones de- 2. Encourage DoD to employ social media as a spite geographic distance has been identified as platform in advancing suicide prevention an issue that has the potential to impact level of programming and training for servicemem- distress (Wong & Gerras, 2006). bers, military leaders, and families, as out- Social media may provide a platform that allows lined in the recent report by the DoD Task servicemembers to monitor the stream of disclo- Force on the Prevention of Suicide by Mem- sure over time, thereby allowing them to bal- bers of the Armed Forces. ance the level of attention to familial or civilian 3. Encourage DoD to appoint a social media social networks in a measured way. Some manager to contribute to the development branches of the armed services are actively en- and oversight of social media-based suicide gaging in this model. For example, the Army has prevention initiatives that are consistent stated “Facebook is a big part of Soldier life. with existing DoD strategies. Long deployments, annual training, and unex- pected assignments force Soldiers to leave their 4. Develop—or support the development of— Families on a regular basis. For the last several psycho-education applications for smartJUNE 2011 3
  4. 4. USC Center for Innovation and Research on Veterans & Military Families (CIR) phones and tablets dedicated to suicide REFERENCES awareness and prevention, and incorporate Adams, D.P., Barton, C., Mitchell, G.L., Moore, A.L., these apps into devices being distributed to & Einagel, V. (1998). Hearts and minds: Suicide servicemembers through government train- among United States combat troops in Vietnam, ing or programs (e.g., iPhones were recently 1957–1973. Social Science and Medicine, 47(11), distributed to Army troops in the Quarter- 1687−1694. master School to enhance training outside of Alao, A.O., Soderberg, M., Pohl, E.L., & Alao, A.L. the classroom). (2006). Cybersuicide: Review of the role of the 5. Encourage Congress to fund research efforts internet on suicide. Cyberpsychology & Behavior, 9 aimed at examining trends in social media (4), 489-493. use and networking among servicemembers Anestis, M.D., Bryan, C. J., Cornette, M.M., & Joiner, who are suffering from varying degrees of T.E., Jr. (2009). Understanding suicidal behavior in suicide risk with the aim of informing sui- the military: An evaluation of Joiners interpersonal– cide intervention and prevention develop- psychological theory of suicidal behavior in two ment. case studies of active duty post-deployers. Journal ____________________ of Mental Health Counseling, 31(1), 60−75. AUTHOR BACKGROUND Beckham, J.C., Feldman, M.E., & Kirby, A.C. (1998). Atrocities exposure in Vietnam combat veterans with Anthony Fulginiti, MSW, LCSW, is a doctoral stu- chronic post-traumatic stress disorder: Relationship dent at the University of Southern California with a to combat exposure, symptom severity, guilt, and special focus on mechanisms for suicidal behavior interpersonal violence. Journal of Traumatic Stress, and suicide prevention programming. 11, 777−783. Eric Rice, Ph.D., is an assistant professor in the Braswell, H., & Kushner, H.I. (2010). Suicide, social School of Social Work at the University of Southern integration, and masculinity in the U.S. military. So- California. His area of expertise is the use of social cial Science and Medicine. doi: 10.1016/ media, social network analysis, and prevention pro- j.socscimed.2010.07.031 gramming. Brenner, L.A., Gutierrez, P.M., Cornette, M.M., Bet- ____________________ thauser, L.M., Bahraini, N., & Staves, P.J. (2008). A qualitative study of potential suicide risk factors in The views expressed in this policy brief are those of returning combat veterans. Journal of Mental Health the author and do not necessarily represent the views Counseling, 30, 211−225. of the USC Center for Innovation and Research on Veterans & Military Families (CIR) or collaborating Brown, B. (February 11, 2011). Facebook Allows agencies and funders. Soldiers to Tell their Story. Retrieved from http:// ____________________ facebook-allows-soldiers-to-tell-their-story/# FOR MORE INFORMATION Bryan, C.J., & Cukrowicz, K.C. (2011). Associations Phone: (213) 743-2050 between types of combat violence and the acquired capability for suicide. Suicide and Life-Threatening Email: Behavior, 41(2), 126-136. Website: Bullman, T.A., & Kang, H.K. (1994). Posttraumatic ____________________ stress disorder and the risk of traumatic deaths among veterans. Journal of Nervous and Mental Dis- SUGGESTED CITATION ease, 182(11), 604−610. Fulginiti, A., Rice, E. (2011). Together We Stand, Durham, S.W. (2010). In their own words: Staying Divided We Fall: Connectedness, Suicide, and Social connected in a combat environment. Military Medi- Media in the Military. Los Angeles, CA: USC Center cine, 175(8), 554-559. for Innovation and Research on Veterans & Military Families. Elbogen, E.B., Beckham, J.C., Butterfield, M.I., ____________________ Swartz, M., & Swanson, J. (2008). Assessing risk of violent behavior among veterans with severe mentalJUNE 2011 4
  5. 5. USC Center for Innovation and Research on Veterans & Military Families (CIR) illness. Journal of Traumatic Stress, 21(1), 113−117. veterans from the Iraq and Afghanistan conflicts: Review of case reports from a national veterans Gibbs, D.A., Martin, S.L., Kupper, L.L., & Johnson, affairs database. Suicide and Life-Threatening Be- R.E. (2007). Child maltreatment in enlisted soldiers havior, 41(1), 21-32. families during combat-related deployments. Jour- nal of the American Medical Association, 298, Nock, M.K., Hwang, I., Sampson, N., Kessler, R.C., 528−535. Angermeyer, M., Beautrais, A., et al. (2009). Cross- national analysis of the associations among mental Hooper, R., Rona, R.J., Jones, M., Fear, N.T., Hull, L., disorders and suicidal behavior: Findings from the & Wessely, S. (2008). Cigarette and alcohol use in WHO World Mental Health Surveys. PLoS Medicine, the UK Armed Forces, and their association with 6(8), 1−17. combat exposures: A prospective study. Addictive Behaviors, 33, 1067−1071. Prigerson, H.G., Maciejewski, P.K., & Rosenheck, R.A. (2002). Population attributable fractions of psychi- Institute of Medicine (2007). Deployment-related atric disorders and behavioral outcomes associated stress and health outcomes; Gulf War and Health, 6. with combat exposure among US men. American Washington, DC: National Academy Press. Journal of Public Health, 92(1), 59−63. Kang, H.K., & Bullman, T.A. (2008). Risk of suicide Rice, E., Monro, W., Barman-Adhikari, A., & Young, among US veterans after returning from the Iraq or S.D. (2010). Internet use, social networking, and Afghanistan war zones. Journal of the American HIV/AIDS risk for homeless adolescents. Journal of Medical Association, 300(6), 652−653. Adolescent Health, 47(6), 610-613. doi:10.1016/ Kessler, R.C. (2000). Posttraumatic stress disorder: j.jadohealth.2010.04.016 The burden to the individual and to society. Journal Ritchie, E., Keppler, W., & Rothberg, J. (2003). Sui- of Clinical Psychiatry, 61(Suppl. 5), 4−12. cidal admissions in the United States Military. Mili- Keuhn, B.M. (2009). Soldier suicide rates continue tary Medicine, 168, 177–181. to rise: Military, scientists work to stem the tide. Selby, E.A., Anestis, M.D., Bender, T.W., Ribeiro, JAMA, 131(11), 1111-1113. J.D., Nock, M.K., Rudd, M.D., Bryan, C.J., Lim, I.C., Lapierre, C.B., Schwegler, A.F., & LaBauve, B.J. Baker, M.T., Gutierrez, P.M., & Joiner Jr., T.E. (2007). Posttraumatic stress and depression symp- (2010). Overcoming the fear of lethal injury: Evalu- toms in soldiers returning from combat operations in ating suicidal behavior in the military through the Iraq and Afghanistan. Journal of Traumatic Stress, lens of the Interpersonal–Psychological Theory of 20(6), 933−943. Suicide. Clinical Psychology Review, 30, 298-307. Taft, C.T., Schumm, J. A., Panuzio, J., & Proctor, S.P. Mahon, M.J., Tobin, J.P., Cusack, D.A., Kelleher, C., (2008). An examination of family adjustment among & Malone, K.M. (2005). Suicide among regular-duty Operation Desert Storm veterans. Journal of Con- military personnel: A retrospective case-control study of occupation-specific risk factors for work- sulting and Clinical Psychology, 76(4), 648−656. place suicide. American Journal of Psychiatry, 162, Thoresen, S., Mehlum, L., Roysamb, E., & Tonnessen, 1688-1696. A. (2006). Risk factors for completed suicide in vet- Marshall, A.D., Panuzio, J., & Taft, C.T. (2005). Inti- erans of peacekeeping: Repatriation, negative life mate partner violence among military veterans and events, and marital status. Archives of Suicide Re- active duty servicemen. Clinical Psychology Review, search, 10, 353−363. 25, 862−876. Van Orden, K.A., Cukrowicz, K.C., Witte, T.K., Martin, J., Ghahramanlou-Holloway, M., Lou, K., & Braithwaite, S.R. & Joiner Jr., T.E. (2010). The inter- Tucciarone, P. (2009). A comparative review of U.S. personal theory of suicide. Psychological Review, military and civilian suicide behavior: Implications 117(2), 575-600. for OEF/OIF suicide prevention efforts. Journal of Yehuda, R., Southwick, S.M., & Giller, E.L. (1992). Mental Health Counseling, 31(2), 101e118. Exposure to atrocities and severity of chronic post- Mehlum, L. (2000). The internet, suicide, and suicide traumatic stress disorder in Vietnam combat veter- prevention. Crisis: The Journal of Crisis Intervention ans. American Journal of Psychiatry, 149, 333−336. and Suicide Prevention, 21(4), 186. You, S., Van Orden, K.A., & Conner, K.R. (2010). Mills, P.D., Huber, S.J., Watts, B.V., & Bagian, J. P. Social connections and suicidal thoughts and behav- (2011). Systemic vulnerabilities to suicide among ior. Psychology of Addictive Behaviors, 25(1), 180- 184.JUNE 2011 5