WHOLE WARRIOR HEALTH HUDDLE: BROADENING OUR KNOWLEDGE OF SUICIDE AND ADDRESSING THE PAIN OF LOSS Q & A TRANSCRIPT
(Printed with the permission of the Navy SEAL Foundation.)
Q: Is the unwellness that potential suiciders think objective or perceived? I’m thinking that some of the personal stories shared indicate ongoing success. Maybe I am mixing up success and well-being?
A: Well-being research indicates that both “objective” and “subjective” aspects of well-being are important and (not surprisingly) correlated with one another. Objective well-being typically refers to standard of living types of things such as income level, stable housing, physical health, and access to resources. These objective indicators of well-being understandably influence a person’s subjective sense of their well-being, but it is possible for someone with many objective indicators of well-being to nonetheless perceive that they are not doing well. Success is hard to define because it means different things to different people. In general, though, believing that one is successful (however you define that) is related to better well-being.
Q: Are the lack of mental health issues in suiciders a lack of diagnosis or just nonexistent?
A: There’s good reason to believe that it’s just not existent. Around half of those who die by suicide do not have a mental health condition like depression or anxiety. They may have experienced an intense level of stress right before they died by suicide, but not all forms of stress are necessarily mental health disorders.
Q: Noted that several have had medical backgrounds. Are corpsmen/combat medics at higher risk?
A: The military did some research on this around a decade ago and did find that medics (broadly defined) had a higher suicide rate than other career fields. Some research suggests this may be due in part to high levels of moral injury secondary to being unable to help patients dying and their inability to save every life.
Q: Should we read anything into if there was a suicide note left behind?
A: Probably not. The majority of suicide decedents do not leave a note. A note is much less likely to be written when the suicide occurs suddenly.
Q: What are the next steps/protocol for a family that just had a suicide?
A: I typically recommend as a first step to address basic needs like eating, sleep, and physical health. You may not feel very hungry, but it’s important to keep taking in nutrients and food to keep your body in balance while you go through this rough patch. Even something as small as a piece of fruit or soup is better than not eating at all. Ask friends and family to help with this, if needed, and make sure you accept their offers for help. Also do what you can to preserve other health-preserving activities as much as possible, even if you have to scale back a bit. Most importantly, be patient with yourself. There is no right or wrong way to respond to a suicide loss, and it’s possible for different people to have different ways of experiencing that loss.
Q: Is a holistic approach considered an option for therapy? I was recently informed by a spouse the military is possibly looking at this. Is this true?
A: When we look at the many studies published over the past fifty years, we find that some forms of therapy are much better than others. Here, “better” means the therapy leads to larger reductions in symptoms for a larger percentage of people. For PTSD, the therapies with the best outcomes and most scientific support are called prolonged exposure and cognitive processing therapy. For suicide risk, the therapy with the best outcomes and most support is brief cognitive-behavioral therapy.
Q: Thanks for doing this. It is a critical discussion. Suicide prevention, or intervention, is a contact sport. We need to move to contact when we see a Teammate acting differently, suffering, self-isolating, etc…. I think we sometimes are uncomfortable intervening when we see something wrong and move further away instead of moving to contact. How can we do this better?
A: I think we sometimes have the impression that “helping others” means we have to sit down and talk about sensitive or personal things face-to-face but moving towards someone to connect can also take the form of doing things together like working out, playing sports, working on the car, getting lunch together, etc. We can move towards others for contact by inviting them to do these sorts of things that build and strengthen connections. Sometimes it’s easier to ask a friend about how things are going when we’re “doing something” together.
Q: Is there any thought to comparing induction blood sample levels with neurosteroid levels post-blast exposures in the community, as seemed to be suggested by Dr. Mark Gordon’s lectures on the TBI/PTSD connection?
A: Research supports differences in blood-based biomarkers after TBI and PTSD. There is also some evidence for biomarker differences between people who die by suicide and those who do not. The differences generally are not large enough or specific enough to be useful as a stand-alone indicator of risk, though.
Q: What is your assessment of the tool “NuCalm?” I know it has helped half a dozen SOF members with learning to sleep again and reset their brain hormones. Care Coalition and SOCOM have begun using NuCalm to support active SOF members.
A: This is a newer technology that has not yet been studied extensively. When a new treatment or device is developed for a health condition, it’s very common for early studies to show very positive results but then those benefits dwindle in subsequent studies. I therefore usually wait to make a judgement about a new treatment or device until multiple studies have been conducted by researchers who were not the original creators or developers of the treatment/device. To that end, I would say it’s too early for me to provide a reliable assessment of NuCalm.
Q: How can we participate in your research? What programs do you have to offer?
A: We have multiple treatment studies underway testing new ways to deliver therapies for PTSD and suicide risk. One of the PTSD studies funded by the Navy SEAL Foundation combines therapy/counseling with the stellate ganglion block (SGB). Some of our studies are for military veterans and some of our studies are for any adult, including civilians. If you are interested in participating in one or more of these studies, you can send me an email at [email protected] or send an email to [email protected]