Suicide is one of the top two causes of death among military service members, and suicide rates among this population have been increasing over the past 20 years.

In an effort to improve and implement effective suicide prevention interventions for military service members, the U.S. Department of Defense (DoD) has awarded $8.4 million to researchers with The Ohio State University Wexner Medical Center and College of Medicine to conduct five suicide prevention studies.

“Beyond the tragic loss of human life, suicides by military personnel have broad impacts on family and friends as well as fellow military personnel, and they adversely impact national security. Research has even shown that military personnel who know another service member who died by suicide are at increased risk of suicidal behavior,” said principal investigator Craig Bryan, a clinical psychologist, professor and director of the Division of Recovery and Resilience at Ohio State’s Department of Psychiatry and Behavioral Health.

Craig Bryan, PsyDOhio State researchers have developed several strategies that are effective for preventing suicidality among military personnel, but little is known about when or for whom these strategies are most likely to work.

The Augmenting Suicide Prevention Interventions for Servicemembers (ASPIS) collaboration proposes to address this overarching challenge by conducting five synergistic studies guided by a common, overarching question: What strategies, delivered how, by whom and under which circumstances, are most effective for which service members?

“Overall, the knowledge obtained from our five studies will preserve and sustain military readiness, enhance quality of life for service members, and prevent suicidality by improving our ability to deliver the right interventions to the right service members at the right time,” said Bryan, a senior researcher in The Suicide and Trauma Reduction Initiative for Veterans (STRIVE) at Ohio State.

STRIVE is one of the nation’s leading research sites for clinical trials on suicide treatment, prevention and intervention. The nationally recognized team conducts research, education, outreach and advocacy for improving the lives of military personnel, veterans, first responders and their families.

Each of the five research projects focuses on an empirically supported strategy that has demonstrated effectiveness for preventing suicidal behavior among military personnel in at least one randomized clinical trial. The projects will be conducted in a variety of settings, including primary care, outpatient mental health, emergency departments and the community, with a diverse spectrum of military personnel recruited from all service branches.

• Project 1 involves a two-stage study aimed at developing and testing a treatment prognosis calculator to identify which suicidal service members are likely to respond well to typical mental health treatment and which should instead receive brief cognitive behavioral therapy for suicide prevention, a specialized treatment proven to reduce suicide attempts among military personnel by 60%. This project will be led by Jay Fournier, director of the Mood and Anxiety Program at Ohio State’s Department of Psychiatry and Behavioral Health. It will be conducted across three military bases: Lackland Air Force Base in Texas, Wright-Patterson Air Force Base in Ohio and Joint Base Andrews in Maryland.

• Project 2 is a clinical trial to test the effectiveness of brief cognitive behavioral therapy for suicide prevention delivered via smartphone app, for reducing suicidal ideation and suicide attempts among service members seeking treatment in primary care clinics. Service members will be repeatedly assessed for one year to determine if use of the app reduces suicidality as compared to treatment as usual. The study will be conducted in primary care clinics at Fort Carson, Colo.

• Project 3 is a clinical trial to assess the impact of crisis response planning training for emergency department clinicians. In this study, emergency department clinicians will be randomly assigned to participate in a crisis response planning workshop with follow-up consultation and support. Crisis response planning is a brief intervention proven to reduce suicide attempts among military personnel by 76 percent. Service members will be repeatedly assessed for one year to determine if crisis response planning reduces their suicidality as compared to existing crisis management procedures.

• Project 4 will seek to understand for whom and under what circumstances specific stress management strategies are most effective for reducing suicidality. This project will enroll a national sample of suicidal service members who are not engaged in mental health treatment. All participants will collaboratively develop a crisis response plan with a trained researcher, then complete 28 consecutive days of assessment surveys via smartphone to assess real-time fluctuations in suicidal ideation and use of stress management and crisis response planning strategies. This project will be led by Lauren Khazem and Heather Wastler, who are both assistant professors in Ohio State’s Department of Psychiatry and Behavioral Health.

• Project 5 will test a brief intervention designed to improve the effectiveness of lethal means counseling on secure firearm storage among firearm owning service members. Participants will receive a brief intervention to improve their ability to tolerate uncertainty as well as lethal means counseling, with a 14-day period of smartphone-based surveys to assess real-time fluctuations in mood following each intervention. Researchers will assess safe firearm storage practices during follow-up. This project will be led by Nik Allan, research assistant professor in Ohio State’s Department of Psychiatry and Behavioral Health.

“Our projects seek to help military clinicians make optimal treatment decisions for service members exhibiting suicidal ideation and will help military leaders decide how to best prioritize and allocate resources surrounding practical but potentially costly matters like treatment implementation efforts and clinician training for effective suicide prevention strategies,” Bryan said.

This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs and the Defense Health Agency J9, Research and Development Directorate or the U.S. Army Medical Research Acquisition Activity at the U.S. Army Medical Research and Development Command, in the amount of $8,375,496 through the Peer Reviewed Medical Research Program under Award No. (W81XWH-22-2-0072). Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense.

(Editor’s note: The Veterans Crisis Line and Military Crisis Line connect veterans and service members in crisis and their families and friends with qualified, caring U.S. Department of Veterans Affairs responders through a confidential toll-free hotline, online chat or text at 1-800-273-8255 (press 1).

The National Suicide Prevention Lifeline is a hotline for individuals in crisis or for those looking to help someone else. To speak with a certified listener, call 1-800-273-8255. Crisis Text Line is a texting service for emotional crisis support. To speak with a trained listener, text HELLO to 741741. It is free, available 24/7, and confidential.)