Editor’s note: This article discusses mental health, its challenges and treatment. If you or someone you know is having a mental health crisis, call the 988 National Suicide and Crisis Lifeline or contact the dedicated Veterans Crisis Line and Military Crisis Line.
The Congressionally Directed Medical Research Programs fund research for interventions to predict, prevent and treat Warfighters who exhibit early indicators of suicidal behaviors or suicidal ideation. By addressing service-specific factors impacting the mental health and well-being of Service Members, CDMRP-funded research preserves military readiness and the strength, stability and effectiveness of the U.S. Armed Forces.
The Department of Defense Annual Report on Suicide in the Military reported 523 Service Members died by suicide and another 1,370 attempted suicide in 2023. Veterans are 1.5 times more likely to die by suicide compared to the general population.
“Suicide is the leading cause of death among active-duty Soldiers, making it a top research and intervention priority,” Col. William “Scott” Killgore, Ph.D., a U.S. Army Veteran and member of the U.S. Army Reserve, said. “While several government agencies fund suicide research, most do not directly address the unique challenges faced by military Service Members.”
Daily Interventions for Lowering Suicide Risk
Service Members experience irregular sleep schedules and lack of sleep due to operational demands. Research suggests suicide is more common in the early hours of the morning, when most people are sleeping, indicating a potential link between a person’s circadian rhythm, or sleep-wake cycles, and suicidal ideation. To address this link, Killgore leads a fiscal year 2021 Traumatic Brain Injury and Psychological Health Research Program Clinical Trial Award at the University of Arizona evaluating morning light therapy to improve suicidal ideation in 400 military personnel.
“My research program focuses on addressing the most pressing performance and psychological health challenges facing our Warfighters, from optimizing sleep and performance under sleep deprivation, to building emotional resilience and supporting recovery from trauma,” Killgore said.
As part of Killgore’s clinical trial, participants receive morning light therapy, and then the research team analyzes the participants’ mood and sleep behaviors. The trial remains open for recruitment, but preliminary findings suggest beneficial changes in sleep cycles following morning active light therapy compared to placebo light therapy.
Like Killgore, retired U.S. Navy Capt. James “Curt” West, M.D., a psychiatrist at the Uniformed Services University, explores preventive interventions for those with high or low risk for suicide.
With a fiscal year 2024 Peer Reviewed Medical Research Program Clinical Trial Award, West and his team plan to assess the effect of daily folic acid, the supplemental form of vitamin B9, on suicidal ideation, suicidal behaviors and overall suicide risk score. Vitamin B9 is naturally found in foods such as dark leafy greens, vegetables and beans. Although most adults receive sufficient levels of the vitamin in their daily diets, studies identified low levels in the blood of individuals who exhibit suicidal behaviors.
West’s clinical trial will examine 5,500 active-duty Marines and Sailors over six months. The study team will assess the electronic health records of participants to collect information on hospital visits related to suicide attempts and related behaviors of participants in both the placebo and folic acid groups.
If successful, these clinical trials could provide simple, rapidly implemented daily interventions to reduce suicide risk across military and civilian populations.
Web-Based Programs Expand Access to Suicide Intervention Provider Trainings
In fiscal year 2022, the Peer Reviewed Medical Research Program funded a Technology/Therapeutic Development Award at The Ohio State University, led by Lt. Justin Baker, Ph.D., a U.S. Navy Veteran and member of the U.S. Navy Reserve, to develop self-led virtual learning courses to teach behavioral health providers effective suicide interventions. Baker and his team focus on brief cognitive behavioral therapy, a form of group or individual talk therapy for changing patterns of negative thinking and developing tools to combat problematic behaviors, and crisis response planning, which involves a single patient and therapist collaboratively developing a safety plan comprised of coping mechanisms and problem-solving tools to use during a suicidal crisis.
To date, the researchers held a summit that brought together researchers and clinicians from across the nation to provide input for the training platforms. Based on this feedback, the team filmed, edited and uploaded 12 preliminary BCBT training modules to the BCBTWeb homepage to begin initial testing with providers. Baker and his team plan to follow suit with the CRP training modules, anticipated ready for testing in fall 2025.
“Currently, we have evidence-based treatments for suicide prevention; however, few providers throughout military treatment facilities, VA hospitals, and civilian hospitals and practices are trained in these treatments,” Baker said. “By developing a web-based training in BCBT and CRP, providers from anywhere with internet will be able to access these effective treatments.”
Predicting Suicide Risk with the Help of Artificial Intelligence The Veterans Health Administration Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment program, or REACH VET, helps providers identify Veterans in the highest tier of suicide risk. Using machine learning algorithms to analyze different variables in Veteran’s electronic health records, such as medication usage, health care usage and socio-demographics, REACH VET showed an overall reduction in documented suicide attempts. Additional improvements to the model could help identify those individuals below the threshold of highest risk but considered moderate risk for suicide, allowing for earlier intervention and enhanced mental health care to prevent suicide.
With a fiscal year 2022 Investigator-Initiated Research Award funded by the Peer Reviewed Medical Research Program, Jiang Gui, Ph.D., and his team at Dartmouth College, aim to improve REACH VET by incorporating AI for the analysis of key words and phrases from providers’ clinical notes to help predict a patient’s suicide risk.
Preliminary testing of the software demonstrated that incorporating language patterns from clinical notes following psychotherapy encounters can enhance predictive accuracy of suicide risk. The team also noted a link between psychosocial risk factors, such as substance use disorder and previous mental health diagnosis, and patient language patterns. Gui and his team plan to further explore this link to improve REACH VET’s performance.
“Suicide remains one of the most urgent public health crises, particularly among Veterans and Service Members who experience disproportionally high suicide rates,” Gui said. “Continuing this research is an opportunity to build solutions that honor the lived experiences of Veterans, reduce stigma in mental health care, and provide clinicians with practical tools that save lives.”
For more information about the Peer Reviewed Medical Research Program, visit https://cdmrp.health.mil/prmrp/.
For more information about the Traumatic Brain Injury and Psychological Health Research Program, visit https://cdmrp.health.mil/tbiphrp/.