Suicide Notes, Attempts, and Attempt Lethality During Episodes of Ideation Among Suicidal Soldiers and Marines

Abstract

Objective

Suicide remains a significant public health problem among military personnel despite expanded suicide prevention efforts over the last two decades. It is important to understand the behavioral antecedents of suicide, including the writing of a suicide note, to inform efforts to identify imminent risk. However, the completion of a suicide note increasing the likelihood of making a suicide attempt (SA) and predicting a higher lethality SA during episodes of suicidality have not been evaluated.

Method

To determine whether or not the completion of a suicide note increased the likelihood of making a SA during a given episode of suicidal ideation (current or worst) and predicted a higher lethality SA, we conducted secondary data analysis with a sample of 657 help-seeking, active-duty U.S. Soldiers and Marines. We hypothesized that service members who completed a suicide note would be more likely to make a SA during that given episode of suicidality and make a higher lethality SA.

Results

Completion of a suicide note increased the likelihood of making a SA in both current and worst episodes of suicidal ideation. Additionally, writing a suicide note predicted making a higher lethality SA during a service member’s current episode of ideation but not their worst episode.

Conclusions

This is the first study to examine note-writing behavior during episodes of suicidal ideation rather than following a suicide death or attempt, demonstrating a non-trivial number (17%) had written a suicide note and this increased the likelihood of making a SA and a higher lethality SA.

HIGHLIGHTS

• The first study of suicide notes during periods of ideation regardless of attempt.

• A suicide note written during an episode of ideation predicted making an attempt.

• A suicide note predicted making a more lethal suicide attempt.

Keywords:

• Suicide notes
• suicide attempt lethality
• suicidal ideation
• preparatory behavior
• military suicide

Additional information

Notes on contributors

Tierney K. Huppert

T. K. Huppert, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Rockville, MD, USA.

M. Fruhbauerova, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Psychology, University of Kentucky, Lexington, KY, USA.

Amanda H. Kerbrat and Christopher R. DeCou, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.

Katherine Anne Comtois, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Psychology, University of Washington, Seattle, WA, USA.

Martina Fruhbauerova

T. K. Huppert, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Rockville, MD, USA.

M. Fruhbauerova, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Psychology, University of Kentucky, Lexington, KY, USA.

Amanda H. Kerbrat and Christopher R. DeCou, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.

Katherine Anne Comtois, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Psychology, University of Washington, Seattle, WA, USA.

Amanda H. Kerbrat

T. K. Huppert, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Rockville, MD, USA.

M. Fruhbauerova, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Psychology, University of Kentucky, Lexington, KY, USA.

Amanda H. Kerbrat and Christopher R. DeCou, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.

Katherine Anne Comtois, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Psychology, University of Washington, Seattle, WA, USA.

Christopher R. DeCou

T. K. Huppert, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Rockville, MD, USA.

M. Fruhbauerova, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Psychology, University of Kentucky, Lexington, KY, USA.

Amanda H. Kerbrat and Christopher R. DeCou, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.

Katherine Anne Comtois, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Psychology, University of Washington, Seattle, WA, USA.

Katherine Anne Comtois

T. K. Huppert, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Rockville, MD, USA.

M. Fruhbauerova, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Psychology, University of Kentucky, Lexington, KY, USA.

Amanda H. Kerbrat and Christopher R. DeCou, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.

Katherine Anne Comtois, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Psychology, University of Washington, Seattle, WA, USA.