Interventions for People Who Have Attempted Suicide and Their Family Members: A Systematic Review

Following a suicide attempt, components of aftercare can include efforts to reduce suicidal behavior (i.e., suicide, attempt, or ideation) of a person who has attempted suicide and facilitate the psychosocial adjustment of the patient and their family members. The purpose of this systematic review and meta-analysis of key outcomes was to synthesize the existing evidence on interventions for people who have attempted suicide and their family members. The authors found that aftercare interventions show a statistically significant reduction in further suicide attempts for intervention participants. Studies also reported a reduction in suicide deaths, depression, and hopelessness, but the results are based on limited quality of evidence. The uptake of interventions and treatment retention varied widely by aftercare intervention. The authors could not explore the effects of the intervention target (e.g., participants who attempted suicide versus family members or both) or populations because of the homogeneity of the sample and the lack of studies measuring family member responses. The identified studies did not meaningfully address the effects of interventions on family members because these were rarely included in existing research studies.

A scoping review of military and Veteran families within international suicidality and suicide prevention research

The impacts of suicidality on families are well known, which is particularly relevant in at-risk populations, such as active duty military personnel and Veteran communities. This scoping review describes how military and Veteran families have been conceptualized within suicide prevention research. A systematic, multi-database search was conducted, and 4,835 studies were screened. All included studies underwent quality assessment. Bibliographic, participant, methodological, and family-relevant data was extracted and descriptively analyzed into Factors, Actors, and Impacts. In total, 51 studies (2007 - 2021) were included. Most studies focused on suicidality rather than suicide prevention. Factor studies described family constructs as a suicidality risk or protective factor for military personnel or Veterans. Actor studies described families' roles or responsibilities to act in relation to the suicidality of military personnel or Veterans. Impacts studies described the impacts of suicidality on military and Veteran family members. The search was limited to English language studies. There were few studies on suicide prevention interventions for or including military and Veteran family members. Family was typically considered peripheral to the military personnel or Veteran experiencing suicidality. However, there was also emerging evidence of suicidality and its consequences in military-connected family members.

Diversity in U.S. Military Families: An Environmental Scan of the Peer-Reviewed Literature on Race and Ethnic Variation for Select Well-Being Outcomes

Researchers explore the literature on race and ethnicity (R/E) in relation to U.S. military service member well-being in the areas of mental health, behavioral health, family violence, marital satisfaction, and financial stress to uncover whether past research has focused on R/E differences in outcomes as a driving research question; the variables used to capture R/E; and the quality of research in terms of design, data, and analysis. The Department of Defense (DoD) has expressed commitment to improving diversity and inclusion in the military. If leaders seek to do this based on existing evidence, they will find that information about how R/E intersects with the well-being of service members and their families is extremely limited. DoD should consider developing a deliberate, strategic, and comprehensive research agenda on R/E diversity in service member and family well-being outcomes. This will help DoD identify where differences exist and where policies and programs can address those gaps.

How the Dobbs Decision Could Affect U.S. National Security

Women are an integral part of the military, comprising 17.2 percent of the active-duty force. They are the fastest-growing subpopulation in the military. In recent years, the Department of Defense (DoD) and military services have been deliberately recruiting women because they represent a higher percentage of the recruitable population than their male counterparts. Service women and their civilian counterparts have been and are serving in roles that are essential to military readiness. The Dobbs v. Jackson Supreme Court ruling will limit service women's and DoD civilian women's access to reproductive health care and affect the health of these critical populations. In this article, the authors use publicly available data to provide an estimate of the scope of the effects of the decision on the health and readiness of the U.S. armed forces. They estimate how many military-employed women's reproductive health options have been or might soon be limited and identify force readiness-related concerns, such as effects on the military health care, education, and child care systems, as well as on military recruiting and retention.

The Impact of Mindfulness Meditation Programs on Performance-Related Outcomes: Implications for the U.S. Army

Although studies have suggested that mindfulness-based interventions might be effective in enhancing military readiness and resilience, this has not been rigorously evaluated. This study presents results from a systematic review and meta-analyses of research examining how mindfulness meditation affects 13 performance-related outcomes of interest to the U.S. Army and broader military. The authors supplemented the systematic review by examining how mindfulness meditation could support stress management and exploring characteristics of selected mindfulness programs. The goal was to develop recommendations for mindfulness meditation programs for soldiers, should the Army choose to implement such programs in the future. Findings suggest that mindfulness may improve some aspects of attention and emotion regulation, impulsivity, and work-related morale and social support. The available evidence does not suggest that mindfulness improves other outcomes of interest to the Army. Notably, mindfulness meditation programs reduce stress and may reduce parental stress, which could benefit Army families. Yet more research is needed to identify best practices for implementing mindfulness programs in the military. The authors recommend conducting high-quality evaluations of mindfulness meditation with soldiers and assessing the effect of mindfulness meditation on military families.

Mental Health Outcomes Associated with Risk and Resilience among Military-Connected Youth

The present study aimed to describe patterns of risk and protective factors affecting U.S. Army families and their association with mental health diagnoses among military-connected children. Wartime military service is associated with increased adverse outcomes for military-connected youth, but few studies have explored the impact of concurrent risk and access to protective factors. Using big data methods to link existing datasets, protective factors (e.g., marital and family functioning) were drawn from a voluntary survey completed by 1,630 US Army spouses. Risk factors (e.g., parent mental health, family moves, deployment) were drawn from Department of Defense (DoD) archival data. Rates of mental health diagnoses among youth were derived from DoD healthcare records. Using the three-step method of latent profile analysis, five profiles emerged with variability across risk and protective factors. The largest group (40% of the sample) had considerable protective factors and limited risk exposure. Statistically significant differences in the prevalence of mental health diagnoses among military-connected youth were observed across profiles (χ²  = 30.067, df = 4, p < .001), with the highest rates (31.1% and 30.5%) observed in the two profiles with the lowest protective factors. Findings suggest most military families are faring well and highlight the importance of a thorough assessment that evaluates both the stressors military families face and the strengths they possess.

Community, Context, and Coping: How Social Connections Influence Coping and Well-Being for Military Members and Their Spouses

Military members and their spouses (n = 223 families) were selected from an Active Duty Army installation and assessed with regard to their connections with the military community, their levels of coping with military culture demands, and their reports of individual (depression and life satisfaction) and family well-being. Guided by the contextual model of family stress and the social organization theory of action and change, results from a structural equation model indicated that military community connections, for both military members and their civilian spouses, were related to coping with the military culture and its demands, which in turn was related to both individual and family well-being. Unique actor and partner effects also emerged where both active duty military members' and their civilian spouses' perceptions of military community connections influenced the civilian spouses' satisfaction with military life, but only the active duty military members' community connections influenced their military-specific coping. Additionally, the associations between military-specific coping and individual and family well-being only had actor effects. When examined within the context of important military culture elements, namely rank and extent of military transitions (deployment and relocation), these core findings linking communities to coping and well-being were unchanged. Implications for theory, future research, and practice are shared.

An Evaluation of U.S. Military Non-Medical Counseling Programs

This study evaluates two programs offered by the U.S. Department of Defense (DoD) that provide short-term, solution-focused counseling for common personal and family issues to members of the U.S. military and their families. These counseling services are collectively called non-medical counseling within the DoD and are offered through the Military and Family Life Counseling (MFLC) and Military OneSource programs. RAND's National Defense Research Institute was asked to evaluate these programs to determine whether they are effective in improving outcomes and whether effectiveness varies by problem type and/or population. Two online surveys were provided to program participants-the first two to three weeks after their initial session and the second three months later. Surveys were designed to gain information on 1) problem severity and overall problem resolution, 2) resolution of stress and anxiety, 3) problem interference with work and daily life, 4) connection to other services and referrals, 5) experiences with MFLC and Military OneSource programs, and 6) perceptions of non-medical counselors. The majority of participants experienced a decrease in problem severity and a reduction in reported frequency of feeling stressed or anxious as a result of their problem following counseling. These improvements were sustained or continued to improve in the three months after initiation of counseling. Non-medical counseling was not universally successful, however, and a small minority expressed dissatisfaction with the program or their counselor. Collectively these findings suggest a number of policy implications and programmatic improvements of interest to program leadership in the Office of the Secretary of Defense.

Bridging Gaps in Mental Health Care: Lessons Learned from the Welcome Back Veterans Initiative

Over the past decade, there have been a growing number of efforts designed to support service members, veterans, and their families as they cope with deployments. Addressing the mental health consequences associated with these deployments has been a priority focus area across the government and nongovernment sectors. The Welcome Back Veterans (WBV) initiative was launched in 2008 by Major League Baseball and the Robert R. McCormick Foundation to support organizations that, in turn, provided programs and services to support veterans and their families. Since WBV's founding, it has issued grants to academic medical institutions around the nation to create and implement programs and services designed to address the mental health needs of returning veterans and their families. Since 2013, WBV has made strides in assisting service members, veterans, and families and in facilitating collaboration among systems of care in local communities. However, strategic efforts are needed to promote sustainability and address emerging challenges as individual programs move toward greater coordination with others in the system of care for veterans. WBV grantees and other programs must continue adapting to sustain their mental health service offerings to meet the demand for care but also to improve integration and coordination. Expanding collaborative networks and adopting a system-of-systems approach may help private mental health care programs like WBV continue to build capacity and have a positive effect going forward.

Improving Support for America's Hidden Heroes: A Research Blueprint

The United States is home to more than 21 million veterans, many of whom deployed to support combat operations around the globe during their military service and sustained service-related conditions or disabilities. Supporting these wounded, ill, and injured warriors once home are millions of informal caregivers-individuals who provide unpaid support with activities that enable the service member or veteran to live in a noninstitutionalized setting. In this study, researchers describe elements of a research blueprint to inform future efforts to improve support for military and veteran caregivers. To construct this blueprint, researchers inventoried currently available research on caregiving for disabled adults and children and gathered stakeholder input by conducting a survey and facilitating an online panel. The study highlights the need for more studies that examine how military and veteran caregiver needs evolve over time, how programs are working, and how caregiving affects specific subgroups. The resulting blueprint should serve as a guide for the caregiver support community to use in prioritizing and facilitating future research.

The Unified Behavioral Health Center for Military Veterans and Their Families: Documenting Structure, Process, and Outcomes of Care

Many veterans and their families struggle with behavioral health problems, family reintegration difficulties, and relationship problems. Although many veterans are eligible to receive care at Department of Veterans Affairs health facilities, family members are generally not eligible and therefore must seek care elsewhere. This situation can pose a barrier to family members' access to care and also make it more difficult for veterans and families to receive high-quality services that are coordinated across providers. A new model of behavioral health care is trying to address these barriers: Created by the Northwell Health System and the Northport Veterans Affairs Medical Center, the Unified Behavioral Health Center (UBHC) for Military Veterans and Their Families in New York state is a public-private partnership that is providing colocated and coordinated care for veterans and their families. RAND evaluated the center's activities to document the implementation of a unique public-private collaborative approach for providing care to veterans and their families. The first component of the evaluation focused on documenting the structures of care (the capacities and resources that the center developed and employed) and the processes of care (the services delivered). The second component focused on outcomes of care. The evaluation suggests that, overall, the model has been successfully implemented by the UBHC and has great potential to be helpful to the veterans and families it serves.

TRICARE Applied Behavior Analysis (ABA) Benefit: Comparison with Medicaid and Commercial Benefits

This study compared the Applied Behavior Analysis (ABA) benefit provided by TRICARE as an early intervention for autism spectrum disorder with similar benefits in Medicaid and commercial health insurance plans. The sponsor, the Office of the Under Secretary of Defense for Personnel and Readiness, was particularly interested in how a proposed TRICARE reimbursement rate decrease from $125 per hour to $68 per hour for ABA services performed by a Board Certified Behavior Analyst compared with reimbursement rates (defined as third-party payment to the service provider) in Medicaid and commercial health insurance plans. Information on ABA coverage in state Medicaid programs was collected from Medicaid state waiver databases; subsequently, Medicaid provider reimbursement data were collected from state Medicaid fee schedules. Applied Behavior Analysis provider reimbursement in the commercial health insurance system was estimated using Truven Health MarketScan® data. A weighted mean U.S. reimbursement rate was calculated for several services using cross-state information on the number of children diagnosed with autism spectrum disorder. Locations of potential provider shortages were also identified. Medicaid and commercial insurance reimbursement rates varied considerably across the United States. This project concluded that the proposed $68-per-hour reimbursement rate for services provided by a board certified analyst was more than 25 percent below the U.S. mean.

The Deployment Life Study: Longitudinal Analysis of Military Families Across the Deployment Cycle

In 2009, RAND launched the Deployment Life Study, a longitudinal study of military families across a deployment cycle in order to assess family readiness. Family readiness refers to the state of being prepared to effectively navigate the challenges of daily living experienced in the unique context of military service. The study surveyed families at frequent intervals throughout a complete deployment cycle---before a service member deploys (sometimes months before), during the actual deployment, and after the service member returns (possibly a year or more after she or he redeployed). It assessed a number of outcomes over time, including: the quality of marital and parental relationshipsthe psychological, behavioral, and physical health of family memberschild and teen well-being (e.g., emotional, behavioral, social, and academic)military integration (e.g., attitudes toward military service, retention intentions).This culminating paper briefly reviews the study design and data collection procedures, presents results from analyses of the longitudinal data collected from some 2,700 military families, and offers recommendations for programs and future research related to military families. The research was jointly sponsored by the Office of the Surgeon General, U.S. Army, and by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.