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Objective: This study identified and prioritized research gaps for suicide prevention in the Department of Defense to inform future research investments.Methods: The 2019 VA/DoD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide was the primary source document for research gaps, supplemented by an updated literature search. Institutional stakeholders rated the identified research gaps and ranked the gap categories. We used Q factor analysis to derive a list of the prioritized research gaps and category rankings.Results: Thirty-five research gaps were identified and prioritized. The highest rated research gap topic was lethal means safety interventions and their effectiveness in increasing safety behaviors and/or reducing suicide-related outcomes. Research on the effectiveness of crisis response planning and several other non-pharmacological interventions (e.g., implementation of cognitive-behavioral therapy, technology-based behavioral interventions, and applications of dialectical behavior therapy to non-Borderline patients) were also rated highly by stakeholders.Conclusions: This work generated a list of priorities for future suicide research as evaluated by Departments of Defense and Veterans Affairs stakeholders. Our findings can help guide the efforts of suicide researchers and inform decisions about future research funding for suicide prevention. [ABSTRACT FROM AUTHOR]

High treatment dropout rates reported in recent literature have brought into question the effectiveness of trauma‐focused posttraumatic stress disorder (PTSD) treatments among military populations. The aim of the current systematic review was to evaluate PTSD treatment dropout rates among military populations by treatment type and other study‐level variables. We searched four databases as well as gray literature for randomized controlled trials that evaluated evidence‐based PTSD treatments in samples of active duty personnel and/or veterans. In total, 26 studies were included in this review, with a total of 2,984 participants. We analyzed dropout rates across treatment types using multivariate meta‐analysis. Across all forms of treatment, the aggregated dropout rate was 24.2%. Dropout percentages based on treatment type were 27.1% for trauma‐focused treatments, 16.1% for non–trauma‐focused treatments, and 6.8% for waitlist groups. We found substantial heterogeneity between studies that was not explained by military status or other study‐level covariates. Summary risk ratios (RRs) comparing relative dropout between treatment groups indicated that trauma‐focused treatment groups had a higher risk of dropout compared to non–trauma‐focused treatments, RR = 1.60. The statistical heterogeneity of within‐treatment dropout risk ratios was negligible. Dropout rates among military patients receiving trauma‐focused therapies were only slightly higher than those reported in the literature among civilian populations and were not explained by study‐level covariates. [ABSTRACT FROM AUTHOR]

Prior research indicates that there is an additive association between traumatic brain injury and mental health diagnoses on health-care utilization. This assumed additivity has not been formally assessed. The objective of this study was to estimate additive and multiplicative interactions associated with mild traumatic brain injury (mTBI) and pre-existing health conditions. Active-duty military patient records over a nine-year period were sampled within four exposure groups (N = 4500 per group) defined jointly by incident mTBI and pre-existing mental health diagnoses. Outpatient and inpatient health encounters were compared between the four exposure groups using generalized linear models for count and proportion outcomes. Additive interactions were estimated using the interaction contrast ratio. Multiplicative interactions were estimated as a product term in the generalized linear models. The joint association of mTBI and pre-existing mental health diagnoses with health-care utilization, overall, was less than multiplicative and greater than additive. Patients with both exposures experienced more health-care utilization than expected under the assumed additivity (independence) of the two exposures. PTSD and anxiety diagnoses were the MH diagnoses associated with the largest interaction contrast values specific to total outpatient encounters. Studies of the interaction of two diagnoses on subsequent health-care utilization should examine both additive and multiplicative interactions. The greater-than-additive findings in this study indicate that there may be synergy, for at least some patients, between mTBI injury and mental health that complicates the treatment course. [ABSTRACT FROM AUTHOR]

Purpose: Measurement of simulator-related side effects (SSEs) is an integral component of competent and ethical use of virtual reality exposure (VRE), but common SSEs may overlap with symptoms of anxiety. Limited research exists about the frequency of SSEs during VRE treatment for post-traumatic stress disorder (PTSD) and no research compares self-reported SSEs for those undergoing VRE with those participating in exposure therapy without virtual reality. This study compared the SSEs of active duty soldiers with PTSD randomly assigned to exposure therapy through traditional prolonged exposure or VRE. Methodology: A total of 108 soldiers participated in up to 10 sessions of exposure therapy. Of those, 93 provided data on simulator sickness both before and after initiation of imaginal exposure. Approximately half (n = 49) used the Virtual Iraq/Afghanistan system to support engagement with their trauma memory. Soldiers completed a 4-item, self-reported measure of SSE after each session. Results: Controlling for age, gender, baseline anxiety symptoms, and SSE symptom counts at the first two sessions of therapy (before initiating imaginal exposure), there was no statistically significant difference between the treatment groups in SSEs at the beginning of imaginal exposure or over the course of treatment. Conclusions: This finding suggests that caution should be exercised in the interpretation of SSE measurements during the use of VRE for PTSD. Virtual reality did not account for any increase in self-reported SSE. It is possible that anxiety accounts for a meaningful proportion of SSE reports during VRE. [ABSTRACT FROM AUTHOR]

Military suicide has increased over the past decade and reports of Service Member and Veteran suicides receive media attention. Some methods of reporting suicide appear to cause a “media contagion” effect, potentially increasing suicide. This effect is explored in relation to media reports of both military and civilian suicides. To reduce possible contagion, recommendations for media reporting of suicides were adapted by the Suicide Prevention Resource Center (SPRC). We assessed 240 military and civilian newspaper reports of suicide from 15 different sources for compliance with the SPRC guidelines. Nearly all reviewed articles violated at least one guideline. Results highlighted military news articles regarding Service Members included more pejorative language and discussion of failed psychological treatment. Conversely, civilian articles romanticized the victim and provided more details regarding the suicide. Further exploration of military suicide reporting bias is discussed as a need in future research. [ABSTRACT FROM PUBLISHER]