Why do active-duty military personnel die by suicide? There’s no single answer. But there may be a new way to prevent some of these deaths: with the text function on your phone.
Journals offer a glimpse of the problem’s scope. Military.com reports that active-duty suicide levels in 2018 had risen to their highest level since 2012, and a paper published in the Archives of Suicide Research noted suicide levels among service members were higher than that of the general U.S. population. It’s a historical shift, and, unfortunately, it’s a trend that continues today.
So, to return to the primary question: Why? Department of Psychiatry and Behavioral Sciences researchers Amanda Kerbrat, MSW, and psychologist Kate Comtois, Ph.D., MPH — who recently published a study in JAMA Psychiatry featuring a suicide intervention called Caring Contacts — have a few ideas.
“The military is predominantly comprised of young men, and that’s a group at elevated risk,” says Kerbrat. “We also have evidence that their suicide attempts appear to be more likely to be fatal…they’re more likely to use lethal means, such as firearms.” Military personnel are also trained to tolerate pain and fear — an adaptation that may make it easier to attempt lethal measures.
Ret. Army Col. Jay Earles, Psy.D., is the past installation director of psychological health at Fort Bragg in North Carolina. Fort Bragg was one of the partners in the Caring Contacts study, which was funded by the Military Suicide Research Consortium. He notes the role of depression and anxiety and another, perhaps unexpected factor in military suicide: the esprit de corps that people bring to their work.
“Bonding — we foster that,” Earles says. “If you feel like you’re not doing well emotionally and can’t keep up, then you might feel bad. You might think that people would be better off without you.”
In short, there are many ways in which active-duty service members might feel alone or unwell. And this is where Caring Contacts, a new twist on an old idea, comes in.
Psychiatrist Jerome Motto, M.D., remembered how much he’d appreciated the steady stream of letters he’d received from a female acquaintance when he’d fought in World War II. And, in the late 1960s, these letters helped inspire a federally funded research project. There were various components to the study, but the bottom line was that Motto proved that checking in with civilian patients — over time and with no expectations — well, it helped keep people alive.
To this day, Motto’s letter-based intervention is one of the few proven ways to prevent suicide. So when Comtois and her colleagues — including psychiatrist Richard Ries, M.D., Res. ’79 — wanted to figure out how to help suicidal military personnel, she turned to Motto’s missives for inspiration.
Comtois, Ries and Kerbrat, and UW Medicine’s partners — Womack Army Medical Center at Fort Bragg, Naval Medical Center Camp Lejeune in North Carolina, and Marine Corps Community Services at Camp Lejeune and at Marine Corps Air Ground Combat Center in Twentynine Palms, California — decided to try to send caring messages, like Motto’s. But with a new medium: phone texts.
It was an interesting experience philosophically, an invigorating mixing of military and civilian cultures.
“A lot of academic research around suicide prevention has focused on diagnosis. The research on prevention takes place via treating depression or treating bipolar disorder, or thinking diagnostically,” Comtois says. “When we were interacting with the military, there was a lot less attachment to a particular way of getting there. Ultimately, the military has a more pragmatic approach. They think: If we can move this needle, let’s do it.”
And the Caring Contacts study did move the needle.
All 658 personnel enrolled in the study received standard psychiatric care. Some of them also received Caring Contacts: brief, periodic texts that express unconditional care and concern. The group that received the text messages were less likely to make a suicide attempt and less likely to have suicidal ideation throughout the year.
Though more research needs to be done, Motto’s basic premise of showing caring — sans expectations — seems to work for active-duty service members. Though the idea wasn’t covered in the study, Kerbrat wonders aloud if texting works better than phone calls, especially with the younger generation. When you send a text, there’s less expectation of reciprocity.
“As John Oliver says about people who call him, ‘Why can’t you just text me, like a normal person?” says Kerbrat. “The Caring Contacts texts aren’t contingent on anything that the recipient does or doesn’t do. The messages just come.”
Although their study used trained professionals to deliver the texts, the two women reflect for a moment on a less-controlled experiment: regular, everyday human kindness, delivered by phone. A friend of Kerbrat’s sends low-key “I’m thinking of you” texts to a distressed friend. Comtois herself regularly texts a depressed cousin.
“Most of the time, this cousin doesn’t get back to me, and it drives other people in the family bananas,” says Comtois. “But it’s a way of reminding her that she’s part of the web of the world.”