- 1. USC Center for Innovation and Researchon Veterans &
Military Families (CIR)POLICY BRIEF JUNE 2011 TOGETHER WE
STAND,bers during the course of Operation Iraqi Freedom (OIF) and
Operation Enduring Free-DIVIDED WE FALL: dom (OEF) (Tanielian &
Jaycox, 2008 in CONNECTEDNESS, SUICIDE, AND Bryan & Cukrowicz,
2011), the relationship SOCIAL MEDIA IN THE MILITARYbetween
deployment and suicide risk war- rants close monitoring, further
investigation, ANTHONY FULGINITI and careful consideration in
suicide preven- ERIC RICE tion programming. Mental health issues,
particularly post- traumatic stress disorder (PTSD) and Major
Suicide in the Military Depression, have been implicated in suicide
Although the suicide rate in the military has in military
populations. For instance, combat traditionally been lower than the
civilianexposure has been identified as a risk factor rate (Kang
& Bullman, 2008), suicide rates in for greater depression
(Lapierre, Schwegler, recent years have trended upwards in active
& LaBauve, 2007), PTSD (Bullman & Kang, duty military
personnel and1994; Elbogen, Beckham, veterans (Kang & Bullman,
The relationship between Butterfield, Swartz, & 2008), spurring
the charac- deployment and suicide risk Swanson, 2008), and
terization of suicide as a warrants close monitoring, substance
abuse sympto- hidden epidemic in the Armed Forces (Sklar, 2007
further investigation, and matology (Hooper, Rona,Jones, Fear,
Hull, & Wes- in Braswell & Kushner, careful consideration
in suicide sely, 2008). A recent 2010). Suicide is now the
prevention programming.RAND survey indicated second leading cause
ofthat almost one-third of death in the military (Ritchie, Keppler,
&servicemembers returning from deployment Rothberg, 2003; U.S.
Department of Defense, in Iraq or Afghanistan suffered a traumatic
2007 in Bryan & Cukrowicz, 2011) and sui- brain injury (TBI) or
satisfied the criteria for cide rates have consistently increased
across PTSD or Major Depression (Kuehn, 2009). all branches since
2006 (Carden, 2010 inPTSD has been identified as the most com-
Braswell & Kushner, 2010).mon diagnosis among veterans
committing Repeated or prolonged deployments in tan- suicide (Kang
& Bullman, 2008), is strongly dem with related combat exposure
have associated with suicidal behavior (Kessler, been identified as
potential factors leaving2000), and is a potent predictor of the
trajec- servicemembers at elevated risk for suicide tory from
suicidal ideation to attempt (Nock, Hwang, Sampson, Kessler,
Angermeyer, (Bryan & Cukrowicz, 2011; Stewart, 2009 in Braswell
& Kushner, 2010). For example, Beautrais, et. al., 2009). tour
of duty duration has been linked toThe Department of Defense (DoD)
and the completed suicides (Adams, Barton, Mitchell,Department of
Veterans Affairs (VA), sensi- Moore, & Einagel, 1998) and
increased expo- tive to escalating concerns over the need for sure
to combat violence has been linked tomental health service
improvement, have im- increased suicidal ideation (Beckham,
plemented programs to enhance screening Feldman, & Kirby, 1998;
Yehuda, Southwick,and treatment of these mental health disor- &
Giller, 1992). An Institute of Medicine ders in primary care
environments (Keuhn, (2007) committee has similarly concluded2008).
Mental health needs have been fur- that warzone deployment confers
added riskther addressed through the establishment of for suicide
in the years subsequent to de-suicide prevention coordinators in
every VA ployment. Given the greater frequency and hospital in the
United States and the develop- duration of deployments for
servicemem- ment of a national suicide hotline staffed
spe-http://cir.usc.edu1
2. USC Center for Innovation and Researchon Veterans &
Military Families (CIR) cifically for veterans (Mills, Huber,
Watts, & Varied sources have documented the relation- Bagian,
2011). ship between military life and social disintegra-tion.
Combat exposure or deployment has been Social Integration in the
Military linked to domestic violence, child maltreatment(Gibbs,
Martin, Kupper, & Johnson, 2007), inti- In addition to mental
health issues, researchers mate partner violence (Marshall,
Panuzio, & Taft, have speculated that increases in suicide
rates in 2005), and divorce (Prigerson, Maciejewski, & the
military may be an adverse consequence ofRosenheck, 2002), with
greater combat expo- disruptions in social connectedness and social
sure being associated with poorer family adjust- integration. A
recent study examining the root ment post-combat zone deployment
(Taft, cause of suicide identified poor communication Schumm,
Panuzio, & Proctor, 2008). Consistent and coordination with the
veterans family orwith the influence of disconnectedness, being
social network in the community as contributingsingle, divorced, or
separated was strongly asso- to elevated suicide risk (Mills et
al., 2011). Inciated with completed suicide among service- fact,
several other root causes have been linked members (Thoresen,
Mehlum, Roysamb, & Ton- to broader issues of communication
break-nessen, 2006). downs, such as continuity of care,
coordination of care, and provider communication (Mills et al., It
is important to recognize that the deployment- 2011). related
disintegration in civilian social networksis accompanied by
commensurate integration In an effort to aid suicide prevention
efforts ininto the military social network (Braswell & military
personnel, recent and ongoing endeav- Kushner, 2010). Moreover,
these military social ors have aimed to elucidate mechanisms
driving networks can be protective with respect to sui- suicidal
phenomena. Social connectedness has cide. The historically lower
suicide rates in the often been touted as centrally important to
suici- military during peacetime have left many to dal processes
(You, Van Orden, & Conner, 2011).credit the social group
cohesiveness of military Along with other well-known risk factors
for sui-life as protective against suicide (Mahon, Tobin, cide,
such as mental disorder, past suicide at-Cusack, Kelleher, &
Malone, 2005; Martin, Ghah- tempts, physical illness, family
conflict and un-ramanlou-Holloway, Lou, & Tucciarone, 2009).
employment, social isolation is considered anAddressing and
balancing dual social networks especially robust risk factor for
suicide (Van Or- lies at the core of Battlemind Transition Train-
den, Cukrowicz, Witte, Braithwaite, & Joiner,ing, which is a
reintegration program that in- 2010). In fact, the strength and
reliability of so-cludes, but is not limited to, simultaneously
cial isolation in predicting suicidal ideation, at-maintaining both
military and non-military rela- tempts, and behavior is arguably
unmatched tionships (Adler, Castro, Bliese, McGurk, & Mil- (Van
Orden et al., 2010).liken, 2007 in Selby, Anestis, Bender, Ribeiro,
The stress associated with extended deploy-Nock, Rudd et al.,
2010). ments and returning home post-deployment have been proposed
as factors that may exacer- Suicide and Social Media bate suicide
risk for servicemembers (Kuehn,Over the past decade a great concern
has arisen 2009). Rising suicide rates have been attributedin both
the academic and popular press sur- to the disintegration of family
relationships, ties,rounding the role of the internet in promoting
and structures associated with frequent, ex-suicidal behavior in
the civilian population. The tended deployments (Stewart, 2009 in
Braswellconcerns focus around the idea that websites & Kushner,
2010). Interviews with OEF/OIFand user groups are discussing the
means by combat veterans suggest a profound sense ofwhich one can
commit suicide, while other sites disconnection from civilians and
civilian lifeand groups are going so far as to promote sui-
(Brenner, Gutierrez, Cornette, Betthauser, Bah-cide as a solution
to lifes problems and discour- raini, & Staves, 2008) and
detachment from oth-age persons from seeking psychological care ers
during, and subsequent to, deployment(e.g. Mehlum, 2000; Alao,
Soderberg, Pohl, & (Anestis, Bryan, Cornette, & Joiner,
2009).JUNE 20112 3. USC Center for Innovation and Researchon
Veterans & Military Families (CIR) Alao, 2006). Researchers
often recognize the years, Facebook has helped bridge the gap be-
potential for the internet to be a vehicle for dis-tween Soldiers
and their Families during ex- seminating suicide prevention
messages tended separations. (Brown, 2011). (Mehlum, 2000) or as a
means by which to iden-Social media, like Facebook, may provide an
ex- tify those with suicidal ideation and link them tocellent
opportunity for early identification of care (Alao et al.,
2006).persons at risk for suicide. To the extent that In the
contemporary era, social networking web-military personnel as well
as their friends and sites like Facebook and Twitter provide new
op-family are made more aware of signs of emo- portunities for
suicide prevention in the form oftional distress and suicidal
thoughts, social me- increasing social support, social integration,
and dia may be an excellent communication tool for a sense of
belonging. Social me-concerned persons to reach out dia can empower
persons who Social mediamay provide to servicemembers and veterans
are physically disconnected a platformthat allows when they are
showing signs of from their social support net-distress. works to
easily and regularly servicemembers to monitor communicate with
those net- the stream of disclosure Recommendations works, which
has been shown in over time, thereby allowing civilian populations
to promote them to balance the levelIn light of the previous
literature healthy behaviors (Rice, Monro, of attention to familial
orthat makes a clear case for the Barman-Adhikari, &
Young,importance of social support 2010).civilian social networks
in a and social connections in the measured way.prevention of
suicide among ac- The introduction and imple-tive duty service
members and mentation of social media to promote and pre- veterans,
we suggest the following ways to em- serve connectedness between
servicemembersploy social media toward suicide prevention: and
their social networks may aid in this urgent suicide prevention
endeavor. It has long been 1. Within the constraints of necessary
security recognized that communication with familial measures,
encourage servicemembers, vet- networks during the period of
deployment is key erans, and their families to utilize social me-
to promoting morale (Wong & Gerras, 2006 in dia, such as
Facebook, to maintain relation- Durham, 2010). However,
servicemembers have ships with military and civilian social net-
expressed that striking the balance between anworks, especially
during critical transitional excessive and inadequate amount of
communi- periods of deployment and community rein- cation is
challenging when situated in a combat tegration when social
networks may be com- environment (Wong & Gerras, 2006).
Moreover,promised. the ability to feel connected to loved ones de-
2. Encourage DoD to employ social media as a spite geographic
distance has been identified asplatform in advancing suicide
prevention an issue that has the potential to impact level
ofprogramming and training for servicemem- distress (Wong &
Gerras, 2006). bers, military leaders, and families, as out- Social
media may provide a platform that allows lined in the recent report
by the DoD Task servicemembers to monitor the stream of disclo-
Force on the Prevention of Suicide by Mem- sure over time, thereby
allowing them to bal- bers of the Armed Forces. ance the level of
attention to familial or civilian 3. Encourage DoD to appoint a
social media social networks in a measured way. Some manager to
contribute to the development branches of the armed services are
actively en- and oversight of social media-based suicide gaging in
this model. For example, the Army has prevention initiatives that
are consistent stated Facebook is a big part of Soldier life. with
existing DoD strategies. Long deployments, annual training, and
unex- pected assignments force Soldiers to leave their4. Developor
support the development of Families on a regular basis. For the
last several psycho-education applications for smartJUNE 2011 3 4.
USC Center for Innovation and Research on Veterans & Military
Families (CIR)phones and tablets dedicated to suicide
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