FAC T SHEET FOR PROVIDERSC  CA Health Campaign of Uniformed Services University, www.usuhs.edu, and theCenter for the Study of Traumatic Stress, Bethesda, Maryland, www.CSTSonline.org

Suicide Facts for Primary
Care Providers:

Helping Service Members and Families
Overcome Barriers to Care
Suicide in our military service
Primary care, however, is where
members is the highest on record,
patients
often present physical andSuicide of our military service members
rising for the fourth straight year
emotional issues that signal distress.
is the highest on record, rising for aand surpassing the suicide rate in theStudies indicate that many who die
fourth straight year and surpassing thegeneral population. In the Army, about
by suicide have seen a health care
one third of suicides occur duringprovider within the month prior tosuicide rate in the general population.
deployment and one third occur post
their death. Military spouses anddeployment. Despite renewed efforts forpartners, often the first to noticemental health prevention and outreach,changes in their returning service
a military culture that values strength and resilience
member, may share information about their service
presents multiple barriers to care. Service members andmember and seek knowledge about mental health issues
families are reluctant to seek mental health services due
including suicidal behavior from their primary care
to “not wanting to let anyone down,” shame, guilt, feelingprovider. Educating military families about mental healthstigmatized by one’s coworkers and loved ones, and fear ofand the need for care for depression and stress can assist in
job loss. Furthermore, frequent military moves can disrupt
help seeking and the care of service members.
and impede patient-doctor relationships that enable a
In this Courage to Care fact sheet, we provide warning
physician to know a patient’s history and more easily detectsigns and risk factors associated with suicidality.
changes in their physical or mental status and behavior.

Suicide Warning Signs
When a patient discloses suicidal ideation, intent,
or plan, an assessment is required. A safety evaluation
should also be undertaken when a provider sees
substantial changes in demeanor, or the following signs
and symptoms: extreme anxiety, appearing withdrawn
and overwhelmed, depression, or when a patient discloses
significant, unexpected, highly important, recent losses (suchas relationships, finances, status, and job). Importantly,
suicide is not only associated with depression, but alsowith anxiety.
The following risk factors should lead the provider toexpand their assessment and questioning about thoughtsof self-harm. Remember, these are not absolute indications
that someone is suicidal; however, they should be factors
to take into consideration in evaluating risk.

Suicide Risk Factors1■ Current thoughts of suicide including ideas, plans, andmeans■ Past thoughts of suicide: ideas, plans■ Past suicide attempts■ Alcohol/substance abuse■ Access to firearms■ Psychiatric diagnosis (e.g., major depressive disorder,bipolar disorder, substance use disorders, and/or anxietydisorders)■ Hopelessness, worthlessness■ Severe anxiety■ Impulsiveness■ Lack of social support

Continued

■ Widowed, divorced, single■ Family history of suicide (e.g., first degree relatives)■ Gender (men complete suicide more, women attemptsuicide more)■ Age (young, enlisted in the military are at risk; elderly

civilians and adolescents have the greatest proportionate
risk and highest number of suicides)■ Physical and chronic illnesses, such as pain syndromes,

head trauma
Ways to Help
In collaboration with the patient, the provider canenlist the support of the patient’s family and identify
other immediate supports. Some service members may
be reluctant to engage in treatment. It is important forproviders to convey that others have experienced similar life
events and there is help available to deal with the present

crisis. Restoring hope and the feeling of not being alone are
the key interventions to move the patient to the next step ofcare
Remember, there are outpatient programs available
that are suited to meet the needs of service members andfamilies. If there is any question regarding need for further
evaluation and more definitive treatment, providers should
consult with their mental health providers and/or refer tomore emergent care/evaluation.
In emergencies tell the patient or the concerned family
member to call 911 or take the suicidal individual to thenearest emergency room.
1 American Psychiatric Association (APA). Factors associatedwith an Increased Risk for Suicide. Accessed 21 November
2008. American Psychiatric Association. Available from URL:
http://www.psychiatryonline.com/popup.aspx?aID=56260

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org