Operation Enduring Freedom/Operation Iraqi Freedom Veterans' Experiences of Habituation to Pain, Perceived Burdensomeness, and Failed Belongingness
Condition: Suicide
MeSH terms: Suicide
Study type: Observational

Summary: 
      Veterans possess significant risk factors for self-directed violence (SDV). For example,
      depressed Veterans are at a greater risk for SDV than the general population. Although
      depressed male Veterans die by suicide at a higher rate than do their female counterparts
      (Zivin et al., 2007), female Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF)
      Veterans are at higher risk for depression than males (Seal et al., 2009). Joiner's (2005)
      theory states that suicidal individuals (a) perceive themselves to be unbearable burdens onto
      others; (b) view their efforts at establishing and maintaining social connections as having
      been thwarted or failed; and (c) have developed the ability to engage in SDV due to from
      increased habituation to pain. This two-part study uses semi-structured interviews in an
      effort to determine the extent to which Joiner's theory is applicable to OEF/OIF Veterans.
      Part I of this study, which has been completed, assessed the components of this theory among
      primarily male OEF/OIF Veterans. Part II of this study is assessing this theory's components
      among female OEF/OIF Veterans. Participants were recruited from the female OEF/OIF Veteran
      population receiving services through the Eastern Colorado Health Care System (ECHCS).
      Comparisons across the interview responses will be made to identify commonalities among the
      participants' experiences.
    

Detailed description: 
      This is a qualitative, interview-based study designed to determine the extent to which three
      theoretical constructs - habituation to painful stimuli, perceived burdensomeness, and failed
      belongingness - are relevant to female veterans who have returned from OEF/OIF deployments.
      Joiner (2005) has proposed that the combination of those three factors is necessary and
      sufficient for an individual to engage in self-harm behaviors. Part I of this study, which
      explored Joiner's model among primarily male Veterans, is complete. Part II of the study will
      be a replication of Part I, but will instead be exploring Joiner's model in a female veteran
      population. The intention is to conduct a series of studies leading up to a full test of
      Joiner's model in a veteran population. OEF/OIF female veterans will be interviewed in an
      effort to determine how they understand these constructs and the language they use in
      discussing them.

      Parts I and II of this study are necessary to determine that the key constructs are pertinent
      to veterans' experiences in general. It is also essential to identify the language they use
      when talking about these constructs. This information may be used in future studies to design
      veteran-specific measures. Using language which is meaningful to the population being studied
      increases the validity of a new measure and is considered good psychometric procedure
      (DeVellis, 2003; Haynes, Richard, & Kubany, 1995). In addition, interviewing female veterans
      from the overall population of those receiving mental health services will increase the
      generalizability of future measures that are developed. Presuming Joiner's model is correct,
      participating in the interview may lead female veterans to spontaneously indicate that these
      factors could lead a person to think seriously about suicide. This possibility is despite the
      fact that the study will not be specifically targeting suicidal veterans or the fact that
      none of the questions ask about suicide or suicide-related behavior.
    

Observational model: Case-Only
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Part I: Subjects were recruited from the population of over 250 OEF/OIF veterans with
        active cases in MHS within the Eastern Colorado Health Care System (ECHCS).

        Part II: Subjects were recruited from the population of over 250 OEF/OIF female veterans
        being cared for within the ECHCS.