When someone dies by suicide, it can traumatize those close to the person–parents, spouses, siblings, friends, co-workers. Research suggests the death could even trigger suicidal thoughts and behaviors among loved ones and friends.
But what about active-duty service members and Veterans? How do they react when someone they are close with dies by suicide?
They take an emotional hit, too. A study in the January 2017 Journal of Affective Disorders finds that military personnel and Veterans who have been bereaved by suicide may themselves be at elevated suicide risk. The study says that "appears to be especially true among those reporting greater closeness to the suicide decedent, with effects observed even when controlling for current suicidal symptoms and prior suicidal thoughts and behaviors."
The researchers pooled data from many other studies. Information on the degree of suicide exposure, or how it compares between the military population and civilians, was not collected.
Study co-author Dr. Peter Gutierrez, a clinical and research psychologist with the VA Eastern Colorado Health Care System and VA's Rocky Mountain MIRECC for Suicide Prevention, says he's been interested in learning whether suicide exposure has a greater psychological impact on Vets and service members than on the general population.
"Serving in the military and especially in combat operations, where your life literally depends on your buddy's ability to do his or her job, creates a very, very tight-knit group," he says. "So we want to know if that leads to different responses when someone dies. There's a lot more about the nature of the relationship in addition to how close someone felt to the person who died by suicide that we think is worthy of study, so we can ask, 'Are there differential effects of relationships for those in the military or who served in the military compared with those who never have?'
"It might be that losing a fellow service member has more of an effect like losing a sibling, than if a civilian co-worker dies by suicide."
"It might be that losing a fellow service member has more of an effect like losing a sibling, than if a civilian co-worker dies by suicide," says Gutierrez, co-director of the Military Suicide Research Consortium, a DoD-funded initiative that researches the causes and prevention of suicide.
Studies show 'troubling effects' of suicide on military
Suicide prevention is a major focus of VA. Of the more than 40,000 suicides in the United States each year, about 20 percent are Veterans.
But little research has been done on suicide bereavement in the military population. A 2015 study led by Dr. Julie Cerel, a clinical psychologist whose work is partly funded by the Military Suicide Research Consortium, looked at suicide exposure among Veterans in Kentucky. Nearly half of 931 Vets reported suicide exposure at some point. Those who did were much more likely to have depression and anxiety, and they reported a greater likelihood of suicide ideation, or thoughts of taking one's life.
Gutierrez and his team took a broader look. More than 1,700 service members and Veterans from around the country answered questions on their experiences with suicide exposure, history with suicidal thoughts and behaviors, suicidal symptoms, and their likelihood of attempting suicide.
The findings mirrored those of the 2015 study.
Nearly 6 in 10 participants reported knowing someone who died by suicide and, of those, more than 4 in 10 said a suicide death had occurred during their military years. Suicide-exposed people were much more likely than the non-exposed to report suicide ideation, suicide plans, suicide attempts, and non-suicidal self-injury. The sample was mainly male.
"Together, our study and theirs [Cerel's] begin to paint a picture of the potentially troubling effects of suicide bereavement among military populations, specifically that loss of a loved one, friend, or peer to suicide may increase one's own risk for suicide," the researchers write.
The average age in Cerel's study was 62, compared with 33 in Gutierrez's research. That means the lifetime suicide exposure rate of those in Gutierrez's study–or the number of people they know who die by suicide–will likely be much greater over time because they've already been exposed at a relatively young age. A large percentage of the participants in Gutierrez's research fought in Iraq and Afghanistan.
Clinicians should look at others besides family members
Gutierrez finds none of his study's findings to be "alarming." He cautions, though, that the impact of being close to someone who died by suicide is clinically important and should not be overlooked. Most clinicians who try to determine the chances of someone dying by suicide ask if that person has had a family member take his or her life, knowing there could be a genetic link, he says. But it's much less common for clinicians to ask about suicides of fellow service members, friends, and co-workers, he notes.
"We think that really should become routine," he says, "because if the person was close to the decedents, the impacts of those deaths can have a huge negative impact on them that clinicians should be aware of."
Experts believe a suicide death intimately affects six people, on average, most of whom are family members. But Gutierrez says Cerel's research supports the fact that more than 20 people are intimately impacted and as many as 110 are at least exposed and potentially affected to some extent.
"When you're talking about military personnel, it's commanders as well as comrades," he says. "So the number of people who are potentially negatively impacted by a suicide death is a lot larger than we used to think it is."
According to Gutierrez's study, suicide exposure and suicide bereavement–and their link to suicidal thoughts and behaviors with service members and Vets–deserve further investigation. Gutierrez would like to see a study in which those who have been exposed to suicide are followed over many years and regularly assessed.
"That way, we can determine whether suicide risk changes over time and whether risk factors interact differently perhaps based on future life stresses," he says. "Much could be learned from a longitudinal study on suicide bereavement. It is also worth designing a cross-sectional study with new variables that would help us much better understand the impact of suicide exposure and suicide bereavement on the military population."