By Brenda L. Mooney

ROCHESTER, MN — With sweeping new initiatives from the White House and elsewhere in response to the burgeoning military suicide rate, little guidance has been offered to the clinicians in the trenches who are best positioned to recognize and prevent such drastic actions.

To remedy that, two new articles recently published in prestigious medical journals offer practical advice to front-line physicians and other healthcare workers to identify and help patients at risk for suicide.

Timothy Lineberry

One article is by Timothy Lineberry, MD, a Mayo Clinic psychiatrist who has consulted with the Army on the suicide epidemic. Writing in a recent edition of the Mayo Clinic Proceedings, Lineberry and his co-author, Stephen S. O’Connor, PhD, offer specific steps to assess and address military suicide — including greater use of gun locks, improving primary care for depression and better monitoring for sleep disturbances.1

“Despite the anticipated end of large-scale military operations in Afghanistan and Iraq, the effects on the mental health of active-duty servicemembers, reservists and veterans is only just beginning to be felt,” Lineberry points out. “Moreover, the potential effect on servicemembers of their war experiences may manifest indefinitely into the future in the form of emerging psychiatric illnesses.”

In the article, Lineberry and O’Connor use published research on the etiology of suicide to recommend practical responses by clinicians. Here are the four steps they suggest:

• Ask all veterans with psychiatric illness about their access to firearms and encouraging them to lock up guns, give someone else the key, or remove them from the home altogether. With nearly 70% of veterans who commit suicide using a gun to do it, slowing down gun access by a few minutes might be enough to stop the impulse, they suggest.
• Identify and treat sleep disturbances in patients. Those problems in otherwise healthy active-duty servicemembers, reservists or veterans might signal the need for taking a detailed history and screening for depression, substance misuse and post-traumatic stress disorder. Sleep disturbances have been identified as a risk factor for suicide, Lineberry notes.
• Prescribe opioid medications carefully and monitor them diligently. Lineberry emphasizes that unintentional overdose deaths from opioids outnumber traffic fatalities in many states, and patients with psychiatric illness are over-represented both among those receiving prescriptions for opioids and those overdosing. He cites a recent study that found Iraq and Afghanistan veterans with a diagnosis of post-traumatic stress disorder who were prescribed opioids were significantly more likely to have opioid-related accidents and overdoses, alcohol and non-opioid drug-related accidents and overdoses, as well as self-inflicted and violence-related injuries.
• Improve primary-care treatment for depression. Patients who die by suicide are more likely to have visited a primary-care physician than mental-health specialist in the previous month, according to recent research. Lineberry says programs developed to improve primary-care physicians' recognition and treatment of depression could help lower suicide rates.

Another article, written by three psychiatrists from the Uniformed Services University School of Medicine, Bethesda, MD, calls for implementation of “trauma-informed care” to stem the high suicide rate among military personnel and other young men and to appropriately treat other emotional damage triggered by traumatic events.