Faith-Based Organizations' Support of Veteran Congregants at Risk for Mental Health Conditions and Suicide: A Qualitative Study of Clergy Experiences in Los Angeles County.

Faith-based organizations (FBOs) are often "gatekeepers" to mental health care for congregants at risk of mental illness and suicide, especially U.S. military Veterans, but data to inform better collaboration are needed. We conducted focus groups with clergy in Los Angeles County to understand the mental health support FBOs provide and barriers to collaboration with the mental healthcare system. Clergy detailed strategies used to support the mental health of Veteran congregants. Barriers included stigma, limits in clergy training, and incomplete knowledge about community and VA mental health resources. Results suggest strategies to improve collaboration between FBOs and the mental healthcare system in Los Angeles County.

Faith-Based Groups as a Bridge to the Community for Military Veterans: Preliminary Findings and Lessons Learned in Online Surveying.

This report examines responses to a brief online survey, comparing how faith-based (n = 27) and non-faith-based (n = 61) organizations engage with Veteran populations as well as the supportive services they provide. Data were analyzed using two-sample z-tests and Chi-squared tests. No significant differences were noted between respondents for self-reported confidence in responding to health care issues/concerns or engagement with Veteran populations. Faith-based respondents were found to provide significantly less mental health, suicide prevention, education/outreach, and other services, while providing significantly more spiritual care. There appears to be ample opportunity for expanding the supportive services provided by faith-based organizations.

Alcohol and Suicide Risk: Examining the Role of Meaning-Making.

OBJECTIVE: Conceptual understandings of meaning-making suggest that it may have protective value in regard to alcohol misuse and suicidal behavior. Accordingly, the aim of this study was to examine whether meaning-making attenuated the relationship between alcohol misuse and suicide risk severity in a population of active-duty service members. METHODS: The sample (N = 97) was recruited while presenting for emergency behavioral health services in circumstances indicative of high-risk suicidality: endorsing current suicidal ideation with intent to die. Those who reported ideation with a lifetime history of a past suicide attempt were conceptualized as being in a more severe category of suicide risk than ideation without a lifetime history of a past suicide attempt. Participants completed the Suicidal Behaviors Questionnaire-Revised, Meaning in Life Questionnaire, Alcohol Use Disorders Identification Test consumption questions, and items that assessed demographic variables. Data were analyzed using chi-squared test of independence, Fisher's exact test, Kendall rank correlation coefficient, and logistic regression modeling. RESULTS: Regression analysis identified a statistically significant association between number of drinks consumed daily and reporting a lifetime history of a past suicide attempt, odds ratio (OR) = 1.60, 95% confidence interval (CI) [1.11, 2.32], p = .01. Number of drinks consumed remained significant even after adjusting for both the search for and presence of meaning, OR = 1.70, 95% CI [1.16, 2.51], p = .01. These results remained unchanged even when adjusting for gender, race, ethnicity, and relationship status. No statistically significant interaction effects were noted between meaning-making and alcohol consumption. CONCLUSIONS: Meaning-making did not appear to attenuate the effect of alcohol misuse on suicide risk severity in a sample of service members at high-risk of suicidality. Additional research is needed to better understand the relationship among meaning-making, alcohol misuse, and suicidal behavior.

A preliminary study examining chaplains' support for veterans at the end of life.

This descriptive study examines the involvement of professional chaplains in addressing loss of dignity, inconsequential life or not having a legacy, fear of burdensomeness, and fear of pain in veterans at the end of life. A convenience sample of Jewish chaplains responded to an online survey gauging their involvement in these areas. Results are presented descriptively. Most respondents stated either rarely (≤1 x month) or sometimes (≥1 x month) encountering veterans with end-of-life issues. Respondents reported varying degrees of involvement in supporting veterans at the end of life with respect to the aforementioned areas. As research into the end-of-life care needs of veterans continues to develop, recognising chaplains as a source of both spiritual and psychosocial support can serve as an opportunity for better meeting the needs of this population.

How Involved are Non-VA Chaplains in Supporting Veterans?

In terms of supporting veteran populations, little is known of the experiences of chaplains professionally active outside of Department of Veterans Affairs (VA) healthcare settings. The present study looks to examine how involved non-VA chaplains are in supporting veterans as well as their familiarity with the VA. An online survey was distributed in a convenience sample of chaplains, of which n = 39 met the inclusion criterion for this study (i.e., no past or present VA affiliation). The results find that most of the non-VA chaplains encounter veteran service users either on a weekly or monthly basis. Though familiar with VA services, non-VA chaplains were not sure of their veteran service users' VA enrollment status nor did they feel able to adequately advise their veteran service users on VA enrollment. The results suggest that non-VA chaplains actively support veteran populations. Opportunities for enhancing chaplaincy services and VA outreach programs are discussed.

VHA chaplaincy contact with veterans at increased risk of suicide.

OBJECTIVES: To examine the extent to which chaplains interact with military veterans at increased risk of suicide and select characteristics related to those at-risk veterans who present for chaplaincy services. METHODS: The nationwide network of chaplains affiliated with the Veterans Health Administration (n = 990) was e-mailed a letter inviting those who have contact with at-risk veterans to complete a survey. This letter included an Internet link, connecting respondents to an online survey collection service. One hundred eighteen chaplains (11.91%) responded to the survey. RESULTS: More than half of the respondents reported that veterans at increased risk of suicide constitute either <5% or 5% to 10% of the overall population of veterans under their care. At-risk veterans are most often identified based on open admission of suicidal behavior or red flags in their treatment file. Veterans typically do not look for chaplains from their own faith tradition, will seek care from >1 chaplain, and present at a moderate-to-high level of risk. CONCLUSIONS: The present study finds that some at-risk veterans look to chaplains for supportive services. The findings also allow for opportunities for future research.

Providing pastoral care services in a clinical setting to veterans at-risk of suicide.

The value of enhanced spiritual wellbeing has largely been overlooked as part of suicide prevention efforts in Veterans. The aim of this qualitative study is to examine the clinical pastoral care services provided by VA Chaplains to Veterans at-risk of suicide. This study was conducted using in-depth interviews with five Chaplains affiliated with a medical center located in upstate New York. This study was able to show that some at-risk individuals do actively seek out pastoral care, demonstrating a demand for such services. In conclusion, a pastoral care framework may already exist in some clinical settings, giving at-risk Veterans the opportunity to access spiritual care.

Examining faith-based collaboration in U.S. States' suicide prevention guidelines.

Faith-based communities (FBCs) are recognized by most states as key players within systematic suicide prevention efforts. The aim of the present study was to conduct a thematic analysis of documents that detail the suicide prevention efforts of individual states with respect to the role(s) delegated to FBCs. Thematic analysis is recognized as a useful methodology for identifying implications for policy and practice. Documents were procured from all states, with the exception of New Mexico (n = 49). The findings suggest six areas relevant to collaboration with FBCs: suicide prevention training for the FBC, suicide prevention training for individual faith leaders, community engagement, faith leaders as gatekeepers, culturally sensitive suicide prevention, and postvention support. These state guideline documents consistently affirm the importance of engaging FBCs in suicide prevention efforts and cover a range of recommendations, though generally lack specifics with respect to how FBCs can optimally engage.

A Preliminary Study Examining the Prevalence and Perceived Intensity of Morally Injurious Events in a Veterans Affairs Chaplaincy Spiritual Injury Support Group.

The aim of this descriptive study was to examine the prevalence and perceived intensity of potentially morally injurious events (PMIEs) in a group of VA chaplaincy service users. A secondary aim was to examine the relationship between PMIEs, spiritual injury, and religiosity. A convenience sample of veterans (n = 84), participants in a spiritual injury support group, completed the Moral Injury Events Scale (MIES). Most individuals also completed the Duke University Religion Index (as a measure of religiosity) and Spiritual Injury Scale. Results suggest a high prevalence of PMIEs among participants. These PMIEs were also higher in perceived intensity compared to other military and veteran samples. No significant correlations were identified between MIES scores and either religiosity or spiritual injury. These findings draw attention to the engagement of chaplains in supporting veterans affected by PMIEs. Implications for future research are discussed.

Health attitudes and behaviour as predictors of self-rated health in relation to mortality patterns (17-year follow-up in a Polish elderly population--Cracow study).

The aim of this 17-year Cracow (Poland) study was to examine and identify the determinants most responsible for the relationship between self-rated health and mortality in non-institutionalized elderly people. Base-line data were collected in a simple random sample of 2,605 Cracow residents, aged 65 years and over. The vital status of all individuals under study was established by monitoring city records. Death certificates were obtained for the deceased and coded according to the underlying cause of death. Predictors related to self-rated health, developed using the results of principal component analysis, were modelled on three indexes: individual predisposition (to disease based on family history), caring about health in the past, and attitudes toward health. Cox multivariate analysis confirmed the significant role of self-rated health in the mortality patterns of women (HR = 1.18). Those who cared greatly about health in the past had a lower mortality risk than those who cared poorly (HR = 1.19). In men, a positive attitude towards health remained an independent predictor of mortality (HR = 1.20). Multivariate regression models found self-rated health to be a significant independent predictor of mortality only in women with a low level of individual predisposition (hazard ratio for self-rated health = 1.35) and in those with a positive attitude towards health (hazard ratio for self-rated health = 1.16).

Association Between Trust and Mental, Social, and Physical Health Outcomes in Veterans and Active Duty Service Members With Combat-Related PTSD Symptomatology.

Background: Trust represents a complex emotion and interpersonal concept which assumes abandoning control over a given situation or set of circumstances, in turn yielding such control to another party. Advances in our knowledge of post-traumatic stress disorder and moral injury have underscored the need to more closely examine how trust stands to impact health outcomes in these disorders. The aim of the present study is to examine and identify relationships linking general trust with select health outcomes in a mixed sample of Veterans and Service members with a self-reported history of deployment to a combat theater and PTSD symptomatology. Methods: This study applied a cross-sectional methodology, surveying n = 427 participants recruited across six sites. This included 373 Veterans and 54 active duty Service members in the United States. Measures included demographic characteristics, combat exposure, general trust, post-traumatic stress disorder symptomatology, depressive/anxiety symptomatology, alcohol use, social involvement, religiosity, and physical health. Data were analyzed descriptively as well as using Pearson correlations, Student's t-test, and multivariate regression. Results: Several significant relationships were identified, indicating an inverse relationship between trust and PTSD, depressive, and anxiety symptomatology. Greater levels of trust were also significantly associated with increased social interaction and religiosity. Lastly, no significant associations were identified with either physical functioning or pain level. Conclusion: The findings suggest that trust is correlated with a variety of health outcomes in Veterans and Service members affected by combat-related PTSD. Additional, hypothesis-driven research, informed by longitudinal data, is needed to better understand how trust stands to impact health outcomes, including the development of strategies and intervention options for repairing trust.

Towards a faith-based understanding of moral injury.

In recent years, the issue of moral injury (MI) has garnered considerable attention, especially as related to the military experiences of Service Members and Veterans. This brief communication is intended to provide an overview of Christian, Jewish, and Islamic understandings of MI. The intent is to draw attention to a faith-based etiology for MI, thereby facilitating dialogue and discussion on the relevance of spiritual and pastoral care to supporting those affected by MI.

Lectio Divina: A Preliminary Evaluation of a Chaplaincy Program.

This participant outcome evaluation serves as a preliminary investigation into the effects of lectio divina, a chaplaincy service representing a form of focused Scripture reading. A sample of n = 19 patients who participated in this service at a Department of Veterans Affairs Medical Center in upstate New York was screened at baseline and 30-days follow-up using the Duke University Religion Index, Berg Spiritual Injury Scale, and a screening question for thoughts of harming self or others. These measures were used to assess the intended outcomes of enhanced religiosity, ameliorated spiritual injury, and decreased thoughts of violence. Data were collected through retrospective clinical chart reviews. The outcomes of enhanced religiosity or decreased thoughts of violence were not observed in this sample population. Ameliorated spiritual injury was observed in veterans with substantial engagement in lectio divina (>2 sessions) as well as those who endorsed thoughts of harming self or others.

Chaplaincy Encounters Following a Suicide Attempt.

This descriptive study examines the provision of chaplaincy services to veterans who sought health care at a Department of Veterans Affairs (VA) Medical Center following a suicide attempt. A system-wide VA database of suicidal behavior was used to identify a cohort of n = 22,701 veterans who survived a suicide attempt. Next, an electronic review of VA clinical records found that n = 7,447 (32.8%) received chaplaincy services in the 30 days following their attempt. Of this group, the overwhelming majority of first chaplaincy encounters took place in in-patient settings: n = 6890 (92.5%). First chaplaincy encounters most often occurred 1-7 days following the attempt: n = 5,033 (67.6%). Most chaplaincy service users had only one chaplaincy encounter: n = 3,514 (47.2%). The findings suggest that, at VA Medical Centers, a relatively sizeable percentage of suicide attempt survivors have contact with chaplaincy services. Additional research is needed to ascertain if chaplaincy services yield any therapeutic benefit for this group.

Religious Coping and Suicide Risk in a Sample of Recently Returned Veterans.

The aim of the present study is to examine religious coping and depression as predictors of suicide risk in a large U.S. veteran sample from recent conflicts. Demographic, military history, depressive symptomatology, positive and negative religious coping and self-reported suicidal behavior were analyzed in a sample of 772 recently returned veterans. Suicide risk was computed as a continuum of risk across 4 separate categories. Negative religious coping was significantly associated with suicide risk, even after statistically controlling for depressive symptomatology and other variables. The present analysis did not find any significant relationships for positive religious coping. No significant gender interaction effects were found. The present findings support the importance of understanding veteran experiences of religious coping, particularly negative religious coping, in the context of suicide prevention efforts.

Sexual development and behaviour issues in Polish teenage magazines.

INTRODUCTION: Adolescents often look to mass media for information regarding issues of sexuality. As one form of media, teenage magazines have long constituted a pervasive and effective element of adolescent media exposure. Teenage magazines discuss a number of aspects concerning adolescent sexuality. Considering their potential impact on health related behaviors, the information they provide and the message(s) they send warrant attention. AIM/PURPOSE: The aim of this study is to perform a content analysis of sexual development and behavior information presented in Polish teenage magazines. Social Cognitive Theory was used as a theoretical basis for this analysis. METHODS AND MATERIALS: The media chosen for this study were general-themed publications targeting an adolescent female audience: Bravo Girl!, Filipinka and Dziewczyna. Each entry was analyzed using a structured key. The specific categories of behavior and development used for this study are: biological information, pedagogic instruction, topics of moral-ethical concern, results of sexual activity, and interpersonal relationships. Each category was then subdivided into separate units. RESULTS: The findings indicate that Polish teenage magazines predominantly focus on relationships, contraception and sex education. Relationships were most often of a romantic nature and discussed sexual activity or the potential of sexual activity. Non-prescription contraceptive methods were most often discussed, with attention given to pregnancy prevention. Sex education offered detailed information on sexual practices and behaviors with much discussion on losing one's virginity. CONCLUSIONS: The general approach of the analyzed magazines is that adolescents currently are, or soon will be, sexually active. As a result, certain sexual behavior and development issues are discussed in great detail, while other topics are somewhat neglected. Accepting information-seeking during adolescence as commonplace, these findings suggest that teenage magazines hold the potential for influencing adolescent sexual behavior and development.

Suicidal behavior and spiritual functioning in a sample of Veterans diagnosed with PTSD.

BACKGROUND: Spiritual well-being has been lauded to exert a protective effect against suicidal behavior. This study examines the characteristics of spiritual functioning and their association with a self-reported history of suicidal thoughts and behavior in a sample of Veterans being treated for post-traumatic stress disorder (PTSD). METHODS: The sample includes 472 Veterans admitted to a PTSD Residential Rehabilitation Program. Measures included the Brief Multidimensional Measure of Religiousness and Spirituality, PTSD Checklist--Military Version, Combat Experiences Scale, and individual items pertaining to history of suicidal thoughts and attempts, spiritual practices, and select demographics. RESULTS: Problems with forgiveness and negative religious coping were uniquely associated with suicide risk, above and beyond age, gender, or ethnicity, combat exposure, and severity of PTSD symptomatology. Organizational religiousness was associated with decreased risk for thinking about suicide in the presence of these covariates. Daily spiritual experiences were inversely associated with suicidal thoughts. Differences in spirituality factors did not distinguish Veterans with both suicidal ideation and prior attempts from those who had ideations absent any prior attempts. CONCLUSIONS: The findings suggest that enhanced or diminished spiritual functioning is associated with suicidal thoughts and attempts among Veterans dealing with PTSD.

Veterans Crisis Line Callers With and Without Prior VHA Service Use.

This study examines differences between Veterans with and without prior Veterans Health Administration service use who received a clinical referral from the Veterans' Crisis Line. Differences between groups were identified using data taken from 13,444 calls and medical records. Approximately 91% of Veterans had a history of service use and 9% did not. Callers with prior service use were older, had more mental health disorders, made in-person contact more quickly, and used more outpatient mental healthcare. Those without prior service use were younger, had more mental health problems, and presented for care later. Callers with suicide-related diagnoses had high rates of service contact. These groups represent different subpopulations with unique healthcare needs and practices.

Use of ICD-9-CM Diagnosis Code V62.89 (Other Psychological or Physical Stress, Not Elsewhere Classified) Following a Suicide Attempt.

OBJECTIVE: This study examined the demographic, diagnostic, and service characteristics of veterans who received services for "other psychological or physical stress, not elsewhere classified" (ICD-9-CM V62.89) in the month following a suicide attempt. METHODS: An electronic search of a Veterans Health Administration (VHA) suicide event reporting system identified 22,701 veterans who were survivors of a suicide attempt. Their clinical service encounter records were extracted from a VHA administrative database to identify those who received services related to V62.89. RESULTS: Services related to V62.89 were provided to N=2,173 (9.6%) of the sample. Chaplains were the predominant service provider, identified in N=1,745 (80%) of the service encounters. Differences were noted between those who received services related to V62.89 from a chaplain or from another service provider. CONCLUSIONS: V62.89 appears to be a focus of clinical concern for some veteran suicide attempt survivors. Additional research is needed to better understand any implications for suicide "postvention."

Chaplains' Engagement with Suicidality among Their Service Users: Findings from the VA/DoD Integrated Mental Health Strategy.

Chaplains play an important role in supporting the mental health of current and former military personnel; in this study, the engagement of Department of Veterans Affairs (VA), Army, Navy, and Air Force chaplains with suicidality among their service users were examined. An online survey was used to collect data from 440 VA and 1,723 Department of Defense (DoD) chaplains as part of the VA/DoD Integrated Mental Health Strategy. Differences were noted for demographics, work setting characteristics, encountering suicidality, and self-perceived preparation for dealing with suicidality. Compared to DoD chaplains, VA chaplains encounter more at-risk service users, yet feel less prepared for dealing with suicidality.