A psychometric assessment of the Military Suicide Attitudes Questionnaire (MSAQ).

Suicide rates remain high among military populations. Stigmatizing beliefs about suicide contribute to the problem of heightened suicide risk as a deterrent for help-seeking. Measurement of military suicide stigma is therefore an important gap in the literature as a necessity toward the development of military suicide prevention programming. This paper assessed the factor structure, reliability, and validity of the Military Suicide Attitudes Questionnaire (MSAQ). Study 1 featured secondary analysis of a suicide risk dataset from active duty treatment-seeking military personnel (N = 200). Study 2 was a secondary analysis of a statewide assessment of Army National Guard service members' beliefs about mental health and suicide (N =1116). Factor analyses results collectively supported a four-factor Military Suicide Attitudes Questionnaire (MSAQ) structure: discomfort, unacceptability, support, and empathic views. Subscale reliabilities ranged from 0.77 to 0.83 across samples. Unacceptability and support displayed significant negative correlations with psychological distress. Men displayed more negative suicide-related beliefs compared to women counterparts. Discomfort and unacceptability beliefs displayed significant positive associations with perceived barriers to care. The final short version of the MSAQ is an efficient, multi-dimensional measure of military suicide-related beliefs. The instrument can be used for public health assessment and program evaluation in military settings.

Outpatient Mental Health Treatment Utilization and Military Career Impact in the United States Marine Corps.

Service members (SM) are at increased risk of psychiatric conditions, including suicide, yet research indicates SMs believe seeking mental health treatment may negatively impact their military careers, despite a paucity of research examining actual career impacts. This study examined the link between seeking outpatient mental health (MH) treatment and military career impacts within the United States Marine Corps. In Phase 1, a retrospective medical record review of outpatient MH treatment-seeking Marines (N = 38) was conducted. In Phase 2, a sample of outpatient MH treatment-seeking Marines (N = 40) was matched to a non-treatment-seeking sample of Marines (N = 138) to compare career-progression. In Phase 1, there were no significant links between demographic, military, and clinical characteristics and referral source or receipt of career-affecting treatment recommendations. In Phase 2, MH treatment-seeking Marines in outpatient settings were more likely than matched controls to be separated from the military (95.0% versus 63.0%, p = 0.002), but no more likely to experience involuntary separation. MH treatment-seeking Marines were more likely to have documented legal action (45.0% versus 23.9%, p = 0.008) and had a shorter time of military service following the index MH encounter than matched controls (p < 0.001). Clinical, anti-stigma, and suicide prevention policy implications are discussed.

Development and psychometric evaluation of the Military Suicide Attitudes Questionnaire (MSAQ).

BACKGROUND: To date, a culturally-sensitive psychological instrument has not been developed to evaluate military attitudes toward suicide. Understanding these attitudes can inform suicide prevention research, clinical practice, and policy. We aimed to develop such an instrument and to evaluate its psychometric properties using an active-duty military sample. METHODS: A team of military personnel, suicidologists, and researchers assisted with item development. A cross-sectional design was used to evaluate the psychometric properties of the Military Suicide Attitudes Questionnaire (MSAQ) via an online survey battery. Exploratory and confirmatory factor analyses were conducted. RESULTS: A total of 317 military service members met eligibility criteria and completed the online surveys. A four-factor model that explained 46.4% of the variance was identified: (1) Individual-Based Rejection versus Acceptance; (2) Psychache versus Pathological; (3) Unit-Based Rejection versus Acceptance; (4) Moral versus Immoral. The MSAQ demonstrated high partial validity and test-retest reliability. LIMITATIONS: The study used a convenience sample and did not control for social desirability. CONCLUSIONS: The newly developed MSAQ is a promising measure that fills a notable gap in the assessment of suicide attitudes within the United States military. The MSAQ has the potential for future use in evaluating suicide prevention and stigma reduction programs within the Department of Defense. Additionally, the MSAQ may serve as a useful tool for leadership in the evaluation of command climates. In clinical settings, the MSAQ could be used along with other cognitive and attitudinal measures to track suicidal patients' attitude towards suicide over the course of treatment.

Principal Component Analysis of the Suicide Opinion Questionnaire in a U.S. Military Sample of Marine Corps Non-Commissioned Officers.

Attitudes about suicide are important to examine among individuals within a specific setting, profession, and/or culture; if found to be condemnatory, such attitudes can be effectively modified with training. The Suicide Opinion Questionnaire (SOQ) is one of the most commonly used instruments for the measurement of attitudes toward suicide. The SOQ has not been tested in military populations and the measure has demonstrated multiple different factor structures across various studies performed on civilian samples. The purpose of this study was twofold: (1) to gain an understanding of the applicability and utility of the SOQ for the military; and (2) to examine the relationship among sex, education, prior exposure to suicide within one's military unit, and suicide opinions. A total of 1,758 Marine Non-Commissioned Officers (NCOs) completed the SOQ as part of a suicide program evaluation study. Results demonstrated a 4-component structure for the SOQ, accounting for approximately 30% of the total variance. Sex, education, and prior exposure to suicide within one's military unit were significantly related to suicide opinions. Recommendations are made for the development and empirical evaluation of a new and/or adapted, culturally sensitive suicide attitude measure for the military.

Perceived barriers to seeking mental health care among United States Marine Corps noncommissioned officers serving as gatekeepers for suicide prevention.

Reducing mental health stigma and perceived barriers to care is a necessary strategy for addressing the public health problem of suicide among the United States Armed Forces. The purpose of this study was threefold: (a) to empirically evaluate the principal component structure of the Perceived Barriers to Care (PBTC) measure; (b) to gain an understanding of the perceived barriers to seeking mental health services among Marine Corps noncommissioned officers (NCOs) selected to participate in a primary suicide prevention training program, Never Leave a Marine Behind (NLMB); and (c) to explore the relationship among sex, education, prior exposure to suicide within one's military unit, and perceived barriers to seeking mental health services. The data for the PBTC (N = 1,758) were drawn from a previously performed pretest/posttest program evaluation study of the Marine Corp's NLMB program, which took place over 6 months in 2009 (April-October). The three highest perceptions of barriers to care reported by NCOs for their Marines were related to being embarrassed, having members of one's unit have less confidence in the Marine, and concerns about being treated differently by military unit leadership. Three principal components for PBTC were identified, accounting for approximately 59% of the total variance. Higher education and prior exposure to suicide within one's military unit significantly correlated with greater perceived barriers to care; sex was not significantly correlated with greater perceived barriers to care. Implications of these findings, in relation to future research, are further discussed. (PsycINFO Database Record