Publication year
2017
Citation Title
Thwarted belongingness as an explanatory link between insomnia symptoms and suicidal ideation: Findings from three samples of military service members and veterans.
Journal Name
Journal of Affective Disorders
Journal Volume
209
Page Numbers
114-123
DOI
10.1016/j.jad.2016.11.032
Summary
Three studies utilizing self-reported data examined whether thwarted belongingness (i.e., the feeling that one does not belong) explained the link between insomnia and suicidal ideation. Results supported this link among three different samples of Service members and Veterans, suggesting that Service members struggling with issues of insomnia who feel like they don't belong may be at an increased risk for suicidal ideation. Therefore, efforts to reduce sleep issues and thwarted belongingness among Service members may reduce the risk of suicidal ideation.
Key Findings
All three studies found that higher levels of insomnia symptoms were associated with more severe suicidal ideations and greater levels of thwarted belongingness.
Thwarted belongingness was found in all three studies to explain the link between insomnia and suicidal ideation, even when controlling for other psychological issues (e.g., hopelessness, anxiety, and perceived burdensomeness).
Insomnia did not explain the link between thwarted belongingness and suicidal ideation in any of the three studies, nor was insomnia directly linked to suicidal ideation.
Study 2 and Study 3 found that perceived burdensomeness (i.e., the belief that one's death is worth more than one's life) also explained the link between insomnia and suicidal ideation.
Implications for Program Leaders
Disseminate information to Service members and their families regarding the importance of sleep to promote psychological well-being and reduce the risk of thwarted belongingness
Offer workshops that provide Service members and their families with strategies for coping with sleep issues
Continue to educate military leadership and families about the risk factors and warning signs associated with suicide
Implications for Policy Makers
Continue to support programs that assess and treat insomnia to help reduce the risk of suicide among Service members with sleep issues
Support programs aimed at helping Service members connect with others to reduce the experience of thwarted belongingness
Continue to support suicide prevention efforts and campaigns aimed at reducing stigma and other barriers to care for Service members
Methods
Data from 15 independent studies funded by the Military Suicide Research Consortium were used for Study 1.
Study 2 participants were new Soldiers recruited for participation during an Army Recruiting Course.
Participants for Study 3 were recruited from the community and completed an online survey; no further information regarding recruitment was given.
Participants
A total of 937 Service members and Veterans participated in Study 1; the majority of participants were Army (49.6%), male (82.1%), White (67.9%), and between the ages of 18-88 years (M = 38.2).
A total of 3,386 Army recruits participated in Study 2; the majority of participants were male (91.5%), White (66.2%), and between the ages of 20-57 years (M = 29.9).
A total of 417 Veterans participated in Study 3; the majority of participants had been in the Army (36.5%) and were male (67.8%), White (86.4%), and between the ages of 20-98 years (M = 50.7).
Limitations
The use of abbreviated measures in Study 1 and 2, may influence results by reducing the ability to detect significant effects and accurately make comparisons with Study 3, which utilized full measures.
Only self-report measures were used and may result in inaccurate or biased data.
Some of the psychological symptom measures (e.g., depression) were not available across the samples, limiting comparisons across the studies.
Study 1 data were collected from 15 distinct studies with different recruitment methods, designs, and study aims, which may have influenced the results.
Avenues for Future Research
Continue to examine other factors (e.g., perceived burdensomeness) that may explain the link between insomnia and suicidal ideation
Examine the effectiveness of programs aimed at reducing the risk of suicide among Service members
Continue to examine perceived barriers to care for Service members dealing with suicidal thoughts and ideations
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Background: Although insomnia has been identified as a robust predictor of suicidal ideation and behaviors, little is known about the mechanisms by which sleep disturbances confer risk for suicide. We investigated thwarted belongingness as an explanatory link between insomnia symptoms and suicidal ideation across three military service member and veteran samples. Methods: Data were collected among United States military service members and veterans (N1=937, N2=3,386, N3=417) who completed self-report measures of insomnia symptoms, thwarted belongingness, suicidal ideation, and related psychiatric symptoms (e.g., anxiety, hopelessness). Bias-corrected bootstrap mediation analyses were utilized to examine the indirect effects of insomnia symptoms on suicidal ideation through thwarted belongingness, controlling for related psychiatric symptoms. Results: Consistent with study hypotheses, thwarted belongingness significantly accounted for the relationship between insomnia and suicidal ideation across all three samples; however, insomnia symptoms did not significantly account for the relationship between thwarted belongingness and suicidal ideation, highlighting the specificity of our findings. Limitations: This study utilized cross-sectional self-report data. Conclusions: Insomnia may confer suicide risk for military service members and veterans, in part, through the pathway of thwarted belongingness. Additional prospective studies are warranted to further delineate this model of risk. Our results offer a potential therapeutic target for the prevention of suicide, via the promotion of belongingness, among service members and veterans experiencing insomnia symptoms.
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