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19.7% 

The percentage of "143,747 suicide decedents in National Violent Death Reporting System" from 2020-2023 who "were reported to have physical health problems as a precipitating circumstance for suicide," according to an article in the American Journal of Preventive Medicine -- Physical Health Conditions Among Suicide Decedents: National Violent Death Reporting System, U.S., 2020–2023.

Nearly one quarter of suicide decedents with physical health problems experienced chronic pain, and almost half had at least 1 chronic condition. Decedents with physical health problems were significantly older (x̄=63.3 vs x̄=42.9 years), more likely to have ever served in the military (26.1% vs 12.3%), less likely to have a mental health diagnosis (43.8% vs 50.5%), and more likely to have disclosed current suicidal thoughts or intent (22.6% vs 20.9%; p<0.001) than those without physical health problems.

The weekly Research Update contains the latest news, journal articles, and useful links from around the web. Some of this week's topics include:  

● The Military Child & Family Collaboratory: A Content Analysis of Collective Impact Actions for Youth Mental Health, Emotional, Development, and Behavioral Needs.
● U.S. Army Reserve and National Guard Soldiers’ Motivations for Joining the Military and Their Effects on Post-Deployment Mental Health.
● Suicide Prevention in the US Military: Assessing the Impact of the Brandon Act.
● U.S. Combat Medicine and Military Morale.
CLICK HERE TO READ THE 1 OCTOBER 2026 RESEARCH UPDATE

By Jessica Soule, LCSW 

Funded by the VA Office of Suicide Prevention, Safeguard Veterans is a one-year pilot research program designed to unite community partners—including 13 key collaborators operating across six target cities—to strengthen the existing web of care surrounding our veterans. The Consortium for Defense Psychology (CDP) plays a vital role in this effort by equipping community providers with evidence-based suicide prevention and trauma-focused training and creating a tailored referral tool that aims to ensure veterans receive top-tier care, no matter where they seek PTSD treatment.

A core pillar of CDP’s work focuses on direct clinical education. To date, Safeguard has reached over 400 attendees through free, virtual workshops centered on Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP), Problem Solving Therapy for Suicide Prevention (PST-SP), and Safety Planning.

CDP’s PTSD training curriculum features an innovative twist: equipping clinicians to deliver Prolonged Exposure Therapy (PE) and Cognitive Processing Therapy (CPT) in both traditional outpatient therapy formats and massed (condensed) schedules. While PE and CPT are highly effective treatments, traditional weekly therapy sometimes poses significant hurdles—ranging from practical scheduling conflicts to the anticipatory anxiety of repeatedly confronting trauma over several months. The best treatments only work if clients can stick with them; by offering condensed delivery options, clinicians can dismantle these barriers and make life-changing trauma care far more accessible and manageable.

To complement virtual training offerings, CDP is delivering immersive in-person trainings across select pilot locations. Following a successful two-day CBT-SP workshop in Fayetteville, NC, and a three-day Prolonged Exposure (PE) workshop in San Antonio, TX, there is still time to sign up for two final in-person trainings: 

• Problem Solving Therapy for Suicide Prevention: Las Vegas, NV, 20-21 October 2026
• Cognitive Processing Therapy (CPT): Hampton, VA, 27-29 October 2026

Beyond provider education, CDP is finalizing an online referral tool designed for veterans, their families and caregivers, and community clinicians. Grounded in VA standards of care and refined through target user focus groups, the tool helps users navigate PTSD treatment programs outside the VA system. This ensures veterans who seek care in their local communities receive high-quality, culturally responsive treatment. As Safeguard’s training calendar culminates at the end of October, visit safeguardveterans.net to learn more or register for remaining trainings.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of War.

Jessica Soule, LCSW serves as a Military Mental Health Social Worker with The Henry M. Jackson Foundation for the Advancement of Military Medicine. She serves as a subject matter expert for the VA SAFEGUARD project.

$119 billion 
 

The "(t)otal annual cost of morbidity-related productivity losses attributable to" major depressive disorder among U.S. adults, according to an article in the American Journal of Preventive Medicine -- Morbidity-related productivity losses from major depressive disorder among U.S. adults. This equates to $5,824 "per affected adult in 2024."

Inability to work costs accounted for 44% of total productivity losses, followed by presenteeism (33%), absenteeism (18%), and household productivity loss (5%). Total productivity loss costs and per-person loss costs differed by sex.

The weekly Research Update contains the latest news, journal articles, and useful links from around the web. Some of this week's topics include:  

● Family Composition as a Moderator of PTSD and Suicidal Ideation-Related Risk for Non-Secure Firearm Storage Among U.S. Army Soldiers and Veterans.
● Prior Sexual Violence, PTSD Symptoms, and Recovery Trajectories After New Trauma.
● Mapping Clinical Diagnoses Associated With Neurodiversity and Neurodivergence in Mental Health Research: A Scoping Review.
● JAMA Insights: Psilocybin 
CLICK HERE TO READ THE 24 SEPTEMBER 2026 RESEARCH UPDATE

By David Obergfell, DSW, LCSW, BCD, DAAETS 

I have sat across from people in the deepest reaches of their pain. I have lost colleagues, supervisees, and clients to suicide across a career that spans more than twenty-five years in mental and behavioral health. And I have experienced suicide loss personally, within my own family. 

None of that makes me an expert on death. But it has given me a particular kind of education on what helps people stay alive, and what the research, increasingly, confirms: connection is not a complement to suicide prevention; it may be its most powerful upstream force.

What Suicide Is Really About
Researcher and clinical psychologist Dr. Thomas Joiner's interpersonal theory of suicide remains one of the most empirically supported frameworks we have. In short: people become most vulnerable to suicide when two painful beliefs converge. The perceived beliefs of “I am a burden to those around me” and “I do not belong anywhere.” Thwarted belonging and perceived burdensomeness. Disconnection from others and from one's sense of worth within a community.

These are not primarily psychiatric diagnoses. They are relational wounds.

Dr. Craig Bryan, whose work at The Ohio State University and across military and veteran populations spans more than 300 published studies and the influential book Rethinking Suicide, has further articulated how suicide risk is not a fixed trait but a dynamic state, shaped profoundly by the quality and felt safety of a person's social environment and real-time circumstances. Both frameworks suggest something most of us already know from lived experience: when a person feels genuinely seen, genuinely needed, and genuinely part of something, the calculus changes.

A Cultural Reflection for Consideration
Here I want to offer a thought, not a settled argument, but an invitation into reflection.

Anthropologist Edward Hall distinguished between high-context and low-context cultures. High-context cultures communicate meaning through relationships, shared history, and collective identity. What goes unsaid is understood because community provides the context. Low-context cultures rely more on explicit, individualized communication; meaning must be stated because shared context cannot be assumed.

Most Western industrialized societies, and the United States in particular, skew decidedly low context. We value independence, self-reliance, and individual achievement. These are genuine strengths. But, unrealized by an individual, they can carry a cost in the domain of mental health.

In a cultural context where self-sufficiency is the standard, struggle reads as failure. Needing others signals weakness. Asking for help means imposing a burden. The implicit message becomes, "You should be able to handle this yourself."

For someone already in the grip of perceived burdensomeness and thwarted belonging, whose internal experience is already whispering, “I am too much and not enough,” a culture that quietly confirms those messages is not a neutral backdrop but can be an accelerant.

The protective factors that appear most consistently in the research are belonging, shared meaning, community accountability, and knowing others would notice your absence. They exist, or fail to exist, in how we organize our relationships, our neighborhoods, and our institutions. This seems worth sitting with, especially for looking at human-centered design in prevention.

What Connection?
When I say connection is an antidote to suicide, I mean something layered.

Connection to self, the capacity to turn toward one's own emotional experience rather than away from it. Healing often shows up here first: someone notices joy again, or grief, or even simple physical hunger. Any signal from the body that says I am still here and something matters.

Connection to others, the experience of being known, imperfect and still chosen. Of having someone who notices when you go quiet and says something. Of mutual accountability that carries a person when they cannot carry themselves.

Connection to meaning, a sense that one's presence has consequences. That something, or someone, is worth staying for. Connection to possibility, the ability to imagine a future self, to believe that current pain is not the permanent shape of things. Hope, in its most honest form, is a connective tissue.

What Evidence Tells Us
One of the more compelling examples in recent prevention science is the Wingman-Connect program, developed for U.S. Air Force personnel and now expanded as Core Connections for law enforcement, healthcare, and community organizations. Rather than focusing on identifying and treating at-risk individuals, the program trains small units to strengthen cohesion, shared purpose, and collective skills to navigate challenges together.

Published in JAMA Network Open, the results showed significant reductions in suicidal ideation, depression, and occupational problems. A follow-up network analysis found that at-risk Airmen in trained units were far less likely to become isolated and saw an average 53% gain in valued peer connections, even though the program never explicitly targeted at-risk individuals. Protection emerged from the community itself.

Dr. Peter Wyman, the program's lead researcher, noted that suicide-preventive coping skills are most often learned from close-knit peers. The implication is quietly radical: build the community first, and the protection follows. This is upstream prevention, not the absence of treatment, but the presence of conditions that make crisis less likely in the first place.

What We Can Do Together
Prevention begins before crisis. It begins with the daily habits of how we show up for each other.

Notice and name. The most protective thing a person can offer someone they care about is to acknowledge their presence and ask, genuinely, with time to wait for the answer.

Reduce the cost of struggling. In communities where failure is treated as information rather than character, people stay visible longer. They don't have to disappear to be safe.

Build accountable relationships, not just supportive ones. Support implies direction. Accountability is mutual. Someone who knows you will notice your absence is different from someone available if you reach out.

Examine your community's norms. What does it mean, in your workplace, your unit, your family, to need help? What happens to people who say so? The answers tell you a great deal about the upstream conditions you are living in.

Human beings change throughout life. We are not fixed. The circumstances that generate despair are not permanent, even when they feel that way. And the research is consistent: that connection to self, to others, to meaning, to possibility is among the most powerful forces we have for keeping each other here.

If you are reading this and it feels personal, know you are not a burden. The people around you would feel your absence. If you are struggling right now, please reach out to someone you trust or one of the resources below. We do this better together.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of War.

David Obergfell, DSW, LCSW, BCD, DAAETS, is a Military Mental Health Social Worker and Subject Matter Expert with the Consortium for Defense Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this capacity, he supports military behavioral health faculty on assignments and bandwidth across the center, providing professional development and performance management

Resources
Crisis Support

• 988 Suicide & Crisis Lifeline: Call or text 988, 24/7; chat available online
• Crisis Text Line: Text HOME to 741741
• Veterans Crisis Line: Call 988, press 1; text 838255

Research & Frameworks

• Joiner's Interpersonal Theory of Suicide, Overview
• Craig Bryan, Psy.D., Rivet Lab, Ohio State University, research on suicide prevention, crisis response, and military populations
• Rethinking Suicide by Craig J. Bryan

Upstream & Community Prevention

• Core Connections / Wingman Connect, SafeSide Prevention, evidence-based peer cohesion model
• Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training: A Cluster Randomized Clinical Trial
• Zero Suicide Institute, system-level framework for healthcare and organizational settings
• American Foundation for Suicide Prevention, education, advocacy, and survivor resource

64%  

The percentage of construction workers who "reported experiencing anxiety or depression in the previous 12 months, substantially higher than the 30% rate reported among US adults in general," according to an article in JAMA Health Forum -- Mental Health and Construction—Intervening to Prevent Collapse.
 

According to a 2023 National Vital Statistics Report, the construction and extraction industry experienced the highest drug overdose death rates (162.6 deaths per 100 000 workers) in the US, approximately 7 times higher than the general population (23.1 deaths per 100 000 standard population), and significantly higher than other industries involving manual labor, such as grounds cleaning and maintenance (70.0 deaths per 100 000 workers); farming, fishing, and forestry (51.3 deaths per 100 000 workers); food preparation and service (117.9 deaths per 100 000 workers); installation, maintenance, and repair (69.9 deaths per 100 000 workers); and transportation and material moving (70.7 deaths per 100 000 workers). 

The weekly Research Update contains the latest news, journal articles, and useful links from around the web. Some of this week's topics include:

● Sleep Health Is Not Optional, It's Operational: Introducing the Biopsychosocial Model of Sleep Deprivation on Warfighter Readiness.
● National trends in mental health outcomes among U.S. combat veterans by war era.
● Extreme Risk Protection Orders Among Military Service Members and Veterans.
● The prevalence and incidence of sleep disorder symptoms, correlates, and sex- stratified longitudinal associations with mental and menstrual health outcomes in UK Service Personnel: a prospective survey-based cohort study protocol.

CLICK HERE TO READ THE 17 SEPTEMBER 2026 RESEARCH UPDATE

By Andrew Devendorf, Ph.D. 

Losing a patient to suicide is among healthcare providers’ greatest fears. But most providers are not prepared for navigating this nightmare. This can worsen the aftermath of a suicide—making it more confusing, more chaotic, and more painful. Everyone loses in this situation: providers, their colleagues, their organization, and, of course, the surviving loved ones.

Over a series of posts, I aim to demystify this important yet underdiscussed area. My hope is to alleviate some anxieties by answering some basic questions. 

These include:

• How common is it for a provider to lose a patient to suicide? 
• What is it like to endure this nightmare? 
• What are some effective ways to cope with it? 
• How can organizations provide postvention support? 
• What are the potential legal concerns of losing a client to suicide (e.g., malpractice)?

This post will address the first 2 questions.

Statistics of Suicide Loss Among Providers
Suicide is a leading cause of death in the United States. It is the 2nd leading cause of death for people ages 10-44, and the 8th leading cause of death for people ages 45-64. Many providers know these statistics, and they recite them for public health awareness. But most do so without knowing that, they too, may be affected by these tragedies.

Unfortunately, losing a patient to suicide is not an uncommon experience. A systematic review of 41 studies, across 15 countries, found that 1 in 2 healthcare professionals experienced a patient suicide across their career. When broken down by specialty, 37% of psychologists, 73% of psychiatrists, and 87% of general practitioners lost a client to suicide over their career. Among trainees, about 1 in 6 psychologists reported losing a client to suicide during their one-year clinical internship, and about 1 in 2 psychiatrists reported losing a client to suicide during their residency.

I think it’s importance to contextualize these rates and their interpretation, as they can be scary. First, these rates represent suicide loss across a provider’s career—and providers may see hundreds or thousands of patients across their lifetime. The fact remains that the likelihood of losing a given patient is still very low, so providers need not be concerned when working with a patient with suicidal thoughts. Second, these rates do not capture the level of closeness or proximity of the patient-provider relationship. For instance, the high rate of patient suicides among general practitioners is likely related to their high case load. They are more likely to see patients in brief primary care appointments rather than a long-term psychotherapy context.

A Nightmare for Providers
A patient suicide can be a tremendous loss for a provider. Like any loss, there’s no right or wrong way to grieve a patient suicide, as each one is different. On a personal level, experiencing a patient suicide simply hurts because our patients matter to us. Particularly when we develop longstanding relationships with them, such as in psychotherapy, we get to know intimate aspects of their lives.

On a professional level, we strive to provide the best care. We see people when they are struggling, when they need our help. And, if a patient dies by suicide, we might perceive it as a personal failure. In fact, even among providers who are trained in suicide prevention, research shows that they may feel a sense of responsibility, or a lack of competency, after a patient suicide. Furthermore, providers may experience a storm of thoughts and feelings related to the tragedy. I outline some common reactions below.

Thoughts, Images, and Concerns: 
“I must have done something wrong.”
“I should have seen the signs.”
“Could I have prevented this?”
“Did I miss something?” 
Replaying sessions in one’s head
Doubting one’s competence
Concerns about not knowing what to do next

Feelings: 
Guilt, self-blame 
Shame, embarrassment 
Grief, profound sadness
Confusion, shock, disbelief
Anger (at self, client, or system)
Fear of judgment, litigation, and working with future suicidal clients

Behaviors:
Withdrawing from colleagues
Second-guessing oneself 
Avoiding suicide-related topics
Over-documenting future cases
Difficulty returning to work
Hypervigilance with other clients
Changes in sleep or appetite

While I have not experienced a patient suicide, I can identify somewhat with the nightmare. I lost my brother to suicide in 2017. This loss hit me with unrivaled pain, confusion, and self-doubt. I replayed every scene with him, especially the times that he confided in me about his chronic depression. I interrogated myself, asking, "Did I do enough?" “Did I say the right things?” and "Why didn’t he feel comfortable reaching out to me?” I was not his therapist, but I was about to embark on my training as a psychologist, and my mission was to specialize in suicide prevention. Losing him made me question my ability, “Would I be capable of treating suicidal ideation?” “Would I be able to handle it?” and “Would I be able to make a difference, or would I fail my patients?”

The Need for Proactive Postvention Support
Postvention is a coordinated approach to providing support for people impacted by a suicide loss. The core components include psychoeducation, social support, and structural support (e.g., at the workplace). Postvention efforts (ideally) give a roadmap for navigating the personal (e.g., emotional), professional, legal, and administrative complications after a suicide. There should be risk management and communication protocols across all parties involved; this includes the provider, their supervisor, their team, their organization, and the patient’s loved ones.

Postvention should be proactive—not reactive. The immediate aftermath of a suicide loss can be an emotionally charged time. Preparing a plan prior to a loss can help decrease the anxiety associated with having to quickly determine necessary action steps following a suicide. It can also reduce administrative confusion and thus allow attention to be placed on the human impact.

It can be useful for providers to treat suicide postvention like fire preparation: fires are unlikely to happen, and yet, everyone should always be prepared for one. Like fire preparation, providers and their organizations should develop a proactive plan for a patient suicide. This can be a usable electronic document that is accessible to everyone in the organization. Plans could be organized into sections for the relevant audience (e.g., staff, trainees, leadership, family members) and by action items for the pertinent topics (e.g., “Communicating with Family,” “Supporting Oneself,” “Liability and Malpractice Information”). Of course, making a plan is just the first step. No different than a firedrill, organizations should hold re-occurring trainings and reminders about postvention protocols. Put simply, suicide postvention is an ongoing discussion.

Stay Tuned… 
Suicide postvention deserves more attention. And so, in later posts, I will get deeper on suicide postvention for providers.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of War.

Andrew Devendorf, Ph.D., is a Military Mental Health Psychologist with the Henry M. Jackson Foundation for the Advancement of Military Medicine. He serves as a subject matter expert in suicide prevention for the VA SAFEGUARD project.

References
Jupina, M., Mercer, M., Weleff, J., Hackett, L., Nunes, J. C., Sebastian, D., & Anand, A. 
(2024). Prevalence of patient suicide and its impact on health care professionals: A 
systematic review. Psychiatric Services, 75(10), 999-1008.
Spruch-Feiner, A., Labouliere, C. D., Brodsky, B., Green, K. L., Brown, G. K., Vasan, P.,
... & Stanley, B. (2022). Effects of patient suicide on professional practice among mental
health providers. Journal of Psychiatric Practice, 28(3), 184.

56.0% vs. 47.3%  
 

The percentage of veterans who report using mental health care versus non-veteran use, according to a study published in the journal Psychiatric Services -- Mental Health Care Use and Barriers Among Veterans and Nonveterans With Suicidal Ideation: Findings From a National Survey.

However, nearly one-third of both veterans and nonveterans reported unmet mental health needs. Veterans were less likely than nonveterans to endorse cost as a barrier to care (APR=0.65) but were more likely to endorse confidentiality concerns (APR=1.65). Fear of involuntary hospitalization and stigma were common in both groups.