Consortium for Defense Psychology

$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