Toward a Gold Standard for Suicide Risk Assessment for Military Personnel

Posted September 13, 2018

Peter Gutierrez, Ph.D., Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver, Colorado
Thomas Joiner, Ph.D., Florida State University, Tallahassee, Florida

Peter Gutierrez, Ph.D., Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver, Colorado

Dr. Peter Gutierrez,
Rocky Mountain Mental
Illness Research, Education and Clinical Center,
Denver, Colorado
Katherine Anne Comtois, Ph.D., M.P.H., University of Washington

Dr. Thomas Joiner,
Florida State University, Tallahassee, Florida

Suicide is a major concern affecting our Service members. Historically, suicide among Service members has been lower than that of the general public; however, in 2008, the rate among U.S. Army Soldiers surpassed the general public and has remained high ever since.1 In 2010 and 2011, more Soldiers lost their lives to suicide than to enemy forces.1 The problem continues to persist, as the most recent Department of Defense quarterly suicide report indicates, in 2017, there were more than 500 suicides across all active duty and reserve Service members.2

Despite these alarming statistics, suicide remains difficult to predict in the short term, making it hard for medical professionals to know when to intervene.3 To address this concern, the Psychological Health and Traumatic Brain Injury Research Program funded Drs. Gutierrez and Joiner to investigate suicide diagnostic tools as part of the Military Suicide Research Consortium (MSRC) through an FY09 Broad Agency Announcement. Drs. Gutierrez and Joiner sought to identify a gold standard diagnostic tool that could reliably and accurately predict suicide risk in Service members. To accomplish this, they compared the performance of four prominent suicide assessments, namely the Columbia-Suicide Severity Rating Scale (C-SSRS), Self-Harm Behavior Questionnaire (SHBQ), Suicidal Behaviors Questionnaire-Revised (SBQ-R), and Beck Scale for Suicide Ideation (BSS). These measures were chosen for comparison based on their prior reliability in the clinic and the scope of the suicidal behavior being measured; however, this is the first study to examine any of these tests regarding their predictive ability on suicidal risk in active duty personnel.

Drs. Gutierrez and Joiner determined that, although each of the four tests were psychometrically sound, not all were equal in their predictive ability. Military personnel seeking mental health services and volunteering for the study were administered each of the four tests during an initial assessment visit, then again during a 3-month follow-up. More than 750 participants completed both visits. Specifically, the research team looked at whether participants received emergency services due to suicidal crises and whether the participants engaged in suicidal behavior during the three-month period between visits. Their results indicated that the SHBQ stood out among the other tests in terms of predicting new episodes of suicidal ideation. The predictive power of the SHBQ was even further improved when combined with the SBQ-R, and together they best predicted return to care due to suicide-related issues.

While this study was limited to Service members already identified as having an elevated suicide risk, it marks a significant advance in military suicide medical research. Drs. Gutierrez and Joiner offer definitive results indicating that the SHBQ and SBQ-R should be used in combination as a standard “go-to” assessment when Service members seek treatment for suicidal factors. Not only do these combined tests predict return to care for suicide-related reasons, but they are also low cost and easy to administer and evaluate making them easy to disseminate and implement throughout the medical community. Taken together, these results may lead to a significant improvement in military suicide risk evaluation and consequent prevention, thereby minimizing lives lost to suicide in Service members.

The MSRC is dedicated to research that prevents suicide and, in doing so, urges anyone to act if they believe someone they know may be in danger. If you or someone you know has thoughts of suicide or has engaged in suicidal behaviors, contact the Military Crisis Line by texting 838255, calling 1-800-273-8255, or starting a confidential chat at


1. Nock MK, Deming CA, Fullerton CS, Gilman SE, Goldenberg M, Kessler RC, et al. 2013. Suicide among soldiers: a review of psychosocial risk and protective factors. Psychiatry. 76(2):97-125.

2. Department of Defense (DoD) Quarterly Suicide Report (QSR) 1st Quarter, CY 2018. Rennie Vazquiz, Acting Director Defense Suicide Prevention Office (DSPO).

3. Glenn CR, Nock MK. 2014. Improving the short-term prediction of suicidal behavior. American Journal of Preventative Medicine. 47(3 Suppl 2):S176-S180.


Public and Technical Abstracts: Military Suicide Research Consortium

Top of Page

Last updated Thursday, May 26, 2022