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The shared experience of veteran transition and its impact on veteran suicide

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The shared experience of veteran transition and its impact on veteran suicide

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Content The Shared Experience of Veteran Transition and Its Impact on Veteran Suicide
by
Paolo Paruccini
Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
In Partial Fulfillment of the requirements for the degree
Doctor of Education
December 2021

© Copyright by Paolo Paruccini 2021
All Rights Reserved

The Committee for Paolo Paruccini certifies the approval of this Dissertation

Jennifer Phillips
Wayne Combs
Patricia Tobey, Committee Chair

Rossier School of Education
University of Southern California
2021
iv
Abstract
The problem to be addressed within this study is the elevated rates of veteran suicides. Veterans
are experiencing increased rates of suicide since serving in the wars in Afghanistan and Iraq. The
phenomenological framework was used to guide this study; qualitative design was used to
analyze the data collected. Qualitative findings helped answer the main research objective. From
the findings, it can be concluded that knowledge of suicide ideation as a suicide risk factor was
an advantage for participants, distrust of suicide prevention programs was found to be a barrier to
evaluating the effectiveness of strategies to reduce suicide, having a clear understanding of
procedures for accessing suicide prevention assistance was found to be an asset for participants
in this study, emphasizing teamwork efficacy was more effective than emphasizing self-efficacy
for veterans, Army discipline contributes to perseverance, veterans strongly rely on one another,
and the culture of self-reliance in the Army contributes to a lack of help-seeking behavior.
Keywords: Veterans, PTSD, suicide, mental health, qualitative, phenomenological
v
Dedication
To my beautiful wife, Brooke and son, Grant, as well as all the Paruccinis and Fords who have
answered our nation’s call to protect freedom around the world.
To the men of Alpha Co. 3rd Platoon 1-12CAV 3rd BCT who showed me what it meant to lead.

vi
Acknowledgments
I am a former infantry officer who served one tour in the Middle East, conducting
numerus missions in support of operation New Dawn. I have left the service and currently work
in the private sector. I was driven to evaluate the problem of veteran suicide because I have lost
more friends, loved ones, superiors, and acquaintances to suicide once home than to war at the
hands of the Taliban or Al Qaida.
The individuals who chose to participate in this study in the hopes of helping those that
have served and those that will serve our nation, and to those that bear the scars of a military at
war and have shouldered more than their years should, thank you for your willingness to
continue to fight.
My peers who showed an unbelievable willingness to aid me in the pursuit of finding
potential causes and solutions for this epidemic that plagues the veteran community and
understanding that many of us have lost more peers and friends at home than overseas, thank
you.
My family: my wife, Brooke; son, Grant; brother, Peter; and mother and father Stephanie
and Luigi Paruccini for pushing me to begin and complete the pursuit of my doctorate degree,
thank you so much for your support. To my father Luigi and brother Peter who wore the uniform
and fought for our nation against communism in Southeast Asia, and radical fundamentalism in
Afghanistan, thank you. They gave me direction and purpose in my pursuit to continue to help
the veteran community.
My committee chair, Dr. Patricia Tobey, thank you for guiding me through this process
and providing much needed words of encouragement more than once. Thank you for pointing me
in the right direction and helping me to work through the sticky points in my writing.
vii
My committee, Dr. Wayne Combs and Dr. Jenifer Philips; thank you for your dedication
to a problem that is so near and dear to me. For your insights and guidance surrounding the
structure, tone, and tenor of the project, thank you. Lastly, thank you for your ability to see the
good that can come from the evaluation of such a somber topic.

viii
Table of Contents
Abstract ..................................................................................................................................... iv
Dedication .................................................................................................................................. v
Acknowledgments ..................................................................................................................... vi
List of Tables .............................................................................................................................. x
Chapter One: Overview of the Study........................................................................................... 1
Background of the Problem ............................................................................................. 2
Importance of Addressing the Problem ............................................................................ 4
Organizational Context and Mission ................................................................................ 4
Overview of the Conceptual and Methodological Framework ......................................... 5
Purpose of the Study and Questions ................................................................................ 6
Definitions ...................................................................................................................... 6
Organization of the Project .............................................................................................. 7
Chapter Two: Review of Literature ............................................................................................. 8
Veteran Suicide ............................................................................................................... 8
Phenomenological Approach of Evaluation ................................................................... 16
Summary....................................................................................................................... 16
Chapter Three: Methodology .................................................................................................... 18
Study Question .............................................................................................................. 18
Overview of Methodology ............................................................................................ 18
Data Collection, Instrumentation, and Analysis Plan ..................................................... 19
Credibility and Dependability........................................................................................ 22
Ethics and Role of Researcher ....................................................................................... 23
Limitations and Delimitations ....................................................................................... 24
Summary....................................................................................................................... 25
ix
Chapter Four: Findings ............................................................................................................. 26
Qualitative Findings ...................................................................................................... 26
Findings Summary ........................................................................................................ 51
Chapter Five: Disscussion ......................................................................................................... 52
Discussion of Findings and Results ............................................................................... 52
Recommendations for Practice ...................................................................................... 55
Recommendations for Future Research ......................................................................... 59
Conclusion .................................................................................................................... 60
References ................................................................................................................................ 62
Appendix A: Interview Questions ............................................................................................. 69
Appendix B: IRB Information................................................................................................... 70
Appendix C: IRB Approval Letter ............................................................................................ 72

x
List of Tables
Table 1: Participant Biographic Information ............................................................................. 28
Table 2: Emergent Themes ....................................................................................................... 31

1

Chapter One: Overview of the Study
According to Harrington (2019), veterans comprised an estimated 7.3% of the overall
adult population. Veterans, within this context, can be defined “as any persons that are currently
serving on nonactive guard, or reserves; or other individuals that once served within the U.S.
Army (U.S. Department of Veteran Affairs Office of Mental Health and Suicide Prevention,
2018). Although veterans represent 7.3% of all adults in the United States, the veteran
community represents a disproportionately high percentage of adult suicides.
The U.S. Department of Veteran Affairs (2019a) found that veterans account for 14.3%
of all adult suicides in the United States. Thus, veterans are 21% more likely to commit suicide
compared with the civilian population at large (U.S. Department of Veteran Affairs Office of
Mental Health and Suicide Prevention, 2018). This is especially true of younger veterans, aged
18–34, that have served in Afghanistan and Iraq during the War on Terror, as this veteran
population has experienced increased suicide rates in recent years (Kang et al., 2015).
Completion of suicide has an array of negative consequences for others, especially other
veterans. First, suicide is often catastrophic for loved ones that are left behind, as they grieve and
attempt to understand why the suicide occurred (Cerel et al., 2016). Individuals that have been
exposed to suicide are at an increased risk of developing anxiety, depression, and post-traumatic
stress disorder (PTSD; Cerel et al., 2016; Hom et al., 2017). Moreover, suicide completion
negatively affects other veterans, as exposure to suicide has been shown to increase suicide risk
in surviving veterans (Hom et al., 2017). Veterans who have been exposed to a suicide from
other veteran associates are four times more likely to take their own lives than veterans that have
not experienced loss by suicide (Cerel et al., 2015).
2

With so many negative outcomes for both individuals that commit suicide and those
exposed to suicide, better understanding why younger veterans are experiencing increased rates
of suicide is imperative to begin to address this devastating issue. This study attempts to better
understand why younger veterans are experiencing increasing rates of suicide and to identify
demographic variables that may lead to more-comprehensive suicide prevention programs to
reduce the rates of suicide within this at-risk cohort.
Background of the Problem
The purpose of this study is to explore the impacts of the veteran’s loss of connectedness
when transitioning to civilian life. The study also endeavors to propose opportunities to improve
the feelings of connectedness within the veteran community to better support the U.S. Army
veterans following their departure from active service, thus reducing the rates of veteran
suicides. Since serving in the wars in Afghanistan and Iraq, veterans transitioning out of military
service are experiencing increased rates of suicide. Especially troubling is that little is known
about why suicide rates within this cohort are increasing (Kang et al., 2015).
Bryan et al. (2015), Logan et al. (2016), and O’Donnell et al. (2018) indicated that
suicide in veterans was influenced by exposure to violence, especially combat-related violence.
Bryan et al. (2015) completed a comprehensive and systematic review of related literature
concerning suicide within veteran populations and found that suicide among veterans was higher
when veterans were exposed to combat killings, armed conflict, and stressful situations during
the deployment process.
In a similar study, Logan et al. (2016) examined causal factors that influenced the
decisions of veterans to commit suicide. The researchers indicated that there were five major
contributors to veteran suicide, including issues with loved ones, problems with mental health
3

symptomology, substance abuse issues, issues at work, and exposure to crises. As such, Logan et
al. (2016) indicated the need to examine how demographic variables influence the likelihood of
veteran suicide within this cohort. Additionally, they opined that there is a need to better
understand how demographic information may influence the demonstration of PTSD and other
mental health disorders that may impact the prevalence of veteran suicide.
O’Donnell et al. (2019) indicated that PTSD may influence the rate of suicide among
younger veterans, especially if PTSD presented after a deployment to areas of violent conflict.
Moreover, O’Donnell et al. (2019) found that PTSD was the strongest predictor of young veteran
suicide compared with family or work issues or other noncombat-related stressors. Finally, the
researchers observed that, during the completion of their study, the incidence of PTSD in young
veterans had increased 30-fold, indicating that if PTSD is indicative of possible veteran suicide,
this issue could worsen within the future. Like Logan et al. (2016), O’Donnell et al. (2019)
suggested that future research examine demographic factors, such as ethnicity, within veterans
aged 18–35 years
Although previous research indicated that combat-related violence and PTSD influence
rates of suicide, little remains known about how demography affects the demonstration of PTSD
in younger veterans (aged 18–24), especially in relation to veteran suicide (Logan et al., 2016;
O’Donnell et al., 2019). As veteran suicide is an issue that is expected to continue to rise among
younger veterans, and can negatively impact family and other veterans, a better understanding
how demography influences PTSD and veteran suicide is imperative. With a better
understanding of how ethnicity affects rates of PTSD that lead to veteran suicide, more-
comprehensive suicide prevention initiatives can be created to mitigate these issues within the
future.
4

Importance of Addressing the Problem
Solving the problem of veteran suicide is important for a variety of reasons. First, suicide
is increasing among veterans, especially young veterans aged 18–24 (U.S. Department of
Veteran Affairs Office of Mental Health and Suicide Prevention, 2018). Although suicide is
catastrophic to survivors, there is evidence to suggest that incidence of suicide can impact the
likelihood that other veterans will commit suicide in the future (Hom et al., 2017).
Currently, there is little understanding of which demographic is most apt to commit
suicide, especially PTSD-related suicide (Logan et al., 2016; O’Donnell et al., 2019).
Demographic information is needed to better inform the Army’s suicide prevention initiatives.
With more-comprehensive suicide prevention protocols, the Army may be able to stave the
incidence of suicide in younger veterans, who are especially at risk for PTSD-related suicide.
This could improve organizational performance as there would be fewer negative outcomes for
service members and improved perception of veteran outcomes after transition back to civilian
life.
Organizational Context and Mission
The Army will be used as a pseudonym to describe the organization of interest for this
project. The Army is a governmentally funded group in the defense sector of the United States.
The Army is a large organization of approximately 25 million persons (PEW Research Center,
2019). The Army comprises both men and women, all ethnicities, varying ages, and all levels of
socioeconomic status.
One of the Army’s missions is to honor and care for those that have experienced battle
and their respective families in perpetuity. As the goal of this project is to identify demographic
variables that indicate increased likelihood of suicide among young veterans aged 18–24, this
5

project will reinforce that mission. Moreover, because results of this project will be used to
create bolder suicide prevention initiatives, this project will also improve outcomes for veterans’
families and the veterans themselves.
Overview of the Conceptual and Methodological Framework
The conceptual and methodological framework employed within this study is the
phenomenological framework developed Edmund Husserl (1913) and described by Stan Lester
(1999). This framework was designed specifically to examine and evaluate the specific shared
experiences of individuals across an organization or across an event. The phenomenological
framework examines factors across a specific shared experience, such as life before service in
the military, life during active service, transition in and out of the service, and life after service
(Lester, 1999; Thompson et al., 2019). Using the phenomenological framework, the
understanding of shared veteran experiences can be better understood as pertaining to transition
out of the service, support from the Army, and the feeling of being directionless reported by the
veteran community upon exiting the service. This examination allows for the evaluation of how
this phenomenon of experience impacts rates of veteran suicide.
This framework allows this project to focus on the interviews of eight participants that
not only transitioned out of the Army but have also dealt with mental health issues and now
support veterans through nonprofit engagement. These interviews allow for the unique
exploration through qualitative analysis of the veterans’ shared experience as those that have
walked the path and ultimately dealt with their lived suicidal tendencies or full-blown ideation.
This information will better inform future studies based due to the poignant and raw data
gathered not having been sanitized by any governmental agency to align public-facing
messaging.
6

Purpose of the Study and Questions
The purpose of this project is to examine the shared experience phenomena among those
that have served in United States Army. While a complete evaluation project would focus on all
stakeholders involved with the Army, for practical purposes, this study focuses on eight
interview participants that serviced in the Army infantry, have transitioned out of the Army, have
dealt with mental health issues, and now service the veteran community through nonprofit work.
Results of this project may inform current practice regarding suicide prevention among veterans
that have exited or will be exiting active service to rejoin civilian life.
A singular question guided this study: What are the greatest influences or barriers to help-
seeking behavior among Army veterans following their departure from active service from the
perspective of nonprofit suicide program personnel who are Army veterans themselves?
Definitions
• Post-Traumatic stress disorder (PTSD) is defined PTSD as a disorder that affects
physical, emotional, and mental health. PTSD originates from exposure to extremely
distressful situations, including combat situations (Helzer et al., 1987).
• Veteran is any person that is currently serving on nonactive guard, or reserves; or other
individuals that once served in the Army (U.S. Department of Veteran Affairs Office of
Mental Health and Suicide Prevention, 2018).
• Veteran suicide is the purposeful taking of one’s own life. Logan et al. (2016) indicated
that there are five major contributors to veteran suicide: issues with loved ones, problems
with mental health symptomology, substance abuse issues, issues at work, and exposure
to crises. O’Donnell (2018) opined that veteran suicide was also linked to the prevalence
of PTSD.
7

Organization of the Project
This project is organized into five chapters. This chapter provided an outline of the
background, purpose, and significance of this project. The organization and the stakeholders
were defined, as were their mission and goals. This first chapter provided information on terms
that are central to the project. Chapter 2 will provide a comprehensive review of the literature,
while Chapter 3 will present information on the methodological approach I used to complete this
project. Within Chapter 3, information on sampling, data collection, and data analysis will be
discussed. Chapter 4 will provide the results of data collection along with a brief description for
context. Finally, Chapter 5 will provide more information on results, including implications for
practice and recommendations for future research.
8

Chapter Two: Review of Literature
This chapter will present information needed to better understand the themes central to
this study. First, an overview of veteran suicide will be presented. Next, causal factors that are
known to facilitate veteran suicide will be provided. This chapter will also provide additional
information surrounding why the phenomenological approach aligns with the exploration of this
problem.
Veteran Suicide
According to the U.S. Department of Veteran Affairs (VA; 2019a), an estimated 45,000
adults died by suicide in 2017. This number of individuals reflects an increase in suicides, as
only 43,000 American adults died by suicide in the previous year (American Foundation for
Suicide Prevention [AFSP], 2016). Furthermore, the AFSP (2016) argued that suicide is now the
tenth leading cause of death among all adults, although suicide is the second leading cause of
death among persons under the age of 44.
When suicide was examined among veteran groups, the VA (2018) estimated that
veterans account for 14.3% of all suicides among adults. This number is disproportionate as
veterans only comprise 6.3% of the adult population of American within the United States
(USCB, 2018). This statistic shows that the number of suicides among veterans are
disproportionate because they are an estimated 21% more likely to commit suicide when
compared to nonveteran adults (VA, 2018). As such, 17 veterans are estimated to commit suicide
every day (U.S. Department of Veteran Affairs Office of Mental Health and Suicide Prevention,
2019).
Veteran groups do not experience rates of suicide similarly. According to the VA (2018),
Marines experience the highest number of suicides, as approximately 35 Marines of every
9

100,000 of veteran suicides were committed by Marine Corps personnel. The second highest rate
of suicide was experienced by members of the National Guard, who represented an estimated 30
per 100,000 die by suicide, followed by individuals from the Army at approximately 25 per
100,000, and by Navy veterans at 21 per 100,000 (U.S. Department of Veteran Affairs Office of
Mental Health and Suicide Prevention, 2019). The lowest rates of suicide are experienced within
the Air Force at an estimated 18 per 100,000 of all airmen.
The VA (2019a) found that 31% of suicides were completed by veterans 49 and younger.
The number of suicides increases with age, as 69% veterans that commit suicide are older than
50 years of age (U.S. Department of Veteran Affairs Office of Mental Health and Suicide
Prevention, 2019).
Influencers of Veteran Suicide
American veterans often struggle when attempting to reintegrate into civilian life. Issues
with homelessness, unemployment, mental illness, and substance use disorders (SUDs) are more
common among veterans than in other adults. Each of these factors in isolation has been linked
to an increased risk of suicide. However, these factors also interoperate, creating increased
likelihood that suicide may occur among veterans.
Upon return from active duty, many veterans struggle with homelessness. The United
States Department of Housing and Urban Development (HUD 2016) completed a seminal study
that included the national demographics of America’s homeless veterans. First, HUB (2016)
found that 90% of homeless veterans are male. However, female veterans were more likely to
care for their children within homeless situations. Moreover, most veterans that were homeless
also reported being single (90%) and residing in urban areas (73%), according to the HUB
(2016).
10

The report by HUB (2016) also indicated that although most homeless veterans were
Caucasian (55%), veterans of ethnic minority were overrepresented within the homeless
population. When ethnicity was explored by the HUB (2016) study, an estimated 45% of
homeless veterans were of either African American or Hispanic heritage. This number of African
American and Hispanic individuals reflects an overrepresentation as these cohorts only comprise
14% of all members of the military (Olenick et al., 2015).
The National Coalition for Homeless Veterans (NCHV; 2019), a leading advocacy group
to address homelessness among United States veterans completed a study in 2019 that identified
the ages of a large sample of homeless veterans. The NCVH (2019) study found that an
estimated 50% of all homeless veterans were under the age of 50, and that 10% were under the
age of 30. As with overrepresentation among homeless veterans, there is an overrepresentation of
younger veterans among the homeless (Olenick et al., 2015). Although 10% of homeless
veterans are under the age of 30, veterans under 30 comprise only 5% of veterans overall
(NCHV, 2019; VA, 2019b). Moreover, veterans in the 31-to-50-year age cohort comprise 40%
of all homeless veterans but only represent 22% of the American veteran population (VA,
2019b).
Olenick et al. (2015) found that there were an estimated 50,000 veterans struggling with
homelessness throughout the United States. However, it is believed that number is low due to
underreporting. In addition to the 50,000 veterans that were homeless at the time of the study,
another 1.4 million veterans are at risk of homelessness at any given time, as physical and mental
health issues can create cycles of poverty and reduction in familial or social supports (VA 2020).
Hoffberg et al. (2018) examined the suicide rate in homeless veterans utilizing a
systematic literature review (SLR). Using extant literature on the topic, Hoffberg et al. (2018)
11

found that, roughly two percent of homeless veterans had current suicidal ideations, while 20%
of homeless veterans had contemplated suicide within the past 30 days. The majority (74%) of
homeless veterans included in this this SLR reported contemplating suicide at least once after
returning from active duty. Hoffberg et al. (2018) also found that of these aforementioned
veterans, an estimated 6% had attempted suicide within the past 30 days, while almost 32% had
attempted suicide in the past 5 years. The rate of suicide attempts at any point in time was
approximately 47%. Moreover, according to Hoffbeg et al. (2018) homeless veterans had a
suicide rate of 81 per 100,000, which is higher than the national average of nonveteran homeless
individuals.
Physical, Emotional, and Mental Health Issues
Homelessness among individuals is often associated with physical, emotional, or mental
health issues (VA, 2019b). Physical issues are often facilitated by combat-related injuries or, in
some cases, the environmental working conditions associated with substances or in conditions
that impede physical health (Reeves et al., 2016). These physical injuries can make finding
gainful employment difficult upon return to civilian life, thus increasing the likelihood of
homelessness (Olenick et al., 2015).
According to a study completed by Olenick et al. (2015), many veterans returning from
active duty are impacted by physical or mental health issues. In fact, over 40% of veterans
returning from active service are diagnosed with some form of mental health disorder upon
return to civilian life (Olenick et al., 2015). These mental health issues include depression,
anxiety, and PTSD (Reeves et al., 2016). According to Reeves et al. (2016), these mental health
issues are often related to the confusion, turmoil, and violence associated with active duty.
12

Bryan et al. (2015), Logan et al. (2016), and O’Donnell et al. (2018) examined the
relationship between suicide and veterans that had experienced or witnessed violence while in
active duty roles. Bryan et al. (2015) completed an SLR and found that veterans that were
exposed to or participated in combat killings were more likely than other veterans to commit
suicide. Veteran suicide was also higher when veterans were exposed to armed conflict or
stationed in stressful situations during deployment (Bryan et al., 2015; Logan et al., 2016)
Logan et al. (2016) examined factors that led to veteran decisions to commit suicide
among younger veterans aged 18–35. Logan et al. (2016) stated that this cohort was worth
studying, as these individuals are at a higher risk of suicide because they may be struggling with
novel life experiences while simultaneously trying to reintegrate into civilian life. Logan et al.
(2016) also found that among the factors that made suicide more likely were mental health
issues, SUDs, and issues facilitated from active duty. Logan et al. (2016) opined that veterans
that were exposed to combat violence were more apt to have PTSD. Veterans with PTSD may
have increased difficulty assimilating back into civilian life, which could greatly increase the
prevalence of veteran suicide (Logan et al., 2016; O’Donnell et al., 2019). In fact, PTSD may be
the strongest indicator related to veteran suicide regarding mental health issues (O’Donnell et al.,
2019; Olenick et al., 2015). O’Donnell et al. (2019) argued that not only is PTSD a strong
indicator of veteran suicide but that the incidence of PTSD is likely to rise among veterans
returning home from conflict in the Middle East, as tension remain high even in times of
intermittent violence.
Physical and mental health issues often interoperate, creating increased likelihood of
substance abuse and homelessness within the veteran community (Olenick et al., 2015). This
combination of health issues, substance abuse, and homelessness, as already stated, increases the
13

incidence of veteran suicide (Hoffberg et al., 2018). In addition, physical and mental health
issues can also lead to another pressing issue among veterans within the United States, the
inability to find and maintain gainful employment (Kintzle et al., 2015).
Unemployment
The Bureau of Labor Statistics (BLS) examined the unemployment rate among American
veterans in 2020. Findings of the BLS (2021) indicated that currently approximately three
percent of all veterans are unemployed. This means that in 2020, approximately 284,000 veterans
were unable to find and secure gainful employment (BLS, 2021).
When the BLS (2021) study was completed, results indicated that there was no
significant difference between rates of unemployment of male and female veterans. However,
female veterans more often had children to feed, clothe, and shelter, creating increased need for
secure employment opportunities (Kintzle et al., 2015). The BLS (2021) found that when the
ages of unemployed veterans were considered, approximately 5% were under the age of 24, 56%
of all unemployed veterans were between the ages of 25 and 54, and the remaining 39% of
unemployed veterans were over the age of 55.
Veterans of ethnic minority were more likely than Caucasian peers to be unemployed
(BLS, 2020). The results of the study completed by the BLS (2020) indicated that an estimated
6% of African Americans were unemployed and 4% of all Hispanic veterans were unemployed,
while only 3% of Caucasian veterans were likely to be unemployed (Bureau of Labor Statistics,
2015).
Tran et al. (2017) stated that unemployment is likely to impact rates of suicide in an
indirect way. Although unemployment in itself is not a strong indicator of suicide among
veterans, it has been associated with other negative outcomes. Unemployment has been
14

associated with higher rates of substance usage, physical and mental illness, and homelessness,
all of which are strongly correlated with suicide (Olenick et al., 2015; VA, 2020). Moreover,
unemployment has been associated with lower levels of self-efficacy and increased rates of
poverty, which are also associated with higher incidence of suicide among veteran groups (U.S.
Department of Veteran Affairs Office of Mental Health and Suicide Prevention, 2019; VA,
2020).
Strategies to Mitigate Veteran Suicide
With so many obstacles facing veterans transitioning out of active duty roles, many
federal and state programs have been initiated to mitigate rates of suicide. Many states have
suicide prevention hotlines that are formatted specifically for use by veterans who are
contemplating suicide (VA, 2018). These initiatives have been shown to have some success in
mitigating rates of suicide. However, these hotlines are only available by phone, which can be
problematic for homeless or impoverished veterans that may not have easy or reliable access to
phones (Jobes et al., 2019).
In addition to hotlines, many VA offices have created programs that are specific to each
branch of the military. As such, veterans from any branch can call, teleconference, or visit the
VA and speak to individuals that have served within their respective branches of the military
(VA, 2020). This aids in the personalization of suicide prevention initiatives and often allows
veterans to feel more comfortable when help-seeking help (VA, 2020).
Additionally, the VA and other local nonprofit organizations have instituted many
programs to address factors that increase the rate of suicide among veterans. For example, the
VA (U.S. Department of Veteran Affairs Office of Mental Health and Suicide Prevention, 2019;
VA, 2020) has established initiatives to increase employment and housing for veterans. Within
15

these programs, recruiters of various job opportunities, VA professionals, and veterans
themselves work together to provide a variety of services (VA, 2018).
First, the VA works alongside the veteran to aid in reintegration efforts into civilian life,
which can be troublesome for veterans (U.S. Department of Veteran Affairs Office of Mental
Health and Suicide Prevention, 2019). Most issues with reintegration occur because the structure,
rules, and power dynamics are different between active duty and civilian life, creating strife and
dissonance for the veterans. To compound employment issues for veterans, there exists a public
stigma about hiring veterans, as they are thought to be more volatile and unpredictable
employees (Caldwell & Lauderdale, 2018; Stone et al., 2018). Stone et al. (2018) also found that
many hiring managers possessed biases and stereotyped some branches of military over others,
creating increased hardship of veterans of the Army when trying to find employment.
Through the programs established by the VA (2016; 2018), veterans learn the skills
needed to better integrate back into civilian life, which can make them more employable. These
programs also provide mock interviews, resume writing, and other skills that can increase the
likelihood of employment. Finally, the programs also typically include job skills training that can
be used to either train veterans for novel job roles or integrate extant skills acquired while in the
service to fulfill job needs within civilian life (VA, 2020).
Additionally, the VA (2018) has established nationwide programs to increase access to
physical and mental health care. In addition, many states and nonprofit organizations have
programs that treat veterans for physical or mental health issues for reduced fees, or completely
free of charge, to ensure that this at-risk population receives adequate care. Through the
mitigation of physical and mental health issues, and associated substance abuse, many veterans
have improved chances of securing gainful employment, finding reliable housing, and mitigating
16

the pervasive symptoms of depression, anxiety, and PTSD that are all associated with a reduced
chance of veteran suicide.
Phenomenological Approach of Evaluation
As stated in Chapter 1, this evaluation of the problem of veteran suicide is leveraging the
phenomenological approach developed by Edmund Husserl (Moran, 2005). This approach allows
the latitude necessary for a rich exploration of this nuanced issue. The phenomenological
approach also offers the opportunity to “gather ‘deep’ information and perceptions through
inductive, qualitative methods” (Lester, 1999).
This approach aligns perfectly with the interviewees participating in this project. All
participants are themselves veterans, they have all transitioned out of the Army, they have all
dealt with suicidal issues, and they all now help the veteran community through nonprofit
outreach. This is an important facet of this study and the implementation of the stated
framework; all of the participants indicated that it was not the Army itself, however, but the
collectivist culture of the Army that drove them to seek help.
Summary
This chapter provided information on the background of veteran suicide, including an
overview of issues related to veteran suicide and potential resources to mitigate this issue.
Additionally, this chapter provided information regarding Husserl’s (2001) phenomenological
approach, which seeks to identify specific phenomena across a group of individuals with a
shared experience for better understanding. Finally, although the development of a conceptual
framework is a common practice for studies of this kind, in this instance it would limit the
effectiveness rather than provide structure to this work.
17

The next chapter will provide details on the methodology needed to complete this study.
Chapter 3 will provide information on the methodological approach, sampling, and data
collection and will conclude with information regarding data analysis and a summary of key
points.
18

Chapter Three: Methodology
The purpose of this phenomenological, qualitative project was to examine and explore
the shared experience of transitioning out the United States Army and the barriers that exist for
the veteran community when seeking mental health assistance. While a complete evaluation of
this problem would be much more broad in its scope this project focuses on the eight participants
of the qualitative interviews. Results of this project may inform current practice regarding the
transition process from the Army as well as suicide prevention or intervention tactics that could
better serve the veteran community. This chapter will provide a discussion on the methodology,
participants, data collection, data analyses procedures, ethical considerations, and limitations and
delimitations considered in the study.
Study Question
One question guided this study: What are the greatest influences or barriers to help-
seeking behavior among Army veterans following their departure from active service from the
perspective of nonprofit suicide program personnel who are Army veterans themselves?
Overview of Methodology
To properly engage the phenomenological framework, the application of a qualitative,
descriptive research method and design was chosen. Qualitative research is the exploration of the
human experience to gain an understanding of a group or individual problem (Creswell, 2014).
Qualitative research seeks to derive meaning from how people describe their interaction with the
world, problem, or process utilizing words as data (Merriam & Tisdell, 2016, Braun & Clark,
2013). This study’s qualitative design included participants who are nonprofit employees or
volunteers and also veterans themselves who provided the unique shared perspective imperative
for this application. The selection of these participants was not constrained by any demographic
19

characteristic. The participants had to be nonprofit employees or volunteers that work with
veterans from any branch of the armed forces, but they themselves were Army veterans.
Qualitative methods rely on an inductive reasoning approach to exploring a phenomenon to
understand and propose possible theories. The qualitative method relied on in this research
supported exploring how nonprofit employees and volunteers perceived that the organizational
culture and context of the U.S. Army contribute to PTSD-induced suicide. A qualitative,
descriptive research design was employed because developing this understanding required
describing the process by which culture and context lead to increased rates of veteran suicide.
As discussed at the beginning of this work, the phenomenological approach offers the
perfect lens through which to view and analyze this information. This approach gives researchers
the latitude to not confine themselves to one specific conceptual framework but rather to allow
the study to follow where human subjects lead for a better understanding of the phenomenon of
lived experience. When approaching the nuanced subject of veteran suicide compared with Army
culture, this approach provided the requisite latitude for a deep meaningful conversation to take
place.
Data Collection, Instrumentation, and Analysis Plan
This section provides a detailed discussion of the method, participants, and
instrumentation used in the study. The section also includes the data collection and the data
analyses procedures that were employed in the study.
Interviews
Semi-structured interviews were used to collect data in accordance with the guiding
research question of this study. The interview questions for this study are available in Appendix
A. Semi-structured interviews support gathering in-depth data related to the phenomenon under
20

investigation. Relying on semi-structured interviews as a technique in this study supports
gathering data associated with several open-ended questions. The semi-structured interviews
included 10 open-ended questions where participants responded based on their reflection on
events associated with the questions. Data collection required participants to be interviewed
through either face-to-face or digital technology-supported meetings, where the responses from
participants were recorded. The questions used in the semi-structured interviews were designed
to provide better insight surrounding the research question for this study; What are the greatest
influences or barriers to help-seeking behavior among Army veterans following their departure
from active service from the perspective of nonprofit suicide program personnel who are Army
veterans themselves.
Participating Stakeholders
This research sought to include 10 interviews. The participants in these interviews were
nonprofit employees or volunteers who work with veterans and themselves are Army veterans
who had experienced the transition from military to civilian life. Ten interviews were selected as
a baseline. However, if following exploration, the responses did not appear to be a sufficient,
additional interviews would have been held until data saturation was reached (Creswell & Plano
Clark, 2017). Saturation for this study was reached at eight participants.
Instrumentation
A semi-structured interview approach was chosen to explore the topic of elevated rates of
veteran suicide. This semi-structured interview approach entailed 10 questions related to the
research question, and also the literature review of the study. This approach was selected based
on its ability to allow the conversations to take any direction necessary to explore the
21

experiential phenomenon of cultural transition and the uniqueness of that particular event as
lived out by the interview participants.
Data Collection Procedures
Prior to collecting data, approval from the Institutional Review Board (IRB) was obtained
to ensure the procedures would meet ethical standards. Once approval was obtained, I began the
interview recruitment process utilizing the approved email template and focusing on nonprofit
organizations with a base in Southern California. The inclusion criteria for the qualitative portion
of the study included working at a nonprofit or volunteering to work with veterans as well as
being a veteran of the U.S. Army who had experienced the transition process firsthand.
The email invitation contained a brief background of the study as well as the role of the
researcher. Participants who qualified by meeting the inclusion criteria were provided an
informed consent form. The informed consent form contained information about the procedures
that were to be followed in the study. Participants were informed that they could opt to skip any
item or to withdraw from the study at any point in time without negative implications.
Participants were also informed that the study was completely voluntary. Once participants
agreed to the informed consent form, an interview was scheduled. Field notes, recordings, and
transcriptions of the semi-structured interviews were leveraged to ensure accuracy when
representing participants’ responses. Transcribed data were prepared for analysis using NVivo
12.0.
Data Analysis
In the analysis of the guiding research question, thematic analysis was used. Braun and
Clarke’s (2006) approach to thematic analysis was used to explore the data. Phase 1 entailed
reading and rereading data to become familiar with the data and patterns in the data. During this
22

phase, the determination was made as to whether the point of saturation had been reached. Once
reached, analysis progressed to Phase 2. In Phase 2, initial coding occurred. Codes were applied
to the data where lines or paragraphs were reduced to codes. Analysis then progressed to Phase
3. In Phase 3, codes were combined to establish themes and grouped together. In Phase 4, the
data were explored to understand how the themes supported the existence of an overarching
theoretical perspective. Phase 5 required the definition of themes and the aspects of data
captured. Phase 6 was the final phase. Phase 6 entailed writing up the report on the results of the
data and performing member checking to ensure that there was accurate representation of the
data in the coding and themes.
Credibility and Dependability
Credibility and dependability refer to the degree to which evidence in a study are
plausible as well as the “consistency trackability and logic of the research design and process”
(Lincoln & Guba, 1985). In the current study, criterion-related content and construct credibility
of the interview questions was established. The content credibility and dependability indicate the
extent to which the items included in the interview questions provided adequate representation of
culture, thus allowing the phenomenological themes to emerge. The interview questions for this
study were reviewed by both the IRB and the presiding committee chairperson of this study. The
method of sampling, or interview selection, was done purposefully and randomly, which lowers
the likelihood of selection bias while increasing credibility and dependability (Braun & Clark,
2006; Krueger & Casey, 2009; Merriam & Tisdell, 2016).
The threat to the credibility of this study was the positionality of the researcher. I am a
U.S. Army infantry veteran who served a tour of duty in the Middle East in support of the Global
War on Terror. I have lost people both in combat and to suicide once redeployed. To mitigate the
23

influence of my positionality, I did not share my story of transition with any of the participants. I
also did not share any details about my military service with the participants other than my
veteran status, branch of service, and military occupation. The confirmation of my veteran status
with participants increased the dependability of this study. This information allowed the
interviewees to feel comfortable providing real, raw, and emotional testimonials of both firsthand
experiences and experiences of helping other veterans through suicidal ideation within the
constructs of the nonprofit.
Ethics and Role of Researcher
The study was guided by the IRB process along with the Belmont ethical principles:
respect for persons, beneficence, and justice (U.S. Department of Health and Human Services,
1979). Respect for persons are the elements of informed consent, where participants should have
comprehensible and relevant information and agree to participate voluntarily. The beneficence
principle is to minimize the risk and maximize the benefit for the research participant. Justice is
the principle of distributing research benefits and burden, whereas one group of participants
should not bear the cost of the research and another group of participants receive benefits. These
ethical principles were used as guidelines for the research to reduce all potential harm and risks
to human participants (U.S. Department of Health and Human Services, 1979). The rights of
participants were respected throughout the study.
Participation in the study was completely voluntary. Voluntary participation was ensured
by asking participants whether they agreed to participate in the study prior to collecting data.
Participants were provided with a consent form before they proceeded to participate in
interviews, signifying that they understood the procedures and their role in the study. Anyone
24

who did not agree to the informed consent was thanked for their interest and excluded from
participation.
The confidential nature of the collected data means that participants should not be
concerned over any negative outcomes should the data be breached. Overall, participation in the
study was optional, and all data were collected with consent. Minimal risk of privacy or
confidentiality issues during the data-collection process was expected because I personally
conducted all data collection and analyses. Only the researcher has access to the data collected.
All field notes and transcripts of conducted interviews were destroyed upon completion of this
study.
This researcher worked to mitigate potential ethical concerns by making anonymous any
identifying information in the interview responses. This was achieved through the use of
pseudonyms for all participants. Only the researcher had access to the corresponding name
pseudonym key, which was destroyed at the completion of this study.
Limitations and Delimitations
According to Theofanidis and Fountouki (2018),
the limitations of a study refer to any particular weaknesses usually out of the
researcher’s control and are closely associated with the chosen research design,
statistical model constraints, funding constraints, or other factors of the characteristics
attached to the design or the methodology that affects the findings and their
interpretation. (p. 156)
limitations often provide constraints on generalizability, practical applications, and other
utilization of the findings. There is no absolutely perfect study because there are various
25

loopholes that can compromise the integrity of a study. However, these loopholes can be
addressed with keen consideration.
A delimitation in the study is the focus on addressing one guiding research question
without being encumbered by a set framework but rather looking for the phenomenon of shared
experience across time and space. Specifically, this study focused on finding the similarities
among the transition stories of veterans who had experienced suicidal ideation and chose to serve
the community rather than take their life. Therefore, the results may be generalized to this
population but require additional exploration. This study serves a merely a starting point or
guide.
Summary
A phenomenological research method and design was employed to examine what the
greatest influences or barriers are to help-seeking behavior among Army veterans following their
departure from active service from the perspective of nonprofit suicide program personnel who
are Army veterans themselves. Participants were asked to read and agree to an informed consent
form prior to providing data. Qualitative data were collected through semi-structured interviews.
Thematic analysis was used to explore responses to the guiding research question in this study.

26

Chapter Four: Findings
This chapter comprises of the presentation of the findings in this qualitative study. The
study followed the guiding question of what the greatest influences or barriers are to help-
seeking behavior among Army veterans following their departure from active service from the
perspective of nonprofit suicide program personnel who are Army veterans themselves. The
purpose of this study was to identify the shared experiences across the veteran community after
transition that facilitated or hindered help seekers and to provide recommendations to better
serve the community. This study included an analysis leveraging the phenomenological approach
to delving into the individual experiences of the interview participants to explore assumptions of
the causes of veteran suicide.
The following sections of this chapter provide the findings of the qualitative interviews
probing the above-stated question. The remaining sections of this chapter correspond and discuss
themes that emerged during the interviews with the participants. A summary of the findings
concludes this chapter.
Qualitative Findings
This section is a presentation of the findings from the qualitative component of this
phenomenological study. The qualitative findings were used to explore the guiding question
stated throughout this study. While analyzing, transcribing, and coding the interviews, the
researcher recognized multiple themes common to all the participants. These themes are
discussed in greater detail in the following sections of this chapter. This section begins with a
subsection describing the qualitative sample in this study. The second subsection is a
presentation of the qualitative findings to answer the research question guiding this study: What
are the greatest influences or barriers to help-seeking behavior among Army veterans following
27

their departure from active service from the perspective of nonprofit suicide program personnel
who are Army veterans themselves?
Participant Overview
The interviewees were a purposeful sample of eight U.S. Army veterans working as
nonprofit employees or volunteers who were U.S. Army veterans themselves working to assist
other veterans after their transition from active service. The sample size of eight was selected
because data saturation was reached with eight participants. Data saturation is reached when
additional data collection and analysis ceases to yield new themes and insights (Creswell &
Plano Clark, 2017). In this study, data saturation was assessed as reached when analysis of
interview data from two consecutive interviewees did not result in the identification of any new
codes. Data saturation under this definition was reached with four participants. To ensure that
data saturation was reached, an additional four participants were interviewed for a total of eight
participants. Analysis of the interview data from the additional four participants strengthened the
trustworthiness of the findings.
Participant Bios
The following section provides a brief description of each participant’s biography. This
information serves to give context to the information gathered during the interviews. It also
underscores the participants’ understanding of Army culture, and the transition from active
service to civilian life. I have limited the biographic information shared to ensure and maintain
the participants’ anonymity. I have also used pseudonyms to identify each participant to further
protect their identities. Table 1 provides a quick reference of this information.

28

Table 1
Participant Biographic Information
Name Age Gender Race MOS Active
service
Deployments
James 35 Male Caucasian Infantry 8 3
John 31 Male African
American
Infantry 4 1
Michael 38 Male Pacific
Islander
Infantry 12 4
Paul 34 Male Caucasian Infantry 4 1
Peter 31 Male Hispanic Infantry 4 1
Philip 49 Male Caucasian Infantry 20 5
Simon 26 Male Caucasian Infantry 4 1
Thomas 37 Male Hispanic Infantry 8 2

James has been out of the service for 8 years and active with his organization for five.
Prior to his transition, James served 8 years on active service as an Army infantryman. James
completed three combat deployments: one to Iraq and two to Afghanistan.
John has been out of the service for 6 years and active with his organization for three.
Prior to his transition, John served 4 years on active service as an Army infantryman. John
completed one combat deployment to Afghanistan.
29

Michael has been out of the service for 8 years and active with his organization for six.
Prior to his transition, Michael served 12 years on active service as an Army infantryman.
Michael completed four combat deployments: three to Iraq, and one to Afghanistan.
Paul has been out of the service for 8 years and active with his organization for five. Prior
to his transition, Paul served 4 years on active service as an Army infantryman. Paul completed
one combat deployment to Iraq.
Peter has been out of the service for 4 years and active with his organization for three.
Prior to his transition, Peter served 4 years on active service as an Army infantryman. Peter
completed one combat deployment to Afghanistan.
Philip has been out of the service for 11 years and active with his organization for eight.
Prior to his transition, Philip served 20 years on active service as an Army infantryman. Philip
completed five combat deployments: four to Afghanistan and one to Iraq.
Simon has been out of the service for 3 years and active with his organization for two.
Prior to his transition, Simon served 4 years on active service as an Army infantryman. Simon
completed one combat deployment to Afghanistan.
Thomas has been out of the service for 7 years and active with his organization for four.
Prior to his transition, Thomas served 8 years on active service as an Army infantryman. Thomas
completed two combat deployments to Afghanistan.
Over the course of the interviews, themes began to emerge. One thing that stood out was
that each participant understood that the more they were exposed to suicide from friends and
colleagues, the more at risk for suicide they became. Distrust was another theme that came to
light as a barrier to help-seeking behavior in the veteran community. Another interesting theme
that emerged was the fact that the Army culture surrounding defeat and teamwork played a larger
30

part in help-seeking with the participants. Table 2 provides a full list of each theme as well as a
short description.

31

Table 2
Emergent Themes
Theme n of
supporting
participants
(N = 8)
n of supporting references Need and influence of Army
culture and context to veteran
PTSD-related suicide
Knowledge of
suicidal
ideation as a
suicide risk
factor
8 8 Participants expressed that
when they recognized they
were having suicidal
ideations, they knew they
needed to seek help.
Distrust as a
barrier to
evaluating the
effectiveness
of strategies to
reduce suicide
7 8 Many veterans may distrust or
be unconvinced of the
effectiveness of suicide
prevention programs.
Strong
motivation not
to commit
suicide
8 15 Participants place a high value
on avoiding suicide and its
expected consequences.
Emphasizing
teamwork
efficacy is
more effective
than
emphasizing
self-efficacy
8 18 Veterans may perceive help-
seeking as a sign of personal
failure and a threat to self-
efficacy.
Army discipline
contributes to
perseverance
7 13 Soldiers are disciplined to
persevere against adversity.
Veterans
strongly rely
on one another
8 18 Soldiers are taught to rely on
one another, and veterans
retain a high level of trust in
other veterans.
32

Theme n of
supporting
participants
(N = 8)
n of supporting references Need and influence of Army
culture and context to veteran
PTSD-related suicide
Help-seeking is
unacceptable
in Army
culture
8 14 In Army culture, help-seeking
may be regarded as an
indicator of incompetence or
unreliability.
Respect for the
Army does not
influence help-
seeking
8 11 Help-seeking is not promoted
by respect for the Army.

Soldiers do not
receive
sufficient
information
about suicide
prevention
programs upon
their discharge
from the Army
7 7 Exposure to information about
suicide prevention programs
is provided only briefly
during the clearance process,
when there are many
competing priorities.
Low trust in the
Army
8 12 Participants expressed distrust
in the Army as a result of
perceived hypocrisy and
indifference to veterans’
mental wellness.

Suicidal Ideation Increases Risk
Findings indicated that all eight participants understood that suicidal ideations are a risk
factor for suicide. The participants stated that they understood this before they became involved
with their current organizations. Suicidal ideations took the form of imagining suicide to escape
the emotional distress associated with PTSD, a difficult transition from the Army, or as a means
of relieving loved ones of the perceived burden of the participant’s presence.
33

Participants did not describe their experiences of suicidal ideation in clinical terms. For
example, after affirming that he experienced suicidal ideations, John expressed that the
experience was brought on by a combination of PTSD and a lack of the clear direction and
purpose he had relied on in the Army:
I think that it [suicidal ideation] is something that everyone getting out the service thinks
of. At least I would think so. You are leaving a place where you know your purpose and
you have direction. You do what you are told when you are told to and then you just
leave. It is hard, especially when you have to deal with some of the shit you saw and went
through on deployments.
Philip was one of the two out of eight participants who indicated that they did not
perceive themselves as having experienced “full” suicidal ideations. However, Philip’s
elaboration of his response indicated that he had contemplated suicide and considered it as a way
of relieving his loved ones of the perceived burden of his being with them:
I don’t think it was full-blown suicidal ideation, but close. I have been through multiple
deployments and been through some crazy shit. When I got out and finally left the service
and had time to decompress from all those years, there was definitely some rough nights
when I thought everyone would be better off if I wasn’t around.
Participants demonstrated their declarative knowledge that suicidal ideations were risk
factors for suicide by seeking help when they became aware of having those thoughts.
Participants’ knowledge that suicidal ideation was a risk factor for suicide was therefore an asset
because it caused participants to seek mental health care and other supports. After stating, “I
did,” in response to the question of whether he experienced suicidal ideation, James answered
34

that the experience caused him to seek help because “I wanted to live,” indicating his knowledge
that suicidal ideation was associated with an elevated risk of suicide.
Similarly, after affirming that he experienced suicidal ideations, Peter stated that he
sought help because some soldiers he served with had died by suicide. “The thought of putting
my loved ones through that was enough to push me to get help.” Like James’s response, Peter’s
response indicated his perception that his suicidal ideations were associated with an elevated risk
of suicide. Participants’ motivation not to commit suicide is discussed further in the motivation
influences section of this presentation of qualitative findings.
Distrust as a Barrier to Evaluating the Effectiveness of Strategies to Reduce Suicide
Seven out of eight participants reported their observation that many veterans perceived
suicide prevention programs as ineffective and untrustworthy. This finding indicated that
veterans may have a need for increased intervention pretransition and posttransition transition to
increase their ability to perceive successful strategies to reduce suicide. Participants
overwhelmingly expressed the perception that veterans had sufficient reason to distrust such
programs and that increasing their ability to perceive the effectiveness of suicide prevention
programs began with building trust between the veteran and other stakeholders.
The six participants who supported this finding attributed veterans’ perceived inability to
evaluate suicide prevention program effectiveness to distrust, an attitude that they described as
partly justified by veterans’ experiences of ineffective or exploitative programs. John indicated
that some veterans distrusted suicide prevention programs too much to evaluate their
effectiveness objectively. “There are a few shitbag organizations out there that are not worth a
shit.” Paul suggested that the Army’s treatment of veterans could cause them to distrust other
organizations, saying, “Time and time again, vets have been used for a cause and then cut loose.”
35

Mike joined Paul in attributing veterans’ perceived suspicion of other organizations to the
treatment they received in the Army, saying that the Army was not sincere in its efforts to
mitigate suicide risks among veterans: “The Army and the DoD do just enough to make sure that
they can pat themselves on the back.”
Participants indicated that, for veterans to be able to increase their ability to evaluate
program efficacy objectively, they needed to build trust with suicide prevention programs and
other supports. Consistently, participants indicated that the trust-building needed for improved
program outreach and success involved two components. First, veterans needed to be willing to
give suicide prevention programs and other supports opportunities to demonstrate their
trustworthiness. Paul discussed this threshold receptivity on the part of veterans in stating, “It is
on the vet to take the first step and assume best intentions. Not everyone is out to fuck you. Take
that first step and see what happens.” Thomas provided another example of this perception in
stating, “The vet has to take the first step and allow those that work at the organizations to prove
they deserve their trust. Most of the people that are doing this work are good.” Similarly, John
stated, “The first thing that vets have to realize is most organizations want to help.”
The second component of building the trust that would enable veterans to assess suicide
prevention program effectiveness was for the organizations themselves to prove their value. Paul
expressed this perception in stating,
Trust comes through time and experience. So, to me, it is not the veteran’s job to develop
or cultivate trust, but those that want to serve [veterans]. The people running these
nonprofits need to understand that time and time again vets have been used for a cause
and then cut loose, so if they say they are going to do something, they better follow
through.
36

Simon also recommended that veterans build the necessary trust through interacting with
organizations and allowing supports to prove their value: “Through those interactions, trust will
build both ways. You will start to trust people, and people will start to trust you.” As
participants’ responses indicated, veterans’ ability to evaluate the effectiveness of suicide
prevention programs and other supports was perceived as being negatively impacted by a lack of
trust in the Army.
Strong Motivation Not to Commit Suicide
All eight participants stated that they placed a high expectancy value on engaging
resources to prevent suicide. The expected outcomes of suicide prevention included survival,
affirming individual value by overcoming adversity instead of succumbing to it, and sparing
friends and loved ones from bereavement. The high expectancy value of successfully preventing
suicide was associated both with Army culture and with understanding of suicidal ideation as a
risk factor for suicide.
One of the reasons three out of eight participants placed a high expectancy value on
avoiding suicide was the perception that their suicide would disappoint, dishonor, or emotionally
harm the fellow soldiers with whom they had served. James expressed this perception in stating,
“I wanted to live to honor those guys that didn’t get the chance to come home. I knew that to do
that I needed help, because I couldn’t do it on my own.” Simon referred to not wanting to
disappoint the soldiers he had served with, stating why he sought suicide prevention assistance:
“It was a need to preserve myself, and [it was because of] the love and respect for my loved ones
and my buddies I served with. I didn’t want them to think poorly of me.” John indicated that he
regarded suicide as failing the soldiers he had served with who had risked their lives to help him
survive: “We [veterans] have all had too many fucking friends take that way out [suicide], and it
37

fucking sucked. Thinking I would do that to a guy that literally saved my ass, I just didn’t want
to be that guy.”
Four out of eight participants indicated that they placed a high value on avoiding suicide
because they did not want to cause their loved ones’ grief. Peter cited this motivation in stating,
“I didn’t want to put my friends and family though that . . . It wasn’t the Army that pushed me to
find help, it was the thought of leaving my loved ones.” Paul felt a sense of obligation to his
loved ones and a desire not to fail them, he indicated: “My friends and family were always in my
corner. So, it was for them.” John wanted to avoid causing his loved ones guilt and grief: “It
scared the shit out of me to think that I would cash it all in. I didn’t want to leave all my loved
ones holding the bag for me.”
Three out of eight participants expressed that they placed a high expectancy value on
avoiding suicide because they wanted to preserve their individual value by overcoming adversity
instead of succumbing to it. John referred to his aversion to failure and to a loss of individual
value, which he referred to as becoming a statistic: “I knew that I had to do something or I would
fail. I would have ended up a fucking statistic.” Paul used language like John’s in stating, “I
didn’t want to be a failure. I didn’t want to be a statistic.” Thomas used the same language as
Paul and John to refer to a loss of individual value and identity, and he added that he valued his
survival because of respect for his loved ones and a desire to respect himself: "I didn’t want to be
a statistic. . . . It had everything to do with respect for my loved ones, and me. I wanted to gain
self-respect back.”
Two out of eight participants expressed that they placed a high value on avoiding suicide
because they valued their survival. Philip indicated that he was motivated by a fear of dying:
“One day, I was sitting alone watching TV in the dark, drinking, and it just fucking hit me. If I
38

kept going this way, I would end up eating a bullet, and that was fucking scary, man.” Mike
compared the fear of realizing his life was at risk to the experience of finding himself at risk of a
sudden, fatal fall: “I saw that I was on a cliff, and I needed to take a step back and get some
help.”
Emphasizing Teamwork Efficacy Is More Effective Than Emphasizing Self-Efficacy
All eight participants indicated that veterans at risk of suicide were likely to lack self-
efficacy but that they were also likely to feel an obligation to exhibit self-sufficiency. As a result,
veterans at risk of suicide might regard help-seeking as an admission of failure or defeat,
potentially deterring them from seeking help. All eight participants indicated that reinforcing
veterans’ self-efficacy was unlikely to be an effective means of preventing suicide. Instead,
participants stated that a need existed to appeal to veterans’ sense of the efficacy of teamwork,
which veterans were likely to have experienced in the Army.
Participants reported that they, and other veterans, were most effectively engaged with
suicide prevention programs and have confidence in their effectiveness when they perceived
those supports as extensions of the teamwork they experienced in the Army. John reported that
these perceptions had influenced his own engagement with suicide prevention programs.
For me, it [help-seeking] was I wanted to feel like I did when I was in the platoon. I
wanted that feeling of helping my buddy that just went through some shit, so they knew
that someone had their six and they weren’t just alone and afraid. So, I guess I would say
just remember what it was like to have guys you knew you could count on when the shit
hit the fan.
Simon used the Army as a point of reference in citing a need for veterans to “Just
remember that they [the Army] taught us to fight as a unit not an individual. So, why are you
39

fighting alone now?” Paul stated that for veterans to engage with suicide prevention programs,
“We all have to remember that we cannot take on a problem like this alone, so if you really want
to make a change, or even drive a change, we have to collaborate.” Peter referred to teamwork
efficacy as an effective motivator for engaging veterans with suicide prevention programs in
stating that veterans needed to understand that “We fought together. You aren’t out of the fight
until you’re dead. So, don’t let it get there. You always have people in your corner that will fight
with you.” Philip also cited the Army as a point of reference for helping veterans understand the
benefits of suicide prevention programs: “Like the Army, one man can make a huge impact, but
he alone cannot win the war. The machine wins the war.” Mike referred to the “traction”
veterans could gain on the problem of suicide prevention by teaming with other veterans through
nonprofit organizations.
I would recommend that vets remember that just because you left the Army, or the
service, doesn’t mean that you leave your brothers and sisters behind. I know that it
sounds corny, but if you just ignore the problem and don’t accept that you have to work
with a larger, or even medium-sized, organization, we won’t get the traction needed to fix
the problem.
Emphasizing the teamwork element of suicide prevention programs and citing veterans’
sense of obligation to assist fellow veterans was effective both in getting veterans to seek help
for themselves and for engaging them to help other veterans:
Man, it [suicide prevention] is just like the Army. You aren’t going to get anything done
unless you have a buy-in for both the higher-ups and the ranks. So, get that by working
with people to help them understand what you need, because if you need it, chances are
others are looking for the same thing. Think of those guys to your left and right that
40

would’ve given their lives for you. This [assisting with suicide prevention] is the least
you can do to potentially help them on the civilian side.
Paul also referred to teamwork efficacy as a benefit of suicide prevention programs that
was effective in engaging veterans, both to get assistance for themselves and to support other
veterans:
You have to lean on your buddies to work though that stuff [PTSD and suicidal ideation].
And we all have shit we bring back [from deployment]. So, for me it [working for a
suicide prevention program] was something I wanted to do to make sure that guys got
help and understood that just because you need help doesn’t mean you’re weak.
Army Discipline Contributes to Perseverance
Seven out of eight participants referred to Army discipline as an asset that influenced
them to seek support when they felt suicidal. The relevant aspect of Army discipline was
associated with the infantry imperative to never give up, quit, or accept defeat. This aspect of
Army culture contributed to participants’ help-seeking because they regarded suicide as
succumbing to adversity, as discussed in relation to expectancy value in the motivational
influences section of this chapter.
All seven participants who contributed to this code consistently characterized suicide as
defeat. Peter reported that the Army imperative to never give up influenced him not to “let the
Army win” by conceding through suicide that he was expendable.
If I had to point to something [an aspect of Army culture that encouraged help-seeking],
it would be the infantryman in me, that the objective is everything, and in this instance,
life is the objective. So, I was not going to let the demons beat me. And, to be honest, I
41

wasn’t going to let the Army win. They trained me and sent me to the shithole Middle
East to fight a war that wasn’t worth it, so I was not going to fucking kill myself.
Thomas also referred to the infantry discipline of never accepting defeat, saying, “For
me, it [cultural influence on help-seeking] was the old saying in the infantry to never accept
defeat. If I didn’t do something, I was just accepting defeat, just rolling over.” James said of the
aspect of Army culture that influenced him to seek help, “It would have to be that ‘never quit’
attitude that is beat into you in the infantry.” John used similar language in saying of the Army
discipline influence on his help-seeking, “I would say that it was the saying ‘we never give up. ’
You have to always achieve the objective. So, I guess it was that ‘never quit’ mentality that they
beat into you starting at boot camp.” Mike also said of Army discipline as an influence, “It
would have to be the never-give-up mantra of the Army . . . it did push me to talk to someone at
the VA and some buddies that were vets.” Mike added that he sought help because, “I had to find
a way to live my oath as a soldier and infantryman to never except defeat and keep fighting until
the last breath.”
Veterans Strongly Rely on One Another
All eight participants stated that an asset they derived from Army culture was their strong
trust in and readiness to rely on their fellow soldiers. Participants stated that they retained this
element of Army culture after they left the Army in the form of readiness to rely on and support
fellow veterans. Participants indicated that after they left the Army, they missed having
comrades they could rely on as strongly as they had relied on their fellow soldiers. The desire to
retrieve this sense of close collective endeavor influenced them to seek help from nonprofit
organizations, as discussed in the self-efficacy code in the motivation section of this chapter. The
42

source of participants’ teamwork orientation, they reported, was the interreliance they learned
through Army culture, training, and combat experience.
Participants indicated that Army culture taught them to rely on their fellow soldiers, and
that the bonds they subsequently developed affirmed their faith in the effectiveness of operating
as a team or unit. John expressed this experience and the resulting sense of loss after leaving the
Army in stating,
You are taught to rely on yourself and the guy next to you and the platoon or unit. . . . So,
when you get out and you don’t have those guys next to you helping you get through shit,
it is hard. I know that when I got out, it was hard because I didn’t have my friends with
me. So that drove me to get involved to help other people.
Participants spoke in emphatic terms of the importance they learned to place on inter-
reliance with fellow soldiers through Army culture. They also spoke of how their faith in their
fellow soldiers was borne out when they witnessed the sacrifices their comrades readily made to
save one another in combat. John provided an account of how the culture of reliance on
teammates was tested and solidified, stating,
“Never leave a fallen comrade.” That’s that saying they beat into us starting in basic
[training]. You know, it was hammered into you that you never leave anyone behind, that
you help your buddies no matter what the cost is to you. Shit, man, you love your
brothers in the platoon more than you love family sometimes. I mean, how many people
could honestly tell you their brother or sister would jump on a grenade to save them?
Well, that shit happens in the Army. Dudes will push you out of the way and jump on a
fucking grenade to help you, so why should that stop when we leave?
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Notable in John’s response was the perception that veterans could continue to rely on
fellow veterans after leaving the Army, just as they could rely on their fellow soldiers while they
were serving. Mike provided a response that corroborated John’s, saying that of the influence of
Army discipline on his decision both to seek help and to provide support to other veterans
inhered in,
The culture of, “You never leave your buddy behind.” No matter what shit is hitting the
fan, you stand next to them, reload, and keep in the fight. So, when I got out and lost that
sense of belonging, this was the best way I thought to get it back: helping fellow service
members.
Paul referenced the imperative to be a dependable member of a team in conjunction with
the Army-cultural imperative to never give up as factors that promoted his seeking help and
supporting fellow veterans: “Those men would walk through hell for you and with you. To give
up is a dereliction of duty and something most infantryman could never do. So, it is that
fortitude, that bond, that drove me to find help.” Paul added specifically of the influence of Army
culture on promoting inter-reliance among soldiers as an asset in help-seeking,
It is a strange thing that people that never served can’t understand. You develop these
bonds, this love, for those [soldiers] around you based on shared experience. You know
that they will have your back and they know that you will have theirs. So, it is that culture
that drives me to help [other veterans]. I don’t want to feel like I am letting my fellow
soldiers down. Even if they weren’t infantry, they still went through some shit, and I
think I can help.

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Help-Seeking Is Unacceptable in Army Culture
All eight participants stated that there was a need in Army culture to make help-seeking
for PTSD and the associated suicide risk acceptable. All eight participants expressed the
perception that during their service, help-seeking was unacceptable in Army culture. Participants
acknowledged that mental health resources were accessible to service members but that
accessing those resources was regarded as a sign of incompetence and unreliability that could
have tangible, negative consequences for career advancement, security clearances, and
assignments. Participants reported that the highest levels of Army command made token efforts
to address PTSD and suicide among veterans but that more immediate superiors were likely to be
abusive if soldiers indicated that they needed help.
Army culture manifested as hostility to soldiers who showed indications of needing help
with mental health issues, participants said. John provided a representative response that
contrasts the Army’s public-facing interest in addressing PTSD with the callousness that
confronted active duty soldiers who needed help.
Man, you know the Army. It is all “Rangers lead the way” and shit like that. Everyone
wants to be the hardest dude in the company, and command fucking loves those super-
moto [highly motivated] guys. No matter what the joint chiefs or other high command
say, if you tell your PL [platoon leader] or CO [company commander] that you want to
go to the shrink, or you are going to kill yourself, they are either going to give you shit,
call you weak, take all your shoelaces away or anything else you can hang yourself with,
or all of the above . . . that’s how it was in the infantry. We were told to be hard and drink
water and drive on. Oh, you saw a dude get his head blown off? “Stop being a pussy and
do your fucking job,” is what you got back.
45

In addition to immediate, informal consequences to a soldier’s reputation and standing in
their unit, help-seeking within the Army could result in long-term consequences to a soldier’s
career. Mike indicated that help-seeking was regarded as weakness and as contrary to the Army’s
culture of self-reliance and perseverance.
From boot camp, it is drummed into you to not be weak, to be self-sufficient, to drink
water and drive on. It [the Army] just doesn’t lend itself to real attention to mental health.
. . . It’s the Army. PTSD may as well be a four-letter word. If you go to get help and have
to have any adjustment to your duty day or your ability to function for any length of time,
you are undeployable, so you may as well not exist. . . . You are seen as a pussy if you
ask for help while you are in and looked at like you are looking for a handout when you
ask for help when you get out.
Philip provided a response corroborating Mike’s about the risk of negative, long-term
consequences to a soldier’s career if they sought help: “If a guy gets home and says he needs to
talk to someone about shit he is going through, and the shrink adjusts his duty or deems him
undeployable, that guy’s career is over.” Simon indicated that negative consequences to a
soldier’s career could stem from adjustments to security clearance resulting from perceptions that
help-seeking indicated unreliability: “If you have to take meds for a bit, say goodbye to your
security clearance, and if you can’t keep a clearance, say goodbye to your career.” Paul stated
that the perceived hostility toward help-seeking for PTSD in Army culture indicated a need for
an intentional cultural shift to make help-seeking acceptable and encouraged:
It is not a sign of weakness if someone asked for help. It is a sign strength, especially in a
hyper A-type culture like the Army. And stakeholders, the leaders, both officer and
enlisted, need to champion that way of thinking if anything is going to change. The
46

leadership needs to be out front telling guys, soldiers, that they don’t have to fight those
demons alone. If they need help, get it, and through actions, show that is the case. It
[help-seeking] wouldn’t hold guys back from promoting or going to the board or
anything like that.
Respect for the Army Does Not Influence Help-Seeking
All eight participants expressed, in emphatic terms, that respect for the Army did not
influence their help-seeking. Participants stated that respect for the Army did not influence their
decision-making because they perceived the Army as indifferent to their wellbeing after their
discharge. James used particularly emphatic language in stating that respect for the Army did not
influence his help-seeking because, “To tell you the truth, I don’t give a fuck about the Army,
just like the Army doesn’t give a fuck about me.” Peter spoke in terms like James’s in replying,
“When I left the Army, the Army stopped giving a shit about me,” to the question of whether
respect for the Army influenced his help-seeking. Mike spoke with respect of the Army’s
warfighting capacity, but he also expressed the perception that the Army was indifferent to his
wellbeing:
Me going to talk to someone to deal with my shit had nothing to do with the Army. Don’t
get me wrong, the U.S. Army is the greatest fighting force in the world, but the “green
weenie” takes what it wants and moves on. So, it was all about the people I cared about.
Paul indicated that the irrelevance of respect for the Army to his help-seeking was based
on his perception that the Army ceased to value him when he ceased to serve it: “Once you leave
the Army, that is it. You have served your purpose, and the relationship is over.” Philip
expressed the perception that the Army’s indifference to the wellbeing of veterans was an
47

implicit betrayal of those who served, saying of the irrelevance of respect for the Army to his
help-seeking.
It wasn’t respect for the Army. It was respect for my loved ones. The Army was, and is, a
huge part of my life, but I have also been part of it long enough to know that the Army
takes what it wants from you, and when it is done with you, that is it. I have watched the
machine turn its back on warfighters that deserved parades for valor. Instead, they got
drummed out.
Soldiers Do Not Receive Sufficient Information About Suicide Prevention Programs Upon
Their Discharge From the Army
Seven out of eight participants expressed the perception that soldiers did not receive
sufficient information about suicide prevention programs when they were discharged from the
Army. Participants reported that being processed out of the Army was a hurried, hectic
experience during which many tasks had to be completed within a narrow time frame. Although
information about suicide prevention programs was provided, it was not given sufficient
emphasis for soldiers to retain it, particularly given that it was not relevant to fulfilling the
immediate requirements of leaving the Army.
Information about suicide prevention was limited, participants stated, to a mention in a
briefing about veterans’ benefits. Suicide prevention programs were listed as a benefit that
veterans could access through VA. Thomas stated that a need existed to provide considerably
more information to enable veterans to access the help they needed.
When I left the service, my benefit briefing was a quick block of instruction and had
mostly to do with the VA, which makes sense. But we all know that the VA is
overwhelmed and has been for some time, so why not offer instruction or information
48

about other organizations that are able to provide services? I mean, it is not like the Army
doesn’t have the resources to disseminate the information.
Simon provided a response that corroborated Thomas’. Simon also emphasized the hectic
nature of processing out of the Army and suggested a need for information about suicide
prevention programs to be provided to departing soldiers over a longer period, rather than being
concentrated into a single, dense briefing about veterans’ benefits.
The biggest thing is getting the information [about suicide prevention programs] in front
of the soldiers before they hit the streets. It should be something that is made available to
the soldiers the minute the unit knows they are not reenlisting or they are getting out.
From the conversations I had, my experience was not unique, in that I had a brief one
afternoon during the clearing process that talked about VA benefits, but that was it. So,
with everything else you’re trying to deal with—moving, clearing, jobs, and money—that
was the least of my concerns.
Participants associated the need for more informational resources with the large number
of responsibilities and concerns soldiers needed to address as they were leaving the military.
Philip agreed with Simon in stating,
They did tell us about the VA [during the benefits briefing] and that we should begin the
claims process, and the rep from the VA was part of that presentation, but you have so
much other stuff going on to get ready to leave the service; that was kind of the last thing
on my mind. I mean, I was worried about a new job, in a new place, and not being in the
Army anymore. So, as far as knowledge increase, I would say that exposure would help.
If they put the information in front of you more than just once. If they took the time to go
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over the information multiple times or had a longer block of instruction where the soldier
got personalized help.
Peter agreed with other participants in citing a need for the Army to provide veterans
with information about nonprofit organizations as a supplement to VA benefits: “The Army
could do a better job of educating those getting out about what is available in terms of help. Not
just the VA, but other nonprofits that can assist in the transition out of the service.” John agreed
that soldiers’ attention was drawn in too many directions during the clearing process and that
reinforcement of information about suicide prevention programs was needed: “They could spend
more time on it and go over it more than once. Also, there is no guarantee that you are going to
stay in the area, so they should try to make it as specific to your home of record as possible.”
James joined other participants in recommending exposure to information about suicide
prevention programs repeatedly over time: “Just exposing the soldiers to it would be a huge help,
and I don’t mean through some dumb flyer or something like that. I mean exposure at the
company and platoon level, letting them know there is help out there.”
Low Trust in the Army
All eight participants stated that they had little or no trust in the Army to promote their
wellbeing as veterans. This code was closely associated with the code regarding a lack of respect
for the Army based on perceptions of its indifference to veterans’ wellbeing. Participants
indicated that they did not trust the Army to contribute to their wellbeing for the same reason
they did not it when they sought help, because they did not believe the Army had any continued
interest in their mental wellness.
Participants’ lack of faith in the Army to provide resources to ensure their mental health
was exacerbated by perceptions that the Army as an organization was hypocritical in its
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expressions of concern about suicide among veterans. Mike expressed his perception of the
Army’s hypocrisy in stating,
I don’t trust the Army to deal with this [suicide among veterans] . . . The command says
all the right things so they don’t get in deep shit, but they don’t actually give a fuck . . . If
the brass really cared, us normal guys would get the same help that is available to the
dudes in SF [Special Forces] or other units like that. We just don’t matter that much,
man, . . . which is why I wanted to get into this. The VA, the Army they aren’t going to
do anything.
Thomas expressed perceptions like Mike’s in stating, “The Army isn’t in business of
helping vets . . . so, I don’t trust them. They will say the right things, they will spend money on
reports, but [they] rarely do anything with those reports.”
John cited an example from the national news as evidence of the Army’s indifference to
the mental health of active duty soldiers: “Look at the shit happening at Fort Hood recently.
They have had multiple soldiers killed or kill themselves in a short amount of time, and it makes
the news. People lose their command, but nothing will really happen.” Partly because of the
perceived hypocrisy and indifference exemplified in stories like that of Fort Hood, John stated, “I
have little faith that the Army is really going to make huge changes to help support the mental
health of the soldiers.”
Simon expressed what he perceived as the Army’s pragmatic rationale for neglecting
soldiers’ mental wellness in stating, “I don’t trust the Army. They are a fighting force. They are
not Mother Teresa. They will do what’s best for the Army, not what’s best for the soldier.”

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Findings Summary
This section has indicated the themes that presented themselves during the interview
process with the eight participants. Their responses indicated that it was a sense of community
that drove the participants to seek help rather than the Army as an institution. Through analysis it
became apparent that it was not the Army as an institution or respect for that institution that
drove help-seeking behavior. The participants indicated regaining a sense of community and
connectedness that is what pushed them to seek the professional help necessary to combat their
suicidal ideation or mental health concerns. The respondents indicated that the Army
organizational culture posed a significant barrier to help-seeking prior to exiting the service in
terms of the unit-level view of seeking mental health as well as the lack of time spent educating
soldiers on program availability.
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Chapter Five: Discussion
This chapter is the discussion of findings and recommendations in this phenomenological
study. The purpose of this study project was to examine what are the greatest influences or
barriers to help-seeking behavior among Army veterans following their departure from active
service from the perspective of nonprofit suicide program personnel who are Army veterans
themselves. In this chapter, the findings and the results presented in Chapter 4 will be discussed.
Recommendations for practice will follow. Limitations and delimitations will be discussed as
well as recommendations for future research.
Discussion of Findings and Results
The first finding of the study was that all interviewees understood that suicide exposure
and suicide ideation increase the veteran populations risk of suicide. This result is not fully
substantiated by the literature. Hoffberg et al. (2018) examined the suicide rate in homeless
veterans utilizing a systematic literature review (SLR). Using extant literature on the topic,
Hoffberg et al. (2018) found that, within literature, roughly 2% of homeless veterans had current
suicidal ideations, while 20% of homeless veterans had contemplated suicide within the past 30
days. Among the aforementioned veterans, an estimated 6% had attempted suicide within the
past 30 days, while almost 32% had attempted suicide in the past 5 years (U.S. Department of
Veteran Affairs Office of Mental Health and Suicide Prevention, 2019). The rate of suicide
attempts at any point in time was approximately 47%, which is higher than the national average
of suicide attempts of nonveteran homeless individuals (Hoffman et al., 2016). Therefore, while
the literature indicates that suicide ideation may be a risk factor for suicide, it does not indicate
that understanding suicide ideation as a risk factor for suicide drives veterans to seeks assistance.
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The distrust of suicide prevention programs was found to be a barrier to evaluating the
effectiveness of strategies to reduce suicide. While the literature does not substantiate that there
is pervasive distrust of suicide prevention programs, it does substantiate that many such
programs have been created and that the suicide rate remains high for veterans. Many states have
suicide prevention hotlines that are formatted specifically for use by veterans who are
contemplating suicide (VA, 2018). These initiatives have been shown to have some success in
mitigating incidence of rates of suicide. However, these hotlines are only available by phone,
which can be problematic for homeless or impoverished veterans that may not have easy or
reliable access to phones (Jobes et al., 2019). In addition to hotlines, many VA offices have
created programs that are specific to each branch of the military. As such, veterans from any
branch can call, teleconference, or visit the VA and speak to individuals that have served within
their respective branches of the military (VA, 2020). Finally, the VA and other local nonprofit
organizations have instituted many programs to address factors that increase the rate of suicide
among veterans. For example, the VA (2020) has established initiatives to increase employment
and housing among veterans (Jobes et al., 2019). Within these programs, recruiters for various
job opportunities, VA professionals, and the veterans themselves work together to provide a
variety of services (VA, 2018). While there is a large body of literature discussing programs
implemented to prevent suicide in veterans, there is limited research related to their effectiveness
(Jobes et al., 2019).
Furthermore, having a clear understanding of procedures for accessing suicide prevention
assistance was found to be a advantage for participants in this study, but soldiers do not receive
sufficient information about suicide prevention programs upon their discharge from the Army.
These findings were not substantiated by the literature. The literature appears to indicate that
54

veterans would likely have a good understanding of procedures for accessing suicide prevention
assistance compared to the general population. Because the suicide risk among veterans is so
high (Hoffman et al., 2016), there are a great deal of programs aimed at supporting veterans
(Jobes et al., 2019). This could indicate that the understanding of procedures for accessing
suicide prevention is an advantage, while a lack of understanding is a barrier to seeking help.
However, it does not explain why veterans would not have received information about these
programs upon their discharge from the Army.
It was discovered that having strong inspiration not to commit suicide was a benefit for
participants. This finding is substantiated by the literature. Gerrard et al. (2006) found that within
intervention studies, if the participant believed that the perceived value outweighed the
discomfort and challenge of completing intervention programs, participants were more likely to
succeed. Additionally, the expectations for participants were more aligned with success if
persons were more motivated to complete the intervention (Jones et al., 2001). This indicates that
motivation is a key contributor to success and likely influences an individual’s ability to
successfully access and maintain mental health treatment.
This study also found that emphasizing teamwork efficacy was more effective than
emphasizing self-efficacy for veterans, that Army discipline contributes to perseverance, that
veterans strongly rely on one another, and that the culture of self-reliance in the Army
contributes to a lack of help-seeking behavior. These findings are substantiated by the literature.
Terriff (2006) reported that the organizational culture of the Army is one steeped in discipline
and respect. These ideals are engrained from enlistment into the Army (Soeters et al., 2006).
Discipline and respect allow for members of this organization to function properly and without
confusion during active duty (Soeters et al., 2006). According to Terriff (2006) another important
55

facet of organizational culture in the Army is the promotion of reliance on oneself and others
around them, especially in times of crises. This reliance on oneself and others is important as it
promotes cohesion during active duty (Soeters et al., 2006). However, Soeters et al. (2006) found
that reliance on oneself can create issues seeking help, especially upon return from active duty.
The findings of the current study align with the understanding of Terriff (2006) and Soeters et al.
(2006), who discussed the importance and interconnectedness of seeking help, teamwork,
discipline, self-efficacy, and self-reliance, and how these variables influence the behavior of
Army veterans.
Finally, participants in this study had low trust in the Army. This finding is not
substantiated by the literature. Liggans et al. (2019) reported that from the formation of the
Army, there has been a great deal of trust between the public and the Army. Trust between the
public and Army is fostered because Army personnel are viewed as protectors and peacekeepers
(Liggans et al., 2019) Subordinates within the Army often rely on their superiors to make
decisions in their best interests and keep them safe throughout active duty (Adams et al., 2008).
This research is at odds with the findings of the current study, which indicated that participants
felt the Army did not care about them, and they did not trust the Army to assist them with
overcoming mental health issues. This could indicate that the literature focused too heavily on
exterior perceptions of the Army and did not seek to represent the voice of the rank and file
soldiers.
Recommendations for Practice
Three recommendations are identified below to address the key findings of this study. To
improve practice, help-seeking behaviors should be promoted as a key component of self-
efficacy and teamwork. Suicide prevention programs, and how to access them, should be openly
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discussed and promoted. Finally, veterans should be encouraged to think about the things that
motivate them.
Recommendation 1: Help-Seeking Behaviors Should Be Promoted as a Key Component of
Self-Efficacy and Teamwork
All eight participants indicated that veterans at risk of suicide were likely to lack self-
efficacy, but that they were also likely to feel an obligation to exhibit self-sufficiency.
Furthermore, seven out of eight participants referred to Army discipline as an asset that
influenced them to seek support when they felt suicidal. Finally, all eight participants stated that
an asset they derived from Army culture was their strong trust in and readiness to rely on their
fellow soldiers. Taken together, this indicates that veterans are strongly influenced by Army
culture and that they feel the need to be self-sufficient, while being conditioned to rely heavily
on other soldiers. Integrating these behaviors and promoting help-seeking behaviors as an
activity that is done to boost self-sufficiency, as well as being a good team member for important
people in the veterans’ lives, could be a powerful motivator to encourage help-seeking behavior.
Currently the Army does require soldiers to complete a clearing program to out-process
from the service. This clearing program focuses mostly on documentation that needs to be filed
and equipment that needs to be turned in to gain your “cleared” stamp from headquarters,
effectively ending your term of service. During this process, there are briefings informing the
soldier of programs available through the Transition Assistance Program or TAP. However, TAP
is a program that is considered a “Commander’s program and a Soldier’s responsibility,” as
stated on the TAP website (2021). This is not conducive to garnering the level of participation
necessary to have a healthy transition out of the Army into civilian life.
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The Army transition or exit program needs to become more robust and mandatory. At a
minimum, soldiers go through a 14-week induction process; however, they receive less than a
week of instruction on their benefits when exiting the service. To prepare a solider to shift into
civilian life, the transition period should at least mirror the induction period. Strategies for self-
care and identifying mental health resources should also be integrated into a soldier’s transition
program, allowing them to fully understand the benefits at their disposal.
Recommendation 2: Increase Access to and Understanding of Suicide Prevention Programs
All eight participants indicated clear procedural knowledge regarding how to access
suicide prevention assistance, despite seven out of eight participants expressing the perception
that soldiers did not receive sufficient information about suicide prevention programs when they
were discharged from the Army. This indicates that there is a disconnect between veterans’ well-
developed understanding of procedures for accessing suicide prevention assistance, and the
perceived lack of communication from the Army. It should therefore not be assumed that
veterans will have a clear understanding of procedures for accessing suicide prevention
assistance.
As stated above, although the Army does have a clear program in place, many of the
required briefings are to facilitate the filing and return of requisite forms and equipment. The
soldier must actively seek out assistance through TAP at the will of their assigned commander.
This is not a culture that fosters and promotes access to and understanding of available programs.
Once indicating they will not sign an additional contract or they file for retirement, the
veteran should be actively connected to support services for regularly scheduled sessions. This
would provide an educational opportunity for the veteran to better understand risk factors or
suicidal indicators as well as be exposed to strategies to identify and combat the onset of suicidal
58

ideations. This elongated engagement period would also build trust between the veteran and the
help services.
Recommendation 3: Veterans Should Be Encouraged to Think About the Things That
Motivate Them
All eight participants stated that they placed a high expectancy value on engaging
resources to prevent suicide. This expectancy value motivation was categorized as an benefit
because it deterred veterans from committing suicide and motivated them to seek support from
suicide prevention programs. To capitalize on this finding during practice, individuals supporting
veterans to overcome mental health issues should encourage them to ruminate on the important
people and things they have in their lives and to consider how getting the help they need could
feed into that motivation.
As it stands today, soldiers do not receive mandatory counseling when they are exiting
the service. Soldiers are told that counseling is available, but participation is at the will of their
command and participation is a soldier’s responsibility. This does not focus on or foster the kind
of intervention necessary to reacclimate soldiers to civilian life.
Much like Recommendation 1, this recommendation requires at a minimum an equal but
opposite socialization period to replace the initial induction the veteran sustains throughout their
time in the Army. To properly implement this recommendation, the servicemember must be
repeatedly exposed to the idea of focusing on the impact self-harm would have on loved ones as
well as the joy brought to the veteran through treasured pastimes. For these reasons, the Army
should integrate this process into its transition program, allowing the servicemember an
opportunity for education and decompression in a controlled environment.

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Recommendations for Future Research
Future research should focus on the effectiveness of currently existing suicide prevention
programs for veterans. While there is a large body of literature discussing programs implemented
to prevent suicide in veterans, there is limited research related to their effectiveness (Jobes et al.,
2019). Furthermore, this study found that distrust of suicide prevention programs was a barrier to
evaluating the effectiveness of strategies to reduce suicide. As this finding is not substantiated in
the literature, future research should also explore whether distrust is a barrier to the effectiveness
of suicide prevention programs and subsequent evaluations of the programs.
Future research should investigate veterans’ trust of the Army. This study found that
participants had low trust in the Army. However, this finding was not substantiated by the
literature. Liggans et al. (2019) reported that from the formation of the Army, there has been a
great deal of trust between the public and the Army. However, pubic trust and understanding if
the service members low trust in the Army could help identify areas where the Army could
utilize targeted interventions to better support veterans once they leave the Army.
Relatedly, future research could also provide valuable insight if researchers investigate
the sufficiency of information about suicide prevention programs soldiers receive upon discharge
from the Army. This study found that having a clear understanding of procedures for accessing
suicide prevention assistance was an advantage for participants, but it also found that participants
believed they were not getting sufficient information about such programs upon their discharge.
Understanding how veterans were learning about suicide prevention programs, if not from the
Army, could help connect other veterans to services. Additionally, understanding what additional
information veterans need upon their discharge from the Army would likely support their mental
health recovery process.
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Conclusion
The purpose of this study project was to examine what the greatest influences or barriers
are to help-seeking behavior among Army veterans following their departure from active service
from the perspective of nonprofit suicide program personnel who are Army veterans themselves.
This study found that knowledge of suicide ideation as a suicide risk factor was a benefit for
participants. This result is not fully substantiated by the literature. Additionally, the distrust of
suicide prevention programs was a barrier to evaluating the effectiveness of strategies to reduce
suicide. While the literature does not substantiate that there is pervasive distrust of suicide
prevention programs, it does substantiate that many such programs have been created and that
the suicide rate remains high for veterans. Having a clear understanding of procedures for
accessing suicide prevention assistance was found to be an asset for participants, but soldiers do
not receive sufficient information about suicide prevention programs upon being discharged
from the Army. These findings were not substantiated by the literature. Furthermore, having a
strong motivation not to commit suicide was a strength for participants. This finding is
substantiated by the literature. Emphasizing teamwork efficacy was also found to be more
effective than emphasizing self-efficacy for veterans. Additional findings were that Army
discipline contributes to perseverance, that veterans strongly rely on one another, and that the
culture of self-reliance in the Army contributes to a lack of help-seeking behavior. These
findings are substantiated by the literature. Finally, participants in this study showed low trust in
the Army. This finding is not substantiated by the literature. Several recommendations for
practice were derived from this study. To improve the veteran’s chance of a successful and
healthy transition to civilian life, the Army should implement a reintegration program of equal
61

length to its induction program. This program should focus on promoting help-seeking behaviors
as a key component of self-efficacy and teamwork and on suicide prevention programs and how
to access them. Veterans should be encouraged to think about the things that motivate them. One
of the limitations of this study was that an internet connection was necessary for participation to
be possible. The study was also limited to the measure of the Army’s organizational culture as
measured from the viewpoint of the eight interview participants. However, saturation was
reached within this sample size.
A delimitation of this study is the focus on addressing one guiding question, specifically,
what are the greatest influences on help-seeking behavior among Army veterans following their
departure from Army service from the perspective of nonprofit suicide program personnel who
are Army veterans themselves? This provided an opportunity to focus on not only a provider’s
view but a veteran provider’s view of the issue of elevated rates of veteran suicide. This unique
perspective garnered findings that will guide future research on how to better serve the veteran
community.

62

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69

Appendix A: Interview Questions
1. What role, if any, do you believe culture in the U.S. Army held in the development of
PTSD while serving?
2. What role, if any, do you believe culture in the U.S. Army held in the development of
PTSD post-service?
3. What role, if any, do you believe service in the U.S. Army held in the development of
PTSD while serving?
4. What role, if any, do you believe service in the U.S. Army held in the development of
PTSD post-service?
5. What role, if any, do you believe culture in the U.S. Army while serving held in the
decision to commit suicide following service?
6. What role, if any, do you believe culture in the U.S. Army post-service held in the
decision to commit suicide following service?
7. What role, if any, do you believe service in the U.S. Army while serving held in the
decision to commit suicide following service?
8. What role, if any, do you believe service in the U.S. Army post-service held in the
decision to commit suicide following service?
9. To what extent, if any, do you believe that PTSD developed during service and was
responsible for suicide?
10. To what extent, if any, do you believe that PTSD developed following service and was
responsible for suicide?
11. Do you have anything additional to add?

70

Appendix B: IRB Information

INFORMATION SHEET FOR EXEMPT RESEARCH

STUDY TITLE: The role of post-traumatic stress disorder on veteran suicide rates in
younger veterans
PRINCIPAL INVESTIGATOR: Paolo Paruccini

FACULTY ADVISOR: Patricia Tobey, Ph.D

You are invited to participate in a research study. Your participation is voluntary. This
document explains information about this study. You should ask questions about
anything that is unclear to you.

PURPOSE
The purpose of this study is to better understand the cultural factors that influence
sucide in the veteran community. Specifically, younger veterans. We hope to learn how
to better serve this population with programs that better suite their needs. You are
invited as a possible participant because you are a veteran between the ages of 18-35
no longer serving on active duty, in the National Guard, Reserve components, or other
group considered to be military personnel.

PARTICIPANT INVOLVEMENT
Inclusion for this study focuses on those that work in the nonprofit sector of veteran
out reach. Over the course of this study potential participants will receive a link to the
Qualtrics survey for completion. No personal data will be gathered at this time, and all
responses are anonymous. At the end of the survey participants will have the
opportunity to opt into the interview portion of this study. The survey portion of the study
will take roughly twenty (20) minutes to complete, and interviews will be run roughly one
(1) hour in length.
Due to the recent pandemic interview will be conduct via MicroSoft Teams, Zoom, or
other acceptable video conference mediums. For the sake of transcribing the interviews
recordings will be used, however, if a participant is uncomfortable with being recorded
they may opt out and remain in the study.
[Describe what participants will be asked to do and provide enough detail for the
participant to understand. Indicate the study procedures; how long each procedure will
take along with their total length of participation. If audio/video-recording will be used,
indicate whether participants can decline to be recorded and continue with their
participation]

71

If they decide to take part, they will be asked to complete a survey which will take
roughly twenty (20) minutes to complete, and potentially participate in an interview
taking roughly one (1) hour to complete.

CONFIDENTIALITY
The members of the research team, and the University of Southern California
Institutional Review Board (IRB) may access the data. The IRB reviews and monitors
research studies to protect the rights and welfare of research subjects.
When the results of the research are published or discussed in conferences, no
identifiable information will be used.

No personal information will be gathered from those that participate in the survey
portion of this study. Only those that opt into the interview portion will have any
information gather about them.

Those that take part in the interview portion of the study will have their
information guarded through the use of pseudonyms. Other identifying, or potential
sensitive information gather from the interview participants will be held under lock and
key in my home office and will be destroyed upon completion of this study to protect
participants anonymity. I am the only one that has access to this space.

Audio video recording of the interview will only be kept for such a time that they
be transcribed. The participants will not be able to view, or edit the recording of the
interview. The primary researcher will be the only one that has access to the recording
for the purpose for transcription. Once the transcript has been completed the
video/audio recording will be deleted.

INVESTIGATOR CONTACT INFORMATION
If you have any questions about this study, please contact Paolo Paruccini at
paruccin@usc.edu, or 530-300-8911. You may also contact his faculty advisor Patricia
Tobey, Ph.D at tobey@usc.edu

IRB CONTACT INFORMATION
If you have any questions about your rights as a research participant, please contact the
University of Southern California Institutional Review Board at (323) 442-0114 or email
irb@usc.edu.

72

Appendix C: IRB Approval Letter

Abstract (if available)

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Asset Metadata

Creator Paruccini, Paolo Rinaldo (author)

Core Title The shared experience of veteran transition and its impact on veteran suicide

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2021-12

Publication Date 09/02/2021

Defense Date 07/22/2021

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Mental Health,OAI-PMH Harvest,phenomenological,PTSD,qualitative,Suicide,veterans

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Tobey, Patricia Elaine (committee chair), Combs, Wayne (committee member), Phillips, Jennifer L. (committee member)

Creator Email paruccin@usc.edu,paul_paruccini66@hotmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC15905093

Unique identifier UC15905093

Legacy Identifier etd-ParucciniP-10048

Document Type Dissertation

Format application/pdf (imt)

Rights Paruccini, Paolo Rinaldo

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright. The original signature page accompanying the original submission of the work to the USC Libraries is retained by the USC Libraries and a copy of it may be obtained by authorized requesters contacting the repository e-mail address given.

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA

Repository Email cisadmin@lib.usc.edu