title: Prevention of suicidal behaviour among army personnel: a qualitative study.
abstract: OBJECTIVE
  To examine the context of suicidal behaviour among soldiers in the United Kingdom and identify factors that could reduce the risk of such behaviour.
  
  
  METHODS
  A series of in-depth interviews with service providers involved in treating soldiers following deliberate self harm. Their responses were compared with those of a small sub-sample of soldiers who presented to Army medical services following self harm.
  
  
  RESULTS
  We interviewed 21 service providers with a range of experience and professional backgrounds and 10 soldiers. Service providers told us that the rarity of suicide among soldiers together with lower levels of mental illness amongst those who end their lives made suicide prevention in the Army a difficult task. However they highlighted concerns about recruitment and retention of young soldiers, and stated that stigmatisation of mental illness in the Army sometimes prevented those with suicidal ideation seeking help. They also highlighted the role of alcohol use in precipitating self-harm. Soldiers who had self-harmed told us that they struggled to balance the demands of work and family life and described harming themselves impulsively often while intoxicated with alcohol. Soldiers look to sources of support outside the Army, and see commanding officers, rather than healthcare professionals, as helping resolve their problems. Neither service providers nor soldiers mentioned helplines and other 'independent' sources of confidential advice and support which are available to soldiers serving with the British Army.
  
  
  CONCLUSIONS
  Our findings highlight problems associated with efforts to reduce suicide among soldiers but suggest that these should focus continuing to try to reduce stigmatisation of mental distress and specifically on the role of commanding officers. Greater efforts should also be made to publicise existing sources of help and reduce levels of alcohol misuse.
authors.affiliation: Department of Psychological Medicine, Faculty of Medicine, Imperial College London, Claybrook Centre, St Dunstan's Road, London W6 8RP. m.crawford@imperial.ac.uk
authors.forename: M J
authors.initials: MJ
authors.lastname: Crawford
authors.forename: D
authors.initials: D
authors.lastname: Sharpe
authors.forename: D
authors.initials: D
authors.lastname: Rutter
authors.forename: T
authors.initials: T
authors.lastname: Weaver
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders; D008603:Mental Health; D008605:Mental Health Services; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data*; D008890:Military Psychiatry / Q000706:statistics & numerical data; D011287:Prejudice; D036301:Qualitative Research; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000517:prevention & control*; D013406:Suicide, Attempted / Q000517:prevention & control; D006113:United Kingdom; D055815:Young Adult; D000092864:Suicide Prevention