Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Social Work


Social Work

First Advisor

Dr. Julie Cerel


Background. Veterans are overrepresented among suicide deaths in the United States, representing 20% of annual suicide deaths but only about 1% of the U.S. population (Department of Veteran Affairs, 2010). Of all military suicide deaths in 2016, one-third (33.4%) were in the National Guard or Reserves (Department of Defense, 2018). Previous suicidal ideation or behavior (SIB) has been shown to increase risk of subsequent ideation or behavior in both active duty and veteran samples (Bryan, Rudd, & Wertenberger, 2016; Hazlett et al., 2016) but studies of SIB specific to National Guard service members were not found.

Access and Barriers to Care. Only 44% to 53% of National Guard service members use mental health services (Gorman et al., 2011; Kehle et al. 2010). Continuity of care may be impacted due to different eligibility requirements, and different electronic medical records systems between systems of care (Martis, 2014). Stigma has been shown to increase feelings of burdensomeness and decrease sense of belonging, thus increasing risk for SIB (Lusk et al., 2015). Stigma has been shown to impact treatment seeking (Gorman et al., 2011), and perpetuate mental health challenges and suicide risk (Lusk et al., 2015). The sub-concepts of “Public Stigma” and “Self-Stigma” (Brown & Bruce, 2016; Rodrigues et al., 2014) are discussed.

Mental Health. Studies have shown that greater challenges with mental health and suicide ideation facilitated treatment engagement (Gallegos, Streltzov & Stecker, 2016). Additionally, studies show a relationship between trauma exposure and negative mental health and SIB. Gradus et al. (2013) found in a 10-year longitudinal study of Marines, that childhood and military trauma and history of suicide attempt were primary risk factors for suicide attempt, and half of those in the study who were lost to suicide had reported at least one such stressor.

Trauma. Adverse events during childhood have predicted post-deployment onset of depression in soldiers with no pre-deployment history of depression or PTSD (Rudenstine et al., 2015). For National Guard service members with Military Sexual Trauma (MST), childhood sexual trauma was a stronger risk factor for suicide attempt than sexual trauma during military service. Though trauma history is an important consideration relating to mental health issues, no studies were identified specifically focusing on National Guard with SIB within the last year.

Research Aims. This dissertation will be focused on three factors that have been shown to influence mental health treatment seeking, and independently examine each factor in a separate manuscript to contribute new knowledge to the field. This dissertation aims to examine stigma, access to care and seeking services among National Guard with recent SIB, assess the relationship of PTSD, Depression and seeking services among National Guard with recent SIB, and explore Pre-military trauma and treatment seeking in National Guard with recent SIB.

Method. This study was based on secondary data collected via survey of military personnel in the Army and Air National Guards in Utah, and Idaho. The original survey was conducted by the National Center for Veteran Studies, administered online and promoted via links on National Guard websites, as well as through command email distribution and social media. Measures included the Self-Injurious Thoughts and Behaviors Interview (Nock et al., 2007) to assess suicidal behavior, a modified Stigma and Barriers to Care, indications of use of twelve resources for seeking care, the PHQ-9 for depression, the PCL-5 for PTSD, and the LEC-5 for traumatic exposure.

Results. A total of 997 respondents completed the survey and of those, 120 reported SIB within the last year and were the focus of these studies. Most respondents were in the Army National Guard (81.5%; n=97), male (81.5%; n=97), and Caucasian (83.1%; n=98). Age was asked in ten-year intervals with the largest prevalence (43.2%; n=51) between 31 and 40 years old. Over half of survey respondents were married (68.3%; n=82), and most fell within the enlisted ranks (80.8%; n=97). Results and implications of analyses are discussed.

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