Page 59 - JSOM Summer 2019

Resilience and Suicide in Special Operations Forces

State of the Science via Integrative Review

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Kate Rocklein Kemplin, DNP, RN *; Olimpia Paun, PhD, PMHCNS-BC ;
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Dan Godbee, MD, FACEP ; Jonathan Brandon, MD 4
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ABSTRACT
Background: Due to alarming rates of suicide in Special Opera- Introduction
tions Forces (SOF) and associated effects of traumatic stress in
military populations writ large, resilience initiatives thought to Special Operations Forces (SOF) are highly trained, elite mili-
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influence Servicemembers’ mitigation of traumatic stress and tary Servicemembers “chosen from the larger pool of military
thus lower suicide risks have been implemented throughout personnel [from criteria] that are believed to be associated
the services. Since combat operations commenced in multiple with increased resilience to operational and work-related
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theaters of war nearly two decades ago, resilience in conven- stressors” [emphasis ours]. Such statements assign resilience
tional military populations became a topic of keen interest in SOF as an inborn trait those Servicemembers possess and
throughout departments of defense worldwide as well. Despite bolster beliefs that being selected for SOF units is due to candi-
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researchers’ consistent assertions that SOF are highly resilient dates’ inborn resilience. Because of similarities in selection,
and at low risk for suicide, granular analysis of pertinent re- qualifications, and length of training, SOF in this study refers
search and escalating suicide in SOF reveals no empirical basis primarily to US Army Special Forces (SF; “Green Berets”) and
for those beliefs. Methods: We report findings from an inte- US Navy Sea, Air, and Land (SEAL) Special Warfare Service-
grative review of resilience research in SOF and larger military members, though we note SOF includes US Army Rangers and
populations to contextualize and augment understanding of US Air Force pararescue jumpers, and other specialized elite
the phenomenon. Results: Throughout the literature, concep- and clandestine units.
tual and operational definitions of resilience varied based on
country, context, investigators, and military populations stud- Key Takeaways
ied. We identified critical gaps in resilience knowledge in the • In 2017, one of the largest suicide studies in military
military, specifically: Resilience has not been studied in SOF; history concluded that SOF had nearly zero risk of
resilience is not concretely established to reduce suicide risk or suicide, asserting SOF are highly resilient due to their
proven to improve mental health outcomes; resilience differs “rigorous selection, intense training, strong unit cohe-
when applied as a psychological construct; resilience research sion, or psychological and biological characteristics.”
is based on specific assumptions of what composes resilience, In 2018, SOF suicides tripled.
depending on methods of measurement; resilience studies in • Amid “historically heightened suicide rates,” the cur-
this population lack rigor; research methodologies and con- rent US SOCOM strategy is to augment resilience
flicting interests invite potential bias. Conclusion: This inte- through wellness programs emphasizing elite athleti-
grative review highlights emergent issues and repetitive themes cism and psychosocial fitness.
throughout military resilience research: resilience program in- • Suicides in SOF could be due to organic, occupational
efficacy, potential investigator bias, perpetuated assumptions, causes of neuropsychiatric symptom spectra; augmen-
and failure to capture and appropriately analyze germane data. tation of psychosocial resilience will obviously not re-
Because of overall inconsistency in military resilience research, verse physiologic sequelae from organic brain injuries.
studies have limited external validity, and cannot be applied • From a clinical perspective, overemphasis on resilience
beyond sampled populations. Resilience cannot be responsibly could be denying resources needed to investigate the
multifaceted natures of PTSD and suicide.
offered as a solution to mitigating posttraumatic stress disor- • The military’s insistence on resilience could be inter-
der nor suicide without detailed study of both in SOF.
preted as shifting responsibility for effects of chronic
physiologic and neurologic stress to Servicemembers
Keywords: military; Special Operations Forces; resilience; characterized as not being positive enough in thought
suicide; traumatic stress; integrative review or resilient if they succumb to PTSD or suicide to stop
their suffering.

*Correspondence to kemplinkate@gmail.com
1 Dr Rocklein Kemplin is assistant professor of Nursing Research and Graduate Statistics Faculty, The University of Tennessee at Chattanooga;
2014–2018 Research Program Chair for the Special Operations Medical Association; and a 2012 Jonas Foundation Veterans Healthcare Scholar.
2 Dr Paun is associate professor and Inaugural Kellogg Faculty Scholar, Rush University College of Nursing, Chicago, IL, and an advanced prac-
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tice registered nurse board certified as a psychiatric mental health clinical nurse specialist. COL Godbee is the group surgeon for US Army 20th
Special Forces Group; a board-certified practicing emergency medicine physician; emergency medical services director for Baton Rouge Parish,
LA; and previously an enlisted 18C, 18D, 18F, and 18Z. SFC (Ret) Brandon is a former 18D for US Army 1st Special Forces Group and Joint
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Special Operations Medical Training Center faculty; a 2018 graduate of the University of California San Francisco School of Medicine; and
currently an emergency medicine resident at Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL.
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