A PRISMA Scoping Review to Explore Interventions to Prevent Firearm-Related Injury and Suicide in Older Adults.

OBJECTIVES: This scoping review aims to examine existing research into firearm safety interventions designed to prevent firearm injury and suicide in older adults. METHODS: Select databases were searched in 5/2023. Included articles involved an/a 1. aim to develop or investigate firearm safety interventions, 2. focus on adults 50 years and older, and 3. primary analysis. RESULTS: The search yielded 10 articles which primarily focused on firearm safety counseling with older adults with suicide risk or emerging impairment. The review found that older adults may be open to receiving firearm safety counseling but that providers feel ill-equipped to have these conversations and to reliably identify suicide risk. Two studies presented promising data on the impact and acceptability of training providers in a firearm safety intervention. The review also identified the importance of building trust between older patients and providers to have helpful discussions regarding firearms, and highlighted specific approaches that facilitate openness to participate in these exchanges. CONCLUSIONS: Further research into adapting interventions to meet the clinical needs of older adults and treatment efficacy trials is necessary. CLINICAL IMPLICATIONS: Training healthcare providers to conduct firearm safety interventions with older adults may be an acceptable and impactful avenue to prevent suicide.

Induced optimism to lessen hopelessness-related cognitions among young adults at risk for suicidal thoughts and behavior.

Background: Hopelessness is one of the best-studied cognitive predictors of depression and suicide. Previous research suggests that hopelessness may develop through repetitive thinking about the occurrence of positive and negative future outcomes. The present study sought to investigate whether mental rehearsal in making optimistic future-event predictions, or induced optimism, would lead to reductions in hopelessness, particularly among individuals with a history of suicide ideation or suicide attempts. Methods: Participants with (n = 58) and without (n = 76) a history of suicide ideation or attempts were randomly assigned to either practice making optimistic future-event predictions or to a control condition in which they practiced making a lexical decision (using the same stimuli) over three study sessions, each separated by one week. Results: Findings offered modest support for the hypothesis that induced optimism would decrease hopelessness but not improve mood; this was regardless of history of suicide ideation or attempts. Limitations: The sample was predominantly female, and assessment of suicide ideation and attempt history was not confirmed by clinical interview, which may limit generalizability. Conclusion: Practice in making optimistic future-event predictions over time may be one way to reduce the hopelessness-related cognitions that confer vulnerability to suicide ideation and behavior.

Cost comparison of in-person and telehealth modalities for a suicide safety planning group intervention: interim results from the "Project Life Force" randomized clinical trial.

Suicide prevention is a clinical priority for the US Veterans Health Administration. Evidence-based interventions, including developing a suicide safety plan, are recommended practices and are becoming more widespread. Adaptations to further augment safety planning include a manualized group intervention (Project Life Force, PLF) that combines safety planning with the teaching of skills to maximize use of the plan. A multi-year randomized controlled trial to test efficacy of PLF compared to treatment as usual is currently in progress. However, approximately a year into the study, in-person groups were converted to telehealth groups due to the COVID-19 pandemic. This study compares the per-veteran cost of PLF when delivered in-person versus by telehealth using preliminary trial data from the first 2.5 years of the trial. Cost to deliver PLF was obtained from the Veterans Health Administration's Managerial Cost Accounting data, which relies on activity-based costing. We found no significant differences in the average number of sessions or average group size between in-person and telehealth. However, the cost per group session was lower for the telehealth modality and this led to significant overall per-veteran savings. While efficacy data comparing from the two arms is still underway and we await the ongoing RCT results, our interim cost analysis highlights potential savings with the telehealth modality.

Sleep quality and in-person versus online social interaction during the early COVID-19 pandemic lockdown: Impact on affect and interpersonal needs among young adults.

We examined relationships among sleep quality and forms of social interaction (in-person vs. online) as predictors of change in affect and interpersonal needs (perceived burdensomeness, thwarted belongingness) - correlates of suicidal thoughts and behaviors - during the early COVID-19 pandemic lockdown. New York City undergraduates (N = 58) from four public colleges completed a baseline survey and daily diaries up to 30 days in April-June 2020. Adjusting for relevant covariates, better sleep quality and in-person communication predicted greater positive affect and lower negative affect over time, but online social interaction only predicted greater positive affect and did not predict negative affect. Better sleep quality predicted lower perceived burdensomeness but not thwarted belongingness. Both in-person and online social interaction - but not total hours on social media - predicted lower thwarted belonging and perceived burdensomeness. Greater hours spent on social media each day lessened the relationship between in-person interaction and positive affect and lessened the buffering effect of in-person interaction on perceived burdensomeness. Improving sleep quality and increasing in-person interaction may ameliorate psychological variables that increase risk for suicidal thoughts and behaviors. However, when in-person interaction is limited, such as during the COVID-19 pandemic, online social interaction might be encouraged - depending on the nature of the interactions - to increase positive affect and buffer against suicide-related factors.

Supporting servicemembers and veterans during their transition to civilian life using certified sponsors: A three-arm randomized controlled trial.

Transitioning servicemembers and veterans (TSMVs) face difficulties throughout their reintegration to civilian life, including challenges with employment, poor social connection, and elevated risk for suicide. To meet the needs of this high-risk population, national initiatives have leveraged community-based interventions. Authors conducted a three-arm randomized controlled trial (n = 200) to evaluate two community-based interventions. The first, Team Red, White, and Blue (RWB), connects TSMVs to their community through physical/social activities. The second, Expiration Term of Service Sponsorship Program (ETS-SP) provides one-on-one certified sponsors to TSMVs who provide support during the reintegration process. TSMVs were assessed at baseline, 3, 6, and 12 months. The primary hypothesis was not supported as reintegration difficulties and social support were not significantly different for participants randomly assigned to the two community-based interventions (Arm-2/RWB and Arm-3/RWB + ETS-SP), when the data from the separate arms were collapsed and combined, compared to the waitlist. The results did support the secondary hypothesis as Arm-3/RWB + ETS-SP had less reintegration difficulties over 12 months and initially had more social support compared to Arm-2/RWB, which suggest that augmenting interventions with sponsors outperforms participation in community-based interventions alone. Overall, the results show some limitations of the studied community-based interventions, as implemented and researched within this study. The authors identified factors that may have contributed to the null findings for the primary hypothesis, which can be addressed in future studies, such as addressing the unique needs of TSMVs, enrolling TSMVs into interventions prior to military discharge, measuring and improving participation levels, and providing stepped-care interventions based on risk levels. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An open trial of VA CONNECT: Caring for Our Nation's Needs Electronically during the COVID-19 Transition.

The COVID-19 pandemic impacted emotional well-being due to safety concerns, grief, employment impacts, and social interaction limitations. Face-to-face mental health treatment restrictions were especially impactful to veterans who often gain social enrichment from Veterans Health Administration (VHA) care. We present results from a novel group-based telehealth intervention, VA Caring for Our Nation's Needs Electronically during the COVID-19 Transition (VA CONNECT), which integrates skills training and social support to develop a COVID-19 Safety & Resilience Plan. Veterans (n â€‹= â€‹29) experiencing COVID-related stress participated in an open trial of this 10-session, manualized group VHA telehealth intervention. We examined whether COVID-19-related stress, adjustment disorder symptoms, and loneliness decreased, and coping strategy use increased after participation in VA CONNECT. Between baseline and two-month follow-up, participants reported a significant reduction in perceived stress and adjustment disorder symptoms, and an increase in planning coping skills use. Significant changes were not observed in loneliness or other specific coping strategies. Findings may support the utility of VA CONNECT as an intervention for pandemic-related stress and improving certain coping skills. Future research should explore group-based telehealth interventions like VA CONNECT with other populations within and outside of the VA, which have value during major disruptions to face-to-face mental healthcare access.

Qualitative Study of Telehealth Delivery of Suicide-Specific Group Treatment "Project Life Force".

Minimal evidence exists for suicide-specific group treatment for high-risk patients offered over telehealth. This qualitative study assessed the acceptability, feasibility, and impact of a telehealth suicide safety planning intervention (SPI) multi-session group. High-risk suicidal Veterans (n = 17) participating in "Project Life Force-telehealth" (PLF-T); a manualized, 10-session SPI video group completed semi-structured qualitative interviews including measures of acceptability, appropriateness, and feasibility. We also interviewed the PLF-T coordinator and PLF-T group facilitators to identify adaptations to deliver PLF-T and learn about barriers and facilitators to implementation. A summary template and matrix analysis approach was used to analyze qualitative data. Veteran group participants were mostly male (88%), age 50 (SD = 15.6), ethnically diverse, and either divorced or separated (54%). Suicide symptoms upon study entry included past month ideation with methods (100%); and past year aborted, interrupted, or actual suicide attempt (59%). Participant interviews revealed an overall positive endorsement of PLF-telehealth with enhanced suicidal disclosure, and improved ability to manage urges and mitigate loneliness. On scales from 1 to 20, PLF-T was rated as highly acceptable (M = 17.50; SD = 2.92), appropriate (M = 17.25; SD = 3.59), and feasible (M = 18; SD = 2.45) by participants. Adaptations to deliver PLF-T included using a communications coordinator to conduct assertive outreach and engagement, adding a telehealth orientation session, restructuring sessions to review suicide severity, and screen-sharing safety plans to maximize learning. PLF-T enhanced convenience and access without compromising safety. Concerns included privacy and technological limitations including connectivity. Project Life Force-telehealth is acceptable and feasible to deliver via telehealth. This opens the possibility of delivery to hard-to-reach high-risk populations. ClinicalTrials.gov Identifier: NCT0365363.

Family Treatments for Individuals at Risk for Suicide.

Background: This PRISMA scoping review explored worldwide research on family-based treatments for suicide prevention. Research on this topic highlights the importance of facilitating familial understanding of a suicidal individual. Aim: The review sought evidence of outcomes of trials in which both the patient and family member in the intervention arm attended the same sessions at which suicide was openly discussed. Method: To explore this topic, the authors searched for randomized and nonrandomized controlled trials using Medline (Ovid), PsycINFO (Ovid), Social Services Abstracts (EBSCO), and Web of Science on July 8, 2020. Results: Ten different studies were included that spanned five treatment modalities. Specifically, of the interventions in these 10 articles, 40% employed some sort of cognitive-behavioral therapy, 20% examined attachment-based family therapy, 20% used family-based crisis intervention, and the remaining 20% were distinct interventions from one another. Additionally, several of these articles demonstrated rigorous study methodology and many of the articles reported significant improvements in suicidal ideation or behaviors. Conclusion: Several important research gaps were identified. While this approach has been largely understudied, and to date has been primarily researched in adolescent populations, family interventions have great potential for treatment and prevention of suicidality.

International PRISMA scoping review to understand mental health interventions for depression in COVID-19 patients.

Preliminary research indicates that the COVID-19 illness affects the mental well-being of patients. This scoping review, thus, aims to examine the current state of research into mental health treatments for depression symptoms in COVID-19 patients. Select databases were searched on 7/1/2021. Full-text articles involved (1) mental health treatment (2) suicide and/or depression outcomes, (3) a quasi-experimental research trial, and (4) a primary analysis. 11 articles were included in this review. The studies spanned 5 countries, and demonstrated immediate positive effects of mental health treatments and tele-health as a treatment modality for depression in COVID-19 patients. 6 studies were randomized controlled trials. Various treatments were administered, including cognitive behavior therapy, mindfulness, and muscle relaxation. Most interventions were conducted in in-patient units and focused on acute symptoms. There were limitations in the design and description of methodology in many studies, which affects the generalizability and replicability of positive findings. Only two studies included a post-intervention follow-up and one study assessed suicide risk. Thus, this review found there is a pressing need for more research in the area, with greater rigor in study methodology, and for treatments targeting long-term symptoms and suicidality, and outpatient services.

Characteristics of suicide attempts associated with lethality and method: A latent class analysis of the Military Suicide Research Consortium.

While suicide prevention is a national priority, particularly among service members and veterans (SMVs), understanding of suicide-related outcomes remains poor. Person-centered approaches (e.g., latent class analysis) have promise to identify unique risk profiles and subgroups in the larger population. The current study identified latent subgroups characterized by prior self-directed violence history and proximal risk factors for suicide among suicide attempt survivors, and compared subgroups on demographics and most-lethal attempt characteristics. Participants included civilians and SMVs reporting lifetime suicide attempt(s) (n = 2643) from the Military Suicide Research Consortium. Two classes emerged from Common Data Elements: suicide attempt and non-suicidal self-injury frequency, suicide attempt method, perceived likelihood of future suicide, suicide disclosure, suicide intent, and perceived and actual lethality of attempt. A Higher-Risk History class was characterized by greater intent to die, certainty about attempt fatality and method lethality, belief injury would be medically unfixable, and likelihood of prior non-suicidal self-injury. A Lower-Risk History class was characterized by greater ambivalence toward death and methods. Higher-Risk class members were more likely to be male, older, SMVs, have less formal education, use firearms as most-lethal attempt method, and require a higher degree of medical attention. Lower-Risk class members were more likely to be female, civilian, use cutting as most-lethal attempt method, and require less medical attention for attempts. Findings have implications for risk assessments and highlight the importance of subjective perceptions about suicidal behavior. Further investigation of real-time individual-level is necessary, especially for SMVs who may be at greatest risk for potentially lethal suicidal behavior.

Suicide and Telehealth Treatments: A PRISMA Scoping Review.

BACKGROUND: This PRISMA scoping review explored worldwide research on the delivery of suicide-specific interventions through an exclusive telehealth modality. Research over telehealth modalities with suicidal individuals highlights the importance of facilitating participants' access to treatments despite location and circumstances (e.g., rural, expenses related to appointments, etc.). AIM: The review sought evidence of outcomes of trials or projects in which both the patient and therapist attended sessions conjointly and openly discussed suicide over a telehealth modality (e.g., phone, zoom). METHOD: To explore this topic the authors searched for research trials and quality improvement projects using Ovid Medline, Ovid Embase, Ovid PsycINFO, EBSCO Social Services Abstracts, and Web of Science on 3/3/2021. RESULTS: Nine different articles were included that each spanned distinct treatments, with eight being research studies and one being a quality improvement project. LIMITATIONS: Publications featuring ongoing or upcoming research in which complete study results were not available did not meet inclusion criteria for this review. CONCLUSION: Several important research gaps were identified. While this approach has been largely understudied, exclusive telehealth delivery of suicide-specific interventions has great potential for the prevention of suicidality, especially in the era of COVID-19 and beyond.

A Pilot Randomized Control Trial of a Dyadic Safety Planning Intervention: Safe Actions for Families to Encourage Recovery (SAFER).

A recent systematic review on family and suicide prevention efforts identified a lack of family-based safety planning interventions for adults. To address this gap, The Safe Actions for Families to Encourage Recovery (SAFER) intervention was created. SAFER is a novel, manualized, 4- session, family-based treatment intervention that provides the tools and structure to support family involvement in Safety Planning Intervention (SPI) for Veterans at moderate risk for suicide. The SAFER intervention includes the use of psychoeducation, communication skills training, and development of a Veteran, and a complementary supporting partner, SPI. This Stage II (2aii) randomized clinical trial (RCT) evaluated the preliminary efficacy of this innovative and much-needed approach. Thirty-nine Veterans and an associated supporting partner were randomized to receive either SAFER or currently mandated (i.e., standard) individual Safety Planning Intervention (I-SPI). Veterans in the SAFER condition as compared to I-SPI exhibited significant monthly decrements in suicide ideation as measured by the Columbia Suicide Severity Rating Scale (B=-0.37; p=.032). Moreover, a treatment-by-time interaction emerged when predicting improvements in Veteran suicide-related coping (B=0.08; p=.028) and supporting partner support of Veteran's coping efforts (B=0.17; p=.032). However, the treatment effect for Veteran coping was not significant in dyadic analyses (B=0.07; p=.151) after controlling for the partner's support (B=0.16; p=.009). Self-reported appraisals of relational factors and self-efficacy were not impacted by condition for either Veterans or supporting partners. This initial efficacy pilot trial suggests that a brief dyad-based SPI has the potential to improve Veteran suicide symptoms and help family members support the Veteran's coping efforts. However more intensive family work may be required for changes in self-perceptions of burdensomeness, belongingness, and caregiver perceptions of the Veteran as a burden. Nonetheless, SAFER's discussion and disclosure about suicide symptoms facilitated more robust development of SPI for the Veteran and their accompanying supporting partner.

Arrest history and psychopathology among veterans at risk for suicide.

While preliminary evidence suggests an association between legal involvement and suicide risk among veterans, no research to date has explored the prevalence and/or correlates of legal involvement among veterans at high risk for suicide. The current study examined the relation of suicide attempt, suicidal ideation, and psychopathology to history of criminal arrest in a sample of 286 veterans at risk for suicide. Results indicated approximately half (47%) of at-risk veterans had a history of arrest. Inconsistent with hypotheses, arrest history was not associated with history of suicide attempt, current suicidal ideation, or severity of psychopathological symptoms. Arrest history was, however, associated with diagnoses of substance use disorder and antisocial personality disorder in this high-suicide risk sample. Further, likelihood of an antisocial personality disorder diagnosis was associated with higher frequency of past arrests. Taken together, results indicate that many veterans at risk for suicide have a history of arrest, and at-risk veterans with such history likely have a specific pattern of psychopathology, including antisocial personality traits and substance use. As such, legal status and history of justice involvement may be important considerations when assessing suicide risk and management of this high-risk population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Better off with you: Exploring congruity between caregivers' and Veterans' experience of efforts to cope with suicide.

The interpersonal theory of suicide posits people are more likely to consider suicide when they perceive themselves as alone and as a burden. However, there is limited research on whether these self-perceptions reflect caregiver experiences. As part of a larger study of collaborative safety planning, 43 Veteran/caregiver dyads (N = 86 individuals) completed measures of belongingness and burdensomeness, caregiver burden, family problem solving, and suicide-related coping. We conducted dyad-level actor interdependence models allowing two types of social coping (i.e., general problem solving and suicide-specific coping) to predict Veteran's self-views and caregiver interpersonal perceptions. Results suggested that Veteran social coping predicted lower Veteran thwarted belonginess and burdensomeness and caregiver involvement in problem solving was similarly associated with their own lower caregiver emotional burden. But examination of cross-partner effects demonstrated that greater Veteran coping was associated with greater time burden for caregivers. Findings suggest that social coping is associated with positive perceptions at the individual level (i.e., Veterans and caregivers to themselves) but does not indicate positive effects at the partner level. Clinicians working with Veterans may wish to involve supports in care to encourage effective collaboration that meets both caregiver/recipient needs.

Group treatments for individuals at risk for suicide: A PRISMA scoping review (ScR).

BACKGROUND: This PRISMA scoping review explored worldwide research of interventions for suicide prevention delivered within a group setting. Research on group treatments underscores the importance of peer connection in diminishing social isolation and increasing social support. Additional benefits of group treatment include cost efficiency and maximization of staff time. However, the clinical outcomes of group treatments with individuals at risk for suicide are less understood and under researched. AIM: This scoping review had two objectives: 1) To identify existing group treatments where suicidal thoughts and behaviors are openly discussed; 2) To examine the outcomes of these identified treatments, with special attention to treatment integrity. METHOD: To address these aims the authors searched Medline (Ovid), Embase (Ovid), and PsycINFO (Ovid), on November 25, 2020. At the Full Text stage, articles were included that were peer reviewed, described a suicide specific group intervention and reported suicide specific outcomes. An additional requirement was open dialogue of suicide in the group intervention. RESULTS: Only ten research reports of suicide-specific group treatments were identified in our PRISMA-ScR. In spite of many differences in setting, population, length, and frequency of sessions, all ten groups reported improvements in varying aspects of suicide symptoms. The only adverse impacts were reported by two studies wherein two (of 92) participants attempted suicide and a small number (7%) of adolescents reported feeling triggered with suicidal thinking during a session. Despite our focus on empirical data in this review, the methodological rigor of the studies evaluated was limited. CONCLUSION: Despite the paucity of group treatment research in which suicidal thoughts and behaviors are openly discussed, the outcomes of these treatments were promising in decreasing suicide risk. These results may be due to unfounded fears of contagion. Further implications of these findings are considered along with limitations that may have excluded clinical work from meeting inclusion criteria for this review. Nonetheless, this evidence suggests that, suicide-focused groups have great potential for prevention of suicidal symptoms and should be further expanded in the future.

Distinguishing veterans with suicidal ideation from suicide attempt history: The role of emotion reactivity.

INTRODUCTION: Growing evidence suggests emotion reactivity-sensitivity and intensity of emotional experience-may represent a diathesis for suicide risk. However, our understanding of its ability to differentiate risk for suicidal ideation (SI) from suicide attempt (SA) is limited. METHOD: This study compares Veterans with SI (n = 81) to Veterans with SA (n = 177) history on factors relevant to emotion reactivity to determine which variable(s) best differentiate groups. Variables examined are multimodal: (a) self-report: childhood trauma, combat exposure; (b) clinician-assessed: non-suicidal self-injury (NSSI), structured diagnostic interview of psychopathology; and (c) psychophysiological: affect-modulated startle (AMS; proxy for amygdala reactivity and emotion reactivity) to unpleasant pictures was examined in a subset (n = 90). RESULTS: SA history was independently predicted by NSSI history, MDD, PTSD, and SUD diagnosis. Childhood trauma and combat exposure did not differentiate groups. The composite risk index demonstrated good accuracy (AUC=0.71, sensitivity=0.90, specificity=0.49). Only AMS independently predicted SA history when added to the model and accuracy was improved (AUC=0.82, sensitivity=0.85, specificity=0.56). CONCLUSION: NSSI history, MDD, PTSD, and SUD diagnosis may be salient risk factors for this population. However, emotion reactivity is a more parsimonious predictor of SA history among Veterans suggesting it is an important treatment target among Veterans with SI.

Feasibility and acceptability of VA CONNECT: Caring for our nation's needs electronically during the COVID-19 transition.

COVID-19 has transformed day-to-day functioning and exacerbated mental health concerns. The current study examines preliminary feasibility and acceptability of a VA CONNECT - a novel 10-session, manualized telehealth group intervention integrating skills training and social support to develop a Safety & Resilience Plan for Veterans experiencing COVID-related stress. Data from the first 20 participants support the intervention's feasibility and acceptability. Strengths, limitations, and suggestions for improvement of the intervention are noted. Collaboration with other VA researchers would aid in protocol dissemination and evaluation of VA CONNECT's utility for reducing COVID-19-related stress, loneliness, and mental health symptoms.

An Open Trial of a Suicide Safety Planning Group Treatment: "Project Life Force".

In 2008, the Department of Veterans Affairs mandated that clinicians oversee the construction of a Suicide Safety Plan for every patient who is identified as "high risk" for suicide. While the Suicide Safety Plan is a mandated "best practice," there are currently no recommended guidelines for its augmentation in a group setting. To address this gap, a novel group intervention, "Project Life Force," (PLF; a 10-session manualized psychotherapy), was developed and piloted. Results indicate high feasibility and acceptability. Exploratory analysis revealed statistically significant decreases in suicidal thoughts/behaviors, depression, and hopelessness. Feedback from Veterans and PLF therapists is also discussed. Despite some limitations (e.g. small sample size) exploratory results suggest that PLF may be a promising treatment for Veterans with suicidal symptomology.

No Community Left Behind: A Call for Action During the COVID-19 Pandemic.

COVID-19 has affected many people worldwide. Beyond the physical symptoms brought on by this virus, it has adversely affected those without the illness through isolation, social distancing, and changes in job and housing security. Clinicians are trying to address the mental health needs of millions of strained Americans with and without COVID-19 and are operating without a systematic strategy. Informed by the authors' experiences during the pandemic, this Open Forum attempts to answer two questions: What are the specific considerations in working with economically compromised Hispanic/Latino and Black/African American populations with mental illness? How can mental health providers and researchers best help?

Ecological momentary assessment (EMA) of mental health outcomes in veterans and servicemembers: A scoping review.

This PRISMA scoping review explores existing research conducted with United States military samples utilizing ecological momentary assessment (EMA) to evaluate mental health outcomes. EMA facilitates understanding of temporal changes of dynamic variables subject to change difficult to capture in standard laboratory assessment. It also elucidates understanding of complex etiology of mental illness in military and veteran samples and treatment approaches. Thirty-two articles published between 1995 and 2019 met inclusion criteria. Most (68.7%) included studies examined mental health symptoms and their temporal relationship to other outcomes among servicemembers and/or veterans, particularly posttraumatic stress disorder and substance use disorders. EMA was frequently employed to better understand underlying mechanisms of mental illness, predict symptom changes, assess feasibility among special populations, and assess treatment outcomes. Considerable variability existed in assessment period duration, number of daily assessments, and EMA modalities utilized. Several research gaps were identified, including underutilization of EMA to study suicide risk in veterans/servicemembers. EMA has great potential for increasing understanding of an array of complex mental health problems; however, this highly promising approach has been largely underutilized to study mental health issues among veteran and military populations to date, perhaps due to institutional delays in its adoption secondary to privacy/data security concerns.