Ian H Stanley

• PhD
• Assistant Professor at University of Colorado

Introduction Active duty service members who are psychiatrically hospitalized for suicide are at the highest risk for suicide death following discharge. It is essential to test brief treatments that can be delivered during the short length of stay in inpatient psychiatry. Written Exposure Therapy, a brief treatment for posttraumatic stress disorder...

Objective: Prior studies have demonstrated a robust link between posttraumatic stress disorder (PTSD) symptoms and suicide attempts among military personnel; however, to our knowledge, no study has examined PTSD in relation to indices of suicide attempt seriousness. Accounting for the multifaceted nature of suicide attempts is especially important...

Background: This study examined if firefighters (an occupational group at elevated suicide risk) who have made a suicide plan involving a firearm reported higher suicidal intent than those whose plans did not involve a firearm. Methods: Participants included 173 firefighters (M [SD] age = 32.0 [9.9], 95.8% male) who reported having made a suicide p...

We examined beliefs and practices regarding firearm assessment and lethal means safety counseling (LMSC) among U.S. Air Force (USAF) mental health providers (MHPs) and behavioral health technicians (BHTs). Data were collected from 204 USAF MHPs (74.0%; n = 151) and BHTs (26.0%; n = 53) via an anonymous, voluntary survey. A modest proportion indicat...

Critical care nursing is a highly dynamic and demanding field, and critical care nurses play a vital role in the US military health care system. Although many critical care nurses are resilient to myriad occupational exposures, for some nurses the job leads to adverse psychological effects, including compassion fatigue and burnout. This article des...

This cross-sectional study compares gun carrying practices and participation in violence prevention programs among youth with vs without a parent in the US military.

Suicide remains a leading cause of death in the United States (U.S.) Armed Forces. Access to firearms increases the risk of death by suicide due to the high lethality of firearm-related injuries (~90% in suicide attempts) and the highly dynamic nature of suicide which includes rapid change from low- to high-risk states. Critical gaps remain in rese...

Introduction The US Department of Defense recommends lethal means safety counseling (LMSC) to promote firearm injury prevention via secure storage of personal firearms. We describe the rollout of a universal, peer‐delivered adaptation of Project Safe Guard (PSG)—a brief, single‐session LMSC discussion—at a US Space Force installation. Method Progr...

Introduction Lethal means safety counseling (LMSC) to promote secure firearm storage may reduce the risk of firearm‐involved deaths, including suicide. We examined if emergency medical services (EMS) clinicians, including emergency medical technicians and paramedics, may be suitable LMSC messengers. Method We conducted a web‐based survey of 229 US...

Firefighters are frequently exposed to trauma and may experience a unique symptom presentation of posttraumatic stress. Prior research has identified stronger associations between certain post-traumatic stress symptoms (e.g. detachment, intrusions, physiological reactivity) using network analysis. However, little is known about the effects of sympt...

Objective This study seeks to better understand firearm ownership among law enforcement officers (LEO), with the goal of informing future firearm injury and suicide prevention efforts. We describe the frequency and sociodemographic correlates of firearm ownership and storage practices among, and examine the association between suicidal ideation and...

We assessed the interrater reliability, convergent validity, and discriminant validity of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF) in a sample of 1,944 active duty service members and veterans seeking services for posttraumatic stress disorder (PTSD) and related conditions. The SITBI-SF demonstrated high interrater...

Background Preventing firearm-involved injuries is a critical public health priority. Firearm locking devices can prevent firearm injuries, such as suicide and unintentional shootings, as well as theft. Various firearm locking devices exist; however, little is known about firearm owners’ preferred locking devices for secure firearm storage. In this...

Compared with the general U.S. population, firefighters (FF) and emergency medical services (EMS) workers (FF + EMS personnel) are at increased risk for firearm suicide. Although secure firearm storage is associated with reduced risk of firearm suicide, no study has examined the prevalence and sociodemographic correlates of firearm ownership and st...

This cross-sectional study analyzes data from the 2021 National Survey on Drug Use and Health to assess whether suicidal experiences among US veterans are associated with the COVID-19 pandemic.

The U.S. Department of Defense and other stakeholders recommend lethal means safety counseling (LMSC) to reduce suicide risk among military service members. Despite the promise of LMSC, few studies have examined moderators of LMSC treatment outcomes, such as posttraumatic stress disorder (PTSD) symptoms. Individuals with elevated PTSD symptoms are...

Background Risk of suicide-related behaviors is elevated among military personnel transitioning to civilian life. An earlier report showed that high-risk U.S. Army soldiers could be identified shortly before this transition with a machine learning model that included predictors from administrative systems, self-report surveys, and geospatial data....

Objective: Emerging evidence indicates that a nontrivial proportion of suicide attempt (SA) survivors develop clinically significant posttraumatic stress disorder (PTSD) symptoms related to their suicide attempt (SA-PTSD). However, SA-PTSD is rarely assessed in either clinical practice or research studies, due at least in part to a lack of research...

Importance: Secure firearm storage may help reduce firearm injury and death. Broad implementation requires more granular assessments of firearm storage practices and greater clarity on circumstances that may prevent or promote the use of locking devices. Objective: To develop a more thorough understanding of firearm storage practices, obstacles...

The U.S. DoD has identified firearm suicide prevention as a key operational priority. One vital approach to addressing firearm suicides is through promoting lethal means safety, which involves the voluntary use of secure storage for personally owned firearms and/or temporarily moving firearms out of the home during risk periods. Despite promising a...

Introduction Active duty service members transitioning to civilian life can experience significant readjustment stressors. Over the past two decades of the United States’ longest sustained conflict, reducing transitioning veterans’ suicidal behavior and homelessness became national priorities. However, it remains a significant challenge to identify...

Background: Approximately 2,900 youth who die by suicide each year in the United States use a firearm. To inform lethal means safety counseling efforts, this study aimed to describe firearm access among youth deemed at risk for suicide in pediatric medical settings. Methods: Youth who presented to one of four urban pediatric medical centers were...

Objective Suicidal intent is a risk factor for engagement in suicidal behavior, use of violent means, and suicide mortality. Yet, scarce research has examined factors associated with suicidal intent among U.S. military veterans, a population at high risk for suicide. This study examined vulnerability factors associated with suicidal intent in a po...

Each year, approximately 50,000 individuals in the United States and over 800,000 individuals worldwide die by suicide (Naghavi & the Global Burden of Disease Self-Harm Collaborators, 2019). Each person who dies by suicide leaves in their wake a network of individuals affected in some way by their death. For individuals connected to mental health s...

Background The transition from military service to civilian life is a high-risk period for suicide attempts (SAs). Although stressful life events (SLEs) faced by transitioning soldiers are thought to be implicated, systematic prospective evidence is lacking. Methods Participants in the Army Study to Assess Risk and Resilience in Servicemembers (ST...

This cohort study compares firearm, suffocation, and poisoning suicide rates among recently separated veterans with those among the general veteran population and examines demographic and military characteristics associated with risk of method-specific suicide mortality among recently separated veterans.

Objectives: Veterans who decline to provide information on their history of self-injurious thoughts and behaviors (SITBs) may be at elevated suicide risk. We examined associations between non-response to a question assessing lifetime SITBs and proxy variables of suicide risk. Methods: In this population-based cross-sectional study of 4069 US vet...

Suicide risk is elevated among military service members who recently transitioned to civilian life. Identifying high-risk service members before this transition could facilitate provision of targeted preventive interventions. We investigated the feasibility of doing this by attempting to develop a prediction model for self-reported suicide attempts...

Background: The Veterans Health Administration (VHA) implemented REACH VET, which analyzes health records to identify veterans at statistically elevated risk for suicide and other adverse outcomes compared to other veterans in VHA. This project evaluated REACH VET program implementation at a large VA health care system by examining program fidelit...

Objective: This study employed network analysis to characterize central autism spectrum disorder (ASD) traits and suicide symptoms within an active duty military sample as well as to identify symptoms that may bridge between ASD traits and suicidality (i.e., suicidal ideation and behaviors). Method: Participants were active duty U.S. military se...

A full account of needed future directions is beyond the scope of this Special Section introduction. The authors of the included articles provide cogent summaries of needed future directions, which I will not repeat in full here. I will, however, highlight a few key themes. First, suicide-related outcomes occur on a continuum, inclusive of passive...

The Depressive Symptom Index-Suicidality Subscale (DSI-SS) is a four-item self-report measure of suicidal ideation severity widely used across research and clinical contexts. However, the psychometric properties of the English-language version of the DSI-SS have not been extensively examined within a psychiatric sample, and important properties of...

The present study compared the utility of categorical (i.e., diagnostic status) and dimensional (i.e., symptom severity) approaches to measuring posttraumatic stress disorder (PTSD) in predicting future suicide attempts among participants in a nationwide, longitudinal study of U.S. military veterans who were deployed in support of operations in Ira...

Suicide is a considerable public health concern, particularly among U.S. veterans. Despite inpatient psychiatric hospitalization being a primary recommended treatment for acute suicidality, available inpatient group treatments remain limited. The current quality improvement project (QIP) aimed to examine the feasibility and acceptability of a newly...

Aim Prior studies suggest that individuals may respond inconsistently to different assessments of suicide attempt (SA) history; yet, little is known regarding why inconsistent reporting of SA history may occur. The overarching goal of this study was to examine individuals’ self-reported reasons for inconsistently responding to different self-report...

Objective The connection of individuals at elevated suicide risk to mental healthcare services represents a critical component of suicide prevention efforts. This article provides recommendations for enhancing the assessment of help‐seeking and mental health service use within the context of suicide prevention research. Method We discuss evidence‐...

Most suicide deaths in the United States are enacted with a firearm, and recent and first-time purchasers of firearms represent at-risk groups. This study aimed to examine differences in indicators of suicide risk among individuals who either (a) reported current firearm ownership/access or (b) denied current firearm ownership/access but reported a...

Individuals admitted to inpatient psychiatry for suicide-related concerns are at increased risk of suicide post-discharge, necessitating an understanding of factors, such as posttraumatic stress disorder (PTSD), that are associated with suicide-related hospitalizations. In this study, we examined if individuals admitted for suicide-related concerns...

To date, the field has been unable to provide a definitive answer on which suicide risk assessment measure or set of measures is most useful in applied clinical settings. This study pits several psychometrically sound suicide risk assessment measures against one another, to determine which tool optimally assesses the likelihood of future suicide-re...

Importance: Although interest is high in addressing suicide mortality after the transition from military to civilian life, little is known about the risk factors associated with this transition. To support the ongoing suicide surveillance work of the US Department of Veterans Affairs (VA) Office of Mental Health and Suicide Prevention, examining t...

Background: Previous work suggests that reasons for living (RFL) are associated with suicide ideation; however, the relationship between RFL and suicide attempts among individuals with suicide ideation remains unclear. Such an examination is necessary to delineate whether RFL are associated with suicide attempts above and beyond their association w...

Purpose The coronavirus 2019 (COVID-19) pandemic has prompted concerns about an increased risk for psychological distress, broadly and suicide mortality, specifically; it is, as yet, unclear if these concerns will be realized, but they are plausible. Design/methodology/approach The authors demonstrate why researchers, clinicians, policymakers and...

Most suicides in the United States are enacted with firearms, and firearm ownership/access and unsafe storage are associated with elevated suicide risk. Exaggerated perceptions of threat, which are characteristic of post‐traumatic stress disorder (PTSD), might lead to the acquisition and/or unsafe storage of firearms, thereby increasing suicide ris...

Introduction Each year, a substantial proportion of trainees who enter the U.S. Air Force (USAF) Basic Military Training (BMT) are unable to complete training. Reentry to civilian life poses significant challenges, including finding employment, establishing a new career path, and paying for education. To our knowledge, no study has examined the ass...

By virtue of their occupational responsibilities, protective service workers are often exposed to stressors and hazards that may increase their risk for various mental health problems. Efforts are thus needed to enhance connection to psychological services across protective service worker groups and to tailor the delivery of these services based on...

To enhance and standardize the assessment of suicidal self-directed violence (SDV) in military populations, the Military Suicide Research Consortium developed the Common Data Elements (CDEs). Previous research supported the CDEs as assessing a higher-order factor of suicidal SDV in military populations. The present study had two aims: 1) confirm th...

There is a dearth of research on mental health in transgender military service members, despite 21.4% of eligible transgender United States citizens having served in the military. The aim of this study was to examine differences in suicide risk and ideation based on gender identity in elevated risk service members over a 3-month period. Participant...

Background Suicide rates are elevated among United States (U.S.) military service members. Research has found that service members with autism spectrum disorder-related (ASD-related) traits are at increased risk for suicide. Complementary lines of inquiry have suggested that unit cohesion is a protective factor against developing suicidal ideation...

Suicide rates within the U.S. military are elevated. The interpersonal theory of suicide, supported within military samples, suggests that social disconnectedness confers risk for suicide. Autism spectrum disorder (ASD) is characterized by symptoms-difficulties in social communication/interaction (SCI) and restricted and repetitive behaviors (RRBs)...

Research indicates that connection to mental health care services and treatment engagement remain challenges among suicide attempt survivors. One way to improve suicide attempt survivors' experiences with mental health care services is to elicit suggestions directly from attempt survivors regarding how to do so. This study aimed to identify and syn...

Objective: Firearms are the most common method of suicide in the United States. The provision of firearm-specific lethal means safety interventions is a best practice for the prevention and management of suicide risk. However, few data exist to inform firearm-specific lethal means safety interventions. This study tested four different lethal means...

Soldiers in the U.S. Army National Guard are at elevated risk for suicide compared to soldiers in the other components. Most suicides by military service members, including members of the U.S. Army National Guard, are enacted with personal firearms. The unsafe storage of firearms is associated with increased risk for death by suicide. Therefore, ef...

Nonalcohol substance use is a robust correlate of suicide risk. However, few data exist regarding the degree to which nonalcohol substance use, as measured by objective indicators (e.g., urinalysis toxicology screen), is related to suicide risk. This study examined the associations of a multimodal assessment of nonalcohol substance use and multiple...

Suicide attempt survivors represent a group at elevated suicide risk that may benefit from connection to mental health care services; however, little is known empirically regarding attempt survivors’ perspectives on their experiences with psychiatric services, including their insights into how these services can be improved. This mixed methods stud...

Suicide rates within the U.S. military are elevated, necessitating greater efforts to identify those at increased risk. This study utilized a multigroup confirmatory factor analysis to examine measurement invariance of the Military Suicide Research Consortium Common Data Elements (CDEs) across current service members (n = 2,015), younger veterans (...

Background: Suicide rates are elevated among United States (U.S.) military service members. Recent research has found that service members with elevated symptoms of autism spectrum disorder (ASD) are at increased risk for suicide. Complementary lines of inquiry have suggested that unit cohesion is a protective factor against developing suicidal ide...

Objectives: Suicide attempts (SAs), by definition, represent a risk for serious injury or death; thus, one's SA may contribute to the development of posttraumatic stress disorder (PTSD). Yet, empirical data on this topic are lacking. This study aimed to characterize the phenomenology, rate, and associated features of PTSD following one's SA. Meth...

Objective The current study examined whether coping strategies mediate the link between adverse childhood experiences (ACEs) and adult psychiatric and physical health outcomes. Methods Data were drawn from wave I (N = 7108), wave II (N = 4963), and wave III (N = 3294) of the Midlife Development in the United States (MIDUS) Survey. An ACE count was...

Background: Theories of suicide posit distinct etiological pathways for suicide attempts (SA) and suicidal ideation (SI) that are marked, in part, by disruptions in the ability to regulate reactions to threat/mutilation and interpersonally-relevant emotional stimuli. However, little research has specifically tested these associations. To address t...

Background: Existing research suggests that inhibitory control deficits may differentiate individuals who think about suicide from those who make a suicide attempt. However, no available research, to our knowledge, has examined whether suicidal behaviors are associated with disruptions in the ability to determine when inhibitory control is needed...

Firefighters represent a group at elevated suicide risk. Identifying segments of the fire service at increased risk may facilitate the targeted provision of suicide prevention initiatives. Among the general population, American Indian/Alaska Native (AI/AN) individuals report higher rates of suicide attempts. This study sought to examine suicide att...

Few clinical practices are as important for simultaneously augmenting patient safety and mitigating legal risk as the judicious evaluation and stratification of a patient's risk for suicide, proportionate clinical actions based thereon taken by the healthcare provider, and contemporaneous documentation of the foregoing. In this article, we draw fro...

Objective Utilizing a sample of military service members at risk of suicide, this study aimed to: (a) identify patterns of suicide attempt (SA) history reporting across five measures and (b) evaluate whether consistent SA reporters (i.e., individuals who consistently report an SA history across measures) differ from inconsistent SA reporters on oth...

Clinicians working in U.S. Department of Defense behavioral health settings rely on standardized suicide risk assessment measures to guide their treatment of service members. Most of the measures used were developed, normed, and validated for use with civilians. Although there is reason to believe such measures will perform similarly in civilian an...

Objective Posttraumatic stress disorder (PTSD) symptoms are associated with increased suicide risk among firefighters. Few studies have examined modifiable factors, such as mindfulness facets, that might attenuate this association. This study examined the interactive effects of PTSD symptoms and mindfulness facets in relation to suicide risk among...

Study objectives: Prior cross-sectional studies indicate that psychological factors (eg, perceived burdensomeness, thwarted belongingness) may explain the relationship between insomnia and suicidal ideation. Longitudinal studies are needed, however, to examine how these variables may relate to one another over time. Using data collected at three t...

Background: Relatively little is known regarding the relationship between attitudes toward suicide, suicide attempt (SA) history, and future suicidal behaviors. Aims: Utilizing a sample of firefighters, this study compared attitudes toward suicide between individuals with/without a career SA history and evaluated whether certain attitudes toward...

Objective: Suicide rates within the U.S. military are elevated, and the assessment and treatment of posttraumatic stress disorder (PTSD) has been identified as one potential conduit for suicide risk reduction. Despite increased interest in examining whether PTSD symptom clusters differentially predict suicide-related outcomes, to our knowledge no...

Objective: Suicide is a global public health concern. To inform the prevention and treatment of suicidality, it is crucial to identify transdiagnostic vulnerability factors for suicide and suicide-related conditions. One candidate factor is anxiety sensitivity (AS)-the fear of anxiety-related sensations-which has been implicated in the pathogenesi...

A core component of suicide risk assessment and management is determining one's physical proximity to specific suicide means and counseling individuals to minimize their physical access to these means. However, this approach ignores other potentially relevant parameters, such as perceptions of how psychologically close/distant one feels to a partic...

Objective: A suicide attempt is at least somewhat life-threatening by definition and is, for some, traumatic. Thus, it is possible that some individuals may develop posttraumatic stress disorder (PTSD) from a suicide attempt. Method: In this article, we consider whether one's suicide attempt could fulfill Diagnostic and Statistical Manual of Men...

Research indicates that women firefighters may experience elevated rates of suicidal thoughts and behaviors; however, little is known about how at-risk women firefighters interface with mental health services and other support sources. This study aimed to identify rates of mental health service use and help-seeking, correlates of service use, and p...

1 Objective To examine experiences with suicide exposure and bereavement among women firefighters. 2 Methods Women firefighters (N = 266, Mage = 37.64y) completed self‐report measures assessing their experiences with suicide exposure, history of suicidality, current psychiatric symptoms, and suicide risk. 3 Results Three‐fourths (74.4%) of partic...

Suicide has become an issue of great concern within the U.S. military in recent years, with recent reports indicating that suicide has surpassed combat related deaths as the leading cause of death. One concern regarding suicide risk in the military is that existing self-report measures allow service members to conceal or misrepresent current suicid...

Separate research groups have independently argued the need for a suicide-specific diagnosis within the psychiatric diagnostic nomenclature. Although a suicide-specific diagnosis could possibly enhance clinical care and improve patient safety, some clinicians have expressed concerns regarding the legal risk of utilizing a suicide-specific diagnosis...

Suicide is a major public health problem, claiming the lives of over 40,000 individuals in the United States each year. Efforts are needed to (1) identify those at heightened risk for suicide utilizing objective assessment methods, and (2) determine factors that may be protective against engaging in suicidal behavior, even in the context of the des...

The present study evaluates the psychometric properties of four commonly used measures of suicidal ideation and behaviors (Beck Scale for Suicide Ideation [BSS], Columbia-Suicide Severity Rating Scale [C-SSRS], Self-Harm Behavior Questionnaire [SHBQ], and Suicidal Behaviors Questionnaire-Revised [SBQ-R]) among a sample of Israel Defense Forces (IDF...

Background: Firefighters are at increased risk for both problematic alcohol use and suicidality. Research has found that problematic alcohol use is related to suicidality among this population; however, limited data exist regarding what might account for this association. The present two-study investigation (1) examined the association between suic...

Past research indicates that firefighters are at increased risk for suicide. Firefighter-specific occupational stress may contribute to elevated suicidality. Among a large sample of firefighters, this study examined if occupational stress is associated with multiple indicators of suicide risk, and whether distress tolerance, the perceived and/or ac...

Background: Firefighters are at increased risk for both problematic alcohol use and suicidality. Research has found that problematic alcohol use is related to suicidality among this population; however, limited data exist regarding what might account for this association. The present two-study investigation (1) examined the association between sui...

Background: Firefighters represent an occupational group at increased suicide risk. How suicidality develops among firefighters is poorly understood. The depression-distress amplification model posits that the effects of depression symptoms on suicide risk will be intensified in the context of anxiety sensitivity (AS) cognitive concerns. The curre...

Firefighters experience high rates of posttraumatic stress disorder (PTSD). It is imperative to identify malleable factors that protect against the development of PTSD symptoms among this population. We examined whether perceptions of belongingness broadly (Study 1) and social support from supervisors, coworkers, and family/friends specifically (St...

Recent research has indicated that firefighters are at elevated suicide risk. Fire service organizations have called for research to examine fire service subgroups that might be at relatively increased suicide risk. Although anecdotal reports suggest that wildland firefighters represent one such group, to our knowledge, no study has empirically exa...