How AI and Resilience Support Can Help Manage Suicide Risk in the Military

Reports of harsh living conditions and deployment strain aboard aircraft carriers like the USS Abraham Lincoln have brought renewed attention to military mental health. Addressing these challenges, psychiatrists Ronald Kessler, PhD, of Harvard Medical School in Boston, and Harold Kudler, MD, of Duke University in Durham, North Carolina, discuss the realities of screening and care at sea.

In a new JAMA Psychiatry study, Kessler’s team demonstrated how predictive algorithms can flag service members at risk for suicide or suicide attempts using administrative data. While Kessler suggests these models could be paired with shipboard interventions like resilient “battle buddies,” an approach that remains untested, Kudler, previously the chief consultant for mental health at the U.S. Department of Veterans Affairs (VA), emphasizes that even robust onboard care hits a wall when extreme operational conditions push personnel beyond the limits of human endurance.

The following is a transcript of their remarks:

Kudler: There probably is no more dangerous work site than the flight deck of an aircraft carrier. How many clinician hours is it going to take to touch 5,000 people? It’s not going to happen.

The Stigma and Disclosure Gap

Kessler: Medical records are not confidential the way they are in the general population. And soldiers know this. So if they say they’re depressed and their unit is going to deploy to Germany, they might be one of the ones who doesn’t get to go to Germany because their commander knows that they said they were depressed.

So in an earlier paper, we found that over 90% of the suicide attempts and deaths that occurred, when you go back to the annual physical and you say, “So tell me, you ever think about killing yourself?” “Nope, never.” So these questions don’t really work.

Kudler: Our military has done a good job of developing different levels of mental health intervention, but there’s this huge social pressure. Military culture, which so much depends on a sense of fitness and readiness because the mission is the most important thing, we’re all here to make the mission succeed, it is not a good idea to feel or let on to others that you might feel that you’re not ready, that you’re losing your edge.

So these are all problems that get in the way of making use of those great programs, whether it’s in the military treatment facility or whether it’s on a ship.

Predictive AI and On-Deck Support

Kessler: We estimated a machine-learning model and found that we could do a considerably better job than if you just use the kind of things they use in the periodic health assessment self-report data. Essentially, we found that something like 10% of soldiers at highest risk account for 50%, 60% of all suicidal behaviors.

Knowing that information is relevant, obviously, and commanders could take that into consideration along with other things. But if you say, look, they have to deploy, one possibility would be to say, let’s take somebody who’s high risk and assign them a “battle buddy” who has high resilience. And I mean, I don’t know if that would work. We’ve never done that. It would be an experiment that would be an experiment of nature. But you could certainly imagine a scenario of that sort that maybe wouldn’t be so operationally impossible that you just do a little tweak that could have the potential to have a big positive impact.

Kudler: More than likely, the [USS] Abraham Lincoln has its own mental health team as well as psychiatric technicians. And that might sound like, oh, why are you sending people who aren’t mental health professionals? But the advantage is these people are peers. They’re of the same rank. They’re noncommissioned officers or lower. They’re seamen. And it’s a lot easier to talk to somebody at your rank.

I’ve learned, even in the VA, I’ve had World War II veterans say to me, “You know Doc, I think of you as an officer. You remind me of an officer. And I learned in the military not to tell an officer I had a problem because that wasn’t going to work out well for anybody.” But to talk to another seaman? That works out well.

The Limits of Endurance

Kudler: When you think about the combined effects of 5,000 people living in a very cramped space — I mean, an aircraft carrier is massive, but it is a very cramped space in terms of living quarters. It is a high-intensity place where people have jobs upon which their own and other people’s lives depend.

These are very old lessons. We’re not going to get around them as good as we can get medically or even culturally, there has to be respect for the limits of human endurance.

Kessler: The world is crazy. There’s stress every place. We can try to make a vulnerable individual more resilient to live in this world, or we can try to change the world.