Abstract
This exploratory study (1) examined the ability of a spiritual distress scale used by chaplains to identify Veterans with certain suicide risk factors and (2) provided an initial assessment of the reliability and validity of this scale to screen for Veterans at increased risk of suicide based on the presence of these risk factors. The scale consisted of five questions examining the presence or absence of guilt, sadness or grief, anger or resentment, despair or hopelessness, and feeling that life has no meaning or purpose. The scale was analyzed using Chronbach’s α-coefficient, factor analysis, Student’s t-tests, and logistic regression. Cut-off values were determined using the maximum Youden statistic. The five questions had a high level of internal consistency (α =0.88). Factor analysis suggested the presence of a common underlying factor, with correlations ranging from 0.42 to 0.78. Those identified with a suicide risk factor had significantly higher mean composite scores on this scale. Further, scores were significantly associated with increased odds of being identified with a suicide risk factor. A score ≥10 may be best suited for differentiating between individuals with and without certain suicide risk factors. This scale shows promise for identifying Veterans who may be at increased risk of suicide.
Similar content being viewed by others
References
Allen, S., & Crouch, A. (2005). Cultural and spiritual health assessment. In A. T. Crouch & C. Meurier (Eds.), Health assessment (pp. 311–330). Malden: Blackwell.
American Association of Suicidology. (2011). Risk factors for suicide and suicidal behaviors. http://www.suicidology.org/c/document_library/get_file?folderId=254&name=DLFE-441.pdf. Accessed 3 August 2013.
Bossarte, R. M., He, H., Claassen, C. A., Knox, K., & Tu, X. (2011). Development and validation of a 6-day standard for the identification of frequent mental distress. Social Psychiatry and Psychiatric Epidemiology, 46(5), 403–411.
Centers for Disease Control and Prevention. (2014). National violent death reporting system (NVDRS). http://wisqars.cdc.gov:8080/nvdrs/nvdrsDisplay.jsp. Accessed 20 September 2014.
Centers for Disease Control and Prevention. (2012). Suicide: Risk and protective factors, injury prevention & control. http://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html. Accessed 9 September 2013.
Department of Defense. (2014). Joint fact sheet: DoD and VA take new steps to support the mental health needs of service members and veterans (Release No: NR-446-14), Washington, DC: Press Operations. http://www.defense.gov/Releases/Release.aspx?ReleaseID=16905. Accessed 29 August 2014.
Department of Veterans Affairs. (2012). FY2012 Q4 EPRP technical manual. Washington, DC: Office of Analytics and Business Intelligence.
Department of Veterans Affairs. (2008a). VHA directive 1111—spiritual and pastoral care in the Veterans Health Administration. Washington, DC: Veterans Health Administration.
Department of Veterans Affairs. (2008b). VHA handbook 1111.02—spiritual and pastoral care procedures. Washington, DC: Veterans Health Administration.
Florkowski, C. M. (2008). Sensitivity, specificity, receiver-operating characteristic (ROC) curves and likelihood ratios: communicating the performance of diagnostic tests. The Clinical Biochemist Reviews, 29(S1), S83–S87.
Gray, M. J., Schorr, Y., Nash, W., Lebowitz, L., Amidon, A., Lansing, A., & Litz, B. T. (2012). Adaptive disclosure: an open trial of a novel exposure-based intervention for service members with combat-related psychological stress injuries. Behavior Therapy, 43(2), 407–415.
Hodge, D. R., & Holtrop, C. R. (2002). Spiritual assessment: A review of complementary assessment models. In B. Hugen & T. L. Scales (Eds.), Social work and Christianity: Readings on the integration of Christian faith and social work practice (pp. 167–192). Botsford: NACSW Press.
Hughes, B., & Handzo, G. (2010). The handbook on best practices for the provision of spiritual care to persons with post traumatic stress disorder and traumatic brain injury. Washington, DC: United States Department of the Navy, Bureau of Medicine and Surgery.
Kemp, J. (2014). Suicide rates in VHA patients through 2011 with comparisons with other Americans and other veterans through 2010. http://www.mentalhealth.va.gov/docs/Suicide_Data_Report_Update_January_2014.pdf. Accessed 20 September 2014.
Knox, K. L., Stanley, B., Currier, G. W., Brenner, L., Ghahramanlou-Holloway, M., & Brown, G. (2012). An emergency department-based brief intervention for veterans at risk for suicide (SAFE VET). American Journal of Public Health, 102(S1), S33–S37.
Kopacz, M. S., McCarten, J. M., & Pollitt, M. J. (2014a). VHA chaplaincy contact with veterans at increased risk of suicide. Southern Medical Journal, 107(10), 661–664.
Kopacz, M. S., O’Reilly, L. M., Van Inwagen, C. C., Bleck-Doran, T. L., Smith, W. D., & Cornell, N. (2014b). Understanding the role of chaplains in veteran suicide prevention efforts—A discussion paper. Sage Open, 4(4), 1–10.
Kopacz, M. S. (2013). Providing pastoral care services in a clinical setting to veterans at-risk of suicide. Journal of Religion and Health, 52(3), 759–767.
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706.
Maguen, S., Metzler, T. J., Bosch, J., Marmar, C. R., Knight, S. J., & Neylan, T. C. (2012). Killing in combat may be independently associated with suicidal ideation. Depression and Anxiety, 29(11), 918–923.
McSherry, W., & Ross, L. (Eds.). (2010). Spiritual assessment in healthcare practice. Cumbria: M&K Update.
McSherry, W. (2006). Making sense of spirituality in nursing and health care practice: An interactive approach. London: Jessica Kingsley Publishers.
Munro, B. H. (2005). Statistical methods for health care research. Philadelphia, PA: Lippincott, Williams & Wilkins.
Rietveld, T., & Van Hout, R. (1993). Statistical techniques for the study of language and language behavior. Berlin, Germany: de Gruyter Mouton.
Schisterman, E. F., Perkins, N. J., Liu, A., & Bondell, H. (2005). Optimal cut-point and its corresponding Youden index to discriminate individuals using pooled blood samples. Epidemiology, 16(1), 73–81.
Streiner, D. L. (2003). Starting at the beginning: an introduction to coefficient alpha and internal consistency. Journal of Personality Assessment, 80(1), 99–103. doi:10.1207/S15327752JPA8001_18.
Suicide Prevention Resource Center. (2004). Risk and protective factors for suicide. http://www.sprc.org/sites/sprc.org/files/library/srisk.pdf. Accessed 9 September 2013.
Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach’s alpha. International Journal of Medical Education, 2, 53–55.
Thompson, I. (2002). Mental health and spiritual care. Nursing Standard, 17(9), 33–38.
The White House. (2014). Fact sheet: President Obama announces new executive actions to fulfill our promises to service members, veterans, and their families. Washington, DC: Office of the Press Secretary. http://www.whitehouse.gov/the-press-office/2014/08/26/fact-sheet-president-obama-announces-new-executive-actions-fulfill-our-p. Accessed 29 August 2014.
Acknowledgments
The views expressed are those of the authors and do not reflect the official policy or position of the U.S. Department of Veterans Affairs or the U.S. government.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kopacz, M.S., Hoffmire, C.A., Morley, S.W. et al. Using a Spiritual Distress Scale to Assess Suicide Risk in Veterans: An Exploratory Study. Pastoral Psychol 64, 381–390 (2015). https://doi.org/10.1007/s11089-014-0633-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11089-014-0633-1