Functional impairment, internalized stigma, and well-being: Considerations for recovery-oriented suicide prevention for US Veterans with serious mental illness

Abstract: Veterans Health Administration’s (VHA) Psychosocial Rehabilitation and Recovery Centers (PRRCs) provide recovery-oriented care to veterans with serious mental illness (SMI). As part of program evaluation, PRRC providers regularly assess recovery-oriented outcomes. Given the high rates of suicidal thoughts and behaviors among veterans with SMI, understanding such outcomes in relation to suicide risk is crucial. Among veterans entering a PRRC (N = 4,731), the present study aimed to (a) report suicidal ideation frequency in the past 2 weeks across demographics and psychiatric diagnoses, (b) explore rates of current functional impairment, internalized stigma, and well-being, and (c) examine differences in suicidal ideation frequency and functional impairment, internalized stigma, and well-being. Measurements before treatment were utilized. Younger (ρ = −0.08, p < .001), married (z = −5.23, p < .001) veterans, those not identifying as Black or African American (z = −4.80, p < .001), not diagnosed with schizophrenia (z = −6.97, p < .001), diagnosed with depressive disorders (z = −8.79, p < .001), anxiety disorders (z = −5.01, p < .001), posttraumatic stress disorder (PTSD; z = −7.69, p < .001), or personality disorders (z = −7.12, p < .001) were significantly more likely to endorse suicidal ideation. Veterans in this cohort had higher than average functional impairment (M = 18.05, SD = 9.85), mild internalized stigma (M = 2.36, SD = 0.51), and lower than average well-being (M = 18.96, SD = 3.93). The more often a veteran reported thinking about suicide in the past 2 weeks, the more likely the veteran viewed themselves to be more functionally impaired (p < .001), reported higher levels of internalized stigma (p < .001), and reported lower levels of well-being (p < .001). Findings and limitations, particularly the suicidal ideation frequency measurement, are discussed to contextualize suggestions to integrate recovery-oriented practices and suicide prevention care. — Almost 40% of veterans with serious mental illness entering Veterans Health Administration’s Psychosocial Rehabilitation and Recovery Centers reported suicidal ideation in the past 2 weeks. The more often those thoughts occurred, the veterans reported worse psychosocial functioning suggesting the importance of integrating recovery-oriented practices with suicide prevention care for this group.

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