(334) 844-3299
Detailed Record
Share this Article

Upstream suicide prevention in the U.S. Army: Noncommissioned officers’ perspectives

APA Citation:

Ayer, L., Holliday, S., Beckman, R., Jaycox, L. H., Elinoff, D., Ramchand, R., Agniel, D., Hoch, E., & Wagner, L. (2023). Upstream suicide prevention in the U.S. Army: Noncommissioned officers’ perspectives. Psychological Services. Advance online publication. https://doi.org/10.1037/ser0000788

Abstract Created by REACH:

Noncommissioned officers (NCOs) in the Army are well-positioned to recognize suicide risk and intervene to prevent suicide among Soldiers. As such, NCOs are required to complete suicide prevention training. To inform Army suicide prevention efforts, this study examined NCOs’ experiences, attitudes, and behaviors related to suicide prevention. 2,468 NCOs completed online surveys about their self-efficacy in discussing suicide with Soldiers, logistical barriers (e.g., not having time and private space), intervention behaviors (e.g., asking about suicidality when it is suspected), and use of soft skills (e.g., active listening, nonverbal communication). Differences among NCOs’ experiences – such as active or reserve status, occupational division, rank, and formal mental health training – were also assessed. Overall, active component NCOs and those with formal mental health training tended to be better equipped for suicide intervention than reserve component NCOs and NCOs without formal mental health training.


Mental health

Branch of Service:


Military Affiliation:

Active Duty

Subject Affiliation:

Guard/Reserve member
Active duty service member


Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)


Cross-Sectional Study
Quantitative Study


Ayer, Lynsay, Holliday, Stephanie, Beckman, Robin, Jaycox, Lisa H., Elinoff, Daniel, Ramchand, Rajeev, Agniel, Denis, Hoch, Emily, Wagner, Lisa


The goal of this study was to examine the factors associated with Army noncommissioned officer (NCO) experiences, attitudes, and behaviors in their role of identifying potential suicide risk factors in their fellow soldiers. To better understand the perspectives of NCOs, an anonymous survey was administered to 2,468 Army NCOs. Descriptive statistics and linear regressions were conducted to compare subgroups of NCOs. Most (71%) Army NCOs have received many (11 or more) hours of suicide prevention training, but training in soft skills that may be important for the gatekeeper role was less consistently reported. Active Component soldiers reported greater confidence in their intervention skills (Cohen’s d = 0.25) and fewer logistical barriers (e.g., time and space to talk) to intervening with at-risk soldiers (Cohen’s d = 0.80) compared to Reserve and National Guard soldiers. Formal coursework in mental health areas like psychology or chaplaincy was associated with a greater level of confidence in intervention skills (Cohen’s d = 0.23) and in more frequent intervention behavior (Cohen’s d = 0.13). Army NCO trainings should be modified to better equip soldiers with the soft skills (e.g., active listening skills and verbally and nonverbally conveying nonjudgment/acceptance and empathy) needed to have effective conversations with soldiers about suicide risk factors and other sensitive topics. Strategies used within mental health education, which appears to be a strength for NCO gatekeepers, could be used to achieve this goal. Reserve and Guard NCOs may need additional supports and tailored trainings to better fit their operational context. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Publication Type:

REACH Publication


military personnel, intervention, Army personnel, military training, suicidality, suicide prevention, noncommissioned officers

View Research Summary:

REACH Publication Type:

Research Summary

REACH Newsletter:

  October 2023

This website uses cookies to improve the browsing experience of our users. Please review Auburn University’s Privacy Statement for more information. Accept & Close