Can Caring Letters Prevent Warrior Suicide?

A service member reads a letter. DoD photo by PHCS Mitchell

A service member reads a letter. DoD photo by PHCS Mitchell

Dr. David Luxton is a Research Psychologist at the National Center for Telehealth and Technology.

“Can caring letters prevent warrior suicide?” The Caring Letters Project, launched by DCoE’s National Center for Telehealth & Technology (T2), aims to answer this question. The project is part of the Department of Defense’s efforts to identify and disseminate the most effective suicide prevention strategies.

The Caring Letters Project is a suicide prevention intervention that involves sending brief caring letters and reminders of available treatment to individuals following psychiatric hospitalization. The project is currently underway at Madigan Army Medical Center (MAMC) located at Joint Base Lewis-McChord in Tacoma, Wash.

Although much research has investigated the factors associated with suicidal behavior in both civilian and military populations, there haven’t been many controlled trial studies of suicide prevention interventions. Sending caring letters to patients after discharge from inpatient psychiatry treatment is one of the few techniques that have been shown to decrease suicide according to a randomized controlled trial (Motto & Bostrom, 2001, Comtois & Linehan, 2006).

Here’s how it works:

  • Research assistants meet with warriors on the MAMC inpatient psychiatry unit and speak with them about their hobbies, family and plans after discharge
  • Then, for the next two years, the Caring Letters Team sends these warriors a series of 13 personalized caring letters by handwritten postal mail or e-mail
  • At first the letters are frequent (about once a month), but by the end of the two years, the team sends letters every few months

About 15% of those participating have contacted the team to thank them for the letters. “It was an incredible feeling. It gives hope that we are doing a service for these individuals. We’re just letting them know that someone out there really cares,” said research assistant Jennifer June of a recent thank you note she received from a participating warrior.

In addition to providing support for the current service members taking part in the study, the team hopes to learn more about effective suicide prevention techniques for the military population. T2 is currently planning the next phase of the project.

“The next step is to conduct a multisite, randomized control trial,” says Dr. Julie Kinn, a research psychologist working on the Caring Letters Project. “Ideally, we could send caring letters from several inpatient units at military treatment facilities across the country. With enough participants, we could truly test an effect. If the caring letters help our warriors, we could potentially change the way we communicate with our patients after discharge.”

Clinical operations for the Caring Letters Project began in July 2009. Initial program evaluation efforts are underway. Preliminary results will be examined later this year. For more information, check out T2’s website. Or contact Dr. David Luxton (T2 research psychologist and program manager) at

*With bills and junk mail, can you even remember the last time you received a personal letter in the mail? Let us know what you think about the Caring Letters Project. What insights do you have?

This post was shared with us by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCOE). The DCoE Blog features information on psychological health and traumatic brain injury issues as well as personal stories and reflections from people within the military community on these topics.