562 Suicide and Life-Threatening Behavior 43 (5) October 2013

© 2013 The American Association of Suicidology

DOI: 10.1111/sltb.12039

The Functions of Social Support as Protective

Factors for Suicidal Ideation in a Sample of Air
Force Personnel
CRAIG J. BRYAN, PSYD, ABPP, AND ANN MARIE HERNANDEZ, PHD

This study examined various functions of social support (i.e., tangible,

esteem, belonging, and appraisal) were examined as protective factors for sui-
cidal ideation in a sample of 273 active duty Air Force Security Forces person-
nel. Generalized linear regression analyses were conducted to determine if
various social support functions were differentially associated with the presence
and severity of suicidal ideation, both as main effects and as moderators of emo-
tional distress. None of the four social support functions differentiated suicidal
from nonsuicidal Airmen, but esteem support (i.e., feeling respected, encour-
aged, and valued by others) was associated with significantly less severe suicidal
ideation (B = .074, SE = .025, p = .003). A significant interaction of tangible
support (i.e., access to material resources) with emotional distress indicated that
emotional distress was associated with more severe suicidal ideation only among
Airmen reporting low levels of tangible support (B = .006, SE = .003, p = .018).
When considered concurrently, both tangible and self-esteem functions of
social support are differentially associated with decreased suicidal ideation
among Airmen, but belonging (i.e., having someone to do things with) and
appraisal (i.e., having someone to talk to about problems) functions were not.
Findings suggest that different aspects of social support affect suicidal ideation
in different ways.

The startling surge in suicide rates among
U.S. service members since the initiation of
combat operations in Iraq and Afghanistan
CRAIG J. BRYAN , National Center for Vet-
erans Studies, The University of Utah, Salt Lake
City, UT, USA; ANN MARIE HERNANDEZ, Uni-
versity of Texas Health Science Center at San
Antonio, San Antonio, TX, USA.
The views expressed in this article are
those of the authors and do not necessarily rep-
resent the position or policies of the U.S. Gov-
ernment, the Department of Defense, or the
U.S. Air Force.
Address correspondence to Craig J.
Bryan, National Center for Veterans Studies,
The University of Utah, 260 S. Central Campus
Dr., Room 205, Salt Lake City, UT 84112;
E-mail: craig.bryan@utah.edu
has spawned renewed interest among scien-
tists, practitioners, and policy makers in risk
factors for suicide. Suicide among members
of the U.S. Armed Forces has increased
dramatically during the past 10 years and is
now the second most common cause of
death among active duty military personnel,
with rates ranging between 9 to 24 deaths
per 100,000 service members (Tanielian &
Jaycox, 2008). Since 2004, suicide rates have
risen across all branches of service, in
contrast with historical trends for decreased
suicide risk among military personnel (Sco-
ville, Gubata, Potter, White, & Pearse,
2007). Within the U.S. Air Force, the sui-
cide rate has nearly doubled from 8.9 per
100,000 active duty Airmen in 2004 to 15.5
BRYAN AND HERNANDEZ
per 100,000 in 2012. Data further suggest
that suicide attempts, although believed to
be significantly underreported, are also
increasing among military personnel across
all branches of service (Ramchand, Acosta,
& Burns, 2011). In light of these statistical
trends, considerable interest in identifying
protective factors that either directly reduce
suicide risk or moderate the effects of other
suicide risk factors has grown. Unfortu-
nately, to date, much less attention has been
given to identifying protective factors for
suicide risk relative to identifying risk fac-
tors.
It is largely well-accepted that “social
support,” as a general construct, is a protec-
tive factor for suicide, based in part on
research supporting an inverse relationship
of social support with suicidal ideation and
suicide attempts (e.g., Chioqueta & Stiles,
2007; Kaslow et al., 2005). However, these
conclusions are limited by theoretical and
measurement issues related to the definition
and operationalization of social support.
For example, a generally accepted definition
of social support is “the presence of others,
or the resources provided by them, prior to,
during, and following a stressful event”
(Cohen & Wills, 1985; House, Kahn,
McLeod, & Williams, 1985). This reason-
ably simple and straightforward definition
synthesizes several distinct, although inter-
related, issues such as social proximity, the
provision of material resources, and the
implicit suggestion of empathy and emo-
tional support. Indeed, several typologies of
social support have been enumerated, each
serving slightly different purposes or func-
tions (Cohen, Mermelstein, Kamarck, &
Hoberman, 1985). Belonging, or companion-
ship support, offers a sense of social belong-
ing or “fitting in” and is observed by the
presence of companions to engage in shared
activities, such as having accompaniment to
a social event. Tangible support involves the
provision of material support or the espou-
sal of concrete responsibilities on someone
else’s behalf to assist with an ongoing prob-
lem, such as receiving assistance with
household tasks and responsibilities or hav-
563
ing someone willing to lend money to assist
in actively dealing with a problem at-hand.
Appraisal support involves the provision of
information that is useful for self-evaluation
purposes, such as constructive feedback and
emotional validation. Finally, esteem support
involves an expression of confidence,
respect, or concern for one’s well-being,
such as expressing faith or trust in one’s
ability to overcome an obstacle.
Although each of these functions is
certainly interrelated, it is possible that
these four functions of social support may
be differentially associated with suicidal
thoughts and behaviors. For example, fol-
lowing a relationship failure or divorce, a
service member might benefit from having
someone to talk with about their disap-
pointment, anger, or other emotions (i.e.,
appraisal), but when his or her car needs to
be repaired, this form of support may be
relatively less important than having access
to someone who can offer a ride to work
(i.e., tangible). Likewise, the service mem-
ber experiencing financial strain due to car
problems might benefit from a short-term
loan from a friend (i.e., tangible support),
but this same form of support might be less
relevant following the death of a service
member’s child. Within the military, these
different forms of social support may be
differentially related to suicidal thoughts
and behaviors. The military culture is char-
acterized by a collectivist identity in which
mutual support and teamwork are explicitly
valued and reinforced, suggesting that
belonging forms of support may be espe-
cially important within the military, whereas
the relatively easy access to a wide range of
support resources (e.g., health care, child
care, and financial planning and assistance),
available to all members for free or for con-
siderably reduced cost, could reduce the
salience of tangible forms of social support.
The military culture also tends to empha-
size mental toughness and self-reliance as
opposed to open emotional expression
(Bryan, Jennings, Jobes, & Bradley, 2012;
Bryan, Ray-Sannerud, Morrow, & Etienne,
2013), which could potentially attenuate the
564
effects of appraisal forms of support.
Furthermore, the military’s valuation of
pride, elitism, collectivism, and respect may
suggest that esteem forms of support may
be especially relevant.
Aggregated scales of social support
could, therefore, obscure the underlying
functions for how different facets of social
support reduce suicidal thoughts and behav-
iors. Chioqueta and Stiles (2003) found, for
instance, that social support was significantly
associated with less severe suicidal ideation
among Norwegian military applicants, but
their scale combined items assessing all four
functions of social support: belonging (e.g.,
“The bonds among my friends is strong”),
tangible (e.g., “When needed, I have no one
who can help me”), appraisal (e.g., “I can dis-
cuss personal issues with friends/family
members”), and esteem (e.g., “My close
friends/family members appreciate my quali-
ties”). Kaslow et al. (2005) similarly used a
global scale of social support (e.g., belong-
ing: “Someone to do something enjoyable
with”; tangible: “Someone to help with daily
chores if you were sick”; appraisal: “Someone
to confide in or talk to about yourself or your
problems”; esteem: “Someone who shows
you love and affection”), and found that
social support significantly differentiated
those who had attempted suicide from those
who had not.
Much more typical, however, are
studies that focus on only one aspect of
social support. Belonging, in particular, has
received considerable empirical attention in
recent years, especially within the context of
research focused on the interpersonal-psy-
chological theory of suicide (IPTS; Joiner,
2005). According to the IPTS, thwarted
belongingness, or the perception that one is
“alienated from others, not an integral part
of a family, circle of friends, or other valued
group” (p. 635, Joiner et al., 2009), is a cen-
tral and proximal contributor to suicidal
desire and, in combination with fearlessness
about death and the belief that one is a lia-
bility to others (i.e., perceived burdensome-
ness), to lethal or near-lethal suicidal
behavior. For example, Joiner et al. (2009)
SOCIAL SUPPORT FUNCTIONS
found that young adults who perceived that
their relatives were less willing to listen to
or talk with them about problems, and who
felt less loved and cared for, reported more
severe suicidal ideation. Among adolescents,
loneliness (i.e., an absence of belonging) is
associated with increased risk for suicidal
ideation (Roberts, Roberts, & Chen, 1998),
whereas higher levels of friend support and
less perceived rejection are associated with
less severe suicidal ideation (Prinstein,
Boergers, Spirito, Little, & Grapentine,
2000). In a sample of methadone mainte-
nance patients, belongingness was found to
be associated with decreased likelihood of a
past suicide attempt (Conner, Britton,
Sworts, & Joiner, 2007). Perceived belong-
ing and connectedness with others is simi-
larly correlated with decreased suicidal
ideation among deployed military personnel
(Bryan, 2011) and decreased suicidal intent
among military veterans enrolled in college
classes (Rudd, in press), but not when con-
trolling for other risk factors such as
depression, posttraumatic stress, and fear-
lessness about death (e.g., Bryan, Clemans,
& Hernandez, 2012). Among adults, includ-
ing military personnel and veterans, belong-
ing actually appears to function as a
moderator of other risk factors rather than
as a direct effect (e.g., Bryan et al., 2012;
Bryan, Morrow, Anestis, & Joiner, 2010;
Bryan, Ray-Sannerud, et al., 2013; Joiner
et al., 2009; Rudd, in press; Van Orden,
Witte, Gordon, Bender, & Joiner, 2008).
These latter findings suggest that the pro-
tective effect of social support on suicidal
thoughts and behaviors may not be direct,
but rather may be due to its ability to atten-
uate or otherwise reduce the effects of other
risk factors.
Thus, although social support is
widely accepted as a protective factor for
suicide, the construct is quite broad and
measurement schemes generally have not
considered the different functions of social
support simultaneously, thereby limiting
our understanding of how social support
might mitigate risk, a critical issue for
appropriately developing and directing
BRYAN AND HERNANDEZ
suicide prevention efforts and treatment
planning. Furthermore, it is unclear
whether social support mitigates the effects
of suicidal thoughts and behaviors directly,
indirectly, or both. As such, this study
aimed to investigate the protective roles of
different functions of social support on sui-
cidal ideation in a nonclinical sample of
military personnel. We specifically tested
the following questions: (a) which function
(s) of social support are directly associated
with decreased suicidal ideation; and (b)
which function(s) of social support moder-
ate (i.e., reduce) the effect of emotional dis-
tress on suicidal ideation? It was expected
that only belonging and esteem forms of
social support (but not appraisal or tangible
forms) would be associated with decreased
severity of suicidal ideation and would
moderate the effects of emotional distress
on suicidal ideation.
METHOD
Participants
Participants included 273 active duty
Airmen (81.7% men, 18.3% women) rang-
ing in age from 19 to 50 years (M = 25.90,
SD = 5.90). Racial distribution was 67.8%
Caucasian, 20.5% African American, 2.2%
Native American, .7% Asian, .4% Pacific
Islander, and 8.4% “other.” Hispanic eth-
nicity was additionally endorsed by 15.0%
of the sample. Participants had been in the
military an average of 6.44 years (SD =
5.37; range: 0–26) and had deployed an
average of 2.21 times (SD = 1.60, range:
0–8), with 92.3% having deployed at least
once to either Iraq or Afghanistan. Rank
distribution was 47.9% junior enlisted
(E1–E4), 38.4% noncommissioned officer
(E5–E6), 7.5% senior noncommissioned
officer (E8–E9), and 2.8% officer (O1–O5).
Procedures
Data were collected during unit for-
mations from two active duty Air Force
565
Security Forces units located at two military
installations located in the southern United
States. The purposes of the study were
explained, and informed consent was
obtained from personnel in the absence of
military leadership to minimize potential
coercion. Survey packets were distributed to
Airmen volunteering to participate, who
completed them anonymously then returned
them upon completion. Airmen were pro-
vided food and refreshments in appreciation
for their participation. Data were manually
entered into an electronic database twice by
separate research assistants and compared
to each other to identify discrepancies and
errors (i.e., double data entry). This study
was approved by the University of Texas at
San Antonio’s institutional review board
and the Air Force’s Office of Research
Oversight and Compliance.
Measures
Beck Scale for Suicidal Ideation-Current
(BSSI-C). The BSSI-C (Beck, Steer, &
Ranieri, 1988) was used to assess the inten-
sity of thoughts and intentions about sui-
cide during the past 2 weeks. The scale
consists of 19 groups of statements that
measure increasingly severe levels of sui-
cidal thoughts on a scale from 0 to 2. Item
scores are summed to provide an overall
indicator of suicidal ideation severity. The
BSSI-C has strong psychometric properties,
including good internal consistency and
predictive validity for suicide. For the cur-
rent sample, estimate of internal consistency
reliability for scores on the BSSI-C was .91
(95% CI = .87–.93; AIC = .35).
Beck Scale for Suicidal Ideation-Worst
(BSSI-W). One of the strongest predictors
of suicidal ideation is past suicidal ideation,
with studies suggesting that the “worst-
point” suicidal episode is the most reliable
and robust predictor of subsequent suicidal
thoughts and behaviors. The BSSI-W is
comprised of the same 19 items and format
as the BSSI-C, but respondents are asked to
recall the time in their life when they
experienced the strongest or most intense
566
suicidal desire and to keep the circum-
stances of that time in mind when answer-
ing the items. The BSSI-W has strong
psychometric properties and has been
shown to predict recent and future suicidal
behaviors better than the BSSI-C (Beck,
Brown, Steer, Dahlsgaard, & Grisham,
1999). For the current sample, estimate of
internal consistency reliability for scores on
the BSSI-W was .95 (95% CI = .92–.97;
AIC = .52).
Anxiety Depression Distress Index-27
(ADDI-27). The General Distress subscale
of the ADDI-27 (Osman et al., 2011) was
used to assess the severity of negative emo-
tional states. The scale is composed of nine
mood descriptors (e.g., sad, worthless, dis-
appointment, hopeless), which respondents
rate on a scale ranging from 1 (not at all) to
5 (extremely). The General Distress subscale
correlates more strongly with measures of
depression and negative affect (rs > .67)
than with measures of anxiety, and reliabil-
ity estimates > .72 have been found across
samples. For the current sample, estimate
of internal consistency reliability estimate
for scores on the ADDI-27 General Dis-
tress subscale was .93 (95% CI = .91–.94;
AIC = .60).
Interpersonal Support Evaluation List
(ISEL). The ISEL (Cohen et al., 1985)
was used to measure four different func-
tions of social support: belonging (i.e., the
availability of others for recreational or lei-
sure activities), appraisal (i.e., the availabil-
ity of someone with whom one can talk
about one’s problems), tangible (i.e., the
availability of individuals who will provide
concrete or material aid, such as money or
transportation, when in need), and esteem
(i.e., the availability of a positive compari-
son when comparing one’s self to others).
Each subscale is comprised of eight state-
ments that are rated on a 4-point scale from
1 (definitely false) to 4 (definitely true), which
are summed to provide overall availability
of each type of social support. All subscales
have demonstrated good reliability and
validity (Cohen et al., 1985). For the cur-
rent sample, estimate of internal consistency
SOCIAL SUPPORT FUNCTIONS
reliability for scores on the tangible scale
was .88 (95% CI = .85–.91; AIC = .42); for
scores on the belonging scale it was .78
(95% CI = .73–.81; AIC = .26); for scores
on the appraisal scale it was .90 (95%
CI = .88–.91; AIC = .48); and for scores on
the esteem scale it was .72 (95%
CI = .66–.76; AIC = .21).
Data Analytic Approach
Eighteen Airmen (6.6%) of the
sample endorsed some amount of current
suicidal ideation (i.e., score > 0 on the
BSSI-C). Generalized linear regression
modeling for a zero-inflated Poisson distri-
bution (ZIP) was therefore utilized for all
analyses. The assumption underlying a ZIP
regression model is that there are two dis-
tinct types of participants included in the
sample: Those who score above zero on the
BSSI-C and those who never (or very rarely)
do. The zero scores therefore comprise a
mixture of these two different subgroups,
which are analyzed within the ZIP model by
combining two regression models simulta-
neously: a logistic regression to differentiate
those who are never (or rarely) suicidal and
a negative binomial regression to consider
severity of BSSI-C scores. The ZIP model
thus splits the analysis into two questions:
(a) “who is suicidal?” and (b) “of those who
are suicidal, what determines its severity?”
Using a smaller-is-better approach, compar-
ison of Akaike’s information criterion (AIC)
values for the ZIP model confirmed that it
provided better data fit than the Poisson
model without a zero-inflated portion and
yielded no difference in overall goodness of
fit as compared to a zero-inflated negative
binomial model.
RESULTS
Airmen currently reporting suicidal
ideation were predominantly Caucasian
(77.8%), non-Hispanic (77.8%) men
(88.9%), with a mean age of 25.78 years
(SD = 5.48). None of these demographics
BRYAN AND HERNANDEZ 567

significantly differed from nonsuicidal Air-
men. A greater proportion of Airmen
(n = 53, 19.4%) reported past suicidal idea-
tion on the BSSI-W. Airmen reporting past
suicidal ideation were similarly Caucasian
(75.5%), non-Hispanic (81.1%) men
(81.1%). Airmen reporting past suicidal ide-
ation on the BSSI-W did not significantly
differ from Airmen denying any history of
suicidal ideation on any variable.
Means, standard deviations, and in-
tercorrelations of all variables are displayed
in Table 1. As can be seen, severity of
recent suicidal ideation was positively corre-
lated with emotional distress and severity of
worst-point suicidal ideation, but was nega-
tively correlated with all four functions of
social support. The functions of social sup-
port were all highly intercorrelated with
each other in the positive direction. Gender
and age were unrelated to severity of past
and current suicidal ideation, emotional dis-
tress, and each function of social support.
Which Functions of Social Support Are
Associated with Severity of Suicidal
Ideation?
Separate regression models were con-
structed for each social support function to
determine if each function was indepen-
dently associated with severity of suicidal
ideation. Age, gender, worst-point suicidal
ideation, and emotional distress were
entered as covariates. For the zero-inflated
portion of the models, results indicated that
none of the social support functions differ-
entiated between zero and nonzero scores
(belonging: B = .069, SE = .066, p = .294;
appraisal: B = .088, SE = .053, p = .095;
tangible: B = .041, SE = .056, p = .469; self-
esteem: B = .072, SE = .070, p = .305), sug-
gesting that social support did not differen-
tiate Airmen who were suicidal from those
who were not suicidal. In the Poisson por-
tion of the models, higher esteem was asso-
ciated with less severe suicidal ideation
(B = .063, SE = .033, p = .020), but none
of the other functions were significantly
associated with suicidal ideation (belonging
(B = .026, SE = .021, p = .214; appraisal:
B = .004, SE = .014, p = .797; tangible:
B = .021, SE = .013, p = .115).
We next considered the relative
effects of all four functions together by
entering them all simultaneously into the
regression model while controlling for age,
gender, worst-point suicidal ideation, and
emotional distress. Because of the high in-
tercorrelations of the four functions of
social support (rs > .70), variance inflation
factors (VIF) were calculated to determine

TABLE 1
Means, Standard Deviations, and Intercorrelations of All Variables (n = 273)
1 2 3 4 5 6 7 8 9

1. Gender –
2. Age .18** –
3. Emotional distress .05 .01 –
4. Belonging .01 .05 .50** –
5. Appraisal .01 .11 .51** .82** –
6. Tangible .01 .07 .46** .77** .76** –
7. Esteem .04 .05 .54** .77** .72** .70** –
8. BSSI-W .00 .03 .38** .39** .34** .29** .38** –
9. BSSI-C .01 .03 .40** .34** .32** .28** .41** .66** –
M – 25.99 17.23 31.04 33.38 33.90 31.52 1.59 .49
SD – 5.90 7.93 5.02 6.38 5.74 4.86 4.85 2.40

BSSI-C, Beck Scale for Suicidal Ideation-Current; BSSI-W, Beck Scale for Suicidal Ideation-
Worst.
**p < .01
568 SOCIAL SUPPORT FUNCTIONS

the magnitude of possible multicollinearity.
VIF values ranged from 2.89 (esteem) to
4.17 (belonging), suggesting that although
highly intercorrelated with each other, the
four functions of social support were not
severely collinear. Results of this model are
displayed in Table 2. In the zero-inflated
portion of the model, none of the social
support functions significantly differentiated
between zero and nonzero scores. In the
Poisson portion of the model, higher
esteem was associated with less severe sui-
cidal ideation (B = .076, SE = .033,
p = .020), but none of the other functions
were associated with suicidal ideation, con-
sistent with previous findings.
Which Functions of Social Support
Buffer the Effect of Emotional Distress?
We next sought to determine
whether any of the functions of social sup-
port buffered the effects of emotional dis-
tress on suicidal ideation by calculating the
interaction of emotional distress with each
function of social support and adding each
interaction term into a separate ZIP model.
In the zero-inflated portion of the model,
we retained only worst-point suicidal idea-
tion and emotional distress as these were
the only two variables that significantly dif-
ferentiated between zero and nonzero
scores on the BSSI-C in the previous analy-
ses. Only the interaction of emotional dis-
tress with tangible support was statistically
significant (B = .006, SE = .003, p = .021);
the interactions of emotional distress with
belonging (B = .001, SE = .002, p = .560),
appraisal (B = .001, SE = .001, p = .610),
and esteem (B = .001, SE = .002, p = .478)
were not significantly associated with sui-
cidal ideation. The form of the two-way
interaction between depression and tangible
support is displayed in Figure 1. As can be
seen, military personnel reporting greater
availability of tangible sources of social sup-
port reported lower levels of suicidal idea-
tion. The Johnson-Neyman technique was
used to test for regions of significance for
the interaction. Results indicated that the
relationship between emotional distress and
suicidal ideation was statistically significant
when tangible support scores were less than
33 (i.e., approximately the mean tangible
value). In other words, emotional distress
was significantly related to suicidal ideation
only among those participants who scored
at or below the mean level of tangible sup-
port.
A final regression model was con-
structed including both the main effect of
self-esteem and the emotional distress-by-
tangible support interaction. Results are
summarized in Table 3, and indicate that
esteem and tangible social support are
directly associated with less severe suicidal

TABLE 2
Zero-Inflated Poisson Regression Analyses Testing the Associations of Social Support Functions with
Severity of Suicidal Ideation
Zero-inflationa Poisson

B SE p B SE p

Age .003 .061 .960 .021 .024 .397

Gender 2.276 1.268 .073 .276 .255 .280
Worst-point suicidal ideation .225 .057 <.0001 .030 .012 .009
Emotional distress .087 .038 .023
Belonging .105 .156 .502 .012 .064 .854
Appraisal .143 .101 .155 .026 .031 .402
Tangible .032 .090 .723 .006 .027 .820
Esteem .067 .119 .572 .076 .033 .020
a
Coefficients predicting zero values of suicidal ideation.
BRYAN AND HERNANDEZ 569

3.5

3
Suicidal ideation
2.5
High tangible
2
Mean tangible
1.5
Low tangible
1

0.5

0
Lo w d ep re s s io n Hi g h d e p r e s s i o n

Figure 1. Form of the two-way interaction between emotional distress and tangible support, plotted at high (1 SD
above the mean) and low (1 SD below the mean).

TABLE 3
Final Zero-Inflated Poisson Regression Model Predicting Severity of Suicidal Ideation
Zero-modela Poisson

B SE p B SE p

Age – – – .010 .023 .658

Gender – – – .574 .267 .032
Worst-point suicidal ideation .200 .048 <.0001 .037 .008 <.0001
Emotional distress .097 .034 .004 .043 .019 .020
Tangible – – – .135 .054 .012
Esteem – – – .074 .025 .003
Emotional distress 9 tangible – – – .006 .003 .018
a
Coefficients predicting zero values of suicidal ideation.

ideation, but tangible support also weakens
the effect of emotional distress on suicidal
ideation.
DISCUSSION
Consistent with previous research,
greater perceived availability of social sup-
port was associated with less severe suicidal
ideation among active duty Air Force per-
sonnel; however, this study adds to our
knowledge of this protective effect by con-
sidering multiple functions of social sup-
port. Interestingly, none of the four
functions of social support differentiated
between those who were suicidal from those
who were not, but for those who reported
recent suicidal ideation, greater esteem sup-
port was significantly associated with less
severe ideation. Furthermore, only tangible
support directly buffered the effects of
emotional distress with follow-up analyses
indicating that emotional distress was asso-
ciated with suicidal ideation only among
those Airmen who fell at or below the mean
level of tangible support. These findings
supported our hypothesis that different
forms of social support would be differen-
tially related to suicidal ideation among Air
570
Force personnel, although the expectation
that only esteem and belongingness would
be associated with decreased suicidal idea-
tion and would moderate the effects of
emotional distress was only partially sup-
ported.
In our final model, only esteem
support (i.e., expressions by others of confi-
dence, respect, or concern for one’s
well-being) was directly associated with less
severe suicidal ideation, which aligned with
our expectations. When considering this
finding, it is interesting to note that although
the esteem subscale of the Interpersonal Sup-
port Evaluation List has been conceptualized
as “the availability of a positive comparison
when comparing oneself with others” (p. 74,
Cohen et al., 1985), careful consideration of
the scale’s items suggest that the scale also
assesses one’s self-perceived value and worth
relative to others (e.g., “Most of my friends
are more interesting than I am”; “There is
someone who takes pride in my accomplish-
ments”; “Most people I know think highly of
me”; “I am more satisfied with my life than
most people are with theirs”). The scale
therefore seems to measure aspects of posi-
tive self-image, confidence, and pride, which
have been found to protect against suicidal
intent and suicide attempts in civilian sam-
ples (Holden, Mendonca, & Serin, 1989; Iva-
noff & Jang, 1991) and suicidal ideation
among Air Force personnel (Bryan, Ray-
Sannerud, et al., 2013). From a prevention
perspective, these findings suggest that Air
Force personnel who feel valued and perceive
that they are treated with respect report less
severe suicidal ideation. Given that elitism,
pride, and self-sufficiency are core values of
the military culture (Bryan et al., 2012;
Bryan, Ray-Sannerud, et al., 2013), it may be
that esteem forms of support are more pro-
tective for military personnel relative to
other forms of social support.
Contrary to expectations, we addi-
tionally found that tangible support weakens
the effect of emotional distress on suicidal
ideation. This is consistent with a long line
of research suggesting that individuals with
stronger social networks may be better able
SOCIAL SUPPORT FUNCTIONS
to cope with stressful life events than those
with weaker bonds (Cohen & Wills, 1985).
Given that relationship problems, financial
strain, and legal problems are among the
stressors that occur most commonly before
suicide attempts and deaths by suicide
among military personnel (Bryan & Rudd,
2012; Department of Defense, 2011), access
to concrete resources that can solve or
otherwise mitigate the magnitude of these
problems might be especially important for
distressed personnel. Recent research has
revealed that the primary motivation for
making a suicide attempt among military
personnel is to relieve emotional distress
(Bryan, Rudd, & Wertenberger, 2013); for
emotionally distressed Airmen, tangible
forms of support may similarly function to
alleviate emotional distress, thereby reduc-
ing the intensity of suicidal desire. From a
prevention perspective, this finding suggests
that tangible, concrete forms of support
(e.g., financial assistance, child care, support
when injured or ill) may be especially
important for Air Force personnel during
times of distress as compared to other types
of social support.
Of interest, belonging was not associ-
ated with suicidal ideation in the current
study, which diverges from one of the main
hypotheses of the interpersonal-psychologi-
cal theory of suicide, which is that thwarted
belongingness is a proximal and sufficient
cause of passive suicidal ideation (Van
Orden et al., 2010). The current results
converge with a number of studies that have
similarly failed to support a direct associa-
tion between belonging and suicidal
thoughts and behaviors (Bryan, Clemans, &
Hernandez, 2012; Bryan et al., 2010; Joiner
et al., 2009; Rudd, in press; Van Orden
et al., 2008). According to the IPTS,
thwarted belongingness is comprised of two
latent variables: loneliness and (absence of)
reciprocal care (Van Orden et al., 2010).
Loneliness entails the perception that one is
disconnected from others, which seems to
be most consistent with the belonging func-
tion of social support, while the absence of
reciprocal care entails the perception that
BRYAN AND HERNANDEZ
one has no one to turn to for support or
assistance, which is more consistent with
tangible and appraisal forms of support. In
light of the current findings, it may be that
the reciprocal care aspect of thwarted
belongingness, especially access to concrete
and tangible forms of assistance, is a rela-
tively more important buffer of emotional
distress. Likewise, the absence of reciprocal
care may be a relatively stronger risk factor
for suicidal ideation among those who are
emotionally distressed. Additional research
is required to more definitely test this possi-
bility.
The current findings should be con-
sidered within the context of study limita-
tions. First, only 6.6% of the sample
reported current suicidal ideation, which
could limit our ability to detect small rela-
tionships. It is possible that we were insuffi-
ciently powered to identify the relationships
between different functions of self-report
with suicidal ideation as a result. Additional
studies with larger samples are required to
confirm these results. Second, this study
relied on self-report measures in a nonclini-
cal sample of active duty Airmen. Thus,
these results may not generalize to treat-
ment-seeking service members and may not
generalize to service members in other
branches of the military. Third, the study
utilized a cross-sectional approach to data
collection, thereby limiting conclusions
regarding causal relationships between
social support and suicidal ideation. Given
that perceptions of social support could
potentially fluctuate over time in response
to different life circumstances, future
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Manuscript Received: February 12, 2013
Revision Accepted: April 16, 2013
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