Development and psychometric evaluation of the Military Suicide Attitudes Questionnaire (MSAQ)

Background To date, a culturally-sensitive psychological instrument has not been developed to evaluate military attitudes toward suicide. Understanding these attitudes can inform suicide prevention research, clinical practice, and policy. We aimed to develop such an instrument and to evaluate its psychometric properties using an active-duty military sample. Methods A team of military personnel, suicidologists, and researchers assisted with item development. A cross-sectional design was used to evaluate the psychometric properties of the Military Suicide Attitudes Questionnaire (MSAQ) via an online survey battery. Exploratory and confirmatory factor analyses were conducted. Results: A total of 317 military service members met eligibility criteria and completed the online surveys. A four-factor model that explained 46.4% of the variance was identified: (1) Individual-Based Rejection versus Acceptance; (2) Psychache versus Pathological; (3) Unit-Based Rejection versus Acceptance; (4) Moral versus Immoral. The MSAQ demonstrated high partial validity and test-retest reliability. Limitations The study used a convenience sample and did not control for social desirability. Conclusions The newly developed MSAQ is a promising measure that fills a notable gap in the assessment of suicide attitudes within the United States military. The MSAQ has the potential for future use in evaluating suicide prevention and stigma reduction programs within the Department of Defense. Additionally, the MSAQ may serve as a useful tool for leadership in the evaluation of command climates. In clinical settings, the MSAQ could be used along with other cognitive and attitudinal measures to track suicidal patients' attitude towards suicide over the course of treatment.