COMMUNITY CASE STUDY article
Front. Public Health
Sec. Public Mental Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1469973
This article is part of the Research TopicAdvances in Preventing Suicide Among VeteransView all 7 articles
The "Tyranny of Distance": Community-Based Veteran Suicide Prevention in Guam
Provisionally accepted
Joanna R. Sells1,2*
Kelly A. Stearns-Yoder1,2
Molly E. Penzenik1,2
Nazanin H. Bahraini1,2
Molly J. Sullan1,2Selena Cruz1,2Lindsey L. Monteith1,2
Lisa A. Brenner1,2- 1Rocky Mountain MIRECC for Veteran Suicide Prevention, Aurora, United States
- 2Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, United States
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The population of Guam is comprised of a high proportion of Asian and/or Pacific Islander individuals, many of whom have served in the military. Minoritized community membership and military service are associated with increased suicide risk. This mixed-methods study was conducted to increase understanding regarding the community context, factors associated with suicide risk among Guamanians, and implementation barriers and facilitators for a communitybased suicide prevention program, Together with Veterans (TWV). For this convergent parallel mixed-methods study, data were collected from twelve individuals. Qualitative data were analyzed via a rapid analysis approach. Themes were organized using a socio-ecological model framework, then integrated with quantitative data. Emergent themes by socio-ecological levels included: intrapersonal (e.g., identities, mental health stigma); social-interpersonal (e.g., perceptions of Veterans); social community (e.g., access to care); social organizational (e.g., hope for raising awareness); social public policy (e.g., part of, yet isolated from, the mainland); and chronosystem (i.e., geopolitical history). Quantitative data yielded convergent and divergent findings. Findings highlight unique risk and protective factors faced by those living in Guam, as well as the utility of structured community-based suicide prevention strategies to make change among those living in island communities that are geographically distant from the mainland.
Keywords: Total score, 10 item-scale, possible score range 10-40, higher scores indicate higher communal mastery, †CES: Adapted 5-item scale, item score range 5-25, higher scores indicate belief in capacity of community to attain goals. §TWV-IQ: Developed to obtain information regarding TWV program: Domains include: Planning and Implementation, Leadership, Community Involvement, Progress and Outcome, and Overall Suggestions and Approval
Received: 24 Jul 2024; Accepted: 13 Jun 2025.
Copyright: © 2025 Sells, Stearns-Yoder, Penzenik, Bahraini, Sullan, Cruz, Monteith and Brenner. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Joanna R. Sells, Rocky Mountain MIRECC for Veteran Suicide Prevention, Aurora, United States
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