Risk management and commitment to the organization amongst IDF mental health officers exposed to suicidal patients of different severity levels: the mediating roles of situational anxiety and occupational self-efficacy

Background: Patient suicide may elicit complex emotional reactions in therapists, potentially altering their risk management practices with other patients and diminishing their organizational commitment. Mental health officers (MHOs) in the Israel Defense Forces (IDF) are subject to considerable role-related stress due to the intensity of their work, with exposure to suicidal behavior representing a unique stressor that may affect their professional functioning. The present study was guided by Hobfoll’s (1989) conservation of resources (COR) theory, which posits that resource loss following trauma or crisis is central to the experience of stress and impairs adaptation and functioning. 
Objective: This study examined the unique and combined contributions of role stress and exposure to varying levels of suicidal behavior to risk management and organizational commitment. Professional self-efficacy and state anxiety were assessed as mediating variables, based on the assumption that exposure to severe suicidal behavior undermines internal resources (i.e., professional self-efficacy) and evokes negative emotions such as anxiety. 

Method: The sample included 164 MHOs, 58 men (35.4%) and 106 women (64.6%), with a mean age of 34.17 years (SD = 5.92), who served in the IDF between 2017 and 2021. Participants were divided into two groups: those exposed to moderate-to-severe suicidal behavior (n = 118, 72%) and those exposed to mild suicidal behavior (n = 46, 28%). All MHOs completed self-report measures of role stress (Job Demand questionnaire), professional self-efficacy, state anxiety, and organizational commitment (assessing affective, continuance, and normative commitment). Additional data were extracted from two computerized military systems: the Mental Health Registry, documenting cases and severity of suicidal behavior, and the computerized medical system, recording risk management practices (e.g., average number of sessions, referrals to senior professionals, psychiatric diagnoses, exemptions from service). Data were collected for six months following exposure to a suicidal patient.  

Results: MHOs exposed to moderate-to-severe suicidal behavior reported significantly higher overall organizational commitment and affective commitment than those exposed to mild suicidal behavior. Differences also emerged in risk management, with MHOs exposed to more severe suicidal behavior adopting more cautious approaches, particularly regarding recording of adjustment difficulties. No group differences were observed in role stress. While role stress was not associated with overall organizational commitment, it was negatively related to affective and continuance commitment. Furthermore, role stress was negatively associated with referrals to senior professionals, contrary to the hypotheses. State anxiety was positively associated with role stress and, together with lower professional self-efficacy, predicted higher organizational commitment. 

Conclusions: The findings highlight the complex interplay between role stress, exposure to suicidal behavior, risk management, and organizational commitment among military MHOs. Contrary to initial hypotheses, exposure to severe suicidal behavior was associated with increased organizational commitment, and higher role stress predicted fewer referrals to senior professionals. These results underscore the nuanced psychological and professional responses to stressful clinical-military contexts. The study emphasizes the need for tailored support systems for MHOs, recognizing that responses to stressful events are not uniformly negative. Identifying and reinforcing resilience-promoting factors may enhance both risk management and organizational commitment. Practically, the results suggest that MHO training programs, both academic and military, should incorporate dedicated modules addressing therapists’ coping strategies when working with suicidal patients, thereby strengthening internal resources, in line with COR theory.