{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T07:07:27Z","timestamp":1789196847121,"version":"build-2803163510"},"reference-count":45,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000005","name":"U.S. Department of Defense","doi-asserted-by":"publisher","award":["HT9402\u201023\u20101\u20100001"],"award-info":[{"award-number":["HT9402\u201023\u20101\u20100001"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate whether the Brandon Act, a 2021 legislation establishing confidential, self\u2010initiated mental health referral pathways for US military service members, was associated with reductions in medically attended suicide attempts among active duty service members (ADSMs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>We employed an interrupted time series design using person\u2010quarter panel data from the Military Health System (MHS) from 2018 to 2024. Segmented regression and event study specifications estimated immediate and trajectory effects of the Brandon Act on suicide attempt rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>Data were drawn from the MHS Data Repository, comprising 39.1 million person\u2010quarters from 2.5 million ADSMs aged 18\u201364. Suicide attempts were identified from inpatient, outpatient, and emergency department claims.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>Prior to the Brandon Act, suicide attempt rates increased by 4.29 per 100,000 per quarter (95% CI: 3.56, 5.02). Enactment in December 2021 was associated with an immediate reduction of 6.51 per 100,000 (95% CI: \u221210.54, \u22122.47) and a downward trajectory shift of 2.25 per 100,000 per quarter (95% CI: \u22123.81, \u22120.70). Official implementation in May 2023 was associated with a further immediate reduction of 21.19 per 100,000 (95% CI: \u221226.83, \u221215.55) relative to the projected trend, with a compounding decline of 1.50 per 100,000 per quarter (95% CI: \u22122.34, \u22120.66). The policy was associated with approximately 3800 prevented suicide attempts over 3\u2009years. Effects were largest among junior enlisted, female service members, and Army and Marine Corps personnel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The Brandon Act is associated with a sustained, compounding decline in medically attended suicide attempts among ADSMs. Immediate reductions upon enactment suggest a signaling effect, while intensifying effects following implementation underscore the role of confidential pathways in addressing structural barriers to care\u2010seeking. These findings highlight the importance of non\u2010financial policy levers in military mental health and offer a replicable model for other health systems where stigma limits care utilization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70167","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T06:18:44Z","timestamp":1789193924000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Suicide Prevention in the US Military: Assessing the Impact of the Brandon Act"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7385-4515","authenticated-orcid":false,"given":"Jangho","family":"Yoon","sequence":"first","affiliation":[{"name":"Department of Preventive Medicine and Biostatistics, School of Medicine Uniformed Services University of the Health Sciences  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8878-4748","authenticated-orcid":false,"given":"Seungbeen","family":"Ghim","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Biostatistics, School of Medicine Uniformed Services University of the Health Sciences  Bethesda Maryland USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3771-8636","authenticated-orcid":false,"given":"Michael","family":"Lindow","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Biostatistics, School of Medicine Uniformed Services University of the Health Sciences  Bethesda Maryland USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Gedeon","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Biostatistics, School of Medicine Uniformed Services University of the Health Sciences  Bethesda Maryland USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0856-3911","authenticated-orcid":false,"given":"Patrick","family":"Richard","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Biostatistics, School of Medicine Uniformed Services University of the Health Sciences  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","DOI":"10.15620\/cdc\/174641","volume-title":"Mortality in the United States, 2024","author":"Xu J.","year":"2026"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1521\/psyc.2013.76.2.97"},{"key":"e_1_2_9_4_1","volume-title":"Military Suicide Prevention and Response","author":"Kamarck K. N.","year":"2021"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/08995605.2021.1976544"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2011.300484"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1037\/bul0000084"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0028589"},{"issue":"1","key":"e_1_2_9_9_1","article-title":"Mental Health Stigma in the Military Context","volume":"20","author":"Martinez A.","year":"2022","journal-title":"Silicon Valley Sociological Review"},{"key":"e_1_2_9_10_1","unstructured":"Military Health System \u201cBrandon Act \u201daccessed March 14 2026 https:\/\/www.health.mil\/Reference\u2010Center\/Frequently\u2010Asked\u2010Questions\/Brandon\u2010Act."},{"key":"e_1_2_9_11_1","unstructured":"U.S. Department of Defense \u201cDOD Announces Implementation of the Brandon Act \u201d2023 https:\/\/www.defense.gov\/News\/Releases\/Release\/article\/3386581\/dod\u2010announces\u2010implementation\u2010of\u2010the\u2010brandon\u2010act\/."},{"key":"e_1_2_9_12_1","unstructured":"Military Health System \u201cU.S. Military Departments Implement Brandon Act to Improve Mental Health Support \u201d2023 https:\/\/www.health.mil\/News\/Dvids\u2010Articles\/2023\/09\/28\/news454551."},{"issue":"2","key":"e_1_2_9_13_1","article-title":"Perceptions of Mental Health Confidentiality Policies and Practices in the US Military","volume":"12","author":"Wong E. C.","year":"2025","journal-title":"RAND Health Quarterly"},{"key":"e_1_2_9_14_1","volume-title":"Understanding Suicidal Behaviour","author":"O'Connor R.","year":"2000"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2014.08.029"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2013.10.006"},{"key":"e_1_2_9_17_1","unstructured":"Military Health System \u201cMilitary Health System Confronts Stigma Surrounding Mental Health Care \u201d2023 https:\/\/health.mil\/News\/Dvids\u2010Articles\/2023\/06\/06\/news446351."},{"key":"e_1_2_9_18_1","unstructured":"K. A.Hepner C. P.Roth N.Qureshi andJ. L.Sousa \u201cImproving Behavioral Health Care in the Military Health System: Challenges Promising Strategies and Research Directions \u201d2023 https:\/\/apps.dtic.mil\/sti\/html\/trecms\/AD1214894\/."},{"key":"e_1_2_9_19_1","unstructured":"U.S. Department of Defense \u201cFor Service Members Access to Mental Health Care Streamlined Under Brandon Act \u201d2024 https:\/\/www.defense.gov\/News\/News\u2010Stories\/Article\/Article\/3651970\/for\u2010service\u2010members\u2010access\u2010to\u2010mental\u2010health\u2010care\u2010streamlined\u2010under\u2010brandon\u2010act\/."},{"key":"e_1_2_9_20_1","doi-asserted-by":"crossref","DOI":"10.7249\/RB9881","volume-title":"Assessing the Department of Defense's Approach to Reducing Mental Health Stigma","author":"Acosta J. D.","year":"2016"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/usad159"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040603"},{"key":"e_1_2_9_23_1","unstructured":"A. M.Charrys \u201cThe Effects of Military Leadership and its Implication on Mental Health Stigma and Treatment Seeking Behaviors of Veterans in Garrison and Noncombat Deployment Environments \u201dDissertations 2021 https:\/\/digitalcommons.nl.edu\/diss\/526."},{"key":"e_1_2_9_24_1","volume-title":"Department of Defense Suicide Event Report (DoDSER) Calendar Year 2014 Annual Report","author":"Pruitt L. D.","year":"2015"},{"key":"e_1_2_9_25_1","volume-title":"Department of Defense Suicide Event Report (DoDSER) Calendar Year 2019 Annual Report","author":"Department of Defense","year":"2021"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2016.0600"},{"key":"e_1_2_9_27_1","first-page":"1","article-title":"Issues in Developing a Surveillance Case Definition for Nonfatal Suicide Attempt and Intentional Self\u2010Harm Using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD\u201010\u2010CM) Coded Data","volume":"108","author":"Hedegaard H.","year":"2018","journal-title":"National Health Statistics Reports"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365\u20102710.2002.00430.x"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czr004"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.03.016"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2014.1384"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2016.09.009"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2016.09.009"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/mlr.0000000000000635"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201600110"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/hec.4153"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12961\u2010021\u201000730\u20100"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2022.00961"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.2307\/2525953"},{"key":"e_1_2_9_40_1","volume-title":"Econometric Analysis of Cross Section and Panel Data","author":"Wooldridge J. M.","year":"2010"},{"key":"e_1_2_9_41_1","doi-asserted-by":"crossref","DOI":"10.1515\/9781400829828","volume-title":"Mostly Harmless Econometrics: An Empiricist's Companion","author":"Angrist J. D.","year":"2009"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0165\u20101765(03)00032\u20106"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.econlet.2005.08.024"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11414\u2010014\u20109412\u20100"},{"key":"e_1_2_9_45_1","unstructured":"Mental Health and Substance Use Disorder Parity Task Force \u201cFinal Report. U.S. Department of Health and Human Services \u201d2016 https:\/\/www.hhs.gov\/sites\/default\/files\/mental\u2010health\u2010substance\u2010use\u2010disorder\u2010parity\u2010task\u2010force\u2010final\u2010report.PDF."},{"issue":"170","key":"e_1_2_9_46_1","first-page":"60283","article-title":"TRICARE; Mental Health and Substance Use Disorder Treatment; Final Rule","volume":"81","author":"Department of Defense","year":"2016","journal-title":"Federal Register"}],"container-title":["Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70167","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1475-6773.70167","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70167","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T06:18:48Z","timestamp":1789193928000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1475-6773.70167"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,11]]},"references-count":45,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/1475-6773.70167"],"URL":"https:\/\/doi.org\/10.1111\/1475-6773.70167","archive":["Portico"],"relation":{},"ISSN":["0017-9124","1475-6773"],"issn-type":[{"value":"0017-9124","type":"print"},{"value":"1475-6773","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,11]]},"assertion":[{"value":"2026-04-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70167"}}