Tallying the Suicide Toll

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Army Photo / Sgt. Luther L. Boothe Jr.

U.S. soldiers in Afghanistan take part in a "stress shoot" designed to improve their mental resiliency and reduce suicides in their ranks.

The Department of Defense has just issued a new report on the sad subject of military suicides.

The statistics are not news. We all know of the steadily rising suicide rate, especially in the Army. The rates of suicide are very high in the military. One a day. What is not often recognized is about the details of the military suicides. The study finds that in 2011:

— Service Members most frequently used firearms to end their lives (60% for all firearms, 49% for non-military issue firearms), or hanging (20%).

— Most Service Members did NOT communicate their potential for self-harm with others prior to dying by suicide (74%) or attempting suicide (76%).

— The majority of Service Members who died by suicide (55%) did not have a known history of a behavioral health disorder. Mood disorders were reported for 57 decedents (20%); 24% had a known history of substance abuse.

— Anti-depressants were the most frequently used psychotropic medication among suicide decedents (22%) and those who attempted suicide (37%).

— 17% of decedents received outpatient behavioral health services within the month prior to suicide. Service Members who attempted suicide used outpatient behavioral health services more frequently (61%) than those who died by suicide (40%).

— A known failure in a spousal or intimate relationship (47% of decedents), with many experiencing the failure within the month prior to suicide (28% of decedents).

— The suicide rate for divorced Service Members was 55% higher than the suicide rate for married Service Members.

— The most frequent known legal issue was Article 15 proceedings/non-judicial punishment (18% of suicide completers), followed by civil legal problems (13%).

— A known history of job loss and instability (e.g., demotion) was pertinent to 21% of decedents and 31% of suicide attempts.

— A minority of suicides (10%) and suicide attempts (2.5%) occurred during OEF/OND [Afghanistan and Iraq] deployments

— Nearly one-half of suicide decedents (47%) had a history of OEF, OIF, or OND deployment; of these, 8% had a history of multiple deployments.

— Direct combat experience was reported for 15% completers and 17% of suicide attempts.

I want to briefly relate the history of collecting data on suicides in the Army and the military, and how we got to this 2011 Department of Defense Suicide Event Report study.

Before 2001, psychological autopsies were done on all suicides in the Army. Psychological autopsies are intensive reports about the motivation and reasons for suicides. They were done by a variety of mental health workers with various levels of training. The 25 or so page reports often ended up in the desk drawers of the local commanders, and led to little systemic change.

The USS Iowa explosion, and the Navy’s push to pin responsibility for it on a sailor, led to questions about the level of expertise of those doing the psychological autopsies. A report on suicides at Fort Bragg in the Fayetteville Observer added to questions about confidentiality of the reports.

In response to these events and other concerns, the DoD Inspector General helped to dictate the circumstances that lead to a memo I crafted in June 2001, when I worked in the Defense Department’s Health Affairs office. The memo said that we would only do psychological autopsies in selected cases, mainly those in which it was not clear whether the cause of death was suicide, accidental, or a homicide.

The DoD IG also said that there should be another way to gather information on suicides. We started to develop the Army Suicide Event Report. But then 9/11 happened, and we went to war in Afghanistan, and then Iraq. Nevertheless the Army Suicide Event Report went live in 2003. It was and still is a web-based report, that allows information to be aggregated in a way that psychological autopsies could not do.

There followed lots of debate about how to make one Pentagon-wide report, rather than separate ones for the Army, Navy and Air Force. Long story short we expanded to the DoDSER by 2005. The National Center for Telehealth and Technology then began publishing summaries of the suicide data.

As the number and rate of completed suicides rose from 2004 to 2011, the composite reports gained national attention. But the focus was largely on the raw numbers, not the details.

Why are the details important? Because they can lead to actionable intelligence, i.e. how to modify suicide-prevention programs to make them more effective. In a later post, I’ll talk about such actionable intelligence.