The military loves to conduct after-action reports, hoping that whatever problems arose during an operation or exercise can be studied and prevented the next time. (The Army even has an outfit that calls itself the Center for Army Lessons Learned.)
So why should the scourge of suicide be any different? The Pentagon recently released its annual report on suicides. After it did, I posted about the history of psychological autopsies and the evolution of the Army Suicide Event report into the DoD Suicide Event report.
Let’s conduct our own AAR on the report to see what lessons can be gleaned:
Finding: Service Members most frequently used firearms to end their lives (60% for all firearms, 49% for non-military issue firearms), or hanging (20%).
Implication: the current discussion about gun violence is highly relevant for suicide prevention.
Finding: most Service Members did not communicate their potential for self-harm with others prior to dying by suicide (74%) or attempting suicide (76%).
Implication: many suicide prevention programs emphasize buddy aid and suicide hot lines. However these initiatives are not effective if a suicidal individual does not communicate their intent.
Finding: 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 20%; 24% had a known history of substance abuse.
Implication: the military population who suicides (called suicide decedents in the report) is very different from the civilian population, where most estimate that 90% of suicides have a history of a behavioral health disorder. Substance abuse is well known as a risk factor for suicide; 24% is lower than I expected, but sometimes all the data are not available for those writing the report.
Finding: 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).
Finding: the most frequent known legal issue was Article 15 proceedings/non-judicial punishment (18% of suicide completers), followed by civil legal problems (13%).
Finding: a known history of job loss and instability (e.g., demotion) was pertinent to 21% of decedents.
Implication: again this pattern of stressors has been apparent for some years. I would urge those who work with service members who get into trouble (commanders, defense attorneys, etc.) to specifically assess for suicidal ideation or refer to a chaplain or a mental health professional (some commanders already do this).
Finding: a minority of suicides (10%) occurred during deployments to Afghanistan and Iraq.
Finding: nearly one-half of suicide decedents (47%) had a history combat deployment; of these, 8% had a history of multiple deployments.
Finding: direct combat experience was reported for 15% of completers.
Implication: here the pattern has changed. Back in 2006 and 2007, about one-third of suicides occurred during deployment. Now it is down to 10%. Over half have never deployed. So providers should focus on the other risk factors listed above, as well as how well new Soldiers are integrating into their unit.
Finding: antidepressants were the most frequently used psychotropic medication among suicide decedents (22%).
Implication: I am actually not sure how this information compares to the civilian world. I do not think similar information exists for the general population of suicide decedents. It may mean that we are actually under-treating Soldiers.
Bottom Line: Commanders and others in positions to effect change should read the report and think hard about how its findings can be leveraged to reduce suicide in the ranks.