Suicide in the US Army
by Timothy W. Lineberry, MD and Stephen S. O’Connor, PhD
Mayo Clinic Proceedings Magazine, September 2012
Suicide in the US Army is a high-profile public health problem that is complex and poorly understood. Adding to the confusion surrounding Army suicide is the challenge of defining and understanding individuals/populations dying by suicide.
Data from recent studies have led to a better understanding of risk factors for suicide that may be specifically associated with military service, including the impact of combat and deployment on increased rates of psychiatric illness in military personnel.
Despite the end of large-scale military operations in Afghanistan and Iraq, the effects on the mental health of active duty service members, reservists, and veterans is only just beginning to be felt. Moreover, the potential effect on service members of their war experiences may manifest indefinitely into the future in the form of emerging psychiatric illnesses. The development of a model for suicide prevention in service members and veterans will require a national effort, public and private, sustained for the foreseeable future.
— Timothy W. Lineberry, MD and Stephen S. O’Connor, PhD
Mayo Clinic Proceedings Magazine, September 2012
The next steps involve applying these results to the development of empirically supported suicide prevention approaches specific to the military population.
This special article provides an overview of suicide in the Army by synthesizing new information and providing clinical pearls based on research evidence.
Suicide in the US Army increased 80% in 2004 to 2008 above the previous stable suicide rate from 1977 to 2003. This increase, corresponding with the beginning of combat operations in Iraq in 2003, has affected soldiers throughout the US Army.
Of the 301 confirmed or suspected suicides reported in 2010, 156 soldiers were on active duty, which includes Regular Army and activated Reserve Component soldiers, and 145 were inactive reservists.
Most recently, the military reported in June 2012 that suicides have outpaced combat casualties since the beginning of the year and that the 154 suicides from January to June represent an 18% increase compared with the same period in 2011.
Thus, suicide remains a pressing concern in the military population.
Read the rest of this report:
Army suicide rate increased 80% from 2004 to 2008.
Army National Guard suicide rates in 2010 were 31 per 100,000 vs 24 per 100,000 in the Army Reserve for the same year.
The 2010 suicide rate in the regular Army was 25 per 100,000.
When screening for psychiatric injury, anonymous surveys resulted in 2 to 4 times higher self-reporting than did nonconfidential screening.
One-fifth of soldiers reported that they were not comfortable in giving honest responses to nonconfidential screening questions.
Among service members meeting the criteria for a mental disorder on military postdeployment screening, only 23% to 40% sought care.
Psychiatric illness, aggressive behavior, and alcohol misuse may result in a transition from psychiatric syndromes alone to actual suicidal behavior.
40% of soldiers acknowledged postdeployment aggressive behaviors compared with a predeployment rate of 11.2%.
Among young adults in the military, self-reported insomnia symptoms were associated with suicidal ideation even after controlling for depression, hopelessness, PTSD diagnosis, anxiety symptoms, and drug and alcohol abuse.
Marines with 2 deployments had higher rates of PTSD compared with those with only 1 deployment.
Soldiers with depression were 11 times more likely to die by suicide, and those with anxiety disorders (PTSD included) were 10 times more likely to die by suicide.
Between 2003 and 2008, the Army psychiatric injury treatment rate, defined by outpatient visits, increased from 116 per 100,000 to 216 per 100,000.
Soldiers with a psychiatric inpatient stay died by suicide at a rate 15 times higher than soldiers who had not been hospitalized.
Psychiatric hospitalizations were the most common reason for inpatient admissions in the military from 2003 to 2008.
Veterans with a PTSD diagnosis were almost 3 times as likely as veterans without a psychiatric diagnosis to be prescribed opioid analgesics.
VA found that opioids were dispensed despite the presence of comorbid alcohol use and concomitant use of benzodiazepines.
Iraq and Afghanistan veterans with a PTSD diagnosis who were prescribed opioids were significantly more likely to have opioid-related accidents and overdoses, alcohol and nonopioid drug-related accidents and overdoses, and self-inflicted and violence-related injuries.
VA has not made public (unknown if VA has collected) definitive data comparing the suicide among of Iraq and Afghanistan war veterans with that of veterans of other wars is not currently available.
Only 36% (7.9 million) of America’s estimated 22 million veterans in 2007 received care at VA.
50% of suicide deaths among VA patients did not have a formal psychiatric diagnosis.
— Suicide in the US Army, by Timothy W. Lineberry, MD and Stephen S. O’Connor, PhD, published in Mayo Clinic Proceedings Magazine, September 2012
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