The Department of Defense (DoD) has released its annual report on the occurrence of military suicide for calendar year 2016. PHCoE’s DoD Suicide Event Report (DoDSER) team is currently preparing the 2017 report and we’re also collecting information on cases that, unfortunately, have occurred in 2018.
The 2016 DoDSER presents a comprehensive overview of the rates and risk factors associated with military suicide, as well as changes over time and comparisons to the U.S. general adult population. The report serves as an invaluable tool for researchers, policy makers, and DoD leaders to inform suicide prevention plans, policies, and programs.
Military suicide is an important and sensitive topic, and the public needs to have access to accurate facts and information, otherwise myths and misunderstandings about suicide can become persistent. However, the DoDSER is a technical report and the content, which includes pages of statistics, data tables and figures, may not be easy for the layperson to understand. This blog aims to provide a plain language summary of the key information and take-aways from the 2016 report. An important note: While it’s easy to just pay attention to ‘the numbers,’ we shouldn’t forget those numbers come from the tragic loss of a service member’s life due to suicide.
A brief history
Between 2005 and 2009, the rate of suicide in the military doubled, and the protection that being a member of military seemed to confer in the past no longer resulted in a lower suicide rate compared to non-military populations. Also, this increase in the suicide rate occurred during a period of active military conflict, which in previous wartime eras had been associated with decreases in suicide. DoD and suicide prevention researchers were left puzzled about why the pattern of military suicide was differing so dramatically from what was expected.
As a result, the DoDSER system was deployed in 2008 as a way to collect detailed and standardized information on every case of military suicide that occurs during a given year across the active and reserve components of the Army, Navy, Marine Corps, and Air Force, including members of the National Guard.
Putting it in perspective
While suicide is an incredibly important problem to address, death due to suicide is a rare outcome, which requires sophisticated analytics for tracking, measurement, determination of change, contextualization, and messaging.
Consider the image below which illustrates the scale of suicide in the military. The figure contains 1,000 gray squares, and each square contains 100 small dots. Thus, there is a total of 100,000 individual dots in the whole figure, each one representing an individual service member. The small red area in the bottom corner encapsulates 21 of those dots, which represents the current rate of 21 cases of suicide observed for every 100,000 service members in the U.S. Armed Forces.
Number of cases in 2016
Over the course of 2016, 478 suicides occurred across the military. Of that 478, 275 occurred among active-duty soldiers, sailors, Marines, and airmen, 80 cases occurred among the reserve forces, and 123 cases occurred across the Air and Army National Guard.
Rate of suicide
Looking only at the number of times suicide occurs provides an incomplete picture. In order to complete the picture, we must discuss suicide rates, which take into account the size of the overall population. For example, the Army experienced nearly twice the number of suicides as the Air Force, and nearly four times as many as the Marine Corps. Does this mean that serving in the Army is a risk factor for suicide? Absolutely not. The Army is the largest of the four services, and because it has a larger base population, it will also have a larger number of suicide cases. When we divide the number of cases by the size of the total population, we see that the rate of suicide in the Army (26.7 suicides per 100,000 soldiers) is quite similar to the rate of suicide in the other three services (Air force = 19.4 suicides per 100,000 airmen; Navy = 15.3 suicides per 100,000 sailors; Marine Corps = 20.1 suicides per 100,000 Marines). By using the graphic above, we can see how relatively equivalent the rate of suicide is across the services.
If we break these cases down into their various demographic and historical elements, we see that the highest rates of suicide occurred among service members who were:
- Between the ages of 20 and 24
- Of Caucasian descent
- Had no more than a high school education
- Had an enlisted (rather than officer) rank
When we look over time, we find that suicide rates across the active component, reserve component, and National Guard have stabilized, and that there is no evidence of an increase or decrease in suicide rates since 2011. If we separate the active component into its constituent services, there is no evidence to suggest a change (neither increase, nor decrease) in the suicide rate for the Army, Navy, or Marine Corps since 2011. The suicide rate for the Air Force has increased, incrementally, since 2011.
Active Component Military Suicide Rate, 2011 - 2016
When we compare suicide rates for the active and reserve components to a similar (in age and sex) slice of the U.S. adult population, we find that the rate of suicide among active-duty members of the military is no different from the suicide rates observed in the general population. However, the rate of suicide observed among members of the National Guard is elevated compared to the suicide rate of the U.S. adult population.
Active Component Military vs. U.S. Adult Population, 2011-2016
Additional 2016 key findings
Data from the DoDSER system allow us to learn about the risk factors and events leading up to military suicide. These are the actionable facts that will help us to fine tune DoD’s suicide prevention programs to reduce the occurrence of military suicide in the future.
- Personally owned firearms continued to be the most common method of suicide within the DoD, accounting for 58.9 percent of all suicides. Military issued firearms accounted for 2.3 percent of suicides.
- Drug and alcohol overdose was the most common method of attempted suicide, accounting for 56.8 percent of recorded suicide attempts.
- Nearly a quarter (23.4 percent) of those individuals who died by suicide communicated about their thoughts or desire to take their own life in the 90 days prior to their death in a manner other than a suicide note. This included talking, writing, or texting/e-mailing others about these thoughts.
- Over half of the individuals who died by suicide did not have a documented behavioral health diagnosis. This doesn’t mean that these individuals were not struggling with behavioral health issues or major stressors in their lives, but rather that they did not seek care for those issues. This is important for understanding how stigma surrounding help-seeking for behavioral health issues can have major consequences.
- Relationship problems are a common occurrence preceding suicide. We found that 39.5 percent of cases had experienced a failed relationship within 90 days of the suicide event. Primarily these involved romantic partners, but also included close friends and family.
- Over 58 percent of individuals who died by suicide had contact with the Military Health System in the 90 days prior to their death. This contact included primary care appointments, pharmacy visits, behavioral health appointments, or any other contact with MHS health care staff.
DoD has engaged in significant suicide prevention and public health efforts over the last decade, and suicide prevention remains a major priority. But there is still more work to do. Suicide rates across the military are stable, but remain elevated compared to levels observed prior to the wars in Iraq and Afghanistan. Key risk factors that can be identified from the DoD’s efforts to monitor suicide-related behavior should be used to tailor prevention programs to reduce suicide risk and encourage healthy, effective coping skills.
Pruitt is a licensed clinical psychologist and the program supervisor for the DoD Suicide Event Report (DoDSER) program at the Psychological Health Center of Excellence.
The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.