Department of Defense Releases Annual Report on Military Suicide

PHCoE graphic
By Larry Pruitt, Ph.D.
July 2, 2018

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. 

 

This image 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
  • Male
  • Divorced
  • 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.

Graph representing the Active Component Military Suicide Rate, 2011 - 2016

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.

This graph represents the Active Component Military vs. U.S. Adult Population, 2011-2016

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.

Summary:

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.


Comments

  • Dr. Pruitt,

    Sir, my name is Pamela Cameron and I am a 100% Disabled Veteran with PTSD from MST. The subject of Suicide Prevention for Active Duty, Guard/Reserve military personnel, as well as Veterans is of importance to me because I have lost family and friends to suicide. There is also an interest in the issue because I am a survivor of attempted suicide while I an active duty service member in 1988. With this said I have a question concerning the data pertaining to the reason for breaking the total number of suicides down 21 per 100,000 service members vs. 478 total suicides for the year 2016? Sir was there an attempted to determine how many service members died from being given Pharmicutical drugs such as the Holy Trinity of Drug's, i.e., opioids, Benzodiazepines, and muscle relaxers and on occasion sleep aids? Dr. Pruitt, has there been an attempt to determine how many service members have died because of drug interactions, which would preclude them from being suicides at all?

    Dr. Pruitt, sir I have an interest in the particular questions I have asked because there is very little available on the current status of the use of the drugs identified in the Holy Trinity of Drug's and individuals who secumb to the drug combination are often classified as overdoses or suicide rather than the drug combination. If it is possible to identify the methods used to screen for death's due drug combinations and if the data reflects adjustments for these death's could the information be provided?

    Thank you for your kind assistance with my concerns. Please enjoy your day stay safe and well in your daily travels through life.

    Kind Regards

    Pamela Cameron, M.A.

    • Thank you for your questions. The first question was about why we break the numbers into a rate versus a total count. We do this because a rate provides more information than the count, alone. The rate, since it takes into account the total size of the population of interest, can tell you if the occurrence of suicide is changing, or not. Change in occurrence cannot be determined by the raw count alone. Let's say the number of deaths decreased by 5%, but so did the size of the active force. Well, in that situation the count will appear to have decreased even though, proportionally, it stayed the same since the population shrunk by the same amount. Also, using rates allows us to dive deeper into the data, statistically, and do things like calculate standardized mortality ratios, compare DoD data to U.S. population data, and to take a longitudinal look at the data over the past several years.

      Your next question had to do with whether we examine the use of pharmaceutical drugs among cases of suicide. The answer is yes. Across the Services, Table 14 (page 56) provides information on event method, including drug overdose. Table 14 (this time on page 57) also gives information about whether drugs were used during the event, regardless of whether or not they were the primary method, and breaks this down into illegal drugs, prescription drugs, and non-prescription/over-the-counter drugs.  Table 15 (page 60) provides information about the use of pain medication that was being used at the time of the event, and also specifically looks at the use of opioid medications. This information is also broken down on the corresponding tables in the chapters for each individual Service.

      In terms of unexpected or unknown drug interactions that result in unintentional or accidental deaths, as opposed to suicide, we don't have information on this. That issue is one that is relevant for the actual cause of death determination, which is made by the Armed Forces Medical Examiner. It is only after the medical examiner officially declares that the cause of a death is suicide that the DoDSER data collection process begins. The Medical Examiner Service has their own guidance, regulations, and best practices that they follow which guide these determinations, including blood toxicology examinations.

      --Dr. Pruitt

  • Has there been any consideration at all that self-harm may be a brain functional imbalance with a likely asymmetrical pattern in specific lobes as indicated on scalp based non-invasive sensors?

    Further, has there been any consideration at all that self-harm which is rooted in a brain pattern may be mitigated if that brain can be supported to simply relax itself and reset itself on its own terms when supported in a totally non-invasive manner?

    • As a descriptive, epidemiological, report the DoDSER is inherently atheoretical, meaning that we just report objective facts, without filtering them through any particular theoretical lens.  Because of this, the DoDSER provides detailed information about the risk factors present for cases of suicide and suicide attempts, but we do not make suggestions or include text about potential causes of self-directed violence. There is another important reason for this, which is that we only collect information on cases of suicide and suicide attempts; we do not collect "control" information on non-suicidal cases.  Without control data, no inferences about causes can be made.

      Now, we can alter your question a little and ask whether we collect any information about the neurological functioning of individuals in the military that die by suicide or engage in a suicide attempt.  To answer that question I'll say that we do specifically ask about individual's histories of traumatic brain injuries as well as any use of psychoactive medication and drugs.  We also collecting information about an individual's history of prior suicidal behavior, including non-suicidal self-harm.  However, we do not collect complex and detailed neurological histories since those kinds of examinations are not routinely conducted on all Service members that may, at some point, engage in suicidal behavior.

      -- Dr. Pruitt

  • I believe we need to do more for managing stress and normal stressors in the liufe of Service members. Remarkable results were found with the Army and air force using Water Therapy Pods for ten sessions. Service Members reported less depression, no suicidal ideation, and no craving for their addictive behaviors.

    Enlist a panel to review and determine the feasibility of such self-treatment augmented by counseling to address tools needed for managing stressors and pain.

  • Dr. Pruitt,

    How many service members who committed suicide or survived an attempt had negative personnel reviews? How did you measure the rate of suicide as a result of poor leadership? Did you consider whether suicides were related to low morale or idiotic standards imposed by poor leaders? Ask the hard questions of our troops and do something about it please. The rising number of deaths in peacetime is a testament to our greatest enemy - a cowardly leader who pick on the weak instead of an enemy.

    Linda

    • Linda, there were 16 deaths in calendar year 2016 associated with a poor performance review (page 61 of the 2016 DoDSER). Regarding your other questions, the DoDSER data collection focuses on a variety of circumstances that each individual faces but does not record quality of leadership. We are not able to evaluate leadership quality across the services.

       

      -- Dr. Derek Smolenski

  • Dr. Pruitt,
    Is there work extant that examines Veteran rates of suicide by individual service? I know that other factors are considered (i.e. era of service, combat vs. non-combat, etc.). Looking at the rates above for active duty I'm wondering if they carry over into the Veteran ranks.

    • Mr. Wellman,

      Thank you for your inquiry about suicide rates in our military and veteran populations. As I think you already know, the VA does publish overall suicide rates for veterans(https://www.mentalhealth.va.gov/suicide_prevention/data.asp). However, we have been unable to find any reports with veteran suicide rates calculated by prior service affiliation. If we do become aware of anything we'll be sure to let you know.

      Regards,

      The DoDSER team

  • Dear Ph.D Larry Pruitt,

    So if relationship is one of the causes do we know if this relationship that active soldier has with their parents or is this with romantic partner?

    Also what are other common factors that are causing active soldiers to suicide? is it money?

    • Dear Mr. Escobar,

      Thank you for your questions and for your interest in military suicide. With respect to relationships, the DoDSER data collection form differentiates between failed or failing "intimate relationships" and failed or failing "other relationships." "Intimate relationships" are considered to be romantic in nature. For the "other relationships" category, the data form does not specify who the relationship is with or what type of relationship it is. With respect to the common factors of suicide, some common risk factors are financial difficulties, alcohol and substance use, relationship difficulties, and psychological symptoms or behavioral health disorders. Some of the common protective factors include a strong support network (like family or friends), a sense of meaning or purpose in life, and good problem solving or coping skills.  That said, there is neither a single risk factor nor a combination of risk and protective factors that applies to every suicidal individual.

      Kind regards,

      The DoDSER Team

  • Doctor: Discussion is on active duty suicide but do you have statistics for suicides of Veterans who are receiving benefits for service connected disabilities? Specifically, when VA proposes to reduce benefits which is unwarranted, and reduction of benefits significantly affects finances of Veteran and family, and due to this reduction commits suicide, has anyone assessed this group of suicides in Veteran population?

    • Ms. Murphy,

      Thank you for your questions and for your interest in military and veteran suicide. As you correctly understood, the DoDSER Annual Report is a reflection of data collected in response to suicide events in military service members. Because the DoDSER data collection system has neither the capability nor the authority to collect data about veterans of the U.S. military, we do not have answers to the questions you posed. 

      Information on suicide in the veteran population, including a suicide data report from the Department of Veterans Affairs, can be found at https://www.mentalhealth.va.gov/suicide_prevention/data.asp. This link also provides an email address where individuals can contact the VA Suicide Prevention Program with questions and concerns. 

      We encourage you to share these suicide prevention resources with anyone you know who may be needing support. 

      Veteran's Crisis Line website: https://www.veteranscrisisline.net/

      Support via phone: Call: 800-273-8255 (press 1 to speak with a responder from the VA)

      Support via text message: 838255

      Support via online chat: https://www.veteranscrisisline.net/get-help/chat

      Additional resources from the VA can be found at https://www.mentalhealth.va.gov/suicide_prevention/resources.asp.

      Sincerely,

      The DoDSER Team

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