Annette M. Boyle
BALTIMORE, MD - Part of the challenge for healthcare providers trying to prevent military suicide is the difficulty of identifying servicemembers at the highest risk. Now, a newly-published study from the Army National Guard provides some information on characteristics shared by soldiers who take their own lives.
Among Army National Guard (ARNG) soldiers, researchers found that males were 3.05 times more likely to commit suicide than females. White soldiers had 1.85 times the risk of suicide as others, and ARNG soldiers aged 17 to 24 were 1.74 times more likely to have taken their own lives than those over age 29.
Suicide rates for the military historically are substantially below the age-adjusted civilian rates, but rates for the military have risen sharply in recent years so that they now exceed the civilian rate. Since 2005, suicide rates per 100,000 for the Army have risen from 13.7 to 25, while the Army Reserve rates reached 24 and the ARNG climbed to 31, compared with adjusted civilian rates of 20.3.
“What’s particularly notable is that the occurrence of suicide in the Army National Guard and the active duty component of the Army as a whole mirrors what we see in civilian suicide literature. Based on our analysis, there is nothing unique in military service that adds risk,” said lead author and retired Col. James Griffith, PhD, a former Army research psychologist.
“It is commonly assumed that excessive stressors put people at risk for suicide, but we found that the strongest correlation were demographic. Deployment and combat exposure had very weak or no correlation to risk,” Griffith added.
Nearly 95% of suicides were male and almost 90% were white. More than 56% were single, 60% had not served previously, 43% were between 17 and 24 years of age and 20% were 25 to 29 years old.
“The U.S. Army Public Health Command also found those to be the primary factors of suicides, plus substance abuse or behavioral health issues that are untreated or inconsistently treated,” he noted. Because ARNG soldiers rely on civilian insurance for their healthcare, the National Guard does not track or treat behavioral health issues, he added..
For the study, recently published in the journal Armed Forces and Society, Griffith and Col. Mark A. Vaitkus, PhD, research psychologist with the ARNG, analyzed information from three data sets. Researchers pulled the first data set from the Army National Guard’s personnel data system (ALURRT) from 2007 to 2010, with data on the actual suicides matched to records of 4,293 living ARNG soldiers. The second data set came from Unit Risk Inventory-Reintegration surveys collected from nearly 5,000 ARNG soldiers returning from deployment in 2010. The third data set came from Army reservists’ responses to the 2009 Status of Forces questionnaires.
Griffith and Vaitkus suggested some explanations for the risk factors. In the age range at greatest risk, individuals are developing their self-identity and intimate interpersonal relations, they pointed out, adding that soldiers who have not clearly defined their self identity may be at greater risk, as are those who are not married or are in troubled relationships.
“Race is likely associated with the nature and amount of informal support available to the individual, especially during stressful circumstances, to help augment the individual’s coping,” the study authors wrote.
In general, they noted, African-Americans have a stronger and more extended support network as well as higher rates of participation in religion, which might act as an “additional inhibition against self-harm.” They suggested African-Americans also might have great resiliency in adapting to adverse life experiences.
The authors noted that other researchers have conjectured that the lower rate of suicide among women may be attributable to a willingness to seek help for problems, identify their own distress, build more supportive social networks and develop flexible coping skills. Men, on the other hand, are “more likely to engage in suicide-risk behaviors, such as alcohol abuse, access to firearms, along with deeper shame from failure,” they wrote.
Even within the groups at greatest risk, only a very small number take their own lives, Griffith emphasized.
“While the rates have gone up significantly, it’s important to remember that suicide in the National Guard is a low, low frequency event, so identifying those at risk is like finding the proverbial needle in the haystack,” he pointed out, “but there are three areas where action could potentially reduce the risk — early identification, case management and behavioral health care.”
The Army and the National Guard are grappling now with how to identify those soldiers at greatest risk of suicide. Developing a screening tool is one approach under consideration, but Griffith cautioned that standardized measures could be invasive and problematic to use in a non-private setting.
Outside of a health exam or similar private setting, “you wouldn’t ask about thoughts of suicide, but you might ask about marital status. Marriage is a protective factor, same with children. Do you have significant relationships? Are they causing you stress? That’s an issue. Drinking? That’s an issue. Those might tip you off that that person is at risk,” Griffith said.
While self-identification or referrals from other soldiers or leaders also might reduce suicide rates, reservists, unless deployed, are only with their unit two days a month. A more effective program might educate soldiers and their families about the signs of depression and risk of suicide — as well as gun safety.
“It may be helpful when out-processing soldiers, to offer free gun locks and education on how to store weaponry at home,” Griffith suggested. “More than 65% of the suicides resulted from gunshot wounds.”
Many of the individuals who commit suicide have behavioral issues, substance abuse problems or personal issues.
“Once they’re identified, they need to get into treatment, and followed up. That’s hard to do when you’re only seeing these soldiers two days a month. Even so, some states have developed behavioral health offices that are notified when a soldier has a crisis,” Griffith said. “They determine appropriate treatment, match the soldier with a provider in the community and follow up.”
Providing behavioral health services also might help. Soldiers in the ARNG often have no insurance or inadequate insurance, noted Griffith. “Even if they deploy and come back, if they develop a problem a year later, they have to rely on personal coverage. For young people, that’s often a problem.”