A Comparative Review of U.S. Military and Civilian Suicide Behavior: Implications for OEF/OIF Suicide Prevention Efforts

Abstract

Suicide is a significant public health concern within the United States military. Suicide may occur before, during, and after military deployment or service for a multitude of reasons that may or may not be directly related to deployment. Therefore, it is crucial that mental health counselors are trained to identify risk at an early stage so they can offer evidence-based practices to manage and reduce it. Enhanced understanding of the similarities and differences in suicide risk and protective factors for civilian and military individuals is crucial for counselors who work directly with Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) active-duty personnel, veterans, and family members. This review aims to educate counselors about the role of demographic, life event, psychopathology, and behavioral and psychological variables in exacerbating or alleviating the desire to die. The information presented is based on an electronic search of medical and psychological databases for terms related to suicide by military service members. Recommendations related to identification, prevention, and management of suicide risk in OEF/OIF service members and beneficiaries are presented.

Prevalence and risk factors associated with suicides of Army soldiers 2001–2009.

“…Similar levels of stressors have been reported for the general population (Heeringen, 2001;Martin et al, 2009;Simon, 2006). Suicide is a rare event; however, it may be possible to identify portions of the population at elevated risk.…”

Correlates of Suicide Among Veterans Treated in Primary Care: Case–Control Study of a Nationally Representative Sample

“…We used a systematic, iterative process to develop a medical record data collection tool to record documentation of previously identified suicide risk factor variables in the 6 months prior to the index date; we have used similar approaches in prior studies. 9,[20][21][22][23][24] Clinical variables determined using this method included sleep problems, functional decline, anger, and suicidal ideation endorsement; psychosocial context variables included housing instability, isolation, grief/loss of a loved one, recent move, and financial, legal, job/school, or relationship problems (Table 2). These items were selected based on prior research suggesting possible relationships among these variables and suicide risk, and recommended data elements from the Centers for Disease Control and Prevention.…”

“…These items were selected based on prior research suggesting possible relationships among these variables and suicide risk, and recommended data elements from the Centers for Disease Control and Prevention. 9,15,20,22,[24][25][26][27] The majority of these variables were recorded dichotomously-counted as "yes" if the construct was documented in any progress note by clinicians or other medical staff (e.g., medical assistants or nurses) during the 6 months prior to the index date. For suicidal ideation and attempts, there were three levels: not asked (suicidal ideation not mentioned in notes); not endorsed (veteran asked, but did not endorse); and endorsed (veteran asked and endorsed).…”

Patient Characterization Protocols for Psychophysiological Studies of Traumatic Brain Injury and Post-TBI Psychiatric Disorders

“…Traumatic brain injury is a risk factor for suicide (233–236), suicide attempts (237, 238), and suicidal ideation (106, 239). The most exhaustive investigation to date of the relationship between TBI and suicide was conducted by Brenner et al (240) who studied individuals receiving Veterans Health Administration services between 2001 and 2006.…”