Prevalence and Risk Factors Associated With Suicides of Army Soldiers 2001-2009

By Sandra A. Black, M. S. Gallaway, M. R. Bell & E. C. Ritchie
Military Psychology (vol. 23, #4), pp. 433-451

Contemporary research on suicide in the general population has shown that biological, psychosocial, and environmental factors interact to influence suicide-related deaths each year (Brown, 2006; Ellis, 2007; Leenaars, 2008; Lester, 2004; Lester, 2008; Schneidman, 1996). Research on biological risk factors suggests that genetic vulnerability to mental disorders, serotonin insufficiency, and serious physical illness or injury are particularly linked to suicide-related deaths (Heeringen, 2001; Mann, 2002; Mann, 2003; Moscicki, 2001; Roy, Rylander, & Sarchiapone, 1997). Similarly, research on psychological risk factors has also linked mood, anxiety, and personality-related disorders, as well as alcohol and substance disorders, with suicide-related deaths (Conner, Duberstein, Conwell, Seidlitz, & Caine, 2001; Harris & Barraclough, 1997; Nock et al., 2009; Simon, 2006), while other research has linked suicidal behavior with hopelessness, impulsivity, aggression, a history of trauma or abuse, and any previous suicide attempt (Beck, Brown, Berchick, & Stewart, 1990; Brown, 2006; Brown, Jeglic, Henriques, & Beck, 2006; Linehan, 1993; Martin, Ghahramanlou-Holloway, Lou, & Tucciarone; 2009; Schneidman, 1996).

Research on sociocultural risk factors suggests that race/ethnicity, marital status, lack of social support, a sense of isolation or not belonging, social losses, financial difficulties, stigma associated with help-seeking, and suicide as a noble or acceptable resolution of a personal dilemma associated with cultural or religious beliefs are correlated with suicide-related deaths (Clarke, Bannon, & Denihan, 2003; Kerkhof & Arensman, 2001; Kolves, Ide, & De Leo, 2010; Kposowa, 2000; Leenaars, 2008; Lester, 2008; Mann et al., 2005; Sartorius, 2007). Moreover, research on environmental risk factors indicates that access to lethal weapons and barriers to health care contribute to suicide-related deaths (Martin et al., 2009; Simon, 2006). Studies on the prevalence and risk factors associated with suicide-related deaths in military personnel have reported similar results. Specifically, mental disorders, substance abuse, physical illness, stigma, family separation, occupational difficulties, and relationship losses have been linked to suicide-related deaths among military personnel (Cox, Edison, Stewart, Dorson, & Ritchie, 2006; Ritchie, Keppler, & Rothberg, 2003).

This research has advanced our understanding of the prevalence and correlates of suicide-related deaths among military personnel. However, it is worth noting that little of this research has examined specific risk factors in relation to trends in Army suicides, particularly over the past decade, that is, 2001-2009. Examining the prevalence and risk factors associated with suicide-related deaths among Army personnel is particularly important given increasing operational demands associated with ongoing operations in Afghanistan and Iraq. In fact, research indicates that stress associated with deployment, combat intensity, and the potential shame of failure or weakness--all of which are known to increase the risk for mood disorders, anxiety disorders, post-traumatic stress disorder (PTSD), and substance-related disorders--have been linked to suicide-related deaths among military personnel (Allen, Cross, & Swanner, 2005; Bodner, Ben-Artzi, & Kaplan, 2006; Hill, Johnson, & Barton, 2006; Hoge et al., 2008; Rand Center for Military Health Policy Research, 2008). Moreover, it is worth noting that many of these risk factors may be accompanied by increased availability of firearms within the military as compared to civilian society (Marzuk et al., 1992).

Additionally, certain risk factors may differentially impact military personnel. For example, the loss of friends, particularly those assigned to the same unit, can have a deep impact, whether in combat or not (Kang & Bullman, 2008). Stress may be greater in the Army population because of increased dependence on social support provided by friends and coworkers in the military environment (Mahon, Tobin, Cusack, Kelleher, & Malone, 2005). Externalized psychopathology (drug and particularly alcohol abuse or dependence) may be more evident in the military due to greater cultural acceptability of these behaviors (Hills, Afifi, Cox, Bienvenu, & Sareen, 2009). Stigma associated with help-seeking behavior or treatment may also be more prevalent in the military, because mental illness is often viewed as a manifestation of weakness or malingering, as well as a threat to one's career (Hoge et al., 2008; Rand Center, 2008).

This is only the beginning of the article.

Thanks to Ken Pope for this information.

As military struggles with suicides, a push for seeking help

By Adam Ashton
Tacoma News Tribune

A Washington state social worker is circulating a petition urging federal lawmakers and the military to adopt a policy declaring that service members shouldn't be punished if they seek help for behavioral health issues, such as post-traumatic stress.

Patricia Bailey, 45, believes the lack of a firm policy on whether service members could be held back in their careers for seeking counseling is one of the main obstacles keeping people in the military from pursuing treatment.

"It will give reassurance to him that if he seeks mental health counseling nothing will be in jeopardy," said Bailey, whose 13-year marriage to a Joint Base Lewis-McChord soldier ended in 2008 as stress built during his deployments to Iraq.

She's targeting a gray area in the military's evolving suicide prevention and post-traumatic stress programs. Leaders at the Pentagon and at Lewis-McChord insist service members won't face professional repercussions for seeking counseling, but it's not clear how well that message reaches down the ranks.

An April study on military suicides released by the nonprofit RAND Corporation pointed out that the Defense Department hasn't taken concrete steps to reverse a perception that service members might be retired for medical reasons or lose out on a promotion if they ask for counseling. The study received funding from the Defense Department.

Bailey got a close view of Lewis-McChord's behavioral health services both as a part-time counselor between 2002 and 2004 and as someone who later reached out for help in keeping her marriage together. She'd like to see a greater emphasis on preventive programs instead of ones that kick in after an outburst, such as an arrest.

"When my husband and I were going through everything, I asked people for help," she said. "I wasn't shy. And they said 'We can't do anything for you.' You're frustrated because you can't do anything. I didn't want my marriage to end."

She's one of many people in the South Sound who are raising their voices to draw attention to the psychological toll 10 years of warfare have taken on military families. In the past year, service clubs have organized retreats for Army couples and the United Way of Pierce County put forward a proposal to deliver more resources to military families.

The military, likewise, is looking for new approaches. Madigan Army Medical Center increased its ranks of behavioral health specialists last year. Lewis-McChord recently hired a new suicide prevention officer.
Yet the Army and the base continue to struggle with how to reach distressed service members.

The Army reported that it was investigating 32 possible suicides in July, the most in any month over the past two years. Lewis-McChord officials told Sen. Patty Murray, D-Wash., that nine soldiers took their lives this year.

Read more here.

Vets face shortage of therapists

New program training clinicians in psychology of combat is an attempt to help fill the gap

By Peter Cameron, Special to the Tribune

When Daniel Brautigam tried to tell therapists how he felt having urine thrown in his face at Guantanamo Bay, he experienced the same frustration as thousands of other returning veterans who have sought counseling.

"They had no idea how to respond to that. It looked like to me that they were grossed out, and they're supposed to be helping me," said Brautigam, 31, who was diagnosed with post-traumatic stress disorder and depression following his return to Hoffman Estates from tours with the Navy in the Northern Arabian Gulf and Cuba.

The Department of Veterans Affairs estimates that 11 percent to 20 percent of veterans from the wars in Afghanistan and Iraq are suffering from PTSD. Others think the number is higher.
When vets seek therapy, they want a professional who can relate to soldiers in combat, and that usually means a therapist who has military experience. Without such empathy, therapy often is doomed, vets say.

Because most psychologists and mental health care professionals don't have a military background, there's a void in the safety net for vets. Some veterans' organizations have stepped up, training members to help their peers, and the Soldiers Project provides free counseling from licensed professionals and veterans by phone to newly returned vets.

A counselor to ex-soldiers for 35 years, Ray Parrish, 58, a self-described angry veteran, sees the problem on a daily basis. He is the benefits director for Vietnam Veterans Against the War in Chicago and helps those trying to navigate the bureaucracy of the Veterans Administration.

"There quite literally are not enough people that have knowledge of veterans' experiences and who have the professional expertise to provide them the health that they need," Parrish said. "That means that all of the veterans get inadequate care."

A new attempt to fill the gap is coming from the Adler School of Professional Psychology in Chicago, which this fall is launching a military specialization track for its doctorate of clinical psychology program. Joe Troiani, a faculty member and Navy veteran who created the track, said the school hopes to prepare students for the specific psychological problems that stem from military service. They will take such classes as the psychology of terrorism, and psychology of combat and conflict.

But some vets scoff at the idea of learning about the horrors of war in the classroom.

"You're dealing with a whole different mindset with a soldier," said Tim Miller, 30, of Chicago, a veteran of the Iraq war who is now studying to be a clinical psychologist at Argosy University. "You can't just wrap your head around that from reading a book."

Troiani called that criticism fair but said the school is training students how to treat the psychological effects of combat, rather than trying to re-create the experience of living in a war zone.

Read the story here.