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Suicide in the military

From Wikipedia, the free encyclopedia

Suicide in the military is the act of ending one's life during or after a career in the armed forces.

A suicide prevention poster shows a photograph of three American soldiers with their arms around each other, facing away from the camera.
US army suicide prevention poster, 2012

While suicide rates in military organizations vary internationally, official statistics in several countries show a consistently higher risk in certain subgroups.

In the United Kingdom (UK), young serving personnel are markedly more likely than older personnel and same-age civilians to end their lives.[1][2]

The risk among former military personnel is higher than among either serving personnel or the general population, according to research in Australia, Canada, the UK, and the United States (US).[3][4][5][6][7] The risk is particularly marked among veterans who joined up at a young age.[3][5][8][6]

Contrary to popular belief, deployment to a war zone has not been associated with an increased risk of suicide overall, according to research in Canada, Denmark, the UK, and the US.[4][9][10][11][12] Participating in, or witnessing killing and wounding, however, can increase the risk.[12]

A study of the US army found that the career stage carrying the greatest suicide risk was not deployment, but initial military training,[13] as a time of disorientation and stress.[14]

Individuals most at risk of suicide during or after a military career include those who: had a troubled childhood;[10] are of low rank;[3][4][1][15][16] have close-combat roles in war;[4][17] and/or leave service soon after joining.[3][8][18] Certain other known risk factors for suicide are common in military life, including depression,[19] posttraumatic stress disorder,[20] alcohol misuse,[20][21] bullying[22][23][24][25] and sexual harassment.[26][27][28][29]

Variations in the suicide rate in military populations may also signify changes in the prevalence of related mental health problems, such as anxiety, depression, and histories of self-harm.[30]

Incidence

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Research from Australia, Canada, the UK, and the US indicates that suicide is a pervasive problem in military life, particularly after personnel leave, and that the youngest are most affected.

Serving personnel

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In countries where data are collected, the rate of suicide among serving armed forces personnel varies widely. The table below presents rates among serving male personnel in the regular armed forces (i.e. excluding reserve forces) of four countries, with comparisons to the general population.

Suicides among serving regular male armed forces personnel in selected countries (with comparison to male general population matched for age)
Date range Crude rate per 100,000 Risk relative to general population
Australia[3] 2002–2019 11 -51%
Canada[4] 2015–2019 25 +122%
UK[1] 2002–2021 8 -57%
US[15] 2020 32 ≈0

Since most military personnel are male and suicide is a rare event, it is not usually possible to calculate a statistically significant rate among female personnel. The large military of the US is an exception, where the suicide rate among serving female personnel in 2020 was 12 per 100,000.[15]

Former personnel

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Typically, former personnel are more likely than serving personnel to end their lives. The table below shows suicide rates among ex-armed forces personnel for three countries.

Suicides among male former armed forces personnel in selected countries (with comparison to male general population matched for age)
Date range Crude rate per 100,000 Risk relative to general population
Australia[3] 2002–2019 30 +24%
Canada[4][5] 2015–2019 Not reported +39%
US[6][7] 2019 33 +52%

(The UK Ministry of Defence has announced that it will begin collecting and publishing official statistics on suicides in the ex-armed forces population from 2023.[31])

Research suggests that the period of maximum risk for those leaving the armed forces is in the years shortly following discharge: within two years in the UK and within four years in Canada.[8][5]

Young personnel and veterans

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Official statistics from Australia, Canada, the UK, and the US show that younger personnel face increased risks.

In the UK, for example, while the suicide rate among male serving soldiers overall was 57% lower than that in the general population between 2002 and 2021,[1] it was 31% higher among those under 20.[2] The graphs opposite illustrate the elevated risk in this youngest age group.

Graph showing suicide rates in the UK armed forces
Suicides among males in two age groups (16-19 and 25-29) serving in the regular UK armed forces (coloured lines) relative to the general population (black line), 1985-2020. Source: UK Ministry of Defence[2]

The risk among young former personnel is markedly higher than that among civilians of the same age and to older veterans. In the UK, for example, those who enlist young have been found to face an increased risk of self-harm[32] and suicide[8][2] after leaving the armed forces, relative both to older personnel and to their civilian peers. Compared with serving personnel of the same age, the suicide rate among young former personnel in the UK has been between two and three times as high, as is also the case in Australia.[3][8] In both countries and additionally in Canada, the relative risk of suicide among young former personnel is also consistently well above the rate found among civilians of the same age.[3][5][8]

The table below shows the rate of suicide among the youngest age groups for which data are collected in three countries (note varying date ranges).

Suicides among young male former armed forces personnel in selected countries (with comparison to male serving personnel and male general population, both matched for age)
Date range Age group Former personnel in age group: suicide rate per 100,000 Serving personnel in age group: suicide rate per 100,000 Former personnel: Suicide risk relative to general population
Australia[3] 2002–2019 Under 30 34 13 +68%
Canada[5] 1976–2014 Under 25 Not reported Not reported +152%
UK[8] 1996–2005 16–19 30 17 +193%
US[6] 2019 18–34 51 Not reported Not reported

At-risk individuals and groups

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Aerial photograph of British army barracks in Sennelager, Germany
British army base at Sennelager, Germany, where Cpl Anne-Marie Ellement reported that two of her colleagues had raped her in 2009. The coroner concluded that the rape and subsequent bullying by the army contributed to her suicide two years later.[33]

Individuals with experiences of distress are more susceptible to suicide. Certain such experiences are typically more common in the armed forces than in civilian life, according to research in various countries, including:

Similarly, research has found that suicide risk if higher in certain military subgroups than others. In addition to those of young age, higher risk is conferred to serving and former personnel who are:

Military risk factors

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Deployment

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Contrary to common assumption, deployment to a war zone (unless in a direct combat role) has not been associated with an increased risk of suicide, according to research in Canada, Denmark, the UK, and the US.[4][9][10][11][12][37][16] When considered overall, US veterans of the Vietnam War[37] and Iraq War,[12][16] for example, and British veterans of the 1982 Falklands War and 1991 Gulf War,[37] have not been more likely to end their lives as a consequence of their deployment.

However, common deployment experiences of certain military groups, such as those with close-combat roles like the infantry, do carry additional suicide risks. For example, research in the US has found that specific types of traumatic war experience add to the risk, including killing and injuring others, or witnessing the same.[12]

Even so, most suicide attempts in the US army are by personnel who have never been to war.[13] According to one large study, US infantry soldiers who had never been deployed were twice as likely to end their lives as those who had.[17]

Initial training

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US Army drill sergeants beasting a recruit during initial training.

A study of the US army found the peak period for attempted suicide not to be during or after deployment, but initial training,[13] a time of prolonged psychological coercion, disorientation and stress.[14] It identified three career-stage points when suicide attempts were most likely, namely early in initial training, late in a first operational tour, and a few months after homecoming. Of these, initial training was the period of greatest risk, with a rate of attempted suicide four times as high as that found during a first deployment.[13] The graph below presents the study's results.

Peak career stage points for attempted suicide in the US army, 2004-2009
Time point Attempts per 100,000 person-months
Second month of initial training
 
 103
Sixth month of first deployment
 
 25
Fifth month after first deployment
 
 40
Source: Ursano et al., 2016

Pre-military adversity

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Some research further suggests that the childhood background of military personnel may play a role in increasing the average suicide risk during and after military life.[36] In the UK, for example, the army enlists new soldiers disproportionately from economically deprived neighbourhoods,[38] where adverse childhood experiences (ACEs) are more common.[39] Since ACEs bear a strong relationship both to stress-related mental health problems such as anxiety and depression,[36] and to self-harm and suicide,[35] this accounts in part for the additional mental health burden found in military populations recruited largely from economically marginalised communities.[36]

Since adolescents with an adverse childhood background are relatively susceptible to the toxic effects of prolonged stress,[40][41][42][43] some health professionals have argued that the coercive resocialisation involved in initial military training may load a particularly heavy psychological burden on these younger recruits, as may any traumatic war experiences later.[42][43]

Protective factors

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In countries where suicide rates among serving personnel as a whole are lower than among civilians, a frequently proposed explanation is the healthy worker effect.[1] This refers to the relatively strong health of people in employment versus the general population, a portion of whom are not economically active. The healthy worker effect may be particularly pronounced in military populations, which are selected for mental health before enlistment.[44] After enlistment, personnel may further benefit from a relatively active lifestyle, conveying an additional health advantage over the general population.

These protective factors may be lost on leaving the armed forces, however.

See also

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References

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  1. ^ a b c d e f g Ministry of Defense (31 March 2022). "Suicides in the UK regular armed forces: Annual summary and trends over time" (PDF). gov.uk. Retrieved 26 August 2022.
  2. ^ a b c d UK Ministry of Defense (31 March 2022). "UK armed forces suicides: 1984 to 2021 data tables". gov.uk. Retrieved 30 August 2022.
  3. ^ a b c d e f g h i j k l Australian Institute of Health and Welfare (29 September 2021). "Serving and ex-serving Australian Defense Force members who have served since 1985: suicide monitoring 2001 to 2019". aihw.gov.au. Retrieved 26 August 2022.
  4. ^ a b c d e f g h i j k Department of National Defense (11 May 2022). "2021 Report on Suicide Mortality in the Canadian Armed Forces (1995 to 2020)". www.canada.ca. Retrieved 30 August 2022.
  5. ^ a b c d e f Simkus, Kristen; Hall, Amy; Heber, Alexandra; VanTil, Linda (18 June 2020). "2019 Veteran Suicide Mortality Study". Veterans Affairs Canada. Retrieved 30 August 2022.
  6. ^ a b c d US Department of Veterans Affairs (Office of Mental Health and Suicide Prevention) (September 2021). "2001-2019 National Suicide Data Appendix". va.gov. Retrieved 30 August 2022.
  7. ^ a b US Department of Veterans Affairs (Office of Mental Health and Suicide Prevention) (September 2021). "2021: National Veteran Suicide Prevention Annual Report" (PDF). va.gov. Retrieved 30 August 2022.
  8. ^ a b c d e f g h Kapur, Navneet; While, David; Blatchley, Nick; Bray, Isabelle; Harrison, Kate (3 March 2009). Hotopf, Matthew (ed.). "Suicide after Leaving the UK Armed Forces —A Cohort Study". PLOS Medicine. 6 (3): e1000026. doi:10.1371/journal.pmed.1000026. ISSN 1549-1676. PMC 2650723. PMID 19260757.
  9. ^ a b Vedtofte, Mia S.; Elrond, Andreas F.; Erlangsen, Annette; Nielsen, Anni B. S.; Stoltenberg, Christian D. G.; Marott, Jacob L.; Nissen, Lars R.; Madsen, Trine (12 October 2021). "Combat Exposure and Risk of Suicide Attempt Among Danish Army Military Personnel". The Journal of Clinical Psychiatry. 82 (6): 20m13251. doi:10.4088/JCP.20m13251. ISSN 1555-2101. PMID 34644465. S2CID 238859228.
  10. ^ a b c d Pinder, Richard J.; Iversen, Amy C.; Kapur, Nav; Wessely, Simon; Fear, Nicola T. (July 2012). "Self-harm and attempted suicide among UK Armed Forces personnel: Results of a cross-sectional survey". International Journal of Social Psychiatry. 58 (4): 433–439. doi:10.1177/0020764011408534. ISSN 0020-7640. PMID 21693487. S2CID 17096673.
  11. ^ a b Armed Forces Health Surveillance Center (AFHSC) (June 2012). "Deaths by suicide while on active duty, active and reserve components, U.S. Armed Forces, 1998-2011". MSMR. 19 (6): 7–10. ISSN 2152-8217. PMID 22779434.
  12. ^ a b c d e f Reger, Mark A.; Tucker, Raymond P.; Carter, Sarah P.; Ammerman, Brooke A. (4 October 2018). "Military Deployments and Suicide: A Critical Examination". Perspectives on Psychological Science. 13 (6): 688–699. doi:10.1177/1745691618785366. ISSN 1745-6916. PMID 30286298. S2CID 52920340.
  13. ^ a b c d Ursano, Robert J.; Kessler, Ronald C.; Stein, Murray B.; Naifeh, James A.; Aliaga, Pablo A.; Fullerton, Carol S.; Wynn, Gary H.; Vegella, Patti L.; Ng, Tsz Hin Hinz; Zhang, Bailey G.; Wryter, Christina L.; Sampson, Nancy A.; Kao, Tzu-Cheg; Colpe, Lisa J.; Schoenbaum, Michael (1 July 2016). "Risk Factors, Methods, and Timing of Suicide Attempts Among US Army Soldiers". JAMA Psychiatry. 73 (7): 741–749. doi:10.1001/jamapsychiatry.2016.0600. ISSN 2168-6238. PMC 4937827. PMID 27224848.
  14. ^ a b McGurk; et al. (2006). 'Joining the ranks: The role of indoctrination in transforming civilians to service members', (in 'Military life: The psychology of serving in peace and combat [vol. 2]'). Westport: Praeger Security International. pp. 13–31. ISBN 978-0275983024.
  15. ^ a b c d e f Department of Defense (30 September 2020). "Annual suicide report" (PDF). Defense Suicide Prevention Office. Retrieved 26 August 2020.
  16. ^ a b c d e Kang, Han K.; Bullman, Tim A.; Smolenski, Derek J.; Skopp, Nancy A.; Gahm, Gregory A.; Reger, Mark A. (February 2015). "Suicide risk among 1.3 million veterans who were on active duty during the Iraq and Afghanistan wars". Annals of Epidemiology. 25 (2): 96–100. doi:10.1016/j.annepidem.2014.11.020. ISSN 1873-2585. PMID 25533155.
  17. ^ a b c Kessler, R. C.; Stein, M. B.; Bliese, P. D.; Bromet, E. J.; Chiu, W. T.; Cox, K. L.; Colpe, L. J.; Fullerton, C. S.; Gilman, S. E.; Gruber, M. J.; Heeringa, S. G.; Lewandowski-Romps, L.; Millikan-Bell, A.; Naifeh, J. A.; Nock, M. K. (November 2015). "Occupational differences in US Army suicide rates". Psychological Medicine. 45 (15): 3293–3304. doi:10.1017/S0033291715001294. ISSN 0033-2917. PMC 4860903. PMID 26190760.
  18. ^ a b Reger, Mark A.; Smolenski, Derek J.; Skopp, Nancy A.; Metzger-Abamukang, Melinda J.; Kang, Han K.; Bullman, Tim A.; Perdue, Sondra; Gahm, Gregory A. (1 June 2015). "Risk of Suicide Among US Military Service Members Following Operation Enduring Freedom or Operation Iraqi Freedom Deployment and Separation From the US Military". JAMA Psychiatry. 72 (6): 561–569. doi:10.1001/jamapsychiatry.2014.3195. ISSN 2168-622X. PMID 25830941.
  19. ^ a b Goodwin, L.; Wessely, S.; Hotopf, M.; Jones, M.; Greenberg, N.; Rona, R. J.; Hull, L.; Fear, N. T. (July 2015). "Are common mental disorders more prevalent in the UK serving military compared to the general working population?". Psychological Medicine. 45 (9): 1881–1891. doi:10.1017/S0033291714002980. ISSN 1469-8978. PMID 25602942. S2CID 3026974.
  20. ^ a b c d Inoue, Catarina; Shawler, Evan; Jordan, Christopher H.; Jackson, Christopher A. (2022), "Veteran and Military Mental Health Issues", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 34283458, retrieved 30 August 2022
  21. ^ a b Irizar, P; Leightley, D; Stevelink, S; Rona, R; Jones, N; Gouni, K; Puddephatt, J-A; Fear, N; Wessely, S; Goodwin, L (21 January 2020). "Drinking motivations in UK serving and ex-serving military personnel". Occupational Medicine. 70 (4): 259–267. doi:10.1093/occmed/kqaa003. ISSN 0962-7480. PMC 7305700. PMID 31961932.
  22. ^ a b Klomek, Anat Brunstein; Sourander, Andre; Gould, Madelyn (May 2010). "The Association of Suicide and Bullying in Childhood to Young Adulthood: A Review of Cross-Sectional and Longitudinal Research Findings". The Canadian Journal of Psychiatry. 55 (5): 282–288. doi:10.1177/070674371005500503. ISSN 0706-7437. PMID 20482954. S2CID 23962627.
  23. ^ a b Koeszegi, Sabine T.; Zedlacher, Eva; Hudribusch, René (April 2014). "The War against the Female Soldier? The Effects of Masculine Culture on Workplace Aggression". Armed Forces & Society. 40 (2): 226–251. doi:10.1177/0095327X12460019. ISSN 0095-327X. S2CID 145747427.
  24. ^ a b Østvik, Kristina; Rudmin, Floyd (1 January 2001). "Bullying and Hazing Among Norwegian Army Soldiers: Two Studies of Prevalence, Context, and Cognition". Military Psychology. 13 (1): 17–39. doi:10.1207/S15327876MP1301_02. ISSN 0899-5605. S2CID 40886078.
  25. ^ a b Cooper, Charlotte; Gee, David (27 May 2021). "Has the Time Come for an All-Adult Army?". rusi.org. Retrieved 30 August 2022.
  26. ^ a b British army (2015). "Sexual harassment report 2015" (PDF). gov.uk. Retrieved 8 March 2018.
  27. ^ a b Anderson, E H; Suris, A (2013). "Military sexual trauma". In Moore, Brett A; Barnett, Jeffrey E (eds.). Military psychologists' desk reference. Oxford: Oxford University Press. pp. 264–269. ISBN 978-0-19-992826-2. OCLC 828143812.
  28. ^ a b Hanson, Linda L. Magnusson; Nyberg, Anna; Mittendorfer-Rutz, Ellenor; Bondestam, Fredrik; Madsen, Ida E. H. (2 September 2020). "Work related sexual harassment and risk of suicide and suicide attempts: prospective cohort study". BMJ. 370: m2984. doi:10.1136/bmj.m2984. ISSN 1756-1833. PMC 7463167. PMID 32878868.
  29. ^ a b Kimerling, Rachel; Makin-Byrd, Kerry; Louzon, Samantha; Ignacio, Rosalinda V.; McCarthy, John F. (1 June 2016). "Military Sexual Trauma and Suicide Mortality". American Journal of Preventive Medicine. 50 (6): 684–691. doi:10.1016/j.amepre.2015.10.019. ISSN 0749-3797. PMID 26699249.
  30. ^ Mental Health Foundation. "Suicidal thoughts". www.mentalhealth.org.uk. Retrieved 30 August 2022.
  31. ^ UK Ministry of Defence (22 September 2021). "Veteran suicide figures to be recorded for the first time". GOV.UK. Retrieved 30 August 2022.
  32. ^ Cooper, Charlotte; Gee, David; McCoy, David (26 May 2021). "Do Junior Entrants to the UK Armed Forces have worse outcomes than Standard Entrants? [Response]". BMJ Mil Health. 169 (3): 218–224. doi:10.1136/bmjmilitary-2021-001787. ISSN 2633-3767. PMID 33879526. S2CID 233313427.
  33. ^ Walker, Peter (3 March 2014). "Anne-Marie Ellement: MoD urged to review care of vulnerable soldiers". the Guardian. Retrieved 24 August 2022.
  34. ^ Whisman, Mark A.; Salinger, Julia M.; Labrecque, Lindsay T.; Gilmour, Anna L.; Snyder, Douglas K. (April 2020). "Couples in arms: Marital distress, psychopathology, and suicidal ideation in active-duty Army personnel". Journal of Abnormal Psychology. 129 (3): 248–255. doi:10.1037/abn0000492. ISSN 1939-1846. PMID 31750678. S2CID 208214016.
  35. ^ a b Carbone, Jason T.; Jackson, Dylan B.; Holzer, Katherine J.; Vaughn, Michael G. (1 August 2021). "Childhood adversity, suicidality, and non-suicidal self-injury among children and adolescents admitted to emergency departments". Annals of Epidemiology. 60: 21–27. doi:10.1016/j.annepidem.2021.04.015. ISSN 1047-2797. PMID 33932570. S2CID 233477047.
  36. ^ a b c d Iversen, Amy C.; Fear, Nicola T.; Simonoff, Emily; Hull, Lisa; Horn, Oded; Greenberg, Neil; Hotopf, Matthew; Rona, Roberto; Wessely, Simon (December 2007). "Influence of childhood adversity on health among male UK military personnel". British Journal of Psychiatry. 191 (6): 506–511. doi:10.1192/bjp.bp.107.039818. ISSN 0007-1250. PMID 18055954. S2CID 28110839.
  37. ^ a b c Holmes, J.; Fear, N. T.; Harrison, K.; Sharpley, J.; Wessely, S. (20 May 2013). "Suicide among Falkland war veterans". BMJ. 346: f3204. doi:10.1136/bmj.f3204. ISSN 1756-1833. PMID 23690507. S2CID 206898096.
  38. ^ Child Rights International Network (21 August 2019). "Conscription by poverty? Deprivation and army recruitment in the UK" (PDF). crin.org. Retrieved 24 August 2019.
  39. ^ Walsh, David; McCartney, Gerry; Smith, Michael; Armour, Gillian (December 2019). "Relationship between childhood socioeconomic position and adverse childhood experiences (ACEs): a systematic review". Journal of Epidemiology and Community Health. 73 (12): 1087–1093. doi:10.1136/jech-2019-212738. ISSN 0143-005X. PMC 6872440. PMID 31563897.
  40. ^ Kishiyama, Mark M.; Boyce, W. Thomas; Jimenez, Amy M.; Perry, Lee M.; Knight, Robert T. (1 June 2009). "Socioeconomic Disparities Affect Prefrontal Function in Children". Journal of Cognitive Neuroscience. 21 (6): 1106–1115. doi:10.1162/jocn.2009.21101. ISSN 0898-929X. PMID 18752394. S2CID 11436047.
  41. ^ Paus, Tomáš; Keshavan, Matcheri; Giedd, Jay N. (12 November 2008). "Why do many psychiatric disorders emerge during adolescence?". Nature Reviews Neuroscience. 9 (12): 947–957. doi:10.1038/nrn2513. ISSN 1471-003X. PMC 2762785. PMID 19002191.
  42. ^ a b Campbell, Katharine Ann (1 June 2022). "Childhood trauma: a major risk factor in the military recruitment of young people". BMJ Military Health. 170 (2): 95–96. doi:10.1136/bmjmilitary-2022-002149. ISSN 2633-3767. PMID 35649690. S2CID 249277481.
  43. ^ a b Louise, R; et al. (17 November 2016). "The recruitment of children by the UK armed forces: A critique from health professionals". Medact. Archived from the original on 31 January 2018. Retrieved 31 January 2018.
  44. ^ Ministry of Defence (8 June 2021). "Information obtained under the Freedom of Information Act, ref. FOI2021/05259" (PDF). gov.uk. Retrieved 30 August 2022.
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