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The social, psychological, and occupational issue of military suicides has
received tremendous amounts of press-time in the past decade, as surges in
fatal suicide attempts amongst service-members have surpassed civilian rates,
a statistic which is startling since wartime suicide rates among military
personnel are typically far lower than contemporaneous civilians (Bryan,
2012) (Nock, 2013). This literature review seeks to further understand the
risks which lead to this needless fatal endpoint, as well as the proposed
solutions that have been presented by experts in the field of military
occupational suicide. Common conceptions about military suicide risks will
be examined, and research will be presented to offer new insight onto the topic
from the perspective of mental and behavioral health
Introduction
Methods
1. Common (mis)understandings of military suicide are guided by many
subjective biases, but not by science.
1. Deployment not associated with rate of suicide (HR = 0.96, CI
= 0.87-1.05). (Reger, 2015)
2. Combat experiences may account for one of the three factors
influencing suicide: the acquired capability to be fearless of
pain and death. It does not influence the other two: feelings of
burdensomeness, and not belonging. (Bryan, 2010)
3. In fact, between 2005-2008 there were increases in attempted
suicides for those who had NOT been combat deployed.
(Bray, 2010).
4. Theater of deployment may not represent a significant risk for
suicidal tendencies. (Wong, 2001)
5. Post traumatic stress disorder (PTSD) or traumatic brain
injury (TBI) are not constant significant indicators of
suicidality. (Skopp, 2012)
6. Rank, education, residence, or alcohol intoxication at death
were not always significant indicators for military suicide.
(Mahon, 2005)
2. Important findings from current research:
1. Risk factors that were common across studies, or not
contradicted across studies:
1. psychiatric illness; a past history of deliberate self-harm;
access to firearms; medical downgrading; and
demographic factors such as being a young male (Mahon,
2005);
2. substance abuse; relationship or familial problems; poor
coping skills; legal or financial problems; social isolation
(Knox, 2003);
3. other-than-honorable discharge; separation from military
service (Reger, 2015);
4. (causality not established) deficiencies in neuroactive
unsaturated omega-3 fatty acids; witnessing friendly
casualties (Lewis, 2011);
5. psychosocial stress (Wong, 2001);
6. (associations with) heavy stress; heavy alcohol use (Bray
2010);
7. impulsivity; aggressive traits; neurocognitive deficits;
early life stressors; significant negative life events (Nock,
2013).
2. Differences exist between the branches of U.S. military
service, as well as between other countries’ militaries
Literature Review
1. USAF suicide prevention program (Knox, 2003)
1. Evaluation of results from suicide prevention program on
risk of suicide, family violence, accidental death, and
homicide
2. Intervention approach: culturally remove stigma for
seeking help with mental health, enhancing understanding
of mental health, changing policies and social norms
3. Results: 33% relative risk reduction for suicide post-
intervention. Reductions among other factors, too.
2. Assessment of occupation-specific risk factors for Irish military
suicides (Mahon, 2005)
1. Suicides occurred more frequently when alone, after duty
commencement in the morning
2. Firearm suicides account for 53% of Irish military suicides,
and 61% of US military suicides
3. Recommendations: Incorporate mental health screenings in
annual, pre/post deployment, and in all consultations;
restrict weapons/ammo, and utilize buddy-system to reduce
alone time with weapons
3. Reformatting approaches to military suicide prevention (Bryan, 2012)
1. Recommendations: reconceptualize mental health in terms
that fit with military culture (e.g. mental fitness);
reconceptualize deployment as a life experience to develop
from; include population based suicide prevention;
integrate mental health promotion in all aspects of life;
incorporate multimodal approach to suicide
awareness/prevention education; implement evidence based
treatment for mental health conditions
4. Preventing suicide in the U.S. military (Ramchande, 2011)
1. Comprehensive programs must: raise awareness and
promote self-care, identify those at high risk, facilitate
access to high quality care, provide high quality mental
health care, restrict access to lethal means to those at risk
(weapon restrictions, engineering controls), and respond
appropriately
2. Different practices across the four main branches of the
military, however the USAF seems to have the best results
from their cultural changes in attitude amongst leaders,
required training, and standardized methods for monitoring
and protecting the privacy of those seeking help through
consolidated suicide prevention entities. The USMC
appears to do the worst, followed by the Army.
Literature Recommendations Conclusions
There is a significant amount of data on the subject of military suicides, and
the psychological and occupational factors that influence it, however there are
also gaps in our ability to understand its specific etiology, as well as how to
best prevent it.
That said, there are no shortage of recommendations for how to prevent it.
Sifting through these claims, and finding evidence-based solutions will be
critical for the service branches and the DoD in order to reverse or slow the
trend of rising military occupational suicides. Many of the best
recommendations involve reframing mental health within the culture of the
military, as well as utilizing proven systems of identification, mental health
care, and restricting the means by which suicide may occur.
References
1. Bray, R. P. (2010). Substance use and mental health trends among US military active duty
personnel: key findings from the 2008 DoD health behavior survey. Military Medicine,
175, 390-399. Retrieved from http://www.dtic.mil/dtic/tr/fulltext/u2/a523045.pdf
2. Bryan, C. C. (2010). Combat experience and the capability for suicide. Journal of
Clinical Psychology, 66(10), 1044-1056.
3. Bryan, C. J. (2012). Understanding and preventing military suicide. Archives of Suicide
Research, 16(2), 95-110.
4. Knox, K. L. (2003). Risk of suicide and related adverse outcomes after exposure to a
suicide prevention programme in the US Air Force: cohort study. British Medical
Journal, 327, 1376. Retrieved from http://www.bmj.com/content/327/7428/1376
5. Lewis, M. H. (2011). Suicide deaths of active duty US military and omega-3 fatty acid
status: a case control comparison. J Clin Psychiatry, 72(12), 1585-1590.
6. Mahon, M. T. (2005). 1. Suicide among regular-duty military personnel: A Retrospective
case-control study of occupation-specific risk factors for workplace suicide. American
Journal of Psychiatry, 162, 1688-1696. Retrieved from
http://www.lenus.ie/hse/bitstream/10147/221317/1/militarypersonnel.pdf
7. Nock, M. D. (2013). Suicide among soldiers: a review of psychosocial risk and protective
factors. Psychiatry, 76(2), 97-125.
8. Ramchande, R. A. (2011). The war within: Preventing suicide in the US military. Santa
Monica: RAND. Retrieved from
http://www.rand.org/content/dam/rand/pubs/monographs/2011/RAND_MG953.pdf
9. Reger, M. S. (2015). Risk of Suicide Among US Military Service Members Following
Operation Enduring Freedom or Operation Iraqi Freedom Deployment and Separation
From the US Military. Journal of the American Medical Association, 72(6), 561-569.
10. Skopp, N. T.-G. (2012). 10. Relations between suicide and traumatic brain injury,
psychiatric diagnoses, and relationship problems, active component, US armed forces,
2001-2009. Medical Surveillance Monthly Report, 19(2), 7-11.
11. Wong, A. E. (2001). Are UN peacekeepers at risk for suicide? Suicide and Life-
Threatening Behavior, 31(1), 103-112.
Contact
Author: Benjamin David Holland (Indiana University)
Contact information: bendholl@umail.iu.edu; (703) 727-8013
This literature review studies some of the most important research on military
personnel suicide risk factors, protective factors, and proposals for solutions.
Sources were gathered through a snowballing approach, or specific literature
searches for particular variables (such as service deployment, substance use,
or traumatic brain injury). Resources originated from a variety of sources,
including peer reviewed journals, military medical journals, and review
publications for legislative purposes.
Analysis of results from the studies was done through a thorough review of
each article’s findings, as well as their conclusions or suggestions.
Insignificant or otherwise non-relevant results were omitted from thorough
review or inclusion in the current literature review.
Benjamin D. Holland
Literature Review on Understanding and Preventing
Military Service Related Suicides
Suicide rates by US military service branch.
(Ramchande, 2011)
Comparison between US Army active duty
suicides and civilians (2004-2009). (Nock, 2013)
3. Gaps and limits in research:
1. Inadequate data to understand when, where, and among whom
suicide may occur
2. Differences in record keeping
3. Differences of opinions on risks and protective factors, and the
development of suicidal psychological pathways
4. Contradictions between studies, as well as with preventative
methods between services
5. Lack of prospective studies
Proposed chart of factors for suicidal behavior amongst military
personnel (Nock, 2013)
Chart ranking conclusions about different methods of suicide
prevention across service branches. (Ramchande, 2011)
Source: GQ Magazine (http://www.gq.com/story/veteran-suicide-daniel-
wolfe?mbid=social_twitter)