Review of Article “Suicide Among Regular-Duty Military Personnel"
I recently read an article titled “Suicide Among Regular-Duty Military Personnel: A Retrospective Case-Control Study of Occupation-Specific Risk Factors for Workplace Suicide”, written by Mahon, Tobin, Cusack, Kelleher, and Malone (2005). This article stated that suicide is the second most killer of active-duty military members, in which they took their lives, usually while they were at work, shortly after they began their work for the day. The authors used a retrospective, case-controlled study, which was aimed at determining if there was a correlation between possibly specific occupational risk factors.
Mahon et al., (2005) determined the service member’s risk factors by using a chi-squared analysis, which can also be translated as the authors using an independent t test, which they entered a binary logistic regression analysis model. According to the authors “The period-averaged suicide rate for the cohort was 15.3/100,000. Firearm suicides accounted for 53% of the cases” (Mahon et al., 2005). Additionally, the authors were able to identify whether if a service members, past psychiatric illnesses, including tendencies of self-harm, were an independent risk factor; the authors determined this through bivariate and logistic regression analyses
The authors were concerned with not only the United States military, but the military of numerous nations. The authors believed that certain occupational factors can influence the prevalence of suicide, including the access of lethal weapons. ”In regular-duty military personnel, a medical downgrading, combined with risk factors established in civilians such as younger age, male gender, psychiatric illness, and past self-harm, increases the risk of suicide. The findings may be used to guide military harm-reduction strategies and have applicability in strategies for other professions at risk for workplace suicide” (Mahon et al., 2005).
In one cohort study that the authors conducted, the untimely deaths of 732 military forces, specifically the Irish Defense Forces were analyzed between the years of 1970-2002; of these deaths, the authors claimed that 8.5 percent or 63 deaths were that of a suicide. However, the authors stated that of 100,000 individuals in the general population ages 20-65 years of age, approximately 18.3 individuals will commit suicide per year, comparing this against the 15.3 individuals in the Irish Defense Forces.
According to the author, “the results of the pair-matched case-control bivariate analysis of data for all personnel who died by suicide (N=63) and the comparison subjects with nonskid deaths (N=63). The following eacharacteristics were significantly associated with suicide: a psychiatric diagnosis (odds ratio=11.9, 95% confidence interval [CI]=3.3-42.6), a past history of deliberate self-harm (odds ratio=2.1, 95% CI=1.8-2.6), a recent psychiatric assessment (odds ratio= 2.2, 95% CI=1.8-2.6), being on morning duty (odds ratio= 3.3, 95% CI=1.2-9.7), and being on a military site (odds ratio=4.7, 95% 01=2.1-10.6)” (Mahon et al., 2005).
Bivariate analysis demonstrated no significant increase in risk of death by suicide, compared to other causes, related to rank or service corps, but a chi-square test for trend of the relative contributions to the number of suicides by rank was highly significant (trend χ^sup 2^=73.1, df=2, p<0.001), suggesting that suicides of privates (lowest non-commissioned rank) disproportionately contributed to the total number of suicides. However, a chi-square test of proportions (unordered data) examining the relative contribution to the number of suicides by service corps was not significant (χ^sup 2^=0.91, df=2, p>0.05). ] Another article, written by Scoville, Vubata, Potter, White, and Pearse (2007), called “Deaths Attributed to Suicide among Enlisted U.S. Armed Forces Recruits, 1980- 2004”, had similar research interests, since both experiment’s subjects were in the military and had exposure to lethal weapons.
The authors claimed that this study’s purpose was to uncover the epidemiology of the suicides amongst all U. S.military branches, including the U.S. Air Force, Army, Marine Corps, and Navy recruits from 1980 through 2004. The method that the authors incurred the information needed to conduct this study was through the Department of Defense Recruit Mortality Registry. The authors used mortality rates of 100,000 recruits per year. “Methods included gunshot (70%), hanging (20%), fall/jump (5%), and poisoning (5%). Therefore, the overall recruit suicide rate was 6.9 (95% confidence interval = 5.4-8.8) deaths per 100,000 recruit-years” (Scoville, 2007).
The authors claim that only 5% of suicides which occurs in recruits are females, and that males had a three fold likelihood of committing suicide than a female (95% confidence interval = 1.1-11.2)” (Scoville et al, 2007). Even though every individual is a possible candidate to commit suicide, individuals in the military are frequently involved with an environment which is frequently violent. Even more so, individuals in basic training, or “boot camp”, are even more surrounded with this way of life and thinking, then individuals who are active duty.
However, the authors concluded, that suicide amongst recruits is lower than in the general civilian population because recruits are constantly monitored, and are screen for psychological issues before enlistment. Unfortunately, there were 46 onsite suicides from 1980 through 2004, resulting to a crude suicide rate of 4.8 deaths (95% CI = 3.6-6.4) per 100,000 recruit-years. The overall age-adjusted suicide rate for the Army was 1.5 to 3.6 times higher than the other services. Only 2 suicides occurred among women and both were to the Army. The all-service rate was triple for males compared to females (rate ratio = 3.7; 95% CI = 0.9-15.2)”.The highest all-service 5-year suicide rate (7.1 deaths per 100,000 recruit-years) occurred from 1985 through 1989.
During thistime period, the Army's suicide rate (11.0 deaths per 100,000 recruit-years) was at its highest throughout the entire study period. The median age at the time of fatal incident was 19 years (range, 17-35) and most (80%) were Caucasian. The median training duration was 41 days (range, 4-88). The majority (76%) of these deaths took place while the recruits were in regular training status. The other 11 suicides occurred while the recruits were: awaiting administrative separation (5), inpatients to the hospital (4), or both (2). Reasons for administrative separation included medical conditions (asthma, somnambulism, and plantar fasciitis), psychiatric illness, and criminal activity (i.e., theft of another recruit's property).
Methods of suicide included gunshot (39%), hanging (35%), fall/jump (22%), and drug overdose (4%).Of the 18 gunshot suicides, the median age was 18 years (range, 18-24) and all but 1 were male. Most were Caucasian (78%), with 3 African Americans, and 1 Asian. All were on regular duty status. Gunshots were the most common method of suicide used by both Army (48%) and Marine Corps (50%) recruits; there were no gunshot suicides identified among Air Force and Navy recruits (Table III). According to the authors retrospective study, the authors claimed that recruits from the years 1980 to 2004 who had the highest risk to commit suicide were males and single recruits This retrospective descriptive study Identified 66 suicides among military recruits from 1980 through 2004, with higher risk among males and single recruits.
The all-service suicide rate was 3.5 times higher among males compared to females, and comparison of pre-enllstment data found a significantly higher proportion of single recruits among the suicides compared to nontraumatic cardiac deaths. These findings of Increased risk among males and single military personnel have been previously described In other military populations.
The exclusion of all three female suicides from the calculation of age-specific mortality rates enabled comparison of male recruit suicide rates to civilian males and further supports the previous finding of lower suicide rates among military recruits.3 The authors claim that one limitation to their study was that they could not include recruits who were enlisted in the reserve component, since those statistics were not available. Also, since ethniticity was not categorized over a 25 year period, that specific population data could not be categorized. Lastly, since only 17% of recruit deaths from the years 1977-2001 were from suicides, there was a significant population limits in terms of analyzability and interpretation.
Mahon, M.J., Tobin, J.P., Cusack, D.P., Kelleher, C., & Malone, K. Suicide Among
Regular-Duty Military Personnel: A Retrospective Case-Control Study of Occupation-Specific Risk Factors for Workplace Suicide. The American Journal of Psychiatry, 162(9), 1688-96. Retrieved September 5, 2008, from ProQuest Psychology Journals database. (Document ID: 896717611).
Scoville, S.L., Gubata, M.E., Potter, R.N., White, M.J., & Pearse, L.A. (2007). Deaths
Attributed to Suicide among Enlisted U.S. Armed Forces Recruits, 1980-2004. Military Medicine, 172(10), 1024-31. Retrieved September 8, 2008, from ProQuest Psychology Journals database. (Document ID: 1395006861).