1. “Medically Ready Force…Ready Medical Force”
DCoE Summit
The Incidence of Suicide in the US Armed Forces: Select Findings from the Department of Defense Suicide Event Report (DoDSER) Larry D. Pruitt, Ph.D., Derek J. Smolenski, Ph.D., MPH, & Nigel E. Bush, Ph.D. National Center for Telehealth and Technology
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2. “Medically Ready Force…Ready Medical Force”
Disclosure
The views expressed in this presentation are those of the presenter and do not reflect the official policy of the Department of Defense or the U.S. Government.
I have no relevant financial relationships to disclose.
I do not intend to discuss devices, products or procedures which are off-label, unlabeled, experimental, and/or not FDA approved.
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3. “Medically Ready Force…Ready Medical Force”
Learning Objectives
At the conclusion of this presentation the participants will be able to:
Discuss the rates and risk factors associated with Service members that die by suicide.
Interpret how the occurrence of suicide differs between the U.S. general population and the Services.
Assess risk and plan interventions based on current risk factors affecting the Service member population.
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4. “Medically Ready Force…Ready Medical Force”
Biography
Larry D. Pruitt, Ph.D.
Program Lead for the DoD Suicide Event Reporting (DoDSER) system
Licensed Clinical Psychologist in the Research Division at T2
Ph.D. in Clinical Psychology from the University of Nevada, Reno, including a clinical internship at the Sierra Nevada VA Medical Center
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T2 & DCoE The National Center for Telehealth & Technology Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury DHA Healthcare Operations
Our Mission: To lead the innovation of health technology solutions for psychological health and traumatic brain injury, and deliver tested, valued health solutions that improve the lives of our nation’s warriors, veterans and their families.
Our vision is world-class health care and optimized health in the DoD through effective leveraging of behavioral science and technology.
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6. “Medically Ready Force…Ready Medical Force”
T2 Web Presence
afterdeployment.dcoe.mil
militarykidsconnect.dcoe.mil
dodser.t2.health.mil
startmovingforward.dcoe.mil
militaryparenting.dcoe.mil
familiesnearandfar.org
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T2 mobile Applications
Twenty T2 mobile applications as they appear on a mobile device
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8. A Day in the Life of T2 Applications
1,200
website visits
2,500 mobile apps downloaded
10,000 times mobile apps used
Daily use of T2’s mobile health products
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Research Endeavors
Telehealth
Can tele-mental health be delivered directly to the home?
Can telehealth save money?
Mobile Health
Can an ‘app’ really collect accurate psychological screening information?
Can internet-based self-care solutions for PTSD actually reduce symptoms?
Emerging Technologies
Is virtual reality exposure therapy better than the standard treatment for PTSD?
Suicide
Can a smartphone app improve clinical treatments for suicide behaviors?
Is mild TBI associated with military suicides?
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10. “Medically Ready Force…Ready Medical Force”
Logo for DoD Suicide Event Report
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11. Healthy Warrior Effect
U.S. Armed Forces’ suicide rates have traditionally been lower than the general population (Eaton et al., 2006)
Service Member Population:
- Is employed
- Meets basic educational and intellectual standards
- Participates in routine physical
conditioning
- Has access to health care services
- Passes basic enlistment criteria
The General Population:
- Includes the unemployed and those without housing and other resources
- Includes those with severe psychiatric disorders
- Includes teens and elderly individuals
- Includes other cohorts with known risk profiles for suicide
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Changing Landscape
Army suicide rates decreased significantly during WW I and II (Rothberg et al., 1987)
No evidence of an increase in suicide during Korean War or Vietnam War eras
Suicide rates among U.S. Service members have increased significantly between Vietnam era and Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) (Reger, et al., in press)
This increase during OEF/OIF has puzzled researchers
Contrasts with Healthy Warrior Effect by violating expectations of occurrence
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13. Unadjusted Suicide Rates 2008-2014
Suicides per 100,000 Service members
Unadjusted Suicide Rates
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14. Unadjusted Suicide Rates 2008-2014
Suicides per 100,000 Service members
Unadjusted Suicide Rates , by Service
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A Need for Better Data
DoD Suicide Event Report (DoDSER) System: - A web-based application to collect standardized DoD suicide surveillance data.
DoDSER Annual Report: - A congressionally reviewed report that characterizes and contextualizes Service member suicide data to inform decision makers.
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16. DoDSER Data Collection Process
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17. Select Findings CY 2014 DoDSER Annual Report
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18. “Medically Ready Force…Ready Medical Force”
CY 2014 Suicide Rates
438 deaths due to suicide
269 Active Component suicides
169 Reserve Component suicides
80 deaths in the Reserves
89 deaths in the National Guard
Combined Active Component Compared to Combined Reserves
Rates per 100,000
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19. Active Component Demographic Risk Factors
Rate Per 100,000 SMs
Age
Ethnicity
Race
Sex
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20. Active Component Demographic Risk Factors
Rate Per 100,000 SMs
Marital Status
Education
Rank
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21. “Medically Ready Force…Ready Medical Force”
Method of Suicide
68.3% of SM suicides were due to injuries caused by firearms
92.2% of these firearms were personal possessions
7.3% of these firearms were military issued
Firearm(s) present in the immediate environment of 63.1% of decedents
DoDSER 2014 Suicide Methods, by Service
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22. Methods for Attempted Suicide
Most frequent methods for attempting suicide were
Drug overdose (56.2%)
Sharp or blunt objects (13.9%)
Asphyxiation (11.5%)
DoDSER 2014 Suicide Attempt Method, by Service
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23. Health Care Utilization Prior to Suicide
60.9% of decedents had engaged medical, behavioral health, or support services within the 90 days prior to their death.
Known Treatment History, 90 Days Prior to Suicide
CY 2012
CY 2013
CY 2014
Reported categories are not mutually exclusive
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24. Behavioral Health History
49.8% of suicides had a history of at least one behavioral health disorder
14.2% had a history of major depressive disorder
9.9% were known to have a diagnosis of PTSD
49.1% had no known history of a behavioral health disorder
Known History of Behavioral Health Disorder
CY 2012
CY 2013
CY 2014
Reported categories are not mutually exclusive
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25. Communicated Potential for Self-Harm
29.2% of decedents made a known communication of potential for self-harm prior to the event
Verbal – 68.3% Text – 31.7% Written – 7.3% Other – 7.3%
Recipients of Communication Prior to Suicide
CY 2012
CY 2013
CY 2014
Reported categories are not mutually exclusive
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26. Psychosocial Stressors Relationships
36.7% of decedents had a failed intimate partner relationship within 90 days prior to suicide
Comparable proportion for suicide attempts (38.7%)
Family or Relationship Stressors 90 Days Prior to Suicide
CY 2012
CY 2013
CY 2014
Reported categories are not mutually exclusive
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27. Psychosocial Stressors Legal & Administrative Problems
At least one known legal/admin. problem in 32.7% of cases
Civil legal problems the most frequent legal issues among decedents
Article 15/NJP the most frequent legal issues among suicide attempts
Legal/Administrative Stressors 90 days Prior to Suicide
CY 2012
CY 2013
CY 2014
Reported categories are not mutually exclusive
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28. Operational Deployment
54.4% of decedents had a history of at least one deployment to OEF and/or OIF/OND
1 Deployment %
2 Deployments %
3+ Deployments 16.4%
Known Combat History Prior to Suicide
Suicides on Deployment
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29. Unadjusted Suicide Rates 2008-2014 Revisited
Suicides per 100,000 Service members
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30. Comparison to the U.S. Population
DoD Populations are predominantly young and male
General population of the U.S. is much more evenly distributed
To compare these groups directly, that difference must be accounted for
U.S. Population
DoD
Age and sex distributions of the U.S. Population and the DoD Population
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31. Adjusted Suicide Rate, DoD 2012-2014
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32. Adjusted Rates, by Service 2012-2014
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Summary
Most common demographic profile:
Young, white, males, high-school educated, enlisted
Suicide rates in CY 2014 were not statistically different from the age- and sex-adjusted suicide rates of the U.S. population
The rate of suicide for the Active Component, all Services, was 19.9 per 100,000 Service members
Air Force: 18.5 per 100,000 Service members
Army: 23.8 per 100,000 Service members
Marine Corps: 17.9 per 100,000 Service members
Navy: 16.3 per 100,000 Service members
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34. “Medically Ready Force…Ready Medical Force”
Summary Continued
Non-military firearms continue to be the most common method for suicide (62.9%)
Drug overdose continues to be the most common method of suicide attempt (57%)
Half of decedents had a diagnosed behavioral health condition
Many attended a health care appointment shortly before their death
Most common stressors included failed relationships and civil legal proceedings
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CY 2015 DoDSER
Currently under review for public release
Cover of the CY 2015 DoDSER Annual Report
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References
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2005). Web-based Injury Statistics Query and Reporting System (WISQARS). Retrieved from
Eaton, K. M., Messer, S. C., Garvey Wilson, A. L., & Hoge, C. W. (2006). Strengthening the Validity of Population‐Based Suicide Rate Comparisons: An Illustration Using US Military and Civilian Data. Suicide and Life-Threatening Behavior, 36(2),
Pruitt, L.D., Smolenski, D., Reger, M., Bush, N., Skopp, N., & Campise, R.L. (2016). Department of defense suicide event report – calendar year 2014 (Publication No. 6-9C3997A). Retrieved from:
Reger, M.A., Reger, G.M., Krieg, C., Pruitt, L.D., Smolenski, D.J., Skopp, N.A., & Bush, N. (In Press). What’s changed? A comparison of army suicide surveillance data to cases from Suicide and Life-Threatening Behavior.
Rothberg, J. M.., Jones, F. D. (1987). Suicide in the U.S. Army: Epidemiological and Periodic Aspects. Suicide and Life Threatening Behavior, 17(2),
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37. “Medically Ready Force…Ready Medical Force”
Contact Information
Larry Pruitt, Ph.D.
National Center for Telehealth & Technology
Joint Base Lewis McChord, WA
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