The Dark Cloud of Suicide Hangs Over Our Military

We announce the publication of the Department of Defense’s first-ever Annual Suicide Report. The Annual Suicide Report, or ASR, that we will discuss provides substantial information on suicide-related data. As we discuss the findings, we are ever aware that these reports represent lives lost, and the lives of loved ones forever changed and shattered.

Our research in this space is critical. It enables the department to better understand and combat this tragedy among our service members and, importantly, the family members who support them through their military service.

Although the suicide rate among most of our military populations is comparable to broader civilian rates, this is hardly comforting, and our numbers are not moving in the right direction.

For those who work in the field, many clients we care for surprise us, sharing their most vulnerable secrets and leaving us in awe of their resilience and their perseverance to move forward, oftentimes despite earth-shattering setbacks and through some of the most horrific, unimaginable and daunting crises any human being could endure. And yet somehow they find hope where there was previously only darkness.

Still, others we work with, including some of those who make the decision to end their life or attempt to do so, sometimes never share those thoughts or impulses that haunt them. Many show few warning signs, even for close friends and other loved ones.

These warning signs can be difficult to detect, they can be intimidating to respond to. And for many, if not most of those left behind after a suicide, the loss of a loved one leaves us with far more questions than answers and an empty feeling that can never be resolved.

This is the extraordinary difficulty of ending this tragedy. What I experienced working with individual clients is similar to what the suicide prevention research shows us about this deeply frustrating challenge. Suicide can often be an impulsive decision occurring only in a matter of minutes, warning signs can sometimes be few and they’re hard to detect, and no two people, no two life experiences leading to suicide, are identical.

At the same time, there are reassuring stories of those that have successfully journeyed through life’s most challenging times and who gives us hope, and sometimes even the smallest actions kept them from the brink and helped save their life.

Across all of our populations – active component, Reserve and National Guard – the 2018 suicide rate is statistically consistent over the past two years. However, rates for the active component are statistically higher than rates from the last five years. We are not going in the right direction.

While we hold ourselves to a higher standard than civilian populations, we are often asked how we compare. This year’s report indicates that suicide rates for active component and Reserve members are comparable to U.S. population rates after accounting for age and sex, but rates for National Guard are higher than the U.S. population after similar adjustments.

This report will also release data for the first time on military families. This is the first time we’ve released this data, so we do not have trends, but we – our military families are one of our greatest assets and our efforts need to consider the unique challenges of military life.

It is because of this that the findings in this report are all the more heartbreaking. We as a country need every woman and every man who bravely steps up to serve. Even one loss to suicide is devastating and reverberates through families, units and the military as a whole.

DR. ORVIS:

Before I overview the results, it’s important to explain two types of data in the report – suicide counts and suicide rates. Suicide counts are the total number of suicide deaths whereas suicide rates reflect the number of suicide deaths by the size of the population.

When we’re drawing conclusions about changes over time – so for example, have suicides increased over the past year in the military – we need to use annual rates, not suicide counts. The rates also factor in changes in the overall population sizes, the end strengths for the military that also may be increasing or decreasing.

Secondly, the rates represent the number of individuals who die by suicide for 100,000 individuals and this is how rates are calculated, using the Centers for Disease Control and Prevention standards and other industry standards.

You’ll also see margins of errors around the suicide rates which are per industry standards. These account for changes in the manner of death determinations that can occur. For example, when a death is first determined to be an accident and then additional evidence becomes available and the death is reclassified as a suicide by a medical examiner, or vice versa, the manner of death can be changed from a suicide to an accident.

In calendar year 2018, there were 541 service members who died by suicide. This slide presents the official DOD suicide rates for calendar year 2018, as well as recent trends in suicide rates over time, examining the past two years and five years.

I’ll draw your attention to the right hand side of the slide. This represents the visual depiction of the data you see to the left. Specifically, when examining the active component, the calendar year 2018’s suicide rates are consistent with rates from the past two years, meaning the rates have been consistent when comparing 2018 to 2016 and 2017. But the rates have increased over the last five years, from 2013 to 2018 for the active component.

When examining the Reserve and National Guard, the calendar 2018 suicide rates are consistent with the rates from the past two years, and they are consistent over the past five years, meaning there is no statistically significant increase in the suicide rate from calendar year 2013 to 2018 for the Reserve and the National Guard.

We’re often asked, how does the military compare to the U.S. population? In comparison to U.S. population rates, military suicide rates are comparable to the U.S. population rates after accounting for age and sex differences, with the exception of the National Guard.

The National Guard is statistically higher than the rate for the U.S. population after accounting for age and sex differences. Note that using CDC and industry standards, we account for age and sex differences across populations when making rate comparisons, as males and young individuals are at higher risk for suicide.

In other words, for our data, this means that after adjusting for the age and sex differences across the military and civilian population, with our military population being younger and comprised of more males, the military has comparable rates to the U.S. population, with the exception of the National Guard.

These are what are known as adjusted rates. And these adjusted rates are used for comparison purposes only. In a few moments I’ll discuss some actions the department is taking to specifically support our National Guard member population, such as through our partnership with the Department of Veterans Affairs.

Turning to slide two. This slide reflects the service member demographics associated with the greater number of suicides in calendar year 2018. Service members who died by suicide were primarily enlisted, male, and less than 30 years of age, regardless of whether they were serving in the active component, the Reserve, or National Guard.

This demographic, enlisted, male, under the age of 30, made up 46 percent of the total military population in calendar 2018, but about 60 percent of our military suicide decedents for that same year. The primary method of suicide deaths for our service members continues to be by firearm.

In summary, we see continued heightened risk for our young and enlisted service members and our National Guard members. I’ll discuss in a moment specific initiatives the department is undertaking to target our efforts on these populations of greatest concern.

Now turning to slide three. This report provides our first published suicide data for our military family members. This is an important first step. These results integrate data from both departmental data sets and the most comprehensive civilian sector data set, the Centers for Disease Control and Prevention’s National Death Index.

Due to the time lag associated with collecting U.S. population data, the most recent data available for our military family members is for calendar year 2017. There were 186 military spouses and dependents who died by suicide in calendar year 2017. Suicide rates for our military spouses and dependents in calendar year 2017 were comparable to or lower than U.S. population rates, after accounting for age and sex.

The primary method of suicide death was by firearm for military spouses and dependents. For female military spouses, this contrasts with similar-age female U.S. populations, where suicide by firearm is as prevalent as by poisoning or drug overdose.

This is our first year of data. The department will continue to work to effectively capture military families’ suicide data and report this out in a transparent and timely manner, reporting on these data each year.

We’re committed to the wellbeing of our military families. And in a moment, I’ll share some specific initiatives focused on supporting our military families.

Turning to slide four.

The DOD embraces a public health approach to suicide prevention that acknowledges a complex interplay of individual, relationship and community-level risk factors.

Based on the Annual Suicide Report findings, the department will focus on fully implementing and evaluating a multifaceted public health approach to suicide prevention, and will target our military populations of greatest concern: young and enlisted service members, and members of the National Guard, as well as continue to support our military families.

For our young and enlisted service members, we’ll be piloting an interactive educational program to teach foundational skills early in one’s military career to help address life stressors, and to enable these individuals, as they progress in their career, to teach others these skills, under their leadership.

We’ll also be teaching young service members how to recognize and how to respond to suicide red flags on social media, to help service members recognize how they can reach out to help others who might show warning signs.

For our National Guard members, we’re partnering with the Department of Veterans Affairs to increase National Guard members’ accessibility to mental health care through the V.A. Mobile Vet Centers during drill weekends.

We will also implement the new Suicide Prevention and Readiness for the National Guard initiative, also known as the SPRING Initiative, which will examine protective factors, risks and promising practices related to suicide and readiness in the National Guard.

The department’s committed to the wellbeing of our military families, and ensuring families are best equipped to support their service members and each other. We will continue to pilot and implement initiatives focused on increasing family members’ awareness of risk factors for suicide, to help our military community recognize when they are at risk so they seek help.

We’re also developing initiatives on safe storage of lethal means. That is, safely storing medications and firearms to ensure family safety, as well as how to intervene in a crisis to help others who might show warning signs.

The department has also developed the joint program evaluation framework, to better measure effectiveness of our suicide prevention efforts. We also look for new promising practices from the civilian sector, in which to pilot and potentially implement more broadly across the DOD.

In summary, the department is committed to preventing suicide within our military community. Today, we release our first ever DOD Annual Suicide Report. This report helps us understand the complexity of suicide, where there is no one fix. Our efforts must address the many aspects of life that impact suicide, and we are committed to addressing suicide comprehensively through a public health approach to suicide prevention.

I am disheartened that the trends in the military, as in the civilian sector, are not going in the desired direction. Calendar year 2018 suicide rates are consistent with rates from the past two years across the military for the active component, Reserves and National Guard.

Our suicide rates are steady over the past five years for the Reserves and National Guard. However, we’ve seen a statistically significant increase in the active component over the past five years since 2013. Our populations of greatest concern continue to be our young and enlisted service members and our National Guard members.

This report also publishes suicide data for our military family members for the first time, with these suicide rates being comparable to or lower than the U.S. population rates after accounting for age and sex.

I fully recognize that we have more work to do and much more progress to make to prevent this devastating loss of life. We will do more to target our initiatives to our service member populations of greatest concern, while continuing to support our military families.

We must all partner together to prevent these tragedies. A public health approach looks at promoting health and prolonging life through the strength of a connected and educated community. It’s not limited to just health professionals. We all have a role to play in preventing suicide for both our military community and the nation as a whole.

And, with that in mind, before we move into Q&A, I want to spend a few minutes sharing some key information on safe reporting on the topic of suicide. You, as the media, you can help us prevent suicide. DOD is committed to being transparent and sharing our findings and initiatives with you, so you can help us in sharing information with the public.

It’s important that everyone has the tools to safely report on the topic of suicide. Careful coverage of suicide, even if only brief, has the potential to change misconceptions and correct misunderstandings. By following best practices in media coverage, vulnerable or at-risk individuals may be encouraged to seek help.

On the other hand, media coverage can also negatively influence behavior by contributing to suicide contagion. Suicide contagion occurs when one or more suicides are reported in a manner that contributes to another suicide. The speed at which reports, photos, videos and stories can go viral makes it critical that coverage of suicide follows safe reporting best practices.

The risk of additional suicides or contagion increases when media stories provide explicit and graphic descriptions of the method of suicide, if the stories include graphic or dramatic headlines or graphic images, and if there is repeated or excessive coverage that sensationalizes or glamorizes the death.

The media can support suicide prevention efforts by advocating and implementing safe reporting guidelines. These are simple but effective strategies for covering suicide. We’re providing you with a fact sheet on safe reporting recommendations, but I’d like to highlight a few of these for you now.

When reporting on suicide, be sure to avoid misinformation and to offer hope. Suicide is complex, and it results from a combination of factors, not just a single cause. Avoid stating that a single event caused the suicide. This can lead to misunderstandings about suicide, as suicide is a result of a combination of many factors.

Always include information about available resources and treatment options, and promote the use of crisis and other supportive resources that encourage help-seeking, such as the Veterans and Military Crisis Line and Military OneSource.

Emphasize that suicidal thoughts and behaviors can be reduced through support and treatment, and that these are not signs of weaknesses or flaws.

Seeking support is a sign of strength. It can be powerful and inspiring to share stories of those who have overcome a suicidal crisis, and also including warning signs and what to do to help in your article is beneficial.

Certain phrasing can contribute to suicide contagions. Terms to avoid – avoid saying a person committed suicide or characterizing attempts at successful or unsuccessful. Instead, report that someone died by suicide.

Avoid using sensationalizing words referring to suicide, such as skyrocketing or as a growing problem. Instead, use non-sensationalizing words like rise or higher when referring to increases in suicide rates.

As I explained earlier, when reporting on trends or changes over time, use the official suicide rates, not counts. We need to use those annual rates, not the counts, as the rates factor in the changes in the overall population sizes that may also be increasing or decreasing.

For military rates, use the rates in our most recent Annual Suicide Report. And for U.S. population rates, we recommend using the most recent CDC data. Consider sharing stories of hope and recovery and information on how to overcome suicidal thinking. It can increase coping skills and increase help seeking.

Finally, there are several misconceptions in the general public about suicide and about military suicide, in particular, and effective reporting on suicide can help dispel those misconceptions. I’d like to highlight several misconceptions that are discussed in the Annual Suicide Report.

First, a common misperception is that deployment increases suicide risk. Several studies have shown that being deployed, including combat experience, length of deployment and number of deployments, is not associated with suicide risk amongst service members.

A second common misconception is that the majority of service members who die by suicide have a mental illness. This is not true in our military or civilian populations. More broadly, we know that when access to one lethal means is removed, someone at risk is unlikely to substitute another means.

As I also explained earlier in the brief, we are often asked how do we compare to the U.S. general population? And there is a common misconception that the military suicide rates are higher than the U.S. general population. This is not true for our active component or the Reserve after controlling for age and sex differences.

However, as we have discussed, we hold ourselves to a higher standard. A final and critical misconception is that talking about suicide with someone may lead to suicide. This is not true. The fact is talking about suicides provides other – the other person an opportunity to express thoughts and feelings about something they may be keeping secret and to be able to obtain help and support.