"Deployments not associated with increased suicide risk"

[wtbcrna, MSN, DNP, CRNA]

I don't know how many have seen this on the news yet, but I am going to start a post that refutes these findings. This is why it is important to understand research.

http://jama.jamanetwork.com/article.aspx?articleid=1724276

"The findings from this study are not consistent with the assumption that specific deployment-related characteristics, such as length of deployment, number of deployments, or combat experiences, are directly associated with increased suicide risk. Instead, the risk factors associated with suicide in this military population are consistent with civilian populations, including male sex and mental disorders.30 Studies have shown a marked increase in the incidence of diagnosed mental disorders in active-duty service members since 2005, paralleling the incidence of suicide.31 This suggests that the increased rate of suicide in the military may largely be a product of an increased prevalence of mental disorders in this population, possibly resulting from indirect cumulative occupational stresses across both deployed and home-station environments over years of war. In addition to screening for and addressing mental health problems, further research is needed to more clearly understand the interrelationship of multiple risk factors leading to suicidal behaviors and the types and timing of interventions that may reduce or prevent death by suicide.

Since data collection ended in 2008, we did not capture suicides in the most recent time period when the rates were the highest.2 However, the study did include the 3 years with the sharpest statistically significant increases in suicides (seen especially in the Army and Marine Corps).2 It is possible that the cumulative strain of multiple and lengthy deployments only began to be reflected in suicide rates toward the later stages of the conflicts, although the overall evidence points to the lack of any specific deployment-related effects.

The most important finding was that mental health problems, including manic-depressive disorder, depression, and alcohol-related problems, were significantly associated with an increase in the risk of suicide. These findings suggest that current prevention initiatives in the DoD and the Department of Veterans Affairs that address previous mental health disorders and involve screening and facilitation of high-quality treatment for mental and substance use disorders in primary care, specialty mental health care, and postdeployment settings have the greatest potential to mitigate suicide risk. However, there are limited studies that validate prevention initiatives and well-conducted program effectiveness trials should remain a high priority.

The PAR%s indicate that suicide deaths could potentially be reduced (by approximately 18% and 11%) in this population as a whole, by preventing or eliminating alcohol-related problems and depression, respectively (assuming that these observed associations are causal and that elimination of these risk factors do not affect distribution of other covariates). Despite the larger magnitudes of the HRs for manic-depressive disorder, the PAR% shows that preventing or eliminating this disorder would have a smaller effect (≈ 5% reduction) due to the very low prevalence of this disorder in this population. In addition, male sex was also a strong contributing factor to suicide deaths (44%) in this population. These findings provide further evidence that the prevention and quality treatment of these mental health disorders may prevent suicide deaths.

This study has several limitations. The findings are based on 83 suicide deaths so the study may have lacked statistical power to produce a stable and reproducible multivariable model. As with any prospective cohort study, nonresponse on the initial survey or loss to follow-up may introduce bias. However, objective national registry-based mortality data obtained for all cohort members minimizes bias due to loss to follow-up. Additionally, a previous study examining weighting for nonresponse among panel 1 members of this cohort indicated that prevalence rates are comparable to results of unweighted analysis for PTSD, depression, and eating disorders.32 Although the study relied on the PHQ and PCL-C self-report screening measures, these measures are standardized validated instruments shown to be reliable in this cohort.24,33- 34 The questions used to assess combat experience were also self-reported and based on 2 different instruments, but combat experience based on self-report has consistently been shown to be associated with a variety of adverse health outcomes.7,35 This study could also be influenced by misclassification of suicide on death certificates. There is some evidence that suicides are underreported on death certificates36; however, this method of cause-specific mortality ascertainment has been widely accepted and there is no reason to believe that cause-of-death reporting on death certificates would be influenced by the risk factor variables that were studied.37- 38 The main findings were based on baseline data that were assessed an average of 3 years (mean [sD] 3.23 [2.03] years) prior to suicide; however, results using all available survey data were consistent. This study was only able to cover the first 3 years of an increasing trend in suicides occurring in military service members that began around 2005, therefore additional research will be needed to confirm these results using data from later years. Lastly, data from the first 3 panels of the Millennium Cohort, which consisted of different enrollment criteria, were combined due to the low numbers of suicides in this study population.

Key strengths of the study that reinforce the validity of the findings include the linkage of records with national registry-based mortality data, the consistency of results between Cox modeling and the nested case-control methods, and the fact that the study spanned the 3-year time period when the greatest increase in military suicides occurred. In addition, this study included individuals from all service branches including active and Reserve members, as well as those who have retired or are no longer serving in the military.

In conclusion, this study prospectively quantified military-specific risk factors associated with suicide in a cohort of military members who were followed-up for as long as 7 years. In this sample of current and former US military personnel, mental health concerns but not military-specific variables were found to be independently associated with suicide risk. The findings from this study do not support an association between deployment or combat with suicide, rather they are consistent with previous research indicating that mental health problems increase suicide risk. Therefore, knowing the psychiatric history, screening for mental and substance use disorders, and early recognition of associated suicidal behaviors combined with high-quality treatment are likely to provide the best potential for mitigating suicide risk."

http://linkinghub.elsevier.com/retrieve/pii/S0140673610606721?via=sd&cc=y

"Abstract

Summary

Background

Concerns have been raised about the psychological effect of continued combat exposure and of repeated deployments. We examined the consequences of deployment to Iraq and Afghanistan on the mental health of UK armed forces from 2003 to 2009, the effect of multiple deployments, and time since return from deployment.

Methods

We reassessed the prevalence of probable mental disorders in participants of our previous study (2003-05). We also studied two new randomly chosen samples: those with recent deployment to Afghanistan, and those who had joined the UK armed forces since April, 2003, to ensure that the final sample continued to be representative of the UK armed forces. Between November, 2007, and September, 2009, participants completed a questionnaire about their deployment experiences and health outcomes.

Findings

9990 (56%) participants completed the study questionnaire (8278 regulars, 1712 reservists). The prevalence of probable post-traumatic stress disorder was 4-0% (95% CI 3-5-4-5; n=376), 19-7% (18-7-20-6; n=1908) for symptoms of common mental disorders, and 13-0% (12-2-13-8; n=1323) for alcohol misuse. Deployment to Iraq or Afghanistan was significantly associated with alcohol misuse for regulars (odds ratio 1-22, 95% CI 1-02-1-46) and with probable post-traumatic stress disorder for reservists (2-83, 1-23-6-51). Regular personnel in combat roles were more likely than were those in support roles to report probable post-traumatic stress disorder (1-87, 1-26-2-78). There was no association with number of deployments for any outcome. There was some evidence for a small increase in the reporting of probable post-traumatic stress disorder with time since return from deployment in regulars (1-13, 1-03-1-24).

Interpretation

Symptoms of common mental disorders and alcohol misuse remain the most frequently reported mental disorders in UK armed forces personnel, whereas the prevalence of probable post-traumatic stress disorder was low. These findings show the importance of continued health surveillance of UK military personnel. " I used this abstract because it was the most recent one I found.

We know that deployments, especially long repeated deployments, are related to increased drinking and mental health problems. The first study states that alcoholism and mental health problems are related to increased suicide risk, but not deployments themselves...Well since one leads to the other how can deployments not be related to increased suicide risk.

[SoldierNurse22, BSN, RN]

Wow...just wow.

I cannot believe that anyone would publish an article--especially nowadays--saying that deployments don't increase a person's risk for suicide. The Army has seen such a huge increase in suicides over the past 10 years! What do they think it's due to--the food?

I see so many WTB/WTU soldiers that are a mess--shot up and blown up and sent to do it all over again, some of them five or six times. Their bodies are damaged and that doesn't even begin to compare to the damage done to their minds.

Thank you, wtbcrna, for refuting such a flawed, utterly disgraceful study. Shame on the folks who refuse to acknowledge that suicide is not always related to mental health disorders but is often a consequence of repeated exposure to a hostile, dangerous, unstable environment (such as deployment).

[Lunah, MSN, RN]

I saw an excerpt from that article in the Stars & Stripes, and my eyes almost fell out of my head. Utterly ridiculous. Looking forward to reading the OP's post more carefully when I am fully awake.

[ckh23, BSN, RN]

The first study states that alcoholism and mental health problems are related to increased suicide risk, but not deployments themselves...Well since one leads to the other how can deployments not be related to increased suicide risk.

I couldn't agree more. I also find it suspect how they don't take into account survivors guilt and how they don't distinguish between types of deployments. They don't go into detail about the suicides that take place and what their deployment entailed. Let's face it, not all deployments are the same.

[jeckrn, BSN, RN]

Can not say if deployments increase suicide rates or not but what does increase them is the way we are raising kids today. Kids today are not taught that failure is part of life. Too often kids are not taught that life is not fair and that they will not always win. Because of this they have not developed needed cooping skills.