Executive summary
Research has shown that suicide rates have increased among military personnel significantly. Faced with challenges in their families, personal life, and professional practice, military personnel are usually at a high risk of committing suicide. This study aims to explore and understand suicide ideation and other mental issues that affect military personnel. The methodology involved a sample of 200 US military service members and veterans who answered interview questions that inquired regarding exposure to suicide symptoms among them, lifetime history with thoughts of suicide, and the perception of having suicidal thoughts in the future. The results showed that most of the participants revealed to have known a close member of the military who has committed suicide. In analyzing the data, one-way ANOVA’s, Chi-Square tests, and regression analysis revealed that the soldiers and veterans who had lost someone close to suicide were more likely to descend into it. The conclusion is that most military personnel were exposed to suicide and as they continued service, many more experienced thoughts of suicide or committed suicide. Additional research would be essential to reducing these instances and the ideation.
Introduction
According to Novotney (2020), each year is marked with over 40,000 cases of suicide in the US alone. For each of the people who commit suicide, thousands more either attempt or sink into thoughts of suicide. Among these, military personnel represents a high-risk group in this regard. Among social groups, the military personnel is among the most frequent to report cases of suicide ideation among personnel. Despite one not being affected by suicide thoughts, the loss of a close member of the family or friend can cause severe mental problems for the loved one, and repeated exposure to these incidences only makes it worse (Hom et al., 2017). Children who have lost a parent to suicide are more at risk of becoming emotionally and mentally affected. Being in the military makes this worse.
The entire US Department of Defense (DoD) has reported increasing cases of suicide causing concern among its policymakers, the military leaders, and the general population (Bryan et al., 2014). The current rate of suicide stands at 30 personnel per every 100,000 people, while the civilian rates stand at 14 suicide cases for every 100,000 people. The year-to-year changes represent a consistent increase. In 2020 alone, the military lost a total of 384 people to suicide cases (Ravindran e al., 2020). However, the figures also vary from service to service. Military veterans have the highest cases of suicide while Marine Corps and US Army follow closely. To combat these rates, the military service has developed mechanisms to help in reviewing the current evidence regarding suicide ideation, identify best practices to eliminate suicide cases, and describe and catalog suicide prevention activities.
Fig 1: Suicide rate statistics among military personnel
Source (https://www.defenseone.com/threats/2021/10/active-duty-suicide-rate-hits-record-high/185882/)
The major leading cause of suicide ideation among military personnel has been depression, followed by Post Traumatic Stress Disorder (PTSD). As they progress over time, these lead to one being easily placed in a position to commit suicide. Many theories have been developed to seek and understand suicide ideation better. One of these theories is the fluid vulnerability theory (Bryan et al., 2014). It asserts that as some individuals are more easily affected by suicidal behaviors, it is progressive in most cases and independent of one’s psychiatric profile. Most influential in this perspective and assertive over their vulnerability are their regard and assumption about themselves in other people’s eyes and the cognitive style they adapt to. The presence of perceived burdensomeness further exacerbates this.
Evidence from many researchers has shown that the desire to commit suicide is majorly driven by the desire to escape certain emotional distresses. The theories are backed by scientific studies that show the brain regions responsible for emotional regulation and decision-making are affected in cases of suicide. According to Harrell & Berglass (2011), the people involved in suicide cases espouse increased brain associated with emotional processing and decreased brain connectivity to regions responsible for regulating emotion and response to stressors. Most victims show difficulty controlling behaviors when under emotional distress and limited ability to control and differentiate between emotions that might be associated with suicide ideation. Overly, fast progression towards committing suicide is marked with a reduced tolerance for distress and increased suicidal thoughts and behaviors.
Efforts to improve this situation have been so far great. Over recent times, the Suicide Cognition Scale (SCS) was launched to help assess the suicidal belief system among potential victims. It uses two main domains to assess and establish the potential suicide ideation. These are Unlovability and also Unbearability. Unlovability entails the perception that one is defective or worthless and even flawed. It is also likened to being the same as shame and self-hatred.
On the other hand, Unbearability points to being incapable of handling stress (Hom et al., 2017). The identity-based beliefs tend to be ingrained in one’s suicide ideation longest. They are more persistent and also enduring. Understanding this persecution among military personnel is one step close to preventing future cases of suicide.
Methodology
Participants
A total of 200 veterans and military members were included in this study. The majority of this sample was male, who made up 85%, while the individual ages varied significantly from 18 to 88 years of age. They were also distributed across races, with 64.8% white, African Americans constituted 1.4%, while the rest represented Hispanic community members among other minority groups. The sample was also distributed across the different military groups of the US army. These were; 69% were reported as being members who had a military affiliation, 13% belonged to the navy, 11% were members of the Marine Corps, 4% constituted of the Airfare members, 1% were from the National Guard whirl the Coast Guard made up 3%. The data did not separate across ranks of the military status as both active members and those in the reserves were included indiscriminately. Other important information was regarding the marital status that was an important variable in establishing the participants’ mental state; 41% were single, 29% were married, and 20% had been divorced. Those separated from their spouses made up 8% of the sample population, as 2% were widowed and 1% cohabited. Lastly, the educational levels were useful, and 50% had completed college education as 31% had high school GEDs, over 5% had more than just a college degree, as 12% had college degrees. Lastly, 2% were reported not to have completed high school education.
Measures
An assessment was administered that represented a strong psychometric analysis, including military men and veterans.
A demographic interview inquired information on the age, sex, race, education levels, marital status, and the military service branch served.
A Social exposure and bereavement experiences interview was also administered, and the participants provided information on whether they knew a person who had taken their own life. It also inquired on their relationship to the person, the proximity of the relationship, the impact of the suicide on their own lives, and their thoughts on suicide after the incident.
The depressive symptom Incendiary –Suicidality Subscale was also used to examine the suicide potential through severity and extent. It sought to assess their suicide thoughts, frequency, and even their ability to suppress them. These were then compared to self-reported suicide risk measures.
Suicidal behaviors interview. This assessed numerous parts that individuals experienced and thoughts in suicide and related behaviors. It sought information on suicide attempts, ideation, and plans against thru self-reported likelihood of committing suicide in the future.
Procedure
The study varied in the aggregate data that was collected across various studies. The variety included differences in the recruitment strategies employed, study settings, study designs, and the study’s aims. The participants all provided consent to being interviewed and completed self-report assessments. All the applicable human subject compliance policies were also applied to the study.
Data analysis
A descriptive statistics model was employed in examining the prevalence of suicide exposure. In contrast, the Chi-square was employed in assessing for those who knew a person who had died by suicide were likely to have experienced suicide ideation, planned or even attempted. Consequently, one-way ANOVA evaluated differences in self-reported symptoms scores. A univariate linear regression also evaluated the extent to which closeness to the suicide descent and the impact was reported and associated with scores of self-report symptoms. Other exploratory analyses were conducted to establish if patterns remained the same when controls were in place for age, sex, and marital status.
Results
Of the entire population, 57% reported to have known a person who died by way of suicide, and 43% of these confirmed the suicide cases had occurred while in their military. 53% also reported having lost a friend, others, 19%. 10.6 had lost a fellow service member, 8.9% had lost an uncle, aunt, or cousin, while 8.7 % had lost other family members. Of the entire population, 30% reported having their lives disrupted by the suicide of a close person or someone they knew. Individuals exposed to suicide were more likely than those not exposed to report having suicide ideation (x2= 94, p<.001), suicide attempts (x2= 37.5, p<.001), and planning to commit suicide (x2=62.4, p<.001). These also reported a greater likelihood of future suicide attempts. People who also reported having their lives impacted negatively by the suicide of another person were reported to have huge suicide ideation and likely hood of a future attempt
Discussion
This study describes the prevalence of suicide among military personnel in a sample population. It turns out that the majority of them have been exposed to suicide, which has increased their likelihood of committing suicide in the future. Others experience negative life direction and hopelessness when exposed to such a situation. However, when controlled for sex, marriage status, and the respective units of the army, there were no significant differences. The study results also extended to show that there is a huge problem in suicide bereavement among military personnel, especially when the person who commits suicide is a close one. According to Harrell & Berglass (2011), mental health services in the army are limited, and most of these people find themselves unable to cope with losing close ones spiral down this road fast.
The lack of opportunities to grief loved ones after a suicide case added to the desire to communicate while being suppressed made the situation words. It increased suicide ideation as the mental stress only seemed to increase the pressure exerted by environmental stressors and the psychiatric symptoms that would be experienced (Ravindran et al., 2020). High levels of Unlovability and Unbearability meant more endurance of chronic suicide risk. The mental stress led to a decline in self-perception, self-worth, respect, and even unable to cope with the stress (Bryan et al., 2014). Military personnel who have attempted suicide espouse more self-injurious behaviors and are more likely to repeat in the future due to their perception of themselves.
The study also confers to the fluid vulnerability theory. It asserts that some individuals have higher trait-like vulnerabilities that make them easily likely to commit suicide in the future. Military personnel who have attempted suicide before are more likely to commit suicide in the future, followed by those who perceive their lives to have been ruined by the suicide of a close family member or friend (Hom et al., 2017). The stressors and life situations in the military are largely to blame for the high suicide cases as the conditions only seem to exacerbate the situations that make life unbearable for the military personnel (Chu et al., 2018). These events and circumstances call for a more delicate approach to dealing with people affected by suicide in the military.
Other researchers have asserted that the close relationship between military service and suicide is closely intertwined with the mental conditions that arise from situations in the army. These mental conditions include that; victims of traumatic brain injury suffered during deployment are 150% more likely to commit suicide than healthy individuals. Other factors like PTSD, depression, sleep disorders, anxiety, substance abuse, and problems with anger management are also highly associated with both military suicide cases (Chu et al., 2018). However, this might only account for mostly the veteran population. Further evidence has revealed that military service gives one a sense of purpose and belongingness that prevents mental stress that might lead to suicide.
Measures To Reduce Suicide Cases among Military Personnel
Numerous measures have been implemented to reduce suicide cases among military personnel globally. Some of these include; the need to raise awareness and promote self-care among the army personnel and build on skills to prevent such future cases. There should be programs that seek to promote one mental state after service in the military. This should include programs that build awareness against self-destructive behaviors, drug abuse, and sinking into self-pity. Skills that may be needed to live better in the world may also be necessary.
Another measure is the identification of the people at risk. For most people committing suicide, the signs are usually already present before they decide to commit suicide. There should be measures that seek to screen individuals, institute therapy programs, and even discharge individuals who cannot keep up with the stress in the army (Ramchand et al., 2011). When the problems are left to go on for too long, solving them becomes difficult.
Also, there should be the facilitation of access to quality care. Accessing quality behavioral and mental care programs is a crucial aspect of suicide prevention. The military is known to have barriers that hinder individuals from getting prompt access to such care (Harrell & Berglass, 2011). Despite being overlooked, instituting a culture where the personnel is granted access to mental health services would be of great significance to the personnel. Free therapy and mental health sessions should be availed to help avoid instances of suicide.
There should also be programs in the military that seek to prevent specific individuals from having access to military weapons if confirmed that they may use them to commit suicide (Ramchand et al., 2011). This can be instituted effectively by setting standards and ensuring that restrictions on weapons and other lethal items from only benign held by people who do not pose a risk to themselves.
Conclusion and Recommendation
In conclusion, this study has sought to establish a baseline for understanding the causes of suicide cases among military personnel. However, the research suffers from a limitation in that the information and evidence provided are not conclusive. There should be more research to establish connections between the emotional, neurological, and physiological constructs behind suicide ideation in the military. The current research does not offer complete evidence of this. There should be monitoring programs made to detect any improvements that may be made with changes in military policy and reforms so that the future may guarantee the wellbeing of the personnel. The extent of this problem is that it is bound to arise in the future if action is not taken in advance to ensure change has been seen or better ways to deal with the suicide cases have been sought.
References
Bryan, C. J., Bryan, A. O., Ray-Sannerud, B., Etienne, N., & Morrow, C. E. (2014). Suicide attempts before joining the military increase risk for suicide attempts and the severity of suicidal ideation among military personnel. PsycEXTRA Dataset. https://doi.org/10.1037/e522252014-178
Bryan, C. J., David Rudd, M., Wertenberger, E., Etienne, N., Ray-Sannerud, B. N., Morrow, C. E., Peterson, A. L., & Young-McCaughon, S. (2014). Improving the detection and prediction of suicidal behavior among military personnel by measuring suicidal beliefs: An evaluation of the suicide cognitions scale. Journal of Affective Disorders, 159, 15-22. https://doi.org/10.1016/j.jad.2014.02.021
Chu, C., Hom, M. A., Stanley, I. H., Gai, A. R., Nock, M. K., Gutierrez, P. M., & Joiner, T. E. (2018). Non-suicidal self-injury and suicidal thoughts and behaviors: A study of the explanatory roles of the interpersonal theory variables among military service members and veterans. Journal of consulting and clinical psychology, 86(1), 56.
Harrell, M. C., & Berglass, N. (2011). Losing the battle: The challenge of military suicide. Washington, DC: Center for a New American Security.
Hom, M. A., Stanley, I. H., Gutierrez, P. M., & Joiner, T. E. (2017). Exploring the association between exposure to suicide and suicide risk among military service members and veterans. Journal of Affective Disorders, 207, 327-335. https://doi.org/10.1016/j.jad.2016.09.043
Novotney, A. (2020). Continuing education: Stopping suicide in the military. Monitor on Psychology, 33.
Ramchand, R., Acosta, J., Burns, R. M., Jaycox, L. H., & Pernin, C. G. (2011). The war within: Preventing suicide in the US military. Rand health quarterly, 1(1).
Ravindran, C., Morley, S. W., Stephens, B. M., Stanley, I. H., & Reger, M. A. (2020). Association of suicide risk with the transition to civilian life among US military service members. JAMA network open, 3(9), e2016261-e2016261.
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