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Tuesday, October 11, 2011

Prevalence and Risk Factors Associated With Suicides of Army Soldiers 2001-2009

By Sandra A. Black, M. S. Gallaway, M. R. Bell & E. C. Ritchie
Military Psychology (vol. 23, #4), pp. 433-451

Contemporary research on suicide in the general population has shown that biological, psychosocial, and environmental factors interact to influence suicide-related deaths each year (Brown, 2006; Ellis, 2007; Leenaars, 2008; Lester, 2004; Lester, 2008; Schneidman, 1996). Research on biological risk factors suggests that genetic vulnerability to mental disorders, serotonin insufficiency, and serious physical illness or injury are particularly linked to suicide-related deaths (Heeringen, 2001; Mann, 2002; Mann, 2003; Moscicki, 2001; Roy, Rylander, & Sarchiapone, 1997). Similarly, research on psychological risk factors has also linked mood, anxiety, and personality-related disorders, as well as alcohol and substance disorders, with suicide-related deaths (Conner, Duberstein, Conwell, Seidlitz, & Caine, 2001; Harris & Barraclough, 1997; Nock et al., 2009; Simon, 2006), while other research has linked suicidal behavior with hopelessness, impulsivity, aggression, a history of trauma or abuse, and any previous suicide attempt (Beck, Brown, Berchick, & Stewart, 1990; Brown, 2006; Brown, Jeglic, Henriques, & Beck, 2006; Linehan, 1993; Martin, Ghahramanlou-Holloway, Lou, & Tucciarone; 2009; Schneidman, 1996).

Research on sociocultural risk factors suggests that race/ethnicity, marital status, lack of social support, a sense of isolation or not belonging, social losses, financial difficulties, stigma associated with help-seeking, and suicide as a noble or acceptable resolution of a personal dilemma associated with cultural or religious beliefs are correlated with suicide-related deaths (Clarke, Bannon, & Denihan, 2003; Kerkhof & Arensman, 2001; Kolves, Ide, & De Leo, 2010; Kposowa, 2000; Leenaars, 2008; Lester, 2008; Mann et al., 2005; Sartorius, 2007). Moreover, research on environmental risk factors indicates that access to lethal weapons and barriers to health care contribute to suicide-related deaths (Martin et al., 2009; Simon, 2006). Studies on the prevalence and risk factors associated with suicide-related deaths in military personnel have reported similar results. Specifically, mental disorders, substance abuse, physical illness, stigma, family separation, occupational difficulties, and relationship losses have been linked to suicide-related deaths among military personnel (Cox, Edison, Stewart, Dorson, & Ritchie, 2006; Ritchie, Keppler, & Rothberg, 2003).

This research has advanced our understanding of the prevalence and correlates of suicide-related deaths among military personnel. However, it is worth noting that little of this research has examined specific risk factors in relation to trends in Army suicides, particularly over the past decade, that is, 2001-2009. Examining the prevalence and risk factors associated with suicide-related deaths among Army personnel is particularly important given increasing operational demands associated with ongoing operations in Afghanistan and Iraq. In fact, research indicates that stress associated with deployment, combat intensity, and the potential shame of failure or weakness--all of which are known to increase the risk for mood disorders, anxiety disorders, post-traumatic stress disorder (PTSD), and substance-related disorders--have been linked to suicide-related deaths among military personnel (Allen, Cross, & Swanner, 2005; Bodner, Ben-Artzi, & Kaplan, 2006; Hill, Johnson, & Barton, 2006; Hoge et al., 2008; Rand Center for Military Health Policy Research, 2008). Moreover, it is worth noting that many of these risk factors may be accompanied by increased availability of firearms within the military as compared to civilian society (Marzuk et al., 1992).

Additionally, certain risk factors may differentially impact military personnel. For example, the loss of friends, particularly those assigned to the same unit, can have a deep impact, whether in combat or not (Kang & Bullman, 2008). Stress may be greater in the Army population because of increased dependence on social support provided by friends and coworkers in the military environment (Mahon, Tobin, Cusack, Kelleher, & Malone, 2005). Externalized psychopathology (drug and particularly alcohol abuse or dependence) may be more evident in the military due to greater cultural acceptability of these behaviors (Hills, Afifi, Cox, Bienvenu, & Sareen, 2009). Stigma associated with help-seeking behavior or treatment may also be more prevalent in the military, because mental illness is often viewed as a manifestation of weakness or malingering, as well as a threat to one's career (Hoge et al., 2008; Rand Center, 2008).

This is only the beginning of the article.

Thanks to Ken Pope for this information.