Preventing Post-Deployment Suicide

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Suicides in the military are not a new phenomenon. However, there was an 80% suicide increase among US Army personnel from 2004 to 2008 when compared to suicides from 1977 to 2003.

2008 was also the first year that the army’s suicide rate was greater than that of the general population’s, after adjustments were made for age and sex.

From January to June of this year, army suicides rose 18% over the same period during 2011. This sharp rise in mental health problems among military personnel and veterans is frustrating to address since an individual’s risk for suicide is still difficult to predict. Still, clues are being found.

In September’s issue of the Mayo Clinic’s publication Proceedings, Dr. Timothy Lineberry shared research findings and recommendations that may help stem the increase in US Army and other military service suicides.

  1. Evidence is mounting that sleep disturbance is a red flag for suicide or suicidal behavior. Even after controlling for PTSD, anxiety, depression, substance abuse, and hopelessness insomnia is correlated with suicidal ideation (thoughts of suicide). The upshot is that sleep disturbance is a predictive factor of attempted suicide within the month following an assessment.

    Other risk factors for suicide by veterans are impulsive and aggressive behavior. These are not considered psychiatric conditions, but about 40% of post-deployment soldiers report an increase in their level of aggression.
  2. There is concern about over-prescription of opioid pain relievers for veterans with PTSD or other psychiatric diagnosis. These analgesics need to be prescribed more judiciously.

    “Iraq and Afghanistan veterans with a PTSD diagnosis and were prescribed opioids, were significantly more likely to have opioid-related accidents and overdoses, alcohol and non-opioid drug-related accidents and overdoses, and self-inflicted and violence-related injuries.” (Lineberry)
  3. Close to 70% of US Army suicides are committed using firearms, and veterans are more likely than non-veterans to own them. The recommendation is that veterans diagnosed with a psychiatric illness should have restricted access to firearms and safely store their weapons, preferably outside the home.
  4. Earlier research revealed that many people who commit suicide had visited a primary care doctor within a month prior to their death. Doctors who are better trained to recognize and treat depression or PTSD symptoms will be more likely to notice and treat these disorders or write referrals.

    Although psychiatric hospitalization of US Army personnel increased from 2003 to 2008, statistics show that outpatient mental health facilities were underutilized during the same period. It is possible that primary care physicians will be the only professionals with an opportunity to diagnose suicidal behaviors in some veterans.

The main reason veterans give for not seeking help at outpatient mental health facilities is fear of being stigmatized. Please support and encourage any veterans you know to seek help if they are experiencing symptoms of depression, PTSD, intense anxiety, high levels of aggression, impulsivity, or problems sleeping.
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Resource:

Lineberry, Timothy W., MD, & O’Connor, Stephen S., PhD, (Sept 2012) Suicide in the US Army, Mayo Clinic Proceedings, 87:9, 871-878.

 
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