Suicides

[Blackadder1916]

I am not sure how accurate the "gen pop" suicide versus accident stats are.
It is not always obvious on scene if the cause of death was suicide, or accidental. Even when suicide is suspected, but not obvious, for the sake of the family, ( often in the home, looking you in the eye ) the word "suicide" is seldom spoken.  . . . . . .

The "gen pop" statistics are probably as accurate as the "mil pop" statistics.  Regardless of the career, those who kill themselves generally do it all the same way, okay, in all the same variety of ways.  Of the ones that I had a professional nexus to (both during my military service and in a civilian capacity), there was similarity in number and method (gunshots, overdoses, hangings, cars running in garages . . . ), likewise with attempts.  The only unique "military" method that I didn't see replicated by a civilian was jumping off a cliff.

Fortunately, determination of cause of death is not made by first responders wishing to spare the feelings of the family.  Again there is a similarity between "gen pop" and "mil pop" - the same authorities (medical examiner, coroner, etc) makes the finding.  If there is a preceived error in the statistics due to including some as accidental deaths, that variance may most likely be the same in both population groups.

 

[Pieman]

That is why i take your comment about 2 suicides in 3 years comment with a grain of salt. In almost 19 years of service i have only known one who committed suicide and one who had a failed attempt.

I'm sure reality lies somewhere in between.

I am sure it is somewhere in-between, I still have a hard time believing it is the same as the suicide rates in the general population.

but every base has a different population and  experience. I personally know of 2 suicides in my 24 years in the CF (meaning knowing the individual)s as well as during my 4 year stay at Base Borden, in 2010 Jan to Mar 3 separate suicides (3 different schools, and rank levels).  So Pieman may very well have know of 2 suicides in 3 years and you CDN Aviator may have had only known one suicide.  Doen't mean either is wrong in their stats just different exposures.

 

I totally agree. The numbers I posted there are accurate to my experience in the army. Shacks I stayed in were dominantly combat arms, and lots of guys staying there just after coming back from deployments. I was surrounded by people who are probably much higher risk to suicide than the rest of the army population. So that might be a good explanation to why I was seeing a lot more. Does this mean it is the same rate as the general population? Could be, but I am not sure I am convinced.

 

[kstart]

I am sure it is somewhere in-between, I still have a hard time believing it is the same as the suicide rates in the general population.
 

I totally agree. The numbers I posted there are accurate to my experience in the army. Shacks I stayed in were dominantly combat arms, and lots of guys staying there just after coming back from deployments. I was surrounded by people who are probably much higher risk to suicide than the rest of the army population. So that might be a good explanation to why I was seeing a lot more. Does this mean it is the same rate as the general population? Could be, but I am not sure I am convinced.

I think that can be a really hard time for others, trying to 're-acclimatize', 'get back to 'normal'.  I had friend, US Marine, post-Iraq-- he hated being back, restlessness, was hating his wife-- he just wanted to get back to the action (physiologically, adrenalized, not re-regulating?).  He presented suicidal risks, the highest re: immediate risks re: planning of method, deciding on method, having access to that method, choosing a time, bringing out that method with intent. . .  What was strong for him and worked in his favour was his prior training in firearms protocol, and being reminded about that, he 'soldiered up' (professionalism) that helped re-steady him.  He survived that crisis and crisis period in his life.  Got in for an assessment, dx'd ptsd, and hung on through the wait for VA services to kick in, partially with support of an on-line community, safe, private place to express.  He got an honourable discharge, re-created his life, took a creative career re-direction; the marriage remained in tact, very in-love (for better and for worse -- they pull together, make it work).  Live-style/career changes, but a really good outcome-- he found a new career direction that he's thriving in and loves it.  He had an abundance of talents and creativity he hadn't tapped.  In the hardest times of struggling, he also found faith, a deeper connection, tested.  I was a different kind of friend, I respected feelings, anger, rage, but also as a bit of a feminist, etc. reminder of responsibility for one's actions, clarity of relationship boundaries (support the wife too).  The wife and him shared some pretty cool hobbies, reall cool adventures together.

Suicide attempt was averted and not statistically recorded.  There may be higher risks, but they can also be mitigated by a variety of factors, resilience, discovery of inner strengths not known till under the heat of experiencing the suffering.  Creative means of safer expression. 

Military people I've encountered with ptsd, and struggling with suicidal impulses, occupations have been combat-related: infantry, medical corps (ambulance, field medics), MPs/in-field intelligence gathering, direct exposures to life-threatening harm, losses and grief is something that can hit back, especially when out of the survival mode, high level of responsibility, survival and protection (where there isn't the luxury to feel it, not compatible mode).  I didn't get hit with full out ptsd, till I was away from survival mode, hit me a 7 years later, it started to bite back.  There were not IED explosions, but explosions of a different nature, still had the physiological effect, booting up survival stress response, risks of injury, life-threatening harm, self/others.

I've seen even in  the wildlife population, manifestations of grief, shock.  I once travelled a road, the driver ahead must have hit this red-tailed hawk.  It's mate was in shock, and swooped down right infront of our car, like anger, shock, a suicide ?  We were able to brake, and checked in on the downed bird, it was freshly hit, but not saveable, died on impact.  Just saying this, cause there's a universality to grief, reactions and actions may differ, but it's part of our wiring  as living beings.


I think statistical gathering by specific military occupations merits study.  I don't know what the stats are re: in-field, combat arms vs. administration (30% to 70%?).  Mental illness can strike anyone regardless of occupation and that's a high risk factor re: suicide attempts.  I'd think the risk factors  for ptsd are stronger with direct exposure, risk to self and others is direct?  Burnout and fatigue can happen in many occupations, anxiety, depression.  Usually there is a trigger event which can bring out a latent mental health disorder, that maybe otherwise wouldn't manifest?

Statistics at best are indicators.  Studies can be biased by things such as sampling which can also conceal trends and realities and are subject to interpretation, areas for further study.  The danger of them is when they are used by policy makers, justifications to remove needed services, protocols to help prevent suicide deaths. 

 

[kstart]

I need to walk away from the thread, before it gets too triggering for me.  I feel a duty to express truthfully, and I'm civillian with no professional obligations, so just making use of that freedom; but I also have a duty to keep myself healthy.  Just wanted to express some perspectives, generate some debate, validate experiences.

 

[Gunner98]

Statistics at best are indicators.  Studies can be biased by things such as sampling which can also conceal trends and realities and are subject to interpretation, areas for further study.  The danger of them is when they are used by policy makers, justifications to remove needed services, protocols to help prevent suicide deaths.

That is why the study (covering 35 years of data) was done through Statistics Canada who have no stake in the outcome.

The final statement in the limitations section of the study states: "The findings of this study therefore apply to a subgroup of the released population and should not be generalized to the overall population of veterans."

 

[mariomike]

Feb 2010
"Report of the Canadian Forces Expert Panel on Suicide Prevention: 

"Suicide rates tend to be somewhat lower in service members relative to the general population: In the Canadian Forces, the suicide rate for Regular Force males * is approximately 20% lower than those of the general population of the same age.":
http://www.forces.gc.ca/health-sante/ps/dh-sd/spr-rps-eng.asp#Summary
* "There are so few suicides in women in the CF that is not appropriate to calculate and report their suicide rates."

 

[mariomike]

June 1, 2011
"Suicide rates among currently serving CF personnel are, however, lower than those among the overall population and there has been no statistically significant change in suicide rates since 1995.":
http://www.forces.gc.ca/site/news-nouvelles/news-nouvelles-eng.asp?id=3799

 

[kstart]

Feb 2010
"Report of the Canadian Forces Expert Panel on Suicide Prevention: 

"Suicide rates tend to be somewhat lower in service members relative to the general population: In the Canadian Forces, the suicide rate for Regular Force males * is approximately 20% lower than those of the general population of the same age.":
http://www.forces.gc.ca/health-sante/ps/dh-sd/spr-rps-eng.asp#Summary
* "There are so few suicides in women in the CF that is not appropriate to calculate and report their suicide rates."

Thanks for supplying that document link.  That makes me feel a lot better.  It shows deep engagement with the issues, sound research. 

So lower incidence of suicide rate, attributed to better screening of mental health disorders.  Also recognition of stressors which can contribute to the development of mental health disorder.  PTSD is indisputably a combat-related injury and can develop at anytime as a result of exposures, on a person's physiology.

Interesting the point re: estimation of 54% with PTSD but not recieving treatment, one of the reasons being unaware of ptsd existing.  I think ptsd is one of those things that can creep up slowly over time, present some symptoms (e.g. nightmares, anxiety), but still able to carry on, function.  Another issue, can be comorbity of addictions overtop of ptsd and that could be anything from alcohol/drugs to workaholism, or other ways of either numbing or other ways of adrenalizing as a way to block out distress/symptoms, to 'carry-on'.  I knew a CF member with ptsd, and it was alcoholism that creeped up over time, and eventually of course fails when hitting the later stages of addiction, creating more incapacitation, a medical emergency.  Post-addiction treatment and learning to face the ptsd head on as trying to maintain sobriety.  He had good things to say about CF response, medical support, OSI clinic, and was accessing the very best of the civilian resources for ptsd-treatment (though that also requires private health coverage).  E.g. Homewood-- it's 4-6 months wait with private health coverage, treating others from the States first, before Canadians without private health coverage, as it's a private hospital.  Provincially funded beds exist, but the waitlist is years.

I think CBT can be positive treatment for anxiety, depression, anger, addictions, and adapted re: suicide prevention, separating thought from actions.  I had an introduction to the concepts via a provincially funded one month hospital outpatient program, post hospitalization.  Hard to adapt to PTSD symptoms which make it hard to stay present, dissociation post-flasback and flashback appears to occur with the body first before throught, although there can be a triggering thought, but flashback happens fast, hard to track.  For this reason, I think the Mindfulness Based Stress Recution can help assist PTSD-sufferers and make it easier to adapt to CBT, because it helps ground, present moment, rediscover what safety feels like, mind/body and in a safe place.  I discovered this accidentally, it was available via a community health centre for free.

Psychotherapy would be an obvious benefit, a trained professional who is attentive to also non-verbal communication, because those provide information about flashback coming on before it happens.  I think it's hard for a ptsd-sufferier to figure that out on one's own, or through whatever 'help books', but feedback from a neutral professional observer can help the sufferer begin to recognize their own symptoms better and there are ways to avert flashback if mindful and catching it before it takes hold.  I had short term experience of a social worker who could did this.  There are civilains who have been exposed to combat situations, mind go on behind closed doors even, or unsafe experiences on our streets here.  Physiology boots up to threat, and long term and no escape, can damage.  The public is not movitaved to wish for taxes to go into school programs, or further stress on an already stressed medical care system.  Psychiatrists are years waitlists.  Although positive things are when doctors take some training re: ptsd assessment (which would matter re: role of medications).

There are a lot of financially strapped work envonments, non-unionized, private sector, or non-profit orgs with no health benefits.  I wonder about non-military, ngo  relief workers in combat zonese.

Help for families and unit is a good idea post-suicide.  Can prevent trauma-formed unhealthy thinking habits from becoming too entrenched, e.g. suvivor guilt.  Relationship and also proximity to event, also risks to children, re: grief, dependent and ifi the caregiver is overwhelmed, can add to the suffering of the children, more complicated problems.

Restriction to access of means is good protocol, I think that would help prevent risk, although a person that is really determined, can find other ways of obtaining means.  It's positive to know the trainging of others on base as well in this regard, a higher standard vs. civilian owners of means.  There are Mental Health Act laws which do apply, but civilian community is less prepared generally.  Will for changes though, don't really exist unless one's been exposed, otherwise doesn't fit with necessityies of fiscal constraint, federal/provincial, etc.  Two-tired help re: ptsd, it's taken for granted "uuniversal health care" which is not true in all cases.

Anyway, I'm really glad to see some good work being done at CF.  Cheers

 

[kstart]

Just some afterthoughts. 

I know I'm afflicted with post-suicide survivor-guilt, hard-wired in me, over a lifetime with it, I can't seem to escape that.  I forget to put a check on it, and I fail to recognize that hypervigilance when it overtakes me.  It's somewhat masochistic to dislose what I have.  I feel a lot better from seeing that the Military is taking the suicide issues, mental health issues seriously and diligently.  I'm like a crow, picking at dead things, drawn to it (trauma compulsion).

Pieman, maybe really out of line of me to suggest this (I'm out of line a lot), but I'm wondering if the losses from your barracks, has left some trauma-imprints on you, some 'complicated grief' that is sticking.  I tend to avoid facing my 'feelings directly' and displace it as anger, and hypervigilance towards external issues-- I get mad at the "system" a lot   There's a good exercise in Aphrodite Matsaki's book, Trust After Trauma re: survivor guilt, realistic appraising of conditions at the time.  It's hard work, that's CBT based, but grief that's been sitting with us for a while, can take hold physioligically, emotionally, etc.

There are some things in life, we're unlikely to just 'get over', those losses can bite back from time to time, even if we think we've 'finished with it'.  I think I've left them behind, only to get a dream/nightmare that reminds me I still hurt, feel the loss (I hide my feelings from others and myself often, in everyday-life, numb it by habit).  I guess it's a matter of monitoring it, and if it's hiccuping a lot, and if the services of help and support are available-- grab it.

From the CF report, estimates of 1/4 of suicides are not preventable, regardless of availability of help.  I feel that my father's suicide was possibly preventable, but we weren't skilled or supported at that time, or prepared by trainign, education, etc.and likewise with the system.  There would have been times for earlier intervention ik we had knowledge and support from the system (we were all friend and burntout from over the years, numb, recurrent trauam/crises.  Also, barriers, attitude of 'suck it up' or denial, 'it'll get better, this crisis will pass-- but it didn't-- it's human, not exclusive to the military or 'military culture' per se, it's also in the dominant culture: stigma, shame, mad eyour bed, suck it up.  The other one, person sought help, knew about resources, but chose differently.  That one I don't think was preventable, he didn't hang on to learn, be open that he could learn, and didn't want to face the declinging health, due to terminal illness.  He didn't want it to look like a suicide, he loved his family, was very well-loved, that's unfortunately not always enough.

My father took himself out in an alcoholic rage, with the means.  It's imprinted on the family, the proximity ot the event, witnessing, direct with the drama of it, etc.  We should have called the cops, but also anxiety abou tthe process, what ifs, getting released when not safe for him or us, etc.  It was him or us, lots of indications he would have taken us down with him, re: prior threats on us with the means.

Those 'means' figure into some family members suicidal ideation, my brother and I.  I'm grateful, split second decision between motel room, drun kand going out to find the means vs. a plane ticket home-- my brother is still alive.  Also, later when he went searching for the means, the street peddler was ethical enough over greed to not sell the means.  Knowing that access to the means would mean having to deal with unscruppled people, remains a helpful deterent for me.  It'd take a lot of energy to do that and I hate those people anyway.

Deterrence, ways of containing risk I guess is as best as can be done.

Okay, going ot walk away from this for a while.  I'm glad to learn of CF concientiousness on sucide prevention and responding to mental health issues, emergencies. 

 

[Journeyman]

I'd just sent kstart a PM on assisted suicide -- not in the context of young troops, but thinking of my dad, who rotted away in a retirement home. I didn't want to derail this thread, but now that I've sent the PM, maybe other members have some thoughts.....

Mods, if there are any relevant responses, perhaps a split.

 

[Pieman]

Thanks for the link to the report Mariomike. I will have to make the time to sit down and read it over.

 

[mariomike]

Thanks for the link to the report Mariomike. I will have to make the time to sit down and read it over.

I am not an expert on prevention, Pieman and Kstart. But, there is one thing I remember a lady said when we asked why she had attempted. She said because no one had smiled at her lately. 

 

[Gunner98]

I am not an expert on prevention, Pieman and Kstart. But, there is one thing I remember a lady said when we asked why she had attempted. She said because no one had smiled at her lately. 

One of the interesting contrasts between two soldiers, their response to the simple greeting - "Hi, How are you?"  Soldier 1: "Another day closer to retirement".  Soldier 2: "Not sure how you want me to answer that?  Do you have time to discuss it or do you really care how I'm doing? "

For many of us in uniform at points during our careers, 'How are you?' is not a greeting, it is a very hard question?

I have experience with CBT and SSRIs as a patient for more than a decade.  I have spent time involuntarily and voluntarily in a lock-down ward.  I will always remember advice given to me by a US Senior Army Officer: "If you intend on asking my soldiers 'how they are', you best be prepared to make time to hear their answer.  We encourage honesty in my Army.  Always look your troops in their eyes when you greet them.  You could be saving a life!"

 

[kstart]

Marionmike, Simian Turner: those are both great attitudes.

Smiles: ""it don't cost very much, but it lasts a long while"-- John Prine   It can make the difference between having a totally lousy day, to more manageable one, a beacon of light, hope.

One of the interesting contrasts between two soldiers, their response to the simple greeting - "Hi, How are you?"  Soldier 1: "Another day closer to retirement".  Soldier 2: "Not sure how you want me to answer that?  Do you have time to discuss it or do you really care how I'm doing? "

For many of us in uniform at points during our careers, 'How are you?' is not a greeting, it is a very hard question?

I have experience with CBT and SSRIs as a patient for more than a decade.  I have spent time involuntarily and voluntarily in a lock-down ward.  I will always remember advice given to me by a US Senior Army Officer: "If you intend on asking my soldiers 'how they are', you best be prepared to make time to hear their answer.  We encourage honesty in my Army.  Always look your troops in their eyes when you greet them.  You could be saving a life!"

Sounds like a very wise man and it's a good leadership quality, fitting in with "lead by example".  It's hard to hide what's going on when asked, "how are you"-- if something's up, it can get one thinking, pause to answer, especially as in seeking to answer honestly.

Impressive that you've worked on CBT for more than a decade.  I just realized I can open that up again, use the forms, re-start a journal (I'm re-examining 'core beliefs' and hypervigilance/triggers).  I think CBT can be good for anyone, heck, good officer's training even, promotes clarity of thought and I think doing that work for a while for oneself, increases perceptiveness when hearing others.  Hospital is a good learning experience too.

Early detection of symptoms, knowing when to monitor and when help can be sought.  It's good to see this attitude, makes sense to work together.

I see good innovative thinking from that report, so if people are working together and there's a back up system for support, that's a good win-win scenario.  I can see many positive attributes of the Military "community", some exemplar innovation, other workplaces and communities can learn from.

I like the preservation of principles of leadership and an on-going seeking of excellence.  They're conditions which can also bring out the best in others, young and older.

It's Great work 

Journeyman, I PM'd you.

 

[mariomike]

This may be of interest.
"How should 911 handle potential suicide victims?":
" "Ah Jesus, I go to my door and it's two ambulance guys with a gurney ... asking, `Can we come in?'"
After a 25-minute chat, McArthur says he convinced the ambulance attendants he was not about to harm himself.
Indeed, he gave one of them a ride around the parking lot in the sidecar of his 1963 BMW motorcycle."
http://www.thestar.com/news/gta/article/696384

 

[Pieman]

During a three year period I count two suicides that happened in the shacks I was living in, one suicide on exercise, and one suicide on tour.  Those are the ones I was aware of.

I get the feeling that things are no where near the general population's rate.

Sadly I need to add another number to this post. That makes 2 suicides from people that I have worked with directly.

 

[daftandbarmy]

Cheerful subject ;D

It seems to be a big deal in the US Army, which issues monthly suicide statistics:

http://www.washingtonpost.com/world/national-security/army-suicides-set-record-in-july/2011/08/12/gIQAfbGlBJ_story.html

 

[McG]

Interesting findings from a US study.  http://globalnews.ca/news/764998/military-study-disputes-link-between-combat-and-suicide/

Military study disputes link between combat and suicide
Lindsey Tanner
Global News
06 Aug 13

CHICAGO – Combat appears to have little or no influence on suicide rates among U.S. troops and veterans, according to a military study that challenges the conventional thinking about war’s effects on the psyche.

Depression and other types of mental illness, alcohol problems and being male — strong risk factors for suicide among civilians — were all linked to self-inflicted deaths among current and former members of the military.

But the researchers found deployment and combat did not raise the risk.


“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 suicides, the authors wrote.

The results echo smaller studies focusing on a specific branch of the military, but this is the first to look at a sampling from the entire military population, said lead author Cynthia LeardMann, a researcher with the Naval Health Research Center in San Diego.

More than 145,000 people from all branches took part, including active-duty service members, reservists and retirees, and they were followed from 2001 to 2008, a period in which the U.S. waged wars in Iraq and Afghanistan. The findings were published Tuesday in the Journal of the American Medical Association.

A recent increase in the military suicide rate has raised concerns about a possible link between suicide and combat, including long or repeated tours of duty in Iraq and Afghanistan. But the new study should lay those concerns to rest, said Dr. Nancy Crum-Cianflone, another researcher with the Navy centre.

She is leading a larger study on the health effects of serving in the military. The newly released findings are based on a subset of participants in that study.

The 2001-08 study looked at a small portion of the thousands of suicides among active-duty service members and veterans during that time.

There were 78 suicides among the study participants, or an average of almost 12 per 100,000 people followed for one year. The rate was about two times higher among men and people with depression, and a little higher than that among those with alcohol problems. But it was four times higher among those with bipolar disorder.

Pentagon data show there were 349 suicides last year alone among active-duty troops, the most since 2001.

Crum-Cianflone said the military suicide rate climbed sharply between 2005 and 2009, to about 20 per 100,000 people followed for one year. At the same time, there was an increase in the number of people with mental illness in the military. The reason for that is unclear, the study authors said.

The suicide rate in the general population also increased in recent years, to almost 18 per 100,000 in 2010, according to a JAMA editorial.

David Rudd, scientific director for the non-profit National Center for Veterans Studies, said the study provides only a snapshot and doesn’t answer whether combat exposure increases the lifetime risk of suicide.

Rudd said evidence suggests most service members who attempt suicide had pre-existing psychiatric problems and may have been suicidal before entering the military. That, he said, suggests a need for better screening and treatment.

In the study, depression was present in about 23 per cent of those who committed suicide and almost 11 per cent of those who didn’t take their lives. Six per cent of the suicides involved bipolar disorder, compared with less than 1 per cent of the non-suicides. Alcohol-related problems afflicted 30 per cent of the suicides and 14 per cent of the non-suicides.

Post-traumatic stress syndrome was uncommon and by itself was not found to be a suicide risk factor.

But Dr. Charles Hoge, a study co-author and retired Army psychiatrist, said: “Service members with PTSD often experience co-existing depression or alcohol problems, which would increase their risk” of suicide.

Rachel Yehuda, director of traumatic stress studies at Mount Sinai School of Medicine in New York, said the study “calls into question the previously assumed relationship between length of combat exposure and suicide” but doesn’t address other ways combat affects mental health.

Hoge said service members are routinely and extensively screened for mental illness before enlisting and afterward and those who are seriously ill are rejected. But he noted that some mental illnesses typically emerge first in young adulthood.

He said the military has made great efforts to offer treatment to those affected.

“There’s been a huge increase over the last several years in the number of mental health professionals working at military facilities,” Hoge said. These include combat stress teams in the field and counsellors back home.

 

[Szczep]

Problem solved!
Research done by employee of Naval Health Research Center in San Diego.
Paid by Navy/Pentagon/etc.  No need to look after veterans, ill and injured, etc., etc.
Self explanatory.
Well done.

 

[Teager]

I find it odd that they are trying to point towards drinking as the casue of suicides. If the member had no drinking problems prior to deployment and then began drinking after deployment there is obviously a connection with deployment. I'm sick of hearing how its always the drinking or drug problem that is for the reason for their behaviour. It may be a contributing factor but there is a reason why they started drinking/drugs. Of course the government won't look into that connection because that will mean $$$.

Heres a link to a more detailed version of the above.

http://www.cnn.com/2013/08/06/health/soldier-suicides-cause-study/