Why the US Military’s suicide statistics are dead wrong

I’ve seen way too many people regurgitate flawed stats regarding suicide rates in the US Military. It seems that the DoD and / or defense-policy think-tanks have created some palatable ‘synthetic data’.

Going back to the 2001-2008 time period, this study seems to be a typical example. It’s from RAND, a large think-tank currently funded by the US Government and private endowments. Their biggest claim to fame is the ‘mutually assured destruction‘ nuclear weapon strategy of the Cold War era. Even they dismissed the DoD’s attempts at ‘adjusting the numbers’ outright because the DoD’s “methods weren’t transparent”. But are RAND’s any better? No.

Let’s take a look:

What Is the Suicide Rate in Military Services?

Suicide rates are typically reported in number of cases per 100,000 people. Figure S.1 shows the suicide rate among active-duty personnel for each military service and for DoD overall and reflects the published rate among active-duty military through 2008. It shows that, in 2008, the U.S. Marine Corps (USMC) and the U.S. Army have the highest rates (19.5 and 18.5, respectively), and the Air Force and the Navy have the lowest rates (12.1 and 11.6, respectively).

The figure also indicates that the suicide rate across DoD has been climbing, rising from 10.3 in 2001 to 15.8 in 2008, which represents about a 50-percent increase.

Okay so now we have a 15.8 per 100,000 number for DoD in 2008. Let’s see how that stacks up to the national average.

How Does the Military Suicide Rate Compare with That of the U.S. Population?

An important question is how the rate in the military compares with that of the general population. The estimated annual suicide rate in the general population for 2001–2006 hovers at around 10 per 100,000 (CDC, 2010), notably lower than that in DoD.

Actual data:

Civilian rate: 10 per 100,000,

Military rate: 15.8 per 100,000!

The military’s suicide rate was much higher than the civilian rate. This indicates that by 2008, there was a real epidemic and an undeniably high suicide rate.

So, are we done?… No. Watch how this dance works.

But these populations are not necessarily comparable, because the military and the national population differ so much in terms of age, sex, and racial makeup and, in part, because the procedures for reporting suicide data also vary, both between states and regions and between the nation and DoD. To derive a comparable population, RAND researchers calculated an adjusted suicide rate for a synthetic national population having the same demographic profile as DoD personnel and as each service. Figure S.2 shows the results of comparing DoD with the comparable segment of the U.S. population for the years 2001–2006.

‘Synthetic data’

Adjusted civilian rate: 19 per 100,00

Military rate: 15.8 per 100,000

It’s not particularly stupid to suggest that more males = more suicides. I’ll buy that much. However, the DoD has much fewer elderly has fewer non-hispanic whites. So racial and age demographics for suicide should work opposite those for gender, according to the CDC.

Is that what we see in this RAND study? Well… yes.

A total count was calculated by extracting personnel data from September of each year on the individual’s service, component, race, ethnicity, sex, and age. Weighted tabulations were produced by year for sex, race or ethnic category, age group, and service using a weighting scheme designed to replicate the denominator used by DoD. 

But does that mean their adjustment is accurate, and accounts for factors that might make the adjusted number less palatable to commanders / the public? NO.

The study identifies several factors that they admit not adjusting for. These factors would significantly alter the formula!

Where the study went dead wrong

Before entering the military you are screened for several things that would bar you from enlistment:

Mental illness – Bipolar, Schizophrenia, and many other disorders are a bar to enlistment.

Depression is the most common psychiatric condition associated with suicide. According to the RAND study: “However, it is believed that only 4 percent of persons with depressive disorders will die by suicide—much higher than a rate of 0.01 percent in the general population but still a risk factor with limited predictive power (Goldsmith et al., 2002).”

Prescriptions – They check to see if you’ve been prescribed anti-psychotics, and other drugs.

Eric Harris, Columbine Highschool Massacre shooter was denied entry into the United States Marine Corps when it was discovered he was on an anti-depressant.

Learning Disorders – Score too poorly on some of the sections of the ASVAB (and other tests), and you’ll be denied entry.

“Researchers propose that problem-solving deficits can both create stress and impede a person’s ability to cope with stressful situations, which, in turn, may lead to suicide (Wenzel, Brown, and Beck, 2009).”

Pass a drug test – Fail the pee test? Nope. Importantly, they keep testing you!

“Across cohort studies, there are more deaths by suicide than would be expected among persons with alcohol- or opioid-use disorders, intravenous drug users, those who use multiple psychoactive substances, and those who drink heavily. The magnitude of increased risk ranges from threefold (among heavy drinkers) to 17-fold (among those who use multiple drugs) (Wilcox, Conner, and Caine, 2004).”

Substance abuse AND mental health issues: “Case-control studies also indicate that 23–46 percent of suicides among young adults and adolescents can be attributed to mental health disorders comorbid with substance abuse (Cavanagh, Carson, et al., 2003).”

Graduate boot camp – These initial weeks are grueling and serve as an ultimate stress test for a typical civilian.

Many people wash out during boot camp and return to civilian life in what’s called ‘Entry Level Separation’.

Debt - The DoD typically runs exhaustive background checks on potential recruits, including financial data.

Historically, money was a leading contributing factor to espionage / spying. Typically a foreign agency sought out people with large amounts of debt, and solicited them for national security compromises in exchange for money. Though more recently cultural, religious, or other ideological factors have surpassed money as the leading factor (SEE G-2? I pay attention!) Large amounts of debt, and other bad financial historical data can severely limit your options, if not outright ban you from military service altogether.

It’s no secret that financial obligations are a leading factor in suicide ideation. According to Air Force publication, AF PAM 44-160 “Of the entire constellation of risk factors, problems with relationships, the law, and finances played a part in an overwhelming majority of suicides.” (page 8)

Criminal history – Serious crimes are always permanent barriers to enlistment, while many lesser crimes may have been (or still are) ‘waiverable’.

I joke around with my fellow soldiers “We’re the best of the worst. Fucked up enough to not go to college (therefore not becoming an officer). But at least we didn’t get arrested.”

Once again AF PAM 44-166 mentions that problems with the law that happen within the a person’s military career are big factors in suicidal behavior. Now take that concept and apply it to the ‘gatekeeper’ that bars so many applicants from entry in the first place. We should theoretically have fewer suicides!

None of the above factors are considered for the ‘adjusted national average’ that RAND came up with! I doubt it’s even possible for most of these factors. Therefore, the very notion that a ‘synthetic population’ similar to the DoD can even be indexed is ludicrous.

Clearly, several suicide risks are mitigated before recruits even become service members. Furthermore, most of those factors are continuously monitored during a person’s career. When the rate jumps this high, somethings very wrong.

Stop throwing good money after bad! Service members are dying at increasing rates. We need real change now. Instead of wasting $125 million on Spiritual Fitness in 2009, they should have spent it on policy, medical, or any other type of improvements.

Lastly, I noticed an interesting ‘fact’ on the CDC’s list of risk factors for suicide. Cultural / religious beliefs are listed as both a risk factor and a protective factor for suicideIt’s like what ‘they’ say about salt. First they tell you it’s good for you, then it’s bad for you, then it’s good for you again. Then you wind up not knowing who to believe, and eventually you become a dangerous salt-militant.

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  • benwoodruff

    So your complaint is that they control for the factors that they can control for such as demographics and don’t control for those that they cannot?

    For instance you talk about drug and alcohol abuse. Those have been on the rise for military members for years. In fact the Army is investiging a ring discovered after several soldiers ODed.

    The cases, therefore, are just a piece of the broader drug use statistics released by the Army earlier this year reporting nearly 70,000 drug offenses by roughly 36,000 soldiers between 2006-2011. The number of offenses increased from about 9,400 in 2010 to about 11,200 in 2011.

    That would at least indicate that drug use is not zero even given the testing policy in place. I served with members that people knew were using so I know some commanders let things slide. This is even after including the binge drinking that is common and even celebrated in the military.

    Other issues like debt (think of the pay day loans sites just off post), relationships (not a stretch when deployed for a year), and mental disorders will show up in military members. If a military member starts to exhibit signs of schizophrenia he is not likely to report himself. The peak age onset is in the 20′s which is after MEPS gave you the green light. PTSD is another driving factor that has high rates in the US military.

    I am not here to fling poo at your post. I am just saying that it is the best comparision they can do with the data they have.

    http://alabamafinance.wordpress.com

    • M Groesbeck

      The convenience of a set of corrections doesn’t guarantee the accuracy of the results. “It would have been too difficult to correct for these other factors” does not, in any sense, guarantee that those factors don’t have an impact. In other words, your comment does nothing to defend the results of the study and much to imply that the study should have been done either right or not at all.

      • eddie

        The statistics are reported with margins of error so that the representativeness of the sample to the overall population can be estimated. Of course, there is no tangible way to assess accurately everybody in the population that would be of interest so the study is done just as well as it could be done. I don’t understand your contention unless you truly prefer that nobody should evaluate this subject area unless they were omniscient. In which case I reject your position as ludicrous.

  • Bob Wyttenbach

    To be fair to the CDC’s listing cultural and religious beliefs as both risk and protective factors, they do break it down (cultural belief that suicide is noble = risk, while beliefs that discourage suicide or support self-preservation = protective).

    Making sense of suicide statistics is tricky. I work at Cornell U, which has some very widely reported suicides (students jumping into one of the gorges that run through campus). The dramatic nature of these has led to the belief that Cornell has a high suicide rate, when it’s actually about average for college campuses nationwide. Furthermore, the suicide rate among college students is about the same as it is for non-students of college age. That just turns out to be a difficult age to go through, and some decide not to. It would be interesting to see how the military rate compares to the college rate; I’d guess they’re similar.

    In any case, it’s not clear what all this has to do with reducing the military suicides (or student suicides, for that matter). Regardless of the statistical slicing and dicing, you still need to offer everyone the psychological support and counseling they need, address the stressors that affect them, and so on.

    • kevinkirkpatrick

      Wow, Bob hits the nail on the head – college populations are gob-smackingly obviously better baselines for comparison vs. the “synthetic population” used in the RAND study. And what does a quick Google search reveal?

      http://youngadults.about.com/od/healthandsafety/qt/suicide.htm

      “Experts estimate 1,0888 suicides occur at colleges every year – that’s roughly 7.5 per 100,000 students. “

      So, military is DOUBLE the base rate of college students; and let’s not lose site of the fact that college-age suicides rates themselves are considered an epidemic:

      “According to the American College Health Association (ACHA) the suicide rate among young adults, ages 15-24, has tripled since the 1950s and suicide is currently the second most common cause of death among college students.”

      If we assume the suicide rate of college-aged students in the 1950′s to be a “healthy baseline” (that is, the rate of suicide amongst reasonably healthy young adults exposed to reasonable levels of stress), and today’s college students have more than tripled that, that means our military suicide rate is at least 6 times this “healthy baseline”.

      • http://alabamafinance.wordpress.com BenWoodruff

        So twice the level of college? Then we would want to adjust to the fact that the military is overwhelmingly male while there are more women in college then men. We also have to account for the class demographics differences since many military members did not come from a privilidged background that allows for them to go to college which is why they are in the military.

        That is what Rand was trying to do. Make the comparison something that is more apples to apples.

        • Justin Griffith

          So what percentage of colleges also pre-examine ALL of the following:

          Mental illness – Bipolar, Schizophrenia, and many other disorders are a bar to enlistment.

          Prescriptions – They check to see if you’ve been prescribed anti-psychotics, and other drugs.

          Pass a drug test – Fail the pee test? Nope. Importantly, they keep testing you!

          Substance abuse AND mental health issues: “Case-control studies also indicate that 23–46 percent of suicides among young adults and adolescents can be attributed to mental health disorders comorbid with substance abuse (Cavanagh, Carson, et al., 2003).”

          * Graduate boot camp – These initial weeks are grueling and serve as an ultimate stress test for a typical civilian. [*willing to concede this one]

          Debt – The DoD typically runs exhaustive background checks on potential recruits, including financial data.

          Criminal history – Serious crimes are always permanent barriers to enlistment, while many lesser crimes may have been (or still are) ‘waiverable’.

  • Len Blakely

    Good show and nicely presented. I do not necessarily agree -entirely- with your entire line of reasoning as to -why- this is, though it is on the whole quite sound.

    It would appear that the US rates are not entirely different from the Canadian ones. However the military demographic is heavily skewed towards young males, who statistically speaking have a higher suicide rate.

    The military aged demographic (25-34 year old, high school educated, male) I was able to find for civilians Canada showed a rate of 25 per 100,000. The most recent military rate available was 16.1 per 100,000. This is -down- from 19.1 per 100,000 and is one major difference between the 2 countries.

    I was only able to adjust for a few factors (not being a major research organization). But it is true that you need to personally go through a lot of raw data and examine methodologies to see if the conclusion is supported by the facts. Even if there is a problem I do stand by my point that the media is presenting the information out of context and in a tone slanted to be sensationalist.

  • http://www.facebook.com/profile.php?id=100000837164286 mariofernandez

    the most important piece of info to rescue from the study is the almost 50% increase in suicide rate. what changed since the last study? when we see 2001 as the previous marker, it is easy to assume that it is a war related increase (for all the reasons posted in the comments above). However, by comparing to civilians, even if the adjustments are accurate, we forget that the real comparison should be to the previous numbers held by the very institutions that are meant to represent an elite group of people, closely supervised, highly trained, and full of resources.

  • karmacat

    I am not sure what Rand is trying to say or what their purpose is in adjusting the numbers. What is clear is that they are missing the big picture. It doesn’t matter how military suicides compare to civilian numbers. What matters most is that there has been an increase in the frequency of suicide. So comparing populations doesn’t help in understanding the causes of military suicides

  • steve B

    I’ve done a fair bit of suicide awareness training in the last month, and I have more training in the pipe. The other part of my month is going to nursing school with the intent of getting into mental health nursing to work with PTSD patients and those at risk for suicide.

    What I think the Army needs first off is more mes. Not me literally, but people with a desire to go into mental health care to help our fellow Soldiers. I read somewhere that mental health AOCs and MOSs on the whole are only at 88% of strength. That’s not good, I’d rather see those areas overstrength, and if anyone chirps about it then we need to do the right (and needed) thing and increase the authorized strength! We can start by putting more psych nurse seats in USUHS and steer more PAs into psych specializations. It’s not exactly a quick fix, but it is something we could get the ball rolling quickly at least. Plus we could step up recruiting of mental health professionals for the reserves. If you’re downrange and you go to a CSH, it’s probably reservists taking care of you. We need trained mental health professionals in those CSHs.

  • Jake

    You mentioned that the military screens for risk factors during the admission process. But, since fewer people are signing up these days, I bet that admission process has become a lot more lax than in the past.

    So at least part of the higher suicide rate has nothing to do with the effects of war, but with the change in admission criteria.

  • Pingback: Suicide Among Soldiers | Mind Unshackled

  • http://www.youtube.com/watch?v=C4wZPgaHq6o asvab exam practice

    YOU HAVE AN 80 !! DONT RETEST . if you fail the retake you will no longer be eligible to enlist . if your score is high enough for the career your chasing then stick with the score that you have .


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