Suicide Among The Armed Forces

Not since the great military suicide epidemic of the American Civil War have we seen so many of our heroes, our soldiers and veterans, die by suicide. Why? War is violence. There is intent to cause death, or serious injury, or threat to the physical and psychological integrity of others. War stress is unforgiving. Suicide is an all too frequent response. Today, one member of the military dies by suicide every day. This is a new epidemic. This book addresses some tough questions: What do we know about suicides in the military? Are rates high? Or low? Is military suicide the same or different in the United States and Canada? Is military culture relevant? Do we know the causes, patterns, and associations? Is suicide among the armed forces similar to or different from suicide among civilians? Can it be altruistic? Through individual case studies and general/population approaches, we attempt to understand the cost of military service. It is especially through the personal stories of the great Civil War hero General Emory Upton, Admiral of the Navy Mike Boorda, and Hospital Corpsman Chris Purcell that we find answers. We learn there is a relative lack of understanding about military suicides, mainly due to the very complexity of suicide. The nature of suicide is not monolithic--it is multi-determined. Military service, we find, is a risk factor for suicide and suicidal behavior. Military veterans are twice as likely as civilians to die by suicide. Posttraumatic stress disorder (PTSD) and traumatic brain Injury (TBI) are especially noted to be huge risk factors, but so are other physical and psychological injuries. Sadly, the aftershocks of war include not only suicides but also incarceration, motor vehicle accidents, homicides, homicide(s)-suicides, and many more faces of violence. And there are many more, uncounted, wounded and dead. The families of traumatized soldiers and veterans, too, are indirect victims of their traumatic experience and, for some, their suicides; there is secondary traumatization. Yet, as this book shows, we must not forget that despite the unbearable pain of war, soldiers, veterans, and their military families, including children, are typically resilient. They can survive! Without question, our vulnerable heroes and veterans are at risk for suicide. But there is secrecy surrounding this, which may well be the biggest barrier. The government, the Department of Defense, the military, veterans groups, survivors, health providers, and other stakeholders need to develop and support more research, more programs, and more care for suicidal and disabled armed services personnel, veterans, and survivors. This war stress needs to stop.

The increase in suicides among military personnel has raised concern. This book reviews suicide epidemiology in the military, catalogs military suicide-prevention activities, and recommends relevant best practices.

Suicide is a major public health concern in the United States (US), claiming over 36,000 lives each year and nearly 100 lives each day, and suicide among military and Veteran populations is of particular concern. Veterans returning from the Iraq and Afghanistan conflicts, referred to as Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans, may be particularly at risk, although the limited available data has shown mixed results. Several aspects of military experience may increase the risk of suicide, including mental health and substance abuse. Many risk factors specific to the OEF/OIF population have yet to be thoroughly evaluated and incorporated into clinical management. Ideally, suicide risk assessment tools need to account for the relationship among different risk factors and identify risk factors or combinations of risk factors that are particularly associated with suicidal self-directed violence. To be practically useful, such tools will be brief enough to be conducted in a primary care setting and will identify a threshold beyond which preventive action should be taken. Risk assessment tools should be able to discriminate those at high- and low-risk for suicidal self-directed violence. Likewise, studies of emerging risk factors need to evaluate the contribution of a new potential predictor of suicide and self-directed violence in the context of known risk factors in order to weigh the contribution of the new risk factor against those that are currently known. The objective of this report is to review recent evidence about risk factors and risk assessment tools within Veteran and military populations to provide evidence for clinical practice guideline development specific to these populations. The key questions addressed in this report were: Key Question #1. What assessment tools are effective for assessing risk of engaging in suicidal self-directed violence in Veteran and military populations? Key Question #2. In addition to the risk factors included by current assessment tools, what other risk factors predict suicidal self-directed violence in Veteran and military populations?

Part of the authoritative Oxford Textbooks in Psychiatry series, the new edition of the Oxford Textbook of Suicidology and Suicide Prevention remains a key text in the field of suicidology, fully updated with new chapters devoted to major psychiatric disorders and their relation to suicide.

Lowering Suicide Risk in Returning Troops: Wounds of War discusses the topic of increased suicide risk in service men and women around the world. Research has shown that those who have served in both combat missions and peacekeeping operations are at an increased risk for suicide. Research suggests that this may result from their ‘wounds of war’. Some wounds may be more ‘invisible’; such as depression, posttraumatic stress disorder, and chronic pain, while others are more visibly apparent; such as physical disabilities. Whatever the wound, however, it seems they may all lead to an increased risk of suicide. In this book, many aspects of military suicide and how to effectively deal with this issue are discussed. Specifically, some of the questions raised are: How do we detect those who are vulnerable to increased suicide risk, possibly due to a combination of genetics and past environmental insults? How do we most appropriately assess for increased risk? Once detected, how do we help to decrease that risk? Are there pre-deployment training methods we can employ to help ‘inoculate’ individuals against increased risk? Are there in-theater and post-deployment methods most appropriate for dealing with this risk?

Includes a new Afterword Finalist for the Council on Foreign Relations Arthur Ross Book Award One of the world’s foremost authorities on the subject of suicide terrorism, the esteemed political scientist Robert Pape has created the first comprehensive database of every suicide terrorist attack in the world from 1980 until today. In Dying to Win, Pape provides a groundbreaking demographic profile of modern suicide terrorist attackers–and his findings offer a powerful counterpoint to what we now accept as conventional wisdom on the topic. He also examines the early practitioners of this guerrilla tactic, including the ancient Jewish Zealots, who in A.D. 66 wished to liberate themselves from Roman occupation; the Ismaili Assassins, a Shi’ite Muslim sect in northern Iran in the eleventh and twelfth centuries; World War II’s Japanese kamikaze pilots, three thousand of whom crashed into U.S. naval vessels; and the Tamil Tigers in Sri Lanka, a secular, Marxist-Leninist organization responsible for more suicide terrorist attacks than any other group in history. Dying to Win is a startling work of analysis grounded in fact, not politics, that recommends concrete ways for states to fight and prevent terrorist attacks now. Transcending speculation with systematic scholarship, this is one of the most important studies of the terrorist threat to the United States and its allies since 9/11. “Invaluable . . . gives Americans an urgently needed basis for devising a strategy to defeat Osama bin Laden and other Islamist militants.” –Michael Scheuer, author of Imperial Hubris “Provocative . . . Pape wants to change the way you think about suicide bombings and explain why they are on the rise.” –Henry Schuster, CNN.com “Enlightening . . . sheds interesting light on a phenomenon often mistakenly believed to be restricted to the Middle East.” –The Washington Post Book World “Brilliant.” –Peter Bergen, author of Holy War, Inc.

Colonel G.W.L. Nicholson's Canadian Expeditionary Force, 1914-1919 was first published by the Department of National Defence in 1962 as the official history of the Canadian Army’s involvement in the First World War. Immediately after the war ended Colonel A. Fortescue Duguid made a first attempt to write an official history of the war, but the ill-fated project produced only the first of an anticipated eight volumes. Decades later, G.W.L. Nicholson - already the author of an official history of the Second World War - was commissioned to write a new official history of the First. Illustrated with numerous photographs and full-colour maps, Nicholson’s text offers an authoritative account of the war effort, while also discussing politics on the home front, including debates around conscription in 1917. With a new critical introduction by Mark Osborne Humphries that traces the development of Nicholson’s text and analyzes its legacy, Canadian Expeditionary Force, 1914-1919 is an essential resource for both professional historians and military history enthusiasts.

Approximately 4 million U.S. service members took part in the wars in Afghanistan and Iraq. Shortly after troops started returning from their deployments, some active-duty service members and veterans began experiencing mental health problems. Given the stressors associated with war, it is not surprising that some service members developed such mental health conditions as posttraumatic stress disorder, depression, and substance use disorder. Subsequent epidemiologic studies conducted on military and veteran populations that served in the operations in Afghanistan and Iraq provided scientific evidence that those who fought were in fact being diagnosed with mental illnesses and experiencing mental healthâ€"related outcomesâ€"in particular, suicideâ€"at a higher rate than the general population. This report provides a comprehensive assessment of the quality, capacity, and access to mental health care services for veterans who served in the Armed Forces in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn. It includes an analysis of not only the quality and capacity of mental health care services within the Department of Veterans Affairs, but also barriers faced by patients in utilizing those services.