This paper is a literature review to gather information on the different causes of suicide in the US military. Ten peer-reviewed articles were selected, and the findings showed that military separation, mental illnesses, problematic intimate partner relationships, childhood trauma, and a history of suicidal ideation are the leading causes of suicide among service members and veterans in the US military.
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Therefore, appropriate programs are needed to ensure that the affected individuals are supported and counseled on how to handle issues that may precipitate suicidal thoughts. Additionally, thorough screening processes are required to identify individuals with childhood trauma, history of suicidal behaviors, and other predisposing factors and take them through the appropriate therapy before entering the military. Before rejoining civilian lives, military personnel should receive the relevant support to ensure that they transition smoothly.
Suicide cases in the US military have been on the rise in the last two decades, and this trend has become an issue of concern. Specifically, high cases of suicide attempts were recorded after the Iraq and Afghanistan wars. From 2005, the numerous suicide cases among the US military have prompted the need for research into the issue to investigate the causes, trends, and solutions to this devastating behavior.
The research question for this paper is – what are the causes of suicidal behaviors in the US military? Evidence-based research (EBP) will be used to determine the leading causes of suicide ideation and attempts among service members in the US military. The available research shows that suicide cases in the US military are lower as compared to the general population. However, within the military, such cases have been on the rise. For instance, between 2001 and 2008, suicide cases among service members in the US military increased by 50 percent, and this change was unprecedented (Griffith & Bryan, 2015).
From a theoretical perspective, suicide in the military could be understood using the interpersonal theory of suicide. According to this theory, people commit suicide due to thwarted belongingness and perceived burdensomeness (Reger, Tucker, Carter, & Ammerman, 2018). In thwarted belongingness, an individual believes that he or she does not belong to a specified social group, which evokes feelings of isolation and loneliness. On the other hand, in perceived burdensomeness, the affected individuals think that they are a burden to others, and thus they contemplate suicide as a solution to that problem.
Researchers have not agreed on the exact causes of suicide cases in the US military. Initially, it was assumed that deployment was a risk factor for this behavior. However, new evidence shows that deployment may not be directly associated with the development of suicidal thoughts. Therefore, given the lack of consensus on the issue, this paper is a literature review to investigate what different studies have concluded on the issue of suicide in the US military using evidence-based practice.
Suicide in the US military is an important issue for social work practice. Social workers play a significant role in the health and mental health fields dealing with clients from diverse backgrounds. Specifically, some professional social work programs focus on training social workers to deal with military service members and veterans to address the diverse health issues affecting this group of individuals. This assertion underscores the importance of understanding the causes of suicide in the US military within the context of social work.
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To gather evidence-based empirical information on the causes of suicide among military service members and veterans, ten peer-reviewed articles were selected. The articles were obtained from different databases, such as EBSCOHost, PubMed, Google Scholar, PsycINFO, and Proquest. The keywords used included military, suicide, causes, service members, veterans, and risk factors. To narrow the scope of the articles, the selected studies had been published in the last 5 years between 2013 and 2018.
In a study to understand the risk factors associated with suicide cases in the US military, Reger et al. (2015) used a retrospective cohort design to collect data. The results showed that deployment was not directly related to the increase in the number of suicide cases among active service members and veterans. This conclusion was startling because according to Reger et al. (2015), the common assumption has been that deployment is one of the leading risk factors of suicidal behaviors in the US military. According to this study, separation from military service was likely to cause suicide with or without deployment (Reger et al., 2015).
Besides, suicide rates were likely to increase significantly among service members who separated having served for less than four years. The study also indicated that service members that separated without honorable discharge were also likely to commit or attempt suicide.
Another study by Villatte et al. (2015) sought to understand the characteristics of suicide attempts among military service members and veterans receiving mental health care services. This study revealed that non-fatal suicide attempts were almost similar among both veterans and service members. However, the study found out that the majority of attempted non-fatal suicides among veterans occurred immediately after separation from the military (Villatte et al., 2015).
On the other hand, such cases among service members occurred during their military duties. Besides, Villatte et al. (2015) revealed that almost 50 percent of service members had suicide ideation before joining the military. This conclusion added to the claims that service members with a history of suicidal thoughts or self-directed violence are twice likely to have the same tendencies once they join the military as compared to their counterparts without such records. This understanding raises questions on the role of screening individuals before joining the military.
In their study, Logan et al. (2014) sought to understand the precipitating circumstances that lead to suicide among active service members in comparison to civilians. The study indicated that the common precipitating suicide factors include problems related to mental health conditions, substance or alcohol abuse, intimate partner problems, and recent crises. Around 27 percent of the deceased individuals through suicide had left notes, which is an indicator of premeditation (Logan et al., 2014).
Of all the precipitating suicide factors, intimate partner problems were the leading causes in both the military service members and civilians. Mental health problems were the second leading cause of suicide among civilians and individuals in the military. This research introduced a different approach to the issue of suicide in the US military. Contrary to the conventional arguments that deployment causes such cases, policymakers can now focus on other contributing elements such as intimate partner problems and mental health.
Ursano et al. (2017) sought to establish whether the nature of occupation within the military contributed to suicidal thoughts among service members. The study surveyed suicide cases among combat medics, Special Forces, and combat arms. The results showed that cases of attempted suicide were higher in combat arms as compared to the others (Special Forces and combat medics) (Ursano et al., 2017).
Besides, combat arms and combat medics were more likely to have suicidal ideation if not deployed or previously deployed as compared to their counterparts in active duty. However, during training, combat medics were more likely to attempt or commit suicide as compared to their counterparts in other military occupations. These findings support other studies with similar conclusions showing that separation is one of the leading causes of suicidal behavior among military service members and veterans.
Griffith and Bryan (2015) sought to understand suicide in the military based on birth cohorts. In other words, the researchers wanted to investigate the role of age and the nature of households as determinant factors of suicide among military service members. According to Griffith and Bryan (2015), demographic shifts in the recruitment process into the military favors individuals with a high risk for suicide, such as young white males. Different studies show that young white males in civilian cohorts are highly predisposed to suicidal thoughts due to being brought up in non-traditional households (Griffith & Bryan, 2015).
However, the same group of individuals is more likely to be enlisted into the military. People with a history of suicidal ideation are likely to experience the same thoughts once they get into the military. These findings highlight the need for proper screening procedures for individuals enlisting in the US military as a preventive approach to the increasing cases of suicide.
Reger et al. (2018) wanted to investigate the role of deployment as a contributing factor to suicide in the US military. The researchers used case studies to achieve their objectives. The results indicated that deployment is a complex issue that should be investigated based on what happens during that period. Some of the factors of deployment that can increase suicide ideation include combat exposure, injury, and experience of killing or witnessing death during combat.
However, deployed individuals without such experiences were unlikely to experience suicidal thoughts. Reger et al. (2018) noted that the common assumption that everyone that has been deployed has a high risk of having suicidal thoughts is misplaced. Such assumptions create stereotypes, which may compel veterans and service members to think of suicide due to associated stigma. Consequently, policymakers should focus on making rounded decisions to address the stereotypes associated with some of these assumptions.
Another study by Youssef et al. (2013) explored the influence of different aspects, such as childhood trauma and combat exposure, in the development of suicidal ideation among service members and veterans who served in the Iraq and Afghan wars. The results indicated that childhood trauma was directly related to suicidal thoughts among service members and veterans. Combat exposure also contributed significantly to the problem of suicide in the US military.
These findings are consistent with other studies that suggest that pre-enlistment experiences affect individuals significantly after they enter the military. Therefore, military service members and veterans should be screened for childhood traumatic experiences and create a support system that can help them overcome the associated challenges. This move would play a significant role as a preventive measure to the rising cases of suicide among service members and veterans in the US military.
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Anglemyer, Miller, Buttrey, and Whitaker (2016) found out that the risk of attempting or committing suicide among service members and veterans depended on the nature of occupation in the military. The results showed that service with infantry or special operations duty specifications were more likely to commit or attempt suicide as compared to their counterparts executing non-infantry duties. In most suicide cases, a firearm was involved.
These results point to the need to identify military service members at the risk of committing suicide and create an effective support structure to help them where necessary. Anglemyer et al. (2016) noted that most active service members refrained from seeing help due to the associated stigmatization and the fear of losing their jobs. Therefore, policymakers and advisors should understand the different risk factors that predispose military service members and veterans to suicidal ideation and come up with comprehensive mitigation measures.
Hester (2017) carried out a study to understand some of the contributing factors to the rising cases of suicide cases among military veterans in the US. One of the outstanding causes identified in this study was the lack of access to proper and timely mental health services for veterans as they re-enter civilian life.
Hester (2017) argued that combat experiences expose military service members to traumatic episodes, which should be addressed appropriately to avoid the possibility of suffering from depression or post-traumatic stress disorder and other related mental conditions. Hester (2017) insisted that most veterans display common characteristics before committing suicide, such as depression, weight loss, perceived burdensomeness, substance use and abuse, and poor sleeping habits. Therefore, proper intervention measures should be put in place to ensure that individuals with such symptoms are taken care of in advance before they attempt or commit suicide.
In another study, Nock et al. (2013) sought to establish the psychological risks that predispose military service members and veterans to suicidal ideation. Some of the vulnerability factors established in this study included mental illnesses, stressful life events, demographic factors (such as age, sex, and race), and prior suicidal behavior. This study’s findings are consistent with other results listed elsewhere in the paper.
Nock et al. (2013) found that stressful life events such as childhood trauma and problematic intimate relationships were some of the leading psychological causes of suicide among military service members and veterans. Besides, mental illnesses were also significant contributing factors to this problem. These findings highlight the need for intervention programs to help military personnel deal with the psychological problems associated with their being in service, whether deployed or not.
Discussion and Recommendations
The evidence provided in the articles used for this literature review is valid. All the articles used were peer-reviewed and published in reputable journals in different areas concerning the issue of suicide in the US military. The studies were carried out using different tested research methodologies, which proves the validity of the results obtained. For instance, Villatte et al. (2015) used a randomized controlled trial study design, which eliminates the problem of biased results. Reger et al. (2015) used a retrospective cohort study design, which allowed the analysis of multiple outcomes.
Ursano et al. (2017) used administrative data from the Army STARRS to establish whether different occupations in the military had varying effects as causative agents of suicide among military service members and veterans in the US military. Youssef et al. (2013) used primary data collection methodologies with 1488 military service members and veterans as participants. The usage of a large sample size increased the viability of the results, and they can be generalized in other populations. In other words, the research findings of the articles selected for this literature review were valid.
The impact of the findings of the articles used in this paper is enormous, and it would influence how the issue of suicide in the military is addressed in the future. Several themes could be established across all the articles selected for this study. Different studies had similar results, which add to the available literature on the issue of suicide among service members and veterans in the US military. One of the common themes was that separation as opposed to deployment was a major cause of suicide cases in the military (Villatte et al., 2015; Reger et al., 2015). These findings would impact how policymakers and advisors address the issue of suicide in the military.
As mentioned earlier, the conventional understanding indicates that deployment is a leading cause of this problem among service members and veterans. However, this new evidence from evidence-based studies will change policymaking on the issue. Ursano et al. (2017) and Anglemyer et al. (2016) found out that the nature of occupation in the military contributed significantly to suicide cases. The impact of these findings is to ensure that intervention measures are tailored based on the risk of certain individuals within the military to address specific needs. Individuals’ experiences before entering the military were also shown to play an important role in how much people would behave once they enlisted.
For instance, it was established that people with a history of suicidal thoughts or childhood trauma were more likely to attempt or commit suicide as compared to their counterparts without such histories (Griffith & Bryan, 2015; Villatte et al., 2015; Youssef et al., 2013). Therefore, the findings of the studies selected for this paper would impact the future of understanding suicide in the military positively.
The research findings of this literature review apply to different set-ups. Some articles had similar conclusions concerning the causes of the rising cases of suicide among military service members and veterans. The applicability of the findings of this literature review is shown through the following recommendations. According to some of the findings, military separation is a leading cause of suicide among military personnel and veterans.
Therefore, proper structures and procedures should be put in place to ensure that service members are separated from the military honorably. Besides, support structures are needs to reintegrate service members back into civilian life. Additionally, it was established that people with historical suicidal behavior are likely to commit or attempt suicide once they enlist in the military.
Therefore, stringent screening procedures are needed to ensure that individuals at risk of suicidal ideation are identified and given the appropriate therapy to avoid such cases later on after they become military service members. The issues of mental illnesses and access to quality mental healthcare services were also identified. Veterans getting back to civilian life should be given the necessary attention and support to facilitate a successful transition.
For instance, as part of proactive crisis intervention, a period of 30 days should be allowed to train veterans on how to deal with drug abuse, marriage, housing issues, and job searching once they re-enter civilian life. Additionally, every regional Veteran Medical Facility should have inpatient beds to admit individuals with drug-related or mental issues. Finally, a mobile crisis response could be established in each regional Veteran Medical facility to train veterans on how to prevent suicide and other related problems.
Conventionally, suicide cases among military service members and veterans have been lower as compared to those of civilians. However, from 2005, the number of military personnel committing or attempting suicide increased tremendously to reach unprecedented levels in 2008. Scholars and researchers have differed on the causes of such increases in suicide cases in the US military. Therefore, this literature review was conducted to establish what evidence-based studies say about this issue.
Articles were obtained from different databases, such as EBSCOHost, Google Scholar, PubMed, PsycINFO, and Proquest, using different keywords including military, service members, veterans, and suicide. The search results were refined by selecting studies published in the last five years between 2013 and 2018. Ten articles were selected to address the causes of suicide in the US military. According to the results obtained, military separation, problematic intimate relationships, mental illnesses, history of suicidal behavior, childhood trauma, and occupation in the military were the leading causes of suicide among service members and veterans.
Therefore, policymakers should come up with intervention programs that address the issue of suicide in the US military by considering the aspects raised in this literature review. The implications for this paper to social work are broad. First, social workers play a significant role in helping military personnel deal with different health challenges that they face. Therefore, social workers would benefit tremendously by understanding the causes of suicide in the US military. By understanding the causes, it becomes easy to come up with evidence-based intervention measures, and this approach would yield positive results. The information contained in this literature review would prepare social workers adequately on how to address the challenges facing service members and veterans concerning the issue of suicide.
Anglemyer, A., Miller, M. L., Buttrey, S., & Whitaker, L. (2016). Suicide rates and methods in active duty military personnel, 2005 to 2011. Annals of Internal Medicine, 165(3), 167-177.
Griffith, J., & Bryan, C. J. (2015). Suicides in the U.S. Military. Armed Forces & Society, 42(3), 483-500.
Hester, R. D. (2017). Lack of access to mental health services contributing to the high suicide rates among veterans. International Journal of Mental Health Services, 11(1), 47-51.
Logan, J. E., Skopp, N. A., Reger, M. A., Gladden, M., Smolenski, D. J., Floyd, C. F., & Gahm, G. A. (2014). Precipitating circumstances of suicide among active duty U.S. Army personnel versus U.S. civilians, 2005-2010. Suicide & Life-Threatening Behavior, 45(1), 65-77.
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Ursano, R. J., Kessler, R. C., Naifeh, J. A., Mash, H. H., Fullerton, C. S., Ng, T., … Stein, M. B. (2017). Suicide attempts in U.S. Army combat arms, special forces and combat medics. BMC Psychiatry, 17(1), 194-184.
Villatte, J. L., O’Connor, S. S., Leitner, R., Kerbrat, A. H., Johnson, L. L., & Gutierrez, P. M. (2015). Suicide attempt characteristics among veterans and active-duty service members receiving mental health services: A pooled data analysis. Military Behavioral Health, 3(4), 316-327.
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