Suicides in the Military: The Post-Modern Combat Veteran and the Hemingway Effect
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Suicides in the military have increased over the last ten years. Much effort has been focused on suicide prevention and treatment, as well as understanding the reasons for the sharp increase in military suicides. Despite this effort, the definitive causes of military suicides remain elusive. Further, highly effective suicide prevention and treatment approaches have not yet been developed. The purpose of this article is to present a short review of the current state of suicide prevention interventions within the context of the military. The root causes of suicidal behavior and the role of combat in the military are each discussed. Interpersonal-psychological theory of suicide and the military transition theory are introduced as guiding frameworks for understanding suicides and suicidal behavior amongst active military personnel and military veterans. The article concludes with a set of recommendations for moving forward in understanding and addressing suicides in the military.
KeywordsMilitary Suicide Veteran Combat Interpersonal-psychological theory of suicide Military transition theory Modern veteran Hemingway effect
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Conflict of Interest
Carl Andrew Castro and Sara Kintzle declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 1.Kemp J, Bossarte R. Suicide Data Report, 2012. Department of Veterans Affairs Mental Health Services Suicide Prevention Program. 2012. Retrieved from the Department of Veterans Affairs website: http://www.va.gov/opa/docs/suicide-data-report-2012-final.pdf.
- 5.Mental Health Advisory Team (MHAT). Operation Iraqi Freedom (OIF) Mental Health Advisory Team (MHAT) Report. US Army Surgeon General. 2003.Google Scholar
- 6.Mental Health Advisory Team (MHAT-III). Mental Health Advisory Team (MHAT-III) Operation Iraqi Freedom 04-06 Report. Office of the Surgeon Multinational Force-Iraq and United States Army Medical Command. 2006.Google Scholar
- 7.Mental Health Advisory Team (MHAT-IV). Mental Health Advisory Team (MHAT-IV) Operation Iraqi Freedom 05-07 Report. Office of the Surgeon Multinational Force-Iraq and United States Army Medical Command. 2006.Google Scholar
- 8.•Bryan CJ, Hernandez AM, Allison S, Clemans T. Combat exposure and suicide risk in two samples of military personnel. J Clin Psychol. 2013;69(1):64–77. doi: 10.1002/jclp.21932. This article examines a complex model of suicide utilizing the concepts of interpersonal-psychology theory while also exploring the role of combat. Combat was not found to have a direct effect on suicide but was directly associated with PTSD severity. PTSD was strongly associated with depression which was in turn related to suicide risk.PubMedCrossRefGoogle Scholar
- 9.DoDSER, 2011 Department of Defense, National Center for Telehealth & Technology (T2), Defense Centers of Excellence for Psychological Health & TBI (DCoE), & T2health.org. Department of Defense Suicide Event Report (DoDSER) Calendar Year 2011 Annual Report. 2011. Retrieved from Office of The Under Secretary of Defense website: ttp://www.t2.health.mil/sites/default/files/dodser/DoDSER_2011_Annual_Report.pdf.
- 10.DoDSER, Department of Defense, National Center for Telehealth & Technology (T2), Defense Centers of Excellence for Psychological Health & TBI (DCoE), & T2health.org. Department of Defense Suicide Event Report (DoDSER) Calendar Year 2012 Annual Report. 2012. Retrieved from Office of The Under Secretary of Defense website: http://www.t2.health.mil/sites/default/files/dodser_ar2012_20140306-2.pdf.
- 14.Brenner LA, Gutierrez PM, Cornette MM, Betthauser LM, Bahraini N, Staves PJ. A qualitative study of potential suicide risk factors in returning combat veterans. J Ment Health Couns. 2008;30(3):211–25. Retrieved from http://search.proquest.com/docview/198688952?accountid=14749.Google Scholar
- 15.Bryan CJ, Rudd MD, Wertenberger E, Etienne N, Ray-Sannerud B, Morrow CE. Improving the detection and prediction of suicidal behavior among military personnel by measuring suicidal beliefs: an evaluation of the suicide cognitions scale. J Affect Disord. 2014;159:15–22. doi: 10.1016/j.jad.2014.02.021.PubMedCrossRefGoogle Scholar
- 17.Lambert MT, Fowler DR. Suicide risk factors among veterans: risk management in the changing culture of the department of veteran affairs. J Ment Health Admin. 1997;24(3):350–8. Retrieved from http://search.proquest.com/docview/205236605?accountid=14749.CrossRefGoogle Scholar
- 18.•LeardMann CA, Powell TM, Smith TC, Bell MR, Smith B, Boyko EJ. Risk factors associated with suicide in current and former US military personnel. JAMA J Am MedAssoc. 2013;310(5):496–506. doi: 10.1001/jama.2013.65164. This article is one of the most recent studies on risk factors associated with suicide in both current and former service members. The longitudinal study has important implications for designing effective interventions that may mitigate the risk of suicide.CrossRefGoogle Scholar
- 19.Mann JJ, Oquendo M, Underwood MD, Arango V. The neurobiology of suicide risk: a review for the clinician. J Clin Psychiatry. 1999;60:7–11. Retrieved from http://search.proquest.com/docview/619416514?accountid=14749.PubMedCrossRefGoogle Scholar
- 22.Rosel P, Arranz B, San L, Vallejo J, Crespo JM, Urretavizcaya M, et al. Altered 5-HT2A binding sites and second messenger inositol triphosphate (IP3) levels in hippocampus but not in frontal cortex from depressed suicide victims. Psychiatry Res Neuroimaging. 2000;99(3):173–81. doi: 10.1016/S0925-4927(00)00076.CrossRefGoogle Scholar
- 24.Schoenbaum M, Kessler RC, Gilman SE, Colpe LJ, Heeringa SG, Stein MB. Predictors of suicide and accident death in the army study to assess risk and resilience in servicemembers (army STARRS): results from the army study to assess risk and resilience in servicemembers (army STARRS). JAMA Psychiatry. 2014. doi: 10.1001/jamapsychiatry.2013.4417.Google Scholar
- 27.Omega-3 supplements eyed as reducing suicide risk among veterans. Except Parent (Online). 2012. 42: 55. Retrieved from http://search.proquest.com/docview/1368152629?accountid=14749.
- 33.Sareen J, Cox BJ, Afifi TO, Stein MB, Belik S, Meadows G, et al. Combat and peacekeeping operations in relation to prevalence of mental disorders and perceived need for mental health care: findings from a large representative sample of military personnel. Arch Gen Psychiatry. 2007;64(7):843–52. doi: 10.1001/archpsyc.64.7.843.PubMedCrossRefGoogle Scholar
- 36.Joiner TE. Why people die by suicide. Cambridge: Harvard University Press; 2005.Google Scholar
- 38.Castro CA, Kintzle S, Hassan AM. Returning home from war: the military transition theory. Submitted symposium for the Annual Meeting of Society for Social Work Research, New Orleans, LA .2014.Google Scholar
- 40.Baker C. Ernst Hemingway: a life story. New York: Scribner; 1969.Google Scholar
- 41.Crum-Cianflone N. The Millennium Cohort Study: answering long-term health concerns of US military service members by integrating longitudinal survey data with military health system records. In: Amara J, Hendricks A, editors. Military health care from pre-deployment to post-separation. New York: Routledge; 2013.Google Scholar
- 43.Fischer. A Guide to U.S. military Casualty Statistics: Operation New Dawn, Operation Iraqi Freedom, and Operation Enduring Freedom. 2014. Retrieved from fas.org: http://www.fas.org/sgp/crs/natsec/RS22452.pdf.
- 44.Department of Veterans Affairs. Epidemiology Program, Post Deployment Health Group, Office of Public Health, Veterans Health Administration. Report on VA Facility Specific Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn Veterans Coded with Potential PTSD, from 1st Qtr FY 2002 through 3rd Qtr FY 2012. Washington, DC: Author. Retrieved from (http://www.publichealth.va.gov/).
- 46.American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.Google Scholar
- 47.Department of Veterans Affairs. VA History in Brief.1997. Retrieved from United States Department of Veterans Affairs website: http://www.va.gov/opa/publications/archives/docs/history_in_brief.pdf.