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An old good friend of mine from college posted on Facebook the other day:

1 military suicide every 36 hours; current prevention programs are not working: http://tiny.cc/9tx05

Clicking through to the referenced link you see the actual data:

The report noted that from 2005 to 2009, more than 1,100 servicemembers committed suicide—an average of 1 suicide every 36 hours.  Suicide rates in the Marine Corps and Army have severely increased and the Army rate has more than doubled.  Since 2001, 252 servicemembers have killed themselves in Iraq and Afghanistan.

The task force recognized efforts made by all military branches to prevent suicide, but concluded that they are a falling short because the programs are not centrally organized.   The rush to respond to the challenge and the lack of strategic planning has led to unintended consequences.  These include, inefficient programs and missed prevention opportunities.

It sounds like a lot right? Well, maybe. In the year I can most easily find data (2006), it looks like 33,300 Americans took their own lives. This corresponds to a suicide rate of roughly 11.1 suicides per 100,000 people. Reporting the rate makes sense. Reporting the gross number of suicides is highly misleading. For example, if the U.S. military were 100x larger than its current size, then we’d see a lot more suicides, instead of one every 36 hours, maybe we’d see one every 3.6 hours. Does that tell us anything about the severity of the problem?

To illustrate this point more clearly, if you report the U.S. suicide rate the same way that the IAVA reported the military suicide rate, there is one American suicide every 16 minutes. It would appear then that the suicide problem for Americans at large is far worse than for a subpopulation who, on its face, would seem to be at a much greater risk for suicide. So this way of presenting the data does not pass the smell test.

How to make an apples to apples comparison? First, let us ask how large the current military is. About 1.5 million men and women appear to be in the active armed forces. I do not know if the Congressional report includes the additional 1.5 million in the reserves. The IAVA link implies that the military experiences about 220 suicides every year. For an active force of 1.5 million, this would correspond to an overall rate of 14.7 per 100,000, about 1/3 higher than the overall rate. If we include the reserve forces, then it looks like the military rate is only 7.3 per 100,000, or about 1/3 lower than the overall rate. Of course, the Executive Summary of the report does not tell us the methodology used – but finally after reading through to page 50 it seems like they are using the lower number as the denominator – which puts the military suicide rate a little above the rate for the entire country. That is the number that ought to have been reported, but alas it was not.

When I pointed this out in a comment on my friend’s page, a respondent included in his message to me:

Why are you putting down the military for caring enough to make the matter public, the effor (sic) to do something about it?

This is a common type of  “argument” I encounter whenever I raise questions about any of the elements  in the stations of the cross near and dear to people’s hearts, particularly if they have to do with government. Question my motives and make it appear that for even trying to be thoughtful about this that I am no better than a child-candy stealing sicko who has no sense of right and wrong. Even if my motives were base, and I was a scoundrel it does not change the appropriateness of this particular question, nor does it make the presentation of the material by these supporters any less “smell-test passable.” But of course, I could and would defend my motives and character here, as I see in this lessons for my students, and I see in it symptoms of larger problems – not having anything to do with the military. For my thoughts on the military, you’ll have to wait for a future post.

Now, back to the issues raised above. The report (and the FB wall post) indicates that suicide rates in the military are on the rise (particularly because of the impacts of the drawn out fighting in the Middle East). It is this increase that really is the problem, even if my analysis above had teeth to it. What to make of this? Well, it would be appropriate to at least compare the rate of change in the suicide rate in the military population with other reference groups – something I do not see at all in the report, and certainly which is not acknowledged in the Facebook exchange (still ongoing). Updated data for 2007, 2008, 2009 and 2010 for the U.S. as a whole are not available, so all I can do is refer to what we know about suicide trends. Right now we are in the midst of a severe recession with lots of jobless and it is likely that suicide rates are similarly increasing if today’s experience with suicide is like it has been in the past. In other words, when the economy is in shambles, suicide rates rise and vice versa. Thus, the uptick in the military rate may be no particular “surge” and no particular policy issue of increased importance. We just cannot say for sure without a lot more serious research.

And as I am sure you understand, at some point the military commanders’ time is better spent on things other than suicide prevention. To make an analogy, isn’t it true that spending more money on (insert favorite program here) would make it better? Isn’t it true that dedicating more time and resources toward (insert favorite program here) is likely to improve outcomes? But that fact alone does not indicate that it makes sense to dedicate said time and resources.

Soldier suicides, like all suicides, are sad matters. But that does not make the issue “untouchable” for clear and easy to understand analysis. So I ask sincerely how the military suicide rates compare to the civilian population, and I ask how the uptick in military suicides corresponds to the uptick nationwide. And on a much larger point, don’t we think that squad leaders and other commanders are powerless to control these sorts of things at some level? Is the proposal in this report to get military suicides in line with the rest of society? Nope – now you cannot actually tell, but from the “discussions” it would seem like the goal is to eliminate them. But we live in a world where that outcome is simply not feasible.
So why do advocates present data this way? Because few people want to spend any energy (and who can blame them) reflecting for more than a microsecond on the myriad facts that hit their brains. And in particular, when the facts that they are presented with seem to fit comfortably in their warm, cozy room of beliefs they hold, there seems to be no reason to reflect on it. I am actually pretty surprised by this. From my experience I feel like people resist wanting to look foolish, especially in public. This is why I am especially vigilant in understanding data and results that would seem upon a glance to advance views that I hold favorably – nothing would be more embarrassing and actually more damaging to one’s credibility than having you be known to rely on misleading presentations and flimsy evidence. But that does not seem to be much of a deterrent for popular opinion.
This post is already way too long, but I could not end it without referencing something else in the report which makes my head spin. And that is looking at how much time and energy was spent in the report congratulating all of the people who worked on this task force, but what’s even better is examining what this government commission recommends for what to do about the problem.
If you expected a cautious approach, a simple approach, a decentralized approach, a sensible approach, an inexpensive approach, you would be of course asked to sit in the back of the class with your dunce cap on. Here are some random highlights given that the Task Force made 76 recommendations about what to do:
#71: “Every suicide prevention program initiated by DoD or the Services must contain a program evaluation component.
You mean to tell me that the programs they have in place now do not include any evaluation? Sounds a lot like the stimulus program.
#57 “Formalize existing interconnectedness of the DCoE Outreach Call Center, National Suicide Prevention Lifeline, and Military OneSource to enable each agency to quickly and effectively route calls to appropriate responders. Ensure ongoing quality review and quality improvement efforts focused on emergency rescue situations, follow-up referrals for callers at-risk, and linkages with community providers of crisis services (e.g., mobile outreach teams).”
Notice that (just like prior to 9-11) enormous amounts of resources are already in place but just seemed to not have been communicating well, or working well. We’ll get it right this time, right boys?
#27 Expand the practice of embedding behavioral health providers in operational units. Conduct studies to determine the range of effective staffing ratios for embedded providers
Are they serious? Now we will have mental coaches following around platoons who are doing street sweeps in the slums of the Middle East? But more than that, notice that such a recommendation is without reference in the report to how other organizations do it, other recommendations by government to do it, and of course, with no recognition of how serious the military suicide problem is relative to the overall problem. Even if the problems were identical that does not mean the military ought not do something about it, but then the report should be written differently – aimed at something like, “it is important for the military to have lower suicide rates than you can expect to reasonably achieve without lots of effort and here is why.”
And of course, it’s the government, and the military to boot, so what do you think recommendation #1 is?   If you said get bigger, get more funding, pay more attention and get more centralized you can take off the dunce cap and move to the head of the class:

Build, staff and resource a central OSD Suicide Prevention Office that can effectively develop, implement, integrate, and evaluate suicide prevention policies, procedures, and surveillance activities. This office should reside within the Office of the Under Secretary of Defense for Personnel and Readiness and be granted the coordinating authority that enables strategic suicide prevention oversight from OSD, through the Services, and down to the unit level.”
I love the humility, and the recognition that you might, perhaps, not be able to do much about this problem. And I especially liked the parts of the report which talked about the costs of all of these recommendations, their likelihood of success and what else the military might be doing with their energy.
About the only thing that did surprise me in the report was that there was not a section about how global warming likely contributed to an increase in the probability of the suicides. My guess is that we have to wait for the next round of NSF funding before we see that section added to it.

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