Largest Study Of Its Kind Finds No Link Between Combat And Military Suicides
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August 7, 2013 1:28 p.m.
Cynthia LeardMann, Senior Epidemiologist, Naval Health Research Center, San Diego
Nancy Crum, Principal Investigator, Naval Health Research Center
Neal Doran, Clinical Psychologist, VA San Diego
CAVANAUGH: Our top story is a study on suicide risk among military personnel that's dispelling some myths around the links between combat and suicide. Stressors associated with increased risk of suicide are similar in both civilian and military suicides. But the question remains why "rate of suicide is increasing faster among those in the military than the general population. My guests, Cynthia LeardMann is welcome to the program.
LEARDMANN: Thank you.
CAVANAUGH: And Nancy Crum, principle investigator for the Millennium Cohort Study. Welcome to the program.
CRUM: Thank you. It's a pleasure to be here.
CAVANAUGH: Let me start with you. This study on suicide is part of a much larger survey of military personnel called the Millennium Cohort Study. Can you tell us briefly what that is and how it is conducted?
CRUM: Yes. This study on suicides is really drawn from a much larger study called the Millennium Cohort Study. It's the largest study in U.S. military history. It began in 2001 before the current conflicts. And it was designed to look at how military experiences, including deployments, might play into the long-term health outcomes of our service members and veterans. Did has over 200,000 participants. It's conducted at the naval health research center in San Diego. And it's been extended to become the longest study in U.S. military history. It's been extended for 67 years. So we'll continue to be able to follow our service members and veterans looking at how military experiences might affect their health.
CAVANAUGH: What kind of information are you trying to gather in this study? What kind of questions are you asking?
CRUM: We're asking a variety of different questions about do deployment, do combat, do certain occupations in the military lead to specific health outcomes? We've looked at mental health outcomes like depression and PTSD. We've also looked at heart disease, diabetes, and of course in this study, we're looking at causes of death, including suicide.
CAVANAUGH: Now, of these estimated 200,000 people taking part in this study, Cynthia, how many of them -- because this is the group that you're looking at, committed suicide?
LEARDMANN: For this particular study, we used 150,000 people. And among them, 83 had a suicide death in the period we looked at, which was from 2001 to 2008.
CAVANAUGH: So the suicides you studied were among the military members that took part in the research. So you must have had a considerable amount of data already compiled.
LEARDMANN: That's correct. We started in 2001. And these people are completing surveys every three years, and they are very in-depth. So they're filling out questionnaires about their health, mental problems, behavioral issues, things like that.
CAVANAUGH: Now, what were the high-risk factors that you found associated with suicide in this study?
LEARDMANN: So among this population of current and former service members, we're found that mental health disorders, specifically depression and manic depressive disorder increased people's risk for suicide. We also found that alcohol-related problems increased their risk. And in addition, we found men as compared to women were at an increased risk for suicide death.
CAVANAUGH: And these factors are similar to high-risk factors in the civilian population?
LEARDMANN: Right. That's correct. So I think some people might assume these military service members, many of them have gone through very stressful environments and trainings and things like that, so they would assume these risk factors might be different in this population. So I think this study really indicates that's not true, and what's happening is that the risk factors are much more similar to what we would see in a general population.
CAVANAUGH: How did you assess that there were no deployment related factors associated with the suicides?
LEARDMANN: That's a good question. We looked at this many different ways. For the deployments, we're using electronic data from the DOD. We look at that, a number of days deployed, we looked at number of tours and things like that. We also looked at combat experience which was self-reported by the service members themselves. And even while we controlled for other factors, nothing really seemed to indicate that there was a direct relationship between these deployment factors and suicide.
CAVANAUGH: Now, let me ask you both, and another Doctor Crumb or Cynthia, you can decide, but the Department of Defense has determined that 80% of military suicides in recent years were among personnel who had not been in combat, have never been deployed to Iraq or Afghanistan. So I'm wondering what you find is new in this study.
CRUM: It is true that most of the suicides that we're seeing in a DOD are among nondeployers: The same is true for this particular study. 60% of people who did commit suicide in our analysis were nondeployers. And so I think overall this is suggesting that it's not specifically deploying in support of Iraq or Afghanistan conflict, that it is the real driver here. It's these traditional risk factors that we've always known about. The mental health issues, the alcohol-related issues that are really the drivers toward the increasing suicide risk that we're seeing. Of course, then the question is why is there an increased risk of suicide? And what are driving up the mental health issues and alcohol-related issues in the military? And we know that the rate of mental health issues and alcohol issues in increased between 2005 and 2009. The same period that we're seeing the increases in a number of suicides.
CAVANAUGH: Right. That brings me to my question, Cynthia, did you determine if the mental health and substance abuse issues linked to military suicide, did they exist if these people before they enrolled in the military?
LEARDMANN: I think that's a good question. And when we're serving these people, they're already part of the military. We're not examining any behaviors prior to their service. That said, many of these service members when we first questioned them, they are quite new to the service. And most of them have never deployed. So most of these behaviors and factors that we're look at are existing prior to their first deployment in the most part.
CAVANAUGH: Okay. On the line is Neal Doran, clinical psychologist with the VA in San Diego. Thank you for joining us.
DORAN: Thanks for having me.
CAVANAUGH: I'm wondering how the results on this study jibe with what you see in military practice.
DORAN: Well, I think they're not -- they're fairly consistent with what we see. It's a little bit counter intuitive in that you would think that being in such a stressful situation would increase the risk of all these sorts of issues associated with suicide. But at the same time, as your guests have said, we've known these are the kinds of issues that put people at high risk, and those are really the sorts of things that we tend to see in veterans as well.
CAVANAUGH: Is it hard for you to believe that deployment and combat are not risk factors for suicide?
DORAN: Well, that's what the data say. Like I said, it does seem counter intuitive. But I also think it's important to recognize that suicide is such a complex issue, and it maybe isn't surprising that there's not one particular thing that has a huge impact.
CAVANAUGH: Last year more military personnel died as a result of suicide than died in the war in Afghanistan. What kind of programs are now available for at-risk personnel and vets?
DORAN: The VA does a couple of things. One of the big things that they've been trying to do is reduce the stigma attached to seeking mental health treatment. Also we've really been working on increasing people's access to mental health treatment. So here locally, we're just rolling out some extended hours clinics where people can come on weekends and evenings, and we do mental healthcare by video conferencing. Also the VA has the veterans' crisis line, 1-800-273-8255. But any veteran or anyone who's concerned about a veteran can call and get connection to suicide prevention coordinators at every VA facility nationwide.
CAVANAUGH: How valuable are studies such as this one to the work that you do?
DORAN: I think they're valuable. I think it's important to point out that the veteran population is different demographically. It tends to be older than the population of active military. But at the same time, studies like this really help us say, okay, here are the things that we need to pay the most attention to, the things that are most important to keep working on reducing the frequency of suicide.
CAVANAUGH: Let me go back to my guests here in-studio. Cynthia, how likely is it that the depression and mental health issues that are identified as suicide risk factors in the study, that they were either caused or identified by combat or deployment?
LEARDMANN: That's an interesting concept. I think going back, we know that at least 58%, 60% of these people never deployed. So for those people, obviously the diagnosis had nothing to do with their combat or deployment. For the rest who were deployed, like I said, a lot of this was identified prior to these deployments. So I think for a large majority, we know that this is occurring prior to these deployments. I don't have the exact numbers with me. But I really think that we're confident in those results.
CAVANAUGH: There's an interesting quote that I pulled from material that I got on your study. It finds that the increase in suicide in the military might be traced to "increased mental disorders resulting from cumulative stresses in both deployments and home station environments over the war." What kind of stresses are you talking about in that quote?
LEARDMANN: I think we're speculating is that the service members have been at war for a decade now, for a long period of time. And we know that peace-keeping time is very different than war time. So even people who are at home, who have never deployed, that type of environment, being here at a base at home is still more stressful. The training, the requirements, it's just a different environment. So I think that comment in the paper is just saying that while deployments might be very stressful, just this period in general, being a military service member during these ten years of war is a stressful time, and that might also be having an effect to increased mental health problems among the service members.
CAVANAUGH: And therefore perhaps lead to the increase of suicide in the military?
CAVANAUGH: Doctor Crumb, a different study, are the Star study, find a link between deployment and suicide, and there are some questions about the relatively small member of suicides studied in the cohort study. How do you answer those criticisms?
CRUM: I think one is that we did only study 83 suicides in this particular report. That being said, I think it is important to recognize suicide is still quite a rare event, and within this cohort, it's over 200,000 participants now, and it really is the largest most comprehensive military study in existence. And so I think the power there of those findings is quite remarkable. The other thing to note, it's a study that involves all five branches. It looks also at reserve and national guard. And it also follows participants not only during their service times but after service. So 30% of the study were actually veterans. So I think it's the most comprehensive, prospective -- it ranged between 2001 and 2008. And we began collecting these factors even before the wars began. So I think the power of that study is remarkable. I can't specifically comment about the army Star's findings. But I think our study speaks for itself in terms of the power of this analysis. I also want to make mention that we're planning to continue to follow this cohort and do further work on suicides to make sure these findings bear out in future research.
CAVANAUGH: And Cynthia, based on the research, are current suicide prevention programs within the military effectively targeting the right risk factors?
LEARDMANN: That's a very good question. I think more needs to be done to really examine the effectiveness of the programs that are currently in place. And I think the other thing I would just say is that I think -- and I think as your guest has said on the radio, it's very important to be following these people, screening everyone as much as we can, and providing the best quality of care. But I think more needs to be done to really see what is the most effective ways to treat and to make sure that the service members as well as the veterans of getting the care they need for these mental health disorders and alcohol-related problems.
CAVANAUGH: Thank you both very much.
CRUM: Thank you.
LEARDMANN: Thank you.