Birth Era May Factor in Risk of Suicide

Birth Era May Factor in Risk of Suicide

Tuesday, January 12, 2016

The U.S. military has seen a marked increase in the number of suicides among personnel. For example, the suicide rate rose from 10.3 suicides per 100,000 service members in 2001 to 15.8 suicides per 100,000 service members in 2008. This 50 percent increase across all the armed services was largely due to the suicide rate in the U.S. Army, which doubled during the same time period.Because the Army contributed substantially to ground forces in Operations Iraqi Freedom and Enduring Freedom, many have speculated that the increased prevalence of suicide was related to military personnel who were deployed, participated in combat, or experienced an overall high operating tempo. We argue that these factors do not necessarily explain the rise in suicides in the U.S. military. Rather, the increase indicates a broader trend of increased vulnerability among more recent generations of young adults.We elaborated on this argument in a paper we wrote for the journal Armed Services and Society, and we presented it last fall to the Inter-University on Armed Forces and Society, an international organization that studies social and behavioral issues involving the military. The following is a summary of our findings.Birth Cohort and SuicideSociologists Jean Stockard and Robert O’Brien suggested in a 2002 article for the peer-reviewed academic journal Social Forces that increased suicide rates among young adults in the general population reflected generational declines in social integration and behavioral regulation. Social integration entails having access to predictable, stable and enduring social ties that can provide support and relief to individuals during times of stress. Behavioral regulation refers to the strength of norms that determine the acceptability of certain behaviors. These two processes formed the cornerstone of Emile Durkheim’s analyses of suicides among Protestants and Catholics in Europe during the late 19th century, documented in his 1897 treatise, Le Suicide.Both social integration and behavioral regulation are influenced by demographic trends. Increases in birth rates and single parenthood may strain social institutions that promote social integration and behavioral norms such as families, schools, recreational clubs and religious organizations. There are more children to care for, but fewer adults are involved. Children in these generations have less attention and supervision while growing up, and social integration and behavioral regulation may be lessened.Stockard and O’Brien found that people from generations with these characteristics had relatively higher suicide rates throughout their lives. Their first finding was that among more recent birth cohorts, suicide rates in the U.S. population have increased among teenagers and young adults. They studied the distribution of suicides for age intervals in three time periods: 1930, 1965 and 2000. In 1930, the total U.S. population showed progressively increased suicide rates from younger to older age intervals. In 1960, a similar pattern of rates occurred until ages 55 to 59, where the increase was less evident. In 2000, this pattern of increase was even less apparent.___________________________________________________________________________Suicide by Age in Three GenerationsAdditionally, suicide rates rose dramatically among ages 10 to 14 through ages 20 to 24, reaching a peak at ages 40 to 44. This peak was not exceeded until ages 75 to 79. Their second finding was that suicide rates of age intervals at a given time period have been reliably predicted by size of the birth cohort and the percentage of nonmarital births—again, demographic characteristics likely impacting social integration and behavioral regulation.Vulnerable GenerationsWe examined evidence related to increased vulnerability among members of more recent generations of U.S. high school and college-aged students in several studies. Analyses of large-scale data sets across time have shown increased emotional and behavioral problems among younger generations of high school and college students, as well as generational shifts in their values.Of particular note, more recent generations of high school and college students report that they value fame and wealth more than earlier generations; they value community relations, interest in social problems and civic engagement less. These changes have been especially pronounced during the transition from Generation Xers—those born in 1962 through 1981—to the millennials—those born in 1982 through the early 2000s. Findings from several military studies are consistent with these larger trends in U.S. society. For example, military studies have reported more psychological disorders among personnel using medical treatment facilities, and more waivers for those enlisting. The Army Study To Assess Risk and Resilience in Servicemembers research team further indicates that mental health conditions that exist before joining the military play an important role in later suicidal behaviors.Evident in MilitaryConsequences of these trends are likely more evident in the U.S. military due to its circumscribed population. First, the Army has proportionally more personnel who are at greatest risk for suicide: young, male and white. Young age, male gender and white racial identity have been identified in both civilian and military research studies as risk factors for suicide.In addition, the U.S. Army has seen over time an increase in the proportion of white soldiers and a decrease in the proportion of racial minority soldiers. These changes in demographics have particular relevance when considering that O’Brien and Stockard found increased suicide risk across birth cohorts greater for young white men than others. In other words, the subpopulation for whom generational vulnerability has increased the most is the same subpopulation that has proportionally increased the most within the U.S. Army.Second, recent studies also suggest that those who now volunteer for military service are distinctly different from non-volunteers of the same age. Recruits disproportionally come from single-family households and households of adverse childhood experiences, both of which are associated with suicide risk. Using large-scale longitudinal data, Naomi J. Spence, Kathryn A. Henderson and Glen H. Elder Jr. observed that youth living in single-parent households had increased odds of military enlistment independent of socioeconomic status, characteristics of parent-child relationships, or feelings of social isolation. Findings were reported in a 2013 article for Journal of Family Issues.Third, increased vulnerability of soldiers in recent years might also be explained in part by a considerable change in the pool of applicants who are eligible for military service. Since the implementation of the all-volunteer force, the number of volunteers has diminished. Of this pool, nearly half are accepted into military service. This situation contrasts with the last prolonged major conflict, the Vietnam War era, during which nearly all 18-year-old men were eligible for conscripted service, though only a fraction was inducted. In more recent times, larger proportions of recruits have more waivers for health conditions or behavior problems.In sum, trends in vulnerability among the more recent generations are more likely to be evident in the military due to characteristics of its changing population: few volunteers, many of whom are young and male; and proportionally more who are inducted. Evidence also suggests that more recruits come from nontraditional family structures, which often are associated with less social integration and higher suicide risk. These factors make increased vulnerability more evident among U.S. military service members than among the general population.Steps Toward PreventionWe have identified several possible directions for the prevention of suicide in the U.S. military. First, if increased prevalence in suicide is, indeed, related to cohort vulnerability, with more recent birth cohorts more susceptible, then the problem of suicide risk is much broader than previously thought. That is, increased suicide risk encompasses all members of specific cohorts within society, not just military members. Second, for the military it means more effective screening of prospective recruits, and for those already in the military, more effective periodic assessments for suicide risk.Current assessments require soldiers to respond to specific questions regarding suicide thoughts, plans and attempts. Although positive responses to these questions are generally considered by suicide experts to be among the most important warning signs or short-term indicators of imminent risk for suicide, research suggests that more than half of those who die by suicide actually deny suicidal ideation and/or intent during their most recent screening. There may be an underlying, chronic vulnerability that is not evident using existing screeners. The question, though, is the specific content that enables effective detection of these underlying risk factors.Finally, the content of preventive strategies should be aimed more directly at domains related to the desire for social integration, such as training and experiences associated with group identity and solidarity, leadership and group norms that develop individual-to-group ties, providing social connections and control of individual-level behaviors. Such processes strengthen bonds among group members through the physical and social environments that promote proximity and communication; behaviors that are interdependent, satisfying individual and group needs; shared feelings; and having commonly identified personal characteristics.Re-examining the Army’s current and past practices, in particular those associated with soldier bonding and cohesive ties among unit members, would not only benefit readiness but also soldiers’ identification with others, the unit and the Army.