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Health See other Health Articles Title: Suicide in the military: Results of a new army study In the past decade, more soldiers have committed suicide than have been killed in combat in the Middle Eastern wars. This observation, which naturally has raised concern, can now be informed by a major study conducted by the Army, recently published in a series of articles in JAMA Psychiatry: the Predictors of Suicide and Accident Death in teh Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Before enlistment: about 2.4% of soldiers had prior suicide attempts t, 5.3% had suicidal plans, and 13.9% had suicidal ideation. In cross-sectional analysis of a one month period, 25.1% of the miliatry sample was diagnosable with a DSM-defined psychiatric term compared to 11.6% of the general population in the National Comorbidity Survey. Many soldiers enlist with pre-existing psychiatric conditions, especially unipolar and bipolar mood illnesses, and those soldiers are less functional and more prone to suicidality. PTSD is a major problem as a result of military experience, as is well known, but less of a problem for role functioning. A third of suicides might be prevented with better psychiatric screening prior to enlistment, especially for past suicide attempts. More effort needs to be made to clinically define patients who are termed "intermittently explosive", since that group of persons seems especially at risk of suicide attempts in the military. My hunch is that many have misdiagnosed other conditions, like bipolar illness or antisocial personality. One-quarter of the military is diagnosable psychiatrically with a DSM term, whatever that means, at any one time. This rate is over twice the general population rate, and it is present based on pre-enlistment diagnoses. Why is the military enlisting more persons with psychiatric conditions than naturally occurs in the general population? Obviously not all have serious mental illnesses that preclude their functioning, and not all should be screened out at time of enlistment. This has been tried and doesnt work in reducing psychiatric complicatiosn of military service (see the experience of Dr Harry Stack Sullivan in overzealous World War II psychiatric screening). But some efforts could be made to develop a multivariate profile of predictors for higher likelihood of post-enlistment suicide attempts. This is an example excellent clinical epidemiological research in psychiatry, with directly useful results for public health. #2, Added By: jherschler, MD, Psychiatry/Mental Health, 08:23PM May 13, 2014 Candidates for military recruitment are uniquely motivated to conceal psychopathology and psychiatric histories as they can interfere with successful enlistment. Furthermore, military personnel face considerably greater stigma in a culture of mental toughness to avoid needed psychiatric care. On the other hand, handsome reward for service connected disability motivates some veterans without psychiatric impairment to seek treatment and malinger pathology. In a culture of mental toughness problems like poor anger regulation or ptsd are more easily endorsed by those affected or accepted by peers than suicidality which may be viewed as weakness rather than illness. In my opinion, the stigma of suicidality in the military culture interferes with hope and instillation of hope by care providers may never be gained. Hopeful individuals do not typically end their own lives according to Aaron Beck. Perhaps the higher prevalence of psychiatric illness in military personnel cited in the above discussion represents socioeconomic drift characteristic of enlisted military members. [gkortyna] #3, Added By: gkortyna, MD, Anesthesiology, 09:51PM May 13, 2014 Why is the military enlisting more persons with psychiatric conditions than naturally occurs in the general population? Cuz you have to be nuts to want to enlist in the military Post Comment Private Reply Ignore Thread
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