Two years ago, a New York Times article sent to Navy psychiatrists (“For Some troops, Powerful Drug Cocktails Have Deadly Results,” February 12, 2011) lead to an email exchange on our role in providing access to medications used by the 32 percent of soldiers who committed suicide by overdose. I, naively, replied to all: “I am curious about the other 68 percent? I suspect those soldiers are dying by self-inflicted gunshot.”
The vociferous responses made me realize how much easier it is to discuss suicide by overdose than suicide by gun. Out of curiosity, I Googled “soldier suicide by gun.” It turns out I was right – about two-thirds of soldier suicides are the result of self-inflicted gunshot wounds. I also discovered I had a lot to learn about the myths of suicide.
Despite all of the efforts by the Military Services to reverse the trend, the soldier suicide rate continues to climb. For the past three years, according to the 2009 - 2012 Department of Defense Suicide Event Reports (DoDSER), more soldiers have died by suicide than in combat.
In 2012, statistics released by the Department of the Army reported that 349 military service members committed suicide, while 295 died in combat.
Existing suicide prevention strategies are not working. Many are based on an existing set of myths about suicide and the individuals who attempt it that are simply incorrect.
Myth #1: People who attempt suicide want to die.
False: Ninety percent – 9 out of 10 individuals – who attempt suicide and survive, will not go on to die by suicide. If they really wanted to die, wouldn't they try until they succeeded?
Myth #2: People who attempt suicide have a major mental illness.
False: Only 26 percent of suicide completers have ever seen a mental health provider. DoDSER data indicates the majority of military suicide completers did not have a prior mental health diagnosis.
Myth #3: Suicide is most often planned and premeditated.
False: Most suicides are a quick impulsive reaction to an acute stressor. Seventy percent of suicide attempters make the attempt within one hour of the decision and 24 percent make a suicide attempt within five minutes of the decision.
Myth #4: The most effective means of reducing suicides is by addressing "The Why" or the reason individuals attempt suicide.
False: The most effective means of reducing suicides is by addressing "The How," or the means or method of the suicide attempt. Those who use a gun rarely survive the first attempt. Eighty-five percent of suicide attempts with a gun are fatal, while only 2 percent of suicide attempts by overdose are fatal. Those who attempt suicide with less lethal means most often survive and never attempt again.
Myth #5: We can identify those at highest risk for suicide, and only those identified as high risk are at high risk.
False: Only 26 percent of suicide completers showed any signs that may have identified them as high risk. Most suicide victims do not become “high risk” until the hour before the attempt, usually involving an acute relationship stress, alcohol and a gun (more than 90 percent use a personal gun).
Myth #6: The increased suicide rate is a result of war and deployments.
False: The suicide rate is equal and increasing for those service members who have never deployed.
Myth #7: The most effective way to reduce suicide is by improving access to mental health counseling.
False: According to research from the Harvard School of Public Health, most suicide victims show no sign of mental illness and do not become suicidal until one hour before the attempt.
Access to mental health services is not the issue; quick access to lethal means is. The most effective way to reduce suicides is by reducing quick access to lethal means so that emotions have time to cool down. There are a number of past success stories that support this idea.
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