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Post by Former NIMH Director Thomas Insel: Bending the Curve on Suicide

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There has been so much concern in the mental health community about cutbacks in services and potential changes in funding, it’s easy to overlook an important, positive change in policy. Earlier this month, the White House announced that henceforth, soldiers who die by suicide while deployed in a war zone will be recognized just as others who die in service to this country. In an extraordinary statement, the President noted, “They didn’t die because they were weak.”

This statement was followed by a White House Blog post from the Army Vice Chief of Staff General Peter Chiarelli, who stated, “Many are struggling with the ‘invisible wounds’ of this war, including traumatic brain injury, post-traumatic stress, depression and anxiety. Any attempt to characterize these individuals as somehow weaker than others is simply misguided.”

Why this change in our approach to soldier suicides? Partly, this reflects recognition of the increasing rates of suicide in the military, rates that have doubled for the Army since 2004. While soldiers traditionally have lower rates of suicide relative to age and gender-matched civilians, the rates in the Army began exceeding civilian rates in 2008. Since 2010, more soldiers have died from suicide than in combat.

What is driving this increase in suicide? An NIMH-Army collaboration, the Army Study to Assess Risk and Resilience in Soldiers (Army STARRS), has been reviewing recent suicides, as well as mounting a prospective study of new and active duty soldiers, to answer this question. The results from reviewing 389 suicide deaths defy any simple or single explanation. There has been an understandable tendency to attribute the increasing rate to the rigors of a continuing war, with many soldiers experiencing multiple deployments and many affected by post traumatic stress disorder and traumatic brain injury. The risk for suicide has risen for all soldiers, regardless of whether they have been deployed, but the data show that a soldier’s risk for suicide is greatest while deployed. Army STARRS, modeled on the Framingham Heart Study, is still in its early phase, but over 17,000 soldiers have now enrolled. We expect that the prospective study can build on these retrospective results to define risk factors for suicide, just as the Framingham study identified risk factors for cardiovascular disease.

Of course, suicide is an even greater public health issue in civilian society. The Centers for Disease Control and Prevention (CDC) reports over 34,000 suicide deaths in 2007. While we do not have comparable rates from the years of the recent recession, the 34,000 figure is nearly double the number of deaths from homicide (roughly 18,000) and even greater than the deaths from motor vehicle accidents (33,000 in 2010). There are only three forms of cancer that kill more than 34,000 Americans annually. AIDS, which has been the most serious infectious disease epidemic of the past three decades, kills roughly 20,000 Americans each year. Perhaps of greatest concern is that while the death rate from each of these other killers has been falling, there has been no substantive change in the rate of suicide death for the past two decades.

While advocates for mental health care have been focused on the “morbidity” of serious mental illness, such as the high disability figures estimated by the World Health Organization, the figures for “mortality” demand equal attention. In fact, there is a new effort to “bend the curve” on suicide. The National Action Alliance on Suicide Prevention, co-chaired by former Senator Gordon Smith and current Secretary of the Army John McHugh, is bringing many stakeholders together to advance the National Strategy for Suicide Prevention (NSSP) by identifying suicide prevention as a national priority, catalyzing efforts to implement high-priority objectives of the NSSP, and cultivating the sources needed to sustain progress. With Phil Satow of the National Council for Suicide Prevention, I am co-leading a Research Task Force for the Action Alliance to determine how changes in research can reduce suicide by 20 percent by 2016, perhaps even 40 percent by 2021. The military has already identified suicide prevention as a high priority. We now need the same level of focus on suicide in civilian society. The Action Alliance intends to do just that.

In the meantime, we can do our part to spread the word about the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), a free, 24-hour hotline that seamlessly connects anyone in suicidal crisis or emotional distress with their nearest crisis center.