Une nouvelle étude publiée par Statistiques Canada rapportait que le taux de suicide chez ce groupe de professionnels est semblable à celui que l'on retrouve dans la population générale. Cependant, au sein des Forces armées canadiennes, certains groupes d'âges présentent des taux de suicide plus élevés, notamment en ce qui a trait aux femmes militaires. L'étude indique également que le suicide est la seconde cause de mortalité chez les militaires canadiens. Dans cette édition des nouveautés du Centre de documentation du CRISE, nous portons à votre attention la thématique du suicide chez les militaires. Nous attirons votre attention sur le rapport publié par le Comité d'experts des Forces Canadiennes sur la prévention du suicide, deux thèses de l’Université Laval (disponible en-ligne) ainsi qu’un numéro spécial de la revue Psychiatry qui porte sur le sujet : http://guilfordjournals.com/toc/psyc/74/2. Des articles sur ceux qui sont enrôlés, qui sont sur le terrain, sur ceux qui sont de retour ou sur les vétérans, sur leurs compagnons et leur famille, d’ici et d’ailleurs.
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PRÉVENTION – PREVENTION
Zamorski, M. A., Jetly, R., & Jung, H. W. (2010). Rapport du Comité d'experts des Forces Canadiennes sur la prévention du suicide. Ottawa: Groupe des services de santé des Forces Canadiennes.
Résumé:Le suicide est un grave problème de santé publique dans les pays industrialisés. Il s’agit de la deuxième principale cause de décès au sein du groupe démographique qui compose la majorité des organisations militaires, à savoir les hommes jeunes et d’âge moyen. Il s’agit donc d’un important facteur de mortalité prématurée dans les forces armées. Les taux de suicide ont tendance à être un peu plus bas chez les militaires par rapport à l’ensemble de la population : dans les Forces canadiennes (FC), le taux de suicide des hommes appartenant à la Force régulière (F. rég) est inférieur d’environ 20 p. 100 par rapport à ceux de l’ensemble de la population du même âge. Les personnes qui souffrent de graves troubles mentaux présentant les risques de suicide les plus importants, ou qui les développent, sont exclues des forces armées. Il n’est donc guère surprenant que ce taux soit moins élevé. Néanmoins, le suicide demeure une importante menace pour la santé publique dans les forces armées. C’est pour cette raison que les organisations militaires doivent s’intéresser activement à sa prévention. C’est dans ce contexte que le Médecin-chef des Services de santé des FC (Méd C FC) a convoqué le Comité d’experts des FC sur la prévention du suicide en septembre 2009. Pendant deux jours, des spécialistes, membres des FC ou non, ont examiné et évalué les activités de prévention du suicide au sein des FC.
Zamorski, M. A. (2011). Suicide prevention in military organizations. International Review of Psychiatry, 23(2), 173-180.
Résumé: Suicide is an important public health problem in the demographic group that forms the bulk of military populations, namely young and middle-aged men. Suicide in the military also has special significance: certain aspects of military service can lead to serious mental disorders that increase the risk of suicidal behaviour. Moreover, military organizations have control over a broad range of factors (notably the direct delivery of mental health care) that could mitigate suicide risk. This article will review the literature on suicide risk in military organizations to answer the important question: Are military personnel at increased risk for suicide? Next, Mann et al.'s (2005) model for specific suicide preventive interventions in civilian settings will be reviewed and then expanded, with an emphasis on identifying special opportunities for suicide prevention in military organizations, including: 1) organizational interventions to mitigate work stress; 2) selection, resilience training, and risk factor reduction; 3) interventions to overcome barriers to care; and 4) systematic quality improvement efforts in mental health care. Finally, the evidence behind comprehensive suicide prevention programmes will be reviewed, with a special focus on the US Air Force's benchmark programme.
Warner, C. H., Appenzeller, G. N., Parker, J. R., Warner, C., Diebold, C. J., & Grieger, T. (2011). Suicide prevention in a deployed military unit. Psychiatry, 74(2), 127-141.
Résumé: Objective: Military suicide and parasuicidal behaviors have been increasing over the last several years, with rates highest in the deployed environment. This article presents a deployment cycle-specific suicide prevention plan utilized during one U.S. Army division's 15-month deployment to Iraq. Methods: Education, identification, and intervention programs were implemented at each phase of the deployment cycle based on the specific unit activities and predicted stressors. Results: During the deployment, there was an annual suicide rate of 16/100,000 within the trial cohort, compared to a theater rate of 24/100,000. Peaks in suicidal ideation and behaviors occurred during months two, six, and twelve of deployment. Conclusions: A deployment cycle prevention program may decrease rates of suicide in the combat environment. This program may serve as a model for other suicide prevention programs.
INTERVENTION, THÉRAPIE ET TRAITEMENT - INTERVENTION, THERAPY & TREATMENT
Roberge, J. (2007). Les stratégies de coping utilisées par les militaires ou ex-militaires masculins atteints d'un stress post-traumatique suite au retour d'une mission de paix. Université Laval, Québec.
Résumé:Avec le rythme opérationnel de plus en plus élevé, de même que le niveau de dangerosité des missions, il est fort probable de continuer à voir des membres des Forces canadiennes revenir avec un syndrome de stress post-traumatique. Lors des années 1990, le personnel dirigeant était peu informé sur la problématique donc préférait en quelque sorte l'ignorer. Par ailleurs, les militaires qui ont développé un syndrome de stress post-traumatique ont été pendant de nombreuses années à fuir leur problème, à utiliser des stratégies d'adaptation inefficaces et nuisibles à leur santé. Cette étude a tenté de regarder quelles sont les stratégies de coping utilisées par les militaires ou ex-militaires masculins atteints d'un stress post-traumatique suite au retour d'une mission de paix. Par cette même étude, nous avons également tenté de voir s'il y avait un lien entre les stratégies de coping utilisées et la qualité de vie et l'ajustement du militaire ou de l'ex-militaire atteint de stress post-traumatique. En terminant, la présente recherche s'est interrogée sur les stratégies de coping utilisées en lien avec la socialisation et les rôles de genre des militaires ou des ex-militaires masculins.
Greden, J. F., Valenstein, M., Spinner, J., Blow, A., Gorman, L. A., Dalack, G. W., et al. (2010). Buddy-to-Buddy, a citizen soldier peer support program to counteract stigma, PTSD, depression, and suicide. Annals of the New York Academy of Sciences, 1208([xx]), 90-97.
Résumé: Citizen soldiers (National Guard and Reserves) represent approximately 40% of the two million armed forces deployed to Afghanistan and Iraq. Twenty-five to forty percent of them develop PTSD, clinical depression, sleep disturbances, or suicidal thoughts. Upon returning home, many encounter additional stresses and hurdles to obtaining care: specifically, many civilian communities lack military medical/psychiatric facilities; financial, job, home, and relationship stresses have evolved or have been exacerbated during deployment; uncertainty has increased related to future deployment; there is loss of contact with military peers; and there is reluctance to recognize and acknowledge mental health needs that interfere with treatment entry and adherence. Approximately half of those needing help are not receiving it. To address this constellation of issues, a private-public partnership was formed under the auspices of the Welcome Back Veterans Initiative. In Michigan, the Army National Guard teamed with the University of Michigan and Michigan State University to develop innovative peer-to-peer programs for soldiers (Buddy-to-Buddy) and augmented programs for military families. Goals are to improve treatment entry, adherence, clinical outcomes, and to reduce suicides. This manuscript describes training approaches, preliminary results, and explores future national dissemination.
Miller, L. (2010). Psychotherapy with military personnel: lessons learned, challenges ahead. International Journal of Emergency Mental Health, 12(3), 179-192.
Résumé: Increasingly, civilian mental health clinicians will be enlisted to evaluate and treat active duty and post-deployment military service members of the OIF/OEF theaters, as well as veterans of previous wars. This article provides a summary of some of the effective psychological treatment modalities for military service members that can be adapted to outpatient psychotherapeutic practice, including structured psychological interventions and specialized techniques of individual psychotherapy, with special applications for dealing with combat stress, depression, suicidality, conflicts over killing, brain injury effects, family issues, post-deployment readjustment, and long-term problems. By adapting and integrating psychotherapeutic lessons learned from treating related populations of law enforcement and emergency services personnel, clinicians who treat military service members and vets can become more flexible, well-rounded, and effective clinicians for a wide variety of high-need service members.
Melamed, B. G., & Castro, C. (2011). Observations and insights about Strengthening Our Soldiers (SOS). Journal of Clinical Psychology in Medical Settings, 18(2), 210-223.
Résumé: The Special Issue (June 2011) of the Journal of Clinical Psychology in Medical Settings titled Strengthening Our Soldiers (SOS) and Their Families: Contemporary Psychological Advances Applied to Wartime Problems revealed the following important concerns: 1) Who is at risk for psychological sequelae during and following service in the U.S. military? 2) How to deliver the best treatment for our soldiers and veterans with PTSD, Traumatic Brain Injury and Pain? 3) How to train the trainers? and 4) What are the current priorities for service delivery, research and funding? Assessment strategies and tools are provided to assist in identification of suicidal ideation and behaviors, alcohol abuse in spouses, posttraumatic stress disorders, depression, brain injuries and post-concussion syndrome, as well as positive growth experiences. Empirically validated Cognitive Processing and Prolonged Exposure treatments are described as are the empirical results already in evidence in our military populations. The innovative use of Virtual Reality and Telehealth applications is demonstrated in both army and naval settings for preparing and reducing trauma in affected soldiers. The Functional and Occupational Rehabilitation Treatment (FORT) Program and its role in returning function to injured soldiers with musculoskeletal pain and motion restrictions, while also leading to reductions of anxiety, depression and use of medical services, is described. A critique about providing service-research for children's reactions to their parent's deployments and family functioning during separation and reintegration is provided. The need for theoretical-empirical approaches to understanding pain-behavior, anxiety dysregulation as it impacts the brain function and structure is provided by experts in pain, neuropsychology, brain circuitry and anxiety management of multiple traumas. This final paper in SOS provides commentary on SOS and describes possible future implications of current psychological knowledge related to military personnel and their families.
Smith, E. G., Craig, T. J., Ganoczy, D., Walters, H. M., & Valenstein, M. (2010). Treatment of Veterans with depression who died by suicide: timing and quality of care at last Veterans Health Administration visit. Journal of Clinical Psychiatry, [xx]([xx]), [xx-xx].
Résumé: OBJECTIVE: To examine the recency and quality of the last Veterans Health Administration (VHA) visit for patients with depression who died by suicide. METHOD: We obtained services and pharmacy data for all 1,843 VHA patients with diagnosed depressive disorders (DSM-IV criteria) who died by suicide from April 1999 through September 2004. We ascertained the location and timing of their final VHA visit. For visits occurring within 30 days of suicide, we examined 3 quality indicators: (1) evidence that mental illness was a focus of the final visit, (2) adequacy of antidepressant dosage, and (3) recent receipt of mental health services. RESULTS: Just over half of the patients (51%) with depression diagnoses had a VHA visit within 30 days of suicide. A minority of these patients (43%) died by suicide within 30 days of a final visit with mental health services, although 64% had received such services within 91 days of their suicide. Among the 57% of patients who died by suicide within 30 days and who were seen in non-mental health settings for their final visit, only 34% had a mental health condition coded at the final visit, and only 41% were receiving adequate dosages of antidepressant (versus 55% for those last seen by mental health services) (P < .0005). CONCLUSIONS: Veterans Health Administration patients with depression who died by suicide within 30 days of their final visit received relatively high rates of mental health services, but most final visits still occurred in non-mental health settings. Increased referrals to mental health services, attention to mental health issues in non-mental health settings, and focus on antidepressant treatment adequacy by all providers might have reduced suicide risks for these patients.
POSTVENTION ET DEUIL – POSTVENTION AND GRIEF
Harrington-LaMorie, K., & Ruocco, K. (2011). The Tragedy Assistance Program for Survivors (TAPS). In J. R. Jordan & J. L. McIntosh (Eds.), Grief After Suicide: Understanding the Consequences and Caring for the Survivors (pp. 403-411). New York: Routledge.
Résumé:The authors present the Tragedy Assistance Program for Survivors (TAPS), a mutual-support organization as a peer-based emotional support program for anyone grieving the death of a person in military service to America.
Carr, R. B. (2011). When a soldier commits suicide in iraq: impact on unit and caregivers. Psychiatry, 74(2), 95-106.
Résumé: There have been studies about the impact of a suicide on family members and friends, but none to date on a military unit in a combat zone. This is the first description, to my knowledge, of the effects of the suicide of a U.S. Army soldier deployed to Iraq. A narrative from the treating psychiatrist's perspective describes both the acute and longer-term (four months) effects of the suicide on members of the soldier's unit, other soldiers at the same base, members of the medical team who attempted to resuscitate him, and mental health care providers. This account describes how the suicide affected at least thirteen other soldiers on the base. The effects of the soldier's suicide showed a few similarities to those described in the literature, including stigmatization of the survivors and the stress experienced by the mental health providers. There were additional repercussions that have not been previously described, including the impact on the soldier's peers within his unit and other soldiers on the base, the need for medical evacuation from Iraq of soldiers following the event, and the reported stress on the medical staff due to the attempted resuscitation of someone known to them. Future research is needed to understand the impact of a suicide on the survivors in a deployed military setting and to establish best practices for postvention strategies.
HOMME – MEN
Braswell, H., & Kushner, H. I. (2010). Suicide, social integration, and masculinity in the U.S. military. Social Science and Medicine, [xx]([xx]), [xx-xx].
Résumé: Reports indicate that suicide in the U.S. military has increased significantly in recent years. This increase has been attributed to a number of factors, including more frequent deployments, more relaxed screening of recruits, combat trauma, economic difficulty amongst soldiers, and the breakdown of interpersonal relationships. In this article, we add an element that we believe is crucial to an understanding of military suicide: the socio-cultural environment of the military itself. In particular, we examine the role that the masculine ideologies governing military life play in the internalization of individual frustrations and in suicidal behavior. Suicide investigators often have ignored the role of masculine ideologies in military suicide because of the assumption that suicide results from social disintegration. In contrast, we argue that military suicide is driven largely by excessive social integration. From this perspective, current explanations of military suicide are constrained by gender and etiological assumptions. Finally, this paper suggests the implications of these findings for designing more effective prevention programs for military suicide.
AUTRES FACTEURS DE RISQUE – OTHER RISK FACTORS
Auxéméry, Y. (2010). Tentatives de suicide chez les militaires français : épidémiologie, facteurs de risques et psychopathologie. A propos de 39 observations cliniques. Université Henri Poincaré, Nancy 1, Nancy, France.
Résumé:Le service de santé des armées accorde un intérêt particulier aux troubles du comportement et aux conduites agressives, non compatibles avec les impératifs opérationnels militaires. Pour l'année 2007, au plan national, 69 suicides et 132 tentatives de suicide ont été dénombrés chez les militaires par la surveillance épidémiologique des armées. A partir de l'étude rétrospective de 39 observations médicales de suicidants militaires pris en charge à l'HIA Legouest durant l'année 2007, nous avons déterminé les caractéristiques sociodémographiques et étiopathogéniques de cette population. Les militaires à risque de conduites auto-agressives correspondent aux engagés volontaires de l'armée de terre. La modalité opératoire la plus représentée est l'intoxication médicamenteuse volontaire (64,1%), suivie de la phlébotomie (12,8%). La majorité des patients (53,85%) ne présentait pas de maladie psychiatrique caractérisée mais souffrait d'une crise suicidaire depuis quelques semaines. Tous les sujets ont bénéficié d'une décision médico-militaire. Plus d'un tiers d'entre eux (35,9%) a été présenté devant la commission de réforme des militaires dont quatre pour trouble de l'adaptation au milieu militaire. L'auteur revient sur les principes de prise en charge pour franchir la crise suicidaire et prévenir la récidive.
Cox, D. W., Ghahramanlou-Holloway, M., Greene, F. N., Bakalar, J. L., Schendel, C. L., Nademin, M. E., et al. (2011). Suicide in the United States Air Force: Risk factors communicated before and at death. Journal of Affective Disorders, x(xx).
Résumé: BACKGROUND: Over the last decade, suicide rates in the U.S. military have steadily increased, resulting in a call for suicide-related research with military populations. The present project aimed to describe and evaluate the communications (i.e., verbally and in suicide notes) of 13 suicide risk factors in the suicide death investigation files of 98 active duty U.S. Air Force (USAF) members. METHODS: Two-hundred thirty-seven suicide death investigation files were coded. Ninety-eight decedents left suicide notes and were included in the current analyses. Descriptive statistics were computed to evaluate the types of risk factors most commonly communicated prior to and at the time of death as well as the medium for their communication. Specifically, verbal and note communications were compared to evaluate which medium decedents most often used to communicate risk factors. Also, the frequency that interpersonal compared to intrapsychic risk factors were communicated was evaluated. RESULTS: Hopelessness (35.7% of cases) and perceived burdensomeness (31.6% of cases) were the risk factors most often communicated in suicide notes but not verbally. Thwarted belongingness (29.6% of cases) was the risk factor most often communicated verbally and in the suicide note. Further, evaluated risk factors were more frequently communicated in suicide notes than verbally. Finally, interpersonal risk factors were more often communicated than intrapsychic risk factors. LIMITATIONS: The validity of the data relies on interviews of decedents' acquaintances and various medical/military records. CONCLUSIONS: Our findings support emphasizing certain risk factors over others in USAF suicide prevention efforts. Further, interpersonal risk factors appeared to be more salient than intrapsychic risk factors in the minds of decedents.
Bryan, C. J., & Cukrowicz, K. C. (2011). Associations between types of combat violence and the acquired capability for suicide. Suicide and Life-Threatening Behavior, 42(1), 126-136.
Résumé: Research suggests that combat exposure might increase risk for suicide. The interpersonal-psychological theory of suicide (IPTS) proposes that exposure to painful and provocative experiences such as combat contribute to fearlessness about death and increased pain tolerance, which serve to enhance the individual’s capability to attempt suicide. Violent and aggressive combat experiences, in particular, should demonstrate relatively stronger associations to this capability. The current study tests this proposition in a sample of deployed active duty combatants. Results indicate that all types of combat exposure independently contribute to capability for suicide. Consistent with the IPTS, when considering all types of combat simultaneously, combat characterized by violence and high levels of injury and death are associated with relatively stronger associations to this capability.
Thomsen, C. J., Stander, V. A., McWhorter, S. K., Rabenhorst, M. M., & Milner, J. S. (2011). Effects of combat deployment on risky and self-destructive behavior among active duty military personnel. Journal of Psychiatric Research, x(xx).
Résumé: Although research has documented negative effects of combat deployment on mental health, few studies have examined whether deployment increases risky or self-destructive behavior. The present study addressed this issue. In addition, we examined whether deployment effects on risky behavior varied depending on history of pre-deployment risky behavior, and assessed whether psychiatric conditions mediated effects of deployment on risky behavior. In an anonymous survey, active duty members of the U.S. Marine Corps and U.S. Navy (N = 2116) described their deployment experiences and their participation in risky recreational activities, unprotected sex, illegal drug use, self-injurious behavior, and suicide attempts during three time frames (civilian, military pre-deployment, and military post-deployment). Respondents also reported whether they had problems with depression, anxiety, or PTSD during the same three time frames. Results revealed that risky behavior was much more common in civilian than in military life, with personnel who had not deployed, compared to those who had deployed, reporting more risky behavior and more psychiatric problems as civilians. For the current time period, in contrast, personnel who had deployed (versus never deployed) were significantly more likely to report both risky behavior and psychiatric problems. Importantly, deployment was associated with increases in risky behavior only for personnel with a pre-deployment history of engaging in risky behavior. Although psychiatric conditions were associated with higher levels of risky behavior, psychiatric problems did not mediate associations between deployment and risky behavior. Implications for understanding effects of combat deployment on active duty personnel and directions for future research are discussed.
Mansfield, A. J., Bender, R. H., Hourani, L. L., & Larson, G. E. (2011). Suicidal or Self-Harming Ideation in Military Personnel Transitioning to Civilian Life. Suicide and Life Threatening Behavior, x(xx).
Résumé: Suicides have markedly increased among military personnel in recent years. We used path analysis to examine factors associated with suicidal/self-harming ideation among male Navy and Marine Corps personnel transitioning to civilian life. Roughly 7% of men (Sailors = 5.3%, Marines = 9.0%) reported ideation during the previous 30 days. Results suggest that combat exposure, substance abuse, and resilience are associated with suicidal ideation/self-harming thoughts through the mediation of posttraumatic stress disorder symptoms and/or depression symptoms. Substance abuse plays a moderating role. Resilience had a direct effect only among the Marines. Implications for improving the transition to civilian life are discussed.
Mills, P. D., Huber, S. J., Vince Watts, B., & Bagian, J. P. (2011). Systemic vulnerabilities to suicide among veterans from the Iraq and Afghanistan conflicts: review of case reports from a National Veterans Affairs database. Suicide and Life-Threatening Behavior, 41(1), 21-32.
Résumé: While suicide among recently returned veterans is of great concern, it is a relatively rare occurrence within individual hospitals and clinics. Root cause analysis (RCA) generates a detailed case report that can be used to identify system-based vulnerabilities following an adverse event. Review of a national database of RCA reports may identify common vulnerabilities and assist in the development of more robust prevention strategies. Our objective was to identify and compare common themes among reports of suicide among veterans of Operations Iraqi Freedom and Enduring Freedom (OIF/OEF) in the Veterans Affairs system. Common themes among root causes of suicide as identified in RCA reports were collected and compared as the primary outcome-systematic vulnerabilities. Actions recommended within the reports were coded as the secondary outcome-prevention strategies. Fifty-one RCA reports of OIF/OEF suicides were identified by our search. Coding generated 16 common categories among 132 root causes, and 13 categories among 108 recommended actions. Assessment of suicidal risk, coordination of care, timely access to care, and communication among providers were the most common root causes. Actions identified by RCA teams to reduce suicide included improving referral processes, staff education in suicide assessment, and follow-up with suicidal veterans. Review of multiple RCA reports can identify organizational vulnerabilities detected at the local level that may be applicable system wide. Attention to improving suicide assessment, coordination of care, and timely access may have the largest impact on reducing suicide among OIF/OEF veterans.
Cox, D. W., Ghahramanlou-Holloway, M., Szeto, E. H., Greene, F. N., Engel, C., Wynn, G. H., et al. (2011). Gender differences on documented trauma histories: Inpatients admitted to a military psychiatric unit for suicide-related thoughts or behaviors. Journal of Nervous and Mental Disease, 199(3), 183-190.
Résumé: Suicide is a leading cause of death among men and women in the United States Military. Using a retrospective chart review design, the current study investigated gender differences on documented traumas for people admitted to a military inpatient psychiatric unit for suicide-related thoughts or behaviors (<xh:i>N =</xh:i> 656). Men more often had no documented lifetime traumas and women more often had 2 or more trauma types. Women had significantly more documented incidences of childhood sexual abuse, adulthood sexual assault, adulthood physical assault, and pregnancy loss. The gender gap in documented trauma types for childhood and adulthood traumas persisted even after adjusting for demographic variables, psychiatric diagnoses, and comorbid trauma types (i.e., trauma types other than the one being used as the dependent variable). Given the observed gender differences in documented traumas, professionals working with military women admitted for suicide-related thoughts or behaviors need to consider trauma in the context of treatment.
ÉPIDÉMIOLOGIE & STATISTIQUES - EPIDEMIOLOGY & STATISTICS
Bilodeau, M.-C. (2008). Les suicides dans les Forces armées canadiennes 1982-2004. Une étude exploratoire. Université Laval, Québec.
Résumé:À notre connaissance, la question du suicide militaire a très peu été traitée en sociologie. Seul Durkheim, semble-t-il, se pencha sur le sujet, croyant pouvoir montrer que le suicide militaire en était un de type altruiste. Longtemps ignoré, le suicide militaire est depuis quelques années l'objet d'une attention médiatique inédite au Canada comme dans le reste du monde. Fortement pointée du doigt depuis une quinzaine d'années par les articles de presse, l'armée canadienne se défend de son côté d'être une institution où l'on se suicide plus que dans la société civile. La présente étude nous paraît confirmer que les taux de suicide des membres du personnel des Forces canadiennes ne sont pas supérieurs à ceux qu'on retrouve dans la société canadienne. Le fait d'une absence de sursuicidité des hommes et des femmes engagés dans l'armée, à l'opposé de ce qui se passait à l'époque de Durkheim, se laisse comprendre si on fait l'hypothèse que l'armée, qui était bien une institution à part dans la société du 19e siècle, se rapproche de plus en plus de la société civile et s'imprègne des valeurs dominantes de cette dernière. On parlera ainsi d'une armée canadienne qui se civilianise.
Tien, H. C., Acharya, S., & Redelmeier, D. A. (2010). Preventing deaths in the Canadian military. American Journal of Preventive Medicine, 38(3), 331-339.
Résumé: BACKGROUND: Combat fatalities are reported by the media as a frequent cause of military deaths, yet they may not reflect the most common and preventable ways that soldiers die. PURPOSE: The purpose of this study was to quantify the leading causes of death in the military and to identify modifiable behaviors that potentially contributed to death. METHODS: This was a retrospective chart review of all Canadian Forces members who died during the past quarter century (January 1, 1983, to December 31, 2007) and included autopsy reports, death certificates, coroner reports, hospital records, military reports, and other miscellaneous sources. Underlying cause of death and modifiable behaviors potentially contributing to death were determined. RESULTS: A total of 1889 individuals died during the study period, and a cause of death was identified for 1710 cases (91%). Traumatic injuries caused 57% of deaths, and medical disease was responsible for 43%. The four leading specific causes of death were motor-vehicle crashes (384 deaths, 22%); neoplasms (374 deaths, 22%); suicide (289 deaths, 17%); and cardiovascular disease (285 deaths, 17%). Combat deaths accounted for less than 5% of all deaths (70 deaths). Approximately 35% of all deaths were attributable to potentially modifiable behaviors, which included suicide (219 non-alcohol-related deaths, 13%); smoking (159 deaths, 9%); and alcohol use (186 deaths, 11%). CONCLUSIONS: Public attention focuses on combat fatalities, yet most military members die from other causes. Avoiding future deaths requires targeting suicide, smoking, and alcohol consumption, in addition to trauma care for combat injuries.
Tien, H. C.-N. (2007). Causes of Death in Active Duty Canadian Forces Personnel. University of Toronto, Toronto, Canada.
Résumé:There may be misconceptions around the real causes of death in the Canadian Forces (CF) as public attention focuses on combat deaths. Objective. To compare the proportion of deaths from natural causes to traumatic causes in the CF. Methods. Retrospective chart review of all CF deaths (1983-2003), classifying deaths as either natural (neoplasm, cardiovascular and other) or traumatic (inadvertent, suicide, homicide or combat). Preventable deaths were assessed using explicit criteria. Results. A total of 1617 CF members died. Traumatic deaths constituted 56% (n=813) and natural deaths were 44% (n=651). Motor vehicle crashes caused 24% (n=351), neoplasms 22% (n=319), cardiovascular diseases 18% (n=259) and suicide 17% (n=248). Combat deaths were only 0.4% (n=6). Discussion. Combat deaths were rare. More military lives might be saved by focusing on prevention strategies for common causes of death including cancer, cardiovascular disease and motor vehicle collisions.
Belik, S. L., Stein, M. B., Asmundson, G. J., & Sareen, J. (2010). Are Canadian soldiers more likely to have suicidal ideation and suicide attempts than Canadian civilians? American Journal of Epidemiology, 172(11), 1250-1258.
Résumé: Significant controversy exists as to whether soldiers are at increased risk for suicide and suicidal behaviors compared with civilians. Furthermore, little is known about whether risk factors for suicidal behaviors in civilian populations are generalizable to soldiers. The aim of the current study is to determine whether the prevalence and correlates of past-year suicidal ideation and suicide attempts differ in Canadian soldiers when compared with Canadian civilians. The current study utilized data from the Canadian Community Health Survey Cycle 1.2-Canadian Forces Supplement in conjunction with the 2001-2002 Canadian Community Health Survey Cycle 1.2. Logistic regression interaction models were used to explore differences between correlates of suicidal ideation and suicide attempts comparing Canadian soldiers with civilians. Although there was no significant difference between the 2 samples on prevalence of past-year suicidal ideation, the prevalence of past-year suicide attempts was significantly lower in the Canadian forces sample compared with the civilian population (odds ratio = 0.41, 95% confidence interval: 0.25, 0.67). Findings suggest that suicide attempts are less common in Canadian active military personnel than in the civilian population. Possible mechanisms for these differences are discussed.
Pinder, R. J., Iversen, A. C., Kapur, N., Wessely, S., & Fear, N. T. (2011). Self-harm and attempted suicide among UK Armed Forces personnel: Results of a cross-sectional survey. International Journal of Social Psychiatry, x(xx).
Résumé: AIMS: Little has been reported on self-harm among the UK Armed Forces, partly due to the difficulties in recording self-harm, within an often-difficult-to-reach population. This study assesses the lifetime prevalence of attempted suicide and self-harm within currently serving and ex-service personnel of the UK Armed Forces. METHODS: Telephone interviews were conducted with 821 personnel who had previously participated in the King's Centre for Military Health Research military health study. Within the telephone interview, participants were asked about attempted suicide and episodes of self-harm. RESULTS: A lifetime prevalence of 5.6% for intentional self-harm (self-harm or attempted suicide) was reported. Intentional self-harm was associated with psychological morbidity (in particular, post-traumatic stress disorder) and adverse experiences in childhood. Ex-service personnel reported lifetime prevalence more than double that of serving personnel (10.5% vs 4.2%, respectively). Participants reporting intentional self-harm were younger (34.4 years vs 39.8 years). CONCLUSION: A lifetime prevalence of 5.6% for attempted suicide and self-harm is higher than previous research has suggested. Younger service personnel, those who have experienced adversity in childhood, those with other psychological morbidity, and ex-service personnel are more likely to report self-harm behaviours.
Belmont, P. J., Jr., Goodman, G. P., Waterman, B., DeZee, K., Burks, R., & Owens, B. D. (2010). Disease and nonbattle injuries sustained by a U.S. Army brigade combat team during Operation Iraqi Freedom. Military Medicine, 175(7), 469-476.
Résumé: Background: A longitudinal cohort analysis of disease nonbattle injuries (DNBI) sustained by a large combat-deployed maneuver unit has not been performed. Methods: A descriptive analysis was undertaken to evaluate for DNBI casualty care statistics incurred by a U.S. Army Brigade Combat Team (BCT) during a counterinsurgency campaign of Operation Iraqi Freedom. Results: Of the 4,122 soldiers deployed, there were 1,324 DNBI with 5 (0.38%) deaths, 208 (15.7%) medical evacuations (MEDEVAC), and 1,111 (83.9%) returned to duty. The DNBI casualty rate for the BCT was 257.0/1,000 soldier combat-years. Females, compared with males, had a significantly increased incidence rate ratio for becoming a DNBI casualty 1.67. Of 47 female soldiers receiving MEDEVAC 35 (74%) were for pregnancy-related issues. Musculoskeletal injuries (50.4%) and psychiatric disorders (23.3%) were the most common body systems involved with DNBI casualties. Among the BCT cohort the psychiatric DNBI casualty rate and suicide rate were 59.8 and 0.58 per 1,000 soldier combat-years. The BCT cohort incidence rates for common musculoskeletal injuries per 1,000 combat–years were as follows: ankle sprain 15.3, anterior cruciate ligament rupture 3.3 and shoulder dislocation 1.2. Conclusions: Musculoskeletal injuries and psychiatric disorders accounted for 74% of the total DNBI casualties, and 43% of the DNBI casualties requiring subsequent MEDEVAC. The BCT cohort had a suicide rate nearly four times greater than previously reported, and selected musculoskeletal injury incidence rates were fivefold greater than the general population.
Weiner, J., Richmond, T. S., Conigliaro, J., & Wiebe, D. J. (2011). Military veteran mortality following a survived suicide attempt. BMC Public Health, 11(1), 374.
Résumé: ABSTRACT: BACKGROUND: Suicide is a global public health problem. Recently in the U.S., much attention has been given to preventing suicide and other premature mortality in veterans returning from Iraq and Afghanistan. A strong predictor of suicide is a past suicide attempt, and suicide attempters have multiple physical and mental comorbidities that put them at risk for additional causes of death. We examined mortality among U.S. military veterans after hospitalization for attempted suicide. METHODS: A retrospective cohort study was conducted with all military veterans receiving inpatient treatment during 1993-1998 at United States Veterans Affairs (VA) medical facilities following a suicide attempt. Deaths occurring during 1993-2002, the most recent available year at the time, were identified through VA Beneficiary and Records Locator System data and National Death Index data. Mortality data for the general U.S. adult population were also obtained from the National Center for Health Statistics. Comparisons within the veteran cohort, between genders, and against the U.S. population were conducted with descriptive statistics and standardized mortality ratios. The actuarial method was used estimate the proportion of veterans in the cohort we expect would have survived through 2002 had they experienced the same rate of death that occurred over the study period in the U.S. population having the age and sex characteristics. RESULTS: During 1993-1998, 10,163 veterans were treated and discharged at a VA medical center after a suicide attempt (mean age=44 years; 91% male). There was a high prevalence of diagnosed alcohol disorder or abuse (31.8%), drug dependence or abuse (21.8%), psychoses (21.2%), depression (18.5%), and hypertension (14.2%). A total of 1,836 (18.1%) veterans died during follow up (2,941.4/100,000 person years). The cumulative survival probability after 10 years was 78.0%. Hence the 10-year cumulative mortality risk was 22.0%, which was 3.0 times greater than expected. The leading causes overall were heart disease (20.2%), suicide (13.1%), and unintentional injury (12.7%). Whereas suicide was the ninth leading cause of death in the U.S. population overall (1.8%) during the study period, suicide was the leading and second leading cause among women (25.0%) and men (12.7%) in the cohort, respectively. CONCLUSIONS: Veterans who have attempted suicide face elevated risks of all-cause mortality with suicide being prominent. This represents an important population for prevention activities.
Lande, R. G. (2011). Felo De Se: soldier suicides in America's Civil War. Military Medicine, 176(5), 531-536.
Résumé: OBJECTIVE: This article examined the factors associated with suicide during America's Civil War and the years immediately following the cessation of armed conflict. METHODS: Contemporary newspaper reports, complemented by book and journal articles, provide an understanding of the incidence and motivations of suicide. RESULTS: The rate of suicide in the general population dramatically increased in the years following the war's end. During the Civil War, suicides occurred nearly every month, reliably peaking in the spring of each year. Depression and alcohol abuse were major factors associated with military suicides. CONCLUSION: Emotional disorders and alcohol misuse, when combined with the hardships of war, contributed to a steady rate of suicides during the Civil War.
Tremblay, Y. (2010). Du suicide, militaire et bibliographique. Bulletin d’histoire politique, 19(1), 115-127.
Résumé: Étant donnée le rôle joué par les statistiques militaires dans la théorie durkheimienne, l'auteur s'intéressent à tester les hypothèses de Durkheim sur les sociétés contemporaines à l'occasion de conflits ou avec des groupes de militaires, en particulier celui des Forces canadiennes. Pour terminer, l'auteur dresse et commente une courte liste bibliographique sur le sujet.
PSYCHOPATHOLOGIE & SANTÉ MENTALE - PSYCHOPATHOLOGY & MENTAL HEALTH
Jakupcak, M., Hoerster, K. D., Varra, A., Vannoy, S., Felker, B., & Hunt, S. (2011). Hopelessness and suicidal ideation in Iraq and Afghanistan war veterans reporting subthreshold and threshold posttraumatic stress disorder. Journal of Nervous and Mental Disease, 199(4), 272-275.
Résumé: We examined hopelessness and suicidal ideation in association with subthreshold and threshold posttraumatic stress disorder (PTSD) in a sample of Iraq and Afghanistan War Veterans (U.S., N = 275) assessed within a specialty VA postdeployment health clinic. Veterans completed paper-and-pencil questionnaires at intake. The military version of the PTSD Checklist was used to determine PTSD levels (No PTSD; subthreshold PTSD; PTSD), and endorsement of hopelessness or suicidal ideation were used as markers of levated suicide risk. Veterans were also asked if they received mental health treatment in the prior 6 months. Veterans reporting subthreshold PTSD were 3 times more likely to endorse these markers of elevated suicide risk relative to the Veterans without PTSD. We found no significant differences in likelihood of endorsing hopelessness or suicidal ideation comparing subthreshold and threshold PTSD groups, although the subthreshold PTSD group was less likely to report prior mental health treatment. Clinicians should be attentive to suicide risk in returned Veterans reporting both subthreshold and threshold PTSD.
MacDermott, D. (2010). Psychological hardiness and meaning making as protection against sequelae in veterans of the wars in Iraq and Afghanistan. International Journal of Emergency Mental Health, 12(3), 199-206.
Résumé: Veterans of the wars in Iraq and Afghanistan are at an increased risk of suicide and other serious psychological sequelae following deployment. Mental health professionals must seek to detect and understand the presence of risk and resilience factors in this vulnerable population so that early intervention and treatment can prevent long-term suffering and suicide. This article explores both psychological hardiness and finding meaning in trauma as factors that can reduce the risk of pathology. Particularly when deployment-related stressors are high, these protective processes may be crucial in fostering hope and resilience. A traumatized individual may interact with the meaning-making process in one of three ways: searching for and finding meaning in the trauma, searching for and never finding meaning in the trauma, and never searching for meaning. These three styles may have a direct effect on a veterans sense of hope or hopelessness, which likely will strongly influence suicidal tendencies and mental health.
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