A Silent Epidemic?

They say:

(CBS) They are the casualties of wars you don’t often hear about – soldiers who die of self-inflicted wounds. Little is known about the true scope of suicides among those who have served in the military.  But a five-month CBS News investigation discovered data that shows a startling rate of suicide, what some call a hidden epidemic, Chief Investigative Reporter Armen Keteyian reports exclusively. CBS News went to the Department of Veterans Affairs, where Dr. Ira Katz is head of mental health. "There is no epidemic in suicide in the VA, but suicide is a major problem," he said.  Why hasn’t the VA done a national study seeking national data on how many veterans have committed suicide in this country?  "That research is ongoing,” he said.

So CBS News did an investigation – asking all 50 states for their suicide data, based on death records, for veterans and non-veterans, dating back to 1995. Forty-five states sent what turned out to be a mountain of information.  And what it revealed was stunning.  In 2005, for example, in just those 45 states, there were at least 6,256 suicides among those who served in the armed forces. That’s 120 each and every week, in just one year.  Dr. Steve Rathburn is the acting head of the biostatistics department at the University of Georgia. CBS News asked him to run a detailed analysis of the raw numbers that we obtained from state authorities for 2004 and 2005.  It found that veterans were more than twice as likely to commit suicide in 2005 than non-vets. (Veterans committed suicide at the rate of between 18.7 to 20.8 per 100,000, compared to other Americans, who did so at the rate of 8.9 per 100,000.)  One age group stood out. Veterans aged 20 through 24, those who have served during the war on terror. They had the highest suicide rate among all veterans, estimated between two and four times higher than civilians the same age. (The suicide rate for non-veterans is 8.3 per 100,000, while the rate for veterans was found to be between 22.9 and 31.9 per 100,000.)   Full story here

But are there some flaws in the statistical analysis of the study?

 

There’s a table in Kaplan’s study in which he presents the difference in veteran suicide rates by individual risk factors, including age, race, marital status, living arrangement, education, employment status, region of residence, urban/rural locality, self-rated health, body mass index, psychiatric conditions and activity limitation. With the exception of race, education and activity limitation, none of these risk factors were statistically significantly associated with increased suicide rates. But since race, education and activity limitation were associated with increased suicide risk, all three should have been among the potential risk factors Kaplan considered when he did his statistical adjustments to produce the 2.13-figure.

 

If you compare the above-mentioned lists of suicide risk factors, however, you’ll note that while activity limitation was identified as a significant risk factor for suicide, it apparently was not included in the statistical adjustment that produced the 2.13-figure. And of the three statistically significant risk factors for suicide, activity limitation was by far the greatest – veterans with activity limitations had a 4.44 times greater rate of suicide than veterans with no activity limitations, as compared to race (3.23) and education (2.67). Read the rest here

To be sure, these are bound to be the opening volleys in a back-and-forth argument that could devolve into counting angels on the head of a pin.  That there have been so many suicides in a distinctly identifiable segment of the population combined with ample documented and apocryphal cases of the VA falling short in providing mental health services to veterans ought to be raising concern re. the adequacy of and access to those services.  Let’s not loose sight of the veterans and their families in the ensuing debate…