Sunday, October 7, 2012

Suicidology - Links List

Suicidology - Links List

suicide epidemiology

suicidal signs

psychometric assessment of suicidal risk - Google Search

suicide research - GS

Military Suicide Research Consortium


Sexual orientation and suicide
The likelihood of suicide attempts are increased in both gay males and lesbians, as well as bisexuals of both sexes when compared to their heterosexual counterparts.[19][20][21] The trend of having a higher incident rate among females is no exception with lesbians or bisexual females and when compared with homosexual males, lesbians are more likely to attempt than gay or bisexual males.[22]
Studies vary with just how increased the risk is compared to heterosexuals with a low of 0.8-1.1 times more likely for females[23] and 1.5-2.5 times more likely for males.[24][25] The highs reach 4.6 more likely in females[26] and 14.6 more likely in males.[27] 


Historical trends
Historical data show lower suicide rates during periods of war.[45][46][47]


suicide epidemic - Google Search


military suicide epidemilogy


Military Psychiatry - Google Search

military psychiatrist - Google Search



The War Within: Preventing Suicide in the U.S. Military
File Format: PDF/Adobe Acrobat
by P SAFETY - Related articles
Review the current evidence detailing suicide epidemiology in the military. • Identify “best-practice” suicide-prevention programs. • Describe and catalog ...

military suicidology

The John Snow Handle

 psychiatric epidemiology

exponential fashion


Suicide as epiphenomenon 



Recognizing the Warning Signs of Suicide


SUICIDE WARNING -- Depression carries a high risk of suicide. Anybody who expresses suicidal thoughts or intentions should be taken very seriously. Do not hesitate to call your local suicide hotline immediately. Call 800-SUICIDE (800-784-2433) or 800-273-TALK (800-273-8255) or the deaf hotline at 800-799-4889.
The best way to minimize the risk of suicide is to know the risk factors and to recognize the warning signs of suicide. Take these signs seriously. Know how to respond to them. It could save someone's life.

How Prevalent Is Suicide?

Suicide is a potentially preventable public health problem. In 2009, the last year for which statistics are available, suicide was the 10th leading cause of death in the U.S. That year, there were nearly 37,000 suicides, and 1 million people attempted suicide, according to the Centers for Disease Control.
Men take their lives nearly four times the rate of women, accounting for 79% of suicides in the U.S.

Are There Risk Factors for Suicide?

Risk factors for suicide vary by age, gender, and ethnic group. And risk factors often occur in combinations.
Over 90% of people who die by suicide have clinical depression or another diagnosable mental disorder. Many times, people who die by suicide have a substance abuse problem. Often they have that problem in combination with other mental disorders.
Adverse or traumatic life events in combination with other risk factors, such as clinical depression, may lead to suicide. But suicide and suicidal behavior are never normal responses to stress.
Other risk factors for suicide include:
  • One or more prior suicide attempts
  • Family history of mental disorder or substance abuse
  • Family history of suicide
  • Family violence
  • Physical or sexual abuse
  • Keeping firearms in the home
  • Chronic physical illness, including chronic pain
  • Incarceration
  • Exposure to the suicidal behavior of others

Are There Warning Signs of Suicide?

Warning signs that someone may be thinking about or planning to commit suicide include:
  • Always talking or thinking about death
  • Clinical depression -- deep sadness, loss of interest, trouble sleeping and eating -- that gets worse
  • Having a "death wish," tempting fate by taking risks that could lead to death, such as driving fast or running red lights
  • Losing interest in things one used to care about
  • Making comments about being hopeless, helpless, or worthless
  • Putting affairs in order, tying up loose ends, changing a will
  • Saying things like "it would be better if I wasn't here" or "I want out"
  • Sudden, unexpected switch from being very sad to being very calm or appearing to be happy
  • Talking about suicide or killing one's self
  • Visiting or calling people to say goodbye
Be especially concerned if a person is exhibiting any of these warning signs and has attempted suicide in the past. According to the American Foundation for Suicide Prevention, between 20% and 50% of people who commit suicide have had a previous attempt.

 American Foundation for Suicide Prevention 



Blumenthal, Susan and Kupfer, David, (Eds.) Suicide over the life cycle: Risk factors, assessment, and treatment of suicidal patients. Wash., DC: Amer. Psych. Press, 1990.

Hendin, Herbert. Suicide in America. New York: W.W. Norton, 1995.
Maltsberger, J.T. Essential papers on suicide.1996.
Schneidman, Edwin. Definition of suicide. Jason Aronson, 1985.

Youth Suicide
American Indian and Alaska Native Mental Health Research.Calling from the rim: Suicidal behavior among American Indian and Alaska Native adolescents. Volume 4, Monograph. Denver, CO: University Press of Colorado, 1994.

Bell, Ruth and Lenizeiger Wildflower. Talking with your teenager. New York: Random House, 1983.
Blumenthal, Susan J. and Kupfer, David J. (Eds.). Suicide over the life cycle. Washington, D.C.: American Psychiatric Association, 1990.
Borst, Sophie R. Adolescent suicidal behavior: A Clinical-Developmental Perspective. 1960.
Carlson, Trudy. The Suicide of My son: A Story of Childhood Depression. Minnesota: Benline Press, 1995.
Farberow; Norman. Many Faces Of Suicide: Indirect Self-Destructive Behavior. New York: McGraw Hill, 1979.
Farberow; Norman and Schneidman, E.S. The cry for help.New York: McGraw Hill, 1961.
Garland, Sherry. I never knew your name. New York: Ticknor & Fields Books for Young Readers, 1994.
Gordon, Sol. When living hurts. New York: UAHC Press, 1985.
Hendin, Herbert. Suicide in America. W.W. Norton & Company, 1995.
Holinger, Paul. Suicide and homicide among adolescents.Guilford Publications, 1994.
Hyde, Margaret O. and Forsyth, Elizabeth H. Suicide: The Hidden Epidemic. CompCare Publishers, 1978.
Klagsbrun, F. Too Young to Die: Youth and suicide. New York: Pocket Books, 1981.
Klerman, Gerald (Ed.). Suicide & depression among adolescents & young adults. Washington, DC: American Psychiatric Press, 1986.
Lettieri, D.J. (Ed.). Drugs and suicide: When other coping strategies fail. Beverly Hills, CA: Sage, 1979.
Noam, Gil G. and Borst, Sophie (Eds.). Children, Youth, And Suicide: Developmental Perspectives. San Francisco: Jossey- Bass, 1994.
Peck, M.L., Farberow, N.L., and Litman, R.E. (Eds.). Youth suicide. New York: Springer, 1985.
Perlin, S. (Ed.). A Handbook for the Study of Suicide.New York: Oxford University Press, 1975.
Pfeffer, C.R. The suicidal child. New York: Guilford Publications, 1986.
Rabkin, B. Growing Up Dead. Toronto: McClelland and Stewart, Ltd., 1978.
Rotheram-Borus, Mary J., Bradley, Jon, and Obolensky, Nina.Planning to live: Evaluating and treating suicidal teens in community settings. National Resource Center for Youth Services, 1990.
Shneidman, Edwin. Definitions of suicide. John Wiley & Sons, 1985.
Slaby, Andrew and Garfinkel, Lili Frank. No One Saw My Pain: Why Teens Kill Themselves. 1995.
Sudak, H., Ford, A.B. and Rushforth, N.B. (Eds.). Suicide in the Young. Boston: John Wright/ PSG, Inc., 1984.

Suicide Prevention
Hipple, J. and P. Combolic (Eds.). The Counselor and Suicidal Crisis: Diagnosis and Intervention. Springfield, IL: Charles C. Thomas, 1979.

Leenaars, Antoon. Treatment of suicidal people. Hemisphere Publications, 1994.
McEvoy, Alan. Preventing youth suicide. 1994.
Mufson, Laura, Donna Moreau, Myrna Weissman, Gerald Klerman.Interpersonal psychotherapy for depressed adolescents. New York: Guilford Press, 1993.
Schneidman, E.S. Psychology of Suicide: A clinician's guide to evaluation and treatment. 1995.
Zimmerman, James and Asnis, Gregory. Treatment approaches with suicidal adolescents. John Wiley & Sons, 1995.

Alexander, Paul. Rough magic: A biography of Sylvia Plath. New York: Penguin Group, 1991.
American Indian and Alaska Native Mental Health Research.Calling from the rim: Suicidal behavior among American Indian and Alaska Native adolescents. Volume 4, Monograph. Denver, CO: University Press of Colorado, 1994.
Bender, David L., Leone, Bruno and Roleff, Tamara. Suicide: Opposing viewpoints. California: Greenhaven Press, Inc., 1998.
Brown, George W. and Harris, Tirril. Social origins of depression: A study of psychiatric disorder in women. New York: The Free Press, 1978.
Carlson, Trudy. The suicide of my son: A story of childhood depression. Minnesota: Benline Press, 1995.
Cobain, Bev. When Nothing Matters Anymore: A survival guide for depressed teens. Minnesota: Free Spirit Publishing, Inc., 1998.
Conroy, David L. Out of the nightmare: recovery from depression and suicidal pain. New York: New Liberty Press, 1991.
Cook, John. How to help someone who is depressed, or suicidal: Practical suggestions from a survivor. Connecticut: Rubicon Press, Inc., 1993.
Cronkite, Kathy. On the edge of darkness. New York: Doubleday, 1994.
Ellis, Thomas E. and Newman, Cory F. Choosing to live: How to defeat suicide through cognitive therapy. New Harbinger Publications, Inc., 1996.
Gordon, Sol. When living hurts. New York: UAHC Press, 1985.
Griffith, Gail. Will’s Choice: A Suicidal Teen, a Desperate Mother and a Chronicle of Recovery. New York: HarperCollins, 2005.
Grinker, Roy R., Miller, Julian, Sabshin, Melvin, Nunn, Robert, and Nunnally, Jum. The phenomena of depressions. Paul B. Hoeber, Inc., 1961.
Hoch, Paul H. and Zubin, Joseph. Depression. New York: Grune & Stratton, 1954.
Klerman, Gerald L., Weissman, Myrna M., Rounsaville, Bruce J., and Chevron, Eve S. Interpersonal psychotherapy of depression. Basic Books, 1984.
Lesser, Rika. All we need of hell: Poems. Texas: University of North Texas Press, 1995.
McIntosh, John L., Santos, John F., Hubbard, Richard W., and Overholser, James C. Elder suicide: Research, theory and treatment. Washington, D.C.: American Psychiatric Association, 1994.
Mufson, Laura, Moreau, Donna, Weissman, Myrna M., and Klerman, Gerald L. Interpersonal psychotherapy for depressed adolescents. Guilford Press, 1995.
Papolos, Demitri and Papolos, Janice. Overcoming depression. New York: Harper & Row, 1987.
Roy, Alec (Ed.). Suicide. Williams & Wilkins, 1986.
Shneidman, Edwin S., Farberow, Norman L. and Litman, Robert E.The Psychology of Suicide. New York: Science House, 1970.
Slaby, Andrew and Garfinkel, Lili F. No one saw my pain: Why teens kill themselves. W.W. Norton & Company, 1994.
Styron, William. Darkness visible: A memoir of madness.New York: Random House, 1990.

Other Topics
Alexander, Paul. Rough magic: A biography of Sylvia Plath. New York: Penguin Books, 1991.

Canetto, Silvia. Women and suicidal behavior. Springer Publications, 1994.
Hendin, Herbert. Seduced by death: Doctors, patients, and the Dutch cure. New York: W.W. Norton, 1996.
Jamison, Kay. Touched with fire: Manic-depressive illness and the artistic temperament. New York: The Free Press, 1993.
McIntosh, John. Elder suicide: Research, theory, and treatment. American Psychological Assoc., 1994.
Pfeffer, Cynthia. The suicidal child. New York: Guilford Publications, 1986.
Rosenberg, Mark and Mary Ann Fenly (Eds.) Violence in America: A public health approach. New York: Oxford Press, 1991.
Styron, William. Darkness visible. New York: Random House, 1990.


The latest data available from the Centers for Disease Control and Prevention indicates that 38,364 suicide deaths were reported in the U.S. in 2010. This latest rise places suicide again as the 10th leading cause of death in the U.S. Nationally, the suicide rate increased 3.9 percent over 2009 to equal approximately 12.4 suicides per 100,000 people. The rate of suicide has been increasing since 2000. This is the highest rate of suicide in 15 years.


  • Psychiatric Disorders
    At least 90 percent of people who kill themselves have a diagnosable and treatable psychiatric illnesses -- such as major depression, bipolar depression, or some other depressive illness, including:
    Alcohol or drug abuse, particularly when combined with depression
    Posttraumatic Stress Disorder, or some other anxiety disorder
    Bulimia or anorexia nervosa
    Personality disorders especially borderline or antisocial
  • Past History of Attempted Suicide
    Between 20 and 50 percent of people who kill themselves had previously attempted suicide. Those who have made serious suicide attempts are at a much higher risk for actually taking their lives.
  • Genetic Predisposition
    Family history of suicide, suicide attempts, depression or other psychiatric illness.
  • Neurotransmitters
    A clear relationship has been demonstrated between low concentrations of the serotonin metabolite 5-hydroxyindoleactic acid (5-HIAA) in cerebrospinal fluid and an increased incidence of attempted and completed suicide in psychiatric patients.
  • Impulsivity
    Impulsive individuals are more apt to act on suicidal impulses.
  • Demographics
    Males are three to five times more likely to die by suicide than females.
    Age: Elderly Caucasian males have the highest suicide rates.
Suicide Crisis
A suicide crisis is a time-limited occurrence signaling immediate danger of suicide. Suicide risk, by contrast, is a broader term that includes the above factors such as age and sex, psychiatric diagnosis, past suicide attempts, and traits like impulsivity. The signs of crisis are:
  • Precipitating Event
    A recent event that is particularly distressing such as loss of loved one or career failure. Sometimes the individuals own behavior precipitates the event: for example, a man's abusive behavior while drinking causes his wife to leave him.
  • Intense Affective State in Addition to Depression
    Desperation (anguish plus urgency regarding need for relief), rage, psychic pain or inner tension, anxiety, guilt, hopelessness, acute sense of abandonment.
  • Changes in Behavior
    suggesting the individual is close to suicide. Such speech may be indirect. Be alert to such statements as, "My family would be better off without me." Sometimes those contemplating suicide talk as if they are saying goodbye or going away.
    Actions ranging from buying a gun to suddenly putting one's affairs in order.
    Deterioration in functioning at work or socially, increasing use of alcohol, other self-destructive behavior, loss of control, rage explosions.

Warning Signs of Suicide

Suicide can be prevented. While some suicides occur without any outward warning, most people who are suicidal do give warnings. Prevent the suicide of loved ones by learning to recognize the signs of someone at risk, taking those signs seriously and knowing how to respond to them.

Warning signs of suicide include:
  • Observable signs of serious depression:
    Unrelenting low mood
    Anxiety, psychic pain and inner tension
    Sleep problems
  • Increased alcohol and/or other drug use
  • Recent impulsiveness and taking unnecessary risks
  • Threatening suicide or expressing a strong wish to die
  • Making a plan:
    Giving away prized possessions
    Sudden or impulsive purchase of a firearm
    Obtaining other means of killing oneself such as poisons or medications
  • Unexpected rage or anger
The emotional crises that usually precede suicide are often recognizable and treatable. Although most depressed people are not suicidal, most suicidal people are depressed. Serious depression can be manifested in obvious sadness, but often it is rather expressed as a loss of pleasure or withdrawal from activities that had been enjoyable. One can help prevent suicide through early recognition and treatment of depression and other psychiatric illnesses.


When You Fear Someone May Take Their Life 

Most suicidal individuals give some warning of their intentions. The most effective way to prevent a friend or loved one from taking his or her life is to recognize the factors that put people at risk for suicide, take warning signs seriously and know how to respond.

Know the Facts

More than 90 percent of people who kill themselves are suffering from one or more psychiatric disorders, in particular:
  • Major depression (especially when combined with alcohol and/or drug abuse)
  • Bipolar depression
  • Alcohol abuse and dependence
  • Drug abuse and dependence
  • Schizophrenia
  • Post Traumatic Stress Disorder (PTSD)
  • Eating disorders
  • Personality disorders
Depression and the other mental disorders that may lead to suicide are -- in most cases -- both recognizable and treatable. Remember, depression can be lethal.
The core symptoms of major depression are a "down" or depressed mood most of the day or a loss of interest or pleasure in activities that were previously enjoyed for at least two weeks, as well as:
  • Changes in sleeping patterns
  • Change in appetite or weight
  • Intense anxiety, agitation, restlessness or being slowed down
  • Fatigue or loss of energy
  • Decreased concentration, indecisiveness or poorer memory
  • Feelings of hopelessness, worthlessness, self-reproach or excessive or inappropriate guilt
  • Recurrent thoughts of death or suicide
Between 25 and 50 percent of people who kill themselves had previously attempted suicide. Those who have made suicide attempts are at higher risk for actually taking their own lives.
Availability of means
  • In the presence of depression and other risk factors, ready access to guns and other weapons, medications or other methods of self-harm increases suicide risk.

Recognize the Imminent Dangers

The signs that most directly warn of suicide include:
  • Threatening to hurt or kill oneself
  • Looking for ways to kill oneself (weapons, pills or other means)
  • Talking or writing about death, dying or suicide
  • Has made plans or preparations for a potentially serious attempt
Other warning signs include expressions or other indications of certain intense feelings in addition to depression, in particular:
  • Insomnia
  • Intense anxiety, usually exhibited as psychic pain or internal tension, as well as panic attacks
  • Feeling desperate or trapped -- like there's no way out
  • Feeling hopeless
  • Feeling there's no reason or purpose to live
  • Rage or anger
Certain behaviors can also serve as warning signs, particularly when they are not characteristic of the person's normal behavior. These include:
  • Acting reckless or engaging in risky activities
  • Engaging in violent or self-destructive behavior
  • Increasing alcohol or drug use
  • Withdrawing from friends or family

Take it Seriously

  • Fifty to 75 percent of all suicides give some warning of their intentions to a friend or family member.
  • Imminent signs must be taken seriously.



Thursday, October 4, 2012

Get "The Handle"! - Comments on 2011 RAND study "The War Within: Preventing suicide in the U.S. military"

Get "The Handle"! - Comments on 2011 RAND study "The War Within: Preventing suicide in the U.S. military"

With all due and the most sincere respect and admiration for this study (apparently the first, very serious and focused study of this kind in the new field of military suicidology) and its authors and their efforts, I have to admit, that in my very humble and personal opinion this study is unsatisfactory, inadequate, superficial and formal. Apparently it follows the general matrix of similar studies in psychiatric epidemiology but it fails to identify and to address the root problems.

Statistics indicate that the rate of suicides in the military since 2005 grew in an exponential fashion, in geometric progression, which means that it is a true psychiatric epidemic: an explosion, a raging wild fire which has not reached its apex yet by far  and has a grim potential for expanding and taking more lives.

If it is a sudden and  a very pronounced epidemic arising de novo, then there must be some very specific and powerful forces which fuel it and propel its pathogenetic mechanism. This RAND study fails to recognise and identify these specific forces and prefers to concentrate on nonspecific and more or less implied in the past general suicidogenic factors. Without the identification of these new specific causes and their mechanisms, it seems to be quite doubtful to me that this epidemic can be understood, addressed and stopped. In other words, if we want to get a handle on it, it must be The John Snow Handle of the specific causation, which has to be found, identified, studied and neutralised or removed.


What makes john snows and their "handle finding and removing ability"?
Emotional, intellectual and scientific independence, open-mindedness and curiosity; search for the truth "and nothing but the truth", commitment to serve, social activism, and probably some other traits. This is an interesting subject for research also.

Summary of the  20011 RAND study on epidemiology of suicidal behavior in the U.S. military

  • "The RAND research team took an epidemiological approach to answering questions of keen interest to DoD policymakers." (p. xiii)

This is exactly what the problem with this study is: you cannot approach this issue from epidemiological - statistical perspectives only: it is just a part, one of the facets of the whole picture. The methodological approach, as always, should be comprehensive, interdisciplinary and analytical - interpretative. "Number crunching" has to be balanced, supplemented, complemented, refined and verified by individual cases and their milieu analyses in the attempt to capture the true, integrated insights and understandings.
  • "The figure also indicates that the suicide rate across DoD has been climbing, rising from 10.3 in 2001 to 15.8 in 2008, which represents about a 50-percent increase. The increase in the DoD suicide rate is largely attributable to a doubling of the rate in the Army." (p.xiv)

One of the most interesting statistical facts on this graph is the difference in rates between the services, which, apparently reflects the smarter and more effective policies, probably along with the better shape of mental health services in the Navy and Air Force (these are, apparently more of the "elite" branches) than in lagging Army and the Marines (the latter is especially telling and troubling).

  • "Across services, there are significant differences in only the Army’s suicide rate over time. Specifically, the Army suicide rates for CYs 2006 and 2007 were higher than in 2001 and 2004, and the rate in CY 2008 was higher than in it was between CY 2001 and CY 2005 and higher than the average rate for CYs 2001 through 2008." (p.xiv)
  • "These results show that the suicide rate in the synthetic civilian population is both fairly constant and substantially higher than that in DoD. Of concern, however, is that the gap between DoD and the general population is closing. The most pronounced increases in the DoD suicide rate occurred in 2007 and 2008, so, assuming that the national rate remains relatively stable in these years, the gap between the rate in DoD and the general population may be even narrower." (p. xv)

It is also possible that this psychiatric epidemic just reflects the demographic and attitudinal "catching up" with the larger (and the main) community, and if it is so, the rates increase curve should plato at this point, at 20 per 100,000. The real reason to worry would be if it continues its exponential growth. The next three years will clarify the picture somewhat.
The interesting question is: can any predictions be ventured based on the characteristics of this curve? Can the possible plato or continuing growth be seen now? Apparently, more accurate, "cleaner", more natural, original, smaller community samples might be more helpful in the attempts to find the answer. And this should be a question for the statisticians and epidemiologists to entertain and seriously consider.

  • "In the United States, males are more likely to die by suicide than females—thus, the expected suicide rate based on this demographic characteristic alone is higher than for the country as a whole." (p.xvi)

 Comments: Why? ("males are more likely to die by suicide than females")
It is, at least hypothetically conceivable that this "niche" is filled with latently homosexual males (which probably is a major suicide risk factor for males; this aspect still is very much underresearched, I think.) If it is so, then it is also possible that those of them who found their "asylum" and their solution for this intrapsychic conflict in the military, became the group which does "the catching up" with the general population when they were deprived of their convenient "cover" and this "safety net" of antigay policies and exclusions. And this brings us back to the hypothesis previously described here. It would be interesting (and valuable, if we want to understand the situation completely) to confirm or refute this hypothesis by research methods. Comparisons with other cultures and countries with different gender distribution of suicide rates might be helpful in this type of a research.

… sexual orientation and suicide risk: Evidence from a … - Russell - Cited by 413

Am J Public Health. 2001 August; 91(8): 1276–1281.
PMCID: PMC1446760
Adolescent Sexual Orientation and Suicide Risk: Evidence From a National Study


Objectives. Sexual orientation has been a debated risk factor for adolescent suicidality over the past 20 years. This study examined the link between sexual orientation and suicidality, using data that are nationally representative and that include other critical youth suicide risk factors.
Methods. Data from the National Longitudinal Study of Adolescent Health were examined. Survey logistic regression was used to control for sample design effects.
Results. There is a strong link between adolescent sexual orientation and suicidal thoughts and behaviors. The strong effect of sexual orientation on suicidal thoughts is mediated by critical youth suicide risk factors, including depression, hopelessness, alcohol abuse, recent suicide attempts by a peer or a family member, and experiences of victimization.
Conclusions. The findings provide strong evidence that sexual minority youths are more likely than their peers to think about and attempt suicide.
The Homosexuality Factor is Associated with Higher Risk for Suicidality ... GLBTTs and Transgender Males at Greater Risk for Attempting Suicide: The ..... an indication of deviance, either latent or actual, from heterosexuality" (Phelan, 1993, p.

Who Is at Risk?

  • Prior Suicide Attempts: "...a prior suicide attempt is the strongest predictor of subsequent death by suicide (Isometsa and Lonnqvist, 1998, Harris and Barraclough, 1997)."


  • Mental Disorders: "depression and anxiety disorders (including post traumatic stress disorder, or PTSD). The Institute of Medicine (IOM) estimates that approximately 4 percent of those with depression will die by suicide (Goldsmith et al., 2002), and, though the same figure is not yet known for those with PTSD, community-based surveys indicate that persons with PTSD are more likely than those without the disorder to report past suicide attempts and ideation (Kessler, Borges, and Walters, 1999; Sareen et al., 2005; Farberow, Kang, and Bullman, 1990)."


  • Substance-Use Disorders: "...approximately 20 percent of servicemembers report heavy alcohol use (drinking five or more drinks per typical drinking occasion at least once per week) (Bray and Hourani, 2007)."


  • Head Trauma/Traumatic Brain Injury (TBI): "persons with concussions, cranial fractures, or cerebral contusions or traumatic intracranial hemorrhages had higher rates of suicide mortality than the general population (Teasdale and Engberg, 2001; Simpson and Tate, 2002, 2005)."


  • Those Suffering from Hopelessness, Aggression and Impulsivity, and Problem-Solving Deficits: "Those with high levels of hopelessness are at increased risk, and there is some evidence that higher levels of aggression and impulsivity, as well as those with problem-solving deficits, are also at increased risk for suicide (McMillan et al., 2007; Mann et al., 1999; Rudd, Rajab, and Dahm, 1994)."


  • Life Events, Precipitating Events, and Triggers: "Most of the scientific literature suggests that it is the interaction with underlying vulnerabilities, such as behavioral health problems, that influence a suicidal response to these relatively common events (Yen et al., 2005; Joiner and Rudd, 2000)."


  • Firearm Access: Military personnel have access to firearms, particularly when deployed, and are more likely to own a personal gun than are members of the general population (Hepburn et al., 2007).


  • Suicides of Others and Reporting of Suicides: "For youth and young adults, there is evidence of contagion—that a suicide may lead to subsequent suicides (Insel and Gould, 2008)  

(p. xvii)


Best Practices

"The challenge in identifying best practices for suicide prevention is the lack of
data on the effectiveness of programs."

"Our assessment of these various programs indicates that promising practices exist, but much remains unknown about what constitutes a best practice."
(p. xviii)
"...Comprehensive suicide-prevention program should include the following six practices:
1. Raise awareness and promote self-care...
2. Identify those at high risk...
3. Facilitate access to quality care...
4. Provide quality care...
5. Restrict access to lethal means...
6. Respond appropriately..."
(p. xix)

"Suicide Prevention in the Army
The Army’s current approach to suicide prevention revolves around programs that encourage “soldiers to take care of soldiers” and those that offer a holistic approach to promote resiliency."
(p. xx)
This is a very sound and practical approach. In general, "self-help" movement and strategies are, most likely, the directions of the future, in both civilian and military mental health services.
Establish psychological help (not just specifically suicide prevention) hotline staffed by trained (1 week initial training, with regular additional training) soldiers. The criteria for their selection (first of all "psychological mindedness" and ability for empathy, ability to be a good listener) and the guidelines for training can be elaborated and described at a later time. Call this hot line, for example, "My Buddy". The same psychotherapists can conduct semistructured interviews and psychometric assessments.
"Suicide Prevention in the Navy
The Navy’s approach to suicide prevention is guided by a model that sees stress on a continuum and in which suicide represents an extreme endpoint on the continuum.The model emphasizes early intervention to prevent and manage stress, particularly in the face of challenging life events (e.g., relationship or financial difficulties)."
(pp. xx-xi)
This is also a very good and logical approach and is consistent with the line of thinking expressed earlier.
This approach should be developed further, expanded and adopted by all other services.
"Suicide Prevention in the Air Force
The Air Force approach to preventing suicide is based on initiating cultural changes in
attitudes and actions pertaining to suicide and implementing these changes through
the highest-ranking Air Force officials.

There is published evidence to suggest that the implementation of the Air Force Suicide Prevention Program (AFSPP) was associated with a 33-percent risk reduction in suicide (Knox et al., 2003).
It has been reviewed by the National Registry of Evidence-Based Programs and Practices, which found that research methods were strong enough to support these claims
(SAMHSA, 2010)."
(p. xxi)
This issue here is taken very seriously, apparently not only because it might involve a significant material loss in addition to human loss, but because culturally and traditionally this is an elite service, adequately saturated with refined attitudes and technology.
There is no reason why the best approaches and methods could not be combined and utilised by all services.
 "Suicide Prevention in the Marine Corps
The Marine Corps approach to suicide prevention relies primarily on programs in
which members of the USMC community are trained to identify and refer marines
at risk for suicide to available resources (e.g., a commander, chaplain, mental health
(p. xxi)
Apparently, this is a more formal approach and there might also be some denial of this issue and its associated complexities.
"Raise Awareness and Promote Self-Care
Most of the messages conveyed focus on raising awareness, which has limited evidence of creating behavior change."
(p. xxii)
Comments: Which is not surprising at all, in the light of what was discussed earlier. It simply does not work: we cannot instruct the ill person (lack of insight of various degrees is very often the part of the problem) to understand his illness or to cure it; just like we cannot expect the dead body to revive itself.
"Identify Those at High Risk"
(p. xxiii)
This is a very important key point. The best identification is the direct one: 1) via the computerised self-reports and 2) standardised semistructured (checklists) assessments by not only and necessarily "gatekeepers" but those who know the subject more or less well: from family and friends to hotline therapists; with further central processing and referral.
"Access to and delivery of "quality care"
(p. xxiii)
"Quality" of care is difficult to define and to measure, and the question will always remain: by what margin the results of this "quality" care might exceed the less expensive and more "mass" options, such as group therapy led by trained therapists selected from soldiers. My hunch is that the latter will be all in all more efficacious and preferable mode of intervention, with "quality" care reserved for serious, severe or treatment resistant cases. In other words, the so called "quality" care is not necessarily the guarantee of "quality results".
"Restricting access to lethal means"
(p. xxiv)
This does not appear to be very practical, especially when the "means", if not some, then the others, could always be found.
"Appropriate response"
(p. xxiv)
This depends on training and the structure of the programs. The best response is always preventive and automatic.
General Comments to "Conclusions":
There is a very "clear and convincing" evidence that the services which pay the greatest attention to this issue and which utilise the best: most thought out and systematic programs and their implementations are the most successful in controlling the problem.

Ep-st an-s

Copmpreh. appr.

Typology of suicidal behaviors

Suicide as epiphenomenon 
Psychotic Suicides

Nonpsychotic suicides
should be viewed as first of all and most of all the manifestations of the disorders of (psycho)social integration. Suicides are practically nonexistent in the animal kingdom. This indicates that the epiphenomenon of suicide is a part and parcel of social nature of man. It is the end result of deep and irreconcilable conflict (as it appears to be to the victim of suicidal behavior) between the individual and his social milieu. It is a wreckage of the ship which has not been able to negotiate with the sea and to become a part of it.
If it is so, then all the corrective and preventive measures directed at the individual only are the palliative half-measures and will ultimately fail. The underlying conflict between the individual and his group has to be addressed, explored, diagnosed properly and objectively and the preventive treatment should be directed at the social reintegration, including, if needed, the transfer and reassignment.
The best measurements of suicide as a psychosocial pathology are not only their nominal numbers (it is just the number of completed shipwrecks), but the measurements of the state and capacity for the adequate and healthy psychosocial integration in a given military community, which should take into account all possible relevant factors: subculture, attitudes, circumstances, complex knots of interrelationships, etc. No service would be better positioned and equipped to handle this task than the military intelligence, with the additional training in psychology, mental health, sociology and philosophy. We have to understand what lead to a shipwreck, what was wrong with the ship's engine, what kind of weather was there at the moment, why the catastrophe happened and what we should do to help the other ships to avoid it.
Psychometric and sociometric instruments have to be developed and used for the assessment of suicidogenic situations and environments and for the overall state of psychosocial health in a military community and for measurements of effectiveness of corrective and preventive interventions. These measurements have to be pooled statistically and epidemiologically, they have to be studied carefully, common threads should be discerned, causal connections should be traced and analysed; conceptual organisation and understanding of this data should be attempted and better, more effective interventions should be sought. This should be ongoing routine activity, especially since the social environments and attitudes always change; almost imperceptibly but most definitely.


Situational Suicides

Altruistic Suicides

Suicidogenic Alienation

Latent Suicidal Wish - Google Search
Suicide as a form of ultimate social protest

Suicide from philosophical perspectives


Stoicism (Stanford Encyclopedia of Philosophy)

15 Apr 1996 – The Stoic view on modality is supposed to make the world safe for ..... however, a choice, for example, to end our lives by suicide can be in ...



Suicide as "pathological" acclamation of freedom and autonomy

Evolution of social perceptions and views on Suicide

Religious views on Suicide

Suicide across cultures
Anomie - From Wikipedia




I would like to respectfully submit the following set of recommendations to DoD:

- Organise Conference on Military Suicidology in PR.

- Attitudes and Policies:
Family model
Sexual attitudes: freedom, equality, no violence, no coercion and no sexual exploitation.
Psychosexual health is one of the most important components of general mental health.
Zero tolerance policies re: homophobia, heterophobia, or any other phobias.

- Issue an order directly prohibiting the self-injurious, aggressive (towards members of the MC) and suicidal behaviors: it would be justified ethically, medically and militarily. Sounds ridiculous but will definitely bring some benefits: soldiers do trust their collective parent: The DOD.

- Train the specialists in Military Mental Health field:

To create an institute of military philosophers-psychotherapists who will be in charge of all issues pertinent to individual and overall MC (Military Community) mental health, recruited primarily from the interested and psychologically minded officers of military intelligence services.
The need for the therapeutic element in the services is apparent. Interpersonal relationship (nonspecific, eclectic, atheoretical, and, for the purposes of this discussion, task oriented) is the basis of any psychotherapy curative mechanism. Therapeutic relationship is a silver cup which "argentifies": charges, purifies, enables, makes therapeutically efficient any psychotherapy theory that is contained in it. It also might become one of the major factors in this "war within" for one of the most valuable, powerful, unique and irreplaceable weapons in any armed forces arsenal: the soldier's soul, mind and his/her mindset. This is not the issue of crude propaganda which does not work anyway. This is the issue of mental and spiritual health and mutual "goodness of fit".
Psychoanalytic theory and methods are not the best choice in these circumstances: they are excessively, emptily (the core of the onion), stressfully and unnecessarily "deep", foster dependence and loss of autonomy in a "transferrential therapeutic relationship", whatever this term means; and might be even detrimental and harmful to troops morale and military readiness. Stoicism as a theory of psychotherapy, based on philosophical teaching, might be much better suited for these purposes and much more therapeutically efficient.

- Therapeutic military philosophy:
Stoicism: to elaborate and develop for practical implementation.

- Continuous Data Collections,
more refined and sophisticated, down to platoon levels, with broader and at the same time more focused scope, with an effort to trace the connections between suicide rates and chronological changes in attitudes and policies on various levels and across all services and  demographic groupings.

- Development of psychometric instruments: scales, computerised interviews and diagnostic-therapeutic video games.

-Use EEG ( Electroencephalography - From Wikipedia ), preferably its computerised option, as a part of routine medical checkup and screening, especially in persons with history of head trauma, somewhat inadequate and puzzling (although not necessarily overtly "abnormal") behavior ( I realise that great many of us might fit into this vague "category", probably including your humble servant); especially with excessive and obsessive religious preoccupations, with the follow-up (or even routine screening, if it can be afforded) by sleep deprivation EEG and neurological consultation. Temporal Lobe Pathology ( Temporal lobe epilepsy - From Wikipedia ), with or without seizure activity, can present with various and protean psychiatric manifestations and be a source of latent psychoticism and various ("not otherwise specified") affective (e.g. "epileptoid disphorias" of various intensities, also as the possible precipitants of suicidal behaviors) and complex behavioral disturbances. This pathological phenomenon is poorly understood conceptually and diagnostically, is mis - and underdiagnosed frequently (if not all of the time), is inadequately researched and can be a frequent and unrecognised source of self-injurious and suicidal behaviors. There is a need for the development of more precise and accurate, and, hopefully, more predictive electrodiagnostic methods and instruments. For example (very grim, shocking and tragic one), major Hasan looks very much "organic" to me; for me (again) it is literally "written on his face"; and his inflexible, overvalued, dysfunctional religiosity (or hyperreligiosity, for that matter), also appears to be quite telling and possibly "symptomatic".
 Generally speaking, the biological, medical, neurological aspects and pathological underpinnings of various suicidal behaviors should not be overlooked in our "easy" and very tempting rush to "psychologising".


References and Links

John Snow (physician) - From Wikipedia

military philosophy - Google Search

therapeutic military philosophy - Google Search

stoicism - Google Search

Stoic Warriors: The Ancient Philosophy behind the Military Mind

Book Description

March 19, 2007 019531591X 978-0195315912 1
While few soldiers may have read the works of Epictetus or Marcus Aurelius, it is undoubtedly true that the ancient philosophy known as Stoicism guides the actions of many in the military. Soldiers and seamen learn early in their training "to suck it up," to endure, to put aside their feelings and to get on with the mission.
Stoic Warriors is the first book to delve deeply into the ancient legacy of this relationship, exploring what the Stoic philosophy actually is, the role it plays in the character of the military (both ancient and modern), and its powerful value as a philosophy of life. Marshalling anecdotes from military history--ranging from ancient Greek wars to World War II, Vietnam, and Iraq--Nancy Sherman illuminates the military mind and uses it as a window on the virtues of the Stoic philosophy, which are far richer and more interesting than our popularized notions. Sherman--a respected philosopher who taught at the US Naval Academy--explores the deep, lasting value that Stoicism can yield, in issues of military leadership and character; in the Stoic conception of anger and its control (does a warrior need anger to go to battle?); and in Stoic thinking about fear and resilience, grief and mourning, and the value of camaraderie and brotherhood. Sherman concludes by recommending a moderate Stoicism, where the task for the individual, both civilian and military, youth and adult, is to temper control with forgiveness, and warrior drive and achievement with humility and humor.
Here then is a perceptive investigation of what makes Stoicism so compelling not only as a guiding principle for the military, but as a philosophy for anyone facing the hardships of life.

Editorial Reviews

From Publishers Weekly

You don't need a working knowledge of the writings of Cicero, Aristotle, Seneca, Epictetus and Marcus Aurelius to appreciate this well-researched, in-depth treatise on the history of stoicism in the military—but it wouldn't hurt. Sherman, who taught military ethics in a pioneering program at the U.S. Naval Academy, delves deeply into ancient Stoic theory to shine light on the moral and psychological aspects of stoicism among today's military men and women. Or, as she puts it, the book is about "sucking it up." Sherman at times plunges into dense and arcane areas, devoting, for example, many pages to an in-depth analysis of comportment, manners and emotional bearing in the military, including the psychology of facial expressions and the "ritualized aesthetics of garments." First-person accounts, derived from extensive interviews Sherman conducted, vividly illustrate her points. Retired Adm. James Stockdale, a student of philosophy, used stoic tenets to keep himself from breaking during seven years as a POW (and was awarded the Medal of Honor). During the My Lai massacre, helicopter pilot Hugh Thompson landed between American troops and Vietnamese civilians and ordered his crew, at gunpoint, to rescue women and children who were about to be slaughtered because it was the right thing to do, even though it meant bearing his men's extreme hatred. (July)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved. --This text refers to an out of print or unavailable edition of this title.

From Scientific American

In this age of live combat coverage, war’s ravages are well known. Soldiers witnessing horrendous carnage often become numb and tortured souls, painfully reliving battle moments. Yet these same soldiers must move on, despite psychic trauma. In Stoic Warriors, Nancy Sherman addresses how soldiers gird themselves for combat. "This book is about ‘sucking it up,’" she notes—about the role of Stoicism in modern life. A philosopher at Georgetown University and, formerly, the U.S. Naval Academy, Sherman traces the origin of today’s military training to the Stoics, a group of philosophers who flourished in Athens and Rome more than 2,000 years ago. The Stoics’ core message was that human emotions are not passive reactions but are subject to cognitive control. Thoughts, opinions and interpretations cause, mediate and shape emotions, which the Stoics saw as "something of an act of judgment and will, and a matter of our own responsibility." But Stoicism can also become extreme, enabling individuals to detach themselves to survive or to kill, which sometimes leaves the doer with lasting trauma. Blending analysis of ancient texts with modern history, anecdotes and tales from combat survivors, Sherman delves into soldiers’ hearts and minds, revealing how Stoic thought prepared them for catastrophe, including discipline of mind and body, manners, demeanor, anger, fear, resilience and grief. This issue could not be more pressing, as Sherman writes, "given the U.S. Army’s expansion of ‘stop-loss’ orders to keep soldiers from leaving the service and the general malaise of a war in Iraq." Thousands of troops in Iraq and Afghanistan will suffer psychic trauma but feel that not toughing it out signals weakness. Others will fear the stigma of seeking help, worrying about dishonorable discharge or the shame of not bearing up. Sherman argues that toughing it out stoically is both a blessing and a curse. She cautions that in pursuing self-reliance and self-mastery, we must also be aware of the need to fortify and renew ourselves through human fellowship, empathy and respect, while striving to "cultivate humanity." This wisdom, of course, applies just as meaningfully to modern peace as it does to ancient war. Richard Lipkin --This text refers to an out of print or unavailable edition of this title.
More About the Author
Nancy Sherman, a distinguished University Professor of Philosophy at Georgetown,
writes on ethics and military ethics. She served as the first Distinguished Chair in Ethics at the U.S. Naval Academy and has been a fellow at the Woodrow Wilson International Center. In her new book The Untold War, she argues that the wounds of war are not simply physical or even psychological injuries, but also moral injuries. The book draws on her training as both a philosopher and psychoanalyst, and is based on interviews with some 40 soldiers, most from the current wars. The Untold War was selected as a recommended "pick" by TIME Magazine and as an "Editors' Choice" by the New York Times. Sherman is also the author of Stoic Warriors: The Ancient Philosophy Behind the Military Mind as well as Making a Necessity of Virtue and The Fabric of Character.

Sherman's work on military ethics has been featured in The New York Times, The Wall Street Journal, Time Magazine, Newsweek, The Boston Globe, The San Diego Tribune, The Atlanta Journal Constitution, The Baltimore Sun, The Hartford Courant as well as in many other metropolitan and regional newspapers. She has appeared on CNN, MSNBC, PBS, WB11, FOX news and Bob Abernathy's Religion and Ethics Newsweekly. She has been a featured guest on over 50 radio stations nationwide, including NPR's "Diane Rehm Show," "This American Life," and the "Kojo Nnamdi Show." She has also been featured on radio stations abroad, including the Australian Broadcasting Company. Sherman lectures widely at universities, institutes, and war colleges here and abroad. She lives in the Washington D.C. area with her husband, Marshall Presser. They have two grown children.
therapeutic military philosophy - Google Search