Learning from Tragedy, Part 3: Caveats, Conclusions

This three-part series describes the Department of Defense Suicide Event Report (DoDSER) system that collects and analyzes data on U.S. military deaths by suicide, as well as data on suicide attempts. The National Center for Telehealth & Technology (T2) compiles these data into an annual report for military leadership and is available to the public. The first blog in the series described how the DoDSER system was put in place; the second blog described the type of data collected about suicides and suicide attempts. This final blog in the series continues that description.

Before you can put any tool to good use, you need to know the capabilities and limitations of the tool. The purpose of the DoDSER is to monitor risk factors, rates and profiles associated with suicide as closely as possible. However, it is not designed to identify potential causes of suicide. There are important considerations to keep in mind when using this system. I shared several of them in the previous blog, others include:

Duty Status

Currently, the report presents data for the military overall, as well as for each service, including all the active component members of that service, as well as reserve component members who were in a duty status at the time of their death. The simplest way to understand what “duty status” means for reserve component personnel is to determine whether or not they were “in uniform” that day; that is, were they performing military duties.

Non-Duty Status

Currently the DoDSER includes information on cases of suicide where the individual was not in a duty status at the time of death. This means the individual was most likely a reservist or National Guard member who was not performing military duties at the time of death. The Services are moving toward collecting data on those who are not in a duty status at the time of their death, however, because each data collection cycle covers a one-year period, there is a slight lag between when procedures can be changed, and when those changes go into effect.

Comparisons

When reading a report like the DoDSER, it’s natural to want to make comparisons with the available data. As a surveillance system, the DoDSER focuses on describing and contextualizing the occurrence of suicide. The only comparisons used are to help ensure any changes in data represent actual changes and are not artifacts of the data collection or analytic processes used.

Stability

When you open an annual report, you’ll notice that the numbers change from year to year. The case counts may go from 269 to 266 and rates may go from 18.5 to 20.2, but it’s important, for a variety of reasons, not to over-interpret small changes. For example:

  • Changing the occurrence of suicide will require changing population attitudes about suicide, which is typically a slow process that occurs over the course of years.

  • There is some expected fluctuation in the rates and counts from year to year as the size and composition of the services change. Sometimes these fluctuations can masquerade as true “changes” even though they are not.

  • The size of the total population must be accounted for, because if there are more or less service members in the armed forces overall from year to year, it will affect the observed rates (which are essentially the number of suicide-related deaths divided by the total size of the relevant population). Thus, the same number of deaths could be observed between years, but if more individuals enlisted in the armed forces than the year prior, the rate would appear to decrease. Conversely, if fewer individuals enlisted, the rate would appear to increase, despite an identical occurrence of suicide.

Caveats

The data obtained through the DoDSER process has very real limitations. First, it is an aggregated look across the entire military, meaning that it compiles lots of cases of information together to look at broad, overarching patterns, rather than looking at each case separately. It does not focus on individual cases.

Additionally, as the purpose of the DoDSER system is to collect and report data, neither the comparisons we use for stability checks, nor the descriptive reports included in the tables, allow us to infer any cause and effects regarding specific risk factors. Independently planned research studies with control groups are required before making causal inferences about the role that any specific risk factor produces.

Surveillance’s Role in Suicide Prevention

The DoDSER system is a surveillance tool; it collects and reports data that can be used by those invested in suicide prevention to plan and evaluate programs. Suicide prevention is a priority for the Defense Department and there are a wide variety of new and ongoing programs aimed at reducing the rate of suicide in the military; the DoDSER system is one part of larger suicide-prevention efforts.

Maya Angelou once stated, “Do the best you can until you know better. Then when you know better, do better.” The National Center for Telehealth & Technology DoDSER team is proud of their work to improve the knowledge about the risks of suicide and the strategies the military takes to improving suicide-prevention efforts.

If you, or someone you know, have thoughts of suicide, please reach out for help immediately:

  • Dial 9-1-1 or go to your closest emergency room.
  • Call the Military Crisis Line at 800-273-8255. If you are a service member or veteran, Press 1 to talk to someone who has served.
  • Start a confidential online chat session at http://www.VeteransCrisisLine.net/chat.
  • Send a text message to 838255 to connect to a VA responder.
  • If you are deaf or hard of hearing, you can connect through chat, text or TTY.