The War Within

The War Within: Preventing Suicide in the U.S. Military

RAJEEV RAMCHAND
JOIE ACOSTA
RACHEL M. BURNS
LISA H. JAYCOX
CHRISTOPHER G. PERNIN
Copyright Date: 2011
Published by: RAND Corporation
Pages: 228
https://www.jstor.org/stable/10.7249/mg953osd
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  • Book Info
    The War Within
    Book Description:

    The increase in suicides among military personnel has raised concern. This book reviews the current evidence on suicide epidemiology in the military, identifies state-of-the-art suicide-prevention programs, describes and catalogs suicide-prevention activities in the U.S. Department of Defense (DoD) and across each service, and recommends ways to ensure that the activities in DoD and across each service reflect state-of-the-art prevention science.

    eISBN: 978-0-8330-5231-5
    Subjects: Psychology, History

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-viii)
  4. Figures
    (pp. ix-x)
  5. Tables
    (pp. xi-xii)
  6. Summary
    (pp. xiii-xxviii)
  7. Acknowledgments
    (pp. xxix-xxx)
  8. Abbreviations
    (pp. xxxi-xxxviii)
  9. CHAPTER ONE Introduction
    (pp. 1-6)

    As the United States enters its ninth year of continuous combat in Afghanistan and Iraq, concerns about the stresses on U.S. forces generated by repetitive deployments to war zones have been heightened. All services have experienced increases in suicides, especially the Army and Marine Corps, whose forces have borne the brunt of combat in these theaters. The Army appears poised to have a record number of suicides in 2009 relative to the recent past.¹

    Today, the U.S. Department of Defense (DoD) remains actively engaged in efforts to prevent suicide. Each service employs a myriad of specific prevention campaigns. A DoD-wide...

  10. CHAPTER TWO The Epidemiology of Suicide in the Military
    (pp. 7-40)

    This chapter presents the most-currently available data on suicide in the U.S. military, along with a discussion of the research challenges particular to epidemiologic investigations of suicide. We did not set out to be comprehensive in our review of the epidemiologic literature on suicide. Rather, we intended only to highlight research findings that we considered relevant to DoD. This chapter deals with such questions of interest to policymakers as what the suicide rate is in the services, whether it differs from that of a comparable segment of the civilian population, how it has changed over time, how it varies between...

  11. CHAPTER THREE Best Practices for Preventing Suicide
    (pp. 41-60)

    This chapter reviews information on the current status of suicide-prevention efforts relevant to the military context. We begin with a framework that describes the continuum of intervention activities and the ways in which they may be combined. We use existing published literature and expert opinion to describe current best practices along this continuum. We also highlight evidence, when it exists, that suggests that certain programs or formats could be detrimental and actually increase risk of suicide. We extract information seen as most pertinent to the prevention of suicide in the military and place it in text boxes to highlight those...

  12. CHAPTER FOUR Suicide Prevention in the Department of Defense
    (pp. 61-84)

    In this chapter, we provide detailed information about the programs and initiatives that aim to prevent suicides in DoD and for each service in turn: the Army, Navy, Air Force, and Marine Corps. We begin our description of each service’s suicide-prevention activities with what we find to be the overarching philosophy guiding suicide-prevention programs in that service. Following this, we provide an overview of the programs and initiatives each service has in place to prevent suicide, categorized as primary or universal prevention programs, selected or indicated prevention programs, and, finally, postvention programs and initiatives. We include programs offered specially to...

  13. CHAPTER FIVE Support for Suicide Prevention in the Department of Defense
    (pp. 85-104)

    In this chapter, we provide detailed information on how suicide-prevention programming in DoD and for each service is supported. For each service, we provide information using the following organization:

    1.official documentation bearing on suicide:We present the service-specific policies and instructions that bear directly on suicide or suicide prevention.

    2.organizations responsible for suicide prevention:We describe the organizations and personnel deemed responsible, by policy or instruction for each specific service, for suicide prevention. For each service, this is described in three domains: headquarter level, installation level, and, when appropriate, organizations and personnel deemed responsible in theater.

    3.funding...

  14. CHAPTER SIX Conclusions and Recommendations
    (pp. 105-122)

    Our review of the literature and interviews with experts in the field led us to conclude that a comprehensive suicide-prevention program has six essential components:

    1. It raises awareness and promotes self-care.

    2. It identifies those at high risk of suicide.

    3. It facilitates access to quality care.

    4. It provides quality care.

    5. It restricts access to lethal means.

    6. It responds appropriately to suicides and suicide attempts.

    Our investigation into the suicide-prevention programs in DoD and across the services revealed examples of programs that fall under some of these domains. However, initiatives or activities were lacking in other...

  15. APPENDIX A Army Suicide-Prevention Initiatives
    (pp. 125-136)
  16. APPENDIX B Navy Suicide-Prevention Initiatives
    (pp. 137-148)
  17. APPENDIX C Air Force Suicide-Prevention Initiatives
    (pp. 149-152)
  18. APPENDIX D Marine Corps Suicide-Prevention Initiatives
    (pp. 153-164)
  19. References
    (pp. 165-189)
  20. Back Matter
    (pp. 190-190)