refused, were not selected, or were not eligible to

participate.
Previous analyses of the relationships be-
tween military service and risk for suicide were
primarily limited to studies of mortality and
service-utilizing subpopulations and might not
extend to nonfatal behaviors or veterans in the
general population. The VHM was selected for
use by 9 additional states in 2011. Future
analyses should be conducted to conrm the
relationships identied in this study. j
About the Authors
Robert M. Bossarte, Kerry L. Knox, Rebecca Piegari and
John Altieri are with the Veterans Integrated Service
Network (VISN) 2 Center of Excellence for Suicide Pre-
vention, Department of Veterans Affairs, Canandaigua,
NY. Robert M. Bossarte and Kerry L. Knox are also with the
Department of Psychiatry, University of Rochester,
Rochester, NY. Janet Kemp is with the Ofce of Mental
Health Services, Department of Veterans Affairs, Wash-
ington, DC. Ira R. Katz is with the Ofce of Mental Health
Operations, Department of Veterans Affairs, Washington,
DC.
Correspondence should be sent to Robert Bossarte, VISN
2 Center of Excellence for Suicide Prevention, Canandaigua
VAMC, 400 Fort Hill Avenue, 3B, Canandaigua, NY
14424 (e-mail: Robert.Bossarte@va.gov). Reprints can
be ordered at http://www.ajph.org by clicking the
Reprints/Eprints link.
This article was accepted September 28, 2011.
Contributors
R. M. Bossarte led development of the Veterans Health
Module, designed the analyses, and drafted the article. K. L.
Knox contributed to the development of the Veterans
Health Module and the article. R. Piegari conducted the
analyses and contributed to the article. J. Altieri con-
tributed to the development of the Veterans Health
Module, reviewed analyses, and contributed to the
article. J. Kemp and I. R. Katz reviewed analyses and
contributed to the development of the article.
Acknowledgments
This work was supported by funding from the VISN 2
Center of Excellence for Suicide Prevention, Canandai-
gua, NY, and the Ofce of Mental Health Services,
Department of Veterans Affairs, Washington, DC.
The authors would like to acknowledge the contri-
butions of Alex Crosby, Marcia Valenstein, Mark Ilgen,
John Crilly, and Glenn Currier for their participation in
the development of the Veterans Health Module.
Human Participant Protection
Analysis of Behavioral Risk Factor Surveillance System
data was approved by the Syracuse Veterans Affairs
Medical Center Institutional Review Board.
References
1. McCarthy JF, Valenstein M, Kim HM, Ilgen M, Zivin
K, Blow FC. Suicide mortality among patients receiving
care in the Veterans Health Adminstration Health Sys-
tem. Am J Epidemiol. 2009;169(8):1033---1038.
2. Kuehn BM. Military probes epidemic of suicide:
mental health issues remain prevalent. JAMA. 2010;304
(13):1427, 1429---1430.
3. Ilgen MA, Bohnert AS, Ignacio RV, et al. Psychiatric
diagnoses and risk of suicide in veterans. Arch Gen
Psychiatry. 2010;67(11):1152---1158.
4. Kang HK, Bullman TA. Risk of suicide among US
veterans after returning from the Iraq and Afghanistan
war zones. JAMA. 2008;300(6):652---653.
5. Kapur N, While D, Blatchley N, Bray I, Harrison K.
Suicide after leaving the UK Armed Forcesa cohort
study. PLoS Med. 2009;6(3):e26.
6. Bossarte RM, Claassen CA, Knox KL. Evaluating
evidence of risk for suicide among veterans. Mil Med.
2010;175(10):703---704.
7. Miller M, Barber C, Azreal D, Calle E, Lawler E,
Mukamal K. Suicide among US veterans: a prospective
study of 500,000 middle-aged and elderly men. Am J
Epidemiol. 2009;170(4):494---500.
8. Kang HK, Bullman TA. Is there an epidemic of
suicides among current and former US military person-
nel? Ann Epidemiol. 2009;19(10):757---760.
9. Pietrzak RH, Goldstein MB, Malley JC, Rivers AJ,
Johnson DC, Southwick SM. Risk and protective factors
associated with suicidal ideation in veterans of Opera-
tions Enduring Freedom and Iraqi Freedom. J Affect
Disord. 2010;123:102---107.
10. Centers for Disease Control and Prevention (CDC).
Behavioral Risk Factor Surveillance System: Operational
and Users Guide. Washington, DC: Department of Health
and Human Services; 2006.
11. Centers for Disease Control and Prevention (CDC).
Behavioral Risk Factor Surveillance System. Summary
Data. Qual Rep. 2010. Version #1, Revised 05/02/2011.
12. National Survey on Drug Use and Health. Suicidal
Thoughts and Behaviors among Adults. Rockville, MD:
Substance Abuse and Mental Health Services Adminis-
tration; 2009.
Characteristics of
Suicides Among US Army
Active Duty Personnel in
17 US States From 2005
to 2007
Joseph Logan, PhD, Nancy A. Skopp, PhD,
Debra Karch, PhD, Mark A. Reger, PhD, and
Gregory A. Gahm, PhD
Suicides are increasing among
active duty US Army soldiers. To
help focus prevention strategies,
we characterized 56 US Army sui-
cides that occurred from 2005 to
2007 in 17 US states using 2 large-
scale surveillance systems. We
found that intimate partner prob-
lems and military-related stress,
particularly job stress, were com-
mon among decedents. Many de-
cedents were also identied as
having suicidal ideation, a sad or
depressed mood, or a recent crisis
before death. Focusing efforts to
prevent these forms of stress
might reduce suicides among sol-
diers. (AmJ Public Health. 2012;102:
S40S44. doi:10.2105/AJPH.2011.
300481)
TABLE 2Continued
Race/ethnicity
White, Non-Hispanic (Ref) 1.0
Black, Non-Hispanic 0.4 (0.1, 2.6)
Other, Non-Hispanic 4.2 (0.7, 23.9)
Hispanic 3.1 (0.6, 17.7)
Mental health status
No report of depression, anxiety, or PTSD (Ref) 1.0
Report of depression, anxiety, or PTSD 21.7 (5.6, 84.3)
Support status
Never, rarely, or sometimes receive social and emotional support (Ref) 1.0
Usually or always receive social and emotional support 0.2 (0.1, 0.6)
Note. AOR = adjusted odds ratio; CI = condence interval; PTSD = posttraumatic stress disorder.
RESEARCH AND PRACTICE
S40 | Research and Practice | Peer Reviewed | Logan et al. American Journal of Public Health | Supplement 1, 2012, Vol 102, No. S1
In recent years, the suicide rate has in-
creased among US Army active duty person-
nel.
1,2
The estimated suicide rate for this pop-
ulation nearly doubled from 2004 to 2008
(from10.8 to 20.2 per 100000).
1,2
Mental health conditions, substance abuse
problems, certain physical health problems
(e.g., cancer, chronic pain), and nancial, legal,
and relationship problems are risk factors for
suicide among civilian and military popula-
tions.
3---14
Building on this research, we used
data from 2 large-scale surveillance systems
to assess the frequency of these factors as
well as other military-related stresses (e.g.,
recent combat exposure, job problems, disci-
plinary proceedings) among suicide dece-
dents who were on active duty in the US
Army and residing in the United States to
determine the most prevalent circumstances
preceding suicide for this population. A bet-
ter understanding of the most common pre-
ceding circumstances among the number
of known risk factors for suicide might
help focus military suicide prevention
initiatives.
15,16
METHODS
We obtained data for active duty US Army
suicide decedents who died during 2005 to
2007. Two large-scale surveillance systems,
the National Violent Death Reporting Sys-
tem (NVDRS) and the Department of De-
fense Suicide Event Report (DoDSER) were
linked to comprehensively characterize the
decedents.
NVDRS uses coroner or medical examiner
and toxicology reports, law enforcement re-
cords, and death certicates to provide details
on suicides, such as decedent demographic
information, mechanism or weapon informa-
tion, and preceding health and stressful life-
event circumstance information.
17
During the
study, NVDRS collected data from 17 US
states; therefore, case inclusion for this study
was limited to suicide cases that had death
certicates led in one of those states. The 17
NVDRS states were Alaska, California, Colo-
rado, Georgia, Kentucky, Maryland, Massa-
chusetts, New Jersey, New Mexico, North
Carolina, Oklahoma, Oregon, Rhode Island,
South Carolina, Utah, Virginia, and Wisconsin.
Data collected in NVDRS was statewide with
the exception of California, which collected
data in only 5 counties (Los Angeles, River-
side, San Francisco, Alameda, and Santa
Clara). NVDRS has been described in detail
elsewhere.
17,18
DoDSER data provide details on suicides for
all active duty service members. The DoDSER
is part of a suicide surveillance program that
standardizes retrospective suicide surveillance
efforts across the US service branches. The
DoDSER was rst launched in 2008; however,
the 2005---2007 data we used were collected
from the Army Suicide Event Report (ASER),
the predecessor to the DoDSER that collected
data only for US Army suicide deaths. The
DoDSERs web-based data collection process
was modeled after the ASER and was devel-
oped by the National Center for Telehealth and
Technology in collaboration with the Depart-
ment of Defenses Suicide Prevention and Risk
Reduction Committees Suicide Prevention
Program Managers representing all of the
service branches. This system provides many
details unavailable in NVDRS, such as the
decedents military background, family history,
health service utilization, combat exposure, and
military disciplinary history.
19
DoDSER data
also provide details on circumstances preceding
suicide. DoDSERs are completed by behavioral
health providers within 60 days of the suicide;
each report requires information from medical,
mental health, and personnel records, any other
relevant documents, and interviews with the
decedents coworkers, supervisors, friends, family
members, and any other acquaintances or in-
volved law enforcement and health profes-
sionals, as appropriate.
19
The decedent population was initially iden-
tied in the DoDSER database. Cases were
linked to NVDRS using incident variables
(i.e., state and date of death) and decedent
demographic variables (i.e., age, gender, race/
ethnicity, marital status, veteran status, and
occupation). No personal identifying informa-
tion was linked into the nal dataset. Fifty-nine
decedents were identied in the DoDSER, and
56 (90%) cases were linked and thereby in-
cluded in the study.
RESULTS
Table 1 shows that most decedents were
males; of White, non-Hispanic race/
ethnicity; less than 30 years old; married;
and in the enlisted ranks. Approximately
46% of the decedents had children, and
half of these decedents had children re-
siding with them. Sixty-one percent of the
decedents died in their personal residences,
and 55% used a rearm in the incident.
Over a third of the decedents left evidence
suggesting their suicide was planned, and
21% left suicide notes, which also suggests
premeditation.
Table 2 shows the prevalence of various
health and stress-related circumstances pre-
ceding death. The most common circumstances
were intimate partner problems (45%) and
military-related stress (41%); current job
problems and combat experiences were the
most common military specic circumstances.
Many decedents showed symptoms of mental
health distress (e.g., 36% communicated their
intent to self harm, 32% were identied as
having a depressed mood) or had a recent crisis
(32%). Twenty-three percent of the decedents
received a mental health diagnosis. Alcohol
was involved in over a quarter of the in-
cidents. Alcohol and substance abuse, physical
health, criminal and civil legal, and nancial
problems were also evident among some
decedents.
DISCUSSION
The range in rank distribution among sui-
cide decedents reected the general Army
population,
20
and the decedent demographics
were similar to other, mostly civilian, suicide
populations.
21---23
The nding that intimate
partner problems were the most common
circumstances preceding suicide death was
also similar to ndings in other studies that
described characteristics of a male suicide
decedent population
21---23
; however, the pro-
portion of decedents with preceding job
problems was concerning. Among mostly
male civilian suicide decedent populations
during the same data years, only 12.3% to
12.6% of decedents had reported job prob-
lems.
21---23
Similar to other suicide populations,
many decedents were identied as sad, de-
pressed, or suicidal by family members,
friends, coworkers, clinicians, and other ac-
quaintances, which further shows the
difculty of knowing when and how to
RESEARCH AND PRACTICE
Supplement 1, 2012, Vol 102, No. S1 | American Journal of Public Health Logan et al. | Peer Reviewed | Research and Practice | S41
help someone in need of mental health
services.
21---23
These ndings must be viewed cautiously.
These results neither provided national rep-
resentation nor representation of suicides
that occurred overseas. Causality could not be
inferred between the circumstances and the
suicides, and all circumstance information
was gleaned from previous reports and in-
terviews, which might not reect all informa-
tion known about the incidents. Mental and
medical health information was obtained
from sources for NVDRS, which include
coroner or medical examiners, family mem-
bers, and friends of the victims. These in-
formants might not have known all of the
decedents health information; therefore,
some health conditions might have been
underestimated.
This research used details from 2 federal
surveillance systems to not only character-
ize US Army suicide incidents but also to
help describe the most prevalent circum-
stances that commonly precede death. Fu-
ture studies are planned to compare the
characteristics of this population to those of
soldiers who died by suicide overseas and
civilian suicide decedents to further deter-
mine their unique suicide circumstances.
The ndings in this report suggest focusing
military suicide prevention efforts toward
building positive intimate partner relation-
ships, increasing coping skills to handle
job-related problems, increasing access to
mental health or substance abuse treatment,
and providing support for soldiers currently
in treatment. j
About the Authors
Joseph Logan and Debra Karch are afliated with Centers
for Disease Control and Prevention, National Center for
Injury Prevention and Control, Division of Violence Pre-
vention, Etiology and Surveillance Branch, Atlanta, GA.
Nancy A. Skopp, Mark A. Reger, and Gregory A. Gahm
are afliated with the National Center for Telehealth and
Technology, Tacoma, WA.
Correspondence should be sent to Joseph Logan,
Centers for Disease Control and Prevention, National
Center for Injury Prevention and Control, Division of
Violence Prevention/Etiology and Surveillance Branch,
4770 Buford Highway, MS-F63, Atlanta, GA
30341-3724 (e-mail: ffa3@cdc.gov). Reprints can be
ordered at http:// www.ajph.org by clicking the
Reprints/Eprints link.
This article was accepted September 21, 2011.
TABLE 1Demographic and Other Background Characteristics of Active Duty US Army
Suicide Decedents and Characteristics of the Suicide Events: 20052007
Variable No. (%)
Age, y
1824 21 (37.5)
2529 14 (25.0)
3039 13 (23.2)
4049 6 (10.7)
5059 . . .
Gender
Male 53 (94.6)
Female 3 (5.4)
Race/ethnicity
White, non-Hispanic 42 (75.0)
Black, non-Hispanic 9 (16.1)
American Indian/Alaskan Native . . .
Asian/Pacic Islander . . .
Hispanic . . .
Marital status
Married 34 (60.7)
Never married 16 (28.6)
Widowed, divorced, or separated 4 (7.1)
Single unspecied or unknown . . .
Household and parental factors
Decedent resided alone 17 (30.4)
Decedent had children 26 (46.4)
Children resided with decedent (% is calculated among decedents who had children) 13 (50.0)
US Army status
Regular 43 (76.8)
Reserve 4 (7.1)
National Guard 8 (14.3)
Other . . .
Duty status
Active duty 45 (80.4)
Active Guard/Reserve 3 (5.4)
Active duty for training duty 4 (7.1)
Other 4 (7.1)
Pay grade
E1E2 6 (10.7)
E3 8 (14.3)
E4 16 (28.6)
E5 8 (14.3)
E6 6 (10.7)
E7 4 (7.1)
E8E9 3 (5.4)
W15 . . .
O110 4 (7.1)
Continued
RESEARCH AND PRACTICE
S42 | Research and Practice | Peer Reviewed | Logan et al. American Journal of Public Health | Supplement 1, 2012, Vol 102, No. S1
Contributors
J. Logan conceptualized and supervised the study and
did the majority of the writing and data analysis. N. A.
Skopp helped conceptualize the study, analyzed the data,
and wrote portions of the article. D. Karch helped with
the data linkage and analysis and wrote portions of the
methods section. M. A. Reger helped conceptualize the
study and provided text where needed. G. A. Gahm also
helped conceptualize the study and provided text and
a critical review.
Acknowledgments
We would like to thank all of the staff at the Centers for
Disease Control and Prevention and the National
Center for Telehealth and Technology who helped
support this project, especially those who helped with
the data linkage.
Note. The ndings and conclusions in this manu-
script are those of the authors and do not necessarily
represent the views of the Centers for Disease Control
and Prevention/the Agency for Toxic Substances and
Disease Registry and National Center for Telehealth
and Technology. Also, The opinions or assertions
contained herein are the private views of the authors
and are not to be construed as ofcial or reecting the
views of the Department of the Army or the Department
of Defense.
Human Participant Protection
All appropriate institutional review board approvals were
received for the data linkage. Approval was not necessary
to conduct this study. No living human subjects were
recruited for this study.
References
1. Levin A. Dramatic increase found in soldier suicides.
Psychiatr News. 2007;42(18):9.
2. Kuehn BM. Soldier suicide rates continue to rise:
military, scientists work to stem the tide. JAMA.
2009;301(11):1111---1113.
3. Kung HC, Pearson JL, Liu X. Risk factors for male and
female suicide decedents ages 15-64 in the United States.
Results from the 1993 National Mortality Followback
Survey. Soc Psychiatry Psychiatr Epidemiol. 2003;38(8):
419---426.
4. Mocicki EK. Epidemiology of suicide. Int Psycho-
geriatr. 1995;7(2):137---148.
5. Miller M, Mogun H, Azrael D, Hempstead K,
Solomon DH. Cancer and the risk of suicide in
older Americans. J Clin Oncol. 2008;26(29):
4720---4724.
6. Brdvik L, Berglund M. Depressive episodes
with suicide attempts in severe depression: suicides
and controls differ only in the later episodes of
unipolar depression. Arch Suicide Res. 2010;14(4):
363---367.
7. Brdvik L, Mattisson C, Bogren M, Nettelbladt P.
Mental disorders in suicide and undetermined death in
the Lundby Study. The contribution of severe depression
and alcohol dependence. Arch Suicide Res. 2010;14(3):
266---275.
8. Ilgen MA, Bohnert AS, Ignacio RV, et al. Psychiatric
diagnoses and risk of suicide in veterans. Arch Gen
Psychiatry. 2010;67(11):1152---1158.
TABLE 1Continued
Location of death
Personal residence 34 (60.7)
Residence of family or friend 6 (10.7)
Automobile (away from residence) 5 (8.9)
Other 11 (19.6)
Weapon/mechanism used
Firearm 31 (55.4)
Poisoning 7 (12.5)
Hanging, strangulation 15 (26.8)
Other or unknown 3 (5.4)
Other event characteristics
a
Left evidence suggesting the event was planned 20 (35.7)
Left a suicide note 12 (21.4)
Note. E =enlisted ranks; O=commissioned ofcer ranks; W=warrant ofcer ranks. The Sample size was n =56. Ellipses
indicate that items with less than 3 counts (<5% of the population) were suppressed to prevent potential identication of
decedents.
a
Categories are not mutually exclusive.
TABLE 2Health Related Characteristics of Active Duty US Army Suicide Decedents
and Stressful Life-Event Circumstances Preceding Death: 20052007
Variable No. (%)
Healthrelated factors
Suicidal ideationdisclosed intent of self harm
a
20 (35.7)
Current depressed mood 18 (32.1)
Substance use at time of incident
Alcohol use
b
16 (28.6)
Drug use
c
(% is calculated among those tested) 8 (30.8)
Current mental health problem 13 (23.2)
Diagnoses
d
(% is calculated among those who had current mental health problems)
Depression/dysthymia 9 (69.2)
Posttraumatic stress disorder 3 (23.1)
Other 3 (23.1)
Unknown . . .
Alcohol or other substance abuse problems 7 (12.5)
Current physical health problem
e
4 (7.1)
Stressful life event factors
f
Recent intimate partner problems 25 (44.6)
Any military-related stressful circumstances
g
23 (41.1)
Military specic circumstances
h
(% is calculated among those
who had any military-related stress)
Current job-related problems 14 (60.9)
Experienced combat in last deployment 9 (39.1)
Subject to administrative separation 5 (21.7)
Continued
RESEARCH AND PRACTICE
Supplement 1, 2012, Vol 102, No. S1 | American Journal of Public Health Logan et al. | Peer Reviewed | Research and Practice | S43
9. CDC. Homicides and suicidesNational Violent
Death Reporting System, United States, 2003-2004.
MMWR Morb Motal Wkly Rep. 2006;55(26):
721---724.
10. Klves K, Vrnik A, Schneider B, Fritze J, Allik J.
Recent life events and suicide: a case-control study in
Tallinn and Frankfurt. Soc Sci Med. 2006;62(11):2887---
2896.
11. Stack S, Wasserman I. Economic strain and suicide
risk: a qualitative analysis. Suicide Life Threat Behav.
2007;37(1):103---112.
12. Jakupcak M, Cook J, Imel Z, Fontana A, Rosenheck
R, McFall M. Posttraumatic stress disorder as a risk
factor for suicidal ideation in Iraq and Afghanistan
War veterans. J Trauma Stress. 2009;22(4):
303---306.
13. Mahon MJ, Tobin JP, Cusack DA, Kelleher C,
Malone KM. Suicide among regular-duty military
personnel: a retrospective case-control study of
occupation-specic risk factors for workplace
suicide. Am J Psychiatry. 2005;162(9):
1688---1696.
14. Pietrzak RH, Goldstein MB, Malley JC, Rivers AJ,
Johnson DC, Southwick SM. Risk and protective
factors associated with suicidal ideation in veterans
of Operations Enduring Freedom and Iraqi Freedom.
J Affect Disord. 2010;123(1-3):102---107.
15. Bagley SC, Munjas B, Shekelle P. A systematic
review of suicide prevention programs for military or
veterans. Suicide Life Threat Behav. 2010;40(3):257---
265.
16. Ramchand R, Acosta J, Burns RM, Jaycox LH, Pernin
CG. The war within: preventing suicide in the US military.
Santa Monica, CA: RAND Corporation. Available at
http://www.rand.org/pubs/monographs/MG953. Ac-
cessed July 25, 2011.
17. Paulozzi LJ, Mercy J, Frazier L Jr, Annest JL.
CDCs National Violent Death Reporting System:
background and methodology. Inj Prev. 2004;10(1):
47---52.
18. CDC. National Violent Death Reporting System
(NVDRS) Coding Manual Version 3; National Center for
Injury Prevention and Control, Centers for Disease
Control and Prevention, Atlanta, GA; 2008. Available
at: http://www.cdc.gov/violenceprevention/pdf/
NVDRS_Coding_Manual_Version_3-a.pdf. Accessed
February 10, 2011.
19. Army Behavioral Health Technology Ofce. Suicide
Risk Management & Surveillance Ofce. Army Suicide
Event Report (ASER) CY 2007. Tacoma, WA: Madigan
Army Medical Center; 2007:98431.
20. Department of Defense. Demographics 2009:
Prole of the military community. Ofce of the Deputy
Under Secretary of Defense Military and Family Policy.
Available at: http://www.militaryhomefront.dod.
mil/portal/page/mhf/MHF/MHF_DETAIL_
0?current_id=20.20.60.70.0.0.0.0.0. Accessed on July
25, 2011.
21. Karch DL, Dahlberg LL, Patel N. Surveillance for
violent deathsNational Violent Death Reporting Sys-
tem, 16 States, 2007. MMWR Surveill Summ. 2010;
59(4):1---50.
22. Karch DL, Dahlberg LL, Patel N, et al. Surveillance
for violent deathsNational Violent Death Reporting
System, 16 States, 2006. MMWR Surveill Summ.
2009;58(1):1---44.
23. Karch DL, Lubell KM, Friday J, Patel N, Williams
DD. Surveillance for violent deathsNational Violent
Death Reporting System, 16 states, 2005. MMWR
Surveill Summ. 2008;57(3):1---45.
Suicidal Ideation
Among Sexual Minority
Veterans: Results
From the 20052010
Massachusetts
Behavioral Risk Factor
Surveillance Survey
John R. Blosnich, PhD, Robert M. Bossarte,
PhD, and Vincent M. B. Silenzio, MD
Suicide is a public health prob-
lem disproportionately associated
with some demographic charac-
teristics (e.g., sexual orientation,
veteran status). Analyses of the
Massachusetts Behavioral Risk
Factor Surveillance Survey data
revealed that more lesbian, gay,
and bisexual (i.e., sexual minority)
veterans reported suicidal idea-
tion compared with heterosexual
veterans. Decreased social and
emotional support contributed
to explaining the association be-
tween sexual minority status and
suicidal ideation. More research is
needed about suicide risk among
sexual minority veterans; they
might be a population for outreach
and intervention by the Veterans
Health Administration. (Am J Pub-
lic Health. 2012;102:S44S47. doi:
10.2105/AJPH.2011.300565)
In 2008, over 400 000 people engaged in
suicidal behavior, with suicide ranking as the
TABLE 2Continued
Subject to AWOL proceedings 4 (17.4)
Subject to medical evaluation board 3 (13.0)
Subject to courts martial proceedings . . .
Recent crisis (within 2 wk of death) 18 (32.1)
Subject to other civil criminal or Article 15 proceedings 8 (14.3)
Recent civil legal issues 8 (14.3)
Recently perpetrated interpersonal violence 5 (8.9)
Recent nancial problems 4 (7.1)
Recent other relationship problems . . .
Recently was a victim of interpersonal violence . . .
Note. AWOL =absent-without-leave. The sample size was n =56. Ellipses indicate that items with less than 3 counts (<5% of
the population) were suppressed to prevent potential identication of decedents.
a
The decedent communicated potential for self harm. This variable excluded leaving a suicide note.
b
Alcohol use was determined by toxicologic tests and whether there was evidence of use (e.g., witnesses or investigative
reports that state the victim was seen drinking before the incident).
c
Drug use was determined by toxicologic tests alone. Toxicologic tests were conducted for 26 decedents.
d
Diagnostic categories are not mutually exclusive.
e
Physical health problems refer to only medical problems perceived to have precipitated the suicide.
f
Stressful life-event factors are not mutually exclusive.
g
The variable any military-related stressful circumstances did not include those undergoing Article 15 proceedings as
a circumstance because these decedents could have been actually undergoing civilian criminal proceedings based on how
information for this variable is collected. However, over 90% of those who were identied as undergoing Article 15
proceedings also had other military-related stresses before death that were included in this variable; therefore, the proportion
of decedents identied as having any military-related stressful circumstances was not largely underestimated.
h
Categories are not mutually exclusive.
RESEARCH AND PRACTICE
S44 | Research and Practice | Peer Reviewed | Blosnich et al. American Journal of Public Health | Supplement 1, 2012, Vol 102, No. S1
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