ARMY SUICIDE EVENT REPORT (ASER) CALENDAR YEAR 2006 Suicide Risk Management & Surveillance Office ‘Army Behavioral Health Technology Office Madigan Army Medical Center ‘Tacoma, Washington 98431 suicide.reportinag@us.army.mil Pho. Colonel, US Army Pho. Research Psychologist “This repart does not necessarily represent theofficial poloy ofthe Department of Defense, the U.S. Army, or the Office of the Surgeon GeneraASER CY 2006 Page 2 of 165 EXECUTIVE SUMMARY ‘The Army Suicide Event Report (ASER) standardizes data collected on suicide events and is an integral part of the Army's Suicide Prevention Program. Completion of the ASER allows for detailed Army-wide statistical reports on suicide events. including attempts and completions. Method: Submission of an ASER is required for all suicide related behaviors that result in death, hospitalization, or evacuation. This web form collects information on suicide events and associated risk and protective factor information across multiple domains. ASER points of contact {POCs) are designated by medical treatment facility {MTF} Commanders and are responsible for ‘completion of ASERs. ASER POCs are also required to submit monthly reports on suicide-related hospitalizations, Purpo: ‘The ASER is a surveillance tool and process to gather standardized risk and protective factor information for suicide events. ASER data comprise the only Army-wide repository for the spectrum of suicide behaviors and a more detailed set of psychosocial and event information on completed suicides than is otherwise available, ASER analyses are frequently relied upon by the Army and DoD leadership. ‘The ASER database, which includes 1032 records from this year alone, provides a meaningful tool for the AMEDD to leverage in support of suicide evaluation. This report for Calendar Year éCY} 2008 is one product from that effort. Conclusions are presently limited by the relatively small ‘sample size when looking at individual risk factors and the unavailability of comparable normative Army data, However. combining 2006 data with 2005 data provided the opportunity to conduct new analyses for deployment subgroups. Future efforts will continue to pursue further advances for the program to enhance support to the AMEDD and the Army. ‘Summary of Results: This annual report of the ASER provides statistics for CY 2008 as reported and submitted as of 1 March 2007. ASERs were received for 85% of all confirmed suicides, including 93% of all OIF- QEF confirmed suicides. Seventy-one suicide attempts were reported as occurring in OIF-OEF. Suicide behaviors were significantly more common for young, Caucasian, unmarried. junior enlisted Soldiers. Attempts and completions were further differentiated from each other, with younger, lower-enlisted female Soldiers overrepresented for suicide attempts compared to ‘completions. Firearms were the most common method for completed suicide and overdoses and cutting were the most common methods for attempts. It was not uncommon for individuals with attempts to have a history of prior self-injurious events, psychiatric diagnoses, substance abuse and/or outpatient or other mental health care, However, most Soldiers who completed suicide did not have a reported prior psychiatric disorder, Failed relationships were prevalent in both groups. ASER data suggested a differential pattern of risk factors for suicide behaviors during OIF-OEF deployments compared to suicide behaviors in other settings. Mariage may be more protective against a completion and less protective against a suicide attempt during deployment compared to other event locations. Rates of work-related problems were generally higher among OIF-OEF events, while rates for a number of traditional stressors and risk factors were lower for Soldiers with events during deployment, even when compared to Soldiers with an OIF-OEF deployment history, Rates of some types of combat exposure were higher in redeployed Soldiers with suicide behaviors than Soldiers with OIF-OEF events. In adition, there was a significant relationship between suicide attempt and number of days deployed to an OIF-OEF country, with the frst two. quarters of deployment showing the highest frequency of suicide attempts. similar pattern was ‘observed for completions, but the finding was not statistically significant. Multiple OIF-OEF deployments were relatively rare among those with suicide behaviors. Conclusions and interpretations regarding noted patterns must be made cautiously until data are avallable for a demographically similar normative group of Amy Soldiers.ASER CY 2006 Page 3 of 165 ACKNOWLEDGEMENTS Preparation ofthis report was sup nee Office (SMSO research team, neudingh erase Sse eels hairs of a RS SRE STI he Je Event Report tool and data collection efforts. P* sine Amy Behovioal Heath Teshnolegy Office were nstumentalin the development and maintenance of the ASER web form and database, The SRMSO is especially grateful to the Armed Fores Medel Examiners Ofc athe med Forces Insite of Pathology an the sim Suiide Prevention Progr for nositeton of sented Army suicides and their support for these efforts, These notifications are crucial in the process of fraaing aval Jaa reprccentaton ofeonpleledulides for the Any, RIGO alee thanks Pend SSS fplthe Army Demographics Office, for prowdng Army population data IRSER data would Pat Be valable whe the Rata work of Ihe ASER POS une have Made feat stides in mproving aubmglan catea eu the past two years, SRUSO lo aloo ateRd i land Psy.D. for their leadership to ensure ‘compliance with the submission requirements,ASER CY 2006 Page 4 of 165 TABLE OF CONTENTS EXECUTIVE SUMMARY . ACKNOWLEDGEMENTS TABLE OF CONTENTS BACKGROUND . METHOD... RESULTS ASER CY 2006 Itemized Results .. Dispositional/Personal Factors Situational/Contextual Factors... Clinical’Symptom Factors HistoricallDevelopmental Factors SUMMARY. REFERENCES APPENDIX A: New in ASER 200 APPENDIX B: ASER 2006 Webform Items .. APPENDIX C: ASER Policies and Procedures. APPENDIX D: ASER and Command POC List .. APPENDIX E: ASER Submission - CY 2006 Compliance APPENDIX F: Comparing Events That Occurred in OIF-OEF To All Other Events APPENDIX G: Comparing Events That Occurred in OIF-OEF To Non-OIF-OEF Events Among Soldiers With OIF-OEF Deployment History APPENDIX H: Comparing Soldiers With Suicide Events And Any History of OIF-OEF Deployment To Soldiers With Suicide Events And No History APPENDIX |: Comparing CY 2005 To CY 2006... APPENDIX J: Acronym List. FEEDBACK AND SUGGESTIONS .ASER CY 2006 Page 5 of 165 BACKGROUND To effectively execute the suicide surveillance mission, the Army established the AMEDD Suicide Risk Management & Surveillance Office (SRMSO) in 2004 at Ft. Lewis, WA. SRMSO uses an epidemiological data collection form called the Army Suicide Event Report (ASER) to collect standardized data on suicide behaviors among Army Soldiers. Completion of the ASER is required for all active duty Soldiers who exhibit suicide related behaviors that result in death, hospitalization, or evacuation. It is not intended to replace the psychological autopsy, which is limited to fatalities in which the manner of death is uncertain, ‘The ASER allows for detailed Army-wide statistical reports on suicide events, including attempts and ‘completions, ‘This report provides statistics for Calendar Year 2006 (CY 2006), with detailed tables presented for ASER items broken down by event type. Appendices inclucle a copy of the ASER 2008 Webform, the policy document that describes the AGER process, the ASER and Command paints of contact (POC), the ASER. reporting compliance rates by location, and additional analyses conducted on deployment status, METHOD ASER Items Development of the current ASER content evolved from structured reviews of the past ASER versions, ‘examination of previous ASER data, and a systematic review of the literature. Risk factors for suicide and suicide behavior relevant to an active duty military population have emerged through this process. To ‘maintain the comparabilty of 2008 and 2006 AGER data, ASER Items were not changed this year (Appendix A). A copy ofthe ASER 2005 Webform is provided in Appendix B. Improvements to the ASER content have been implemented for ASER 2007. For theoretically meaningful presentation, risk variables are organized into categories. While multiple alternatives were available for this organization, a relevant prototype successfully implemented in the violence risk assessment literature [1] was selected: (1) dispositional or personal factors (e.g demographics, etc}, 2) historical or developmental ¢e.g., family history, prior suicide behaviors, fe events, etc.) (3) contextual or situational (e.g., access to firearms, place of residence, etc.), and (4) clinical or symptom factors (e.g. post-traumatic stress disorder, other psychiatric disorders or symptoms), This categorical banding of risks is intended to help organize the multiple and complex factors that contribute to suicidal behaviors. These factors were combined with a comprehensive set of ‘questions related to the event to form the current ASER Data Collection Process The ASE! ne internet and submitted to the SRMSO via a secure website at |The ASER data presented! here are a clescriptive ‘compilation oF 3S as they have been completed and submitted by ASER POCs across the Army ASER data included in this report are for suicide behaviors that occurred in CY 2006 as reported and submitted as of 1 March 2007, two months following the end of the calendar year. Consideration has been given to extending this date to obtain additional ASERs as it may take as long as one year to determine suicide as cause of death, The Centers for Disease Control (CDC) has addressed this with longer timeframes for reporting (e.g. 2004 data are available at the end of 2006) [3]. The March date was established as a compromise between the competing values of timely reporting and complete data collection. ‘The Army policy on ASER submission can be reviewed in Appendix C. Submission of an ASER is required for all suicide related behaviors that result in death, hospitalization, or evacuation. This requirement has been in place since March 2004. To support this requirement, SRIMSO has worked with ‘each Medical Treatment Facility (MTF) to identify two POGs: an ASER POC and a Command POG.ASER CY 2006 Page 6 of 165 (Appendix D). Command POCs are the MTF Commander or thelr designee. Command POCs are responsible for ensuring their MTFs’ compliance vith reporting requirements, ASER POCs are designated by the MTF Commander and each Is generally a behavioral health (BH) provider, responsible for ASER completion and submission at that locaton, The ASER POC at each MTF is responsible for either personally completing, or ensuring that a qualified provider completes the ASER. An ASER must Table 1 ‘Source Information Required to Complete an ASER ‘Completed Sulcidee ‘Suicide Attompte Revew or Revawot Medical ard EH records * ackeal end EH records Interviews (28 needed and + Persornel and counseling records rere aperepnate} vest est Patient + Investigate agency records (6: cv “+ Conworkers and supervisors + Records related te manner of death (cosually reports, toxicclogy, autopsy, suicide notes} Interviews (as neededt and eppropnate) Comverkérs and supervisors + Responsible investigative agency onteer + othar invalved protessionais ana fernly members be completed by a oredentialed BH provider (e.g... psychologist, psychiatrist, social worker, or psychiatric nurse), as completion of some ASER items require clinical judgment and knowledge of BH Issues and diagnoses. Completion of an ASER requires a review of all relevant records. In addition, interviews may be needed in some cases. The data sources used to complete an ASER differ somewhat based on whether the ASER is sumitted for an ‘attempt oF a completion. Compared to an attempt, a suicide completion requires a review af additional Feoords, such as personnel, Criminal Investigation Division (CID), and autopsy records (Table 1). Different interviews are sometimes conducted as well Following a suicide attempt, ASER POCs frequently utilize an interview with the patient to collect some of the required information, while interviews with co-workers, and CID officers are more commen following a completion. Completed Suicides ‘The typical flow of information is illustrated in Figure 1. For completed suicides, the event may be identified locally anc an ASER submitted based on that determination, or completed after notification from SRMSO. SRMSO receives notification from the Armed Forces Medical Examiner's Office (AFME) at the Armed Forces Institute of Pathology that a Soldier's death is confirmed as a suicide. Upon such notification, the ASER and Command POC for the MTF are notified and requested to complete an ASER within 60 days, Formal requests are sent to ASER POCs for each AFME confirmed event with follow-up messages sent for all events for which an ASER is not received in the required timeframe. Additionally, compliance reports that highlight delinquent ASERs are issued monthly to ASER and ‘Command POCs. Hospitalization/Evacuation in adkition to completed suicide events, ASERS are required for any suicide beha vor that resus in hospitalization and/or evacuation. These ASER submissions are referred to as “attempts’ for the: purposes ofthis document, For suicide attempts, the reporting process requires the ASER POC for teach MTF to track these events and ensure ASER Submission. an ASER POC Is required to submit monthly reports on suicide-related hospitalizations: for each MTF by the 5” working day of the Figure 1. Typical flow ofinfometion resulting in an ASER Submission fo SRMSO. ASERS can be Subynttea ater eh vont 1s dertited local rafter reminder Fern SRMSO.ASER CY 2006 Page 7 of 165 following calendar month to identify the number of attempts for that MTF. ASERs are then expected for events based on these reports. This generally involves ccordination with Inpatient Psychiatric personnel and the Outpatient Behavioral Health Clinio(s} personnel Data Quality Control Procedures. Four primary quality control procedures are conducted. First, the data submission website has been developed to minimize the possibilty of data entry errors. The software utilizes form field validation to request user clarification when data is not logically possible (e.g., impossible dates}. Radio buttons and checkboxes are utilized to further reduce the chances of data entry errors. Second, each submitted ASER is individually reviewed to ensure that its face valid. The AGER website isa secure site (HTTPS). ‘Third, ASERs are analyzed for incorrect data entry. Individuals make a variety of data entry mistakes {such as transposing years) and these are corrected when identified. A conservative approach is taken to ‘correcting errors such that only clear mistakes are corrected. Fourth, all ASERs are reviewed to ensure that two or more ASERs were not suiomitted for the same event. When duplicates are identified, the local ASER POC is contacted in an attempt to determine which submission represents the most complete data, and this ASER Is used in analyses. Statistical Analysis POC Compliance ASER submission compliance rates are calculated for each MTF. In the Department of Defense (DOD), suicide completions are officially defined by the AFME's Office. The number of ASER submissions for each MTF is compared to the number of suicides for its region. For suicide attempts, the number of ASER submissions is compared to the number of reported suicide-related behaviors that resulted in hospitalization or evacuation, Comparison to Army Population Fiscal year (FY) Army population data was available for a number of demographic variables from the Office of Army Demographics (2]. Pearson chi square statistics vere calculated to determine whether suicide behaviors were independent of these demographic variables. In the analyses, ASER suicide behavior classifications (Attempts, Completions) were used to compare suicide behaviors to the Army: population. though the Army population is signifcarty larger than the attempt and completion groups, frequency counts for suicide behaviors were subtracted from Army population totals to satisfy the assumption of independent groups. Where an overall relationship between a variable and suicide behaviors was detected, a second similar analysis was conducted to determine whether completion status (Attempt, Completion) was independent of the factor. Where cell counts were too small to analyze, ‘subgroups were combined to increase the cell frequency (e.g.. No Diploma combined with GED). In the case of Cadets/Midshipmen. there was no intuitive vay to combine these data. and they were excluded from the analysis, Comparison of Suicide Attempts and Completions Data are presented in detail by event type: “completed” for suicide behaviors that result in death, and “attempts” for a suicide event not resulting in death. Statistical comparisons between these categories ‘must be interpreted with caution, as ASER compliance rates are not necessarily randomly distributed, and analyses of such patterns are difficult to interpret with no event base rates determined for attempts. In addition, the different data collection methods described above may impact the resus. With the exception of demographic variables where Army population data was available, Attempts and ‘Completions are not statistically compared inthis report, Enough data is provided to alow the readerto caleulate some comparisons, when of interestASER CY 2006 Page 8 of 165 History of Deployment Pearson chi square statistics were calculated to determine whether Operation Iraqi Freedom or Operation Enduring Freedom (OIF-OEF) events and non-OlF-OEF events were independent of a variety of possible risk factors. The analyses were repeated for OIF-OEF events compared to the subgroup of the non-OlF- COEF events where Soldiers were postive for a prior OIF-OEF deployment. These subgroup analyses were possible by combining ASER data submitted for 2005 and 2006 events. In addition, events in which Soldiers were Ever-Deployed were compared in a similar manner to events in which Soldiers were Never Deployed, Comparison of 2005 and 2006 ASERS Since the ASER content did not change from 2005 to 2006, item responses could be analyzed for changes from the previous year. Again, chi squares were used to examine possible differences. interpretive Considerations The purpose of this report is to broadly examine all ASER items, Therefore. exploratory analyses were conducted without corrections for multiple comparisons. This inereases the probability of finding statistically significant results by chance, even when no real cifference exists, ‘When interpreting the results, itis also important to note the effect of the "Den't Know" option that is provided for many ASER items. Percentages were often calculated based on the tetal number of responses, including “Den't Know” responses. If one group has a higher "Don't Know” response rate than ‘comparison groups. it affects the way the data appear. For example, a group that is really 50% male ‘would show about a 40% male rate (and 40% female rate) where a 20% Don't Know" response rate is, observed. In some cases, cells were combined into super-ordinate categories to create surficient cell sizes appropriate for analyses (e.g., combining multiple item options into Married, Not Married categories) Frequencies for all item options are provided in the data tables. Therefore, percentages may not match with those cited in the text in a few analyses, and these are noted where they occur, RESULTS ASER Submissions and POC Compliance 2006 Reported Suicide Events A total of 1032 ASERs for 2008 events were analyzed'. Of these, 84 were submitted for completed suicide events, and 948 were submitted for events that did not result in death. Fifty-bvo ASERs reported that the hospitalization or evacuation was based only on suicidal ideation. These are incluced in the. broad category described as “suicide attempts,” as outlined above. " attr conducting the quay centro procedures described inte Methods section, there wore a ola of 1085 ASERS for evans that CY 2008. Tive ASERS were submitted for completans that are sil pring tnal determinations by AEME and, those neludedin our analyses, However, warly-four ASERE ware submited for averts that dd rot resut in hozpalzaton, ‘evacuaton, o death since these cid not mest # prior inclusion enisha, they were excluded fem the analyses. Six ASERS Submited for suicide behavers by fe sponsor's spouse were excluded, An additonal tree ASERs wars alsa excluded attr ‘uner examineton. One was sutmites fr a Navy evert, ane is currenty classified as an accident by AFME (Dut is sll pend), {nd one feperted Information for @ eomploton of whieh AFME nas ao krowedyeASER CY 2006 Page 9 of 165 ‘The official number of Army completed suicides for CY 2006, as of 1 March 2007, per AFME was 87. Eighty-five of these were Regular Army component (not National Guard or Reserve), for a orude rate of 16.91 (per 100,000}, assuming a denominator of 502,790 (FY 06) [2]. Breaking this down by sex, ten of the 97 AFME confirmed completed suicides were for females. with 8 of the 8 regular Army suicides: ‘completed by females (Table 3). This resuited in Active Component crude rates of 17.82 far Army men and 11.33 for Army women. Any comparison to U.S, suicide rates requires adjustment for age and gender. Rates for men and women age 17-45 cakoulated from most recently available U.S. population statistics (CY 2004) from the CDC [3]are presented in Table 4, as well as a U.S. rate adjusted for gender. (Adjustment for age was not possible as Army population numbers for gender by age were not available at the time of this writing). The Army suicide rates reported here are not official, and are only intended to assist interpretation of ASER data, The Army Suicide Prevention Program (G-1) maintains the Army's official suicide rates, Table 2 CY 2006 ASERs SUBMITTED ‘Count Percent EVENT TYPE Attempt 22% Completion a4 8% ‘Das tveugh Taaao0 se ora Table 3 Completed Suicides by Data Source "ASERs Recetved that AFME Confined AFMEAC Suicides ore Pending AFME Suicides Onty Contimnation| Male 7 7 2 Female 10 8 0 Total Suicides: oa 8 - [ASERs Received a 7 2 ‘Compliance Rate 25% % z Table 4 Army and U.S. Population Suicide Crude Rates Number Population Suicide Rate Population Suicides ‘Size ‘Overall US age 17-48 16333 121,990,757 18.38 ‘Adjusted US Rate™ 18.28 ‘Overall Army- Active Component only 85 302,720 16.91 US Men age 17-45 13045 61,756,739 21.12 ‘Army - Active Component Men 7? 482,157 17.82 US Women age 17-45 2288 60,234,018 3.46 “Anny Active Component Woman a 70.683 11.33 Excopt where specified, crude suv ral ave otowm * atching for gender ves calculated by mulbplying Army rates for each sexby the respectve US crude suicide alas ege 17-45) ana summing te resus ( 14" 5.46 + 85" 2112),ASER CY 2006 Page 10 of 165 Submission Rates Completed Suicides: ASERs were received for 82 of the 97 AFME confirmed suicides. Thus. the estimated compliance rate for completed suicide events that occurred in CY 2008 was 85%. The CY 2008 compliance rates by MTF are presented in Appendix E. Hospitalization/Evacuation: As the ASER is the only tracking mechanism for attempts. itis net possible to caloulate a true response rate for this category of suicide behavior at thistime. However, submissions \were compared to reported MTF hospitalization and evacuation data, as deseribed in the Methods section, These C¥’ 2008 compliance rates by MTF are also presented in Appendix E, ASER CY 2006 ITEMIZED RESULTS Dispositional/Personal Factors Demographics (Table 5) ‘There was a significant difference between altempts, completions, and the Army population on all measured demographics. Table 5 displays the distributions. Soldiers with suicide behaviors were less. likely to be ethnic minorities compared to the Amy population. Suicide behaviors were also significartly less common in married individuals than would be expected based on the marriage rate in the general Army population, supperting the view that marriage may be a protective factor against suicide in the Army. Educational patterns differed by group membership. and ASERs were more commonly submitted for Regular component Soldiers than National Guard or Reservists, combined. Other differences in demographic factors net only differed between the three groups, but also differentiated Soldiers who completed suicide from those who attempted! suicide. Suicide attempts were made by a disproportionately high number of females. Aithough Soldiers who completed suicides were younger than the general Army population, the youngest Soldiers were more likely to attempt suicide than to complete suicide. & similar pattem was observed for rank, with attempts shewing the highest proportion of lower enlisted Soldiers. Table 5 CY 2006 ASER DEMOGRAPHICS EVENT TYPE At Complatad (Overall Army * Count Percant Count Percent Gaunt _Parcent ‘GENDER Male 869, 1% 73. 431,416 86% 001 Femele 27e 29% 10 O26 14 RACEVETHNICITY Asian/Pacific slander 24.~=~=O«SK~SCS*~«S 18,700 4% —_<001 Affican American 13% 18 104,028 21% Caucasian eas 8% BH 309,178 62% Hispenic a2 o% 53.279 11% OtheDK Missing 7 8% 8% 8.879 3%ASER CY 2006 Page 11 of 165 Table 5 (continued) CY 2006 ASER DEMOGRAPHICS EVENT TYPE. Attempt Completed ‘Overall Army ‘Count Percent Count Count AGE RANGE Under 25 638 70% 38 201,582 =.001 2B 1108 4 112,834 20-8 Ha 1% 136,108 40+ 20 8 51274 RANK Enlisted 328% TS 419,167 <001 E-Es 80985" 53 225104 EBES Wig 12% 24 194.064 Officer 18 2% 68,504 Warrant Officer 2 2% ~~? 15,008 3% iclethishipman 3 at% 1 4.342 1% COMPONENT’ Regular a2 8% «TS 601.863 48% 001 Reserve a ae 189,975 18%. Wational Guard! a oe 2 346.243 33%. EDUCATION Wo AS Diploma 7 m0 3.208 <1% 001 GED 1% 36,766 7% HS Diploma 407 a8% ~~ 310,991 ‘Some College/aA 12 7 1,016 BABS 38a 62.864 Mat 3st 2 30,868 6% Unknown 12 1% 6 16,664 3% MARITAL Never married a7 8% at - = STATUS Maniied 384 38% 30 274,052 =.001 Legally separated 19 Dh 2 - Divorced 62 mH 5 : - Widow ° o% 0 Bont Know a SHS - - (sattraugh 1290/2006 a8 or 82007 Note. Data may nat adlto expected totals due to missing temrespenses. Rounding and mutiple responses forindviduals may recut in ttals acing to greater than 100%. P = proteoilty that te stanstcal erence between te three grous Is Ueto heros * army data are based upon Regular Active Duty solders only (tal of 902,780) for FY 2006. with the exception of Component whichincudes Regul, Reserve and National Guard [total of 1,030,058) for FY 2006. Count for sme and Completions nero Subtracted ern the Army doa to create independant graups e= describedin the Methods. Dla proud bythe Office of Army Bamograpriss Ary Prana FY-08ASER CY 2006 Page 12 of 165 Event Setting (Table 6} Both completions and attempts ocourred most commonly in the Soldier's personal residence, For suicide attempts, the nest most likely setting was a worksite. Completions were equally likely to ocour at the residence of a family of friend, a worksite, or in an automobile. Table 6 CY 2006 ASER EVENT SETTING EVENT TYPE Attempt Completion Count Percent Count Percent EVENT SETTING Residence (personaly 380 40% 36 a3 Residence (fiendifamiy) 23 2% 7 8% Woikfobsite 137 15% 7 8% Automobile (eway from resiclence) 21 2% 7 8% Inpatient medical facility 14 1% ° 0% Other 368 30% 26 31% ‘Dara raugh T2SVZ006 ss oFSTT=0OT (The majonty af explanations for response “Other” were ‘Berrarks," which wud generally be considerad one's personal sider}, Event Method (Figure 2) Figure 2 displays the differential event methods by type of event. Firearms were the most commonly reported method for completed suicides (71%, n = 80}, followed by Hanging, strangulation or suffocation (19%, n= 18}, Overdose (53%, n= 495) and Cutting (18%, n = 170) were most common for attempted ‘suicides. Attempt methods in the Other category include Jumping (1%, n= 11), Motor vehicle crash (51%, n = 9), Submersion/drowning (<1%, n = 3), and Poisoning by exhaust (<1%, n = 2) or Utility gas (1%. n= 1), 6 o 8 3 6 40 . z= 6 8 $2 2 10 ° i a oo ‘Cunnay J Hanang! | Firearm’ | Fream? [Posonng ont overdose | Fiorina |Sirznauis| Gun |un(ner-) by | othor | Lent rrovumt | ten | aaitay | Mitay) |sunstence featemorm | sar | wer | 38 | 2a 18 7 | 87 la completion 3p] 6 o 18 aa | sai | 2 b 24 Figure 2. Suiide behawor mathod by type of eventASER CY 2006 Page 13 of 165 Event Motivation (Table 7) After reviewing all relevant records and conducting appropriate interviews, the ASER asks the provider to ‘subjectively identify the patient or decedent's primary motivation for performing the event, Although this item attempts to clocument what might have motivated Army suicide behaviers, in doing so it simplifies an extremely complex behavior. Due to the subjectivity of the content, results for this item should be inlerpreted with caution For 43% of the completed suicides, the motivation was unknown or unreported. Of those for which a motivation was identified, 14% in = 12} reported Emotion Relief (e.g., to stop bad feelings, seit-hatred, anxiety relief), and 14% (n = 12) reported Hopelessness (e.g, pessimistic regarding future). Frequencies for other primary motivations are displayed in Table 7. Primary motivation for attempts, in order of frequency. was reported as follows: 31% (n= 281) Emotion relief; 14% (n = 130} Hopelessness: 12% in = 109} Depression: 10% in = 94) Avoidance or escape: 9% (n= 86) impulsivity; 8% (n = 75) Interpersonal influence; 3% (n = 26) Other psychiatiic reasons; 3% {n= 26) Individual reasons; 1% (n= 7} Feeling generation; 11% (n = 88) Other/don't know. Table 7 CY 2006 ASER EVENT MOTIVATION EVENT TYPE, Attempt Completion Count Percent Count Percent MOTIVATION Emotion relief 13% «12 «Ta Interpersonal influence BS 8% 3 4% Feeling generation 7 1% 0 0% Avoidanselescape a4 10%} Ineivieual reasons z 3% 4H Hopelessness 130 14% 12 14% Depression 109 12% 1% ‘Other psychiatric symptoms 2% 1% Impulsty 8 8% CH ‘Other B26 ~~ COBH Don't Know 46 5% 6% ‘Das bveugh 12302008 sear 9Vz007 Other Event Details In adeition to method, location, and motivation assoctated with the suicide event, detailed information is gathered as to whether alcohol or ether drugs were used during the event (not necessatily as a method for selt-harm), whether the Soldier intended to die, communicated the intent for self-harm, and whether the method (e.g.. quanity of substance} used is one that is typically lethal. Additional items inthis section pertain to evicence of deattrrisk gambling such as Russian roulette or walking railroad tracks, planning or premeditated acts, ancl whether suicide events were performed in areas or under circumstances in wich Soldiers are likely to be ebserved by thers.ASER CY 2006 Page 14 of 165 Substance Use During the Event. A total of 26% of submitted completions reportedly used alechol andlor drugs during the event (Figure 3)°, This percentage is likely an underestimate, as a significant minority of cases did not have access to information about substance use, presumably because autopsy results were not available at the time of the ASER submission, After exchiding cases containing "Dont Know" responses, 41% of ASERs submitted for a completion reported alcohol andior drug use during the event In contrast, during suicide attempts, a teal of $7% of submitted cases reportedly used alechol and/or i drugs during the event”. After excluding “Don't Completions Know eases, 54% of ASERs submitted for an attempt reported alechal and/or dug use deting the fevenk. Interpretation ofthis data requires the recognition that Overdose was the most commonly reported method of suicide attempt. Other Event information. Since ASERs are submitted for a wide variety of “suicide attempts,” information is gathered to help characterize the nature of the reported events. A significant [Drugs Both seach see snes appease epresent Bath dangerous behaviors with a high possibility of death. Sere Pitoatts ce wan tanea ee Attempts i Dont know {n = 353) of attempts and 30% (n= 278) used methods that are typically lethal. Suicide notes were rare among those who attempted sulcicle (7% n= 76), but over haif ofthe reported notes were left by those who used typically lethal methods (n = 38). in contrast, 51% (n = 484) of reported attempts were performed under circumstances where it would likely be observed and intervened by others. 13% “thnnnnnrT For completed suicides, 82% of cases (n= 68) showed evidence to suggest intent to die, and €4% (n= 79) used methods that are typical lethal. Fity 002 SubtancoUee Duing Evans Nate percent of completed sticides showed evidence that stages fon alot nay al sn iotre sare the event was planned cr premeditated (n= 42). ° Suicide notes ware found in 17% of completions in=14) Evidence of death risk gambling (e.g.. Russian roulette) was faitty rare (2% of suicide completions and attempts). Ten percent of known death risk gaming events resulted in deati (2 completions, 18 non= fatal events), but this is likely an over-estimate, astthere is a high probabilty that a number of such attempts went undetected 2 The cases used both crugs and alcohol during the event. Two of fe drug-use cases roportedy represented overthe-courtor oF presorgton medication use “without overdose." The intent of is response is ambiguous, as he ASER item does net iferertiste between appropriate thorapeube crug use and drug abuso, conservatva approach to the data was use! and these cases nore {gcludod in he dats repartee above roported data refocs fe foxt Tat 119 cases raportedy used oth drugs end alcohol during Iie avent. Forty ASERS reported over tne-courter ar prescnption medication use “wihout averdose": there were similar concerns regarding the ASER POCS inert Pera, cr these oases wate ewoludedASER CY 2006 Page 15 of 165 Table 8 ASER 2006 OTHER EVENT INFORMATION EVENT TVPE Attempt Completion Count_Percent_Gount_Percent INTENT To DIE Yer 363 (38% «688% No ””~<“Ct«~iSCiHS Dont Know 155 17% ~~ 113% LETHAL Yes 278 30% ~=—79 (04% Ne 507 «54% 1% Dont Know 156 17% 45% DEATH Yes 18 2% RISK/GAMBLING © > $$J ££ No 862 92% 74 88% ‘DontKnow BC i HSSCOC«iR(i«‘«irR PLANNED/ Yes 246 26% «42 «50% Pr IT gn REMEDITATED yg 572 61% 24-20% Don't Know 818% «18 21% OBSERVABLE Yes 84-51% 117% No ssi BSCMHCBCPOM Don't Know 130 14% 118% ‘SUICIDE NOTE LEFT Yes 70 7% 14 «17% Nos CBM Don't Know 80 8% 720% aa treagh OVO oT Communication of intent Table 9 (Table 9). The majority of patients and decedents did not ‘communicate their potential for CY 2006 RECIPIENTS OF COMMUNICATED INTENT ‘self-harm prior to the event. ——— ‘Thirty-six percent of individuals —____SVENT TYPE who attempted suicicle “Attanpt Completed (n= 334), and 25% of Soldiers Count Percent Count Pereant ‘who completed suicide (n= 21) ——E——evr ‘communicated ther intent prior MENTAL HEALTH STAFF 133 4 to the event. At least 5 Soldiers FRIEND 116 6 Th who completed suicide (6%) reported thei intent to maiple SUPERVISOR, a people. However, similar to ‘SPOUSE oF other analyses, these CHAPLAIN = percentages are probably an OTHER = 7 7 underestimate, as ASER POCs responded "Don't Know in 15% “Gastraugn evauue wat a0ASER CY 2006 Page 16 of 165 of attempts (n= 138} and 17% of completions (n= 14). In addition, false-negative response errors are likely. In almost all positive cases, intent was communicated verbally (296 of the attempts and 20 of the completions). Text messages were reperted in the “Other” category for 2 attempt cases. Examination of the type of individuals with whom patients and decedents shared intent may be helpful for informing suicide prevention efforts, Soldiers who attempted suicide most commonly shared their intent with Mental Health Staff, Friends, and Supervisors (Table 9). For completions, Soldiers most commonly shared their intent with Spouses, Friends, and Mental Health Staff, There may be a bias in favor of, identifying intent communicated to mental health staff, given the documentation requirements of providers, land the fact that ASER POCs are generally behavioral heaith providers, The majority of the *Other’ responses reflected a variety of co-workers and family members. Three ofthe “Other” responses for completions identified Mother 2s the recipient of the communication, Situational/Contextual Factors Situational Factors Table 10) ‘These items pertain to the individual's current situation, such as place of residence, current living situation and stressors, factors that are subject to change over time. The majority of attempters (70%, n = 658) and 56% of completers (n = 47) resided in barracks, with off-post family housing the second most prevalent response for both groups. Less than 30% of both groups resided alone at the time of the event. Thirty-one percent of completions (n = 26} and 24% of attempts (n = 226} reportedly had minor children, Of those, very few resided with their minor children; percentages for this item pertain only to those who. reported having minor children and responded to the follow up question and, therefore, are not ‘comparable to percentages of total ASERs submitted as presented for other items. A gun was present in the home or immediate environment for 60% (n = 50) of completed suicides and 13% in = 122) of attempts. Table 10 CY 2006 ASER SITUATIONAL INFORMATION EVENT TVPE Attempt Compl Count Percent Count Percent RESIDENCE Barracks, aiher shared miltary 58 70% 47” ~—~=56% Tormiltary shared ——SS~=~—“~*~sSC“‘( wT BEQBOO—s—<“‘C;*és:SC!SOC OH “Onpestfamiyhousing ATSC “OfFpestfamilyhousing 1% TOM. ‘he siiCHSSC«SCi«‘ ‘Dentknow———SSSOS~SGSC‘iC*«i RESIDES Resides with spouse 736% +15 ~—«=50% Weise “Separated, relationship issues ——«77—~—~CSC“C~* a (SC ‘Separated, other ie 36% «8 «27% Donit Know ‘6 5% 1amASER CY 2006 Page 17 of 165 Table 10 (continued) CY 2006 ASER SITUATIONAL INFORMATION EVENT TYPE Attempt ____Completion Count Percent Count Percent RESIDES ALONE Yes 201 21% ~—23 7% No ”~”~”—”—~C*C«RNSCPOMHSC«CSC«C DentKnow ———> Bae eB Dont Know 168 17% 30 36% FX FAMILY Yes 312 38% «10% EA IDE Ne 419 4% 202d Dant Know 213 25% 58 87% Gana Dai aTASER CY 2006 Page 26 of 165 Administrative & Legal History (Table 18) History of Aticle 15 proceedings were reported for 17% of attempters (n = 18) and 23% of completers (n = 19}. Civil legal problems were also fairly common; 14% of completions (n= 12) and 6% of attempts {n= 60) had a history of civil legal problems, Twelve percent of attempters (n= 113) and 7% of completers (n = 6) were reportedly the subjects of administrative separation proceedings. Other administrative and legal risk factors were less commonly reported as shown in Table 18 Table 18 CY 2006 ASER ADMIN/LEGAL HISTORY EVENT TYPE Attempt Completion Count Percent _Count_Percent COURTS-MARTIAL PROCEEDINGS Yes 31% 2 2% No 230 88% ~——«G«BBM% Dont Know 98 10% 12 14% ARTICLE 15 PROCEEDINGS Yes 158 17% 188% No e77 72% «54 BH Dont Know 107% 18% ‘ADMIN SEP PROCEEDINGS Yes 113 12% 6 7% No 728 78% 66 80% Dont Know 9 10% ~~ 18% AWOLIDESERTION PROCEEDINGS Yes 52 6% 3. 4% No 805 86% 68 83% Dont Know a2 8% 18% MEB PROCEEDINGS Yes 468% 3 4% No att 26% 71 86% Dont Know at 8% 2 11% CIVIL LEGAL PROBLEMS Yes 60 6%) 12% No 767 8% 51 81% Dont Know 14 12% 20 24% Eltron Series doarASER CY 2006 Page 27 of 165 Abuse history (Table 19) Of completed suicides, 7% (n = 6) had a reported history of being a victim of physical abuse. 4% in = 3) sexual abuse, and 4% (n= 3) emotional abuse. History of sexual harassment was not reported for any completed suicides, Of attempts, 18% (n = 169) hadl a reported history of being a victim of physical abuse, 18% (n= 163) sewual abuse, 22% (n= 205) emotional abuse, and 5% (n= 43) sexual harassment, Abuse in which the Soldier was the perpetrator was not commonly indicated, although ASERs for 7% (n = 6) of completers and 3% (n= 31) of attempters reported alleged or confirmed petpetration of physical abuse in the past. Table 19 CY 2006 ASER ABUSE HISTORY EVENT TYPE Attempt Completion —_ Gount_Percent _Gount_Percent ‘VICTIM PRYSICAL ABUSE Yes 162 (18% += C7% No 504 6H «88 «OM Dont Know 165 (18% —«30—«AT% VICTIM SEXUAL ABUSE Yes Cc No 606 65% 41-49% Dont Know 198 17% «38% VICTIM EMOTIONAL ABUSE Yes 205 «OSH No 551 59% 36 44% Dont Know 18% 435% VICTIM SEXUAL Yes HARASSMENT oF No 695 75% =A «8M Dont Know Ted 20% «421% PERP PHYSICAL ABUSE Yes 1% BO No 737 78% S58 Don't Know 718% 838—88% PERP SEXUAL ABUSE Yes 7 1% 1 1% No 762 81% «47_—«58% Don't Know WT? 18% 86 48% PERP EMOTIONAL ABUSE Yes Bm 0% No 741 78% 48 57% Dont Know 182 19% «36 «43% PERP SEXUAL HARASSMENT Yes 0. 0%) 11% No 762 81% 4B 57% Dont Know 180 19% G5 42% Faatvegh amie ot TOOTASER CY 2006 Page 28 of 165 Financial and Workplace Difficulties (Table 20) Excessive dept or bankruptey was reported for 8% (n= 77) of attempts and 11% (n= 9) of completed suicides. Additional information related to job or employment difficulties are presented below. History of ‘employment problems or co-worker dificulies were relatively common for both attempted and completed suicides and were also the most frequently endorsed items of this section Table 20 CY 2006 ASER OTHER HISTORY VENTE Attempt Completion Count _Pervent Count Percent “EXCESEWEDEBTEARRRUPTOY Ves No 683 75% 47 57% Don't Know: 156 17% 27 33% HX JOB PROBLEMS: Yes 233 25% 24 29% No 563, 61% 45 55% Don't Know 122 13% 13 16% ‘SUPVICOWORKER ISSUES Yes 227 26% 16 18% No 545, 60% 50 60% Dont Know 140 15% 7 20% POOR PERFORWACE EVAL Yes 158 17% 16 18% No 605, 66% 49 59% Dont Know 152 17% 18 22% FIX WORKPLACE HAZING Yes es No 696 77% 57 70% Don't Know 159 18% 2a 26% Gana aati sora Comparing 2005 and 2006 ASER Results (Appendix I) Few differences were identified between 2005 and 2006 ASER responses. For completions. higher rates of Mood Disorders, including Major Depression were reperted in 2006 (p=.02). Similarly, more 2008 ‘completions were Seen by Outpatient IMental Heath (p = .02) and Inpatient Mental Health {p = .02} prior to the event. and more 2006 events reportedly took psychotropic medications prior to the event (p = .04). However, in all of these items, a lower proportion of ‘Don't Know’ responses were noted on the 2006, items, which may have driven the results.ASER CY 2006 Page 29 of 165 ‘Comparisons of 2005 and 2006 attempts may be mare affected by changes in compliance with ASER submission requirements than completions, which have high compliance rates that are known, Significant effort has been dedicated to improving compliance with attempt submissions; ASER ‘submissions for attempts increased from 708 in 2005 to 948 in 2008. Therefore, changes in ASER items from 200 to 2008 should be interpreted with caution. In adkition, comparisons af all ASER items is likely to result in some significant cifferences between 2008 and 2008 simply by chance. However, Appendix | displays the results. Although cell sizes made attempt method difficult to analyze, more suicide attempts by overdose were reported in 2006 (53% vs. 43%), Mote 2006 attempts used alcohol during the event than in 2005 ép = .03), and fewer 2006 Soldiers reportedly communicated ther intent to harm themselves {p= .006), In contrast to the results for completions, fewer ASERs for 2006 attempts reported a history of a Mood Disorder ¢p = .02). A number of other risk factors differed significantly, but only because of ‘changes in "Don't Know responses. These distributions can be Viewed in Appendix | SUMMARY ‘This annual statistical report of the ASER provides statistics and analyses for Amy suicide events ‘occurring in CY 2006, with detailed tables presented for ASER items broken down by event type. A crude suicide rate of 16.91 éper 100,000) was calculated for Regular Army. This is lower than the gender matched U.S. rate of 18.93 calculated from the most recent available U.S. population statistics {CY 2004) from the Centers for Disease Control (CDC). & total of 1032 valid ASERs were submitted fer CY 2008; 84 were for completed suicide events. Of the 87 AFME confirmed suicides, an ASER hacl been received for 82, fora submission compliance rate of 85% for completed suicide events that occurred in CY 2008. (Two ASERs submitted for completions are stil pending final AFME determination at the time of this writing). Demographic variables differentiated Soldiers with suicide behaviors from the rest of the Army population, Suicide behaviors were most common for young, Caucasian, unmarried, jurior enlisted Soldiers. Attempts and completions were further differentiated from each other by age. gender, and rank, with younger, lower-enlisted female Soldiers overrepresented for suicide attempts compared to completions. Firearms were the most common method for completed suicide, and overdoses and cutting were the most ‘common methods of settharm not resulting in death. The majority of events occurred in a garrison chy fervironment, although almost a third of completed suicides cecurred in a deployed environment. Itwas not uncommon for individuals to have had prior sefinjurious events, past psychiatric diagnoses, andfor prior outpatient or other mental health care, although most completed suicides (74%, n= 52) did not have a reported diagnosed psychiatric disorder. The most frequently reported stressors included failed or failing relationships (especially marriage), legal problems, work-related problems, and excessive debt. Almost two thirds of completions had a history of at least one OIF-OEF deployment. However, multiple OIF-OEF deployments were relatively rare among those with suicide behaviors. ASER data suggested a differential pattern of risk factors for suicide behaviors during OIF-OEF cleployments compared to suicide behaviors in other settings (Appendix F-G). Some evidence suggested that marriage may be more protective against a completion during deployment than during other assignments. In contrast, marriage may be less protective against a suicide attempt during a deployment compared to other assignments. Rates of work-related problems were generally higher among OIF-OEF events, However, a number of traditional stressors and risk factors were lower for Soldiers with events during deployment, even when ‘compared to Soldiers with an OIF-OEF deployment history. Still base rate data for OIF and non-OlF= OEF populations are required for a proper interpretation. Some combat exposure rates were higher among previously deployed Soldiers with non-OIF-OEF events than Sokliers with suicide behaviors in OIF-OEF (Appendix G). Assuming that the two groups have theASER CY 2006 Page 30 of 165 same combat exposure base rates, this suggests that combat exposure may be more of a tisk factor for suicide behaviors after Soldiers redeploy. However, this possibilty requires additional study, In addition, there was a significant relationship between suicide attempt and number of days deployed to ‘an OIF-OEF country, with the frst two quarters of deployment showing the highest frequency of suicide attempts, A similar pattern was observed for completions, but the finding was not statistically significant Conclusions and interpretations regarding noted patterns must be made with caution until data are available for a normative group of Army Soldiers that is demographically similar.ASER CY 2006 Page 31 of 165 REFERENCES [1] Monohan J, Steadman H J, Appelbaum PS, et al, Developing a Clinically Useful Actuarial Toot for Assessing Violence Risk. BR J Psychiatry. 2000; 176:312-319, [2] Office of Army Demographics. Army Profile FY-06. U. S. Army, Office of Amy Demographics. Received data from Chief, Army Demographics Office G-1, Office of the Deputy Chief of Staff for Personnel U.S. Army on 18 March 2007 va e-mail [3] Centers for Disease Control and Prevention, U.S. Population Statistics for CY 2003. Available at hitpsivunw cde aovincipeiwisuars/default.im. Accessed March 14, 2007,ASER CY 2006 Page 32 of 185 APPENDIX A NEW IN ASER 2006 The Suicide Risk Management & Surveillance Office conducts an annual review of ASER content and deploys a revised ASER January 1 of each CY. SRMSO maintains a list of proposed changes which can be derived from ASER or Command POC suggestions, consult questions from Army leaders during the year, changes in the Army mission, recent research findings in the literature, or other sources. A SRMSO committee consisting of two research psychologists, the ASER administrator, and the SRMSO Director review potential changes and attempt to balance requests for new items with the requirement to keep the ASER brief. Significant changes to ASER items were deployed in the 2005 version of the ASER. For ASER 2006, there was a strong desire to maintain comparability between 2005 and 2006, as the annual Nis very low for some analyses and between year comparisons are of interest. Therefore, although technical improvements to the website were deployed, the ASER content remained unchanged,ASER CY 2006 Page 33 of 185 APPENDIX B ASER CY 2006 ASER 2006 WEBFORM ITEMSASER CY 2006 Page 34 of 185 Etiinouncal 1, Event date! (a-mmmyy) Event time: {local ime, hmm) 2. Geographic location of event: Country: State (or equivalent) ity, post, or camp: 3. Event setting residence cown) [Residence of friend or family Li werkjiobsite [_JAutomobile (away from residence} [inpatient medical facility (other: 4, Type of event [Completed suicide (onsek al et SEP) [_]Hospitazation (inpatient) [JE vacuation 5. Primary method used: [Overdose (medication, drugs, or alcohol) [Poisoning by solid or quid substance {not medication} [Poisoning by vehicle exhaust [Poisoning by utity gas (Firearm / qun, military issue or duty weapon (Firearm f qua, other than miltary issue [Jumping from high place [)Metor vehicle erash [JHanging, strangulation, or suffocation [1 Cutting or piercing instrument Cstemersion crowning Dother: [Ldon't know 6 During the event, was alcohol” [] ves used? [ne [Li don't knowASER CY 2006 Page 35 of 185 Enc ee) 7. During the event, were drugs [] Yes used? ne Lider know 3 Is there evidence that the Lives patietdecedet intendedto yyy die? [ident know 8. Was the method used (and Lives ) yg potential for set-harm?ASER CY 2006 Page 36 of 185 Sn eee) 15. What was the patient decedent's primary motivation for performing this event? {select enya (lemetion rei (a9. tip eae Woing, stated, awe et [interpersonal infuence 9.1995 hp ost attr, stoskeber) [Feeiing generation (19 tuo tang numb) [aveidancetescape (a. acs or eeape dileert,promnting Turtin ahr ways) [individual reasons (ser pusimert 0 exrass ent ba wat ceased ove one) [Hopelessness fc .possmateregerdng tir) [Depression te 9 cnenic er severe ctniealy apressed moos) [Llother psychiatric symptoms (a 5 PTS0,payetote) Limputsivity (2.9. cue to substance abuse, personality characteristics) other: port know 16. Duty environment/status at time — [_] Garrison (Psychiatric hospitalization (ceva sot Fiteave Medica ots LitovTap—___ nevacuation chain Dawot [under command observation ec) Lideployea 1 Other: Litraining ‘7. Was the event related to a Lives deployment? Ene Lidentt know ieASER CY 2006 Page 37 of 185 (Esta aad 18. Last name: First name & middle initial: Social Security Number: 19. Date of birth: (de-mram-yy} 20. Sex LMate [Female Libor know 21, Relationship to sponsor: [sponsor Li spouse Cena Clothe: 22, Racial category. [checkeenly ene) [American Indian/Alaskan Native [asianiPacitic islander LBlackiaftican American Lwiite/Caucasian Doother: Lion know 23. Specific ethnic group: Hispanic ‘Asian (chockeniyone) Limerican (chinese [Puerto Rican [Cuapanese (cuban [korean Ctatin american Clndian [other spanish Filipino Native American L)vietnamese Lialeut Doother Asian LEskimo Pacific Islander [Ju.sicanadian indian Tribes [_]Melanesian [Polynesian Dother other Pacific islands [Li don't know 24. Marital status: [JNever married [check oni ene} marca [Li tegatly separated [Dbivorcea widowed25, Education: eer oe rene ASER CY 2006 Page 38 of 185 te Some high school, cid not graduate seo [nigh sehoot graduate [some cotege or tecnieal school, ne degree or certifeate [college dearee of less than four years or technical school certificate [lFour-year college degree [)Master’s degree or greater Ldont know 28. Residence at the time of event [learracks. tents, or other shared military iving environment [Non-military shared living environment [8e0 or Boa [i onpost family housing [orpost family housing other: [bent know 27. Did the patientidecedent reside" [| yes alone at the time ofthe event? Lion know 28. Did the patientidecedent have [yes Ad the patlertic minor children’ ne [Don't know “Ihyes: were'the children: “esicing ath hind he elASER CY 2006 Page 39 of 185 TESTE as 29. Service! Barmy [coast Guard navy Foreign miltery DAir Force [other uniformed service [Marines [other 30. Componentiviitary status: [Regular (oo Amy. Ar Fore) LiReserve tea usar, USMCRI [National Guard Llother 31, Job code: (NOS, SS), AFSC, DAFSC or otnermitary job cons) — 32. Duty status: LiAaive Duty EEN) LAGER tAcive GusrarReserse} [DIET teasie ent Aavenced Indcuatzed Traring) []Mobilized RC (reserve ana Nate! Guard) [ADT (active Cuty for Trarinat [IIDT (weekend Reserve Dri} Diretirea [Released from active duty vithin 120 days Lootner: Lidoes not apply 33. Pay grade: Lier Cjes Ow Lior Dios Oe Cer Ow. Ooz Dor Oe (ee Ows (os, Loe Des Ces Owe Dot Los Hes Ows Hos Low [cadetiidshipman [does net apply 34. Permanent duty station 7 [Same as geographic event woation command! location other location 35. Permanent duty assignment: Division: Brigade: Battalion: Company: 36. UIC or other unit identification: 237. Length of time in unit years, _months |] Check if unknownASER CY 2006 Page 40 of 185 Ta 7 yes, heW Jona prio! fo event Was the patientdecedent seen 35a eal Westman Fay? 29, ... Substance Abuse Services? 0. ...a Family Advocacy Program? 47, ...Chaplain services? 42, ... Outpatient Mental Health? (ncudng soln mental 3. ... Inpatient Mental Health? Had the patient/decedent... 4. ...been diagnosed with any Mood Disorder? 45. ...been diagnosed with a Bipolar Disorder? 46. ...been diagnosed with Major Depression? 47_....been diagnosed with a Psychotic Disorder? 48, .,.been diagnosed with PTSD? 9, ...been diagnosed with an Anxiety Disorder? 30, ...been diagnosed with a Personality Disorder? 37. ...had a history of Substance 35 Taken oats medications? 53, ...had prior selFinjurious A events? ee ‘any prior events? | [EJ One' prior eventASER CY 2006 Page 41 of 185 Wane recncn e ow long prior to € Was the patient/decedent the subject of. 34, ... courts Martial proceedings? 35, .. Arlisle 15 proceedings or civilian criminal problems? 36. ... Administrative Separation proceedings? 37. ... AWOL or desertion proceedings? 38, ..a Medical Evaluation Board? 39, ... civil legal problems? (ag cha listed cispute,tigaton) 0. ...non-selection for advanced Schooling, promotion, or command? Was the patient/decedent an alleged or i. ...physival abuse or assault? T 2, ...Senual abuse or assault? 63. ...emotional abuse or assault? Gd, ... Sexual harasament? [ ‘Was the patient/decedent an alleged or confirmed PERPETRATOR 5, .. physical abuse or assault? E 5, ...senuial abuse or assault? of 7, ...emotional abuse or assault? $5, ., Sexual harassment?vy. ASER CY 2006 Page 42 of 185 Deployment location 1 (Afghanistan) Kosavo Crea 1 Other Europe OO Karat (1 North America 0 Korea 1 Central or South America other: _ Deployment start date —teammmn yy) Deployment end date: (or expected ert date) — erm) Deployment location 2 [Afghanistan L] Kosovo OF traq 1 Other Europe Co Kurait (1 North America 0 Korea C) Central or South America other: _ Deployment start date —teammmn yy) Deployment end date: (or ewectad end date) (oan Deployment location 3 Tl Afghanistan] Kosovo Ci traq other Europe CO Kuwait (North America Ci Korea 1 Central or South America Ci other: _ Deployment start date tearm) Deployment end date: {or epectad end dato) — seni) ‘Tong prior te event reopened Yes No 70. Did the patientidecedent experience direct combatWas there evidence of... ASER CY 2006 Page 43 of 185 a a failed or falling spousal or intimate partner relationship? 72. ‘a failed or falling other relationship? 73. ‘a completed spousal suicide? 7H 2 completed family member Suicide? 75. ‘a completed suicide by a fiend? 78. ‘a death of spouse or family member? (other than suicide) 77. a death of a fiend? {other than suicide} 7. ‘a physical heath problem? 78. ‘a chronie spousal or family severe illness? 3. ‘excessive debt or bankruptey? a job problems? (oa ld of trod ‘cessive pressure] 22. ‘supervisor or cowarker issues or problems? 3. ‘a poor work performance review or evaluation? (8.9. ba for Fecnistment, tagged record, era duly imposed) Ba. unit oF workplace hazing? Yes 85. Did the patientidecedent have a family history of mental ines or suicide? 36. Was there a gun in the home or immediate environment?ASER CY 2006 Page 44 of 185 Rae Personally denying information inthe naratve summary I protected by HIPAA and FOV exemption (SUS C.(D|6)) 87. Describe any details of the circumstances that led to the suicide attempt/completion that have not already been captured by this form. 88. Provide a brief “bio-psycho-social formulation as to WHY this patienticlecedent engaged in suicidal behavior. optional) 89. Identify any adcitional risk management issues associated with this case.ASER CY 2006 Page 45 of 185 ECE ene es 90, Today's date: (aéemmmyy) $1. Location where this ASER was [_] Same as geographic event lecation completed: Lother location City, post, or cam 982. Medical facility where this ASER was completed or supporting MTF: (use standard acronym, —§ § ——— e.g. WRAMC} ‘93. Behavioral Health provider Name: Rankigrade: SSN Phone number: DSN prefix Email: Speclaty CPsycholocist Ci Psychiatst ( Secial worker (Psychiatric Nurse Licensed Mental Health Counselor or equivalent Cother: 24, Form completer, ifnot Behavioral Health provider Name: _ Ranklarade: Ssh Phone number: DSN prefix Email: 25. CommentsASER CY 2006 Page 46 of 185 APPENDIX C ASER CY 2006 DEPARTMENT OF THE ARMY ARMY SUICIDE EVENT REPORT POLICIES & IMPLEMENTATION PROCEDURES 27 December 2005 1. Purpose. This document establishes responsibilities and procedures for submission of the Army Suicide Event Report (ASER). This document is designed for, but not limited to, credentialed behavioral health providers (psychologists, psychiatrists, psychiatic nurses, and social workers). 2. References a. Army Regulation (AR) 600-63 Health Promotion, update publication pending. b. Deputy Surgeon General Memorandum “Amy Suicide Event Reporting’ 4 February 2004 c. Deputy Surgeon General Memorandum “AMEDD Suicide Event Report Compliance” 13 August 2004. 3. Responsibilities: a. Medical Treatment Facility (MTF) Commander: (1) Will appoint a point of contact (POC) from within the Command Group who will be kept informed of the MTF’s ASER status, and who will be an altemate contact in the event that the MTF's ASER POC is not available, (2) Will appoint POC from the MTF's Behavioral Health staff who will serve as the MTF's ASER POC. b. ASER POC: (1) Will ensure that an ASER is submitted when requiredASER CY 2006 Page 47 of 185 (2) Will ensure that the Command POC is kept informed of the MTF's ASER status at all times, (3) Will report monthly hospitalization numbers to the Suicide Risk Management and Surveillance Office not later than the fifth working day of each month for the previous month. Reporting should be accomplished via electronic mail to suicide.reporting@us.army.mil cc. Suicide Risk Management and Surveillance Office (SRMSO): (1) Will provide notification to ASER and Command POCs when the submission of an ASER is required for a completed suicide event. (2) Will monitor compliance with the procedures delineated herein (3) Will maintain the database of ASER information, and provide regular reports to leadership, ASER POCs and Command POCs on the status of suicide events within the Army. (4) Will maintain a list of current ASER POCs and Command POCs. 4. Policy and Procedures. a. An ASER is required to be submitted for any suicide behavior that results in hospitalization, evacuation, or death of an active duty Army Soldier, as well as any National Guard or Reserve Component member in an active duty status. (1) The ASER will be completed by a credentialed behavioral health provider psychologist, psychiatrist, psychiatric nurse, or social worker), (2) ASERs for hospitalizations or evacuations will be due within 30 days of the date of the event. ASERs for completed suicides will be due within 60 days of the date of the event, or within 60 days from notification that the death of a Soldier has been determined to be a suicide by the Armed Forces. Medical Examiner System (AFMES), (3) __ Inthe event of an evacuation, the ASER will be completed by the facility initiating the evacuation, and a copy should accompany the patient through the evacuation chain, A copy of the web ASER is available by clicking on the Print button within the browser window when on the Summary page of the ASER. Print the ASER prior to clicking the Submit button, : ASERs will be completed online atASER CY 2006 Page 48 of 185 b.__ The SRMSO will receive notification from the Ammed Forces Medical Examiner System (AFMES) at the Armed Forces Institute of Pathology (AFIP) when 2 determination is made that the death of a Soldier was a suicide. SRMSO will in tun provide that notification to the ASER and Command POCs at the MTF responsible for providing mental health care to the decedent's unit, When the decedent’ unit is a Reserve or National Guard unit that does not fall within the catchment area of an MTF, ASER responsibility will be assigned to the closest Army MTF to the unit, as determined by standard mapping applications. cc. The SRMSO will receive casualty reports from the COCOPNS, TAGD, HRC-Alexandria on a daily basis. In turn, SRMSO will provide notification of any death that has the possibility of being determined to be a suicide to the ASER POC at the MTF that services that individual's unit, This will alert the ASER POC to initiate contact with the local investigative agencies (Military Police, Criminal Investigation Division, Field Officer of the Day. civilian law enforcement agencies, etv.) to facilitate early communication should it be determined that the casualty wes a suicide. d The SRMSO will provide ASER annual and other reports as appropriate.ASER CY 2008 Page 40 of 165 APPENDIX D ASER AND COMMAND POC LIST As of 1 March 2007 REGION MTF POST ‘ASER POC ‘Command POC ERMC | Landstuhl RUC TEER ERMC | Heidelberg AH ERMC | Weurzburg AH [ GPRMC | Brooke AMC Ft. Sam Houston GPRMC | Darnall ACH Ft. Hood GPRMC | W Beaumont AMC Ft. Bliss GPRMC | RW Bliss AHC Ft. Huachuca GPRMC | Evans ACH Ft. Carson’ GPRMC | Irwin ACH Ft. Rile GPRMC | Munson AHG Fi. Leavenworth GPRMC | GL Wood AHC: Fl. Leonard Wood (BT) GPRMC_| Reynolds ACH Ft. Sill (BT) GPRMC_| B-Jones ACH Ft. Polk WARMG_| Dunham ARC, Carlisle Banacks NARMG_| Barquist AC Ft, Detrick NARMG_| Guthrie AHC. Ft Drum. NARMG_| DeWitt ACH Ft Belvoir NARMG_| Ireland ACH Ft Knox (BT) NARMG_| Womack AMC Ft. Bragg. NARMG_| Kenner AHC Fi. Lee NARMG_| Kimbrough ACG Ft. Meade NARMG | Walter Reed AMC ‘Washington, DC NARMC | MeDonald ACH Ft. Eustis NARMC_| Keller ACH ‘West Point NARMC_| DiLorenzo TSHC Pentagon NARMG_| Kirk AHC. Aberdeen PG [NARMG_ [A Rader AKC Ft. Myer NARMG_| Patterson AHG Ft, MonmouthASER CY 2008 Page 50 of 165 REGION MTF POST I ‘ASER POC Command POC TENET PRMG__| Tripler PRMG__| USAMEDDACI Camp Zama SERMC_|L Joel AHC Ft. McPherson ‘SERMC_| Rodriguez AHC Ft. Buchanan, PR ‘SERMC | Winn ACH tewart SERMC | Lyster ACH Ft. Rucker ‘SERMC_| Martin ACH Ft. Benning (BT) ‘SERMC_| Monerief ACH Ft. Jackson (BT) ‘SERMC_| Eisenhower AMG Ft. Gordon ‘SERMC_| Fox AHC Redstone Arsenal ‘SERMC_| Blanchfielei ACH Ft. Campbell WRMC__| Madigan AMC Fe. Lewis WRMC_| Bassett ACH Ft. Wainwright WRMC__| Weed ACH Fe. Inwin WRMC_| POM USAHC Presidio of Monterey KOREA | 127 Gen Hosp IRAQ KUWAIT AFGH (BT) indicates a basic training location, and were coded based on reported Sponsor Location Station (Item 30} and/or City (Item 31) andlor POC identification information,outs)outs)ASER CY 2006 Page 53 of 165 APPENDIX F ASER CY 2006 COMPARING EVENTS THAT OCCURRED IN OIF-OEF TO ALL OTHER EVENTS Risk factors for suicide behaviors were compared between events that occurred during OIF-OEF deployments and other events. In order to improve the feasibilty of the analyses (e.g. increase small cell sizes), ASERS submitted for events during both 2005 and 2006 were combined. When cell sizes were stil two small, attempts were made te combine cells Into super-ordinate categories, as discussed in the Methods. Although the analyses included a number of potentially confounded variables (e.g., factors that are probably associated with deployment, as well as suicide in a non-deployed population), chi-square analyses were performed in an exploratory manner to examine potential differences in risk factors between Soldiers with suicide behaviors on deployment, and Soldiers with suicide behaviors elsewhere, Significant differences for clearly confounded variables are not discussed in the text. For example, combat exposure is obviously expected to be higher for OIF-OEF events, since many Soldiers with non-OIF-OEF events have neverdeployed. (Sixty percent of completions and 72% of the attempts in the tatal sample had never deployed to OlF-OEF). However, the full data Tables are presented below for the reader ‘There were 50 ASERs submitted for OIF-OEF completions, and 119 ASERs submitted for non-O1F-OEF ‘completions (2005-2006 events}, There were 121 ASERs submitted for attempts that occurred in OIF-OEF, and 1532 for non-OIF-OEF attempts. Marital status demonstrated differential resuits for completions and attempts. After combining item options into Married or Net Martied, Soldiers who completed suicide curing an OIF-OEF deployment showed a sigrificantly lower rate of marriage compared to Soldiers with Non-OIF-OEF events (30% vs. 82%, respectively: p = 01). Although the marriage rate for deployed and non-deployed populations was not available, the overall Army rate is 55% [2]. This suggests that marriage may be more protective against suicide completion during an OIF-OEF deployment than in ether duty environments. In contrast, Soldiers who attempted suicide during an COIF-OEF deployment showed a significantly higher rate of marriage (58%) than those who were not deployed to OIF-OEF at te time of the attempt (35%: p<.001). This provides some evidence that marriage may be less protective against suicide attempt during an OIF-CEF deployment. OIF-OEF completions and attempts also differed from non-OIF-OEF events with regard to suicide method. While the increased use of a military firearm is not surprising, it highlights the importance and challenges of carefully evaluating options to limit access to weapons during periods of increased risk for individuals. ‘As might be expected, use of alcohol and drugs were significantly less frequent during the events for OIF-OEF completions and attempts (p<.01}. In addition. trends suggested that diagnoses of psychiatric conditions may be less prevalent among completions in OIF-OEF, especially for Mood Disorders (p = 01}. OIF-OEF attempts showed similar resus, Soldiers who complete suicide in OIF-OEF may see Chaplains prior to the event more frequently than other Soldiers who completed suicide (21% vs. 10%, respectively), although the difference was not statistically ‘significant (p = .12). Soldiers who completed suicide in OIF-OEF were seen at significantly lower rates by other helping professionals compared to Soldiers who completed suicide elsewhere, including MTFs, ASAP. FAP, Outpatient Mental Health, and inpatient mergal health (p's <03). OIF-EF sulide attempts showed similar patterns with the exception of outpatient mental health where ASERs for OIF-OEF events suggested a higher rate of services (p = 003),ASER CY 2006 Page 84 of 165 Examining common stressors revealed an unexpected pattern, The prevalence of many traditional stressorsirisk factors trended lower for Soldiers who completed suicide in OlF-OEF compared to Soldiers who ‘completed suicide in other locations. For example, a failed spousal relationship was reported for 57% of nor- OIF-OEF completions, but only 38% of OIF-OEF completions (p = 065). A history of civil legal problems was reported In 17% of non-OIF-OEF events, but only 4% of OIF-OEF completions. A history of family mental illness or suicide was reported for 13% Non-OlF-OEF events and 6% of OIF-OEF events. There was also no evidence that Soldiers who completed suicide during deployment had higher rates of debt or bankruploy (16% in the non-OlF-OEF group compared to 4% in the OIF-OEF group; p = .10). The notable exception was work related problems. While the difference between the groups again was not significant, higher rates of ‘supervisor of co-worker problems were reported for the OIF-OEF group (OIF-OEF = 14%, nomOIF-OEF = 28%: p= 08), ‘The pattern was more striking for OIF-OEF suicide attempts. Significantly lower rates of physical health problems, history of family suicide, history of friend suicide, history of family death, history of chronic family illness, history of family mental health problems, administrative separation proceedings, AWOLidesertion proceedings, and excessive debt/bankruptey were reported for attempts during an OIF-OEF deployment ‘compared to other attempts (p's < 05}. Itis also important to note that in contrast to suicide completions. attempts during an OIF-OEF deployment demonstrated higher rates of failed spousal relationships compared to non-OIF-OEF attempts (49% vs. 38%, respectively: p = .002). Similar to OIF-OEF completions, higher rates of supervisor or co-worker issues were reported for OIF-OEF attempts compared to non-OIF-OEF attempts. Lower rates of stressors and traditional risk factors in OIF-OEF events may be confouncled by deployment statusin some cases. For example, deployed Soldiers are paid more and may therefore be less ikely to have significant financial problems. Other findings may reflect a “healthy worker effect”. That is, since Soldiers with 2 variety of physical and behavioral health problems are not deployed, any factor that correlates with non- deployable concitions will ikely show lower rates in the deployed sample. Base rate information is required for both populations to assist interpretation. However, the relevance of same of the findings in this section is strengthened by similar findings when Soldiers with suicide behaviors and deployment histories were used as the comparison group (Appendix G). Finally, for suicide attemots, itis possible that OIF-OEF attempts represent higher risk behaviors than non- ‘OIF-OEF attempts. Attempts canied out during deployment mare frequently used typically lethal methods {p = .004) and reportedly intended to die more frequently than Soldiers with non-OIF-OEF attempts, While itis possible these results are confounded by differing ASER submission rates (unknown for attempts), the fact that 34 of 119 OIF-OEF submissions (29%) reported firearms as the suicide attempt method, compared to 34 of 1518 non-OIF-OEF attempts (2%) adds some weight to the finding. Data tables displaying the frequencies and percentages for ASER items by location of the event follow.COMPLETED EVENTS ASER CY 2006 Page 55 of 165 OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: DEMOGRAPHICS ‘COMPLETED EVENTS Location of Events NomOIF-OEF Event_OIF-OEF Event Count Percent Count Percent GENDER Wale Ti. Seas ~« Female 7 74% RACE/ETHNICITY American Indian/Alaskan Native 1 1% 0 O% ‘Asian/Pacific Islander 4 3% 1 ‘African American 2 1% 14% ‘Caucasian BI 68% 29 ——«5B% Hispanic 3 3% «7 ~«14% ‘Other/DKiMissing e e% <8 12% ‘AGE RANGE Under 25) 50-43% «25 «88% 25-23 26% 30-30 26 OSC«dT 40+ 4 12% 6 (13% RANK Enlisted 15 88% «ASCO Officer 8 7% 5 10% Warrant Officer 4 3% 00% ‘CadetiMidshipman 1 1% 00% ‘COMPONENT Regular Ee eed Reserve 0 % 1% National Guard @ 7% 7 14% Cr 20 and CY OND ae FSNAOOTASER CY 2006 Page 56 of 165 OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: DEMOGRAPHICS (CON'T) ‘COMPLETED EVENTS Loe: ‘Non-O1F-OEF Event ion of Events O1F-08 EF Event ‘Count Percent Count Percent EDUCATION ‘Some HS, did not graduate a a GED 4 3% «510% HS graduate 35 2o%~~C«NCM ‘Some collegeitech, no degree 18 15% «SS «1O% College degreeitech cert <4 yrs 3 3% «=o Four-year degree 5 4% 3 «6 Masters degree or greater 3 B% 2 A Don't Know 51 43% «15 80% MARITAL STATUS Never married 38 32% OO Married 54 46% «137% Legally separated 4 B% +O «0% Divorced 7 6% 612% ‘Widowed a O% «OOO Dont Know 14 12% «6 «12% Cr 2006 nd CY 0038 TINO ‘OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: SETTING ‘COMPLETED EVENTS Location of Events: EF Event Percent Count Percent EVENT SETTING Residence (personaly Residence friendifamily) 8 ‘Worldjobsite 4 ‘Automobile (away from re 2 Inpatient medical faciity 1 Other 24 Ba 11% 3% 10% 1% 21% 4 1 3 0 22 Fa Bh 27% We O% Bm Cy 2005 and CY 2B 5 FIFO?ASER CY 2006 Page 57 of 165 OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: METHOD ‘COMPLETED EVENTS Location of Events Non-O1F-OEF Event _OIF-OEF Event Count Percent Count Percent METHOD Overdose 1 9% 1 2% Poisoning by substance 2 2% 0 0% “Poisoningbyevhaust—OKHSSC CH Poisoning by utlity a5 0 0% a 0% Firearmigun (military) a 8% 4B 82% Firearmigun (non-military) 61 51% 12% Jumping 00% 0 0% Motor vehicle crash 0 0% 0 0% Hanging/strangulation 27 23% 1 2% Cultting/piercing instrument 2 2% a _0% ‘Submersionidrowning 00% 0 0% Other 3 8% 0 0% Dont Know 4 3% 1 2% Cr 20 and CY OND ae SNAOOT OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: MOTIVATION ‘COMPLETED EVENTS Location of Events Non-OIF-OEF Event OIF-OEF Event Count Percent Count Percent MOTIVATION Emotion relief 12 10% 318% Interpersonal influence 33% 1% Feeling generation oom 00% Avoidancelescape 7 8% 3 8% Individual reasons 8% 2 4% Hopelessness 714% 7 14% Depression 33% 1 2% ‘Other psychiatric symptoms 3 3% 00% Impulsivity 6 8% 72% ‘Other 5 4% a 18% Dont Know 35 46% ~~«18 «= Cr 20 and CY OND ae SNAOOTASER CY 2006 Page 58 of 165 OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: OTHER EVENT INFORMATION COMPLETED EVENTS Location of Events: Non-OIF-OEF Event OIF-OEF Event Count Percent Count Percent ALCOHOL USED Yes 252i 1am No B 36% «370% Dent Know BO 42% «td ~—«OBM DRUGS USED Yes. 41% No 52 4a% 34 68% Dont Know 53 46% Ok INTENT TO DIE Yes 7 74% TCO No 8 7% 5 10% Don't Know 22 18% 14% LETHAL Yes 109 92% «AT «86% No 1% 1 2% Don't Know 8 7% 1 2% DEATH RISKIGAMBLING Yes 43% 1 2% No 100 86% 43 ~—~BAM Dent Know 131% «510% PLANNED? Yes 35 40% 21 «4% PREMEDITATED. Ne 35 28% 1 Dont Know 29 24% «18 — 36% OBSERVABLE Yes 24 20% «B18 No 79 66% 37 76% Don't Know 16 13% 8M ‘SUICIDENOTELEFT Yes 18 1% 4 2 No 71 60% 268 53% Dont Know 20 25% «8 «18% ‘CONMUNIGATED INTENT Yes 28 24% «10 20% No 80 50% 32 ~~ Dent Know B26% == «18% RELATED TO Yes 131% 24 «48% DEPLOYMENT Ne TE BO dE Dent Know 28 2d% 122d Crane nacre waaOIF-OEF EVENT COMPARED TO NON OIF-OEF EVEN COMPLETED EVENTS ASER CY 2006 Page 59 of 165 SITUATIONAL INFORMATION Location of Events: Non-O1F-OEF Event_OIF-OEF Event Count Percent Count Peroent RESIDENCE Barracks, other shared military 32am «SSC Non-miltary shared 1% 0 OW BEGIBOO 1 00% (On-post family housing @ a% 00% Ofe-post family housing Ee Other 1s 15% 1% Dent Know a 7% 38% RESIDES WITH Resides with spouse 2 51% 828% ‘SPOUSE ‘Separated, relationship issues 4 2% 18m ‘Separated, other 4 &% 8 68% Don't Know 74% 00% RESIDES ALONE Yes 30 sam ~=C«SC« No 38 40% —«OT_~«TA Dont Know 218% ~7_~1% MINOR GHILDREN Yes %__oa% +16 30% No 50 42% ~—aT =i Dont Know 220% ~~«8~«O% CHILDREN RESIDE Yes 8 20% ~~ 2 14% witH No 30 65% ~—~«tt~~«78% Dont Know 715% 17% GUN IN IMMEDIATE Yes ss OCR ENVIRONMENT No 28 2% 2% Dont Know 33 28% ~—OT«TA% Cr 20 and CY OND ae SNAOOT "Note: Percentages for Resides with Spouse and Resides wih Cilcren were calculated based only an the numberof Sldiers with pauses oF minor chiten, respectivelyASER CY 2006 Page 60 of 165 OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: DUTY STATUS ‘COMPLETED EVENTS Location of Events Non-O1F-OEF Event _OIF-OEF Event Count Percent Count Percent ACTIVE 38 82% a2 ~~ AGR @ 7% 1 2% iT 5 % 0 0% MOBILIZED a 3% «8 «12% ADT 3 3% 0 Om 1OT 1 1% 80% RETIRED 0 0% 0 O% REFRAD. 1 1% 0 0% OTHER 5 a 1 a TRAINING 7 6% 0% Cr 208 snd CY 2 a NEO? OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: DUTY ENVIRONMENT ‘COMPLETED EVENTS Location of Events: Non-OIF-OEF Event_OIF-OEF Event Count Percent Count Percent GARRISON 7 6% 2 4% PSYCH HOSPITALIZATION, o 0% ~~ LEAVE 10 8% 0 0% MEDICAL HOLD. 2. 2 00% TDY 2. 0 0% IN EVAG CHAIN 1 1% 00% AWOL 78% 0 0% UNDER CMD OBS 0. 0% 0 0% DEPLOYED. 33h 48 ~—88% OTHER 25 21% 0% TRAINING, 70% 0 0% Crome ma cr ais asraTamFASER CY 2006 Page 61 of 165 OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: SYMPTOM FACTORS. ‘COMPLETED EVENTS Location of Events: Non-OIF-OEF Event _OIF-OEF Event Count Percent Gount Percent DXMOOD DISORDER Yes 2 1e% ~«1~*~*~« No 64 64% «32 ~—«N% Dont Know 322% ATC DX BIPOLAR Yes 3. 3% 0 om DISORDER No 74 68% 28 —~62% Don't Know 220% ITM. DX MAJOR, ves 2 1% 2 a DEPRESSION No 6 60% 28 BAM Don't Know 32 20% 17 38% DX PSYCHOTIC Yes 11% 9% DISORDER No @269% 33 «00% Dont Know 36 80% «Ta DX PTSD Yes 5% 0 OO No 74 68% 28 62% Dont Know 30 28% IT ~~«CRM DX ANXIETY Yes 2 1% 1 om DISORDER No 74 62% 32 ~—~64% Dont Know 33 28% ~~ ~~—«8am DX PERSONALITY __Yes 5 a De DISORDER No 74 62% 32 64% Don't Know 40 34% «17 ~—=8a% HX SUBSTANGE Yes 20 24% 4% ABUSE No 33 45% 23 «AM Dont Know 87-81% 22 ABM Crane nacre waaASER CY 2006 Page 62 of 165 OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: COMBAT EXPERIENCE ‘COMPLETED EVENTS. Location of Events. Non-OIF-OEF Event_OIF-OEF Event Count Percent Count Percent EXP DIRECT COMBAT Yes EEL Ne”~—<“—SOS™SOCSSC‘Ca CS Dont Know a0 38% ‘SAW CASUALTIES Yes 2 40% ~«4 OPH Ne 31% 8 «88% Don't Know 10 40% 3 20K INJURED INCOMBAT Yes 3 1% Ne 13 BA% 18 Don't Know CES 2 WITNESSED KILLING IN Yes 7 28% 8 COMBAT Ne 3. 1% Don't Know 15 80% 8 ‘SAW DEAD BODIES IN’ Yes un 4% 8 COMBAT Wee Don't Know 2 40% «3 «IS KILLED OTHERSIN. Yes. 416% «21S COMBAT No 520% (10 ~~67% Don't Know ed Grats ara oY a a NP Percentages for Direct Combat 1c tynes of combat expasure were celulated based anly on the number of Solders who ExperASER CY 2006 Page 63 of 165 OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: TREATMENT HISTORY ‘COMPLETED EVENTS Location of Events Non-OIF-OEF Event OIF-OEF Event Count Percent Count Percent ‘SEEN BY MTF Yes 7 om% 2 ~~=«aa No 30 25% 20-40% Don't Know 21 16% ~—«1eSSC« ‘SEEN BY ASAP Yes ie 16% 1% No 74 63% _31_—«8% Don't Know 25 21% 17 «38% ‘SEEN BY FAP Yes e % 0 0% No. 28 74% 32 «BM Don't Know 2 18% 88% ‘SEEN BY CHAPLAIN Yes 8% 10 21% No, 30% «16 Don't Know 60 52% NCB ‘SEEN BY OP MH Yes e 4% 8 «18% No 54 45% OT «A Don't Know 16 18% ~«t4~~«28% ‘SEEN BY IP MH Yes mW 9% 0 0% No, 88 74% —38~«T% Don't Know 20 17% ~~*16~~—«38% TAKEN PSYCHOTROPIC Yes 2 2% —«8SC«d MEDS No. Ba 45% B= Don't Know 37-31% +18 ~—«38% HX PHYSICALHEALTH Yes 7 2% 3 —~6% PROBLEM No, 68 59% «2 —«M Don't Know 21 18% 148% Crane nacre waaASER CY 2006 Page 64 of 165 OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: FAMILY HISTORY ‘COMPLETED EVENTS Location of Events Non-O1F-OEF Event _OIF-OEF Event Count Percent Count Percent FAILED SPOUSE Yes ooh +19 ~«S RELATIONSHIP No 24 20% ~~ «T~Sd% Don't Know 2 23% «~~ FAILED OTHER Yes 1 4% OT RELATIONSHIP No 31 4he~—OSSCT Don't Know 48 42% «19 ~—«30% HX SPOUSE SUICIDE Yes 1 1% 00% No. 22 79% <7 «76% Don't Know 220% 12H HX FAMILY SUICIDE Yes 4 3% 1 No, B4_<50% «1B «CBM Don't Know 47 41% 31 «62% HX FRIEND SUICIDE Yes 1 1% «1% No 64-55% —-20~—« 41% Don't Know a ad%~OOBCT% HX FAMILY DEATH Yes @ a% 2 4% No 644% BCT Don't Know 45 38% 22-45% HX FRIEND DEATH Yes 2 D2 No. Be 51% 25 «SI% Don't Know 34.47% ~—«22 «ABM HX CHRONIG FAMILY Yes 6 t% 38% ILLNESS No, 68.58% 2B «SDM Don't Know 44 8T% Ot AO HX FAMILY MENTAL Yes 15 13% 3 CO ILLISUICIDE No 3B 8 Don't Know Ti 60% 38 76% Cram ma CY TU as TINASER CY 2006 Page 65 of 165 OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: ADMIN/LEGAL HISTORY COMPLETED EVENTS Location of Events: Non-OIF-OEF Event _OIF-OEF Evert Count Percent Count Percent COURTS-MARTIAL Yer 33% 726 PROCEEDINGS Ne o580% 888% Don't Know 21 18% ARTICLE 15 Yes 22 18% 8 16% PROCEEDINGS Te 77 BE BO BONE Don't Know 20.17% «12 «AM ADMIN SEP. Yes 1 8% 1 PROCEEDINGS No 36 73% 88% Don't Know 218% 12H AWOLIDESERTION Yes 10 o% 0 0% PROCEEDINGS Ne 20 76% «39 «80% Don't Know 18 15% 10 20% MEB PROCEEDINGS Yes 6 5% 0 0% Ne 2 7% «38 Don't Know 19 16% 8 1% CIVIL LEGAL PROBLEMS Yes 20 17% 2 Ne 63 84% «30 ~—«8H Don't Know 33 28% «1B =~ Crane nacre waaASER CY 2006 Page 66 of 165 OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: OTHER HISTORY ‘COMPLETED EVENTS Location of Events: Non-O1F-OEF Event OIF-OEF Event Count Percent Count Percent EXCESSIVE ves 18 16% 24% DEBTIBANKRUPTCY = jp Ba 0% a Dont Know 34% «18 «88% HX JOB PROBLEMS Yes 30 28% ~~ «COM No. 60 62% 24 «48% Don't Know 28 20% OSC ‘SUPV/COWORKER Yes. 18 14% 14 BM ISSUES No 58% SOM Dont Know 33 28% 1S (20% POOR PERFORMACE Yes 18 15% «10 20% EVAL No 65-55% 09 «BAM Don't Know 35 30% OH HX WORKPLACE HAZING Yes 0 0% 6 18% No 76 6T% oF «BT% Dont Know 38 38% Cram end CY TUE a FNPOIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: ABUSE HISTORY ‘COMPLETED EVENTS Location of Events. ASER CY 2006 Page 67 of 165 Non-OIF-OEF Event OIF-OEF Event Count Percent Gount Percent VICTIM PHYSICAL ves 8% 8 12% ABUSE No. ei 51% 20% Dont Know 30 42% 23 ~«AT% VICTIM SEXUAL ABUSE Yes 2% 3 6% No. 6 58% SCT Don't Know 32 44% 28 ATM VICTIM EMOTIONAL Yes 3 4% 8 (18% ABUSE No 60 50% «7 ——35% Don't Know Bt 45% 25 «SOM VICTIM SEXUAL Yes o O% 0 o% HARASSMENT No 5 56% 24 «ADM Don't Know 52 44% 25 51% PERP PHYSICAL ABUSE Yes 1 O% 2 4% No. 64-54% 26 «82% Dont Know dh 37% «DCM PERP SEXUAL ABUSE Yes 4% 1 Oh No. 6 Sth oT «Sam Don't Know a7 30% 22% PERP EMOTIONAL Yes 4 3% 1 ~« ABUSE No. 66 56% OT «54% Don't Know a7 40% 22 PERP SEXUAL Yes: 1 1% 00% HARASSMENT No 71 80% 28 56% Don't Know a7 30% 22 —Ad% Crane nacre waaASER CY 2006 Page 68 of 165 ATTEMPT EVENTS OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: DEMOGRAPHICS ATTEMPTS: Location of Events Non-O1F-OEF Event OIF-OEF Event Count Percent Count Percent “GENDER—oMaleS~S~™~—SSSOSOSCSCSCSCSC~—~tOBSSC*SSC*«iR SC‘ Female 444 28% 34 28% RACE/ETHNICITY American Indian/Alaskan Native 4 1% 2 2% AsianPacific Islander 36% 4 3% ‘African American 208 4% «AH Caucasian 1062 60% 71 ~—~=50% Hispanic 128 8% TSC (Other/DKAvissing 6% 10 AGE RANGE Under 25 1045 70% «G1 «BM 25-28 225 (18% 25% 181 13% ~~ ~=«B a1 6 o% RANK Enlisted 1484 87% tid Officer 201% 5 aK ‘Warrant Officer 4 1% oO Cadetfividshipman 5 a% o O% (Other/DKAvissing 19 1% 2 2% COMPONENT Regular 1385 82% 88 83% Reserve 55% 7 6% National Guard 4% ‘Cr 20 ond CY 2008-9 oT /2007ASER CY 2006 Page 69 of 165 OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: DEMOGRAPHICS (CON'T) ATTEMPTS: Location of Events: Non-O1F-OEF Event _OIF-OEF Event Count Percent Count Percent EDUCATION a 206 14% tC HS graduate 630 42% «dB ‘Some oollegetech, no degree 322mm 1 om College degreeitech cen <4 yrs cr Four-year degree 7 4% OSC Master's degree or greater 6 1% 0 0% Don't Know 234 15% 371% MARITAL Never married 790 52% 37% ‘STATUS Mariied 526 36% 68 «5% Legally separated 20 Om Divorced Es ee Widowed 0. 0% 0 % Dont Know 4% 8 Cram a CY Ta NP OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: SETTING ATTEMPTS, Location of Events Ne IF-OEF Event Ol EF Event Count Percent Count Percent EVENT SETTING Residence (personaly Residence (friendifamily) Workijobsite Automobile (away from residence) Inpatient medical facility Other eas 38 188) 38 30 578 aO% 3% 13% Ea 2% 30% 21 o 54 a 2 4 18% 0%: 48% 0% 2% EE Crane nacre waaASER CY 2006 Page 70 of 165 OIF-OEF EVENT COMPARED TO NON OIF-OEF EVENT: METHOD ATTEMPTS: Location of Events Non-OIF-OEF Event OIF-OEF Event Count Percent Count Percent METHOD Overdose 740 40% ~~«S2« Poisoning by substance 27 2% 0 0% ‘Poisoningby exhaust OB IHSOSC«S Poisoning by utility gas 1

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